Biomedical subjects
E Wilkes
Publications and source records attributed to E Wilkes.
The control of cancer pain in the community: science or pragmatism?
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Rheumatoid arthritis: review of searches for an infectious cause. Part II.
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Rheumatoid arthritis: review of searches for an infectious cause. Part I.
No distinctive pattern has yet emerged from the accumulated mass of results that would provide a generally acceptable hypothesis of the etiology of rheumatoid arthritis. A number of immunologic aberrations have been described, but there has been no identification of a key immunologic defect that might link together the various components of the immune response into an agreed pattern. The possibility of a persistent antigenic stimulus arising from an infection cannot be confirmed or refuted. If a virus is involved, it would seem more likely to be a "slow" virus rather than a commonly recognized form, but there is no strong candidate of this type in view. Despite the fact that mycoplasmas are undoubtedly arthritogenic in other species, their role as an etiologic agent in rheumatoid arthritis has not been proven. The idea that bacterial cell wall peptidoglycan may provide a persistent stimulus has much to offer, but it is not possible at this stage to accept peptidoglycan as a recognized etiologic factor. This suggestion will, however, indoubtedly stimulate much further investigation.
A different kind of day hospital--for patients with preterminal cancer and chronic disease.
A new day hospital has been set up in Sheffield for patients with preterminal cancer and chronic disease. During the first 26 months 197 patients with cancer and 66 chronically sick patients attended. Of the 2701 attendances by patients with cancer, breast cancer accounted for 38%. One hundred and forty of the patients with cancer died, 83% in the terminal-care unit and 12% at home. Ninety per cent of respondents to a questionnaire thought that the support provided was of great importance to both patient and family; and over two-thirds of the patients were said to have benefited from improved control of symptoms. A similar facility could be developed within existing day hospitals without major revenue consequences, and should produce a genuine improvement in care. This study suggests, however, that it would not shorten the terminal stay in hospital.
Mental state and other prognostic factors in femoral fractures of the elderly.
Fifty elderly patients with fractured femurs were followed up for six months. A hospital stay of less than 28 days and a good prefracture mental state were such important favourable prognostic factors that their absence made the outlook poor and carried clear implications concerning management.
Quality of life: effects of the knowledge of diagnosis in terminal illness.
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Mild hypertension: a clinical trial conducted in hospital general practice.
To compare findings in a hospital trial of hypotensive drugs with those in a general practice trial several patients with mild hypertension were studied at the same time in hospital and in general practice. They received bendrofluazide and potassium chloride or bendrofluazide, potassium chloride, and reserpine according to a double-blind crossover protocol, and blood biochemical values were studied over eight weeks and six months. When reserpine was withdrawn from nine women they followed a modified protocol comparing bendrofluazide and potassium chloride with potassium chloride alone. The blood pressure values measured by the general practitioners were similar to those measured in hospital. Both the diuretic alone and the diuretic with reserpine produced significant falls in blood pressures. Although plasma renin activity increased on diuretic treatment, continued treatment did not produce a further increase, and levels gradually declined towards normal.
BCG for handicapped children.
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Modern obstetrics and the general practitioner.
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Terminal care and the special nursing unit.
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The new responsibilities for the nurse in the community.
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Lessons from bad general practice.
The paucity of resources for general practice correlates well with high losses through emigration and questions the expensive over-production of doctors now being undertaken.The variable quality of community care and the absence of a structure yet providing real planning or capital, leads to the uneconomic abuse of hospital facilities and to an excessive emphasis on institutionalisation.Medicine is becoming depersonalised because unrealistic expectations lead to an overloading of the service. Simultaneously we allocate a low priority to education in the use of the service, have little training in the sociological aspects of medical care, and even less in how best to use the skills of our non-medical professional colleagues.
Health promotion in nursing practice.
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Blue field entoptoscopy in diabetic retinopathy.
Blue field entoptoscopy was performed in 50 consecutive patients with diabetic retinopathy. Several statistically significant correlations were obtained. The number of "flying corpuscles" was reduced in eyes harboring a vitreous hemorrhage, and in severe and proliferative diabetic retinopathy. On the other hand, patients with a history of focal or panretinal photocoagulation had better corpuscle counts than patients who had never received any treatment. It appears therefore, that argon laser photocoagulation is beneficial in preserving the blue field entoptic phenomenon.