Biomedical subjects
H Noble
Publications and source records attributed to H Noble.
How is the high vaginal swab used to investigate vaginal discharge in primary care and how do GPs' expectations of the test match the tests performed by their microbiology services?
OBJECTIVES: To describe the management of vaginal discharge in general practice, with particular regard to the use of the high vaginal swab (HVS), and to compare GPs' expectations of this test with the processing and reporting undertaken by different laboratories. METHODS: A postal questionnaire survey of 2146 GPs in the North Thames area and postal questionnaire study of the 22 laboratories serving the same GPs were carried out. GPs were asked how they would manage a young woman with vaginal discharge and what information they would like on an HVS report. Laboratories were asked how they would process and report on the HVS sample from the same patient. RESULTS: Response rate was 26%. 72% of GPs would take an HVS and 62% would refer on to a genitourinary medicine (GUM) clinic. 45% would offer empirical therapy and 47% of these would treat for candida initially. 75% of GPs routinely request "M,C&S" on HVS samples but 55% only want to be informed about specific pathogens. Routine processing of HVS samples varies widely between laboratories and 86% only report specific pathogens. 78% of GPs would like to be offered a suggested diagnosis on HVS reports, and 74% would like a suggested treatment. 43% of laboratories ever provide a diagnosis, and 14% provide a suggested treatment. CONCLUSIONS: GPs frequently manage vaginal discharge and most of them utilise the HVS. GPs' expectations of the test are not well matched to laboratory processing or reporting of the samples.
Chronic penile oedema secondary to chronic masturbation.
We report the case of a man with proven chlamydial conjunctivitis and urethritis who was found to have asymptomatic chronic penile oedema secondary to masturbation.
Who is doing laparoscopic appendicectomies and who taught them?
BACKGROUND: Laparoscopic appendicectomy offers potential advantages, but its use seems variable and perhaps related to the enthusiasm of individual trainees. There is limited opportunity in many hospitals for consultants to do and teach laparoscopic appendicectomy because of the way emergency work is organised. METHODS: This study investigated the use and teaching of laparoscopic appendicectomy in two health regions, by a questionnaire sent to all specialist registrars (SpRs) in general surgery and completed by 78% (56 of 72). RESULTS: Of the responding SpRs, 43% had performed a laparoscopic appendicectomy (with an average of 2.5 supervised by a consultant and 7.5 with a more junior assistant). Of these, 92% had been taught by a consultant, but only 31% (33 of 108) of the consultants for whom they were currently working had done appendicectomy laparoscopically, and laparoscopic appendicectomy was only being performed on 14% of the SpRs current firms (47% with upper gastrointestinal and 40% with colorectal specialist interest). Some 5-30% of patients on those firms were treated laparoscopically, mostly at the preference of the SpR. CONCLUSIONS: Dedicated consultant time for emergencies would facilitate teaching of laparoscopic appendicectomy but theatre time, costs of disposable instruments, and the inexperience of many consultants in this operation are likely to continue limiting its use. Further debate is needed on its place in the treatment of appendicitis.
Management of opiate dependence.
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Laryngeal masks and chair dental anaesthesia.
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The natural history of carotid bruits in elderly persons.
STUDY OBJECTIVE: To determine the relative risk for cerebrovascular events in elderly patients with carotid bruits. DESIGN: Population-based prospective study. SETTING: Community-based home for the aged. PATIENTS: All patients were residents of a home for the aged and were at least 75 years old in 1985. MEASUREMENTS AND MAIN RESULTS: Two hundred and forty-one residents were examined for carotid bruits and signs of previous stroke. The mean age of the residents was 86 years. Twelve percent of residents had asymptomatic carotid bruits. The prevalence of asymptomatic carotid bruits was 8% in residents who were 75 to 84 years of age, 10% in residents who were 85 to 94 years of age, and 13% in residents who were at least 95 years old. Interval cerebrovascular events and cause of death were ascertained from chart review, and recorded events in survivors were confirmed by a repeat examination. The 3-year cumulative incidence of cerebrovascular events in asymptomatic residents with carotid bruits was 10%, compared with 9% in residents without carotid bruits, yielding a relative risk of 1.1 (95% CI, 0.45 to 2.7). In 60% of surviving residents, baseline carotid bruits were no longer present at the time of follow-up examination. The disappearance of these bruits was not associated with the occurrence of interval cerebrovascular events. CONCLUSIONS: The prevalence of asymptomatic carotid bruits increases with advanced age. Carotid bruits do not greatly increase the risk for subsequent stroke in elderly patients. Carotid bruits may often disappear without clinical sequelae.
Dominantly inherited Alzheimer's disease: cerebral glucose metabolism.
Cerebral glucose metabolic rate (CMRGlu), measured by positron emission tomography, was bilaterally and symmetrically reduced in two patients with autosomal dominant Alzheimer's disease. Supramarginal gyri and temporal lobes were most severely affected. An isolated reduction of CMRGlu in the left supramarginal gyrus was observed in one asymptomatic at-risk subject.
A field study of the fertility of transported equine semen.
A field trial of artificial insemination in horses with transproted, chilled semen was conducted using a specially designed container which permitted a controlled, slow initial rate of cooling (-0.3 degrees C/min) and maintenance of a final temperature of 4 degrees -6 degrees C for more than 36 hrs. Forty-six mares in 23 states were inseminated with semen from three German Warmblood stallions standing at stud in Hamilton, Massachusetts. A third-cycle conception rate of 91% was obtained.
Phobic children one and two years posttreatment.
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Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children.
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Factor structure of childhood fears.
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Test-retest reliability of parent ratings of children's deviant behavior.
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Children's deviant behavior within the general population.
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The cessation of dialysis in patients with end-stage renal disease: developing an approppriate evidence base for practice.
Recently there has been a growing awareness that not all patients with Established Renal Failure will benefit from dialysis treatment, and it has been recognised that this patient population requires an enhanced approach to assessment and control of symptoms, as well as supportive management, including effective and high-quality palliative care. This overview of the literature examines supportive care for the patient with Established Renal Failure and how conscious decision-making in this group of patients can be best facilitated. It highlights recommendations, which have been produced to assist in the decision-making process regarding withholding and withdrawing dialysis, and is a starting point prior to establishing supportive care programmes for the renal population. Patients who decide to abstain from dialysis or for whom such a decision is made should be offered appropriate supportive and palliative care.
Caring for people who are dying on renal wards: a retrospective study.
Unfortunately, there is still a high mortality rate among patients with end-stage renal disease (ESRD). If the decision is made to activate non-dialytic management of the patient with ESRD, it should be made jointly by the patient and responsible consultant nephrologist after consultation with relatives, the family doctor and other relevant members of the caring team. This paper discusses the establishment of a new renal supportive care service for patients opting not to have dialysis and focuses on the results of a 'death audit' carried out on this patient population. Recommendations for practice resulting from analysis of the audit results include, the use of advance directives, identification and prompt treatment of symptoms, increased staff education, timely referral to the palliative care team and expansion and further integration of the renal supportive care team.