Medical abortion.
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Abortifacient Agents, Nonsteroidal↗
Biomedical subjects
I T Russell
Publications and source records attributed to I T Russell.
Laparoscopic versus open cholecystectomy and the need for a randomized trial: a survey of surgeons and ethical committees in the British Isles.
A questionnaire on the necessity and ethics of a randomized trial to compare laparoscopic cholecystectomy and open cholecystectomy was sent to 200 randomly selected surgeons in the British Isles, of whom 117 replied. Of these, 58% thought that a trial was needed to compare laparoscopic cholecystectomy with open cholecystectomy by either minilaparotomy or the conventional approach. Nearly half (45%) expressed interest in participating in such a trial. A hypothetical protocol for a trial was sent to 40 ethical committees; 25 gave approval and only 3 considered that a trial was unethical (12 refused to comment). This survey shows wide support for a trial comparing laparoscopic cholecystectomy with open cholecystectomy.
Attitude of Health Personnel↗
Audit: the third clinical science?
In summary, we believe that if clinical audit is accepted and prosecuted as the third clinical science, it has the potential to deliver substantial benefits to patients and health professionals.
Guidelines as Topic↗
A criterion for low birthweight.
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Humans↗
Respiratory illness in children: what makes parents decide to consult?
Parents of a stratified random sample of 234 children from 21 training practices in north east England were interviewed at home. All these children had been reported in a postal questionnaire as having had a cough between six and 10 weeks before the interview. Interviews covered social characteristics of the family, the severity of the child's cough and the child's previous respiratory history. These data were analysed using the statistical technique of logistic regression. This produced a good model of consulting behaviour. The model showed that a doctor was likely to be consulted if the child had severe symptoms, or if the cough affected the child's behaviour. This suggests that most parents deciding whether to consult the doctor make careful decisions based on what they see as objective criteria. No social characteristic had a significant influence on the decision to consult the doctor over and above the influence of the characteristics and effect of the cough itself.
Adult↗
Percutaneous transluminal angioplasty for atheromatous renal artery stenosis--blood pressure response and discriminant analysis of outcome predictors.
Percutaneous transluminal angioplasty was performed in 39 consecutive patients with atheromatous renal artery stenosis associated with hypertension. The mean blood pressure before angioplasty was 191/107 mmHg and this had dropped to a mean of 167/90 mmHg at the patient's most recent visit, representing a significant fall in both systolic (p less than 0.01) and diastolic pressures (p less than 0.001). The mean serum creatinine was 166.7 mumol/l before percutaneous transluminal angioplasty and 155.3 mumol/l at the most recent visit (not statistically significant). The mean number of anti-hypertensive drugs fell from 2.4 to 1.9 after percutaneous transluminal angioplasty (p less than 0.05). Three patients (eight per cent) were 'cured' (diastolic blood pressure less than 90 mmHg without medication), 25 (64 per cent) had 'improved' (diastolic blood pressure less than 109 mmHg, with a fall of more than 15 per cent) and 11 (28 per cent) had not improved. Logistic discriminant analysis showed that pre-percutaneous transluminal angioplasty diastolic blood pressure, age, serum creatinine and smoking habit together correctly predicted the outcome of percutaneous transluminal angioplasty in 90 per cent of patients, with four 'false positives' and no 'false negatives'. Ten patients suffered a total of 12 serious complications related to the procedure: one death in acute renal failure, one myocardial infarction, one severe hypotension just after the procedure, one deep vein thrombosis, one episode of transient ischaemia of the toes and seven groin haematomas. Thus percutaneous transluminal angioplasty for atheromatous renal artery stenosis rarely 'cures' hypertension, but improved blood pressure control is often achieved, albeit at the expense of troublesome complications. A prospective, randomized trial is needed to establish whether or not the improvement is due directly to percutaneous transluminal angioplasty.
Age Factors↗
HIV infection and Scottish general practice: workload and current practice.
To estimate the effect of human immunodeficiency virus (HIV) infection on general practice, a postal survey was undertaken of one in three of all principals in Scotland. Of the 834 general practitioners who responded (78% response rate), 31% were working in practices with patients known to be infected with HIV. The estimated prevalence of known HIV infection in general practice was 19 per 100,000 population, and the estimated annual consultation rate for HIV related problems (including consultations by the 'worried well') was seven per 1000 population. Both statistics showed considerable variation between health boards, with peaks in Lothian and Tayside. Few practices had drawn up policies relevant to HIV infection, and the use of procedures for controlling infection was variable. Policies about HIV and for infection control tended to be more common in areas where the prevalence of HIV infection was higher. Most respondents were offering both opportunistic health education and counselling about HIV infection, especially to patients at high risk. Although general practitioners are responding positively to the increasing demands of HIV infection, there is an urgent need for policies, both national and local, to guide specific aspects of practice.
Acquired Immunodeficiency Syndrome↗
HIV infection and Scottish general practice: knowledge and attitudes.
To assess the knowledge and attitudes of general practitioners about HIV infection, a postal survey was undertaken of one in three of all principals in Scotland; 834 (77.6%) responded. Respondents' knowledge about HIV was often limited, and they found the discussion of sexual behaviour difficult. Most were in favour of routine HIV testing being offered to patients, but against testing without consent. Most general practitioners considered consent unnecessary for the passing of information about HIV status between medical colleagues, but necessary for informing others, in particular the patient's family and sexual partners. Most general practitioners would accept high-risk and HIV-positive patients onto their lists but less than half would accept intravenous drug users. Most respondents did not feel at significant personal risk of HIV infection, but expressed reservations about many other aspects of HIV infection in general practice. If practitioners are to fulfil their potential for tackling the problems of HIV infection, they need increased resources and a policy for education and training that is responsive to local needs.
Acquired Immunodeficiency Syndrome↗
Is paediatrics safe in general practitioners' hands? A study in the north of England.
More than half the general practitioners in the north of England, and all the health visitors, were sent questionnaires about the primary health care of children. Eighty per cent of general practitioners responded. Their qualifications and experience in paediatrics were poor, although this was less true for younger practitioners. The doctors differed widely in their management of hypothetical clinical problems, possibly owing to this lack of training. Health visitors were thought to have an important role in developmental screening within the primary health care team, but the teamwork itself seemed weak. Although 83% of general practitioners considered developmental screening should be primarily the responsibility of the primary health care team, 31% of practices did not do it and had no plans to start. Rather more than half of the doctors in these non-screening practices would accept a clinical medical officer to screen their patients on their premises. Suggestions are made for ways of encouraging general practitioners to carry out developmental screening.
Clinical Competence↗
What do health visitors contribute to the care of children? A study in the north of England.
All the health visitors in the north of England, and more than half the general practitioners, were sent questionnaires about the primary health care of children. More than 90% of the health visitors responded. Most of them took part in developmental screening and considered it primarily their responsibility; some conducted developmental or well baby clinics with no other professionals present. Clinics run by health authorities often occupied several hours per week, and were more frequently attended by health visitors than clinics run by general practitioners. Almost all the health visitors' remaining time was spent in attached practices, despite the fact that more than half said they had neither office nor clinic space of their own on practice premises. A high proportion of time was spent on clerical work; more help with this could free the health visitor to provide better developmental care for all children.
Child↗
Variations in avoidable mortality and variations in health care resources.
It has been proposed that the effectiveness of medical treatment should be measured by mortality from specified diseases for which death is apparently avoidable given appropriate medical intervention. Unfortunately, that proposal was not supported by direct analysis of the relation between health care resources and avoidable mortality--an analysis which is essential for establishing the validity of avoidable mortality as an indicator of the outcome of health care. Thus the proposal does not yet have any basis, theoretical or practical. A more realistic but still oversimple model is now proposed. With presently available data, however, the validity of avoidable mortality is unlikely to be established, even by this model.
Evaluation Studies as Topic↗
Birthweight and perinatal mortality: III. Towards a new method of analysis.
Perinatal mortality is closely related to birthweight. We propose a model that summarizes this relationship and provides a basis for the analysis of perinatal mortality. The components of this model are the frequency distribution of birthweight and the curve of weight-specific mortality. Taken together, these two curves completely describe perinatal mortality for a given population. The perinatal mortality of two populations can be meaningfully compared by plotting each weight-specific mortality curve relative to its own birthweight distribution. By this means, the excess mortality in one population can usually be expressed as the sum of two excess mortalities--one that occurs uniformly over the whole birthweight distribution, the other due to an increased number of small births. To illustrate this method, we analyse differences between white and black infants. We find that the excess mortality of black infants is chiefly due to an excess of small black births, but also to higher mortality over all (adjusted) birthweights. In contrast to other methods of analysis, the proposed method does not assume a priori that a difference in the mean birthweight of two populations is the cause of any difference in perinatal mortality. Furthermore, the proposed method is unbiased; in particular, it is preferable to direct or indirect standardization for birthweight, previously shown to be biased.
Birth Weight↗
General practitioner participation in intranatal care in the northern region in 1983.
In 1983 a quarter of general practitioners in the Northern region of England cared for obstetric deliveries and half of these for a minimum of 10 deliveries a year. Most expected their intranatal work to remain at the same level or increase in the next 10 years. Most participating general practitioners did their own forceps deliveries and initiated inductions. Most out of hours deliveries were attended by the mother's own general practitioner or a partner. A quarter of all respondents had cared for planned and unplanned home births. Few were happy about attending them, but most would provide planned home care if urged to do so.
Delivery, Obstetric↗
General practitioner obstetrics in the Northern region in 1983.
In late 1983 a four page questionnaire on general practitioner obstetrics was sent to a 50% random sample of general practitioners in the Northern region of England; 84% responded. Half of them said that they had access to general practitioner facilities for delivery, and half of these used them. A quarter of all respondents had provided intranatal care previously but had given it up, most of them during the late 1970s. Younger general practitioners were more highly qualified in obstetrics than older ones but did not do more intranatal work. Isolated general practitioner maternity units were much more likely to be used than those that were alongside consultant units or integrated with them. Ninety per cent of respondents provided antenatal care, 77% of these at special clinics and 88% with midwives in attendance. Teamwork, however, was not well developed. Increasing general practitioner participation in obstetric care seems feasible but depends heavily on more appropriate training and intranatal facilities being provided for general practitioners in association with specialist units.
Delivery, Obstetric↗
Birthweight and perinatal mortality: I. On the frequency distribution of birthweight.
Perinatal mortality is closely related to birthweight. Hence the study of perinatal mortality requires a sound understanding of the influence of birthweight on perinatal mortality. This paper discusses one aspect of this problem--the frequency distribution of birthweight. This distribution is essentially Gaussian but with additional births in the lower tail. It can therefore be divided into two components--a predominant (Gaussian) distribution and a residual distribution. The complete distribution can be summarized by three parameters: the mean and the standard deviation of the predominant distribution, and the proportion of births in the residual distribution. This paper shows that the predominant distribution is composed largely of term births, while the residual distribution is composed almost entirely of small preterm births. It also shows that the three parameters together help to explain the apparent paradox that male infants suffer a higher perinatal mortality than females despite there being fewer light male births.
Birth Weight↗
Birthweight and perinatal mortality: II. On weight-specific mortality.
The study of perinatal mortality requires a sound understanding of the influence of birthweight on perinatal mortality. This paper discusses one aspect of this problem--the pattern of weight-specific mortality. Mortality is very high at the lowest birthweights, falls to a minimum within the range of the most frequent birthweights, but rises again for the heaviest birthweights. Such a curve is best displayed and modelled by plotting the ratio of deaths to survivors on a logarithmic scale. Transformed in this way, perinatal risk may be regarded as the sum of three components--one independent of birthweight, one which decreases linearly with birthweight and one which increases linearly with birthweight. These two lines appear to have slopes of equal magnitude. Each is shown to represent general susceptibility to perinatal problems, rather than the cumulative effect of diseases specific to low birthweight or to high birthweight.
Birth Weight↗
Perinatal mortality: standardizing for birthweight is biased.
Standardization is often used to compare perinatal mortality between populations with different birthweight distributions. Unfortunately, the relationship between perinatal mortality and birthweight seldom satisfies one prerequisite for standardization. Furthermore, standardizing for birthweight is biased against populations with heavier birthweights. For example, the standardized perinatal mortality rate of the heavier of two populations is biased upwards by 15 to 25% when the difference in mean birthweight between those populations is 150 g. As a result, the use of standardization may confuse the interpretation of differences in perinatal mortality.
Birth Weight↗
Peer review in ambulatory care: use of explicit criteria and implicit judgments.
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Ambulatory Care↗