Search PubMed⌕ Search

Biomedical subjects

J Fenwick

Publications and source records attributed to J Fenwick.

50 records · Page 3Linked to original sources
PubMed1987

Lessons from the national asthma mortality study: circumstances surrounding death.

The circumstances surrounding all deaths from asthma in New Zealanders under 70 years of age between August 1981 and July 1983 have been analysed from information recorded or recalled by doctors or relatives of the deceased. Factors which may have reduced the time available for effective treatment of these severe attacks are described to draw attention to ways in which mortality might be reduced. For almost half of the 271 deaths medical help had not been called before the patient was in extremis. When medical help was summoned in sufficient time doctors commonly did not give corticosteroids or used them inadequately. Difficulties in using medical care and noncompliance with asthma management were common particularly in Polynesian patients. In 38% of patients some medical inadequacy appeared to contribute to poor long-term care and education. Failure of patients to attend for ongoing medical care, education and preventative treatment, or a medical failure to deliver these may have led to chronically reduced lung function. Any further deterioration may then have more rapidly led to a fatal outcome. Lack of patient or family awareness about how to detect and cope with an unusually severe attack was found and contributed to avoidable fatalities.

Asthma↗
PubMed1986

Deaths from asthma in New Zealand.

We report the first complete population based study of childhood deaths due to asthma. All deaths ascribed to asthma in New Zealand children aged 0-14 were investigated as part of a two year national study of mortality from asthma. The 16 children who died from asthma all developed asthma by the age of 4; 15 had a family history of asthma, and 12 had associated atopic disorders. Disturbed pyschosocial relationships were evident in eight families. Seven children died in less than three hours from the onset of their final attack. All children died outside hospital. Mortality from asthma in Maori children (3.14 per 100 000) was five times that of European children. With hindsight, factors which if avoided could have led to a different outcome were identified in eleven cases. The circumstances surrounding these deaths were similar to those described for adults with asthma; this study, however, underlines the importance of parental care and knowledge in the management of children with asthma. Inadequate long term medical care, underassessment of severity by family and doctors, failure of the family to call for help when required, and inadequate responses of medical services contributed to the fatalities. Excess beta2 sympathomimetic dosage or overreliance on home nebulisers were uncommon. Most childhood deaths from asthma should be prevented by increased family awareness, better assessment of severity, improved long term treatment, and rapid access to emergency medical care.

Adolescent↗
PubMed1986

A case-control study of deaths from asthma.

A population based case control-study was initiated in 1981 to identify risk factors for death from asthma. Over a two year period all deaths in the Auckland population possibly due to asthma, in people less than 60 years of age, were investigated. From the 47 people who died from asthma 44 who had useful reversibility of airways obstruction (records showing greater than 20% variability of peak flow or a history indicating equivalent variability of shortness of breath) before death were selected as cases for the study. Both hospital and community based controls were used. The cases were more likely than were the community controls to have had severe disease, a hospital admission or visits to a hospital emergency department in the previous year (odds ratios 4.4, 16.0, 8.5 respectively). The asthmatic patients who died were more likely than either group of controls to have had a previous life threatening asthma attack. Poor management of the disease and poor compliance on the part of the patient increased the risk of death. In addition, use of three or more types of asthma drug within the past year was associated with an increased risk of dying that was independent of disease severity. Of interest was a similarity between asthmatic patients admitted to hospital and those who died. Nevertheless, a history of a previous life threatening attack and a recent admission to hospital identified a group at high risk.

Acute Disease↗
PubMed1986

Retinoid-binding proteins in cone-dominant retinas.

We identified and localized interphotoreceptor (or interstitial) retinoid-binding protein (IRBP) and cellular retinaldehyde-binding protein (CRALBP) in the cone-dominant retinas of diurnal squirrels. Western blots were prepared from sodium dodecyl sulfate polyacrylamide gels (SDS-PAGE) from whole retina, and from retina proximal and distal to the photoreceptor nuclei. Blots were incubated with purified rabbit IgG's specific for the bovine retinal antigens, and the labeled components were visualized using immunoperoxidase techniques. Anti-bovine IRBP and anti-bovine CRALBP recognized single components on gels of retinal supernatants that corresponded to the electrophoretic migration of the bovine antigens. The component recognized by anti-bovine IRBP on blots of outer retinal proteins (Mr 146,000) was absent on blots of inner retinal proteins. Twelve and 24 hr after intravitreal injection of 3H-L-fucose, electropherograms showed one major peak of radioactivity that coincided with the component recognized by anti-bovine IRBP. By immunoelectron microscopy, anti-bovine CRALBP labeling was restricted to the cytoplasm of both RPE and Muller cells, with light labeling of nuclear euchromatin in both cell types. In contrast, anti-bovine IRBP recognized antigenic sites primarily in the interphotoreceptor space (IPS). Intracellular labeling was limited to occasional granules in the photoreceptor myoids and the apical RPE cytoplasm. Extracellular labeling with anti-bovine IRBP was strongly associated with patches or small clumps of amorphous, electron opaque material distributed throughout the IPS. This material was particularly prominent near the cone outer segment plasma membranes, and was tentatively identified as the residual interphotoreceptor matrix that remained after exposure to the solvents used during tissue processing. In general, the results are consistent with those obtained in rod-dominant species. In addition, they imply that cones as well as rods are responsible for IRBP synthesis in the ground squirrel.

Animals↗
PubMed1985

The Second International Urban EMS Conference.

The major difference between the 1983 and 1984 conferences was the increased participation of EMS-system administrators in the latter program. Although there was refinement by the conferees of the previous positions, the focus of the 1984 conference moved away from purely medical issues and towards concerns about cost/benefit analysis, organization, and governance. The triad of government officials responsible for public safety, systems administrators responsible for efficiency, and physicians responsible for medical control is balanced in different ways in different jurisdictions. Nevertheless, there is continuing convergence towards international urban EMS systems that are more similar than different.

Computers↗
PubMed1984

Death from asthma in Auckland: circumstances and validation of causes.

New Zealand has experienced an epidemic of asthma deaths since 1977 with mortality rates of over 3.0/100 000 for people aged 5-34 years, more than three times the rate of comparable countries. To examine the reasons for this high mortality rate all deaths from asthma in people under 70 years in the Auckland region in 1981-82 were investigated. A total of 84 possible cases were studied and the validity of death certificates was found to be excellent for people under the age of 50 years. Fifty-three cases had usefully reversible asthma at the time of death and the mortality rate was almost four times higher in Pacific Islanders than in caucasians, with the Maori rate being intermediate. Sixty-seven percent (35) of the deaths in people with usefully reversible asthma occurred at home. In only 40% of cases had the patient reached some form of medical care. No deaths occurred in the patients admitted to hospital with the diagnosis of asthma during this period.

Adolescent↗
PubMed1980

Hemodynamic monitoring and vasodilator therapy in acute left ventricular failure. Preliminary report on a new vasodilator, tolmesoxide.

Data, obtained by invasive hemodynamic monitoring, are now routinely available in our Intensive Care Unit, and are processed by means of a small calculator to a cardiovascular profile, including O2 transport/consumption, vascular resistance and ventricular work values. Patients with clinically persistent shock states, after 12-24 hours optimal classical cardiovascular therapy, are invasively studied. Vasodiltor therapy frequently improves not only hemodynmic parameters, but also oxygen delivery to the tissues. Tolmesoxide, a new peripheal vasodilator, has been used in eleven patients. Preliminary results are discussed.

Acute Disease↗
PubMed1977

Quantitative evidence for the helicoid relationship between the maxillary and mandibular occlusal surfaces.

A method for measuring the transverse inclination of molar teeth is described which enabled significant differences (P less than 0.001) between the three molars to be demonstrated for a sample of English Modern (n 24) and Romano-British (n20) skulls. No significant differences between the transverse molar inclinations were found for the Bronze Age (n 10) or the Neanderthal (n 8) sample.

Dental Occlusion↗
PubMedDate not supplied

Facial plastic surgery in the otolaryngology training program: an update.

In 1985, we demonstrated that, following the institution of a specific curriculum in facial plastic surgery, the number of cosmetic procedures generated and performed by residents rose dramatically. We have now demonstrated that this increase has been sustained in the 5 years since establishing the curriculum. We continue to maintain that the key to a successful curriculum in facial plastic surgery is the presence of at least one full-time staff member whose primary function is the practice and teaching of facial plastic surgery.

Curriculum↗
PubMedDate not supplied

Recruitment in a primary care trial on smoking cessation.

The purpose of this study was to describe and compare the rates of recruitment during a randomized clinical trial on smoking cessation in two primary care practices. One site was a five-physician private family practice setting with about 15,000 patients. During 34 days, 576 patients were screened, of whom 22% were smokers. Among the smokers screened, 54% consented, 33% refused consent, and 13% were called in too early to consent. The other site was a six-physician academic medical practice with about 16,000 patients. During 53 days, 1,692 subjects were screened, of whom 16.2% were smokers. Among the smokers, 19% consented, 81% refused consent, and none were called in early. The enrollment of smokers was 3.3 times greater in the private practice than the academic practice. At the first site, study personnel screened 26.6 subjects per day, whereas the practice receptionist screened only 13.4 subjects per day (P less than .01). A randomized trial of having subjects read the informed consent versus having study personnel read it to them showed no differences in recruitment. The data suggest that private practices may have greater potential for subject recruitment than academic sites, that using study personnel improves recruitment, and that having study personnel actively involved in informed consent does not improve recruitment.

Adult↗