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Biomedical subjects

J Newton

Publications and source records attributed to J Newton.

At least 73 records · Page 4Linked to original sources
PubMed1994

Role of primary care in the prevention of malignant melanoma.

One of the targets for health in the United Kingdom is the reduction in the year-on-year increase in the incidence of skin cancer. Most of the mortality associated with skin cancer is attributable to malignant melanoma. One possible way to reduce the incidence of malignant melanoma is to develop a strategy for prevention based in primary care. This paper considers the arguments for and against three possible strategies: giving general advice; identifying patients at high risk; and undertaking early diagnosis. It is concluded that elements of all three strategies are likely to prove useful, but that major studies need to be undertaken before any strategy is adopted on a national basis.

Adult↗
PubMed1994

Analysis of p53 in human cutaneous melanoma cell lines.

Mutations in the p53 tumour suppressor gene have been detected in a variety of human malignancies. Mutations have been found predominantly in conserved regions two to five. Our aim was to analyse p53 at the protein and DNA level in seven melanoma cell lines of cutaneous origin (HMB-2, DX3, LT5.1, MJM, SK23, A375P and A375M), including two parental/metastatic derivatives (A375P and A375M; DX3 and LT5.1). By immunohistochemical staining with three mouse monoclonal antibodies and a rabbit polyclonal serum, it was possible to observe differential nuclear expression of p53. The quantitation of p53 protein levels by ELISA correlated with the nuclear staining pattern. Western blotting showed an intact p53 protein in all cell lines; p53 was polymorphic in three cell lines (MJM, A375P and A375M). DNA sequencing studies showed that all cell lines had wild type p53. These results suggest that p53 is unlikely to play a significant role in the genesis of cutaneous melanoma.

Cell Nucleus↗
PubMed1994

An agenda for change in referral--consensus from general practice.

BACKGROUND: Wide variations in rates of referral from primary to secondary care have been a matter of concern for many years. Effective strategies for optimizing referral depend on doctors being able to understand what the influences on their referral behaviour are, as well as having the ability to identify priority areas for action and to develop strategies for pushing through effective measures. AIM: This study set out to ascertain general practitioners' priorities for change with respect to the referral process, and to set an agenda for change to be tackled by general practitioners, providers, policy makers and educationalists. METHOD: Through the use of the Delphi technique and focused interviews, general practitioners throughout Northumberland contributed to the consensus view. RESULTS: The main themes to emerge related to hospital waiting lists, open access, flow of information between secondary and primary care and general practitioners' knowledge and training. Ideas for implementing change included the production of directories of hospital services and the development of guidelines for the use of the term 'urgent' in referral letters. CONCLUSION: All of the proposed changes are manageable and share the burden between general practice and other professionals with an interest in the referral process.

Attitude of Health Personnel↗
PubMed1993

Fundholding in northern region: the first year.

OBJECTIVE: To describe the experiences of 10 fundholding practices in the Northern region during 1991-2 and to elicit subjective assessments of the impact of their change in status on practice management and patient care. DESIGN: Semistructured interviews were conducted with clinicians and practice managers; other staff in the practices were asked to fill in questionnaires. Questions were asked about the preparatory year, the impact of fundholding on clinical practice and practice management, perceptions of the costs and benefits of fundholding, and views about the future of the scheme. SETTING: 10 of the 28 first wave fundholding practices in the Northern region, March-July 1992. RESULTS: Two interviews were conducted in nine practices and one interview in the tenth practice. Replies to the questionnaire were received from 35 general practitioners (73%) and 89 (58%) nonmedical staff. Practices sought independence in applying for fundholding status and found the preparatory year challenging and time consuming. General practitioners thought that the greatest change had occurred in relationships with consultants and the least change in relationships with patients. Most respondents thought that fundholding had changed the way they worked. The perceived benefits of fundholding were mentioned more often than the perceived costs. CONCLUSIONS: The results offer some encouragement to the proponents of fundholding, but more longitudinal studies are needed to evaluate the misgivings of critics of the scheme. Fundholders are uncertain about their ability to make savings year after year, particularly in an increasingly cost contained environment.

Attitude of Health Personnel↗
PubMed1993

Multiple hospital admissions in a calendar year.

Hospital in-patient workload is routinely measured as episodes of care. We report on the extent to which counts of episodes of care differ from counts of patients treated in different specialties and in different age groups. Linked records of hospital care in a population of 1.9 million people, collected over an 11-year period (1976-1986), were analysed. The all-ages multiple admission ratio (the number of admissions per 100 people admitted in the same specialty and year) varied between specialties from 102 to 171. Medical specialties tended to have higher ratios than surgical ones. The influence of age on multiple admission ratios varied between specialties, although in general the ratios increased with increasing age. There were progressive but small increases in multiple admission ratios over the period studied in a number of specialties but, by and large, stability over time was more striking than any change. The information presented could be used to estimate person-based admission rates from available episode-based data where the former are not available. This should be helpful both in managing hospital resources and in purchasing care on behalf of resident populations. Purchasers in particular should be aware of numbers of people being treated as well as the numbers of episodes of care provided.

Adolescent↗
PubMed1993

Accidental skin punctures during ophthalmic surgery.

PURPOSE: Accidental skin puncture carries the risk of both hepatitis B and human immunodeficiency virus transmission. There have been studies of the incidence of these skin punctures in general surgery, but no study has focused on ophthalmic surgery. METHOD: All incident reports of skin punctures in the Bascom Palmer Eye Institute operating rooms from January 1990 through November 1991 were reviewed retrospectively. The incidence of skin puncture also was studied propsectively from December 1991 through May 1992. During the prospective phase, the healthcare worker was asked to complete an anonymous form regarding the instrument involved, whether it was clean or contaminated, the persons involved, and whether the room lights were on or off. RESULTS: There were 37 such occurrences in 14,878 operations (0.25%) during the retrospective study and 12 in 4246 operations (0.28%) in the prospective period. In only one case was the instrument contaminated by contact with a patient known to have positive serology for the human immunodeficiency virus. There were no documented seroconversions of healthcare personnel for either hepatitis B or human immunodeficiency virus. In 63% of these occurrences, the penetrating instrument was known to be definitely contaminated with the patient's blood. Only one person was handling the instrument 84% of the time. CONCLUSION: The low but present danger to ophthalmic personnel during surgical procedures justifies precautions to decrease the occurrence of skin punctures.

Accidents, Occupational↗
PubMed1993

Long acting methods of contraception.

Long acting methods of contraception have been developed and refined over the last 10 years. From the classical long acting progestogen-only depot preparations we now have a range of delivery systems including both combined and progestogen only injection systems and vaginal rings also containing either progestogen only or oestrogen and progestogen in combination. Subcutaneous implants at present containing only a progestogen, offer a range of durations from 2-5 years. The efficacy of these methods is high, with failure rates as low as 0.1 per 100 woman years. However, with progestogen only systems a significant proportion of women develop unpredictable menstrual bleeding, which with counselling is acceptable. The commonest reason for discontinuation still remains menstrual disorders and recent WHO workshops have investigated the cause of this bleeding and refined the reference periods of analysis. The method of action of progestogen-only systems is primarily cervical mucus blockade and prevention of sperm penetration. However, they also tend to produce a thinned atrophic endometrium. Ovarian effects ranging from complete anovulation to disordered luteal phase, persistent follicles and disorganised hormone production add to the contraceptive effect in more than half of the treatment cycles, but cause some of the menstrual disturbance. All these long acting methods are essential to family planning programmes, offering highly acceptable, and in some cases novel methods with high efficacy.

Administration, Intravaginal↗
PubMed1993

Melanization stimulating activity in the skin of the gilthead porgy, Sparus auratus.

The presence of a melanization-stimulating factor (MSF) was discovered in dorsal and/or ventral skin of Sparus auratus. Skin from this marine species was used to condition Steinberg's balanced salt solution (BSS), which was subsequently tested with the neural tube assay. BBS conditioned by dorsal and/or ventral skin of S. auratus at 25% and 50% concentrations had a profound stimulatory effect on the percentage of melanization of neural crest cells throughout the 3-day assay period. In some cases 90% melanization occurred within the first 24 hr. Such stimulated cells showed a doubling of the number of dendrites per cell. To assess the effects of MSF on other indices of melanization, dorsal and/or ventral skin was used to condition MEM used in the culture of B16-F10 murine melanoma cells. During the first 24 hr, B16-F10 murine melanoma cells responded to conditioned media by demonstrating a considerable increase in activities of tyrosine hydroxylase, dopa oxidase, and dopachrome tautomerase, but no effect was observed on melanin content. In contrast, melanin content increased after 48 hr of incubation, whereas the enzymatic activities were inhibited during this period. It seems that MSF activity, expressed in several ways, may be present generally among marine species.

Animals↗
PubMed1993

Continuing professional development.

There is increasing political and consumer pressure on professions, which have a degree of monopoly of service, to ensure that their members are competent to practise. One means of maintaining competence is the requirement of professionals to undertake professional development activities throughout their practising careers. Options reviewed are: voluntary attendance at continuing education activities; complaints-initiated professional development; compulsory attendance at continuing education activities; practice audit; a professional development programme for recent graduates; and the professional development review process.

Clinical Competence↗
PubMed1992

Communication between general practitioners and consultants: what should their letters contain?

OBJECTIVE: To canvass the views of all general practitioners and consultants working in Newcastle upon Tyne on the content of referral letters and replies, the feasibility of standardising certain aspects of referral letters, and the use of communications data for audit purposes. DESIGN: A postal questionnaire was sent to all general practitioners and consultants in Newcastle upon Tyne in May 1991. Questions were asked about the clinical and administrative content of letters, the utility of standard categories to state the reason for referral, the idea of using letters for feedback purposes, and communications as a potential topic for professionally led audit. SETTING: Area served by Newcastle upon Tyne Family Health Services Authority and District Health Authority. RESULTS: Replies were received from 274 (77%) doctors (115 general practitioners and 159 consultants). A majority (225; 82%) were in favour of items defined as "always important" forming a minimum requirement for referral letters and for consultants' replies. Using standardised categories to state the reason for referral was not endorsed: 102 (89%) general practitioners and 132 (83%) consultants preferred referrers to use their own words. Using referral communications to provide feedback was less popular with consultants (54; 34%) than general practitioners (72; 63%). Finally, a majority of doctors (179; 65%) were in favour of using written communications as a topic for professionally led audit. CONCLUSIONS: A high degree of consensus exists among clinicians about the content of referral communications. Although doctors may still reject the concept of standardised communications, they have unambiguously endorsed a standard for communication that they can aspire to, and they are prepared to use it as a yardstick for their actual performance.

Communication↗
PubMed1992

A review of the effects of long-acting progestogen-only contraceptives on ovarian activity.

Progestogen-only contraception acts mainly by blocking cervical mucus and preventing sperm penetration through it does have a variable pattern of contraceptive effects on the endometrium and ovary. In contrast with the complete suppression of ovarian function with combined pill or injectable use, a variable degree of endocrine activity is demonstrated in women choosing a long-acting progestogen-only contraceptive. This degree of suppression of ovarian activity explains the decrease in systemic side-effects, the rapid resumption of ovulation and recovery of fertility following the discontinuation of the method. New delivery systems of progestogens, the vaginal ring and implant, offer better and more consistent contraceptive effects.

Cervix Mucus↗
PubMed1992

Risk factors for melanoma: site variation in minimal erythema dose.

Skin types 1 and 2, increased numbers of moles, and excessive intermittent sun exposure are known risk factors for cutaneous melanoma, but the inter-relationship between UV radiation exposure, moles and melanoma remains unclear. There is a noteworthy site variation in melanoma, it being more common on the lower leg in women and on the back in men. In order to determine whether this site variation could provide further clues to the pathogenesis of melanoma, we examined site variation in photosensitivity and its relationship to other known melanoma risk factors (number of moles, skin type and skin colour) in 25 healthy volunteers. A marked site variation in photosensitivity was found. The pale skin of the volar aspect of the forearm was markedly less photosensitive than the darker skin of the back. Females were more photoresistant than males on the lower legs even though this is the more common site for melanoma in women. There was some correlation between the number of moles and photosensitivity at the two sites.

Adult↗