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Biomedical subjects

J R Lewis

Publications and source records attributed to J R Lewis.

At least 19 recordsLinked to original sources
PubMed1995

Examining patient perceptions of quality care in general practice: comparison of quantitative and qualitative methods.

BACKGROUND: The consultation satisfaction questionnaire and surgery satisfaction questionnaire, and the critical incident technique have been identified as examples of, respectively, quantitative and qualitative (interview) techniques with considerable theoretical merit regarding the measurement of patients' views in a general practice context. AIM: This study set out to assess these techniques in terms of ease of administration and analysis, respondent acceptability, and the extent to which the information provided was useful to the practitioner/practice manager, as well as validity. METHOD: Patients from three practices completed the interview and questionnaires. Data were provided for each practice giving their own results as well as data from the other two practices and the results of previous research. RESULTS: Both methods were, in the main, received positively by general practitioners, managers and patients. Patient responses to the questionnaires in general followed predictable patterns, variations from which suggested practice-specific problems. CONCLUSION: There are caveats regarding the use and interpretation of both methods, of which potential users should be aware. This is particularly the case with the consultation satisfaction questionnaire, scores on which, it is suggested, may be on a downward trend over time. It is possible that results from the consultation satisfaction questionnaire/surgery satisfaction questionnaire could be merely demoralizing for practice staff in some instances. Other research supports this notion of demoralization which, although unproven, would reduce the instrument's potential for comparison between studies, and which is, therefore, a finding which requires further attention. Increasing patient expectations are implicated in this.

Adult↗
PubMed1994

Patient views on quality care in general practice: literature review.

The present paper examines research on patient satisfaction and the factors which influence patient attitudes regarding quality in general practice. Although data are used from U.S. and other sources, conclusions are drawn with a specific focus on a U.K. general practice context. This is a research area with a growing literature, much of it based on unsystematic research. The purpose of this paper is to make a contribution to the process or ordering the data in a manner which will be of utility to those involved in the provision of healthcare and the assessment of that provision. The data suggest conclusions in two broad areas: (1) methods by which patient satisfaction may be assessed; specific published instruments are reviewed, and (2) factors which have been indicated, by the research to date, to influence patient satisfaction. Most consistently identified as being of particular value to patients are interpersonal skills on the part of the practitioner. It is suggested that such techniques should receive wider acknowledgement as a basic element of the practitioner's technical repertoire.

Data Collection↗
PubMed1993

Pulseless (Takayasu) disease with ophthalmic manifestations.

Pulseless disease (PD) is a rare disorder in which inflammation of the aorta and its major branches leads to stenosis or occlusion of these arteries. It mainly affects young Oriental women, who suffer chronic ischemic injury to tissues of the brain, orbits, upper limbs, myocardium, and kidneys. The ophthalmologic features of pulseless disease tend to be late manifestations, and can include ischemia of the retina, choroid, and anterior segment. The inflammatory process may be reversed in early stages with systemic corticosteroids, but, more frequently, significant arterial stenosis necessitates arterial bypass surgery. A 59-year-old Caucasian woman with stenosis of all four major cervical arteries presented with recurrent blurred vision, syncope, mental obtundation, and a remarkable funduscopic appearance due to bilateral orbital hypoperfusion. Her acute symptoms improved slightly on high-dose systemic corticosteroids, and then resolved completely following arterial bypass surgery.

Arterial Occlusive Diseases↗
PubMed1992

Therapeutic strategies and outcomes: perspectives from different cultures.

Two forms of psychological therapy, one Japanese the other Euro/American, are described and compared. It is suggested that each identifies comparable goals for individual change. However, each differs in the means by which change is induced. The consensus concerning goals is taken as evidence of universal values in the definition of the fully functioning self. However, the divergence in means by which these goals are attained reflects specific cultural differences. The implications of these differences are related to individualistic versus relational values within the cultures discussed. It is proposed that the comparisons have implications for the practice of any specific form of psychotherapy on members of a culture other than that within which the therapy has developed.

Cross-Cultural Comparison↗
PubMed1990

Juvenile xanthogranuloma of the corneoscleral limbus.

Juvenile xanthogranuloma presenting as an isolated corneoscleral lesion is rare. We report such a case in a 5-year-old boy who required lamellar sclerokeratectomy to the level of Descemet's membrane. Ten months after treatment by total excision and lamellar corneoscleral grafting with donor tissue there was no evidence of recurrence. We discuss the clinical and histologic features of this disorder, the differential diagnosis and treatment options.

Child, Preschool↗
PubMed1988

Rhinoplasty and the nasolabial area.

The nasolabial area is important to consider in achieving a satisfactory relationship between the nose and the other features of the face; this will result in a natural-looking nose. However, the importance of the entire nose on a particular face should be kept foremost in mind.

Face↗
PubMed1987

Nasal tip projection: counterpoint.

The achievement of tip projection in rhinoplasty has been overemphasized in recent programs and publications. The normal spring support of the tip by the medial crura will ordinarily give adequate tip projection in a well-executed rhinoplasty. If additional tip projection is required, the simplest procedures are advancement of the columella and tip upward on the end of the septum and similar advancement of the alar cartilages toward the bridge. For additional support, a cartilage strut is inserted between the medial crura. Retrusion of the distal nasal complex requires maxillary advancement or support beneath the base of the alae and columella. If a tip graft is required, one achieves a more natural tip by a posterior conchal graft, utilizing its natural curve, rather than by a building-block support.

Cartilage↗
PubMed1983

Multiple-tiered deep support of cheeks in meloplasty and rhytidectomy.

Maintaining satisfactory long-term results in a face-lift on an aging face is an important aspect of facial plastic surgery. While undermining and support of the SMAS in the posterior cheek has achieved recent popularity, plication of the fascia in the cheeks has been at least equally effective and safer. Variations of this technique have been used for 30 years with satisfactory results.

Cheek↗
PubMed1983

A method of direct eyebrow lift.

A very simple procedure, requiring about twenty minutes, accomplishes moderate elevation and support of the eyebrows. It may be utilized for eyebrow ptosis alone, whether unilateral or bilateral; in conjunction with meloplasty and blepharoplasty; for equalizing asymmetrical eyebrows, and for further support of markedly ptotic upper lids. It has been used by the author in instances of partial and complete facial paralysis in conjunction with other procedures about the face to accomplish better symmetry. The duration of results with this procedure varies with tissue quality and healing, surgical technique, care given the area during healing by the patient, amount of frowning and vigorous facial muscle use by the patient, and aging. It is a useful adjunct, especially when used for moderate or subtle brow lifts.

Aging↗