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Biomedical subjects

J Shepherd

Publications and source records attributed to J Shepherd.

422 records · Page 24Linked to original sources
PubMedDate not supplied

Facilities for the management of patients with lipid disorders in the United Kingdom: results of the British Hyperlipidaemia Association Survey.

A national survey was undertaken by the British Hyperlipidaemia Association to obtain data on the current clinical practice for the investigation and management of patients with hyperlipidaemia. An additional objective of the survey was to establish a United Kingdom register of lipid clinics. The results show a considerable variation in the availability of lipid clinics, and medical practitioners involved in these clinics came from a variety of specialty backgrounds. Some clinics had clearly defined policies with regard to acceptance of referrals. However, deficiencies in clinical services were identified including the lack of dietetic and laboratory support.

Ambulatory Care Facilities↗
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Trends in the management of fractured mandibles 1983-93.

The aetiology, presentation and management of fractured mandibles were investigated in a major accident and emergency department in 1983 and 1993. Demographic features of patients in both years were similar: most injuries were in males (89%), most were a result of an assault ( > 75%), and 50% of the patients presented for treatment between the hours of 10pm and 5am. There were striking reductions in the numbers of patients who waited more than 24-hours for an operation (60% in 1983; 34% in 1993), and out-of-hours operating (60% in 1983; 41% in 1993). There was an increase in the number of patients for whom consultants were the principal operator (13% in 1983; 32% in 1993). Changes in the methods of treatment included a decrease in the use of postoperative intermaxillary fixation (98% in 1983; 56% in 1993) and an increase in internal fixation using bone plates (2% in 1983; 53% in 1993). Total inpatient stay was the same in both study years (mean = 3 days), and there was no difference in duration of stay between treatment modalities (internal versus intermaxillary fixation).

Accidents, Traffic↗
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Risk factor modification extends the benefit of coronary artery revascularisation procedures.

The management of coronary artery disease has undergone major changes in the past three decades. Early medical preventive strategies rapidly gave way to surgical intervention by the end of the 1960s; 10 years later this was supplemented by the introduction of angioplasty. Both of these approaches offered rapid symptomatic relief but were dogged by a predisposition to restenosis. While technical improvements have helped reduce this problem, there is a growing perception that the imbalance between the enthusiastic adoption of surgical intervention and the jaundiced neglect of secondary medical prevention needs to be redressed. This can be achieved without stepping back in time, for, since the 1960s, agents far more effective in the struggle against ischaemic vascular disease have proven their worth in the clinical arena. Graft protection following bypass surgery is vital, but equally important is the need to target the metabolic derangement which caused the occlusion in the first place. This article reviews medical strategies designed to add life to coronary artery revascularisation procedures.

Cholesterol↗
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Preemployment examinations: how useful?

BACKGROUND: An article in the March-April 1991 Journal of the American Board of Family Practice noted a lack of consensus among family physicians regarding preemployment testing of workers. Family physicians do not seem to adhere to any explicit or uniform criteria in performing these tests. Previous writers have suggested how these examinations might help both the employer and the worker. The Americans with Disabilities Act, which went into effect 26 July 1992, however, appears to make true preemployment examinations illegal. METHODS: A review of the Healthline (1975 to 1991) and the MEDLINE (1980 to 1991) data bases using the MeSH headings "physical examination," "personnel management," "occupational medicine," and "personnel selection" yielded 13 articles dealing with the benefit of preemployment examinations to employees or employers. No studies appeared under the text word "preplacement." RESULTS: All of the published articles addressed the protection of the employer in some manner, but only three studies revealed any benefit to the employer or any protective value for the worker. The testing in these three investigations used detailed knowledge of the demands and duties of the job and, therefore, allowed for more task-specific examinations. CONCLUSIONS: The paucity of evidence demonstrating the usefulness of preemployment examinations suggests the need for further research and the development of preemployment evaluations that would allow family physicians to examine employees in a consistently beneficial and more standardized manner.

Cost-Benefit Analysis↗
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Lipoprotein metabolism in familial hypercholesterolemia.

Low density lipoprotein (LDL) receptor deficiency, which causes homozygous familial hypercholesterolemia (FH), is accompanied by a gross disturbance in the metabolism of apolipoprotein (apo) B-containing lipoproteins. Not only is plasma LDL increased, but also the less dense lipoproteins (of very low and intermediate density) accumulate to a similar extent. Only the largest triglyceride-rich subfraction of very low density lipoprotein (VLDL) is not affected. The metabolic disturbance is characterized by oversynthesis of apo B and a defect in its clearance along the length of the delipidation cascade from VLDL to LDL. This phenomenon leads to delayed transit of particles through the system, extending the residence time of the B protein in the plasma by three- to fourfold. Receptor deficiency, therefore, results in accumulation of a number of lipoprotein species that have been implicated in the pathogenesis of atherosclerosis.

Humans↗
PubMedDate not supplied

Severe co-trimoxazole reaction in a man with AIDS.

Although other drugs can be used in the prophylaxis and treatment of HIV-infected persons, family physicians will prescribe co-trimoxazole frequently. These providers need to recognize the overall increased frequency of adverse reactions to this drug in this population and the potential for severe hypersensitivity effects requiring intensive hospital care. While the exact importance re-exposure has in causing this reaction remains unclear, certainly providers must pay particular attention to patients who have had any earlier sensitivity to the drug before treatment is resumed. Desensitization therapy has been used successfully in some HIV-positive individuals, even after severe reactions; however, this case again teaches the need for prudence in the use of all pharmacological agents.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

International comparison of awareness and attitudes towards coronary risk factor reduction: the HELP study. Heart European Leaders Panel.

BACKGROUND: An international survey was conducted to assess public awareness and attitudes to coronary heart disease and to establish the frequency with which certain health-related behaviours are practised in five European countries. METHODS: Members of the general public (n=5013), individuals at increased risk of coronary disease (n=2500), patients who had suffered a myocardial infarction (n=1256) and members of their families (n=1249) were interviewed in a study conducted in France, Germany, Italy, Sweden and the UK. Questions were asked about respondents' attitudes to their health and about their current health practices. RESULTS: The survey revealed a considerable degree of indifference to coronary heart disease, despite the possession of a reasonable level of knowledge of the risks involved, even among patients who had suffered a myocardial infarction. At the same time, respondents declared themselves satisfied with the quality of advice about coronary health that they obtained from the medical profession and regarded these sources of information as highly credible. Media health campaigns, by contrast, had comparatively little impact. CONCLUSION: A survey of five European countries shows that individuals possess reasonable levels of knowledge about coronary heart disease. They also have access to sources of heart health information that are perceived as highly credible. Nonetheless, such information has a very limited impact on their practice of health-related behaviours.

Adult↗