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Biomedical subjects

J Wilson

Publications and source records attributed to J Wilson.

At least 991 records · Page 55Linked to original sources
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Implications of the international initiative against avoidable disablement ("impact") for rubella control.

The case for controlling congenital rubella as part of The International Initiative Against Avoidable Disablement rests not on the excessive prevalence of the disease but on the severity of its consequent multiple handicaps. Here is a totally preventable disease afflicting a readily identifiable section of the community that is controllable by a vaccine that is safe, noncontroversial, and simple and inexpensive in its application. Successful national programs against rubella have a potential beyond their immediate objective in promoting the use of immunization as the most powerful weapon against other vaccine-preventable diseases that are estimated to disable 5 million children annually. It is therefore essential that the practical benefits of rubella immunization be convincingly expressed in human-no less than in economic-terms and that any remaining technologic and administrative problems be vigorously explored and, where possible, be solved.

Child↗
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Nasal histamine and heparin in chronic rhinitis.

Histamine and heparin, both free and cellular, were assayed in the nasal mucosa of 11 atopic and 15 nonatopic patients undergoing turbinectomy for chronic rhinitis. There was no significant difference between the free and cellular histamine levels of the atopic and nonatopic patients. There was also no significant difference between the free heparin levels of atopic and nonatopic patients. Mean cellular heparin was, however, significantly greater in the nonatopic group. This finding, together with the results of mast cell counting, suggests either that in atopic patients heparin stores are already depleted prior to turbinectomy, or that in nonatopic individuals nasal mast cells contain an excess of heparin in nonreleasable stores.

Adult↗
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Comparison of ossicular replacement materials in a mouse ear model.

Four biomaterials, UF45S5 Bioglass, Silastic, Plasti-Pore, and Proplast, were used to replace the incus in a mouse ear model. Bioglass, a bioactive glass ceramic, compared favorably with the other test materials in maintaining surgical positioning between malleus and stapes and remaining stable to a blast of nitrogen gas and to pick manipulation. In a short-term animal study, Bioglass showed histocompatibility comparable to that of these other implant materials now used in ossicular replacement surgery in humans.

Animals↗
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Is Trichomonas vaginalis still a marker for other sexually transmitted infections in women?

Trichomonas vaginalis (TV) has, in the past, been regarded as a useful marker for other asymptomatic sexually transmitted infections such as gonorrhoea and chlamydia in women. The aim of this study was to determine whether TV is still such a marker. All women attending the Department of Genito-urinary Medicine at the Leeds General Infirmary with a diagnosis of TV during 1983 and 1993 were identified and concurrent infections were tabulated. In 1993 approximately 30% of women with TV had at least one other sexually transmitted infection. The prevalence of gonorrhoea in women with trichomoniasis fell from 20% in 1983 to 10% in 1993 whilst the prevalence of chlamydia in these women remained unchanged at 15%. Thus trichomoniasis is still frequently associated with other pathogens in women and screening of these women for other infections remains essential.

Animals↗
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Clinical risk modification.

Claims for compensation in cases of clinical negligence have risen dramatically in recent years. The implementation of the NHS reforms, with greater clarity of roles and responsibilities and the emphasis on devolving decision-making as close to the patient as possible, is meant to affect the entire performance of healthcare delivery. For most senior managers and clinicians, the environment in which they operate has grown increasingly turbulent and complex. Both purchasers and providers of health care want the best and most effective and efficient care. The cost and quality of care are components in determining the value of health care delivered, and both are elements of healthcare risk. To begin to manage these elements of risk, the process of healthcare risk modification can be applied. Healthcare risk modification provides the best service for patients through obtaining a synergy between risk management, quality and the law.

Humans↗
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The Clinical Negligence Scheme for Trusts.

The Clinical Negligence Scheme for Trusts (CNST) is a mutual pooling pay-as-you-go arrangement for NHS trusts in England, designed to assist trusts in meeting the costs of clinical negligence claims. A similar scheme has been set up in Wales and this is called the Welsh Risk Pool (WRP). The emphasis of the schemes is on: adopting prudent risk management strategies; meeting CNST and WRP risk management standards; implementing in full the new complaints procedure, including its potential linkages to near misses, clinical indicators and clinical incidents to provide an alternative remedy for some potential litigants; and adopting a systematic approach to claims handling in line with best practice.

England↗
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Incident reporting.

Healthcare delivery is a risky business. People view the NHS in the same light as other commercial businesses such as the hotel, retail and airline industries. The White Paper 'The New NHS: Modern, Dependable' (Secretary of State for Health, 1997) places statutory responsibilities on managers and clinicians to provide a quality service and to have accountability for clinical governance and performance management. Quality and risk are two sides of the same coin, i.e. if you have good quality you have low risk, and this firmly supports the clinical effectiveness agenda. Healthcare organizations in all sectors of care delivery need to demonstrate their high levels of achievement and commitment to continuous quality improvements. Risk management is a process for identifying, assessing and evaluating risks which have adverse effects on the quality, safety and effectiveness of service delivery, and taking positive action to eliminate or reduce them. Having an open, honest and blame-free organization which is open to improving processes and systems of care is a big step towards having staff who are committed to quality and getting things right. Near-miss, incident and indicator recording and reporting are cornerstones of any quality and risk management system.

Humans↗
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Will primary care groups lead to improvements in health care?

The author has participated in a series of regional workshops in Wales, Scotland and England where mixed views were expressed by GPs, nurses and primary care professionals regarding the impact of the new White Paper 'The New NHS: Modern, Dependable'. Many welcome the proposals and the opportunity to influence change. Others, however, expressed widespread concern about the proposed changes, particularly the short timescales, lack of skills, resources and information technology with which to achieve the changes, the lack of start-up funds to get the process going and the lack of incentives to sustain it. The input of community nursing to these workshops was disappointing--many were unclear of their role and involvement, and some were waiting for the GPs to involve them; others, however, were starting to set up their own groups to ensure that their views were heard and included. Primary care groups need active involvement of community nurses at management and operational level and nurse representation at governing body level. It is essential for nurses and nursing to get their act together in relation to the decision-making; configuration and determination of the functionality of primary care groups/trusts.

Health Policy↗
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Proactive risk management: effective communication.

Communication is the most powerful tool in clinical practice. Repeatedly, research has shown that good communication skills result in better clinical outcomes, a greater propensity to follow clinical recommendations and reduced risk of clinical negligence and complaints. In using a proactive approach to communication, healthcare professionals must become increasingly sensitized to the stresses associated with illness and hospitalization and must learn the importance of good listening and effective communication to ensure high quality patient care. A study by Lester and Smith (1993) demonstrated that time-limited, negative communications by doctors is associated with increased litigious intentions among patients, even when outcomes were neither adverse nor negligent. The qualities of caring and concern exhibited by doctors make a difference in healthcare outcomes.

Benchmarking↗
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Clinical governance.

Clinical governance has marked a significant shift towards involving clinicians in the assurances of both quality and accountability in healthcare delivery. The White Paper (Department of Health (DoH), 1997) stated that: 'The Government will require every NHS trust to embrace the concept of clinical governance, so that quality is at the core, both of their responsibilities as organizations, and of each of their staff as individual professionals.' In order to achieve this the Government will bring forward legislation to give NHS trusts a new duty for maintaining quality care. Under these arrangements, chief executives will carry ultimate responsibility for assuring the quality of the services provided by their NHS trust, just as they are already accountable for the proper use of resources. In 'A First Class Service Quality in the NHS' (DoH, 1998), clinical governance is defined as 'a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish'. The principles of clinical governance apply to all those who provide or manage patient care services in the NHS. It requires staff to work in partnerships, breaking down boundaries by providing integrated care within health and social care teams (Wilson, 1996), and between practitioners and managers and between the NHS, patients and the public.

Decision Making, Organizational↗
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Patient safety and the reuse of single-use medical items.

Trusts owe a duty of care to patients, staff, the public and the environment. This article considers the risk issues associated with the reuse of medical devices. The practice of reusing medical devices labelled by the manufacturer for single-use only must be carefully considered by managers and clinicians responsible for patient safety, to ensure that account has been taken of outcomes which may adversely affect clinical procedure and be harmful to the patient.

Disposable Equipment↗