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Biomedical subjects

M A Potter

Publications and source records attributed to M A Potter.

36 records · Page 2Linked to original sources
PubMed1998

A prospective controlled study of the association of Streptococcus bovis with colorectal carcinoma.

AIM: To investigate the ability of Streptococcus bovis to colonise colorectal cancers. PATIENTS: 19 patients with colorectal cancer and 23 controls without malignancy. SETTING: University teaching hospital. METHODS: Prospective study comparing unselected patients with known colorectal cancer with age and sex matched controls. Carcinoma tissue from patients with colorectal cancer and normal colonic mucosa, stool, and blood from both patients and control subjects were cultured. RESULTS: In contrast to published data, the faecal carriage rate was similar in cancer (11%) and control groups (13%). CONCLUSIONS: Faecal colonisation by Str bovis in colorectal cancer patients is lower than previously reported and does not differ significantly from controls.

Adenocarcinoma↗
PubMed1998

Gene therapy in pediatrics.

There has been a rapid proliferation of gene therapy trials in humans in the last few years. Gene therapy in pediatric patients has included treatment of classical genetic diseases as well as cancer and AIDS. Despite hundreds of trials involving thousands of patients, to date no disease has been cured with gene therapy. Setbacks in these trials have led to the development of new vectors for gene transfer, more specific targeting of therapy and increased efforts to understand the pathophysiology of diseases.

Journal Article↗
PubMed1998

Diagnostic accuracy, angiographic correlates and long-term risk stratification with the troponin T ultra sensitive Rapid Assay in chest pain patients at low risk for acute myocardial infarction.

AIMS: This prospective study of acute chest pain patients clinically at low risk for a myocardial infarction was designed to: determine the diagnostic accuracy of a cardiac troponin T (cTnT) ultra sensitive Rapid Assay (RAII) compared with the quantitative cTnT assay; evaluate the association of a positive RAII with the presence and severity of coronary artery disease (CAD); and determine the ability of the RAII result to predict adverse events during long-term follow-up. METHODS AND RESULTS: A total of 199 patients referred for chest pain, without ST segment elevation on presenting ECG, underwent RAII, quantitative cTnT, CK and CK-MB tests drawn simultaneously > or = 10 h after symptom onset. An abnormal value for cTnT was defined as >0.1 ng.mL(-1). The presence and extent of CAD was recorded in patients undergoing angiography. Adverse events, including cardiac death, non-fatal infarction, and readmission for unstable angina or heart failure, were assessed long-term. An abnormal RAII was found in 41 (20-6%) patients. The RAII sensitivity for detecting abnormal quantitative cTnT levels was 100%, specificity 96.3% (158/164) and overall concordance 97.5%. Although the presenting ECG was normal or non-specific in 95%, ST depression or T wave inversion occurred in 17% of RAII-positive versus 2%, RAII-negative patients (P=0.004). Of RAII-positive patients who underwent angiography (79%), 87% had CAD and 60% had multivessel disease. Kaplan Meier event-free survival curves showed early separation and continued to modestly diverge for patients with positive and negative RAII (69% versus 90% one-year event-free survival, P=0.002). CONCLUSION: In a chest pain population anticipated to have a low prevalence of acute coronary syndromes and a good prognosis, the RAII is a quick and reliable test. It provides an important initial opportunity to identify patients with a high prevalence of CAD and increased incidence of future cardiac events.

Adult↗
PubMed1996

An objective assessment of surgical training.

The aim of this study was to determine the feasibility of assessing surgical training from routine, prospectively collected data and to establish whether weighted workload assessed surgical training more objectively than caseload (case counting). The surgeons in this surgical unit prospectively documented details of all operations and endoscopic procedures (caseload) on a database. Over a six-month period the workload was calculated by weighting the caseload using Intermediate Equivalent (IE) values. Some 1827 procedures were documented. The three consultants performed 796 (44 per cent) procedures, the senior registrar (SR) 137 (7.5 per cent), the registrar 241 (13 per cent) and the three senior house officers (SHO) 644 (35 per cent). The consultant was first assistant in 185 (66 per cent) procedures performed by the SHOs, in 52 (61 per cent) by the registrar in 9 (13 per cent) by the SR. When assessed by caseload one SHO (as a representative example) performed 224 procedures compared to 137 by the SR. The IE workloads were 156 and 166 respectively. This better reflected the greater complexity of the operations performed by the SR. This study has shown that details of surgical training can be easily retrieved from existing administrative databases. This can be used to document the number and type of operations performed by a trainee and the degree of consultant supervision. The degree of surgical training is better assessed by weighted workload rather than caseload.

Education, Medical, Graduate↗
PubMed1996

Written discharge advice sheets reduce visits to the general practitioner.

A prospective audit of early post-operative morbidity in patients who would not normally receive routine outpatient review was undertaken. One-hundred-and forty-seven (92 per cent) of 162 patients invited returned for assessment. Thirty-five patients (24 per cent) had complications. These were of a minor nature with infected wounds being most numerous. Much of this morbidity appeared avoidable if the patients had received appropriate advice whilst in hospital. Also noted was the surprising frequency with which patients required to consult their general practitioner (GP) for guidance regarding an otherwise uncomplicated convalescence. Written advice sheets for the patients were drawn up and the study repeated. One-hundred-and-fifty (93 per cent) of 162 patients attended including 11 (7.3 per cent) who did not receive an advice sheet. Twenty-five (16.7 per cent) had complications. Although the overall complication rate was not significantly different there were significantly fewer wound infections in the second group (6 (4 per cent) versus 15 (10 per cent); p < 0.05). The number of GP visits was also reduced (24 (16.3 per cent) versus 13 (8.7 per cent); p < 0.05). Written post-operative advice sheets should be given to all patients following minor surgery.

Family Practice↗
PubMed1995

A 10-year analysis of case load and weighted workload in a single Health Board.

This study analysed the general surgical activity in a single Health Board in terms of caseload (case counting) and Intermediate Equivalent (IE) workload. Endoscopy and surgery performed wholly within the specialist vascular and urological units were excluded. Some 180,466 procedures were prospectively recorded through the Lothian Surgical Audit over a 10-year period (1983-92). They have now been weighted to reflect workload according to the British United Provident Association's schedule of procedures. 5,058 (2.8 percent) procedures could not be 'matched' and in a further 2,400 (1.4 percent) there was an error in the Lothian Surgical Audit code leaving 172,968 operations for analysis. The total number of operations (caseload) performed annually fell by 12 percent over the 10-year period. This fall was entirely due to a 28 percent decrease in the number of minor operations. The total annual IE weighted workload rose by 2.7 percent for the 10-year period. Analysis by IE workload revealed that the fall in minor operations had been compensated for by an increase in complex major operations (CMO). The total caseload of CMO had increased from 224 (1.0 percent) to 551 (2.9 percent). This represented an increase in the proportion of workload from 5.3 percent to 12.45 percent. Thus a 1.9 percent increase in case load represented a 7.1 percent increase in IE workload. In the final year major and complex major operations formed 24.6 percent of the caseload which represented 53.2 percent of IE weighted activity. This study suggests that IE workload based on the BUPA schedule is a valid and reproducible method of weighting that accurately reflects the changing workload of different case mixes. This differential must be appreciated to ensure accurate allocation of resources. In future surgical activity,including waiting lists,should be assessed by weighted workload rather than case numbers.

General Surgery↗
PubMed1994

Toward a consensus for health care reform: the use of focus group interviews.

Ten focus group interviews were conducted, with each group representing a different constituency of a regional health care system. Among the groups, there appeared to be similar visions of what the system should be, and similar assessments of the status quo and future trends. But there were differences about what barriers to reform exist and what compromises among the constituencies are necessary. Every group stated the need to educate the public about healthy behaviors, self-reliance, and responsible use of health care resources.

Focus Groups↗
PubMed1994

The divergence of federal and state policies on the charitable tax exemption of nonprofit hospitals.

Nonprofit hospitals have traditionally enjoyed charitable exemption from real estate taxes because they provide specific social benefits. However, in the past three decades, major health policy changes at the federal level--most significantly, implementation of the Medicare and Medicaid programs--have weakened this rationale. Federal tax regulations during this period have changed in ways that complement these federal health programs and the accompanying federal interests in encouraging efficiency and performance uniformity among hospitals. States and local governments, however, have different interests, and these may favor a strict set of tax exemption standards that disregard efficiency and elevate the importance of a measurable level of charitable service. Their divergent policies rest on a fundamental value judgment about whether nonprofit hospital care is intrinsically charitable or not. Increasingly, this judgment may be forced upon state courts and legislation by local governments seeking new tax revenues through the elimination of hospitals' exemption from real estate taxes.

Charities↗
PubMed1993

Streptococcal toxic shock-like syndrome. The importance of surgical intervention.

Pyrogenic exotoxins A, B, and C produced by group A beta-hemolytic streptococci (Streptococcus pyogenes) may cause a syndrome characterized by fever, rash, desquamation, hypotension, and multi-organ-system dysfunction. This syndrome, the streptococcal toxic shock-like syndrome (TSLS), has a rapid and fulminant course closely resembling the staphylococcal toxic shock syndrome (TSS) caused by the staphylococcal toxic shock syndrome toxin-1 (TSST-1). The recent recognition of this syndrome is thought to stem from the appearance of more virulent strains of streptococci that have a greater tendency to produce potent exotoxins than prior strains. During the past 6 years, the authors have treated six patients with TSLS; three of these patients have presented recently. The sites of streptococcal infection associated with the development of the syndrome are frequently in soft tissue and skin. Early diagnosis, treatment with penicillin, and radical operative debridement are required.

Adolescent↗
PubMed1992

Plasma levels of sex steroids in the North Island brown kiwi (Apteryx australis mantelli) in relation to time of year and stages of breeding.

North Island brown kiwi (Apteryx australis mantelli) have a seasonal pattern of egg laying with a peak in mid to late winter. This study is the first description of changes in plasma steroid concentrations during the annual reproductive cycle of this species. Blood samples were collected at intervals over a 2 1/2-year period from a population of kiwi at Tangiteroria, Northland, New Zealand. Male kiwi had annual cycles of plasma levels of testosterone and estradiol. Mean testosterone levels were low (less than 0.18 ng/ml) during February to April, rose in May to a broad peak lasting 4 months (maximum levels 1.90 +/- 0.76 ng/ml), declined in September, and reached low levels in November to January. With respect to the breeding cycle, testosterone levels were low in the nonbreeding period, rose to high levels over 2 to 4 months before egg laying, then declined steadily toward the start of incubation. Plasma testosterone levels were very low in brooding males. Mean estradiol levels in males showed a pattern similar to testosterone levels, except that the rise to peak levels (1750 +/- 680 pg/ml) started in April. In female kiwi mean testosterone levels were low (less than 0.10 ng/ml) throughout the year. There was an annual cycle of mean estradiol levels in females which in timing and amplitude was similar to the male cycle. Estradiol levels in relation to stages of the breeding cycle in females were basal in the nonbreeding period, increased over a 3-month period before egg laying, declined in the 2 weeks before laying, and were low thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Taxation of nonprofit hospitals: a cost impact model.

At a time when taxing authorities at all levels of government are reexamining present exemptions, nonprofit charitable hospitals may become concerned about potential new tax liabilities. The Tax Impact Model described here can predict the dollar amount of new taxes, the probable amount of shortfall in major payers' reimbursement for these expenses, and the resulting net financial impact. This model incorporates a set of issues that should be considered and factors for which data or assumptions are needed. It can be applied to hospitals singly or in groups. Here, the model's application to a single hospital shows that payer mix and pretax financial strength are important determinants of the impact of taxation. These findings also suggest that hospitals with a large disproportion of Medicare and Medicaid patients, and those with small revenue margins, are least able to absorb new tax expenses.

Charities↗
PubMedDate not supplied

ASPH report.

Explore the source record for details and available documents.

Cooperative Behavior↗