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Biomedical subjects

M Ashworth

Publications and source records attributed to M Ashworth.

At least 37 records · Page 2Linked to original sources
PubMed2000

Motivating general practitioners to change their prescribing: the incentive of working together.

OBJECTIVE: To determine the extent to which GPs were motivated to change their prescribing upon joining a Primary Care Commissioning Group (PCCG) and how effective certain interventions planned by the PCCG might be as a means to change prescribing. To define the characteristics of GPs less motivated to change their prescribing. DESIGN: A cross-sectional survey of participating general practitioners linked with current prescribing information derived from PACT data. SETTING: General practice covering a geographical locality within inner-city south London. SUBJECTS: All 72 general practitioners who had joined a GP Commissioning Group. MAIN OUTCOME MEASURES: questionnaire responses. RESULTS: 93% of GPs entering the GP Commissioning Group expected their prescribing to change but none expected substantial change. There was no difference between fundholders, singlehanders nor training practices in their expectation of change. GPs in practices with the lowest quality prescribing, as measured by a quality index, were least likely to expect change (Spearman's r = 0.25, P = 0.04). Those in practices with higher prescribing costs were not more likely to expect their prescribing to change, whereas expensive prescribers who were unaware of their practices' prescribing costs were associated with a reduced expectation of prescribing change (P = 0.05). Educational interventions were thought to be the most effective means by which prescribing could be changed, whereas formularies and financial factors were perceived as weaker influences. CONCLUSION: Acceptance of a cash-limited prescribing budget by GPs is accompanied by the expectation of personal prescribing change. The motivation to change prescribing may be related to a strongly developed collectivist perspective amongst GPs who are prepared to consider the prescribing implications for their fellow GPs. It is ironic that those with the least expectation of change should have the lowest quality prescribing, or be unaware of their high cost prescribing. Engendering greater commitment to the professional group may be one way of changing their prescribing.

Adult↗
PubMed2000

When questionnaire response rates do matter: a survey of general practitioners and their views of NHS changes.

This paper investigates whether general practitioners (GPs) who do not participate in questionnaire surveys (non-responders) hold different views on participation in primary care reorganisation than their more compliant colleagues. A survey of 72 GPs' involvement in a pilot primary care prescribing group elicited an initial response of 74%. Non-responders were then approached personally and persuaded to complete the questionnaire. Comparison of the responders and the non-responders showed that the latter did differ significantly from the responders in many of their views. This difference needs to be considered whenever the results of surveys are used to guide policy-making in the more corporate model of primary care that is now emerging.

Attitude of Health Personnel↗
PubMed1999

Unilateral agenesis of the diaphragm: a separate entity or an extremely large defect?

Since the mid-1980s, unilateral agenesis of the diaphragm (DA) has attracted the attention of paediatric surgeons as more babies affected by this extreme form of congenital diaphragmatic hernia (CDH) survive. Some authors believe that it represents a separate clinical entity. We undertook a retrospective analysis of all babies with CDH treated in the South-West Regional Paediatric Surgical Centre in Bristol between 1981 and 1995. Of 108 babies 16 (14.8%) were identified as having DA. All presented with severe respiratory distress from birth. In comparison to the group of patients with postero-lateral hernia, neonates with DA had lower Apgar scores and required longer preoperative stabilisation with inotropic support and vasodilators. Nine were subjected to operation and all required diaphragmatic replacement. Only 3 survived; thus, mortality in the DA group was 81.25%, and among those who underwent surgery 66.6% The same data for babies with postero-lateral hernia were 15.2% and 7.2%, respectively. Our results indicate that DA is associated with high morbidity and mortality, but we have not found any evidence that this anomaly is a distinct entity. In addition, we reviewed all post-mortem reports of fetuses with diaphragmatic defects available for the same period. Of 19 fetuses, 10 (52.6%) had DA. The morphological details of the diaphragmatic defect and the presence of associated anomalies were analysed. Our observations support the hypothesis that DA occurs in the very early stages of embryonic life and may be attributed to developmental arrest of the septum transversum.

Diaphragm↗
PubMed1999

Sources and implications of dissatisfaction among new GPs in the inner-city.

OBJECTIVES: We aimed to examine the factors that were most stressful for new principals in inner-city general practice. In addition, given the concerns about retention of new principals, to ascertain whether high perceived stress translated into regret that they had joined their practice and factors that might protect from regret. METHODS: A questionnaire survey, within an inner-city Health Authority. The subjects were 101 GPs appointed as principals between 1992 and 1995. RESULTS: Eighty-three out of 101 GPs replied. The greatest sources of stress were, in order, patient expectations, fear of complaint, out-of-hours stress and fear of violence. Although these stresses were scored highly, 61% expressed no regret at having joined their practice with just 4% reporting considerable regret. Stress within the partnership and stress arising from patient expectations accounted for 23% of the variation in regret. Holders of the MRCGP were significantly protected against regret; there was no evidence that other factors such as medical positions outside the practice, membership of a young principals support group, fundholding status or training practices offered significant protection against regret. CONCLUSION: Despite reported difficulties in recruiting new young principals to the inner-city-and despite their reported high levels of stress-few have regrets about their decision to join their practice. For those who did regret joining their practice, the three principal associations were partnership stress, patient expectations and not possessing the MRCGP. Each of these factors may be amenable to intervention by policies geared to improve GP retention.

Adult↗
PubMed1997

Congenital malignant rhabdoid tumour of the gum margin.

The case of an infant born with a large polypoid tumour arising from the mouth is described. The tumour had the histological, immunohistochemical and ultrastructural phenotype of an extrarenal malignant rhabdoid tumour and followed an aggressive clinical course. This is one of the few reported cases of malignant rhabdoid tumour to present at birth. The oral tumour was associated with a mass in the posterior cranial fossa. This was most likely to be a simultaneous second primary tumour.

Fatal Outcome↗
PubMed1995

Withdrawal of triazolam's product licence: effect on patients 18 months later.

The product licences for triazolam in Britain were suspended in October 1991. We aimed to determine whether the sudden withdrawal of a benzodiazepine from the market constitutes a major impetus for patients to reduce or stop their benzodiazepine consumption. Patients in 10 London general practices who were prescribed triazolam in the 12 months prior to the withdrawal of its licence were interviewed. Data from written and computerized general practice records were also studied. One hundred and forty-seven patients were identified, of whom 107 (73%) were interviewed; 38 were chronic users; 68 patients had a history of serious physical illness while 33 had a history of psychiatric problems; 45% of chronic and 66% of intermittent triazolam users had stopped receiving prescriptions for benzodiazepines from 6 months after the withdrawal of triazolam's licence up to 18 months later. Only 12 (11%) recalled suffering significant withdrawal effects. We conclude that official action to curb prescribing of a benzodiazepine acts as an important stimulus for patients to reduce or stop their use of all psychotropic medication without increasing psychological morbidity or leading to unacceptable side effects.

Adult↗
PubMed1994

Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines.

BACKGROUND: It is recommended that long-term users of benzodiazepines in general practice be withdrawn from their medication where possible. AIM: A study was undertaken to assess the effectiveness of minimal intervention delivered by general practitioners in helping chronic users of benzodiazepines to withdraw from their medication, and to determine the psychological sequelae on patients of such intervention. METHOD: Patients taking benzodiazepines regularly for at least one year were recruited by their general practitioner and allocated either to a group receiving brief advice during one consultation supplemented by a self-help booklet or to a control group who received routine care. The patients completed the 12-item general health questionnaire and a benzodiazepine withdrawal symptom questionnaire at the outset of the study and at three and six months after this. RESULTS: Eighteen per cent of patients in the intervention group (9/50) had a reduction in benzodiazepine prescribing recorded in the notes compared with 5% of the 55 patients in the control group (P < 0.05). In the intervention group, 63% of patients had a score of two or more on the general health questionnaire at baseline compared with 52% at six months. Of the 20 intervention patients reporting benzodiazepine reduction, 60% had a score of two or more at baseline compared with 40% at six months. Intervention patients had significantly more qualitative, but not quantitative, withdrawal symptoms at six months compared with baseline. Consultation rates were not increased in the intervention group. CONCLUSION: The study indicates that some chronic users can successfully reduce their intake of benzodiazepines with simple advice from the general practitioner and a self-help booklet. This type of intervention does not lead to psychological distress or increased consultation.

Adult↗
PubMed1989

Long-term tolerability, pharmacokinetic and preliminary efficacy study of lamotrigine in patients with resistant partial seizures.

Four adult men with resistant partial seizures underwent an intensive open-label protocol designed to evaluate long-term add-on lamotrigine (LTG) therapy. Following an 8-week baseline, LTG was added to their background medication(s) (carbamazepine in three; carbamazepine and phenytoin in one). Incremental LTG doses of 50, 100, 150, and 200 mg every 12 h were given on days 58-60, 61-63, 64-127, and 128-176, respectively. The patients were hospitalized during and after each of the dose increases for a total of 25 days. Frequent outpatient visits were performed biweekly, weekly, or monthly, depending on the phase of the protocol. Frequent clinical, electrocardiographic (ECG), and laboratory evaluations were performed. Serial blood levels and 24-h urine collections were performed sequentially. In patients 1, 2, and 3, LTG was well tolerated at 200 mg b.i.d. Patient 4 did not tolerate 150 mg, b.i.d., but tolerated and maintained complete seizure control on 100 b.i.d. All four patients tolerated LTG and continued to receive it for 39, 46, 105, and 104 weeks, respectively. Serial 12-h plasma LTG levels were obtained on days 63, 70, and 133. On these days, the mean (+/- SD) LTG clearances (dose/AUC) were 0.0436 +/- 0.0171, 0.0468 +/- 0.0093, and 0.0575 +/- 0.0160 L/h/kg, respectively. Some 43-87% of the LTG was recovered in the urine, predominantly as the glucuronide metabolite. In the four patients, the mean weekly seizure frequency per patient was 6.5 in baseline, 5.0 on submaximal LTG doses, and 3.5 on the maximum administered doses. Three of the four patients eventually experienced a greater than 50% decrease in seizure frequency. In conclusion, when given for long periods of time (9.5 months to 2 years), LTG was well tolerated in doses up to 400 mg/day and mean trough levels of 3.0 +/- 0.6 microgram/ml; LTG has a favorable pharmacokinetic profile and appears to exhibit first-order linear kinetics during long-term chronic dosing; LTG shows preliminary evidence of efficacy during long-term administration; and to date, our patients represent the longest reported experience of continuous and closely monitored LTG therapy in the literature.

Adult↗
PubMed1988

Endemic bladder stones in Nepal.

Bladder stones account for a large proportion of surgical admissions in many developing countries. We report in detail the clinical features and risk factors of one such case, a 5 year old Nepali boy, and propose the theory that a low calcium intake, by causing hypocalciuria, predisposes to bladder stone formation.

Child, Preschool↗
PubMed1986

Are cardiovascular reflexes more commonly impaired in patients with bronchial carcinoma?

Non-invasive tests of cardiovascular autonomic function were performed in 69 patients with histologically proved bronchial carcinoma and the results compared with those obtained in a group of age and sex matched controls. Only two patients were under 50 years of age, and with the exception of the heart rate response to deep breathing the tests performed have no accepted normal ranges in patients of this age. None of the patients had features of florid, disabling autonomic neuropathy. All the tests of autonomic function showed declining performance with age but in addition there were significant differences in the results when the two groups were compared. In the group with carcinoma the resting heart rate was higher (p less than 0.05), the resting supine blood pressure lower (p less than 0.01), and the postural fall in blood pressure greater (p less than 0.01). Test results were not related to tumour histology, the presence of finger clubbing, drug history, or symptoms suggestive of autonomic dysfunction. Abnormal responses in tests of cardiovascular autonomic function are commonly found in elderly patients but bronchial carcinoma appears to have an additional effect. The precise mechanism of this effect remains a matter for speculation.

Adult↗