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Biomedical subjects

M Dodd

Publications and source records attributed to M Dodd.

At least 19 recordsLinked to original sources
PubMed1997

Senior house officers in medicine: postal survey of training and work experience.

OBJECTIVES: To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive. DESIGN: Postal questionnaire survey. SUBJECTS: All senior house officers in medicine and related specialties in post in Scotland in October 1995 (n = 437); 252 (58%) respondents. MAIN OUTCOME MEASURES: Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training. RESULTS: In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was "the needs of the patients or the service." Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z = -4.2, P < 0.0001) or full shifts (z = -2.08, P = 0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale. CONCLUSIONS: The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a close working relationship between trainee and supervising consultant.

Adaptation, Psychological↗
PubMed1997

Young doctors' health--I. How do working conditions affect attitudes, health and performance?

Long hours and other difficult working conditions are thought to affect the health of young doctors, but there has been little evidence to support these assertions. Data are presented from a class cohort of junior doctors in the U.K. showing the relationships between working conditions, health and performance. Long hours appear to have short-term consequences in terms of the doctors feeling unwell and reporting poor performance, as measured by the somatic and social dysfunction scales of the General Health Questionnaire, but there are no demonstrated long-term health consequences. Instead, a number of working conditions, number of emergency admissions, number of deaths on the ward and the number of minor menial tasks contribute to a perception of being overwhelmed, as revealed by factor analysis of the Attitudes to Work questionnaire. This factor correlates significantly with a range of long-term physical and mental health measures as well as measure of work performance.

Adult↗
PubMed1997

Young doctors' health--II. Health and health behaviour.

There is little published information on the health of young doctors, apart from a number of studies which show increased rates of psychiatric symptoms. Nor is there much known of their health behaviour. Anecdotal accounts suggest that doctors' own health care is poor, especially in terms of their willingness to consult other doctors. This paper presents data from a longitudinal study of a class cohort of young doctors first interviewed when they were students. Data show that they suffer from frequent minor physical ailments, with women reporting more ailments than men. Despite this, they took less sick leave. Overall, the doctors took very little time off work. Using the GHQ-28, with a threshold of 5/6, 30% of doctors fell into the "caseness" category for psychiatric symptoms. This is in keeping with findings elsewhere. From the doctors' own reported health behaviour, both in terms of their response to illness over the past year, as well as their predicted response to hypothetical illness, they have developed maladaptive patterns. These include continuing to go to work when unfit, self-prescribing, and consulting friends and colleagues rather than going for a formal consultation. This is seen as inappropriate, especially in cases of mental illness. A third of the young doctors are not registered with a local general practitioner and the majority have no clear idea of the role of the Occupational Health Service. The results are discussed in terms of the need to change attitudes to health care and to develop guidelines, staffing and services to enable doctors to take better care of themselves.

Adult↗
PubMed1996

Squamous cell carcinoma of the distal urethra in a patient with congenital hypospadias.

A previously well 43-yr-old man with congenital hypospadias presented with a fungating lesion of 2 mths duration and surrounding the ventral urethral opening. After biopsy showed this to be a squamous cell carcinoma, a definitive procedure of partial penile amputation and urethroplasty was performed. This is believed to be the first reported case of squamous cell carcinoma of the distal urethra in conjunction with hypospadias.

Adult↗
PubMed1996

Health perceptions and treatment adherence in adults with cystic fibrosis.

BACKGROUND: Clinical and demographic variables are poor predictors of treatment adherence. This study therefore examined the relationships between the patients' perception of their cystic fibrosis and their reported adherence to physiotherapy, exercise, pancreatic enzyme and vitamin therapies. METHODS: Sixty adults with cystic fibrosis completed the Health Perception Scale, Health Locus of Control Scale, and the Manchester Adult Cystic Fibrosis Compliance Questionnaire. RESULTS: Reported adherence to physiotherapy, exercise, pancreatic enzyme and vitamin therapies was not influenced by patients' perceptions of their past, current and future disease severity, or their perceived susceptibility to recurrent infections. The greater their level of worry regarding their disease, the more likely they were to adhere to their physiotherapy (p < 0.002), pancreatic enzyme (p < 0.001) and vitamin (p < 0.001) regimens. No difference between the exercise adherent and non-adherent groups emerged regarding their level of worry. Compared with patients who believed that they were in control of their health, those who believed that their cystic fibrosis was controlled by others (family and health professionals) reported greater levels of adherence to their physiotherapy (p < 0.001), pancreatic enzyme (p < 0.001) and vitamin (p < 0.001) therapies. In contrast, patients who adhered to their exercise regimen believed that they were in control of their disease to a greater extent than those who did not (p < 0.003). CONCLUSIONS: Worrying about cystic fibrosis and the perception of having little personal control over the disease facilitated treatment adherence. It is clear that patients perceive exercise therapy differently from other forms of treatment.

Adolescent↗
PubMed1995

Measurement of lower limb blood flow in patients with neurogenic claudication using positron emission tomography.

STUDY DESIGN: Ten subjects (seven with neurogenic claudication and three control subjects) underwent examination of lower limb muscle blood flow before and after exercise using positron emission tomography. OBJECTIVES: To investigate the hypothesis that lower limb muscle ischemia was the origin of symptoms in neurogenic claudication. BACKGROUND: Patients with neurogenic claudication secondary to spinal stenosis experience lower limb discomfort after exercise similar to that of ischemic claudication. However, they do not have clinical evidence of peripheral vascular disease. The authors postulated that the lower limb discomfort in patients with neurogenic claudication may arise from muscle ischemia due to inadequate dilatation of arterioles in response to exercise, this itself arising secondary to sympathetic dysfunction due to spinal stenosis. METHOD: Using O15-labeled water and positron emission tomography measured thigh and leg muscle blood flow response to exercise bilaterally in seven patients with unilateral neurogenic claudication and three control subjects were measured. RESULTS: The average values obtained for mid-thigh and mid-calf muscle perfusion at rest were 2.57 ml/min/100 g tissue (2.23-3.90) and 2.39 ml/min/100 g tissue (2.03-3.46), respectively. The average values obtained from mid-thigh and mid-calf perfusion after exercise were 4.41 ml/min/100 g tissue (2.8-6.0) and 4.87 ml/min/100 g (2.2-11.7). We found no difference in muscle perfusion between symptomatic and asymptomatic limbs in this group of patients. CONCLUSION: These studies suggest that muscle ischemia is not the origin of symptoms in most patients with neurogenic claudication.

Adult↗
PubMed1995

Clinical evaluation of meropenem versus ceftazidime for the treatment of Pseudomonas spp. infections in cystic fibrosis patients.

Cystic fibrosis patients (children and young adults) with Pseudomonas spp. chest infections were treated with meropenem or ceftazidime. This study was the first to investigate the use of meropenem in cystic fibrosis. Meropenem was well tolerated with only transient elevations of serum transaminases. No patient experienced nausea and vomiting, even when meropenem was administered as a bolus injection. This allowed home therapy to be used. Meropenem appeared to be at least as active as ceftazidime even at the low doses used. Patients showed a greater improvement in respiratory function on meropenem than ceftazidime. Only one patient (out of 60 courses) failed to respond to meropenem (98% success rate) compared with two failures out of 21 episodes with ceftazidime (90% success rate). There was little emergence of resistance to meropenem even though some patients were treated up to eight times over a 2 year period.

Adolescent↗
PubMed1995

Different perceptions of disease severity and self care between patients with cystic fibrosis, their close companions, and physician.

BACKGROUND: An investigation was carried out to determine whether patients with cystic fibrosis, their close companions, and physician perceived the severity of the disease and the level of patient self care similarly. METHODS: Sixty adults with cystic fibrosis (16-44 years), their close companion, and physician independently completed scales measuring their perceptions of disease severity and patient self care on three occasions over a two year period. Percentage predicted forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), Shwachman score, and weight for height were recorded following each assessment. RESULTS: Patients and close companions considered the disease to be less severe than their physician. Fifty patients (83%) rated their health as "above/well above average", and 49 (82%) close companions rated the patient's health in the same way, but only 21 (35%) patients were considered by their physician to have mild disease. Differences also emerged in the estimation of patient self care; 48 close companions (80%) rated patients as "very good" or "excellent" in their self care, compared with 26 (44%) of the patients themselves. Only nine patients (15%) were considered to achieve this level of self care by their physician. Over the two year period the physician's ratings of severity increased in accordance with the decline in lung function. Patients' perceptions remained unchanged. CONCLUSIONS: From the physician's view-point, patients and close companions underestimate the severity of cystic fibrosis and overestimate patient self care. Patients' perceptions remain constant over time even when their health is clinically deteriorating.

Adolescent↗
PubMed1995

The isolation and characterization of non-typeable Haemophilus influenzae from the sputum of adult cystic fibrosis patients.

The role of non-typeable Haemophilus influenzae in cystic fibrosis (CF) remains unclear. We wanted, therefore, to determine the presence and characteristics of non-typeable H. influenzae in sputum samples from patients with CF. In order to do this, we have assessed sputum samples from 55 consecutive clinically stable patients seen routinely at an adult CF out-patient clinic. Quantitative bacterial culture was performed using a selective media containing cefsoludin, and isolates were characterized by biotyping and outer membrane protein profile analysis. In 17 (30%) of these samples, non-typeable H. influenzae was isolated and was present in similar viable numbers (mean 7.7 x 10(8) colony-forming units (cfu).mL-1; SEM 3.1) to Pseudomonas aeruginosa (mean 8 x 10(8) cfu.mL-1: SEM 2.4). All non-typeable H. influenzae isolates recovered were beta-lactamase negative and sensitive to a range of antibiotics. Several biotypes and outer membrane protein profiles were observed, with no apparent association between these two phenotypic characteristics. The study showed that large numbers of non-typeable H. influenzae are often present in sputum from adult patients with CF. Further longitudinal studies of outer-membrane protein profile analysis are required to determine the dynamics of non-typeable H. influenzae colonization in individual patients and the clinical significance.

Adolescent↗
PubMed1994

Treatment compliance in adults with cystic fibrosis.

BACKGROUND: The study comprised three interrelated aims: (1) to ascertain (a) patient compliance with physiotherapy, exercise, enzyme and vitamin regimens, (b) how compliance was perceived by patients, and (c) the reasons for poor compliance (2) to identify demographic and clinical variables associated with compliance; and (3) to determine how accurately patient compliance can be predicted by carers. METHODS: Demographic and medical history data were obtained from medical records and a patient questionnaire. The data obtained included age, sex, employment status, inpatient or outpatient status, frequency of contact with the clinic, age at diagnosis, and the number of years practising physiotherapy. Measures of clinical status, including FEV1 and FVC percentage predicted, Shwachman score, and 24 hour sputum weight were recorded before completion of the questionnaire. The questionnaire, administered by a psychologist, assessed the reported degree of patient compliance, their perception of compliance, and their reasons for poor compliance. RESULTS: Sixty patients participated in the study and 51/60 and 41/55 patients were considered compliant with enzyme and exercise therapies, respectively. Compliance was lower with physiotherapy (32/60) and vitamin treatment (21/45). Patients reporting immediate benefits following exercise and physiotherapy were more compliant than those reporting no improvement. The perception by patients that compliance was sufficient ("about right") was physiotherapy 67%, exercise 37%, enzymes 78%, and vitamins 9%. Compliance was not influenced by demographic details nor by severity of disease, although patients producing large amounts of sputum and receiving help with physiotherapy were more compliant with physiotherapy. The physiotherapist and physician judged correctly the degree of compliance with physiotherapy in 83% and 75% of cases, respectively, and with exercise in 68% and 67% of cases, respectively. CONCLUSIONS: The reported degree of compliance and reasons for poor compliance were treatment specific. Demographic and disease severity variables were not associated with compliance. Those involved in the care of patients with cystic fibrosis were able to predict patient compliance.

Adolescent↗
PubMed1993

Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis.

Pulmonary colonisation with Pseudomonas cepacia in patients with cystic fibrosis can be associated with increased morbidity and mortality. The modes of transmission of P cepacia are, however, unclear. We used selective media and phenotypic and genomic typing systems to investigate the acquisition of P cepacia by adults with cystic fibrosis. An analysis of isolates from 210 patients attending regional clinics in Edinburgh and Manchester between 1986 and 1992 showed that the main cause of increased isolations of P cepacia from 1989 was the emergence of an epidemic strain that had spread between patients in both clinics. Epidemiological evidence indicated that social contact was important in spread of the epidemic strain within and between clinics. We suggest that guidelines to limit the acquisition of P cepacia should not be restricted to patients in hospital, and that intimate or frequent social contact is associated with a high risk of cross-infection.

Adolescent↗
PubMed1992

A cost description of an adult cystic fibrosis unit and cost analyses of different categories of patients.

BACKGROUND: There is little information on the costs of running an adult cystic fibrosis centre. The aim of this study was to provide detailed costs to assist funding and planning for these patients. METHODS: The cost of a regional adult cystic fibrosis centre serving 119 cystic fibrosis patients, categorised according to four treatment regimens, was determined. District health authority, family health service authority, and voluntary resources used from April 1989 to March 1990 were determined, with appropriate bases for allocation of costs and patient based costs from local information. RESULTS: The total annual cost of treating the 119 patients was 980,646 pounds, with an average cost 8241 pounds per patient. An outpatient reviewed at three monthly intervals cost 2792 pounds a year; an outpatient receiving intravenous antibiotics cost 8606 pounds; an inpatient receiving intravenous antibiotics cost 13,501 pounds; and a patient needing a high level of care cost 19,955 pounds. Medication accounted for 57% (561,395 pounds) of the total cost. CONCLUSIONS: This analysis has helped us to secure funding for patients with cystic fibrosis and it facilitates the prediction of future requirements. The study also indicates the limitations of using average patient costs and difficulties as a result of the poorly structured British National Health Service accounting and information systems.

Adolescent↗
PubMed1992

Measurement of blood flow in tibial fracture patients using positron emission tomography.

The quantification of local bone blood flow in man has not previously been possible, despite its importance in the study of normal and pathological bone. We report the use of positron emission tomography, using 15O-labelled water, to measure bone blood flow in patients with closed unilateral fractures of the tibia. We compared fractured and unfractured limbs; alterations in blood flow paralleled those found in animal models. There was increased tibial blood flow at the fracture site as early as 24 hours after fracture, reaching up to 14 times that in the normal limb at two weeks. Blood flow increase was less in displaced than in undisplaced fractures. The muscle to bone ratios of blood flow were similar to those in previous animal work using other techniques. Positron emission tomography will allow study of human bone blood flow in vivo in a wide variety of pathological conditions.

Adult↗