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Biomedical subjects

M King

Publications and source records attributed to M King.

At least 217 records · Page 12Linked to original sources
PubMed1994

Measuring the costs and quality of palliative care: a discussion paper.

In an era of ever increasing emphasis on cost-effectiveness of health care, and with the introduction of the internal market, there is now an urgent need for information on the costs and quality of palliative care. This paper highlights the complexities involved in acquiring and measuring such information and discusses methods which were tried out in an exploratory study. The study took the form of in-depth case studies in two hospices, one in the voluntary sector and one in the NHS.

Consumer Behavior↗
PubMed1994

Mucolytic treatment with N-acetylcysteine L-lysinate metered dose inhaler in dogs: airway epithelial function changes.

N-acetylcysteine L-lysinate Nacystelyn (L-NAC) is a newly synthesized mucolytic agent, of which the action in vivo has not been well defined. In six healthy mongrel dogs, the rheological properties of mucus, its mucociliary and cough clearability, and the transepithelial potential difference (PD) of the tracheobronchial epithelium were evaluated after placebo and L-NAC metered dose inhaler (MDI) aerosols. The principal index of mucus rigidity, log G*, decreased at all airway sites with L-NAC administration, i.e. the mucus became less rigid and more deformable (the overall change in G* was 0.29 log units, i.e. ca. twofold decrease). The viscoelasticity-derived mucus transportability parameters, mucociliary (MCI) and cough (CCI) clearability indices, increased with L-NAC MDI, particularly CCI, which predicts the effect of mucus rheology on cough clearability. PD increased significantly with L-NAC administration at all measurement sites, which appears to be a novel effect for a direct acting mucolytic agent. Tracheal mucus linear velocity (TMV) increased after L-NAC compared with placebo, as did the normalized frog palate transport rate (NFPTR). The increase in NFPTR was greater than that predicted from the mucus rheological properties alone, suggesting that L-NAC still resident in the collected mucus stimulated the frog palate cilia. The index of mucus flux, the collection rate in mg.min-1, was higher with L-NAC compared with placebo. From our results, we conclude that L-NAC shows potential benefit in terms of improving mucus rheological properties and clearability. It may act, in part, by stimulating the fresh secretion of mucus of lower viscoelasticity. The stimulation of mucociliary clearance could be related to ion flux changes, as indicated by the increase in PD.

Acetylcysteine↗
PubMed1994

Exogenous surfactant enhances mucociliary clearance in the anaesthetized dog.

Therapy with exogenous surfactants is currently used for the treatment of respiratory distress syndrome of the newborn (RDS) and is under investigation for treatments related to adult RDS. However, the possible use of exogenous surfactant as a means of enhancing mucus clearance in other respiratory diseases has not been addressed. We therefore studied the effects of an artificial surfactant (Curosurf) on in vivo tracheal mucus velocity in intubated pentobarbital-anaesthetized dogs. Five dogs were randomly administered, on separate occasions, either vehicle (saline) or 10 mg Curosurf by means of local instillation via a catheter into the right lung. Tracheal mucus was collected by inserting a soft-bristled cytology brush to the level of the carina, and analysed for viscoelasticity by microrheometry. Mucociliary clearability in vivo, tracheal mucus velocity (TMV) in mm.min-1, was determined by bronchoscopic observation of charcoal marker particle transit times. The initial placement of charcoal was at the same level of the lower trachea that mucus was collected from. The effect of ciliary beat frequency was assessed on the frog palate assay by a videoscopic technique. In the dog, TMV was significantly increased after administration of surfactant. The values of TMV in the vehicle- and surfactant-treated dogs were 6.3 +/- 4.0 vs 25.6 +/- 6.5 mm.min-1 (SD), respectively. There were no discernible differences between prevehicle and postvehicle TMV values, and no significant differences in any mucus viscoelastic parameter, as determined by magnetic rheometry.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1994

Ten-year follow-up of 50 patients with bulimia nervosa.

Long-term outcome studies for people suffering from bulimia nervosa are few. Ten years after presentation, we followed up 50 patients (49 women, 1 man) who were originally involved in a double-blind, controlled trial of the antidepressant mianserin. Standardised interviews and questionnaires were used to assess eating attitudes and behaviour, psychiatric status and social functioning. A DSM-III-R diagnosis was given where appropriate. Sufficient information to make a diagnosis was obtained for 44 subjects (88%). Of patients traced, 52% had recovered fully and only 9% continued to suffer the full syndrome; 39% continued to experience some symptoms. Significant predictors of favourable outcome were younger age at onset, higher social class and a family history of alcohol abuse. Outcome for bulimia nervosa continues to improve over ten years with the majority of patients eventually making a full recovery or suffering only moderate abnormalities in eating attitudes. Although predictors of recovery were few, it would appear that intervention has a significant impact on ultimate outcome.

Adult↗
PubMed1994

Let's treat body and mind. Collaborative rehabilitation for chronic breathlessness.

1. People with emphysema suffer breathlessness and present with varied health and social needs. 2. Needs analysis can usefully use the WHO classification of impairment and handicap, also assisting with the nursing contribution and determining research priorities. 3. Rehabilitation aims to be responsive to clients' needs so they benefit from healthcare. 4. A CPN and RHW discuss their collaborative roles as a whole and finding this of greater value than their individual contributions.

Aged↗
PubMed1994

Controlled trials in the evaluation of counselling in general practice.

In this paper the difficulties of conducting a controlled evaluation of counselling (brief psychotherapy) in general practice are discussed. Results of a pilot study indicate that patients referred by family doctors to counsellors are often seriously emotionally distressed and recovery is slow. Counsellors come from different backgrounds and use a variety of therapies. Although the results show that controlled research is feasible, in a definitive trial patients should be randomized in a stratified manner, according to severity, by the researcher after initial assessments have been made. Counsellors should have a recognized accreditation and preferably be employed for the trial to ensure uniformity of approach and avoid long waiting lists. Blind assessments of outcome are desirable but are not always feasible and reliance on patient self-report is important. Within the limitations of current knowledge, only controlled evaluations will provide a greater understanding of the efficacy of counselling in general practice.

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↗
PubMed1993

Syntheses of 2,5- and 2,6-difluoronorepinephrine, 2,5-difluoroepinephrine, and 2,6-difluorophenylephrine: effect of disubstitution with fluorine on adrenergic activity.

Synthetic routes to difluorinated analogs of the adrenergic agonists, norepinephrine (NE), epinephrine (E), and phenylephrine (PE) have been developed. The syntheses were based on elaboration of the ethanolamine side chains from the appropriately polyfunctionalized benzaldehydes. The benzaldehydes were prepared from precursor difluorinated benzenes by sequential regioselective lithiations and reaction with electrophiles to introduce hydroxyl and carboxaldehyde functionalities. Binding and functional assay data demonstrate that the 2,6-difluorinated analogs are relatively inactive at both alpha- and beta-adrenergic receptors. These results are consistent with earlier observations that 2-fluoro substitution of adrenergic agonists decreases alpha-adrenergic activity whereas 6-fluoro substitution decreases beta-adrenergic activity.

Animals↗
PubMed1993

Accuracy of diagnosis of psychosis on general practice computer system.

OBJECTIVES: To determine the accuracy of diagnoses of schizophrenia and non-affective psychosis entered by general practitioners on a computer system. To compare recording of clinical events on computer with written records. DESIGN: Examination of case notes of all patients with a computer diagnosis of psychosis. Search of 8000 randomly selected patient records to identify patients with psychosis not recorded on computer and comparison of 141 computer and written entries for prescribing and consultation in each practice. SETTING: 13 London practices on the VAMP research bank. MAIN OUTCOME MEASURES: Accuracy of record of psychosis compared with ICD 9, American Psychiatric Association diagnostic manual, and syndrome checklist criteria. RESULTS: Computer search revealed 102 patients with schizophrenia, 78 with other psychoses, and 71 with non-affective psychosis who had adequate case notes. The sensitivity and positive predictive value of the computer diagnosis of schizophrenia were 88% (95% confidence interval 62% to 98%) and 71% (48% to 88%). For all non-organic psychoses sensitivity was 91% (74% to 97%) and positive predictive value was 91% (74% to 98%). On average 95% of all known prescriptions and 74% of all consultations were recorded on computer compared with 42% and 75% in written records. CONCLUSIONS: Recording of psychotic illness on the VAMP computer is accurate and complete. Prescribing was more fully recorded on the computer than on the written records. Computer databases of well motivated general practitioners could be used for research.

Ambulatory Care Information Systems↗
PubMed1993

Decision making by general practitioners in diagnosis and management of lower urinary tract symptoms in women.

OBJECTIVE: To identify factors influencing decision making by general practitioners in the diagnosis and treatment of lower urinary tract symptoms in women. SETTING: Two suburban London general practices. SUBJECTS: Women presenting to their family doctor with lower urinary tract symptoms. DESIGN: After each consultation the doctor completed a questionnaire on presenting symptoms; clinical examination; investigations undertaken; presence of psychological, social, and menstrual problems; patients' requests for antibiotics; antibiotic prescribing; knowledge of the patient; attitude towards the consultation; and any other factors assisting in diagnosis and management. Finally, doctors predicted the presence or absence of clinically important bacteriuria. Each woman completed a demographic questionnaire, the 12 item general health questionnaire, and the modified menstrual distress questionnaire, after which each provided a clean catch midstream urine sample. Case notes were examined for information on previous reports of results of urine analysis. RESULTS: When the general practitioners did not know the patients well they were 4.5 times more likely to assume that there was a clinically important infection. When they knew the patient well, they were four times more likely to make a correct prediction of the test result and 12 times less likely to prescribe antibiotics. Doctors were five times more likely to predict the test result correctly in patients from social classes 1 and 2 and were six times more likely to prescribe antibiotics for the older women in the sample. CONCLUSIONS: In women presenting with urinary tract symptoms, these family practitioners seemed to take no particular regard of physical, psychological, or menstrual factors in making their assessments. They were most accurate in their prediction of the result of urine analysis and least likely to prescribe antibiotics when they had a good general knowledge of the patient. Which came first, the diagnosis or prescribing, is difficult to say and probably differed in individual cases. Doctors tended to be more conservative in their management of older women and those whom they knew less well.

Adolescent↗
PubMed1993

Demographic entrapment.

Demographic entrapment is a situation in which a population exceeds the carrying capacity of its own ecosystem and its 'connectedness' to other ecosystems. It can be looked upon as a disorder of the demographic transition which presents serious ethical problems in that there are occasions on which there is a conflict between the interests of the child and the community. Reasons are given for the aid agencies' recognizing the existence of entrapment, which presently they do not. Since there are at present considerable obstacles to their doing this, we must accept a period of 'legitimate double-think' meanwhile.

Africa↗
PubMed1993

Effect of epidural opioids on gastric emptying in labour.

The effect of epidural opioids on gastric emptying was studied in 36 women in labour. Women who had received one dose of epidural bupivacaine were randomised to receive 10 ml of bupivacaine 0.25% alone (n = 8) with fentanyl 50 microg (n = 8) or with diamorphine 2.5 mg (n = 8), or 10 ml of bupivacaine 0.125% alone (n = 4) or with fentanyl 100 microg (n = 4) or with diamorphine 5 mg (n = 4) when they first requested a top-up. Mean+/-SD fentanyl concentrations measured at delivery were, in maternal venous plasma (MV) 0.72+/-0.19 ng/ml and in umbilical venous plasma (UV) 0.75+/-0.3 ng/ml. The mean dose-delivery interval was 280 min (range 107-608 min) and there was a negative correlation between UV/MV and dose-delivery interval. Gastric emptying was assessed by measuring paracetamol absorption following an oral dose of 1.5 g given 30 minutes after the study top-up. Time to peak plasma paracetamol concentration was significantly delayed in the groups given fentanyl 50 and 100 microg and diamorphine 5 mg, compared to the groups given bupivacaine alone, and peak concentration was significantly reduced in the group given diamorphine 5 mg. It is concluded that epidural fentanyl 50 and 100 mg and epidural diamorphine 5 mg delay gastric emptying. The addition of 2.5 mg diamorphine has no significant effect.

Journal Article↗
PubMed1993

Training balance and strength in the elderly to improve function.

Short-term exposure to altered sensory input or destabilizing platform movement results in significant improvement in sway control and inhibition of inappropriate motor responses, resulting in improved balance during repetitive testing. In addition, there is recent evidence that strength and function can be increased in both active and frail elderly who participate in strength training programs. Therefore, the hypotheses to be tested are that (1) balance training alone, or (2) strength training alone will each be capable of significantly improving balance, gait, and functional mobility, and that (3) a combined program of balance and strength training will be more effective than either approach alone. These hypotheses will be tested relative to a control group, using a 2 x 2 design (30 subjects per group), in a community-dwelling elderly at least 75 years of age. Intervention sessions of at least 45 minutes will occur three times per week for 3 months, with 6 months of follow-up, home-based Tai Chi training. The primary outcome variable is a basic measure of functional balance, ie, the occurrence of loss of balance during tilts of the support and/or movement of the visual surround.

Aged↗