Recruitment of general practitioners to a randomized trial.
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Cognitive Behavioral Therapy↗
Biomedical subjects
M King
Publications and source records attributed to M King.
Implementation of critical incident stress debriefing at the Johnson City Medical Center Emergency Department.
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Burnout, Professional↗
Immunohistochemical evaluation of merosin deficiency in congenital muscular dystrophies.
OBJECTIVES: To determine the prevalence of merosin deficiency in cases of unclassified congenital muscular dystrophy and to determine the temporal stability of merosin epitopes in fixed and stored archival material. MATERIALS AND METHODS: Using an antibody to human merosin we retrospectively studied 12 cases of undiagnosed muscular dystrophy from our files to determine the prevalence of merosin deficiency. Where fresh muscle was not available, unstained stored cryostat sections or destained archival stored sections were incubated with the merosin antibody. RESULTS: Two of the 12 cases of undiagnosed muscular dystrophy were merosin-deficient. No difference in intensity of merosin staining was found between freshly cut cryostat sections and unstained stored cryostat sections. There was no difference in the intensity of merosin staining in sections archived for up to 10 years. CONCLUSIONS: We conclude that 16% of unclassified muscular dystrophies in our study are due to merosin deficiency and that merosin antigenicity remains intact in archival stored muscle tissue, facilitating retrospective evaluation of patients in whom frozen muscle is not available. To our knowledge, this latter observation has not been reported previously.
Biopsy↗
Victims of violence and the general practitioner.
BACKGROUND: Violent crime is on the increase in Britain, with 17% of the 15 million incidents of crime reported in 1991 being of a violent nature. Although there is some information on the role of accident and emergency departments for victims who sustain physical injury, little is known about the role of the general practitioner (GP) in managing the acute and longer-term sequelae of violence. AIM: To examine the links between experiencing physical of sexual assault and seeking help from GPs in London. METHOD: A cross-sectional survey of all adult attendees in one large group practice was carried out. The main outcome measures were prevalence of assault, reporting to the doctor and other people, and scores on the General Health Questionnaire (GHQ) and the Impact of Events scale. RESULTS: Of the 195 people who took part, 33 (17%) reported a physical or sexual assault in the previous year. Women were three times more likely than men to report any type of assault. Women rarely spontaneously disclosed these experiences to the GP and yet the experience of violence was associated with higher levels of distress, as measured on the GHQ and the Impact of Events Scale. CONCLUSIONS: Assault is a relatively common event in the lives of people who consult their GP. Doctors could help these patients through gaining an awareness of the problem and by fostering links with voluntary services, such as victim support schemes, which can provide support, practical assistance, and advice on compensation claims and legal procedures.
Adult↗
A controlled evaluation of small-group education of general practitioners in the management of drug users.
We evaluated the effectiveness of small-group education of general practitioners (GPs) in the management of drug users. A total of 40 doctors were trained. Some 28 doctors who were unable to attend and 30 who did not want training participated as comparison groups. Sixteen months after the education, trained doctors notified significantly more drug users to the British Home Office database and more often prescribed methadone at first consultation with a drug user.
Education, Medical, Continuing↗
The role of the general practitioner in the community care of people with HIV infection and AIDS: a comparative study of high- and low-prevalence areas in England.
BACKGROUND: Policy for the care of people suffering from HIV and AIDS has changed over the past decade. Schemes for shared primary and secondary care have been met with varying success, and patients may be reluctant to become involved. No systematic evaluation comparing the views of primary care providers and users in areas of varying HIV prevalence has been published. AIM: To examine the role of general practice in areas of England with low and high human immunodeficiency virus (HIV) prevalence and to compare barriers to general practice care in each area. METHOD: We used focus groups, semistructured questionnaires and interviews in north London (high HIV prevalence) and Nottingham (low HIV prevalence). RESULTS: Four focus groups took place in London. A total of 411 general practitioners (GPs) in London and 405 in Nottingham replied to postal questionnaires. Overall, 121 primary care staff in 40 London practices and 26 staff in five Nottingham practices were interviewed. In all, 54 people infected with HIV were interviewed in London and 20 in Nottingham. Providers and users regarded the 24-hour availability and the familiar environment of general practice as its key assets. Lack of expertise and time were its disadvantages. Providers were concerned about inadequate communication with specialist services. Although providers were concerned about confidentiality, whether they had liberal and sympathetic attitudes was more important in deciding whether people with HIV used the service. In the low-prevalence area, general practice involvement was the result of individual initiatives, and practices were not integrated into specialist care. In the high-prevalence area, HIV care was more usual in general practice, but there was also little integration with HIV services. CONCLUSIONS: In high-prevalence districts, a strategy to make HIV care routine for all GPs may be appropriate. In low-prevalence areas, a network of selected, strategically located, relatively high-involvement practices may be more effective in meeting the primary care needs of people with HIV infection and acquired immunodeficiency syndrome (AIDS).
Community Health Services↗
Mental health research in general practice: from head counts to outcomes.
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Community Mental Health Services↗
To the point of farce: a Martian view of the Hardinian taboo--the silence that surrounds population control.
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Attitude to Health↗
Population growth in Africa.
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Africa, Eastern↗
Enhanced kappa-opioid receptor-mediated analgesia by antisense targeting the sigma1 receptor.
In the current study, we used an antisense oligodeoxynucleotide targeting the recently cloned sigma1 receptor to assess its functions within the nervous system. Sigma1 antagonists potentiate the analgesic actions of opioids. Similarly, the antisense probe targeting the sigma1 receptor enhanced the analgesic activity of the kappa1-opioid receptor agonist U50,488H (trans-3,4-dichloro-N-[2-(1-pyrrolidinyl)cyclohexyl]benzeacetamidel++ +) and the kappa3-opioid receptor agonist naloxone benzoylhydrazone. A mismatch control was inactive. These results confirm the role of sigma1 receptors in an anti-opioid analgesic system and illustrate the utility of antisense approaches towards the elucidation of sigma receptor functions.
3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
Acute thrombogenicity of intact and injured natural blood conduits versus synthetic conduits: neutrophil, platelet, and fibrin(ogen) adsorption under various shear-rate conditions.
We investigated the acute thrombogenicity of synthetic arterial prostheses compared to biological arterial surfaces in contact with flowing nonanticoagulated blood. The acute events following blood/surface interactions were quantified using 51Cr-platelet deposition, 111In-neutrophil adhesion, and 125I-fibrin(ogen) adsorption on expanded polytetrafluoroethylene (ePTFE) synthetic arterial surfaces (Goretex and Impra) and on intact and injured biological arterial surfaces in ex vivo superfusion flow chambers at low (424/sec) and high (3397/sec) shear rates for 5 min at 37 degrees C. The hematological parameters were determined, and surface analysis was assessed by scanning electron microscopy. At low shear rate, the retention on intact arterial surfaces averaged 3.7 +/- 0.7 x 10(6) platelets/cm2, 26.5 +/- 4.2 x 10(3) neutrophils/cm2, and 10.7 +/- 2.2 cpm of fibrin(ogen)/cm2; retention remained statistically similar at the high shear rate on both Goretex and Impra ePTFE surfaces. In contrast, the deposition of platelets and neutrophils on injured arterial surfaces was significantly higher and increased with shear rate, although the significant increase in fibrin(ogen) adsorption was not influenced by the shear rate. At shear rates characterized by patent and stenosed arteries, ePTFE arterial prostheses demonstrated a low level of thrombogenicity compared to injured arteries. This favorable comparison can be considered as the first requirement for their successful use in arterial substitution.
Adsorption↗
Mucus quality on horse tracheal epithelium: microscopic grading based on transparency.
The aim of this ex-vivo study on excised tracheas of healthy horses was to characterise the microscopic heterogeneity of mucus quality by a visual grading system based on transparency and to determine whether differences in mucus quality, assessed by a visual grading system, influence tracheal mucus velocity (TMV). Small pieces of each trachea were mounted into a humidified chamber under a microscope. Mucus quality was visually subdivided into four grades (MG) and ciliary beat frequency and TMV were determined. Mucus on excised horse tracheal epithelium does not form a homogenous layer. We observed flakes and streams of a great heterogeneity, which by the characteristic of transparency can be qualified and quantified. Visual characterisation of mucus was able to explain a considerable part of TMV variation. Therefore, it can be considered as a suitable non-invasive method for the evaluation of mucus quality and transport effectiveness.
Animals↗
Sexually assaulted males: 115 men consulting a counseling service.
The nature of sexual assault on men and their help seeking following the assault was investigated. All men were seen at least once for face-to-face counseling at SURVIVORS, a counseling service for male victims. Data on 115 men were analyzed: 69 were assaulted while under age 16. Mean time from assault to contact with SURVIVORS was 16.4 years. 51 men (44%) were assaulted more than once. The assailant was known to the victim in all but 16 cases. 100 men (87%) were assaulted by at least one man, 7 (6%) by a man and a woman, and 8 (7%) by women. Forced anal penetration took place in 88. 27 men (23%) feared for their lives during the assault. 88 men (79%) sought no help and only 17 men (15%) reported to police. For victims assaulted under the age of 16, the assault was more likely to be their first sexual experience and they were more likely to delay contact with SURVIVORS for more than 17 years. They were also less likely to report to police. Victims assaulted by more than one person were more likely to have been assaulted by strangers, by women, and to have suffered physical harm. They were less likely to have experienced the assault as their first sexual experience.
Adolescent↗
Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner.
BACKGROUND: Despite the recent focus on sexual behaviour and AIDs, there are almost no data on the prevalence of sexual dysfunction within primary care settings. METHOD: One hundred and seventy patients attending a general practice participated in a questionnaire survey of the prevalence and characteristics of sexual problems. The detection rate of the general practitioners (GPs) and indicators in the patient notes were also investigated. RESULTS: Thirty five per cent of the men (n = 22) reported some form of specific sexual dysfunction: premature ejaculation was identified in 31 per cent of the men; 17 per cent experienced erectile dysfunction, which was associated with current medication, a high mean annual attendance and increasing age. The prevalence of sexual dysfunction in the women was 42 per cent (n = 41); vaginismus was reported by 30 per cent of the sample; 23 per cent of the women suffered from anorgasmia. General sexual dissatisfaction was more common than specific dysfunction; 68 per cent (n = 66) of the women and 75 per cent (n = 54) of the men reported at least one problem with dissatisfaction, avoidance, infrequency or non-communication. The large majority of the sample (70 per cent) considered sexual matters to be an appropriate topic for the GP to discuss. Despite this, sexual problems were recorded in only 2 per cent of the GP notes. CONCLUSIONS: This study confirms the high prevalence of sexual disorders in the population. Many of these problems are concealed from GPs. Predictors in patients' notes could help GPs to detect those patients with more serious problems.
Adolescent↗
Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis.
BACKGROUND: Patients with cystic fibrosis are known to have decreased mucociliary clearance. It has previously been shown that inhalation of a 7.0% solution of hypertonic saline significantly improved mucociliary clearance in a group of adult patients with cystic fibrosis. The aim of this study was to measure the response to increasing concentrations of inhaled hypertonic saline. METHODS: Ten patients (seven men) of mean (SE) age 22 (4) years and mean forced expiratory volume in one second (FEV1) 52.0 (6.7)% predicted completed the study. Mucociliary clearance was measured using a radioaerosol technique for 90 minutes after the interventions which comprised 0.9% NaCl + voluntary cough (control), 3.0% NaCl, 7.0% NaCl, and 12% NaCl. RESULTS: There was a significant increase in the amount of activity cleared from the right lung with all concentrations of hypertonic saline (HS) compared with control. The amount cleared at 90 minutes on the control day was 12.7% (95% confidence interval (CI) 9.8 to 17.2) compared with 19.7% (95% CI 13.6 to 29.5) for 3% HS, 23.8% (95% CI 15.9 to 36.7) for 7% HS and 26.0% (95% CI 19.8 to 35.9) for 12% HS. The improvement in mucociliary clearance was not solely due to coughing as the number of coughs recorded on the control day exceeded that recorded on any other day. The hypertonic saline did not induce a clinically significant change in FEV1. CONCLUSIONS: Within the range of concentrations examined in this study, the effect of hypertonic saline appears to be dose dependent. Inhalation of hypertonic saline remains a potentially useful treatment for patients with cystic fibrosis.
Administration, Inhalation↗
Rheology of cystic fibrosis sputum after in vitro treatment with hypertonic saline alone and in combination with recombinant human deoxyribonuclease I.
Treatment with recombinant human deoxyribonuclease I (rhDNase) is currently used as therapy for cystic fibrosis (CF) lung disease. Hypertonic saline (HS) acts as an expectorant promoting mucus secretion and augmenting the volume of sputum. We evaluated the individual and combined effects of HS and rhDNase in vitro on the viscoelasticity of CF sputum. Sputum samples were collected from nine CF patients to use for in vitro testing. Aliquots of CF sputum (0.20 to 0.40 g) were subjected to the following protocols: (1) negative control sample without any treatment; (2) positive control sample, adding 10% volume of normal saline (0.9% NaCl); (3) application of hypertonic saline (HS-3% NaCl); (4) combining approximately 100 nM concentration of rhDNase with protocols 2 and 3. The samples in protocols 2 through 4 were incubated for 30 min at 37 degrees C. For each protocol, CF sputum was analyzed at baseline and at 30 min for spinnability by filancemeter and viscoelasticity by magnetic microrheometry. Spinnability decreased for the sputum samples that were treated with rhDNase, in combination with either HS or normal saline. Treatment with HS alone and combined treatment with rhDNase and HS decreased log G* (the principal viscoelasticity index) to the same degree. Saline alone and rhDNase in normal saline both increased the predicted cough clearability of the sputum; however, the combined treatment with rhDNase and hypertonic saline had the best overall effect on cough clearability. The change in predicted mucociliary clearability, although greatest after HS, was not significant. These in vitro results suggest that combined treatment with rhDNase and HS should be evaluated further as a potential mucotropic approach to augment the clearance of purulent sputum in CF lung disease.
Adolescent↗
First-onset psychotic illness: patients' and relatives' satisfaction with services.
BACKGROUND: Despite the growth in patient satisfaction studies, scant attention has been paid to the satisfaction of patients with a first episode of psychotic illness soon after presentation to services. We were particularly interested in any ethnic differences in satisfaction at this seminal stage in patient care. METHOD: Using multi-item questionnaire, face-to-face interviews were conducted with patients and relatives 12 months after first contact with psychiatric services. Relatives were also questioned on support and advice issues related to after-care. RESULTS: Most patients and relatives were generally satisfied with the treatment, and with the 'humane' qualities of psychiatric staff, but were less satisfied with the 'hotel' aspects of hospital care. Patients, and particularly relatives, were most concerned about levels of information and advice received. Relatives were dissatisfied with after-care. There were no significant differences between Black and other patients, but some differences between their relatives. Patients born abroad were significantly more satisfied than those born in Britain, irrespective of ethnicity. Compulsory detention under the Mental Health Act was also significant in determining low satisfaction for patients and especially for their relatives. CONCLUSIONS: For improved care in the community patients and their relatives need to be seen as partners in care rather than as passive recipients. The issue of information-giving by psychiatric services demands serious attention. Black patients and their relatives were not especially likely to be dissatisfied.
Black or African American↗