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Biomedical subjects

M Roland

Publications and source records attributed to M Roland.

At least 73 records · Page 4Linked to original sources
PubMed1996

Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices.

OBJECTIVE: To identify the socioeconomic determinants of consultation rates in general practice. DESIGN: Analysis of data from the fourth national morbidity survey of general practices (MSGP4) including sociodemographic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take account of both individual patient data and small area statistics to relate socioeconomic and health status factors directly to a measure of general practitioner workload. RESULTS: Higher rates of consultations were found in patients who were classified as permanently sick, unemployed (especially those who became unemployed during the study year), living in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (girls only), and living in urban areas, especially those living relatively near the practice. When characteristics of individual patients are known and controlled for the role of "indices of deprivation" is considerably reduced. The effect of individual sociodemographic characteristics were shown to vary between different areas. CONCLUSIONS: Demographic and socioeconomic factors can act as powerful predictors of consultation patterns. Though it will always be necessary to retain some local planning discretion, the sets of coefficients estimated for individual level factors, area level characteristics, and for practice groupings may be sufficient to provide an indicative level of demand for general medical services. Although the problems in using socioeconomic data from individual patients would be substantial, these results are relevant to the development of a resource allocation formula for general practice.

Adolescent↗
PubMed1996

Case-control study of hazards in the home and risk of falls and hip fractures.

The importance of environmental hazards in the home as risk factors for falls and fractures is uncertain. A case-control study was conducted, involving people aged 65 years and over referred to an occupational therapy department for home assessment. There were 52 subjects with a recent hip fracture, 43 fallers (subjects with two or more falls in the past year but no hip fracture), and 157 non-fallers (subjects without hip fracture and with fewer than two falls in the past year). Subjects' homes were assessed for environmental hazards by occupational therapists using a structured home assessment form comprising 35 potential hazards. Overall, the homes of fallers were no more hazardous than the homes of non-fallers. However, fallers with cognitive impairment had significantly more hazards in their homes than non-fallers with cognitive impairment. A wide range of environmental hazards was associated with hip fractures. Many of the findings of this study could be due to bias inherent in the case-control design. To overcome the inadequacies of observational studies for the investigation of home hazards and falls, randomized trials are recommended to determine if removing hazards reduces the risk of falls and fractures.

Accidental Falls↗
PubMed1996

[Headache in general medicine: status and clinical evaluation].

Headache is one of the most frequent population health problems. It is also one of the most frequent complaints during an encounter in general practice. The family doctor is confronted with a difficult way of getting action, either diagnostic or therapeutic, which has to take into account the specificity of decision making in primary health care. A pragmatic and efficient proposal is built up, step by step.

Adolescent↗
PubMed1995

Referrals between specialists in hospital outpatient departments.

There is little information on referrals between consultants (cross-referrals), and they are difficult to identify within current information systems which may affect the development of efficient services, and erode the traditional role of the general practitioner (GP) as the gatekeeper to secondary care. For one month in 1994, the source and outcome for all outpatient attendances was recorded in medical, paediatric and orthopaedic clinics in a teaching hospital and in a district general hospital. Detailed interviews were also held with consultants to increase understanding of reasons for cross-referral, and their appropriateness. Referrals from hospital doctors were more frequent in the teaching hospital and in the more specialised clinics. Cross-referral as an outcome of a clinic attendance was more common in the teaching hospital, and among patients seen in the general clinics. These findings support the view that cross-referrals are likely to increase as specialisation among consultants increases. Interviews with consultants showed that they did not believe that there was a need to reduce cross-referrals, which were regarded as an integral part of an effective service for patients. However, the development of GP fundholding may impose new constraints on specialists' ability to refer within the hospital system.

Data Collection↗
PubMed1993

How valuable is feedback of information on hospital referral patterns?

OBJECTIVES: To determine general practitioners' responses to and explanations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour. DESIGN: Visits by audit facilitators to general practices after feedback of details of rates of referral to hospital derived from annual reports in general practice. SETTING: 92 general practices in East Anglia. RESULTS: General practitioners judged that access to specialist care, the individual skill of general practitioners, patient demand, and fear of litigation were major determinants of referral behaviour. Because there was widespread scepticism about the accuracy of the data on which the feedback was based and because there is no clear relation between rates of referral and quality of care, it was extremely difficult to encourage doctors to use the feedback as a basis for auditing their own hospital referrals. CONCLUSION: If general practitioners are to contribute meaningfully to monitoring future changes in referral patterns it will be essential to develop reliable information systems in which doctors have confidence. Furthermore, audits need to be based on analysis of clinical cases rather than on rates of referral.

Attitude of Health Personnel↗
PubMed1993

Understanding variation in rates of referral among general practitioners: are inappropriate referrals important and would guidelines help to reduce rates?

OBJECTIVES: To determine the extent to which variation in rates of referral among general practitioners may be explained by inappropriate referrals and to estimate the effect of implementing referral guidelines. SETTING: Practices within Cambridge Health Authority and Addenbrooke's Hospital, Cambridge. MAIN OUTCOME MEASURES: Data on practice referral rates from hospital computers, inappropriate referrals as judged by hospital consultants, and inappropriate referrals as judged against referral guidelines which had been developed locally between general practitioners and specialists. Effect of referral guidelines on referral patterns as judged by general practitioners using the guidelines in clinical practice. RESULTS: There was 2.5-fold variation in referral rates among general practices. According to the specialists, 9.6% (95% confidence interval 6.4% to 12.9%) of referrals by general practitioners and 8.9% (2.6% to 15.2%) of referrals from other specialists were judged possibly or definitely inappropriate. Against locally determined referral guidelines 15.9% of referrals by general practitioners were judged possibly inappropriate (11.8% to 20.0%). Elimination of all possibly inappropriate referrals could reduce variation in practice referral rates only from 2.5-fold to 2.1-fold. An estimate of the effect of using referral guidelines for 60 common conditions in routine general practice suggested that application of guidelines would have been unlikely to reduce rates of referral in hospital (95% confidence interval -4.5% to 8.6% of consultations resulting in referral). CONCLUSION: The variation in referral rates among general practitioners in Cambridge could not be explained by inappropriate referrals. Application of referral guidelines would be unlikely to reduce the number of patients referred to hospital.

Decision Making↗
PubMed1992

Factors affecting iontophoretic mobility of metoprolol.

The effect of different factors on the iontophoretic transport of metoprolol was analyzed. In vitro experiments were first performed in a diffusion cell with a cellophane membrane. Comparison of different pH, buffers, and ionic strengths in the donor compartment showed that higher iontophoretic transport was obtained with phthalate buffer (0.01 M) at pH 3. When the current density increased, the flux of metoprolol also increased. A decrease in drug concentration or an increase in viscosity slowed down the iontophoretic transport of metoprolol. The fluxes of metoprolol through hairless rat skin were strongly enhanced compared with passive diffusion. Direct current seemed to be more efficient than pulse current. When the on:off ratio of the pulse current was reduced, the flux also decreased.

Algorithms↗
PubMed1992

Macrophage activation by polymeric nanoparticles of polyalkylcyanoacrylates: activity against intracellular Leishmania donovani associated with hydrogen peroxide production.

Nanoparticles of polyalkylcyanoacrylates (PACA) can be useful carrier for the targeting of antileishmanial drugs into macrophages and also possess significant antileishmanial activity by themselves. No significant difference in antileishmanial activity could be detected between nanoparticles of five PACAs with differing alkyl side chains, suggesting that the main degradation products of PACA are not involved in their antileishmanial action. The effect of polyisohexylcyanoacrylate (PIHCA) on the induction of the respiratory burst in a macrophage-like cell line (J774G8) was assessed in non-infected macrophages and in macrophages infected with amastigotes of Leishmania donovani infantum, by measuring nitroblue tetrazolium (NBT) reduction and hydrogen peroxide production. Phagocytosis of PIHCA nanoparticles led to a respiratory burst, which was more pronounced in infected than in uninfected macrophages. The production of reactive oxygen intermediates associated with the respiratory burst was inhibited by addition of superoxide dismutase and catalase to the cell suspensions. The addition of catalase to the culture medium together with PIHCA nanoparticles significantly reduced the antileishmanial activity of PIHCA. Moreover PIHCA nanoparticles did not induce interleukin-1 release by macrophages. It is suggested that the antileishmanial action of PIHCA and other PACA nanoparticles results from the activation of respiratory burst in macrophages.

Animals↗
PubMed1992

Drug targeting with polyalkylcyanoacrylate nanoparticles: in vitro activity of primaquine-loaded nanoparticles against intracellular Leishmania donovani.

The efficacy of primaquine-loaded polyisohexylcyanoacrylate (PIHCA) nanoparticles was evaluated using J774G8 macrophage-like cells infected with Leishmania donovani: as an in vitro model of visceral leishmaniasis. The in vitro antileishmanial activity of primaquine-loaded nanoparticles showed a 21-fold increase in ED50 compared with free primaquine. Although unloaded PIHCA nanoparticles also exhibited a significant anti-leishmanial effect, the loaded nanoparticles showed a synergistic effect compared with a mixture of unloaded nanoparticles and free primaquine at equivalent concentrations. Primaquine release and isohexanol production were evaluated in a lysosomal fraction; the correlation of both with protein concentration and the rapid drug release indicate the processes are associated with an enzymatic degradation. The results indicate that PIHCA and other polyalkylcyanoacrylates may be useful for targeting drugs at intracellular Leishmania, and that the unloaded carrier itself could be of interest in experimental chemotherapy of leishmaniasis.

Animals↗
PubMed1992

Comparison of nephrotoxicities of different polyoxyethyleneglycol formulations of amphotericin B in rats.

The aim of the present study was to assess whether amphotericin B (AmB)-Myrj 59, AmB-polyoxyethyleneglycol 24 cholesterol (PC), and AmB-Synperonic A50 (SA50) were less nephrotoxic than AmB-deoxycholate (DC). Rats were treated with the different AmB formulations (10 mg/kg of body weight) intraperitoneally or with the surfactants alone. A group of control rats receiving the vehicle was also examined. After 6 days of daily intraperitoneal injections of AmB-DC, decreased body weight and glomerular filtration rate as well as increased degree of diuresis, uremia, microalbuminuria, and N-acetyl-beta-D-glucosaminidase excretion in urine were noted. Urinary excretion of potassium and sodium was also decreased in AmB-DC-treated rats. Most of these effects were more pronounced with AmB-PC and AmB-SA50. In contrast, AmB-Myrj 59 was less nephrotoxic than AmB-DC. Indeed, after 6 days of treatment with AmB-Myrj 59, the natriuria, kaliuria, albuminuria, and glomerular filtration rates were unchanged compared with those of controls. Moreover, the body weight loss and uremia increase of the rats treated by AmB-Myrj 59 were less than those of the rats treated with the commercial preparation. Among the surfactants, only PC was toxic for the rats. The intrinsic toxicity of PC and the higher systemic exposure to AmB could contribute to increased toxicities of AmB-PC and AmB-SA50, respectively. AmB-Myrj 59 was less nephrotoxic than AmB-DC at equivalent areas under the plasma concentration-time curves. These preliminary results suggest that this formulation could be a good alternative to the commercial product.

Amphotericin B↗
PubMed1992

Boneline: evaluation of an initiative to improve communication between specialists and general practitioners.

In response to a previous study of GPs' and consultants' satisfaction with orthopaedic outpatient referrals, orthopaedic surgeons at Doncaster Royal Infirmary made themselves available for telephone consultations with general practitioners (GPs) at advertised times. This service, called 'Boneline', was used infrequently, though the GPs who did use it found it valuable, and reported that a number of referrals had been avoided by speaking to the consultant. There was, however, no significant change in the rate at which requests for out-patient appointments were received during the six months of Boneline's operation. Opportunities for improving telephone communication between GPs and consultants are discussed.

Communication↗
PubMed1991

The influence of Myrj 59 on the solubility, toxicity and activity of amphotericin B.

The effect of Myrj 59 (a polyoxyethyleneglycol derivative of stearic acid) on amphotericin B (Am B) solubility, toxicity and activity has been investigated. We showed that Myrj 59 could solubilize the antibiotic. Moreover, it also decreased and abolished the haemolytic activity of the drug by increasing the resistance of the red blood cells and impairing the interaction of Am B with the cellular membrane cholesterol, but it did not modify the in-vitro antifungal activity of the drug. On the other hand, Myrj 59 did not decrease the acute in-vivo toxicity of the drug (LD50 and nephrotoxicity). In a previous study we have shown that a polyoxyethleneglycol derivative of cholesterol could solubilize Am B and was able to decrease the in-vitro and in-vivo toxicity of the antibiotic without altering its in-vitro antifungal activity. The results of the present study suggest that the cholesterol moiety of the surfactant is not necessary to decrease the in-vitro lytic activity of the drug but could play a role in the reduction of the in-vivo toxicity.

Amphotericin B↗
PubMed1990

Perimenopausal women's views on taking hormone replacement therapy to prevent osteoporosis.

OBJECTIVE: To find out perimenopausal women's views on taking hormone replacement therapy to prevent osteoporosis. DESIGN: Semistructured postal questionnaire survey; the questionnaire was enclosed with a letter to explain the purpose of the study and to give patients some information about hormone replacement therapy and osteoporosis. SETTING: Mixed social class, urban general practice with 12,000 registered patients. PATIENTS: All women aged 50, 51, or 52 were selected from the age-sex register; 102 women were identified and 84 (87%) replied to the questionnaire. MAIN OUTCOME MEASURES: Response rates to questions on interest in taking hormone replacement therapy, the importance of preventing osteoporosis, and worries about side effects of the treatment. RESULTS: More than three quarters of the respondents (65) were interested in taking hormone replacement therapy to prevent osteoporosis, but 48 of them would have liked further information. Sixty four women thought that it was very important to prevent osteoporosis. More than half of the respondents (51) were worried about side effects of the treatment, but only 15 women thought that continued menstruation would be a major disadvantage. CONCLUSIONS: There is considerable interest among perimenopausal women in taking hormone replacement therapy to prevent osteoporosis. The resource implications for primary care in meeting this interest are substantial.

Attitude to Health↗