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Biomedical subjects

M S Phillips

Publications and source records attributed to M S Phillips.

At least 55 records · Page 3Linked to original sources
PubMed1987

Importance of airflow obstruction after thoracoplasty.

Thirty six patients previously treated for pulmonary tuberculosis by thoracoplasty were studied to determine the prevalence and effect of airflow obstruction. The mean (SD) FEV1 was 1.3 (0.65) 1 and the mean forced expiratory ratio (FER) 64% (12%). FEV1 was less than predicted in every patient whereas FER was less than predicted in 30, being below the lower 98th percentile in 15 (42%). In the 18 patients who complained of breathlessness the means of the standardised residuals (SR) for FEV1, peak expiratory flow (PEF), and FER were significantly lower and that for residual volume/total lung capacity (RV/TLC) significantly higher than those for the 18 patients who were not breathless (all p less than 0.0001). There was no difference in the smoking history of the two groups. Only three of the 23 patients in whom reversibility of airflow obstruction was assessed showed a greater than 25% increase in PEF. None showed an increase in FEV1 of greater than 15%. The 18 who were breathless had significantly lower values of arterial oxygen tension (PaO2) and higher values of arterial carbon dioxide tension (PaCO2) (p less than 0.0001). Thirteen of these patients were in chronic respiratory failure (PaO2 less than 8.0 kPa or PaCO2 greater than 5.9 kPa, or both) compared with only one of the 18 who were not breathless. The indices correlating best with PaO2 and PaCO2 were SR FEV1 and SR PEF respectively. SR FEV1 accounted for 34% of the variance in PaO2 and SR PEF for 29% of the variance in PaCO2. Airflow obstruction has been found to be common in patients with a thoracoplasty and to be associated with hypoxia and hypercapnia.

Aged↗
PubMed1987

Late sequelae of pulmonary tuberculosis treated by thoracoplasty.

With the help of information provided by the Office of Population, Censuses and Surveys the survival up to 1 July 1985 of the 171 patients treated for pulmonary tuberculosis by thoracoplasty at Papworth from 1951 to 1953 was determined. Thirteen (8%) could not be traced, 65 (38%) had died, and 93 (54%) were alive. For those who were traced the survival at 10, 20, and 30 years from the date of operation was 93%, 79%, and 65%. This represents a significantly greater mortality rate than that predicted from the Registrar General's review of deaths in England and Wales (1841-1984). Nineteen patients died from cardiorespiratory failure. Eight of the survivors are known to have developed respiratory failure, five having enjoyed apparently good health before this was precipitated by intercurrent illness or drugs. A stepwise logistic regression analysis using information from the 124 patients for whom full details were available showed significant associations between the development of cardiorespiratory or respiratory failure and a preoperative contralateral artificial pneumothorax, older age at operation, the presence of cavities before operation, and male sex. In a questionnaire 50 of the survivors (57% of those who replied) reported cough, 45 (51%) breathlessness, 41 (47%) wheeze, and 24 (27%) ankle swelling. Nineteen (22%) smoke and the same number now attend a chest clinic. Many patients treated for tuberculosis by thoracoplasty have respiratory symptoms and some are at risk of respiratory failure. There are grounds for considering that they should be reviewed periodically by a chest physician.

Adolescent↗
PubMed1987

Mushroom compost worker's lung.

This study draws attention to difficulties in the diagnosis and the understanding of the mechanism of action of mushroom compost worker's lung. Descriptions are given of 4 workers in one factory who developed acute respiratory failure within a 6-month period; 13 others who were unaffected were also studied. Serological investigation appears to be largely unhelpful, and the evidence against the condition being included amongst the extrinsic allergic alveolitides is discussed. A detailed clinical and occupational history is essential for diagnosis.

Adolescent↗
PubMed1987

Persons discharged from warrants of the Lieutenant Governor.

The authors compiled demographic, psychiatric, and criminological information on persons who were held on warrants of the Lieutenant Governor in Ontario. These warrants were vacated between the period 1969-1982. Of the entire population of 296 such persons, 46% were held as being Unfit to Stand Trial, 51% were Not Guilty by Reason of Insanity, and the remainder were Mentally Ill prisoners. Separate analyses were conducted with the Unfit sample. The average length of confinement on a warrant was 7 years.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

Young patients detained under the Lieutenant Governor Warrant in Ontario.

Few studies have focused on mentally ill juvenile offenders who end up on warrants of the lieutenant governor (LGW). The present study arose out of a larger study (1982) of all patients (N = 332) being held on lieutenant governor warrants in Ontario, Canada. Of this group, 24 were placed on warrants as juveniles (18 years and younger). The characteristics of this group, who are predominantly males with histories of psychiatric illnesses, diagnosed mainly as antisocial personality, and who have been found not guilty by reason of insanity on charges primarily of murder, or attempted murder, are described. In light of the proposed Young Offenders Act, a further study of all juveniles held on warrants of the lieutenant governor in Canada is proposed.

Adolescent↗
PubMed1986

How useful is computed tomography in the diagnosis and assessment of bronchiectasis?

A study was performed to determine the value of computed tomography (CT) in the diagnosis and assessment of cylindrical and mild varicose bronchiectasis. Fifteen patients, in whom bronchography had shown such bronchiectasis in 34 of 73 lobes that could be assessed, were examined by CT. A control group of 12 subjects in whom there was no clinical or plain radiographic suspicion of bronchiectasis was also studied. Computed tomography (CT) was considered to show bronchiectasis in 28 lobes, 27 of which were bronchiectatic as shown by bronchography. Of 45 lobes where CT was not thought to show bronchiectasis, bronchography demonstrated 38 normal and seven bronchiectatic lobes. All lobes in the control group were interpreted as normal. Using bronchography as the definitive investigation for cylindrical or mild varicose bronchiectasis, CT has a sensitivity of 79% and a specificity of 99% in the diagnosis of the disease. The high specificity indicates that a diagnosis of cylindrical or mild varicose bronchiectasis by CT is reliable but CT is too insensitive to be used as a screening test.

Adult↗
PubMed1986

Multiple-regression hospitalization-cost model for pharmacy cost analysis.

A multiple-regression model that used hospital data for a single diagnosis-related group (DRG) was developed and tested as a tool for measuring the effect of pharmaceutical services on costs. Computer-generated data from one university teaching hospital for fiscal year 1983 were used to develop a model for identifying patient-specific and treatment-specific factors that correlated with total hospital costs and adjusted total costs (total costs minus room and board). Costs were analyzed for patients hospitalized for cardiothoracic procedures (DRG 108). Data for 100 patients were included. The demographic, severity, treatment-intensity, and drug-use factors included in the model accounted for 95.6% of the variation in adjusted total cost. Length of stay, number of secondary surgical procedures, quantity of supplies or drugs used in the operating room, and several drug therapies--tobramycin, i.v. electrolytes, and i.v. fluids--had significant effects on adjusted total cost. This regression model was useful for assessing the effects of the choice of drug therapy or specific services on the costs for one DRG; it should be tested for other DRGs in other institutions. The usefulness of the model for planning cost-effective services is limited by the need for better billing information, cost-estimation techniques, and records of clinical services provided.

Computers↗
PubMed1986

Solving problems through staff participation in focus groups.

Use of a survey and employee focus groups to solve problems in a hospital pharmacy department is described. All pharmacy staff members were asked to identify perceived problems; 33% completed the written questionnaire. Managers clarified the survey comments and ranked problems for priority, using nominal group technique. Focus groups were formed to address appropriate problems; for each focus group supervisors selected two pharmacists and two technicians who volunteered or were nominated by peers. A pharmacy resident was the facilitator for each group. Meeting weekly for one hour, each group defined problems, set priorities, gathered ideas, analyzed possible solutions, and proposed a solution to the pharmacy supervisors. One group proposed guidelines for staff scheduling and seven-days-on, seven-days-off rotations for night pharmacists; the other proposed a structure for technician training in the department and a required orientation and training schedule for all employees. This process required more staff time than unilateral management decisions would have, but the solutions were acceptable to all levels of staff members. The focus group process was effective in identifying and solving problems at this hospital. Routine resurveys will be conducted and new focus groups will be formed to address problems that would benefit from analysis and consensus by employees.

Florida↗
PubMed1985

A sequential double blind cross-over trial of tocainide hydrochloride in tinnitus.

A sequential double blind cross-over trial of tocainide hydrochloride, an oral analogue of lignocaine, is reported. The dosage of tocainide hydrochloride ranged from 200-600 mg daily. Of the 32 patients who completed the trial, 1 had complete relief and 2 had partial relief of their tinnitus whilst taking tocainide. An increased incidence of side-effects in patients taking tocainide was noted, in particular, headache, dizziness, nausea and skin rashes.

Adult↗
PubMed1985

Persons held on Warrants of the Lieutenant Governor in Canada.

Gross demographic data are supplied on all patients held under Warrants of the Lieutenant Governor in Canada. The composition of the total population varies considerably from one province to another, with resulting differences in such important factors as total time spent on warrant. A plea is made for some kind of continuing monitoring of this expensive-to-treat group, and it is argued that the Boards of Review are, because of lack of basic statistical information, at an unnecessary disadvantage when it comes to making decisions as to whether to release individuals or not. It is suggested that a fairly simple information and tracking system could reduce treatment costs, with concomitant decreases in confinement of patients, without at the same time increasing risk of harm to the general population.

Canada↗
PubMed1984

Neuropathological findings in Miller Fisher syndrome.

The neuropathological findings in a fatal case of Miller Fisher syndrome are described. The demyelinating peripheral neuropathy and normal appearance of the central nervous system that were observed support the inclusion of the syndrome within the spectrum of acute inflammatory polyneuropathy.

Aged↗
PubMed1983

Interaural time and amplitude discrimination in noise.

Just-noticeable differences (jnds) of both interaural time delay (ITD) and interaural intensity difference (IID) were measured for binaural tones in the presence of broadband maskers. The tones were presented at 50 dB SPL, the target frequency was 500 Hz, and the masker frequency was 100-1000 Hz, with various combinations of ITD and IID. The time and amplitude jnds exhibit similar dependencies on target-to-masker ratio and masker type. At a given target-to-masker ratio, discrimination was generally best in the presence of diotic maskers and worst in the presence of the interaurally out-of-phase maskers. Results for the other masker types examined tended to fall in between these two extremes. Many of these data trends are consistent with predictions of the lateralization model and the position-variable model based on auditory-nerve activity.

Auditory Threshold↗
PubMed1983

A computerized timing algorithm for determination of pulmonary tissue volume.

We developed a computerized method to measure pulmonary tissue volume (Vt) and capillary blood flow (Qc) that requires only a single interface for measurement of a soluble and an insoluble gas. The method uses a timing algorithm that replaces either a marker gas (C18O) or a volume signal. Gas concentrations are stored in digitized form. The data analysis consists of three parts: 1) initial and end-tidal samples found by using minima and maxima; 2) a timing algorithm derived from the end-tidal dead space method (ETDS, J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 44: 782-795, 1978); and 3) calculations of Vt and Qc, also by the ETDS method. Both the timing and Vt and Qc agree well with the hand-calculated values, but the coefficient of variation of Vt is slightly improved (6 vs. 7% manually). We conclude that our computerized method is equivalent to the manual ETDS method, but it is faster and more accurate; in addition, it has the advantage of requiring only one interface without the use of expensive gases.

Capillaries↗
PubMed1983

Psychiatric patients who discharge themselves against medical advice.

Hospital treatment staff are constantly faced with the problem of psychiatric patients who discharge themselves against medical advice before their treatment is completed. A total of 50 patients who signed themselves out of the 9th floor service of the Clarke Institute of Psychiatry, over a two year period, were analyzed. When compared with a random sample of patients who remained for the duration of their treatment, the authors found the AMA patients to have the following characteristics: The patient is likely to be a young male, admitted as an emergency, remain in hospital for three days or less and have a diagnosis of personality disorder or schizophrenia. The authors conclude with a number of recommendations to assist in dealing with the problem.

Adult↗