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Biomedical subjects

P E McGill

Publications and source records attributed to P E McGill.

At least 19 recordsLinked to original sources
PubMed2005

A team approach to musculo-skeletal disorders.

INTRODUCTION: The majority of patients with musculo-skeletal problems referred to hospitals in the UK have to wait for months, if not over a year, before finally seeing an orthopaedic surgeon. In Stobhill Hospital, Glasgow, the waiting time for an out-patient appointment was 182 days in 1995, with only 20% of the referrals requiring surgery. The aim of this paper was to reduce the out-patient waiting times based on a co-ordinated team approach. METHODS: An outpatient musculo-skeletal service was developed over a 7-year period at Stobhill Hospital. The traditional consultant-based model, in which the consultant and a trainee saw all new patients referred to the hospital, was gradually replaced with a team approach, based on continuous reconfiguration of the roles of the orthopaedic surgeon and rheumatologist and extending the roles of nurses, physiotherapists and podiatrists. This was achieved by: (i) protocol-based daily triage for all referrals to the most appropriate health professional in the team, by the senior out-patient nursing staff; (ii) allocation of appointments based on clinical priority, with a fast-track for urgent cases; and (iii) improvement of inter-disciplinary communication, facilitating the retraction as well as the extension of traditional roles. RESULTS: Despite the number of GP referrals to the orthopaedic out-patient department at Stobhill nearly doubling in a period of 5 years, the out-patient waiting time decreased by about 50% (90 days from 182 days). This reduction in waiting times improved patient and GP satisfaction levels. We also noticed an improved morale and personal development of the health professionals as they saw patients appropriate to their skills and expertise. CONCLUSION: The team's experience demonstrates the effectiveness of a team approach in tackling what is often seen as the insoluble problem of orthopaedic waiting times. This is based on excellent communication and collaboration, with a clear aim of improving patient care that is evidence based.

Clinical Protocols↗
PubMed2003

Geographically specific infections and arthritis, including rheumatic syndromes associated with certain fungi and parasites, Brucella species and Mycobacterium leprae.

This overview is designed to introduce the reader to the broad spectrum of rheumatic syndromes associated with certain fungal and parasitic diseases, brucellosis and leprosy. Musculoskeletal disorders caused by fungi are uncommon and difficult to diagnose, particularly in the early stages. Deep fungal infections involve-in order of frequency-bone, soft tissues and joints. Rare but well-defined rheumatic syndromes occur in a variety of parasitic diseases. Brucellosis remains a major challenge to both human public health and clinical acumen in many countries today. The arthritis of leprosy deserves wider recognition and study as it contributes to disability and may hold clues to the mechanism of inflammation in other rheumatic disorders. All of the above may afflict residents in endemic areas and occasionally appear far from the source of origin in travellers or migrants, and usually cause diagnostic confusion.

Animals↗
PubMed2002

Rheumatic disorders in Sub-saharan Africa.

OBJECTIVE: To review prevalence of rheumatic disorders in Sub-saharan Africa and in the context of current medical practice in the region assess the need for service and educational provision. DATA SOURCES: Medline, (English, French). Pre-Medline literature review from the 1950's (Current contents). Various conference reports including attendance at all three AFLAR (African League Against Rheumatism) congresses in the 1990's. Author's personal database. All cited references read in full. CONCLUSIONS: The evidence shows rheumatoid arthritis and systemic lupus erythematosus to be increasing in frequency in the indigenous populations of East, Central and South Africa but remaining rare in West Africans. Gout is now more prevalent than ever throughout the subcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactive arthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositis and osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rare and rheumatic fever is common. Acute and chronic locomotor problems associated with diverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis, rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educational requirements. Suggestions made to address the challenge posed by the burden of rheumatic disorders.

Adult↗
PubMed1995

Endemic fluorosis.

The presence of excessive quantities of fluorine in drinking water is accompanied by a characteristic sequence of changes in teeth, bone and periarticular tissues. These changes lead to a variable degree of locomotor disability, ranging from simple mechanical back pain to severe, crippling, combined locomotor and neurological impairment. In endemic areas, a substantial proportion of the population may be affected, posing a severe public health problem. In some areas, the hazards to human health are not fully appreciated and are under-reported. The maximum impact is felt in those communities engaged in physically strenuous activities, either agricultural or industrial. The need of these often isolated communities in economically hard-pressed countries, for the provision of low-fluoride drinking water remains a hope rather than an expectation at the present time.

Africa↗
PubMed1995

The spondyloarthropathies.

The spondyloarthropathies occur with variable frequency in the tropics. Ankylosing spondylitis, in particular, is thought to be rare in tropical Africa, reflecting a low frequency of the HLA B27 gene. However, in the Melanesian populations of Papua New Guinea where there is a relatively high frequency of HLA B27, ankylosing spondylosis is infrequent. These diverse observations may be related to variations in B27 sub-types. Reactive arthritis is a common and important form of acute arthritis in the tropics and in Papua New Guinea at least has a strong association with HLA B27. In Africa an increasing prevalence of reactive arthritis may be related to the spread of HIV infection. Extra-articular features such as balanitis and enthositis are helpful pointers to the diagnosis. Disseminated gonococcal infection and tuberculosis must always be considered and treatment offered if doubt exists. The mainstay of treatment of reactive arthritis is, as always, an anti-inflammatory drug, supplemented by hydrocortisone injections; docycline is available for chlamydia-triggered arthritis and chloroquine or dapsone for more chronic, unresponsive cases.

Arthritis, Psoriatic↗
PubMed1995

Viral infections: arthritis in the human immunodeficiency virus (HIV) infected patient.

Reactive arthritis is common in HIV-positive patients and may be mistaken for septic arthritis. We feel that the association is probably, in part, due to the increased incidence of diarrhoeal diseases in HIV-infected patients rather than a specific effect of HIV on the synovium. Disabling, chronic, sero-negative polyarthritis is common in the later stages of HIV infection and further palliative therapeutic strategies are urgently needed.

Adult↗
PubMed1995

Viral infections: alpha-viral arthropathy.

Six different mosquito-borne viruses (Chikungunya, O'nyong-nyong, Mayaro, Ross River, Sindbis and Barmah Forest) have been associated with arthritis in humans. These viruses are prevalent in the tropics and subtropics and they produce similar symptoms, consisting of fever, joint pains and rash. The symptoms are usually of short duration, around 1 week; complete recovery is the rule apart from exceptional cases of Chik infection. Precise diagnosis requires a serological service which is not available in many parts of the tropics these days. Treatment is symptomatic and there is no vaccine currently available. With an increasing number of visitors to the tropics being exposed to potential infection and with rapid air transport it is possible that visitors may return home during the viraemic incubation stage, infect the local mosquito populations and then develop clinical disease.

Africa↗
PubMed1995

Bacterial infections: pyomyositis.

Staphylococcal pyomyositis is an important and common condition in many areas in the tropics. The cause is probably multifactorial and includes damage to the skeletal muscle in the presence of staphylococcal bacteraemia, with or without depressed immunity. In Africa, there are indications of an increased prevalence in association with HIV infection in young adults in whom multiple and recurrent abscesses are common. Long bone osteomyelitis is an important differential diagnosis in these patients. Timely surgical drainage and antibiotics leads to resolution. Delayed diagnosis is associated with disseminated disease and septic cardiorespiratory complications.

Bacterial Infections↗
PubMed1995

Rheumatic syndromes associated with parasites.

A variety of musculoskeletal syndromes has been described in association with numerous parasitic infestations. Arthritis, enthesitis, myositis and vasculitis have been described in infected individuals resident in, or visitors to, endemic areas. The diagnosis of parasitic rheumatism is supported by poor response to anti-inflammatory drugs and improvement following antiparasitic treatment.

Child↗
PubMed1993

The consequences of H2 receptor antagonist--piroxicam coadministration in patients with joint disorders.

A randomised crossover study was performed in subjects with rheumatoid arthritis (or other arthropathies) to investigate if any alteration in the steady pharmacokinetics of the NSAID piroxicam (a drug which is extensively metabolised via cytochrome P450) or its major metabolites occurred as a result of coadministering either cimetidine or nizatidine. Twelve females and 2 males with mean age, weight, and albumin concentrations of 58 years, 61 kg, and 40 g.L-1 respectively, completed the study. Comparisons were made between the following parameters: plasma piroxicam AUCs [AUC0-24(P)], plasma 5-hydroxypiroxicam AUCs [AUC0-24(5-OHP)], the ratio of these i.e. AUC0-24(5-OHP):AUC0-24(p), the % piroxicam daily dose excreted in urine as 5-hydroxypiroxicam (before and after glucuronidase incubation); and the mean of the steady state trough piroxicam, and 5-hydroxypiroxicam concentrations (obtained during each study phase in addition to the wash-out period). A statistically significant difference as a result of initiating either cimetidine or nizatidine was obtained only for the ratio AUC0-23(5-OHP):AUC0-24(P). This was indicative of a weak potential to inhibit piroxicam hydroxylation. No clinically significant alteration in the steady state pharmacokinetics of piroxicam occurred in these subjects as a result of cimetidine or nizatidine coadministration. Consequently it is unlikely that any adverse events would arise from these combinations.

Adult↗
PubMed1988

Naproxen dose and concentration: response relationship in rheumatoid arthritis.

Information on the relationship between the plasma concentration of nonsteroidal anti-inflammatory drugs (NSAIDs) and clinical response in rheumatoid arthritis is sparse. As a result treatment is often relatively empirical. Standard doses are prescribed and an apparent lack of response leads either to the prescription of another drug, or an increase in the dose beyond that recommended. This study investigated 18 patients given three doses (500, 1000 and 1500 mg/day) of naproxen in a randomized double-blind design for 12 days at a time. Using a linear modelling approach we found that three out of four clinical response measurements improved linearly with increasing naproxen trough concentrations, suggesting that most patients will achieve an improvement in symptoms if the dose of naproxen is increased up to 1500 mg/day. However, since trough naproxen concentrations show a less than proportional increase with increasing dose (due to saturation of binding sites on plasma albumin), the improvement in response will be less dramatic as the dose is increased.

Arthritis, Rheumatoid↗