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P Meredith

Publications and source records attributed to P Meredith.

At least 37 records · Page 2Linked to original sources
PubMed1995

Comparison of patients' needs for information on prostate surgery with printed materials provided by surgeons.

OBJECTIVES: To identify strengths, weaknesses, and omissions in existing leaflets and factsheets on prostatectomy given by surgeons to patients. DESIGN: Comparison of content of leaflets and factsheets with patients' needs and discontents in a questionnaire survey as part of the national prostatectomy audit. SETTING: All NHS and independent hospitals performing prostatectomy in four health regions. SUBJECTS: 87 surgeons, 53 of whom used printed material to inform patients about their operations; a total of 25 different factsheets being used. 5361 men undergoing prostatectomy were sent a closed response questionnaire about their treatment; 4226 men returned it completed. A random sample of 2000 patients was asked for further comments, of whom 807 supplied pertinent comments. MAIN MEASURES: Content of the 25 factsheets compared with patients' needs identified in the questionnaires. RESULTS: Much of the information distributed had considerable shortcomings: it lacked uniformity in form and content, topics of relevance to patients were omitted, terminology was often poor, and patients' experience was at variance with what their surgeons said. For example, only one factsheet discussed the potential consequences of malignancy. Patients wanted more information on prostate cancer (1250(29%)) and some thought that the explanation of biopsy results was inadequate (29(4%)). Only six factsheets discussed the possible changes in sexual sensation after transurethral resection of the prostate, stating that patients would feel no change. However, 1490(35%) patients reported a change and 500(12%) were worried about it. CONCLUSION: Current standards of printed information do not meet the needs and requirements of patients undergoing prostatectomy.

General Surgery↗
PubMed1995

The development of The Royal College of Surgeons of England's patient satisfaction audit service.

Clinical auditing is now well recognized as an effective way of ensuring the highest quality of surgical services by ensuring that practice is recorded, reviewed and made accountable. Surgeons increasingly see this as necessarily involving the monitoring of 'consumer feedback' by patients. Taking the initiative to encourage its membership to recognize these issues, in 1990 The Royal College of Surgeons of England Surgical Audit Unit (RCS) embarked upon a three year project to investigate the patient's experience of surgery and surgeons, and to develop an 'audit instrument' to record their routine evaluation. A two-stage pilot study provided information on response rates, question validation and the methodology required to run such studies routinely as audits. This is now offered to UK hospitals as a patient satisfaction audit service.

England↗
PubMed1993

Patient satisfaction with communication in general surgery: problems of measurement and improvement.

The research reported here is taken from a pilot inquiry into patient experiences of general surgery provided in National Health Service hospitals. This study sought to identify how the cross section of patients facing general surgery experienced communication and information problems particular to their surgical 'settings', how such discontent is understood or rationalised by them, and consequently how it would be reported to relatives or researchers. Drawing on interviews with patients and surgical staff, the paper explores the range of communication difficulties facing certain types of patient which arise from the hospital setting and the routines and rituals of service providers. While it is concluded that communication should be explored with some reference to disease classification, this should not divert attention from the general context of care to the unique circumstances of patient or surgeon. It is questioned whether patients are always disposed to rationalise their difficulties in terms of 'dissatisfaction' in the way required by survey research. Drawing on interview-generated comments by patients and staff, the paper illustrates less obvious validity problems for patient satisfaction studies, and addresses briefly questionnaire design which may account for them.

Adult↗
PubMed1993

NHS provision for the treatment of ankle fractures: a patient satisfaction study.

From a clinical audit of the treatment given to 1005 patients suffering from ankle fractures, 507 patients of 626 taken randomly from 15 hospitals were contacted and asked to complete a questionnaire describing and evaluating their experiences. The design of the study aimed in a number of ways to reduce respondents' tendency towards a positive response in completing satisfaction scales. The very high response rate, commentaries and variations in opinions about specific service criteria indicate that the results have a high degree of validity. The generally high rates of satisfaction reported here reflect very well on existing NHS provision for a specific procedure, with the exception of certain hospitals' arrangements for waiting, and the provision of certain types of information. Against general indicators of satisfaction with the management of pain relief in hospitals, that in ankle fracture treatments appears to be exceptionally high. However, it would be valuable to discover why younger patients appear to be strikingly more critical than older patients across the entire range of issues. The inquiry aims to compare findings with studies of other orthopaedic services using a similar elementary methodology as a routine component of clinical audit.

Adolescent↗
PubMed1993

[Traumatic lesions caused by the "air-bag" system].

Hand injuries have occurred due to inflation of an air bag security system during a high velocity car accident. A driver and a passenger retained by three-point lap-shoulder belts crashed on the central railing of a motorway during their vehicle lost of control due to aquaplaning. The air bags inflated during the collision. The driver presented a superficial second degree burn with a 12 cm long blister on the radial side of the hand and distal forearm. The passenger suffered an intra-articular palmar avulsion fracture of the middle phalanx (PIP joint) and a mallet finger of the left fifth digit. The driver was treated conservatively and healed without sequelae. The passenger had K-wire fixation, after fracture repositioning, under local anaesthesia. Physiotherapy was started early. K-wires were removed at three weeks and active therapy continued. 6 months later the digit presented PIP joint stiffness and a 20 degrees flexion deformity. To the best of our knowledge this is the first description of upper extremity lesions due to inflation of an air bag device.

Accidents, Traffic↗
PubMed1992

Newborn screening for sickle cell and other hemoglobinopathies: a Canadian pilot study.

We estimated incidence of HbS disease in Quebec. It is approximately 9 cases per 100,000 births (equivalent to the incidence of the hyperphenylalanemias). Accordingly, we performed a voluntary pilot study in 9 self-identified ethnic groups; 3528 families were counselled about the relevance of newborn screening for hemoglobinopathies; and 2779 cord blood samples were collected (participation rate, 78.7%) and analyzed for Hemoglobin S and other hemoglobin variants by cellulose acetate electrophoresis. There were 95 (3.42%) positive tests on the initial (cord blood) samples, of which only 40 could be confirmed because of low participation in follow-up. We identified 8 false-positive tests; 7 had been classified initially as alpha-thalassemia trait and one as HbC heterozygosity on the first test. The relative frequency of hemoglobinopathy genes (confirmed) was: 52.5% HbS; 22.5% alpha-thalassemia; 22.5% other mutation; all but one patient with sickle cell disease were heterozygotes; the majority (71%) of HbS genes were accounted for by the 7% of screened newborns who were Black; a further 24% of the HbS genes were accounted for by 7% with Central American ancestry. Record linkage of the findings in heterozygotes for use later in life is an unsolved problem. Seventy five first-degree relatives of the 48 probands were screened in follow-up studies (64% of parents participated); 5 couples at risk for having a future child with a hemoglobinopathy were identified. Attitudes toward follow-up varied among the ethnic groups. The single family with an affected newborn (sickle cell anemia) was counselled effectively; the infant received penicillin prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia, Sickle Cell↗
PubMed1991

Phase I and pharmacokinetic study of D-verapamil and doxorubicin.

The calcium antagonist verapamil (a mixture of D- and L-racemers) is a potent modulator of the multi-drug resistance phenotype in vitro at a concentration of 6 microM. Clinical studies have shown dose-limiting toxicity of hypotension and heart block when plasma levels approach the concentrations active in vitro. Previous data indicate that the D-isomer is less cardioactive than the L-isomer but they appear to be equipotent in reversing drug resistance in vitro. In an attempt to increase plasma verapamil concentrations, we have treated ten patients (total of 27 courses) with oral D-verapamil (DVPM), 150-300 mg 6 h, and doxorubicin i.v. 70 mg m2 q 3 weeks. Hypotension (supine systolic BP less than 100 mmHg or a fall in systolic BP of greater than 30 mmHg) occurred in 5/6 patients at 1200 mg day DVPM, in 1/5 at 800 mg day, and in 1/5 at 600 mg day. PQ prolongation (greater than 0.23 s) was demonstrated in 2/5 patients at 800 mg day DVPM. Plasma levels of DVPM and its active metabolite norverapamil were measured and, combining these, levels of 3-4 microM were achieved at 1200 mg day DVPM; however this dose is likely to lead to unacceptable toxicity in the outpatient setting. Using an oral outpatient schedule of administration, an appropriate dose of DVPM is 800 mg day. This provides a combined plasma level (for VPM and DVPM) of 2-3 microM. If DVPM is to prove useful as a resistance modulator, it may require to be administered intravenously with careful inpatient monitoring and support.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1991

The pharmacokinetics of ramipril in a group of ten elderly patients with essential hypertension.

This open, general practice study looked at the pharmacokinetics of ramipril over a period of 1 year in elderly (greater than 65 years) hypertensive patients. Ten patients with a diastolic blood pressure between 95 and 125 mm Hg were treated with 5 mg of ramipril daily for 4 weeks, followed by an additional 11 months of treatment in which the dose was titrated against the blood pressure. Pharmacokinetic data were collected at baseline, 4 weeks, and 1 year. Mean peak concentrations of ramiprilat (the active diacid) were 11.5 ng/ml acutely, 18.5 ng/ml at 1 month, and 31.3 ng/ml at 1 year, and these were all statistically significantly different. Mean half-lives of ramiprilat were 5.5 h acutely, 5.2 h at 1 month, and 4.6 h at 1 year, and these were not statistically significantly different. Mean areas under the curve excluding the component for saturable binding were 106.8 ng/h/ml acutely, 115.7 ng/h/ml at 1 month, and 248 ng/h/ml at 1 year; the latter was statistically significantly different from the earlier readings. There is no evidence from this study that the pharmacokinetics change in any clinically relevant way.

Aged↗
PubMed1989

Penetration of enoxacin into lung tissue.

For a study of penetration of enoxacin into lung, patients undergoing pneumonectomy were given 400 mg by mouth the night before and again approx 2 h before operation. A blood sample was taken as the lung was excised. Lung and serum enoxacin concentrations were assayed by high pressure liquid chromatography. Results from 15 patients showed that enoxacin was concentrated in the lung. Enoxacin lung concentrations were 3.2-13.1 mg/l, and ratios of lung to serum concentrations were 3-6 (mean, 4.2).

Adult↗
PubMed1989

[Long term results of 68 cases of breast reduction performed at a university surgical service].

The authors have analyzed long-term (4.2 years) results of 68 cases of breast reductions, defined as an excision of 300 g or more per side, operated in the Plastic Surgery Unit of the University Hospital of Geneva. After a brief historical review of breast reductions both subjective and objective results are analyzed and discussed. The subjective results were obtained by analyzing a standard questionnaire sent to the 68 patients. Objective results were obtained by a physical analysis of 35 patients who came for the check-up by a single examiner. 87% of all the patients were satisfied with the results, would repeat the operation again and would recommend it. Although there are still some problems with scar length, width and postoperative glandular function, it is hoped that the newer techniques will solve these.

Adolescent↗