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Biomedical subjects

P Oakeshott

Publications and source records attributed to P Oakeshott.

47 records · Page 3Linked to original sources
PubMed1992

Testing for cervical Chlamydia trachomatis infection in an inner city practice.

The aims of the study were to find the prevalence of cervical Chlamydia trachomatis infection in women attending for a speculum examination, to examine possible risk factors, and to see if we could develop a rational policy for testing for chlamydia in our deprived inner London practice. During 18 months 409 women aged 17-45 (mean 28) who attended for a cervical smear or vaginal examination were tested for chlamydia using the direct immunofluorescent test. They were assessed for possible risk factors: age less than 25, more than one sexual partner in the previous 3 months, sexual contact with men with urethritis, past history of chlamydia infection, purulent vaginal discharge, cervicitis and abnormal cervical cytology. Thirty-six women (8.8%) were chlamydia positive. Chlamydia infection was significantly associated with the presence of purulent vaginal discharge or an inflammatory cervical smear. In view of the prevalence of chlamydial cervicitis, the lack of symptoms and signs, and the potential consequences of untreated infection, ideally all young women in this population should be offered screening when they attend for a speculum examination. If this is not practical, chlamydia testing might be offered to women thought to be in high-risk groups including those with purulent vaginal discharge or an inflammatory cervical smear.

Adolescent↗
PubMed1992

Intermittent self catheterization for patients with urinary incontinence or difficulty emptying the bladder.

Urinary incontinence, difficulty voiding and recurrent urinary tract infections are common in general practice. In patients with multiple sclerosis, spina bifida, intervertebral disc lesions, spinal injuries or tumours, the symptoms may be associated with a high residual volume of urine owing to a neuropathic bladder. Similar complaints may occur in elderly people or in women with gynaecological problems owing to atonic urinary retention. Provided that a significant residual volume of urine is found on abdominal examination, ultrasound, x-ray or catheterization, both groups of patients may be helped by intermittent self catheterization. Intermittent self catheterization is a safe and simple technique. By catheterizing themselves between four and six times daily patients can gain control over their bladders. Abandoning indwelling catheters or bulky external appliances does much for a patient's morale and self esteem. In addition, since the bladder is being drained effectively, urinary tract infections cease to be a problem and the kidneys are safeguarded. Severe disability is not a contraindication since patients in wheelchairs have mastered the technique despite paraplegia, an anaesthetic perineum, spinal deformity, intention tremor, mental handicap, old age or blindness. Patients should be referred to urologists for a trial of intermittent self catheterization. If unsuccessful or unacceptable it can be abandoned with no long term consequences. If it is effective the benefits may be considerable.

Adult↗
PubMed1990

Prophylaxis against hepatitis A for travel.

OBJECTIVE: To develop a rational practice policy for prophylaxis against hepatitis A for travellers to high risk areas. DESIGN: 18 Month prospective study of consecutive patients who requested prophylaxis against hepatitis A. SETTING: Inner city general practice. SUBJECTS: 104 Patients aged 15-61 (mean 30) assessed for risk factors for hepatitis A and put into groups depending on predictions from the risk factors of their immunity. MAIN OUTCOME MEASURES AND RESULTS: All patients were screened for antibody to hepatitis A virus. Of 52 patients with no risk factors 47 had no antibody and were thus susceptible to hepatitis A. All 27 patients with major risk factors (having been brought up in an endemic area or with a history of jaundice) were immune. Of 25 patients with minor risk factors (a history of previous travel in high risk areas, drug abuse, having lived in a squat or travelled rough, or having lived with someone who had jaundice) 12 were immune (p less than 0.001, chi 2 test). CONCLUSIONS: All travellers requesting prophylaxis against hepatitis A should be assessed for risk factors for previous exposure to hepatitis A. Those with no risk factors could be immunised with human normal immunoglobulin without screening. The remainder should be tested for hepatitis A antibody and those found to be susceptible should be immunised.

Adolescent↗