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Biomedical subjects

R C Fraser

Publications and source records attributed to R C Fraser.

At least 55 records · Page 3Linked to original sources
PubMed1985

Information systems for general practitioners for quality assessment: I. Responses of the doctors.

A questionnaire was sent to all general practitioner principals in Leicestershire and Lincolnshire (n = 669) to determine (a) the extent to which they would participate in quality assessment activities based on objective evidence of performance and (b) the personal and professional characteristics of interested doctors. The overall response rate to the questionnaire was 76% (508 replies). The highest response rates were recorded by trainers (100%), principals in training practices (94%), and younger doctors (80-86%), the lowest by overseas graduates (59%) and older doctors (65%). Distinctive patterns of interest and participation in three types of audit activities were clearly evident. Overall, 61% (310) of respondents wished to be provided with profiles of practice activity from their family practitioner committees, 36% (183) volunteered to participate in a prescribing study, and 34% (172) expressed interest in carrying out an audit in depth. Proportionately, the most enthusiastic and active groups were trainers 88%, 70%, 62%), principals in training practices (74%, 49%, 47%), and members or fellows of the Royal College of General Practitioners (71%, 50%, 45%). Also active were younger doctors, vocationally trained doctors, and principals in large group practices. These figures suggest that roughly 15 000 general practitioners in the United Kingdom would be prepared to participate in performance review activities using information provided by external agencies, 10 000 would if they had to generate some of the information, and 7500 would if they had to produce all the information themselves.

Age Factors↗
PubMed1985

The significance of left ventricular volume measurement after heart transplantation using radionuclide techniques.

Multigated equilibrium blood pool scanning using Technetium 99m labeled red blood cells was used to measure left ventricular volumes in three heterotopic and one orthotopic heart transplant recipient(s). Simultaneously, an endomyocardial biopsy was performed and the degree of acute rejection was assessed by a histological scoring system. The scores were correlated to changes in ejection fraction and heart rate. Technetium 99m scanning data were pooled according to the endomyocardial biopsy score: no rejection; mild rejection; moderate rejection, and severe rejection. In each group, the median of the left ventricular volume parameters was calculated and correlated with the endomyocardial biopsy score, using a non-parametric one-way analysis of variance. A decrease in stroke volume correlated best with the endomyocardial biopsy score during acute rejection. A decrease in end-diastolic left ventricular volumes did not correlate as well. Changes in the end-systolic left ventricular volumes were not statistically significant, but using a simple correlation between end-systolic left ventricular volumes and endomyocardial biopsy the correlation reached significance. Changes in left ventricular volumes measured by Technetium 99m scanning may be useful to confirm the presence or absence of acute rejection in patients with heart grafts.

Adolescent↗
PubMed1984

Absence of evidence of myocarditis in endomyocardial biopsy specimens from patients with dilated (congestive) cardiomyopathy.

This study aimed: to assess the clinical value of endomyocardial biopsy (EMB) in 76 patients with dilated cardiomyopathy (DCM); to look for residual evidence of myocarditis, especially in patients in whom EMB was undertaken shortly after the onset of cardiac symptoms; to identify ultrastructural changes which may indicate the cause of DCM; and to see if the observed ultrastructural alterations correlated with duration of symptoms, left ventricular ejection fraction and the ratio of left ventricular wall thickness to chamber diameter. Biopsy diagnosis of DCM was possible with adequate exclusive clinical data combined with evidence of myofibre hypertrophy and exclusion of other morphologically detectable causes of cardiac hypertrophy and dilatation, e.g. myocarditis. The ultrastructural features did not correlate with duration of symptoms, ejection fractions or ratio of left ventricular wall thickness to chamber diameter. The lack of evidence of myocarditis in EMB specimens from our DCM patients, including those with a short history, suggests that myocarditis is an uncommon cause of DCM. Only a quarter of the biopsy specimens showed fibrosis and the ultrastructural features were those of hypertrophy. Degenerative changes were present in varying percentages of the specimens examined (e.g. myofilament loss in 64%). This study suggests that conditions other than myocarditis should be considered as causes of DCM--such causes (e.g. metabolic dysfunction) may be potentially reversible if recognized and treated.

Adolescent↗
PubMed1984

Research in general practice. Sources of advice.

Regional advisers, faculty secretaries of the Royal College of General Practitioners, heads of academic departments of general practice and primary care, and heads of RCGP research units were invited to complete a semistructured questionnaire to determine the nature and availability of current sources of advice for general practitioners participating in research activities and the demands placed on the available sources in the United Kingdom. The principal source for research advice was university departments of general practice, yet these have insufficient resources to cope with requests and few have spare capacity to stimulate research. Regional advisers and faculty secretaries do not seem to be kindling a spirit of inquiry and they seem somewhat complacent about both the lack of requests for research advice from general practitioners and the difficulties of academic departments. Proper development of research capability in general practice and primary care is unlikely to occur without more resources to create training posts in academic departments and a greater spirit of inquiry in vocational training programmes, which should lead to both review (audit) and research.

Faculty, Medical↗
PubMed1983

Effect of a principal's gender on consultation patterns.

This report describes a study of consultation patterns of male and female partners in a group practice. It was found that fulltime principals of both sexes had similar levels of workload; that patients chose to consult a doctor of the same sex not only for sex-specific disorders but also for conditions which were not sex-linked; that female partners were seeing a different age distribution of patient; and that doctor-initiated appointments varied not only between individual partners but were also related to both the sex of the doctor and the sex of the patient.

Adolescent↗
PubMed1982

Management of heart disease in pregnancy.

Cardiac disease in pregnancy is the most important non-obstetric cause of maternal death; such patients should be assessed by a cardiologist before considering pregnancy. Once pregnant, the patient is managed by a combined cardiac and obstetric team familiar with the special risks associated with heart disease in pregnancy. Delivery should be undertaken in a hospital equipped with specialist cardiac, anaesthetic and obstetric facilities. If the patient cannot be expected to survive in good health, puerperal sterilization is advised.

Abortion, Therapeutic↗
PubMed1982

Technique, complications, and clinical value of endomyocardial biopsy in patients with heterotopic heart transplants.

A review of 157 consecutive biopsies of donor endomyocardium in patients with heterotopic heart transplants is reported. The technique of percutaneous transvenous endomyocardial biopsy after this operation is described; manipulation of the catheter and bioptome into the junction of the donor superior vena cava and right atrium can be difficult when this anastomotic junction is small, as a result either of operative surgical technique or of subsequent contraction. The complication rate was 4%, but one patient may have died from infection resulting from biopsy when the bioptome had to be introduced at the groin. The histopathological changes seen in the biopsy specimens have been graded according to a scoring system to give the clinician a guide to the severity of rejection. Histopathological assessment was of clinical value in 96% of cases, but was inaccurate on two occasions, once because an opinion was given on what was in retrospect an inadequate sample. In patients undergoing persistent low-grade acute or chronic rejection there was difficulty in detecting or appreciating the true extent of myocardial fibrosis; this led to inadequate immunosuppressive treatment in two patients. Attention is drawn to the fact that ischaemic fibrosis resulting from the vascular changes of chronic rejection may spare the endomyocardium, which is kept viable by intracavitary blood, and that this may lead to a misleading histopathological report.

Biopsy↗
PubMed1982

Enzyme immunoassay of the glycoprotein tropic hormones--choriogonadotropin, lutropin, thyrotropin--with solid-phase monoclonal antibody for the alpha-subunit and enzyme-coupled monoclonal antibody specific for the beta-subunit.

Monoclonal antibody technology has made it possible to produce homogeneous populations of antibodies to discrete determinants on an antigen surface. We have produced monoclonal antibodies to the alpha-subunit and beta-subunits of the glycoprotein hormones choriogonadotropin, thyrotropin, and lutropin, and developed two-site simultaneous enzyme-linked immunospecific assays for these hormones. The anti-alpha-subunit monoclonal antibody was used as the solid-phase (coated tube) capture antibody for all three hormones; the anti-beta-subunit monoclonal antibodies were coupled to horseradish peroxidase (EC 1.11.1.7). Cross reactions between the closely related choriogonadotropin and lutropin were apparently greater in this method than in RIA, with use of the same antibodies. Ka of the antibodies did not appear to be as critical to sensitivity of the sandwich assay as it was for RIA. The lower limit of detection was 0.2 microgram/L after a 2-h incubation with serum sample at room temperature and a 30-min incubation with enzyme substrate at room temperature after washing away excess enzyme conjugate. Within-assay precision (CV) was very good, less than 6%.

Antibodies, Monoclonal↗
PubMed1982

Patient movements and the accuracy of the age--sex register.

This longitudinal study assessed the effects of patient movements on the accuracy of the age-sex register. For one year all patient movements into and out of five teaching practices were monitored and the ways in which inflation and deflation of the register can occur were identified and measured. Inflation has a greater influence than deflation on the accuracy of the register because:1. Practices can readily identify all new patients as they register and can include them in the age-sex register, but only a minority of patients (23.5 per cent) can be identified when they move away.2. The time interval between leaving a practice and registering with a new one is much shorter than that between leaving a practice and the practice becoming aware of the fact.Recommendations are made about how to make the register as accurate as possible.

Longitudinal Studies↗
PubMed1981

The accuracy of age-sex registers, practice medical records and family practitioner committee registers.

This paper presents the results of a point prevalent evaluation of the comparative reliability and validity of age-sex registers, practice medical records and family practitioner committee (FPC) registers from five teaching practices. They all exhibited similar levels of acceptable accuracy for patient names, sex and age, but the distribution of wrong addresses varied greatly: practice medical records 3.9 per cent, age-sex registers 8.2 per cent and FPC registers 17.1 per cent. The presence of a patient entry in all three registers was associated with a high degree of probability (95.3 per cent) that this individual would be a bona fide practice patient. The register population inflation rates were FPC records 5.5 per cent, practice records 9.8 per cent and age-sex registers 10.6 per cent, but there were large variations between individual practices. A statistically significant contribution to inflation rates came from the age groups 0 to 1 and 21 to 40 (p<0.0005). The register population deflation rates were minimal. The significance of these findings is discussed and the need for practices to determine the accuracy of their individual age-sex registers is stressed. A convenient and economic method for so doing is suggested. We also suggest ways of making it easier to construct and use age-sex registers, since they can be a most versatile and useful aid to research in general practice.

Adolescent↗
PubMed1980

Long-term survival after orthotopic and heterotopic cardiac transplantation.

Five long-term survivors of heart transplantation were reinvestigated. Two patients had undergone orthotopic heart transplantation over 11 and 9 years earlier and constitute two of the world's longest-surviving patients after this procedure. Three patients had undergone heterotopic heart transplantation (one left heart bypass alone and two biventricular bypass) four to six years earlier. Four of the five patients had had only one or no documented acute rejection episodes. Three had been given blood transfusions. None had had particularly good tissue matching in relation to the donor on HLA typing. All five patients were leading full and active lives. At review two patients had significant coronary artery disease, one severe, presumably due to chronic immune-complex deposition. Heart transplantation remains a major undertaking, but it can offer the patient many years of good-quality life.

Adult↗
PubMed1980

The effect of variations in vitamin C intake on the cellular immune response of guinea pigs.

The uptake of tritiated thymidine by isolated peripheral blood lymphocytes obtained from male guinea pigs immunized with bovine serum albumin was studied in animals maintained on various amounts of Vitamin C for 28 days. Animals were pair-fed on ascorbate-free diet and were supplemented intraperitoneally with 0, 25, or 250 mg Na-ascorbate per day. Scorbutic animals lost weight rapidly during the final 2 experimental weeks. Their daily food intake averaged only 4 g/day during the last week; thus, pair-fed ascorbate-supplemented groups were also subjected to acute nutritional stress. Lymphocytes from guinea pigs receiving 250 mg Na-ascorbate per day incorporated in vitro the highest amounts of tritiated thymidine both in the absence of nonspecific mitogen and in the presence of concanavalin A or phytohemagglutinin. Responses to lipopolysaccharide were not conclusive. Total circulating white cells counts and relative numbers of T and B lymphocytes were assessed in a second study made under identical constraints. In scorbutic animals the percentage of B lymphocytes increased and that of T lymphocytes decreased continuously over the 4-week period. The opposite effect was observed in vitamin C-supplemented animals. These studies suggest that very high doses of ascorbate support elevated mitotic activity after 4 weeks of much reduced food intake.

Animals↗