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Biomedical subjects

S M Wilkinson

Publications and source records attributed to S M Wilkinson.

At least 19 recordsLinked to original sources
PubMed1995

Reactions to other corticosteroids in patients with allergic contact dermatitis from hydrocortisone.

It has been proposed that corticosteroid cross-reactions occur more frequently within structurally well-defined groups. To test this hypothesis we have compared the patch-test reactions to other corticosteroids in 96 patients allergic to hydrocortisone. We found that our data did not agree with the previously proposed classification. The presence of a substitution at the C6 or C9 position was the most important factor in determining whether a patient would be allergic to another corticosteroid. This information should facilitate the choice of an alternative corticosteroid in patients allergic to hydrocortisone, if facilities for patch testing to other corticosteroids are not available.

Cross Reactions↗
PubMed1995

The changing pressures for cancer nurses 1986-93.

Over the last decade in the United Kingdom there have been changes in the delivery of health care, technical advances in medicine, and rising public expectations for health care, all situations which effect nurses caring for cancer patients. Nursing cancer patients has frequently been described as stressful. In order to limit stress, it is necessary to monitor nurses' perceptions of its causes. This paper focuses on three studies which have identified cancer nurses' stressors between 1986 and 1993. Although no firm conclusions can be drawn from these results there is evidence to suggest sources of stress have changed. Work overload, lack of resources and staff shortages now seem to be major concerns for nurses. Conflicts with health-care workers (in particular doctors) has decreased, possibly due to improvements in pain and symptom control management. Patients' deterioration and death continues to cause nurses concern. Job satisfaction remains high, but it has declined since 1986. In order to maintain quality care for cancer patients it will be necessary to continue to provide good staff support, stress management and education in cancer care.

Burnout, Professional↗
PubMed1994

Stress in cancer nursing: does it really exist?

Nursing cancer patients has been identified as a particularly stressful occupation. However, most studies have been descriptive, and few have measured levels of stress. A study was set up to identify cancer nurses' general proneness to stress and characteristics of nurses who experience the most stress. Sixty-five registered nurses working on six wards in two hospitals identified the two most stressful incidents over the last 3 months and completed the Spielberger State-Trait Anxiety Inventory over an 8-week period. The state anxiety subscale was completed six times, the trait anxiety once. Data were analysed using SPSXX. Statistical tests included analysis of variance and the Kendall tau correlation coefficient. The nurses' general anxiety proneness was no different from the normal values for working females, and their overall state anxiety levels were only significantly higher than the normal values for working women under examination conditions on the first time of testing. Newly qualified nurses had a tendency to be more anxious compared with sisters and enrolled nurses. Most nurses reported high levels of job satisfaction. However, there was a statistically significant difference in nurses' anxiety levels between wards. The results suggest overall that the nurses in this sample were not experiencing high levels of stress. They were perhaps only stressfully satisfied.

Adult↗
PubMed1994

PUVA and methotrexate therapy of psoriasis: how closely do dermatology departments follow treatment guidelines? Psoriasis Audit Workgroup of the British Association of Dermatologists.

Following publication of treatment guidelines for patients with psoriasis, a six-centre audit was undertaken to assess current therapeutic practice for two second-line treatments, PUVA and methotrexate. The audit consisted of random sampling of casenotes by external auditors from a paired dermatology department, and assessment by questionnaire. One hundred and eight PUVA and 118 methotrexate casenotes were audited. The commonest indications for treatment were: (a) failure of tropical therapy--PUVA (mean 81% of casenotes), methotrexate (84%); (b) repeated hospital admissions--PUVA (16%), methotrexate (25%). For both PUVA and methotrexate, some aspects of treatment were well documented: PUVA--psoralen dosage (91%), response to PUVA (89%), cumulative lifetime UVA dosage (81%); methotrexate--pretreatment assessment of full blood count (91%), urea and electrolytes (85%), liver function tests (84%). For other aspects documentation was less complete: PUVA--no documentation of presence/absence of skin cancer history (66%), note of photoactive drugs (32%); methotrexate--concurrent medication (69%), history of presence/absence of liver disease (36%). Another aspect which was poorly documented in both PUVA and methotrexate notes was whether advice on contraception/fertility had been given. There was no indication in 29 of 32 casenotes of females of child-bearing age receiving PUVA, and 52 of 63 case notes of relevant patients on methotrexate. This project has demonstrated that formal, multicentre audit based on published guidelines is a practical proposition.

Clinical Protocols↗
PubMed1994

IgG antibodies and early intradermal reactions to hydrocortisone in patients with cutaneous delayed-type hypersensitivity to hydrocortisone.

Seven of 25 patients with cutaneous delayed-type hypersensitivity to hydrocortisone had an immediate reaction following the intradermal injection of hydrocortisone sodium succinate. Using an ELISA method, we found that these patients had significantly increased levels of IgG antibodies to hydrocortisone when compared with normal blood donors (P < 0.005) and nickel-allergic patients (P < 0.05). We suggest that these patients are at risk of developing type III and possibly type I reactions following the systemic administration of hydrocortisone and that, if needed, an alternative systemic corticosteroid should be used, for example betamethasone or dexamethasone.

Antibodies↗
PubMed1994

Immunohistochemical appearance of corticosteroid contact hypersensitivity reactions.

We have studied, immunohistochemically, hypersensitivity reactions to corticosteroids and compared them with allergic contact dermatitis from nickel and appropriate controls. We could find no qualitative differences between nickel and corticosteroid contact reactions, providing further evidence that hypersensitivity to corticosteroids is an immunologically mediated reaction.

Administration, Topical↗
PubMed1993

Suspected cutaneous drug toxicity in rheumatoid arthritis--an evaluation.

Cutaneous toxicity from drugs used to treat RA is a major perceived problem. Over a 2-yr period we have prospectively reviewed 114 patients with a suspected adverse cutaneous reaction to anti-rheumatic drugs. In 71 (62%), the rash was thought to be unrelated to drug therapy. This group included 10 in whom the rash had resolved before review (usually < 1 week), 38 with a rash related to their rheumatoid disease and 23 with eruptions unrelated to either drugs or arthritis. Forty-three (38%) patients had rashes thought to be related to their drug therapy. Gold therapy (both oral and intramuscular) was implicated most frequently (31 patients). However, the majority of these (23) had a pityriasiform/discoid eczematous eruption that responded to potent topical steroids occasionally with a reduction in gold dosage. In this sample it was possible to continue drug therapy in 82% of patients with what were initially thought to be cutaneous adverse drug reactions. Careful evaluation should allow a majority of patients to continue drug therapy from which they are often gaining benefit.

Anti-Inflammatory Agents↗