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Biomedical subjects

S Purdy

Publications and source records attributed to S Purdy.

At least 19 recordsLinked to original sources
PubMed2000

Patient participation in research in the managed care environment: key perceptions of members in an HMO.

This study's objective was to elicit the views of research among enrollees in an HMO. A questionnaire was mailed to 207 adult enrollees, 55% had been exposed to research and 45% had not. Ninety-four percent of respondents supported research within the HMO, and 87% thought using information from medical records for research was acceptable. Sixty-three percent thought participation in research increased patient understanding of health care. Significantly more prior research participants thought that participation in research improves care. More patients would participate if written information were provided (67%), if feedback of results was provided (72%), and if their clinician invited them (67%). Only a modest percentage (20%) of patients would participate in a randomized trial.

Adult↗
PubMed2000

Demographic characteristics and primary health care utilization patterns of strictly orthodox Jewish and non-Jewish patients.

BACKGROUND: The importance of providing health care services that are acceptable to different cultural groups is widely acknowledged. Strictly orthodox Jewish communities have particular health care needs that reflect their religious teaching and beliefs. OBJECTIVE: To describe the demographic characteristics and health care usage patterns of the strictly orthodox Jewish population of Gateshead. METHODS: Registration and claims data were used in combination with encounter data from computerized and manual practice records. Jewish patients were identified and comparisons made between Jewish and non-Jewish populations registered at the same practices. RESULTS: The orthodox Jewish population was predominantly young (69% aged under 20). The birth rate in orthodox Jewish women aged 20-44 was much higher (294 per 1000) than non-Jewish women. Rates of uptake of cervical screening and childhood immunizations were significantly lower in the orthodox Jewish population. Uptake of breast screening and attendance at diabetic clinics did not differ significantly. The average number of consultations and home visits per annum was higher in Jewish than in non-Jewish patients. CONCLUSIONS: The demographic and health care utilization patterns of orthodox Jewish and non-Jewish patients in Gateshead are different. There are implications for the provision of primary care services, particularly with regard to preventative health care.

Adolescent↗
PubMed2000

Enrollees' perceptions of participating in the education of medical students at an academically affiliated HMO.

PURPOSE: Little is known about how enrollees in health maintenance organizations (HMOs) perceive the benefits and risks of participating in the education of medical students. This case study elicited the views of enrollees of one academically affiliated HMO about the education of medical students. METHOD: Data from focus groups were used to design two questionnaires that were mailed to 488 adult patients and 298 parents or guardians of pediatric patients. A sample of non-respondents was followed up by telephone. Descriptive analyses were performed on the responses to the questionnaires. RESULTS: Response rates were 46% (adult) and 43% (parent or guardian). More than 75% of the respondents thought the HMO should be involved in teaching, most because teaching contributes to the training of better doctors and increases the skills of teacher-clinicians. Of those who responded, 28% of adults were concerned about risks to confidentiality and 18% were concerned about increased costs for enrollees. Nearly 50% of adults would be uncomfortable with students participating in visits involving "internal" examinations or emotional problems. Of those who responded, 56% of adults and 33% of parents or guardians were uncomfortable about a student's conducting an unsupervised history and physical examination. A total of 52% of adults preferred that the preceptor and student discuss their case in their presence. Respondents who had seen students previously were more comfortable with student activities associated with their care. CONCLUSIONS: The respondents thought the HMO should be involved in teaching, but they had specific concerns about the effects of student participation. Educators in other settings may wish to explore these concerns among their patient populations and develop policies to maximize the "enrollee-friendliness" of medical education in HMOs. While the study provides a first look at how enrollees at one HMO viewed participation in medical students' education, further research is needed at HMOs elsewhere to determine the representativeness of the study's findings.

Adult↗
PubMed1997

Bronchioloalveolar carcinoma in a child with congenital cystic adenomatoid malformation.

An 11-year-old girl was evaluated for chest pain, and chest radiographic findings of multiple nodules throughout both lungs. She underwent resection of several of the lesions from her left lung, which were found at pathologic examination to be bronchioloalveolar carcinoma. Her previous medical history included incomplete resection of a type I congenital cystic adenomatoid malformation in the neonatal period. To our knowledge, this girl is the youngest reported case of bronchioloalveolar carcinoma in a nonimmunocompromised patient, and one of several in which the association of congenital cystic adenomatoid malformation and bronchioloalveolar carcinoma has been observed.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1996

Rationing: a transatlantic perspective.

Despite the differing mechanisms of health care delivery and financing in the United Kingdom and the United States many of the issues faced by the two countries are similar, most notably the increasing financial pressures. In both countries there have been recent changes in the allocation of resources and the mechanisms of decision making. Different criteria for determining resource allocation have been tried in the two health care systems. These developments change long traditions of rationing decisions at the individual patient level in the US, and of centralised government decision making in the UK.

Health Care Rationing↗
PubMed1995

Longitudinal assessment of physiological and psychophysical measures in cochlear implant users.

OBJECTIVE: The purpose of this study was to evaluate the effects of long-term electrical stimulation on human cochlear implant users. DESIGN: Repeated measures of electrically evoked auditory brain steam response (EABR) threshold, slope of the EABR growth function, and behavioral measures of threshold and dynamic range were made for a group of 22 Ineraid cochlear implant users and 19 Nucleus cochlear implant users over a 3- to 5-yr period. RESULTS: Data from both Ineraid and Nucleus cochlear implant users suggest that EABR threshold, slope of the EABR growth function, and behavioral measures of threshold and dynamic range remain reasonably stable for periods up to 5 yr postimplant. CONCLUSIONS: The results of this study show little evidence that prolonged electrical stimulation through daily use of a cochlear implant has deleterious effects on the auditory system.

Cochlear Implants↗
PubMed1995

Public accountability for health: new standards for health system performance.

This article reviews the failure of contemporary quality oversight organizations to respond to the changing health care environment and suggests an overhaul of quality measurement and assurance functions. The authors examine the factors that have limited public accountability for health care, emphasizing the limited agreement that exists on the purpose of American health care, standards for evaluating care, or the appropriate locus of responsibility for quality of care. A five-part quality oversight system is proposed including development of quality measures, promulgation of national standards, validation and accreditation, use of data for purchasing and provider selection, and use of data for quality improvement.

Accreditation↗
PubMed1990

Characterization of the human gene that encodes the peptide core of secretory granule proteoglycans in promyelocytic leukemia HL-60 cells and analysis of the translated product.

Based upon the deduced amino acid sequence of a cDNA (cDNA-H4) that had been proposed to encode the peptide core of an eosinophil and a HL-60 cell secretory granule proteoglycan, a 16-amino acid peptide was synthesized. This peptide was then used to elicit rabbit antibodies for study of the translation and post-translational modification of this gene product in hematopoietic cells. When HL-60 cells were radiolabeled for 2 min with [35S]methionine, a protein that migrated in a sodium dodecyl sulfate-polyacrylamide electrophoresis gel with a Mr of 20,000 was immunoprecipitated with the IgG fraction of the anti-peptide serum. Kinetic experiments revealed that within 10 min this radiolabeled precursor protein was converted in HL-60 cells into an Mr approximately 150,000 chondroitin sulfate proteoglycan intermediate. After a 20-min to 1-h chase, this [35S]methionine- or [35S]sulfate-labeled proteoglycan intermediate lost its antigenicity, presumably due to proteolysis of its N terminus. A human genomic library was probed under conditions of high stringency with cDNA-H4 to isolate genomic clones that contain the gene that encodes this proteoglycan peptide core. This gene spans approximately 15 kilobases and consists of three exons. The first exon encodes the 5'-untranslated region of the mRNA transcript, as well as the entire 27-amino acid signal peptide of the translated molecule. The second exon encodes a 49-amino acid region of the peptide core, predicted to be the N terminus of the molecule after its proteolytic processing in the endoplasmic reticulum. The third exon encodes the remainder of the molecule, including its glycosaminoglycan attachment, serine-glycine repeat region. As assessed by S1 nuclease mapping and primer extension analysis, the transcription-initiation site in HL-60 cells for this gene resides 53 base pairs upstream from the translation-initiation site.

Amino Acid Sequence↗
PubMed1988

Gastrointestinal sarcoidosis resembling Crohn's disease.

We describe a patient with disseminated sarcoidosis, who had granulomatous enterocolitis with radiological narrowing of the terminal ileum, and was presumed to have Crohn's disease. At autopsy, there were numerous sarcoid-like granulomata throughout the mucosa of the large and small bowel, but no transmural inflammation, lymphoid aggregates, or strictures, thus making Crohn's disease unlikely. It is proposed that a granulomatous enterocolitis resembling Crohn's disease can be a manifestation of disseminated sarcoidosis.

Crohn Disease↗
PubMed1986

Ultrastructural and immunocytochemical definition of component neoplasms in an unusual gastro-oesophageal collision tumour.

An unusual collision tumour (concrescence of two neighbouring independent neoplasms) is reported. One tumour was a small cell undifferentiated (oat cell) carcinoma of the lower oesophagus and the other was a gastro-oesophageal adenocarcinoma. There was little intermingling of the two patterns. The adenocarcinoma stained strongly positive for mucin and carcinoembryonic antigen (CEA), but the small cell carcinoma was negative for both and also argyrophil-negative; both were negative for neurone-specific enolase and common leukocyte antigen. Ultrastructural study showed extra-cellular glandular lumina lined by cells with apical microvilli and junctional complexes in the adenocarcinoma; primitive cells without tonofilaments or dense-core granules, and joined by rudimentary desmosomes were seen in the small cell carcinoma. Collision carcinomas may result from a carcinogenic stimulus affecting two neighbouring regions of mucosa or may simply be the chance apposition of two unrelated tumours.

Adenocarcinoma↗
PubMedDate not supplied

A comparison of functional, patient-based scores in subacromial impingement.

The goal of this study was to compare the Oxford Shoulder Score (OSS), the Shoulder Pain and Disability Index (SPADI), and the Short Form 36 (SF-36) for their correlation, agreement, sensitivity to change, and test-retest reliability in patients with a clinical diagnosis of subacromial impingement. All patients attending a specialist subacromial impingement clinic over a 6-month period completed the OSS, SPADI, and SF-36 at each visit. A total of 323 sets of observations were recorded in 110 patients. The first 38 of these patients were also sent the questionnaires to complete before their visit. There was good correlation between the OSS and SPADI scores (correlation coefficient = 0.85) and good agreement between the scores on each scale (weighted kappa = 0.79). The correlation with total SF-36 was poor (0.37 for OSS and 0.26 for SPADI). The OSS and SPADI showed good effect sizes compared with the total SF-36 score and good test-retest reliability. These data support the use of the OSS or SPADI in patients with subacromial impingement.

Adult↗