Showing papers by "Leicester General Hospital published in 1996"
01 Jun 1996
TL;DR: The hypothesis that proteinuria may be an independent mediator of progression rather than simply being a marker of glomerular dysfunction is reviewed and the mechanisms by which particular proteins may cause renal pathology are reviewed.
Abstract: The cause of the relentless progression of chronic renal failure of diverse origins remains unknown and is likely to be multifactorial. Numerous studies have now demonstrated a correlation between the degree of proteinuria and the rate progression of renal failure, which has led to the hypothesis that proteinuria may be an independent mediator of progression rather than simply being a marker of glomerular dysfunction. This article reviews the evidence underlying this hypothesis and the mechanisms by which particular proteins may cause renal pathology. The abnormal filtration of proteins across the glomerular basement membrane will bring them into contact with the mesangium and with the tubular cells. There is evidence to support a role of lipoproteins on mesangial cell function, which ultimately could contribute to glomerular sclerosis. The proximal tubular cells reabsorb proteins from the tubular fluid, which leaves them particularly vulnerable to any adverse effects proteins may have. It has been postulated that the sheer amount of protein to be metabolized by these cells may overwhelm the lysosomes and result in leakage of cytotoxic enzymes into the cells. In addition, the increased metabolism of proteins may result in production of ammonia, which can mediate inflammation through activation of complement. Specific proteins that have been shown to be cytotoxic are transferrin/iron, low-density lipoprotein, and complement components, all of which appear in the urine in proteinuric states. Other specific proteins have been shown to stimulate production of cytokines, chemoattractants, and matrix proteins by tubular cells and thus may stimulate interstitial inflammation and scarring. The mechanisms by which the presence of proteins in the tubular fluid alters tubular cell biology is yet to be determined.
309 citations
TL;DR: It appears that relatively less importance should be attached to the involvement of neutrophils at isocheimal‐reperfusion sites, and relatively more to a local postiischaemic imbalance in the levels of nitric oxide and endothelin.
Abstract: Ischaemia-reperfusion injury is a complex interrelated sequence of events that classically involves the vascular endothelium and activated leucocytes. During the ischaemic phase the endothelium is primed both to produce free radicals and to secrete chemoattractants. The resultant neutrophil sequestration serves to amplify the injury, but damage is not confined to the postischaemic area and more generalized effects typically follow. The situation in the kidney is complex for, while ischaemia primes the tissue for reperfusion damage, it also causes early and irreversible tubular injury. Furthermore, it appears that relatively less importance should be attached to the involvement of neutrophils than at other sites, and relatively more to a local postischaemic imbalance in the levels of nitric oxide and endothelin. Despite a greater understanding of the pathogenesis of ischaemia-reperfusion injury, effective treatment remains elusive and research is hampered by apparent species and organ-specific differences.
233 citations
TL;DR: Patients with ulcerative colitis who were not on long-term sulphasalazine or 5-aminosalicylic acid therapy (either because a doctor stopped it or they did not comply with treatment) were significantly more likely to develop colorectal cancer than their compliant counterparts.
Abstract: OBJECTIVES The aims of this study were to (i) estimate the prognosis of a 10-year cohort as expressed by risk of colectomy and risk of development of colorectal cancer, and (ii) assess the impact of long-term sulphasalazine on the natural course of ulcerative colitis. PATIENTS One hundred and seventy-five patients diagnosed between 1972 and 1981 with either total colitis (n = 143) or with limited ulcerative colitis but deceased (n = 32) were identified. Overall there was 98% case ascertainment and verification. RESULTS A total of 49 patients underwent a colectomy, 6 as emergency laparotomies, 36 for failed medical management and 7 for known colorectal cancer, giving a crude colectomy rate of 23.2%. The colectomy rate was 7.2% in the year of diagnosis, decreasing in frequency over the next 4 years, then reaching a steady state of approximately 1.7% per year. In the total cohort, colorectal cancer occurred in 10 patients within the study period. The cumulative incidence of colorectal cancer 10 years after diagnosis was 2.1% and at 20 years 7.4% for the total group of patients excluding those with a colectomy. The mean duration of ulcerative colitis before diagnosis was 7.9 years (range 5-12). The crude proportions developing cancer were 5/152 (3%) in the group who took long-term sulphasalazine but 5/16 (31%) in the those who had had their treatment stopped or who did not comply with therapy. This is highly significant using a simple chi 2 test (chi 2 = 20.2, df = 1, P < 0.001). Two methods were used for survival analyses, the log-rank and the generalized Wilcoxon methods. Both give highly significant values for the crude effect of compliance (P < 0.001). CONCLUSION Patients with ulcerative colitis who were not on long-term sulphasalazine or 5-aminosalicylic acid therapy (either because a doctor stopped it or they did not comply with treatment) were significantly more likely to develop colorectal cancer than their compliant counterparts.
233 citations
TL;DR: It appears that relatively less importance should be attached to the involvement of neutrophils at ischaemia-reperfusion sites, and relatively more to a local postischaemic imbalance in the levels of nitric oxide and endothelin.
Abstract: Ischaemia-reperfusion injury is a complex interrelated sequence of events that classically involves the vascular endothelium and activated leucocytes. During the ischaemic phase the endothelium is primed both to produce free radicals and to secrete chemoattractants. The resultant neutrophil sequestration serves to amplify the injury, but damage is not confined to the postischaemic area and more generalized effects typically follow. The situation in the kidney is complex for, while ischaemia primes the tissue for reperfusion damage, it also causes early and irreversible tubular injury. Furthermore, it appears that relatively less importance should be attached to the involvement of neutrophils than at other sites, and relatively more to a local postischaemic imbalance in the levels of nitric oxide and endothelin. Despite a greater understanding of the pathogenesis of ischaemia-reperfusion injury, effective treatment remains elusive and research is hampered by apparent species and organ-specific differences.
149 citations
TL;DR: A questionnaire which measures GPs' attitudes towards discussing smoking with patients is developed with the intention of using this instrument to select GPs with diverse views for a qualitative interview study.
Abstract: Method. Thirteen attitude statements with an accompanying Likert-type scale were completed by 327 GPs in one FHSA area. Factor analysis of responses produced two subscales: 'perceived efficacy' and 'enthusiasm'. Reliability and validity of these were examined. Results. Each subscale had good internal reliability and preliminary exploration of construct validity supported the notion that the subscales were valid. Conclusion. The use of this type of instrument in sampling GPs for qualitative studies could be effective for selecting subjects with a diversity of views towards the research topic.
113 citations
01 Jan 1996
TL;DR: The data suggest that excess production of dimeric IgA occurs in the bone marrow in IgA nephropathy, and the possible role of the systemic IgA immune system in the pathogenesis of IgA neutropathy is investigated.
Abstract: AIM: To investigate the possible role of the systemic IgA immune system in the pathogenesis of IgA nephropathy METHODS: J chain mRNA expression in the IgA cells of the bone marrow was studied. Bone marrow trephine biopsy specimens from seven patients with IgA nephropathy and seven matched controls were examined by (1) non-isotopic in situ hybridisation (ISH) and (2) combined immunofluorescence and non-isotopic ISH to identify the plasma cell type. Serum polymeric IgA was also determined using standard high pressure liquid chromatography and sandwich enzyme linked immunosorbent assay. RESULTS: Non-isotopic ISH revealed a similar number of J chain mRNA positive cells/unit length in biopsy specimens from patients (16.5 +/- 2.7 cells/mm) and controls (17.7 +/- 2.4 cells/mm). Combined immunofluorescence and ISH revealed a greater proportion of J chain mRNA positive IgA cells in patients (7.6 +/- 1.45%) compared with controls (3 +/- 0.8%). Serum polymeric IgA was similar in both patients (91 +/- 22 mg/l) and controls (77 +/- 24 mg/l). CONCLUSION: These data suggest that excess production of dimeric IgA occurs in the bone marrow in IgA nephropathy.
107 citations
TL;DR: Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths and it seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten‐free diet.
Abstract: Objectives The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease. Method This was a case control study in which patients and controls, matched for age and sex, were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied, but only 68 pairs could be matched for this study. Results The mean age of menarche in patients was significantly older (13.6 years) than in controls (12.7 years). The mean ages at menopause in patients and controls were 47.6 and 50.1 years, respectively. The mean number of children born to patients was significantly less at 1.9 (SD +/- 0.9) compared to 2.5 (SD +/- 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD +/- 0.9) compared to 0.7 in controls (SD +/- 1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with coeliac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. Conclusions Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.
102 citations
TL;DR: Cox stepwise logistic regression analysis demonstrated that DGF was a more powerful predictive factor for poor graft survival than acute rejection occurring in the first 90 days post-transplant (P=0.001); further efforts at improving graft outcome should concentrate on reducing the incidence of DGF.
Abstract: Three hundred and eight cadaveric renal transplants were analysed to establish the effects of acute rejection in the first 90 days and delayed graft function (DGF) on graft outcome. There were 120 patients (39%) with no DGF and no rejection (group 1), 101 patients (33%) with rejection but no DGF (group 2), 41 patients (13%) with DGF but no rejection (group 3) and 46 patients (15%) with both rejection and DGF (group 4). The actuarial 4-year graft survival rates for groups 1,2,3 and 40.4%, respectively. The acute rejection rate was 101/221 (46%) in patients with initial graft function compared with 46/87 (53%) for those with DGF (χ2=1.02, P=0.31). Cox stepwise logistic regression analysis demonstrated that DGF was a more powerful predictive factor for poor graft survival (P=0.001) than acute rejection occurring in the first 90 days post-transplant (P=0.034). Further efforts at improving graft outcome should concentrate on reducing the incidence of DGF.
100 citations
TL;DR: Recombinant EGF administered via the gut lumen could still prove a valuable tool for the treatment of gastrointestinal ulceration and the old term for EGF, 'epidermal healing factor' or EHF, was more appropriate after all.
Abstract: The jury is still out on the role of luminal EGF in the normal gastrointestinal tract. Recent evidence, however, suggests that its major function is to act as a 'luminal surveillance' peptide, which is available to stimulate repair and that it is not of major importance in maintaining normal gut growth. Recombinant EGF administered via the gut lumen could still prove a valuable tool for the treatment of gastrointestinal ulceration. Perhaps the old term for EGF, 'epidermal healing factor' or EHF, was more appropriate after all!
100 citations
TL;DR: One hundred and fifty‐eight consecutive patients attending a university memory clinic were assessed using a variety of standardized instruments, and three main categories of anxiety symptoms were evident—anxiety related to depression, anxietyrelated to psychosis and anxiety related to interpersonal situations.
Abstract: One hundred and fifty-eight consecutive patients attending a university memory clinic were assessed using a variety of standardized instruments. Dementia was diagnosed according to DSM-III-R criteria. One hundred and nine patients had DSM-III-R dementia, of whom 22% had subjective anxiety, 11% experienced autonomic anxiety, 38% experienced tension, 13% experienced situational anxiety and 1.8% had panic attacks. Thirty-two (29.4%) had one or more anxiety symptoms. None of the cognitive or demographic variables were significantly associated with the presence of anxiety symptoms. Three main categories of anxiety symptoms were evident-anxiety related to depression, anxiety related to psychosis and anxiety related to interpersonal situations.
69 citations
TL;DR: A nutrition team aims to teach simple methods of detecting malnutrition and found MAMC is useful in those who cannot be weighed or who have fluid retention, but fluid retention may limit their accuracy.
Abstract: Malnutrition in hospital is often unrecognized. A nutrition team aims to teach simple methods of detecting malnutrition. On a single day all medical in-patients underwent a nutritional assessment. Eighty-four patients (43 men), median age 71 years (range 28-97), were assessed. The most common diagnoses were cardiac disease (26), stroke/dementia (12), non-malignant lung disease (9) and malignancy (6). A weight loss of more than 10% (%WL) was found in 17/65 (26%) and a body mass index (BMI) of less than 19 kg/m2 in 13/69 (19%). A mid-arm muscle circumference (MAMC) less than the fifth percentile occurred in 16/83 (19%) patients. Percentage weight loss alone detected seven patients of whom four were overweight (BMI > 25 kg/m2), BMI alone detected three patients, and MAMC alone eight patients of whom three could not be weighed and three had fluid retention. There was fluid retention in 35/84 (42%) patients of whom nine were malnourished (six detected by BMI and/or %WL, and three by MAMC alone). All three measurements were made in 64 patients, six (9%) of whom were detected as malnourished by all three methods. Combining the three measurements 29/84 (35%) of patients were malnourished and only 28% of these patients had been assessed by a dietitian. BMI and %WL detect most patients but fluid retention may limit their accuracy. MAMC is useful in those who cannot be weighed or who have fluid retention.
TL;DR: There appears to be a reluctance to prescribe opiate analgesia, and when this was prescribed the doses were not modified to achieve full pain or symptomatic relief, and the need for education of both nursing and medical staff as to the current principles of palliative care is needed.
Abstract: A retrospective case note audit was conducted in order to determine the most prevalent symptoms in terminal dementia and to assess the palliation given. Seventeen case notes were audited. Pain and dyspnoea were the most common symptoms. The palliation and treatment of constipation and oral candidiasis was within current accepted practice. Palliation of other symptoms were inadequate compared to current accepted practice. There appears to be a reluctance to prescribe opiate analgesia, and when this was prescribed the doses were not modified to achieve full pain or symptomatic relief. Many patients were unable to take medication orally, but syringe drivers were not used. The conclusions include the need for education of both nursing and medical staff as to the current principles of palliative care.
TL;DR: In this paper, the authors consider the apparent gap between the paradigm of strategic human resource management on the one hand and actual HR practice on the other and generate practical advice for senior HR specialists who are aspriring to develop a strategic role for their function.
Abstract: This paper has two aims. First, to consider explanations for the apparent gap between the paradigm of strategic human resource management on the one hand and actual HR practice on the other. Second, to generate practical advice for senior HR specialists who are aspriring to develop a strategic role for their function. the research underpinning these findings was based on case studies in three hospitals in Adelaide and a comparison of the findings with the situation at Leicester General NHS Trust where the first named author of this article was the HR director and a senior board member. the analysis reveals that specific features of each organisation's history, current structure and management, shape powerfully the nature of the HR function. Moreover, the local shaping factors define the degrees of freedom open to the HR function, so much so, that the notion that it can choose its organisational stance is here challenged.
TL;DR: Assessment of symptoms of stress and stressful events, as well as job satisfaction and attitudes towards the elderly and the home, in care staff in three Local Authority Social Services residential (Part III) homes for the elderly in Leicester suggested that with increasingly high levels of dementia and dependency in the residents, the homes’ structure has not sufficiently responded to the increasing demands on the staff.
Abstract: The present study assessed symptoms of stress and stressful events, as well as job satisfaction and attitudes towards the elderly and the home, in care staff in three Local Authority Social Services residential (Part III) homes for the elderly in Leicester. These homes have been reported as caring for a highly dependent group of residents (Neville et al., 1995). From the pattern of the care staff’s responses on both the Stressful Events Questionnaire and the Minnesota Satisfaction Questionnaire, it was indicated that organizational factors are identified as being as stressful as aspects of caring for the residents and managing their behaviour. Staff in these homes indicated favourable attitudes towards the elderly and towards caring for confused residents in the home. It is suggested that with increasingly high levels of dementia (82%) and dependency in the resident group, the homes’ structure in terms of staff group, training and support has not sufficiently responded to the increasing demands on the staff, which may significantly contribute to the reported high levels of stress and low job satisfaction.
01 Sep 1996
TL;DR: Human tubular cells grown on permeable membrane supports were characterized to be predominantly of proximal tubular origin and exposure of HTC to serum resulted in increased release of lactate dehydrogenase, suggesting a degree of cytotoxicity.
Abstract: Fibronectin production by human tubular cells: The effect of apical protein. In progressive renal disease the degree of renal failure correlates with interstitial scarring and the rate of progression correlates with the degree of proteinuria. This has led to the hypothesis that proteinuria may cause interstitial scarring. Human tubular cells (HTC) grown on permeable membrane supports were characterized to be predominantly of proximal tubular origin. HTC produce the matrix protein fibronectin in a polarised fashion the ratio of basolateral to apical secretion being 2.9 ± 0.2 at 48 hours. The addition of serum proteins (1.0mg/ml) to the apical medium resulted in increased basolateral secretion of fibronectin, 2.62±0.23-fold after 24 hours and 2.40±0.16-fold after 48 hours. Serum fractionation revealed that the stimulant to fibronectin production had a molecular weight 40 to 100kDa. Platelet derived growth factor secretion was also stimulated by apical exposure to serum but transforming growth factor β secretion was not detected. Addition of neutralizing anti-PDGF antibodies did not decrease fibronectin secretion. The activity of serum was not reproduced by albumin or by transferrin. Exposure of HTC to serum resulted in increased release of lactate dehydrogenase, suggesting a degree of cytotoxicity. This evidence could provide a mechanism for the link between proteinuria and interstitial scarring.
TL;DR: Patients were more critical if the diagnosis was worse than expected and more satisfied if they felt they had been able to ask questions and there was no evidence that unsatisfactory communications were associated with later mood disturbance.
Abstract: Communication of the diagnosis of motor neurone disease (MND) is a particularly difficult task for doctors in view of the poor prognosis and the lack of significant treatment. This study examined patients' views of being given the diagnosis and of how it was communicated. Fifty people who had been diagnosed with MND more than six months previously were interviewed about their experience of the diagnosis. The majority reported positive aspects of being told, especially having a label for their condition. The most frequently mentioned critical aspect of how they were told was the directness and clarity with which they were given the information. Patients were more critical if the diagnosis was worse than expected (as it was for most patients) and more satisfied if they felt they had been able to ask questions. There was no evidence that unsatisfactory communications were associated with later mood disturbance. A longitudinal study is recommended to overcome limitations in this cross-sectional design.
TL;DR: The purpose of this review is to summarise selected recent developments in this field, and to consider how these developments may alter the ways in which histopathologists might assess the extracellular matrix in the kidney.
Abstract: Introduction Histopathologists have long recognised that excessive accumulation of extracellular matrix in the kidney is a serious sign of irreversible damage. However, we have rarely attempted further analysis of such accumulations, beyond noting the presence of pink staining material in our haematoxylin and eosin sections, and a rough estimation of its severity. This is remiss of us, as fibrosis of the renal interstitium has repeatedly been reported to be the best single morphological correlate of renal function and prognosis. 2 The purpose of this review is to summarise selected recent developments in this field, and to consider how these developments may alter the ways in which histopathologists might assess the extracellular matrix. Although I will concentrate on the kidney, there are obvious parallels with the assessment of non-neoplastic disease in other organs.
Journal Article•
TL;DR: An important finding is the demonstration of residual parathyroid function in 14/16 patients (87.5%) undergoing totalParathyroidectomy without autotransplantation and followed-up for 2 years.
Abstract: The efficacy of subtotal parathyroidectomy (n = 11), total parathyroidectomy+autotransplantation (n = 13) and total parathyroidectomy alone (n = 24) were compared in a series of renal patients with hyperparathyroidism. The principal indication for surgery was severe bone disease but other indications were uncontrolled hypercalcaemia, soft tissue calcification and grossly elevated parathyroid hormone (PTH) levels. The clinical success rates at 24 months follow-up for subtotal, total plus autograft, and total parathyroidectomy were 100, 89 and 97% respectively. Similar improvements in radiological changes and alkaline phosphatase levels were seen in all three groups. Recurrent hyperparathyroidism was recorded in three (27%) members of the subtotal parathyroidectomy group and two (16%) of the patients undergoing total parathyroidectomy and autotransplantation. Two patients required re-exploration of their forearm parathyroid autograft. No patients undergoing total parathyroidectomy only suffered persistent or recurrent hypercalcaemia. Vitamin D analogue requirements rates in patients undergoing subtotal, total plus autotransplant, and total parathyroidectomy at 24 months were 44, 70 and 81% respectively. An important finding is the demonstration of residual parathyroid function in 14/16 patients (87.5%) undergoing total parathyroidectomy without autotransplantation and followed-up for 2 years.
TL;DR: Polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.
Abstract: Crohn's disease (CD) and tuberculosis (TB) of the gastrointestinal tract pose major diagnostic problems for clinicians where these conditions coexist. Clinically and radiologically, the diseases are similar. In the West, TB is considered in the differential diagnosis of all suspected cases of CD, particularly among Asian migrants. Earlier age of presentation, perianal disease and enteric fistulae favour a diagnosis of CD. Aphthoid ulceration, pseudopolyps and filiform mucosa at endoscopy are suggestive of CD and a negative tuberculin test us useful. The final diagnosis depends largely on histopathology and the presence or absence of acid fast bacilli. Tuberculosis is more common in developing countries and intestinal TB frequently coexists with pulmonary tuberculosis. TB is known to affect all age groups and fistulous communication, although uncommon, does occur. In addition to radiology and endoscopy, laparotomy may be required to establish the diagnosis. In developing countries, CD is uncommon and remains largely a diagnosis of exclusion. A trial of anti-tuberculosis therapy may often be prescribed before definitely diagnosing CD. The development of molecular biology techniques had led to a revival of interest in mycobacteria as a possible aetiological agent in CD. DNA from Mycobacterium paratuberculosis and Mycobacterium kansaii have both been identified in CD cases but the significance of this finding has not been established. However, in the near future polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.
TL;DR: The prime objective of this study was to assess the benefits and practicalities of an investigation protocol to identify, follow-up and investigate fetal uropathies in a manner to maximize efficiency.
TL;DR: The differences between various South Asian groups such as Gujaratis, Bangladeshis and Punjabis are discussed in the context of age standardisation of incidence data and various dietary and social activities.
Abstract: We present a review of epidemiological studies of inflammatory bowel disease and abdominal tuberculosis in various migrant communities in the United Kingdom. The differences between various South Asian groups such as Gujaratis, Bangladeshis and Punjabis are discussed in the context of age standardisation of incidence data and various dietary and social activities.
TL;DR: Findings showed that covering the instruments reduced total bacterial fallout fourfold by reducing the exposure time, particularly during periods of increased activity and bacterial dispersal.
Abstract: The use of ultraclean air (UCA) in operating theatres reduces the infection rate after joint replacement but some cases of infection still occur. We investigated one possible source of contamination, namely the setting up of instruments in a conventional plenum-ventilated preparation room. We measured bacterial fallout using agar settle plates and compared instruments set up in the preparation room with those set up in the UCA theatre, assessed the effect of covering instruments after preparation and compared fallout during their preparation with total fallout throughout the operation. Our findings showed that covering the instruments reduced total bacterial fallout fourfold by reducing the exposure time, particularly during periods of increased activity and bacterial dispersal. Preparation in the UCA theatre and subsequent covering of the instruments reduced total fallout 28-fold. All measurable bacterial fallout occurred during the setting up and not during surgery.
TL;DR: The high prevalence of severe and uncontrolled symptoms of urinary incontinence combined with the lack of support received by the homes for the management of these residents indicated the urgent need for a greater input from the specialist continence service.
Abstract: Summary We assessed the management of urinary incontinence amongst older people in residential and nursing homes and examined strategies for continence care in the homes. A random sample of local authority and private residential and nursing homes was drawn from an earlier census of long-term care. Strategies for continence care, the standard of care provided and the need for more help were determined by means of a structured questionnaire and the observations of a continence adviser. A random selection of residents in each of the homes was assessed for the presence, severity and symptoms of urinary incontinence, for symptom control and physical dependency. Eighty-seven per cent of the homes used pads and 83% daytime toileting to promote continence care but only 52% practised night-time toileting and 49% the use of clear toilet signs. A greater emphasis was placed on incontinence management rather than continence promotion, the latter being 'good' in only 32% of homes. Although the majority of homes reported having adequate access to aids and appliances, 39% of residents had severe symptoms of urinary incontinence resulting in bed-wetting and wetting of clothing. Substantial social and psychological effects were found; 87% of residents needed changes in their management of the condition and incontinence management was 'good' in only 47% of homes. Although 73% of homes were optimistic about offering good continence care, they were infrequently supported by continence nurses (30% of homes) or specialist continence doctors (9% of homes). Consequently 57% requested more help from the specialist services. The high prevalence of severe and uncontrolled symptoms of urinary incontinence combined with the lack of support received by the homes for the management of these residents indicated the urgent need for a greater input from the specialist continence service.
TL;DR: It is concluded that NHBD kidneys are a good source of additional organs for transplantation, but only one-third of referrals result in a successful procurement procedure, and the setting up of a successful programme is labour-intensive and requires a highly committed staff.
Abstract: The work-load generated by a non-heart-beating donor (NHBD) kidney transplant programme over a 3-year period is reported. A total of 73 referrals were made, 64 from the Accident department and 9 from the wards. Organ procurement was performed in 24 cases (33%) and resulted in the retrieval of 44 kidneys. Reasons for failure to achieve organ procurement were: refused consent (n=13; 18%), relatives unavailable to ask for consent (n=9; 12%), technical problems with catheter insertion or perfusion (n=10; 14%), transplant staff unavailable (n=1; 1%), long asystolic period (n=8; 11%) and donor unsuitable for other reasons (n=8; 11%). Of the 44 kidneys retrieved, 30 were transplanted locally, 8 were transplanted at other United Kingdom centres and 6 were discarded. Locally transplanted NHBD kidneys represented 21% of the total transplant programme during the time period under study. We conclude that NHBD kidneys are a good source of additional organs for transplantation, but only one-third of referrals result in a successful procurement procedure. Moreover, the setting up of a successful programme is labour-intensive and requires a highly committed staff.
TL;DR: The recruitment of 53 GPs to a research project which involved video-recording their consultations to determine how GPs approach the topic of smoking cessation with patients and how this apparent self-selection by participating GPs could influence research results is recorded.
Abstract: Coleman T. Sampling for qualitative research using quantitative methods. 2. Characteristics of GPs who agree to video-taping of consultations . Family Practice 1996; 13: 531-535. Background and objectives. Studies using video-recordings of GPs' consultations have been important in investigating GPs' clinical behaviour. Unfortunately, the characteristics of participating GPs are rarely described, making it difficult to assess how representative they are or how generalizable the studies' results can be. This paper documents the recruitment of 53 GPs to a research project which involved video-recording their consultations to determine how GPs approach the topic of smoking cessation with patients. Methods. The Attitudes to Smoking Advice Questionnaire was used to select GPs with diverse attitudes towards discussing smoking with patients. Results. Out of 123 GPs who were eligible to take part, 53 (43.1 %) agreed. GPs who agreed to become research subjects were younger, more likely to work in teaching or training practices and more likely to be current members of the RCGP.
TL;DR: The majority view is that electron microscopy and immunocytochemistry are necessary in the investigation of most native renal biopsy specimens, and the few pathologists who report renalBiopsy specimens without these methods risk accusations of negligence.
Abstract: AIMS: To determine the variation in practice of British renal histopathologists in the use of immunohistochemistry and electron microscopy in the investigation of renal biopsy specimens; to attempt to identify a consensus on what acceptable practice should be; and to satisfy requests from laboratories which have found immunoperoxidase methods unreliable on renal biopsy specimens, by disseminating methods from laboratories which have had success. METHODS: A questionnaire was sent to all 58 laboratories which participate in the UK National Renal Pathology External Quality Assessment Scheme. RESULTS: A response rate of 88% was achieved. Most laboratories use immunocytochemistry and electron microscopy to investigate most renal biopsy specimens, but a few use these methods only rarely and one, never. There is a widespread wish to switch from immunofluorescence to immunoperoxidase, but this is frustrated by the unreliability of the method. This seems to be mainly because of the need to tailor the time of enzyme pretreatment to each biopsy specimen. CONCLUSIONS: The majority view is that electron microscopy and immunocytochemistry are necessary in the investigation of most native renal biopsy specimens, and the few pathologists who report renal biopsy specimens without these methods risk accusations of negligence. Difficulty in using fixed renal tissues for immunocytochemistry stem largely from variations in the requirement for enzyme pre-digestion. Even where immunoperoxidase methods are usually successful, the occasional use of immunofluorescence in parallel to check that false negatives are not occurring is advocated. In all cases it is wise to keep some frozen cortex in reserve in case there is an unexpected or inconsistent immunoperoxidase result.
TL;DR: Findings of a prospective study of two residential units for elderly people with dementia: a community hospital ward providing an enhanced version of traditional hospital care and a scheme developed in partnership with a charity operating an explicit policy emphasizing resident choice, opportunity, support and independence are reported.
Abstract: This article reports the findings of a prospective study of two residential units for elderly people with dementia: a community hospital ward (unit 1) providing an enhanced version of traditional hospital care and a scheme developed in partnership with a charity (unit 2) operating an explicit policy emphasizing resident choice, opportunity, support and independence. Residents, staff and unit policy were assessed at baseline in long-stay mental hospital wards, and at 6 months and 12 months after relocation. The Quality of Interactions Schedule (QUIS) was carried out on one occasion on a comparison long-stay mental hospital ward, at 12 and 24 months in unit 1 and at 6 and 12 months in unit 2. At 12 months, there was an increase in the quality but not the number of staff- resident interactions observed in unit 1, compared to the long-stay ward: both number and quality had improved on this unit at 24 months. Much larger increases in number and quality of interactions were observed in unit 2 at both 6 and 12 months. These changes were associated in unit 2 but not unit 1 with a decrease in observed depression, no decline in self-care (ADL) and improvement in communication skills over the follow-up period. There was a significant excess mortality in the unit 2 cohort at 6 months, but there was no difference at 12 months. At 12 months, staff on both units reported good levels of job satisfaction and morale.
TL;DR: The combination of oral nifedipine and CyA significantly improves initial graft function, rejection frequency and long term graft survival in cyclosporin A-treated renal transplant recipients.
Abstract: The aim of this study was to test the hypothesis that nifedipine will improve graft survival in cyclosporin A (CyA)-treated renal transplant recipients. One hundred and forty-seven patients were randomised to one of three regimens. Group A received CyA, 7 mg/kg per day, and prednisolone; group B followed the same regimen as group A plus oral nifedipine and group C received CyA, 4 mg/kg per day, prednisolone and azathioprine. Calcium channel blockers were avoided in groups A and C. The crude 2-year (P=0.0223) and 4-year (P=0.0181) graft survival was significantly better in group B (86% and 81%, respectively) than in group A (75% and 63%, respectively). Delayed initial function was seen least frequently in group B (10.2%) compared to groups A (31%) and C (28%; P<0.01). Group B also experienced fewer rejection episodes than groups A and C (P<0.05). We conclude that the combination of oral nifedipine and CyA significantly improves initial graft function, rejection frequency and long term graft survival.
Journal Article•
TL;DR: Patient information and its effect on the understanding of disease processes and management can be assessed by various standard techniques but their effectiveness must ultimately be validated in randomised controlled trials.
Abstract: Information designed for patients aims to educate them. This means that the written word must be both read and understood. In whatever format patient information is presented it must influence patient behaviour and favourably affect compliance and morbidity if it is to be of value. The production of patient information should take account of the needs of the audience as well as the aims of the educators. Prototypes should be field tested to ensure that they are effective and that the material can be revised before general use. Patient information and its effect on the understanding of disease processes and management can be assessed by various standard techniques. Their effectiveness must ultimately be validated in randomised controlled trials.