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Francis D, Davies C. 49th Annual Scientific Sessions of the American College of Cardiology. HEART FAILURE MONITOR 2000; 1:37-9. [PMID: 12638557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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Davies C. Pony with skin allergy. THE BRITISH HOMOEOPATHIC JOURNAL 2000; 89:41-2. [PMID: 10703913 DOI: 10.1038/sj.bhj.5800381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
AIMS To follow-up patients with a 'sausage' deformity of the toe associated with local neuropathic ulceration to confirm the diagnosis of underlying osteomyelitis. This was based on our observation that some diabetic patients with suspected pedal osteomyelitis with a local neuropathic ulcer have a 'sausage' deformity of a toe. METHODS Over a period of 2 years, 14 patients with foot ulcers, who were observed to have the 'sausage' deformity of a toe in the diabetic foot clinic were followed up and investigated. RESULTS Underlying osteomyelitis was confirmed in six on the very first X-ray examination. A further seven had osteomyelitis diagnosed on bone scanning. Both the X-ray and the bone scan were equivocal in one patient, whose ulcer only healed after an 8-week course of antibiotics. Antibiotic therapy was successful in 11 patients and three patients required amputation of the affected toe. Following successful treatment, there was full resolution of the 'sausage toe' in the majority. CONCLUSIONS The appearance of a 'sausage toe' should alert the physician of the possibility of underlying osteomyelitis in diabetic foot, so that prompt treatment can be commenced with antibiotics.
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Davies C, Grimshaw G, Kendall M, Szczepura A, Griffin C, Toescu V. Quality of diagnostic services for cancer: a comparison of open access and conventional outpatient clinics. INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE INCORPORATING LEADERSHIP IN HEALTH SERVICES 1999; 12:87-91. [PMID: 10537861 DOI: 10.1108/09526869910265075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE AND STUDY DESIGN To assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost-effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six-month cohort of all referrals (November 1996-April 1997). SUBJECTS All referrals for suspected cancers of: upper gastro-intestinal tract; urinary tract, prostate and testis; skin. EFFECTIVENESS Median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention. RESULTS GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics. COST-EFFECTIVENESS Extra (incremental) NHS cost per patient diagnosed. RESULTS Less than 5 Pounds per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than 3 Pounds per day saved between GP referral and consultant decision for: testicular; haematuria. Less than 3 Pounds per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma. CONCLUSION A "quick and early" diagnostic route provides a higher quality service through improved effectiveness and cost-effectiveness compared to conventional outpatients.
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Davies C. Wound care. Cleansing rites and wrongs. NURSING TIMES 1999; 95:71-2, 75. [PMID: 10847088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Davies C, Peto R. Early breast cancer: how long should tamoxifen continue? Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Novak PG, Davies C, Gin KG. Survey of British Columbia cardiologists' and emergency physicians' practice of using nonstandard ECG leads (V4R to V6R and V7 to V9) in the diagnosis and treatment of acute myocardial infarction. Can J Cardiol 1999; 15:967-72. [PMID: 10504177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND There is evidence that the addition of nonstandard electrocardiographic (ECG) leads results in significant increases in sensitivity for the diagnosis of acute myocardial infarction compared with the standard 12-lead ECG. OBJECTIVE To examine how cardiologists and emergency physicians in British Columbia use nonstandard ECG leads (V4R to V6R and V7 to V9) in the diagnosis and treatment of acute myocardial infarction. DESIGN A list of fax numbers of all cardiologists and emergency physicians in British Columbia was obtained and questionnaires were then transmitted. MAIN RESULTS More than 75% of cardiologists and emergency physicians correctly identified the diagnostic criteria for acute right ventricular and posterior myocardial infarction. More than 70% of surveyed physicians reported that they would use the 18-lead ECG regularly if they could gain an increased sensitivity for the diagnosis of acute myocardial infarction. However, fewer than 20% of all surveyed physicians reported regular use of the 18-lead ECG. Furthermore, the survey determined that the majority of physicians would alter their choice of thrombolytic if they could diagnose right ventricular infarction complicating an inferior infarction. Finally, most physicians reported that they would treat an isolated posterior wall myocardial infarction with a thrombolytic. CONCLUSIONS This study suggests most cardiologists and emergency physicians in British Columbia are aware of 18-lead ECG diagnostic criteria for acute right ventricular and posterior wall myocardial infarction. Furthermore, these physicians would be willing to use this tool if it were to increase diagnostic sensitivity for acute myocardial infarction. Despite these findings, only the minority of surveyed physicians use this tool regularly.
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Davies C, Salvage J, Smith R. Doctors and nurses: changing family values? We want to hear about how doctors and nurses work together. BMJ (CLINICAL RESEARCH ED.) 1999; 319:463-4. [PMID: 10454385 PMCID: PMC1116374 DOI: 10.1136/bmj.319.7208.463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Davies C. How well do doctors and nurses work together? NURSING TIMES 1999; 95:3. [PMID: 10614397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Davies C, Peacock S, Day N, Berendt A. Clinical correlates of adhesion and slime production in coagulase-negative staphylococcal prospthetic joint infection. J Infect 1999. [DOI: 10.1016/s0163-4453(99)90156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Davies C. Advocacy for gender equity: the case of bridewealth in Uganda. PROMOTION & EDUCATION 1999; 6:13-5, 37-8, 49. [PMID: 10434340 DOI: 10.1177/102538239900600205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
This article describes an action research project designed to develop a teaching programme which would enable students to bridge the theory-practice gap they experienced while on placement in a gynaecology unit.
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Powell JJ, Marren P, Wojnarowska F, Davies C. Xanthoma disseminatum with multi-system involvement and fatal outcome. J Eur Acad Dermatol Venereol 1999; 12:276-8. [PMID: 10461659 DOI: 10.1111/j.1468-3083.1999.tb01050.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carlisle C, Luker KA, Davies C, Stilwell J, Wilson R. Skills competency in nurse education: nurse managers' perceptions of diploma level preparation. J Adv Nurs 1999; 29:1256-64. [PMID: 10320511 DOI: 10.1046/j.1365-2648.1999.01011.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the 'fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the 'core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.
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Abstract
Serum cholesterol, triacylglycerols and low-density lipoprotein (LDL) subfractions were determined in 120 primagravid women during normal gestation (40 in each trimester) and in 20 non-pregnant age-matched controls. LDL subfractions were determined by PAGE, and an LDL score was calculated. The higher the score, the smaller the subfractions. The objective of the study was to determine the effects of the hyperlipidaemia, high oestrogen concentrations and insulin resistance known to exist in normal pregnancy on LDL subfraction formation. Pregnant women had an increased mean serum cholesterol concentration [5.78 (S.D. 1.09) mmol/l] in the first trimester compared with the non-pregnant controls [5.11 (0.77) mmol/l; P<0.01]. The serum cholesterol concentration increased progressively throughout gestation to a mean of 8.14 (1.39) mmol/l in the third trimester (P<0.001 compared with the second trimester). Triacylglycerol concentrations in the first trimester were similar to those of controls, and there was a non-significant increase by the second trimester to 1.32 (0.44) mmol/l. However, by the third trimester the mean triacylglycerol concentration had doubled [2.58 (0.98) mmol/l; P<0.001 compared with the first and second trimester]. During gestation the LDL score increased dramatically, from 1.17 (0.39) during the first trimester to 2.01 (0.37) in the second trimester (P<0.001) to 2.73 (0.48) in the third trimester (P<0.001 compared with the second trimester). Thus an atherogenic lipid profile develops during normal gestation. The significance of these changes remains unclear, but thay may have important implications for mother and foetus.
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Abstract
Hemangiopericytomas are mesenchymal tumors and account for about 1% of all CNS tumors. Aggressive growth, tendency to local recurrence and relatively frequent metastases are the clinical features of these tumors. Histological characteristics are marked cellularity, vascularity and a dense net of reticular fibers. This case presents a patient with a local recurrence of a right temporal, atypical meningioma that had been operated on and irradiated elsewhere. After embolization large parts of the tumor were removed palliatively. Histological aspects of the resected tumor were consistent with a diagnosis of an atypical meningioma. Not until hepatic metastases from this tumor were found was the diagnosis re-examined and corrected to a malignant meningeal hemangiopericytoma. Surgical resection of primary tumor with frequent controls and, if needed, postoperative radiation therapy is the treatment of choice. Furthermore metastasizing atypical meningiomas should be examined critically to determine if a hemangiopericytoma is present.
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Clarke RW, Davies C, Panarese A, Yardley MP. Otorhinolaryngology Research Society Abstracts. Palatal Surgery for snoring: 2-year follow-up of a randomized controlled trial. Clin Otolaryngol 1999. [DOI: 10.1046/j.1365-2273.1999.00196-9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Campbell-Lendrum D, Pinto MC, Davies C. Is Lutzomyia intermedia (Lutz & Neiva, 1912) more endophagic than Lutzomyia whitmani (Antunes & Coutinho, 1939) because it is more attracted to light? Mem Inst Oswaldo Cruz 1999; 94:21-2. [PMID: 10029909 DOI: 10.1590/s0074-02761999000100008] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Stilwell P, Stilwell J, Hawley C, Davies C. Measuring outcome in community-based rehabilitation services for people who have suffered traumatic brain injury: the Community Outcome Scale. Clin Rehabil 1998; 12:521-31. [PMID: 9869256 DOI: 10.1191/026921598673761855] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To develop a way of measuring long-term outcomes after traumatic brain injury (TBI) that takes account of individual circumstances. DESIGN Reports by head-injured people and their families about problems and coping strategies were elicited via semi-structured interviews. Specially designed computer software was used to record problems and strengths and to measure their impact for the individual on four handicap dimensions. SETTING Interviews took place in the respondents' homes. SUBJECTS Between 1992 and 1997 the services at 10 rehabilitation centres in England were evaluated. Subjects were men and women aged between 16 and 65 who had suffered TBI and who had been referred for treatment to one of the centres under study. INTERVENTIONS Head-injured people and their families were interviewed three months, 18 months and in some cases 36 months after recruitment. MAIN OUTCOME MEASURES The Hospital Anxiety and Depression Scale (HAD) and the Functional Independence/Assessment Measure (FIM/FAM) were used to validate relevant dimensions of the new scale. RESULTS A measure of long-term outcome was developed and called the Community Outcome Scale. Relevant dimensions of the scale showed significant correlation with the HAD and with items of the FIM/FAM. CONCLUSION The scale captures information which no other instrument does, and merits further validation.
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Brogdon J, Eckels DD, Davies C, White S, Doyle C. A site for CD4 binding in the beta 1 domain of the MHC class II protein HLA-DR1. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 1998; 161:5472-80. [PMID: 9820523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Using a lymphocyte binding assay, we have previously demonstrated that the CD4 protein can mediate cell adhesion by direct interaction with MHC class II molecules. In this report, we have used this assay to test whether synthetic peptides, corresponding to DR beta sequences, could inhibit CD4-class II adhesion. A peptide derived from sequences within the beta1 domain (DR beta 41-55), as well as two peptides derived from sequences within the beta 2 domain (DR beta 121-135 and DR beta 141-155), were shown to inhibit CD4-class II adhesion. Inasmuch as a site for CD4 binding in the beta 2 domain had been previously documented, these studies were designed to investigate the role of the beta 1 domain as an additional site of interaction with CD4. Sixteen site-specific mutations were engineered within the beta1 domain of DR beta 1*0101. Several mutations were shown to disrupt CD4-dependent T cell activation. Based on these results, we propose a model for the molecular interaction of CD4 with MHC class II proteins in which both the beta 1 and beta 2 domains of class II interact with the two amino-terminal Ig-like domains of CD4.
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Davies C, Gillings B. Evaluating mentor performance. NT LEARNING CURVE 1998; 2:8. [PMID: 10076329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Davies C. Orthodontic products update. Cross infection control and elastomeric module delivery systems. BRITISH JOURNAL OF ORTHODONTICS 1998; 25:301-3. [PMID: 10075452 DOI: 10.1093/ortho/25.4.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Gillings B, Davies C. Learning in clinical practice. 5. Evaluating student performance. NT LEARNING CURVE 1998; 2:8. [PMID: 10067541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kugler W, Breme K, Laspe P, Muirhead H, Davies C, Winkler H, Schröter W, Lakomek M. Molecular basis of neurological dysfunction coupled with haemolytic anaemia in human glucose-6-phosphate isomerase (GPI) deficiency. Hum Genet 1998; 103:450-4. [PMID: 9856489 DOI: 10.1007/s004390050849] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Glucose-6-phosphate isomerase (GPI) deficiency, an autosomal recessive genetic disorder with the typical manifestation of nonspherocytic haemolytic anaemia, can be associated in some cases with neurological impairment. GPI has been found to be identical to neuroleukin (NLK), which has neurotrophic and lymphokine properties. To focus on the possible effects of GPI mutations on the central nervous system through an effect on neuroleukin activity, we analysed DNA isolated from two patients with severe GPI deficiency, one of them with additional neurological deficits, and their families. The neurologically affected patient (GPI Homburg) is compound heterozygous for a 59 A-->C (H20P) and a 1016 T-->C (L339P) exchange. Owing to the insertion of proline, the H20P and L339P mutations are likely to affect the folding and activity of the enzyme. In the second family studied, the two affected siblings showed no neurological symptoms. The identified mutations are 1166 A-->G (H389R) and 1549 C-->G (L517V), which are located at the subunit interface. We propose that mutations that lead to incorrect folding destroy both catalytic (GPI) and neurotrophic (NLK) activities, thereby leading to the observed clinical symptoms (GPI Homburg). Those alterations at the active site, however, that allow correct folding retain the neurotrophic properties of the molecule (GPI Calden).
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Davies C, Gillings B. Learning in clinical practice: 4. Developing competence. NT LEARNING CURVE 1998; 2:14-5. [PMID: 10196972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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