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1.  Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices. 
BACKGROUND: Patients who attend frequently may present a problem for general practitioners (GPs) in several ways. The frequency of patients' consulting, comparisons between practices, and the effect of frequent consulting on the clinical workload have not been quantified previously. AIMS: To examine the distribution of the number of consultations per patient in four general practices. To estimate the clinical workload generated by frequent attenders. To model the data to demonstrate the contribution of age, sex, and practice on the likelihood of attending frequently. METHOD: Analysis and modelling of a validated data set of date records of consultations collected routinely over a 41-month period from four practices in and around Leeds, representing 44,146 patients and 470,712 consultations. RESULTS: A minority of patients consulted with extreme frequency. All practices had similar distributions but varied with respect to the numbers of frequent attenders, and the frequencies of their consulting. The most frequent 1% of attenders accounted for 6% of all consultations, and the most frequent 3% for 15% of all consultations. Females and older people were more likely to be frequent attenders. CONCLUSION: Frequent attenders have an important effect on GPs clinical workload. Between one in six and one in seven consultations are with the top 3% of attenders. Further research is needed to explain the behaviour underpinning frequent attendance in order to identify appropriate management strategies; such strategies could have an important effect on clinical workload.
PMCID: PMC1409909  PMID: 9604412
3.  Evidence based general practice: a retrospective study of interventions in one training practice. 
BMJ : British Medical Journal  1996;312(7034):819-821.
OBJECTIVES--To estimate the proportion of interventions in general practice that are based on evidence from clinical trials and to assess the appropriateness of such an evaluation. DESIGN--Retrospective review of case notes. SETTING--One suburban training general practice. SUBJECTS--122 consecutive doctor-patient consultations over two days. MAIN OUTCOME MEASURES--Proportions of interventions based on randomised controlled trials (from literature search with Medline, pharmaceutical databases, and standard textbooks), on convincing non-experimental evidence, and without substantial evidence. RESULTS--21 of the 122 consultations recorded were excluded due to insufficient data; 31 of the interventions were based on randomised controlled trial evidence and 51 based on convincing non-experimental evidence. Hence 82/101 (81%) of interventions were based on evidence meeting our criteria. CONCLUSIONS--Most interventions within general practice are based on evidence from clinical trials, but the methods used in such trials may not be the most appropriate to apply to this setting.
PMCID: PMC2350715  PMID: 8608291
6.  Survey of general practice audit in Leeds. 
BMJ : British Medical Journal  1991;302(6773):390-392.
OBJECTIVE--To determine general practitioners' attitudes to medical audit and to establish what initiatives are already being undertaken; to define future ideas for audit and perceived difficulties in implementing audit in primary care. DESIGN--Analysis of responses to a self administered postal questionnaire. SETTING--Urban conurbation with a population of about 750,000. PARTICIPANTS--386 general practitioners on the general medical list of Leeds Family Practitioner Committee. MAIN OUTCOME MEASURES--Extent of recording of practice activity data and outcome measures and clinical data, use of data, and audit performed; ideas for audit and perceived difficulties. RESULTS--317 doctors responded to the questionnaire (individual response rate 82%) from 121 practices (practice response rate 88%). In all, 206 doctors thought that audit could improve the quality of care; 292 collected practice activity data, though 143 of them did not use it. A total of 111 doctors recorded some outcome measures, though half of them did not use them. Varying proportions of doctors had registers, for various diseases (136 had at least one register), disease management policies (60 doctors), and prescribing policies. In all, 184 doctors met monthly with other members of the primary health care team. CONCLUSIONS--Much poorly focused data collection is taking place. Some doctors have experience in setting up basic information systems and practice policies, and some audit is being performed. The family health services authorities need to take seriously the perceived difficulties of time, organisation, and resources concerned with audit.
PMCID: PMC1676315  PMID: 2004145
7.  Microhaematuria in general practice: is urine microscopy misleading? 
During a health centre screening programme for men aged 60 years and over, the urinary dipstick results of 58 patients found to have microscopic haematuria were compared with the results of immediate microscopy at the health centre and routine microscopy by a hospital laboratory. There was agreement between a positive dipstick test for haematuria and the presence of red cells at routine microscopy reported by the hospital laboratory in only 18 cases (31%). Routine urine microscopy results requested from general practice should not be taken as the criterion for deciding whether further investigation is needed in cases of microscopic haematuria.
PMCID: PMC1371144  PMID: 2107855
8.  Problems in using the hospital anxiety and depression scale for screening patients in general practice. 
A study was made of the feasibility of screening general practice patients for anxiety and depression using the hospital anxiety and depression scale. A group of consecutive patients aged 18 years and over completed the questionnaire at the surgery and an age and sex matched sample were sent questionnaires by post; 94 patients (84%) returned the postal questionnaire. A further group of 170 consecutive patients coming for consultation were recruited. Using a threshold score of eight and over, 51% of patients screened by post were probable 'cases' of psychiatric disorder and using a score of 11 and over, 28% were 'cases'. These proportions were similar for patients screened when attending the surgery. The findings are discussed in the context of well-person screening, and a strategy for follow-up of probable cases is put forward.
PMCID: PMC1371211  PMID: 2107836
9.  Dipstick haematuria: its association with smoking and nonsteroidal anti-inflammatory drugs. 
Of 1015 men over the age of 60, 125 (12.3%) were found to have dipstick haematuria on a single test. Analysis of smoking history revealed a 1.6 fold increased incidence of dipstick haematuria in current smokers as compared with ex-smokers and non-smokers. The relationship with bladder cancer and smoking is discussed. Several commonly used drugs, including nonsteroidal anti-inflammatory preparations, have been implicated as a cause of urinary tract bleeding. In this study of 1015 men over the age of 60, no association was found between the presence of dipstick haematuria and the intake of aspirin, other nonsteroidal anti-inflammatory drugs or warfarin.
PMCID: PMC1292557  PMID: 2325056
10.  Dipstick haematuria and bladder cancer in men over 60: results of a community study. 
BMJ : British Medical Journal  1989;299(6706):1010-1012.
OBJECTIVE--To investigate the prevalence and relevance of dipstick haematuria in a group of men in the community. DESIGN--Prospective study of elderly men invited to attend a health centre for urine screening as part of a health check. SETTING--An inner city health centre in Leeds. SUBJECTS--578 Of 855 men aged 60-85 responding to an invitation to participate. INTERVENTIONS--The subjects had their urine tested with a dipstick (Multistix) for the presence of blood and then tested their urine once a week for the next 10 weeks. Those with one or more positive test results were offered full urological investigation. MAIN OUTCOME MEASURE--The prevalence of urological disease in those subjects with dipstick haematuria. RESULTS--78 Men (13%) had dipstick haematuria on a single test and a further 54 (9%) had evidence of dipstick haematuria when testing their urine once a week during a subsequent 10 week period. Investigation of 87 men disclosed urological disease in 45, including four with a bladder tumour and seven with epithelial dysplasia. CONCLUSION--Dipstick haematuria is a common incidental finding in men over 60 and is associated with appreciable urological disease. The introduction of less invasive methods of investigation, particularly flexible cystoscopy and ultrasonography, has made investigation of these patients simple and safe and makes screening for bladder cancer in the community more feasible.
PMCID: PMC1837876  PMID: 2511941
12.  Novel replicative properties of a capsid mutant of bacteriophage phi chi 174. 
Journal of Virology  1976;18(3):942-949.
A capsid mutant of bacteriophage phi chi 174 demonstrates altered requirements for the conversion of viral single-stranded DNA to double-stranded replicative form DNA. In the presence of puromycin at 42 C, wild-type phi chi 174 is unable to complete this replicative event, whereas phi chi ahb is able to do so. Furthermore, in contrast to wild-type phi chi 174, formation of phi chi ahb parental replicative form DNA is sensitive to rifampin under certain experimental conditions. These data suggest that the mutant capsid proteins of phi chi ahb influence the biosynthesis of phi chi ahb complementary strand DNA.
PMCID: PMC354794  PMID: 775131
13.  Growth studies of three phi chi 174 mutants in tsDNA mutants Escherichia coli. 
Journal of Virology  1975;15(4):720-725.
Three mutants of phi chi 174 were examined for their abilities to grow in temperature-sensitive dna,A, dnaC, dnaE, or dnaG mutants of Escherichia coli. The results indicate that the phage mutants have acquired the ability to grow in some tsDNA mutants that normally block the replication of wild-type phi chi 174. Evidence is presented indicating that the phage mutants contain one or more altered structural proteins. Several models are presented to explain how altered phage structural proteins could affect phi chi 174 replication.
PMCID: PMC354514  PMID: 1090749
14.  Growth of a Capsid Mutant of Bacteriophage φX174 in a Temperature-Sensitive Strain of Escherichia coli 
Journal of Virology  1975;15(2):281-287.
A capsid mutant of φX174 is capable of forming replicative form and synthesizing single strands at the restrictive temperature in a dnaB mutant of Escherichia coli. Under similar conditions, the wild-type bacteriophage is incapable of either step in viral synthesis.
PMCID: PMC354451  PMID: 1089804
15.  Letter: Parents of battered babies. 
British Medical Journal  1974;1(5908):637.
PMCID: PMC1633459  PMID: 4821024
16.  Replication of Bacteriophage φX174 in a Temperature-Sensitive Deoxyribonucleic Acid Host Cell 
Journal of Virology  1971;8(4):594-596.
Bacteriophage φX174 is unable to replicate in Escherichia coli t3 at the restrictive temperature. However, if progeny phage synthesis is initiated at the permissive temperature, it will continue after a shift to the restrictive temperature.
PMCID: PMC376234  PMID: 4943079
17.  Host Cell Participation in Small Virus Replication I. Replication of M-13 in a Strain of Escherichia coli with a Temperature-sensitive Lesion in Deoxyribonucleic Acid Synthesis 
Journal of Virology  1968;2(11):1308-1314.
The replication of M-13 in a strain of Escherichia coli with a thermosensitive lesion in deoxyribonucleic acid synthesis was studied. M-13 failed to replicate at the restrictive temperature, even when the parental replicative form was allowed to form at the permissive temperature. When cells which were actively producing phage at the permissive temperature were shifted to the restrictive temperature, phage production continued. The incorporation of radioactive label into phage particles at 42 C indicated that continued single-strand synthesis was unaffected by the lesion in the host cell.
PMCID: PMC375470  PMID: 4883018
18.  Replication of Coliphage M-13 II. Intracellular Deoxyribonucleic Acid Forms Associated with M-13 Infection of Mitomycin C-treated Cells1 
Journal of Virology  1968;2(11):1296-1307.
Intracellular deoxyribonucleic acid (DNA) forms associated with bacteriophage M-13 infection have been isolated and characterized. Escherichia coli HF4704 (F+, hcr−, thy−) cells were treated with mitomycin C to inhibit host-cell DNA synthesis and were then infected with phage M-13. This treatment permitted radioactive labeling of phage-specific DNA forms with 3H-thymine. These labeled DNA components were characterized by sucrose density sedimentation and equilibrium density gradient centrifugation in neutral and ethidium bromide CsCl gradient. Two double-stranded circular forms were found with properties analogous to the replicative form I and replicative form II of φX174. A third component, identified as single-stranded DNA, was isolated in some samples removed 45 min after phage synthesis was initiated.
PMCID: PMC375469  PMID: 4883017
19.  Replication of Coliphage M-13 I. Effects on Host Cells After Synchronized Infection1 
Journal of Virology  1968;2(11):1290-1295.
Techniques have been described for synchronization of bacteriophage M-13 infection of host cells. The latent period in infected cells was 10 min, and no appreciable number of intracellular phage was observed. Phage production proceeded in three phases after release of the starvation block: an initial rapid exponential rate of progeny phage release without cell lysis, a period of rate transition accompanying the resumption of host cell division, and a second, slower exponential rate of phage production which paralleled the rate of host cell division. The size of infected cells was not affected by infection, but the generation time was increased by 25%. Starved infected cells exhibited a much longer lag in attaining an exponential rate of growth upon the addition of nutrients than did an uninfected control culture.
PMCID: PMC375468  PMID: 4883016
Journal of Bacteriology  1962;84(5):1076-1079.
Dowell, C. E. (The University of Texas, Dallas) and E. D. Rosenblum. Staphylococcal transducing particle. J. Bacteriol. 84:1076–1079. 1962.—When novobiocin-resistant transductants were isolated under conditions that permitted superinfection, almost all the clones were lysogenic for the transducing phage. If superinfection was prevented, then the transductants isolated were nonlysogenic, suggesting the defective nature of the transducing particle. It was noted that the transducing and plaque-forming particles showed no appreciable difference in buoyant density. No difference was found in transduction rates when either sensitive or lysogenic cells were used as recipients. Transduction rates as high as one transductant per 7 × 104 phage particles were obtained for novobiocin resistance.
PMCID: PMC278012  PMID: 16561970
Journal of Bacteriology  1962;84(5):1071-1075.
Dowell, C. E. (The University of Texas, Dallas) and E. D. Rosenblum. Serology and transduction in staphylococcal phage. J. Bacteriol. 84:1071–1075. 1962.—A triply lysogenic strain of Staphylococcus aureus was shown to carry a serological group B phage capable of transduction. Three typing phages (53, 80, 42D), either belonging to serological group B or having a close association with it, were also shown to have transducing ability. A rapid screening method was used to isolate two new transducing phages, both of which belonged to serological group B. Propagating strain 42B/47C was found to carry a transducing phage that was neutralized by both group B and group F antisera. Nine other phages belonging to serological groups other than group B did not have generalized transducing ability, nor did three group B typing phages that were atypical in their calcium requirement. It was postulated that transducing ability is associated with staphylococcal phages of serological group B and with related phages of group F.
PMCID: PMC278011  PMID: 16561969

Results 1-21 (21)