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1.  COMMENTARY 
Quality & safety in health care  2003;12(3):227-228.
doi:10.1136/qhc.12.3.227
PMCID: PMC1743705
2.  Stress, burnout and doctors' attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates 
BMC Medicine  2004;2:29.
Background
The study investigated the extent to which approaches to work, workplace climate, stress, burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students.
Methods
Prospective study of a large cohort of doctors. The participants were first studied when they applied to any of five UK medical schools in 1990. Postal questionnaires were sent to all doctors with a traceable address on the current or a previous Medical Register. The current questionnaire included measures of Approaches to Work, Workplace Climate, stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). Previous questionnaires had included measures of learning style (Study Process Questionnaire) and personality.
Results
Doctors' approaches to work were predicted by study habits and learning styles, both at application to medical school and in the final year. How doctors perceive their workplace climate and workload is predicted both by approaches to work and by measures of stress, burnout and satisfaction with medicine. These characteristics are partially predicted by trait measures of personality taken five years earlier. Stress, burnout and satisfaction also correlate with trait measures of personality taken five years earlier.
Conclusions
Differences in approach to work and perceived workplace climate seem mainly to reflect stable, long-term individual differences in doctors themselves, reflected in measures of personality and learning style.
doi:10.1186/1741-7015-2-29
PMCID: PMC516448  PMID: 15317650
5.  Association of use of a log book and experience as a preregistration house officer: interview survey. 
BMJ : British Medical Journal  1997;314(7075):213-215.
OBJECTIVE: To determine whether use of a log book improved the experiences of preregistration house officers. DESIGN: Confidential questionnaire and interview survey of preregistration house officers carried out as part of University of London inspection process. MEASURES: Preregistration house officers were asked to rate educational and pastoral elements of their posts and about the use made of previously distributed log books. SUBJECTS AND SETTING: Preregistration house officers in North Thames. RESULTS: The incumbents of 535 of 560 (95%) preregistration house officer posts in the region were surveyed between June 1994 and July 1995, 490 by questionnaire and interview, 45 by questionnaire alone. House officers who had discussed the log book with their consultant expressed more satisfaction with their induction, consultant supervision and feedback, and formal and informal education and were more likely to recommend their job to a friend. CONCLUSION: Preregistration house officers who had discussed the log book with their consultant expressed more satisfaction with the educational elements of their jobs. The structured discussion with their consultant about the job and their performance seemed to make the difference.
PMCID: PMC2125655  PMID: 9022443
6.  Reflex sympathetic dystrophy. 
BMJ : British Medical Journal  1995;310(6995):1645-1648.
Images
PMCID: PMC2550015  PMID: 7795454
7.  A case cluster of possible tissue invasive gonorrhoea. 
Genitourinary Medicine  1995;71(2):126-128.
OBJECTIVE--To describe a cluster of patients presenting with severe symptoms and infected with an unusual strain of Neisseria gonorrhoeae. SETTING--A north London Department of Sexual Health. PATIENTS--Five patients were linked by reported sexual contact or other epidemiological evidence as part of a cluster of gonococcal infection. Cultured N gonorrhoea were subtyped by serological (serovar) and cultural (auxotype) methods and antibiotic sensitivities measured by minimum inhibitory concentration (MIC). RESULTS--Four of the patients had severe gonorrhoea-related systemic or extragenital symptoms: disseminated gonococcal infection with oligoarthritis (1 patient), acute pelvic inflammatory disease (1 patient, who was also chlamydia positive) and tender inguinal adenopathy (2 patients). The fifth patient was asymptomatic. N gonorrhoeae was isolated in four of the patients. All four organisms had identical MICs. Three of the organisms were subtyped and found to be the same rare strain (serovar 1A1, auxotype NR). CONCLUSION--This case cluster provides evidence for strain-related virulence in an uncommon gonococcal subtype.
PMCID: PMC1195469  PMID: 7744403
8.  ABC of rheumatology. Pain in the hip and knee. 
BMJ : British Medical Journal  1995;310(6975):319-322.
Images
PMCID: PMC2548703  PMID: 7866179
11.  Autonomic neuropathy in systemic sclerosis: a case report and evaluation of six patients. 
Annals of the Rheumatic Diseases  1986;45(11):957-960.
We describe a case of systemic sclerosis with sympathetic and parasympathetic neuropathy and detail autonomic testing in six further patients. Of these six patients, three showed early parasympathetic damage. None of the patients had evidence of peripheral neuropathy, and there was no correlation between the presence of autonomic dysfunction and the severity of Raynaud's phenomenon.
PMCID: PMC1002028  PMID: 3789830
12.  Spontaneous fracture of the sternum and sternal tuberculosis. 
Thorax  1987;42(12):984-985.
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PMCID: PMC461064  PMID: 3125625
13.  An immunohistological study of secondary Sjögren's syndrome. 
Annals of the Rheumatic Diseases  1984;43(3):470-476.
The labial biopsies from 13 patients with secondary Sjögren's syndrome (SS) and four disease controls were examined with a panel of monoclonal antibodies to human leucocyte antigens. Large numbers of T cells were found in most of the biopsies. In seven SS patients the T helper/inducer subset was found to be predominant. Antibody to HLA class I antigens consistently stained leucocytes, but other cell types stained more variably. Although the staining with antibody to HLA class II antigen was often weak, approximately as many cells stained with this antibody as with an antileucocyte antibody, implying that the T cells were activated. Anti-IgD revealed membrane staining of a corona of IgD-positive cells in structures resembling germinal centres. Isolated cells throughout the sections also showed strong cytoplasmic staining with anti-IgD. These results suggest a role for T-cell-dependent local antibody synthesis in the pathogenesis of the disease.
Images
PMCID: PMC1001372  PMID: 6378107
14.  Serum angiotensin converting enzyme in Sjogren's syndrome--a case report and study of 21 further cases. 
Postgraduate Medical Journal  1984;60(702):270-271.
We report the case of an elderly woman with primary Sjogren's syndrome and abnormal liver function tests indicative of primary biliary cirrhosis. She was found to have a raised serum angiotensin converting enzyme activity. We proceeded to study 21 further cases of Sjogren's syndrome to discover whether raised levels of this enzyme were a feature of Sjogren's syndrome. None of them had any features to suggested associated primary biliary cirrhosis. The cases included 12 with associated rheumatoid arthritis, two with systemic sclerosis, three with systemic lupus erythematosus and four with primary Sjogren's syndrome. In only two of these 21 patients was a raised serum angiotensin converting enzyme obtained, the elevation being modest. We conclude that a raised activity of the enzyme is not usually associated with primary or secondary Sjogren's syndrome, and that discovery of such an abnormality should prompt a search for an associated condition.
PMCID: PMC2417831  PMID: 6328467
15.  The use of C3d as a means of monitoring clinical activity in systemic lupus erythematosus and rheumatoid arthritis. 
Annals of the Rheumatic Diseases  1983;42(6):668-671.
Plasma samples from 44 patients with systemic lupus erythematosus (SLE) and 43 with rheumatoid arthritis (RA) were assayed for C3d, a breakdown product of the third component of complement (C3), which was also measured in parallel. Levels of C3d varied in direct proportion with disease activity in RA, whereas C3 showed little change. Although C3d values also increased with worsening clinical condition in SLE, this trend was not considered to be sufficiently clear to be useful and did not provide any advantage over the routinely performed C3 assay.
PMCID: PMC1001326  PMID: 6606402
16.  Sternoclavicular erosions in polymyalgia rheumatica. 
Annals of the Rheumatic Diseases  1983;42(4):379-383.
The incidence of erosive arthropathy of the sternoclavicular joints in 25 consecutive cases of polymyalgia rheumatica was studied by means of sternoclavicular tomography. Definite erosions were found in 11 patients. Erosions were most likely to be found in patients whose symptoms had been present for more than 6 months.
Images
PMCID: PMC1001246  PMID: 6882033
17.  Letter: practolol, indoramin, and asthma. 
British Medical Journal  1975;2(5971):617.
PMCID: PMC1673496  PMID: 1131650
18.  Back pain. 
1. Back pain is very common and can be the result of a wide range of different conditions. A detailed history of the complaint often points towards the cause. Positional backache suggests a mechanical cause, unremitting pain may indicate malignancy or infection especially if accompanied by night sweats, whereas morning stiffness is more often the result of inflammation. 2. Examine the patient lying and standing as outlined. A general examination should also be performed if there is a history of weight loss, night sweats, or if the patient looks ill. 3. The vast majority of cases of backache are mechanical in origin. Plain x-rays are not normally contributory and should be avoided unless there are factors in the history and examination suggestive of infection or malignancy. 4. Patients with backache and sphincter disturbance and/or perineal anaesthesia require immediate hospital admission. 5. Analgesia and bed rest are the mainstays of treatment for acute backache of mechanical origin. Once there has been some improvement, physiotherapy can be beneficial. 6. Chronic back pain is present if the complaint lasts for more than 8 weeks. Investigations should include full blood count, ESR, calcium and alkaline phosphatase. The patient needs to be referred to a rheumatologist or orthopaedic surgeon for further assessment and possible imaging studies. If no cause other than mechanical dysfunction is found the patient should be assessed by a physiotherapist and taught back care.
PMCID: PMC2560219  PMID: 1345153

Results 1-18 (18)