Piloting a new approach in primary care to identify, assess and support carers of people with terminal illnesses: a feasibility study.

Background: General practices in the United Kingdom are encouraged to have a protocol for the identification of carers and a mechanism for social care referral. However, a minority of carers are identified and those caring for someone with a terminal illness often cope until the situation becomes overwhelming. Earlier identification could enable more timely support.

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions.

Background: Injury surveillance has been established since the 1990s, but is still largely based upon single-source data from sentinel sites. The growth of electronic health records and developments in privacy protecting linkage technologies provide an opportunity for more sophisticated surveillance systems.

Objective: To describe the evolution of an injury surveillance system to support the evaluation of interventions, both simple and complex in terms of organisation.

Unusual trend in the prevalence of trisomy 13 in mothers aged 35 and older: A population based study of national congenital anomaly data.

Background: Trisomy 13 is one of the three autosomal trisomies compatible with viability. It is associated with structural anomalies, learning disability and poor survival. Advanced maternal age is the most frequently suggested risk factor.

Understanding the barriers to identifying carers of people with advanced illness in primary care: triangulating three data sources.

Background: Approximately 10% of the UK population have an unpaid caring role for a family member or friend. Many of these carers make a significant contribution to supporting patients at the end of life. Carers can experience poor physical and psychosocial wellbeing, yet they remain largely unsupported by health and social care services.

Profiling health in the UK and Ireland.

The technique of describing health using a range of measures has been termed 'health profiling'. This article discusses the emergence of health profiling in the UK and Ireland over recent years, led by the public health observatories (PHOs). The steps in developing health profiles are described, including defining the purpose, consulting users, choosing indicators, establishing the methods of presentation, disseminating and evaluating.

Developing the public health intelligence workforce in the UK.

Recent UK health policies have consistently stressed the importance of basing local action on evidence and local intelligence. A suitably skilled workforce is required to achieve this. In recent years, a new cadre of skilled public health intelligence practitioners has emerged in the UK.

Audit of the relationship between episiotomy and risk of major perineal laceration during childbirth.

The beneficial effect of mediolateral episiotomy in reducing major perineal lacerations during childbirth has been questioned. In a test of the hypothesis of no association between episiotomy and the incidence of major perineal lacerations, the incidence of major perineal laceration was determined in three cohort groups in one maternity unit between 1984 and 1991. Among those undergoing non-instrumental delivery, no reduction in the incidence of major lacerations could be demonstrated following episiotomy.

Chronic beryllium disease in a dental laboratory technician.

Workers involved in the manufacture of dental prostheses are exposed to a number of potentially harmful substances capable of inducing lung disease. In this report, we describe a dental laboratory technician who developed chronic beryllium disease as a result of exposure in the workplace. The diagnosis of chronic beryllium disease was suspected from the clinical, radiographic, and histologic features and confirmed by the in vitro proliferation of lung lymphocytes to beryllium salts.

Beta-adrenoceptors in human lung, bronchus and lymphocytes.

The ability of propranolol, metoprolol, acebutolol, atenolol and practolol to reverse the stimulant effect of 10 M isoprenaline on lymphocyte cyclic AMP levels was determined. The ratios of doses required to produce 50% inhibition as compared with propranolol were 1:316 for metoprolol 1:1780 for acebutolol and 1:2820 for atenolol. No ratio could be calculated for practolol as it never produced more than 35% inhibition possibly because of its intrinsic sympathomimetic activity.

Comparison of four weeks' treatment with fenoterol and terbutaline aerosols in adult asthmatics. A double-blind crossover study.

Fenoterol and terbutaline, two long-acting beta 2-adrenoceptor agonists in aerosol form, were compared in an 8-wk randomized double-blind crossover study in 22 mild to moderately severe asthmatics. Patients completed diary cards, recorded peak expiratory flow rate (PEFR) twice daily, and attended a clinic for measurement of PEFR, 1-sec forced expiratory volume (FEV1), and forced vital capacity (FVC) twice during each treatment period. Fifteen patients completed the study; 5 dropped out while using fenoterol, and 2 while using terbutaline.

Use of exercise challenge to investigate possible tolerance to beta-adrenoceptor stimulation in asthma.

The effect of prolonged salbutamol administration on beta-adrenoceptor function in asthma has been examined. Six adult patients received salbutamol tablets (16 mg daily) for between 4 and 20 weeks and six adolescents received salbutamol aerosol (800 microgram daily) for 2--5 weeks. Before and after the treatment period the acute bronchodilator response to inhaled salbutamol and the ability of inhaled salbutamol to protect against exercise-induced asthma were examined.

Desensitization of the beta-adrenoceptor of lymphocytes from normal subjects and asthmatic patients in vitro.

1 A lymphocyte culture method has been developed for studying in vitro the effect of prolonged exposure (24 h) to isoprenaline (10(-8) to 10(-6) mol/l) and prostaglandin E1 (PGE1; 2.8 x 10(-6) mol/l). 2 The cyclic AMP response to isoprenaline is reduced by prolonged exposure to isoprenaline.

Desensitization of the beta-adrenoceptor of lymphocytes from normal subjects and patients with phaeochromocytoma: studies in vivo.

1 Following the observation that lymphocyte beta-adrenoceptor responsiveness was not depressed in asthmatics treated only with non-adrenergic drugs we have explored the effects of prolonged exposure to beta-adrenoceptor agonists in normal subjects. 2 Treatment with oral salbutamol (12-16 mg/kg/day for 10 days), or with inhaled salbutamol (3000 microgram/day for 8-10 days) resulted in a significant reduction in lymphocyte beta-adrenoceptor responsiveness. 3 A 48 h infusion of isoxsuprine (10 mg/h) resulted in a marked depression of lymphocyte beta-adrenoceptor responsiveness (P less than 0.

The beta-adrenoceptor of the human lymphocyte and human lung parenchyma.

1 The response of the beta-adrenoceptors of human lymphocytes to selective agonists and antagonists has been studied quantitatively by measuring changes in cyclic adenosine-3',5'-monophosphate (cyclic AMP) levels. 2 The receptor was activated by isoprenaline and by salbutamol, and blocked by propranolol but not by practolol. A similar pattern of response was obtained with fragments of human lung tissue.

The lymphocyte beta-adrenoceptor in normal subjects and patients with bronchial asthma: the effect of different forms of treatment on receptor function.

beta-Adrenoceptor function has been compared in lymphocytes of normal subjects, asthmatic patients taking large doses of beta-adrenergic bronchodilators, and comparable asthmatics treated exclusively with nonadrenergic medication. The effect of prolonged administration of beta-adrenoceptor agonists on receptor function in normal subjects has also been examined. beta-receptor response in each situation was quantitated by changes in levels of cyclic AMP, measured by a protein-binding assay.

Comparison of levodopa with carbidopa or benserazide in parkinsonism.

The therapeutic efficacy and side-effects of two preparations of levodopa with extracerebral decarboxylase inhibitors have been compared in 19 patients with idiopathic parkinsonism in a blind randomised crossover trial. The mean daily dose of levodopa was 658 +/- 64 mg/day (mean +/- S.E.

The cardiovascular effects of bromocriptine in Parkinsonism.

The cardiovascular effects of bromocriptine, a dopamine receptor agonist, were investigated in twenty-eight Parkinsonian patients. Bromocriptine caused a significant impairment of postural compensation with a fall in systolic pressure and an absence of the rise in diastolic pressure after standing for 1 min when patients taking active drug were compared to the same patients on placebo. The hypotensive effect persisted for at least 6 weeks of treatment.

Idiopathic parkinsonism treated with bromocriptine.

The efficacy and toxicity of bromocriptine, a drug which simulates dopamine, have been studied in twenty-eight patients with idiopathic parkinsonism. A double-blind, within-patient comparison between maximum tolerated doses of bromocriptine (mean 46-9 mg daily) and placebo revealed a substantial and statistically significant therapeutic response to the active drug. Adverse reactions were dose dependent, reversible, and similar to those encountered with levodopa.