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Articles by A. Edwards
Total Records ( 4 ) for A. Edwards
  A. Edwards , A. Springett , J. Padfield , J. Dorling , G. Bugg and P. Mansell
 

Aims

The reason for the fivefold increased risk of stillbirth in women with diabetes is not known. Further understanding of the underlying mechanisms may facilitate identification of pregnancies at increased risk. We have compared post-mortem reports in matched pairs of stillbirths in women with and without diabetes.

Methods

Post-mortem reports were provided by the Centre for Maternal and Child Enquiries. Stillbirths as a result of lethal congenital and genetic abnormalities were excluded. Whole body, placenta and organ weights and histo-pathological findings in cases and controls were compared and also related to published reference values.

Results

We analysed post-mortem reports on 23 matched pairs of stillbirths from 2009 to 2010. Mean placental weight in women with diabetes was 75 g less than in control subjects (95% CI −143 to −7 g; P = 0.032). In maternal diabetes, the thymus was often small and showed a ‘starry sky’ pattern on histology in 11 of 20 cases compared with four of 22 controls (P = 0.03). This histological finding was associated with a particularly low mean placental weight z-score −2.1 (1.1) standard deviations below a reference population corrected for gestational age.

Conclusions

In over half of the stillbirths occurring in women with diabetes, there was a ‘starry sky’ appearance in the fetal thymus on histology, this being associated with a small placenta. These findings are consistent with a critical subacute metabolic disturbance being a prominent cause of the increased risk of stillbirth in pregnancies complicated by maternal diabetes.

  M Kelly , J. N Egbunike , P Kinnersley , K Hood , E Owen Jones , L. A Button , C Shaw , A Porter , H Snooks , S Bowden and A. Edwards
 

Background. Several different models of out-of-hours primary care now exist in the UK. Important outcomes of care include users’ satisfaction and enablement to manage their illness or condition, but the determinants of these outcomes in the unscheduled care domain are poorly understood.

Aim. To identify predictors of user satisfaction and enablement across unscheduled care or GP out-of-hours service providers in Wales. The design of the study is a cross-sectional survey. The setting of the study is nine GP out-of-hours services, three Accident and Emergency units and an all Wales telephone advice service in Wales.

Methods. Postal survey using the Out-of-hours Patient Questionnaire. Logistic regression was used to fit both satisfaction and enablement models, based on demographic variables, service provider and treatment received and perceptions or ratings of the care process.

Results. Eight hundred and fifty-five of 3250 users responded (26% response rate, range across providers 14–41%, no evidence of non-response bias for age or gender). Treatment centre consultations were significantly associated with decreased patient satisfaction and decreased enablement compared with telephone advice. Delays in call answering or callback for triage and shorter consultations were significantly associated with lower satisfaction. Waiting more than a minute for initial call answering was associated with lower enablement.

Conclusions. Giving users more time to discuss their illness in consultations may enhance satisfaction and enablement but this may be resource intensive. More simple interventions to improve access by quicker response and triage, and keeping users informed of waiting times, could also serve to increase satisfaction and ultimately impact on their enablement.

  P Kinnersley , J. N Egbunike , M Kelly , K Hood , E Owen Jones , L. A Button , C Shaw , A Porter , H Snooks , S Bowden and A. Edwards
 

Background. Considerable changes have occurred over the last 5 years in the organization of out-of-hours care in the UK. Users’ experiences of their care are an important part of ‘quality of care’ and are valuable for identifying areas for improvement.

Aim. To identify strengths and weaknesses of out-of hours service provision in Wales. The design of the study is a cross-sectional survey. The setting of the study is nine GP services, three Accident and Emergency units and NHS Direct in Wales.

Method. Survey using the validated Out-of-Hours questionnaire. We identified the four most and least favourably rated items regarding users’ experience of care. These were analysed by type of care provided, telephone advice, treatment centre and home visit groups.

Results. Eight hundred and fifty-five of 3250 users responded (26% response rate). Across providers and types of care, consistent strengths were the ‘manner of treatment by call operator’ and the ‘explanation of the next step by call operator’. Consistent weaknesses were the ‘speed of call back by the clinician’, the ‘information provided by the GP’, ‘getting medication after the consultation’ and ‘when to contact the (in-hours) GP’.

Conclusions. Users of out-of-hours care identify clear and consistent strengths and weaknesses of service provision across Wales. Specific areas for improvement concern the interface between in-hours care and out-of-hours care and between out-of-hours care and self-care. GP surgeries need to give better information on how to access the out-of-hours services. Out-of-hours providers should improve their advice on how and when to access in-hours surgeries and also improve the availability of medicines after out-of-hours consultations.

  N. Bernard , A. Mohammed , A. Edwards and P. Bridgemohan
  Leaf and gel extracts of Aloe barbadense are added to the drinking water in local broiler production to reduce mortality and enhance broiler performance. In this study, 420 day-old chicks (Aber Acres) were randomly divided into 7 groups of 60 chicks of mixed sexes of 20 per replicate (3 replicates per group). The experiment used a 2 x 3 x 3 randomized design with three experimental treatments of either Aloe vera (Aloe barbadense) gel T1, T2, T3, or leaf (T4, T5, or T6) and one control. Across the 42-day grow-out period, there were no significant differences (p>0.05) in feed intake (FI), water consumption (WI), average daily gain (ADG), or feed-conversion ratios (FCR) across treatments. At the end of 21 days, however, the lowest FCR indicator of best performance was found in the T6 20 mL-treated leaf extract group. However, both the 20 mL leaf and 15 mL gel extracts were likely to produce birds of similar weights as traditionally formulated feeds for broilers. Therefore, poultry producers should include a moderate level of Aloe vera gel and the highest leaf extracts in the drinking water, as these extracts may prove to be more cost effective than manufactured feeds for optimal broiler performance. It may also be more cost effective for the poultry producer to use the 20 mL leaf and gel extracts as a means of reducing overall mortality. The finding that compounds in Aloe vera foster less bone deposition and greater muscle accretion in female broilers warrants further investigation.
 
 
 
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