Current and potential providers of blood pressure self-screening: a mixed methods study in Oxfordshire.

OBJECTIVES: To (1) establish the extent of opportunities for members of the public to check their own blood pressure (BP) outside of healthcare consultations (BP self-screening), (2) investigate the reasons for and against hosting such a service and (3) ascertain how BP self-screening data are used in primary care. DESIGN: A mixed methods, cross-sectional study. SETTING: Primary care and community locations in Oxfordshire, UK. PARTICIPANTS: 325 sites were surveyed to identify where and in what form BP self-screening services were available. 23 semistructured interviews were then completed with current and potential hosts of BP self-screening services. RESULTS: 18/82 (22%) general practices offered BP self-screening and 68/110 (62%) pharmacies offered professional-led BP screening. There was no evidence of permanent BP self-screening activities in other community settings.Healthcare professionals, managers, community workers and leaders were interviewed. Those in primary care generally felt that practice-based BP self-screening was a beneficial activity that increased the attainment of performance targets although there was variation in its perceived usefulness for patient care. The pharmacists interviewed provided BP checking as a service to the community but were unable to develop self-screening services without a clear business plan. Among potential hosts, barriers to providing a BP self-screening service included a perceived lack of healthcare commissioner and public demand, and a weak-if any-link to their core objectives as an organisation. CONCLUSIONS: BP self-screening currently occurs in a minority of general practices. Any future development of community BP self-screening programmes will require (1) public promotion and (2) careful consideration of how best to support-and reward-the community hosts who currently perceive little if any benefit.

Radial and ulnar artery dominance in normal digits.

Pulse volume plethysmography was done on 1249 digits in 125 volunteers to determine relative blood flow to each digit. Twenty-five volunteers had diminished pulse contours (24:1 female to male); 20% of these had cold intolerance compared with 1% of the remaining volunteers. The 200 hands without vasospasm were used to calculate vessel dominance by comparing pulse volume plethysmography amplitudes during radial or ulnar artery compression. Only 5% were found to have ulnar artery dominance (ie, pulse volume plethysmography amplitude larger during radial artery compression) in all digits, and 28% were found to have complete radial artery dominance. Ulnar dominance in three or more digits was seen in 21.5% compared with 57% with radial artery dominance; 21.5% had equal dominance. Overall, 87% of thumbs and 70.5% of index, 60% of long, 52% of ring, and 52% of small fingers were radial dominant.

Disruption of reference in aging.

A homogeneous sample of normal adults living in a religious order in a study of age effects on reference as a cohesive device in discourse production and comprehension. Narrative and procedural discourse were examined across various levels of complexity and stimulus/response requirements. Results indicate that significant ambiguity of reference emerges in the younger elderly group (age 64-76) in comparison to the middle-aged group (age 27 to 55), and increases markedly in the older elderly group (age 77-92). Related impairments of comprehension and cognition were also observed. These findings are interpreted to be general features of linguistic variation with advancing age. Communicative consequences of ambiguous reference are discussed.

Metacarpophalangeal joint arthroplasty eleven year follow-up study.

During a period from April, 1972 to May, 1983, 339 Swanson silastic implants were implanted in eighty-two hands of fifty-five patients. A follow-up study was performed to evaluate the long-term function of these implants. Our follow-up study indicates that metacarpophalangeal joint arthroplasty can relieve pain, correct deformity, improve appearance and improve hand function by providing functional motion and stability. Few long-term problems were noted and the functional benefits gained by surgery decreased little with time. Patient satisfaction was high.