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Papers by Richard Primavesi
BMJ, 1983
An outbreak of colonisation and infection with a netilmicin resistant strain of Serratia marcesce... more An outbreak of colonisation and infection with a netilmicin resistant strain of Serratia marcescens occurred in a special care baby unit. S marcescens was isolated from a total of 13 babies; significant infection occurred in five, of whom two died. Epidemiological investigation failed to detect a common source but gastrointestinal colonisation of babies formed a prolonged and possibly important reservoir for infection. Containment proved difficult until the unit was closed to new admissions, and even then spread to a temporary unit ensued. 0 Serotyping and bacteriophage typing disclosed a single epidemic strain. This produced an aminoglycoside acetylating enzyme (AAC(6')) conferring resistance to netilmicin and tobramycin and moderate resistance to amikacin. Use of gentamicin resulted in the isolation of serratia with increased resistance to all aminoglycosides, and, similarly, increased resistance to third generation cephalosporins emerged with their use.
The Lancet, 1982
It would be comforting to think that a simple answer could be found to the difficult problem of i... more It would be comforting to think that a simple answer could be found to the difficult problem of informed consent in medical practice. Dr Brewin (Oct. 23, p. 919) and Mr Bywater (Nov. 6, p. 1051) appear to have found it-the doctor should inform only those patients who ask for information. It would be a grave error, however, to regard this as an acceptable approach to the problem. As the British Medical Association's Handbook on Medical Ethics states (para 1.9): "The onus is always on the doctor carrying out the procedure to see that an adequate explanation is given." Were it otherwise, informed consent would become the luxury of those patients sufficiently articulate, self-confident, and foresighted to ask questions of their doctor. To say that "those who don't ask, don't want" is surely a complete non-sequitur in the context of the consulting room.
BMJ, 1983
An outbreak of colonisation and infection with a netilmicin resistant strain of Serratia marcesce... more An outbreak of colonisation and infection with a netilmicin resistant strain of Serratia marcescens occurred in a special care baby unit. S marcescens was isolated from a total of 13 babies; significant infection occurred in five, of whom two died. Epidemiological investigation failed to detect a common source but gastrointestinal colonisation of babies formed a prolonged and possibly important reservoir for infection. Containment proved difficult until the unit was closed to new admissions, and even then spread to a temporary unit ensued. 0 Serotyping and bacteriophage typing disclosed a single epidemic strain. This produced an aminoglycoside acetylating enzyme (AAC(6')) conferring resistance to netilmicin and tobramycin and moderate resistance to amikacin. Use of gentamicin resulted in the isolation of serratia with increased resistance to all aminoglycosides, and, similarly, increased resistance to third generation cephalosporins emerged with their use.
The Lancet, 1982
It would be comforting to think that a simple answer could be found to the difficult problem of i... more It would be comforting to think that a simple answer could be found to the difficult problem of informed consent in medical practice. Dr Brewin (Oct. 23, p. 919) and Mr Bywater (Nov. 6, p. 1051) appear to have found it-the doctor should inform only those patients who ask for information. It would be a grave error, however, to regard this as an acceptable approach to the problem. As the British Medical Association's Handbook on Medical Ethics states (para 1.9): "The onus is always on the doctor carrying out the procedure to see that an adequate explanation is given." Were it otherwise, informed consent would become the luxury of those patients sufficiently articulate, self-confident, and foresighted to ask questions of their doctor. To say that "those who don't ask, don't want" is surely a complete non-sequitur in the context of the consulting room.