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Biomedical subjects

A Grant

Publications and source records attributed to A Grant.

At least 109 records · Page 6Linked to original sources
PubMed1998

Treatment for aphasia following stroke: evidence for effectiveness.

A systematic review of SLT for aphasia following stroke, for the Cochrane Collaboration Stroke Group. Twelve randomised controlled trials were identified, however there was no standard comparison group amongst the trials. Based on this review, it is not possible to reach a conclusion about the effectiveness of the treatments evaluated in these trials. Further research is therefore indicated, and SLTs must base decisions about treatment for aphasia on other forms of evidence.

Aphasia↗
PubMed1998

Beliefs about effectiveness of treatment for aphasia after stroke.

A postal survey of SLTs in Scotland was conducted. 598 SLTs responded, 194 worked with people aphasic after stroke. A number of obstacles to the provision of the SLT service to aphasic people were identified. SLTs expressed concern about the effectiveness of the treatments they offered, and about factors which may influence effectiveness. A number of suggestions are made for further research into this area including into the problems of competing client groups.

Aphasia↗
PubMed1998

Informatics methodologies for evaluation research in the practice setting.

A continuing challenge in health informatics and health evaluation is to enable access to the practice of health care so that the determinants of successful care and good health outcomes can be measured, evaluated and analysed. Furthermore the results of the analysis should be available to the health care practitioner or to the patient as might be appropriate, so that he or she can use this information for continual improvement of practice and optimisation of outcomes. In this paper we review two experiences, one in primary care, the FAMUS project, and the other in hospital care, the Autocontrol project. Each project demonstrates an informatics approach for evaluation research in the clinical setting and indicates ways in which useful information can be obtained which with appropriate feed-back and education can be used towards the achievement of better health. Emphasis is given to data collection methods compatible with practice and to high quality information feedback, particularly in the team context, to enable the formulation of strategies for practice improvement.

Cross-Sectional Studies↗
PubMed1997

Analytical evaluation of the CK-MB mass assay on the Technicon Immuno 1 system.

OBJECTIVES: To evaluate the performance of the Technicon Immuno 1 CK-MB mass assay. DESIGN AND METHODS: The precision was measured using the BioRad Liquichek CK-MB controls and the Technicon Immuno 1 SETpoint CK-MB calibrators. The linearity was verified by diluting 9 patient serum samples containing high CK-MB concentrations, and the minimum detectable concentration determined by repetitive analysis of the zero calibrator. The assay was compared with the Johnson & Johnson Vitros CK-MB activity assay using 111 patient serum samples. The reference range was determined using serum samples from 100 healthy adult volunteers. RESULTS: The assay shows within-run CVs varying from 1.5 to 7.5% and between-day CVs from 1.5 to 4.8% for CK-MB concentrations ranging from 3.9 to 99.0 micrograms/L. The linearity study gave correlation coefficients greater than 0.9961. There was a very good correlation between mass and activity assays (r = 0.985). The reference values were estimated at 0.0-4.2 micrograms/L and the minimum detectable concentration at 0.5 micrograms/L. CONCLUSIONS: The evaluation shows that the Technicon Immuno 1 CK-MB mass assay has the analytical characteristics suitable for its inclusion in the modern clinical repertoire.

Creatine Kinase↗
PubMed1997

Salter-Harris type III fracture-dislocation of the proximal humerus.

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result.

Child↗
PubMed1997

A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia.

OBJECTIVE: To compare endometrial laser ablation (ELA) with transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia. DESIGN: Randomised controlled trial. SETTING: Gynaecology department of a large teaching hospital. PARTICIPANTS: Women with menorrhagia due to dysfunctional uterine bleeding (n = 372) were randomly allocated to ELA (n = 188) or TCRE (n = 184). MAIN OUTCOME MEASURES: Operative complications, post-operative recovery, relief of menstrual and other symptoms, need for further surgical treatment, satisfaction with treatment after 6 and 12 months, and differential resource use. RESULTS: TCRE was significantly quicker, with lower rates of fluid overload. Perioperative morbidity was low and similar in both groups. Outcome at 12 months was also similar: 72 women (45%) had either amenorrhoea or brown discharge in the ELA group compared with 71 (49%) in the TCRE group; 79 (49%) versus 68 (46%) had lighter periods. Thirty (16%) versus 36 (20%) had received further surgical treatment: 9 (5%) compared with 25 (14%) had had a hysterectomy and 21 (11%) versus 11 (6%) had received repeat ablation. Anxiety and depression, dysmenorrhoea and pre-menstrual symptoms were improved by both procedures and bladder symptoms were affected by neither. At 12 months 148 (90%) women in the ELA group and 140 (91%) women in the TCRE group were satisfied with their treatment. The estimated additional cost of ELA was Pound 145 per procedure. CONCLUSIONS: At one year there was no clear difference in clinical outcome between ELA and TCRE. Both procedures were associated with low morbidity. ELA was the more costly procedure. Despite the need for further surgery for about one in six women, satisfaction rates were high following both ELA and TCRE.

Adult↗
PubMed1997

Analytical performance of Bayer Immuno 1 estradiol and progesterone assays.

We evaluated the analytical performance of new estradiol and progesterone assays performed on the Bayer Immuno 1 system. Within-run and between-day CVs for estradiol at concentrations of 116.8-6645.8 pmol/L were < or = 6.4% and for 5.54-103.95 nmol/L progesterone were < or = 7.7%, thus meeting published analytical goals. The detection limits (2 SDs from mean of zero calibrator) were 27.1 pmol/L for estradiol (n = 72 over 20 days) and 0.51 nmol/L for progesterone (n = 47 over 20 days). The assays were linear to 9766 pmol/L and 113.0 nmol/L, respectively. Estradiol results agreed well with the Diagnostic Products Corporation (DPC) assays, except for serum samples from patients receiving estrogen replacement therapy; results for these samples agreed closely with the DPC estradiol-6 assay. The progesterone assay agreed closely with the DPC assay, except for samples from uremic patients. Reference values were estimated by the study of 29 women throughout the menstrual cycle with 15 samples per subject. We concluded that both assays demonstrate suitable precision, linearity, and intermethod agreement to allow their use in the clinical laboratory.

Automation↗
PubMed1996

Surgical research.

Explore the source record for details and available documents.

General Surgery↗
PubMed1996

The Impact of Environmental Variation on Demographic Convergence of Leslie Matrix Population Models: An Assessment Using Lyapunov Characteristic Exponents

In a constant environment, the rate of convergence of a density-independent Leslie matrix model to stable age distribution is determined by the damping ratio (the ratio of the absolute magnitudes of the first and second eigenvalues of the projection matrix). In a stochastic environment, the difference between the first two Lyapunov exponents is known to be analogous to the logarithm of the damping ratio, but there has been no systematic investigation of the consequences of enviromnental variation on convergence rates. In this study, the Lyapunov spectrum has been calculated for a wide variety of density-independent projection matrices subject to random variations in vital rates. This allows the impact of these random variations on convergence rates to be assessed. For rapidly convergent life histories, stochastic variation leads to a decrease in convergence rate. For life histories which are slow to converge, stochastic variation speeds up convergence. These effects are, however, relatively minor, and the value of the damping ratio for the mean matrix is a good predictor of the damping ratio in a stochastic environment. Consequently, when only an approximate indication of convergence rates is needed, the damping ratio for the mean projection matrix gives a very good guide. Detailed calculations of the Lyapunov spectrum would only be necessary to make comparisons between similar life histories or if very precise information on convergence rates were needed.

Journal Article↗
PubMed1996

Evaluation of household dust mite exposure and levels of specific IgE and IgG antibodies in asthmatic patients enrolled in a trial of immunotherapy.

BACKGROUND: Monitoring the response to immunotherapy entails understanding exposure to relevant allergens. For the major indoor allergens, this requires sampling of dust from the patient's house. The objectives of this study were to measure indoor allergen levels during a controlled trial of dust mite immunotherapy for asthma and to relate these results to serum antibody levels. METHODS: Eighty-eight asthmatic patients with mite allergy from seven geographic areas in the United States were enrolled in and completed a course of immunotherapy with Dermatophagoides extract or placebo control. Sensitization was evaluated by quantitative measurements of IgG and IgE antibodies. Dust samples were assayed for group I mite (Der p 1 and Der f 1), cat (Fel d 1), and cockroach (Bla g 1) allergens by monoclonal antibody-based ELISA. RESULTS: Over the 4 years of the study, each of the houses had at least one sample that contained more than 2 micrograms of group I mite allergen per gram of dust. Mean mite allergen levels, however, varied over a wide range, from 0.2 microgram/gm or less to more than 50 micrograms/gm. IgE antibodies to mite were present in sera from 78% of the patients, whereas IgE antibodies to cat and cockroach allergens were found in sera from 34% and 11% of patients, respectively. Sixty-four percent of the patients had exposure and sensitization to mite, whereas the comparable figure for each of the other allergens was 5%. CONCLUSIONS: Examination of the results suggested that allergen exposure, relative to a trial of immunotherapy, could be expressed as (1) the maximum level found in the house, (2) the percentage of sites having greater than 2 micrograms/gm, or (3) the mean value at the site with the maximum level. This report provides a background for evaluating the clinical results of immunotherapy in these patients and a model for the way in which sensitization and exposure should be monitored in studies of this kind.

Adolescent↗
PubMed1996

A cost-effectiveness analysis of neonatal ECMO using existing evidence.

A cost-effectiveness analysis is part of the U.K. ECMO Trial. In preparation for this analysis, existing evidence on the costs and effectiveness of neonatal ECMO was evaluated. ECMO appears to be more costly but may be more or less effective than conventional treatment. No case can be made for introducing ECMO before trial results are available.

Cost-Benefit Analysis↗
PubMed1996

Costs and benefits of cervical screening. I. The costs of the cervical screening programme.

In 1991, the average total Health Service cost of a cervical smear, including follow up at the colposcopy clinic, was almost 22.70 pounds in the Perth and Kinross district of Scotland. The average cost per colposcopy clinic visit was 30 pounds. The main cost elements were in general practice (55% of total) and the laboratory (33%), and most of the cost was for staff time.

Cost-Benefit Analysis↗
PubMed1996

Varicella infection and toxoplasmosis in pregnancy.

Varicella occurring in pregnancy can be dangerous for the fetus, the mother, and the newborn. The fetus may experience multiple system damage. The mother and newborn are at increased risk for varicella pneumonia with a 9% and 20% fatality rate, respectively. The recent introduction of the varicella vaccine will affect the occurrence of gestational infection. Toxoplasmosis is rarely dangerous for the pregnant woman, yet the fetus and newborn may be at risk for chorioretinitis, hydrocephalus, intracranial calcifications, and convulsions. The greatest challenge in the management of toxoplasmosis in pregnancy is diagnosis of the asymptomatic newborn before damage occurs. Strategies to prevent toxoplasmosis should be taught to every pregnant woman as part of parental care.

Chickenpox↗
PubMed1996

Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials.

OBJECTIVE: To compare a policy of elective caesarean delivery with a policy of selective caesarean delivery for women in spontaneous preterm labour. DESIGN: Systematic review of relevant randomised controlled trials. PARTICIPANTS: One hundred and twenty-two women from six trials. INTERVENTIONS: Random allocation to "intention to deliver by caesarean section' (elective caesarean policy), compared with "intention to deliver vaginally' (selective caesarean policy). MAIN OUTCOME MEASURES: Actual use of caesarean delivery, low Apgar score, neonatal intubation, intracranial pathology, perinatal death, and major maternal complications. RESULTS: One in six women in both groups were not delivered as allocated. Typical odds ratios for all adverse neonatal outcomes tended to favour the elective group, but for all outcomes studied the confidence intervals were wide and did not exclude clinically important hazards of the policy. The odds of serious maternal morbidity were increased in the caesarean section group (OR 6.2; 95% CI 1.3-30.1). CONCLUSION: A policy of elective caesarean delivery increases the risks of maternal morbidity, but it remains unclear whether these are offset by benefits for the infant.

Anesthesia, Obstetrical↗