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Biomedical subjects

A J Wing

Publications and source records attributed to A J Wing.

At least 55 records · Page 3Linked to original sources
PubMed1985

High cost dialysis and transplantation--dilemmas for nephrologists and nations.

The linked successes of dialysis and transplantation pose dilemmas for nephrologists struggling to meet the clinical need and for health care planners wondering where to find the resources required. The low rate of acceptance of new patients in the UK compares unfavourably with the service given in other countries. Successful rationing is achieved by a sparse distribution of centres and of specialists and operates through a low rate of referral of patients to nephrologists. Political initiative is beginning to emerge to redress the underprovision of facilities by setting realistic targets before regional health authorities.

Europe↗
PubMed1985

Cardiovascular risk factors and cardiovascular death in haemodialysed diabetic patients.

In a retrospective study, causes of death and the cardiovascular risk conferred by established risk factors were analysed in 200 diabetic and 200 matched non-diabetic uraemic patients admitted for haemodialysis. Total and cardiovascular mortality was considerably higher in diabetics, both type I (4.8-fold) and type II (3.0-fold). Fifty-eight per cent of deaths in diabetics, but only 38 per cent of deaths in non-diabetics were due to cardiovascular causes; myocardial infarction and stroke accounted for less than 15 per cent of deaths, the majority being due to sudden death. Cardiovascular death in diabetes was predicted by both history of hypertension and by cardiomegaly, but to a much lesser extent by clinical evidence of macroangiopathy. The results are compatible with an important role of non-coronary cardiomyopathic mechanisms of cardiovascular death in dialysed diabetics.

Cardiovascular Diseases↗
PubMed1984

Negative selection of patients for dialysis and transplantation in the United Kingdom.

In order to understand why the United Kingdom ranks low in the treatment of end stage renal failure a questionnaire investigating knowledge of current acceptance practice for dialysis and transplantation was sent to various groups of doctors throughout the country. The questionnaire comprised 16 case histories of patients with established end stage renal failure and associated social and medical problems. In each case the responding doctor was asked to indicate whether the patient would be suitable for treatment by dialysis or transplantation or both. The questionnaire was sent to a randomly selected sample of general practitioners and non-renal consultant physicians and their responses compared with those of all the nephrologists identified in the United Kingdom. The mean number of cases rejected by both general practitioners and non-renal consultant physicians was significantly higher than the number rejected by nephrologists. The findings suggest that underreferral of patients to dialysis and transplant units contributes to the current low acceptance rate of new patients into treatment programmes in the United Kingdom.

Adult↗
PubMed1984

Survival on integrated therapies--what assumptions shall we make?

The problems inherent in using actuarial survival calculations in order to compare different methods for treating end-stage renal failure (ESRF) are emphasized. Assumptions must be made concerning the date for commencement of follow-up observation, the method for handling patients who change therapy, and the impact of antecedent therapies on the one under consideration. It is stressed that patients involved in different treatment methods do not comprise comparable groups since they are not randomly assigned but are selected by the availability and applicability of treatment modes as well as physician and patient preferences. We have proposed that interval mortality and treatment change rates are descriptions of clinical events that have happened to any defined group of patients and may be easily understood by the physician who must advise and make decisions.

Hemodialysis, Home↗
PubMed1984

Development of dialysis and transplant activity in the world during the seventies of the 20th century.

Statistical surveys of dialysis and transplantation activities, conducted every year since 1965, and in greater detail since 1971, by the European Dialysis and Transplant Association and, according to its example, also by certain institutions in other countries, are very valuable and serve as a basis for a further development of these activities and for their management in the different countries. Also the firms manufacturing dialysis equipment make use of this information for the planning of their production. The dialysis and transplant therapy in the national range in the rich industrial countries was on the increase at the turn of sixties and seventies. This expansion was enabled by the sophisticated dialysis technique, produced in the factories and by the fact that the governments were taking on all expenses of the therapy. The development of dialysis and transplant activity in the European socialist countries was slower than in the western rich industrial states. It was due to the lack of currency for the import of dialysis technique. As the dialysis technique has been produced in some of these countries from the beginning of the eighties, one can expect the same expansion of the dialysis and transplant therapy in this decade as it was in the western countries ten years ago. The dialysis and transplant programme in the developing countries is negligible because their gross national product per capita is too low. Success of the dialysis therapy depends on the quality of the dialysis technique. It is hardly understandable why less expensive modes of therapy such as home dialysis and transplantation are less frequently used than centre dialysis in the majority of countries.

Developing Countries↗
PubMed1983

Recovery of renal function after prolonged dialysis and transplantation.

Out of 250 patients with renal failure, seven (2.8%) treated by regular haemodialysis alone (four) or given cadaveric allografts (three) later showed recovery of function of their own kidneys lasting from one to four years. In the patients receiving haemodialysis alone recovery was easily recognised from their serum creatinine concentrations, but in those with transplants recovery was discovered unexpectedly during radionuclide scanning. These findings suggest that recovery of renal function may be more common than generally recognised, which should be borne in mind when beginning renal replacement treatment and particularly when contemplating bilateral nephrectomy.

Female↗
PubMed1983

Evolving methodologies in computerized European Registries.

The histories and present roles of four European Registries are described. Three are transplant sharing organizations, Eurotransplant (ET), Scandiatransplant (ST), and the United Kingdom Transplant Service (UKTS). The Registry of the European Dialysis and Transplant Association is a patient Registry that tracks patients on dialysis as well as after transplantation and follows them from center to center. The transplant organizations collaborate by linking patient records on the EDTA Register. These large central Registries have evolved specialized computer methodologies for recording the follow-up of patients, researching the patient file, and improving the service to centers. The log-rank test is useful for the evaluation of pooled results. Reliability of donor typings can be verified by testing results for the Hardy-Weinberg equilibrium. A method for the prediction of pool size required to find matched recipients is described. Collaborative studies have been carried out in an attempt to discover the factor(s) responsible for the "center effect." New trends in analysis of transplant results will include detailed documentation of rejection episodes. Compliance by centers contributing to the transplant organizations is ensured by the need for organ interchange, whereas the EDTA Registry depends on the directors of centers being motivated by the publication of pooled statistics and results and by the provision of feedback information to the individual units.

Computers↗
PubMed1983

Detoxification treatment for chronic schizophrenic patients: experimental results and data from a survey.

Blood detoxification as a treatment of schizophrenia has been studied intensively since 1977 by a number of research centers. Results of an open study on 10 chronic schizophrenic patients--two showing improvement--were less favorable than those reported in the initial publications. In order to possibly identify a subgroup of responders to this treatment, a survey was undertaken in which 95 centers were invited to participate. Of the 95 centers which originally treated schizophrenic patients with detoxification and which were asked to send data on these patients to the Registry of the European Dialysis and Transplant Association, 39 centers replied (35 from Europe and four from the United States). From the 100 patients reported on in Europe, 17 were reported to be very much improved and 22 to be improved. Of the patients from the United States, 86% were reported as improved. No subgroup of responders could be identified, and differences between centers concerning nosological subgroups, treatment methods, and results were so great that no real comparison was possible. Although data from this survey are not totally conclusive, in connection with the updated literature they do not encourage further research in this treatment of schizophrenia.

Adult↗