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Biomedical subjects

B G Charlton

Publications and source records attributed to B G Charlton.

At least 19 recordsLinked to original sources
PubMed1999

The 'anti-delirium' theory of electroconvulsive therapy action.

It is proposed that electroconvulsive therapy (ECT) is not specifically mood-elevating or anti-depressant but that its effect is as an anti-delirium intervention. I suggest that ECT exerts its primary therapeutic effects by inducing a generalized epileptic seizure which operates on the brain like a deep and restorative sleep that acts rapidly to resolve delirium. Provided that the diagnosis is made using sufficiently sensitive criteria, delirium is here assumed to be a common feature of many so-called 'functional' psychoses - frequently occurring as a consequence of sleep deprivation, and leading to symptoms such as hallucinations, bizarre delusions and psychomotor retardation. Testable predictions of this 'anti-delirium' theory of ECT action are described.

Convulsive Therapy↗
PubMed1998

Individual case studies in clinical research.

Case studies have acquired an unmerited reputation as being anecdotal, unscientific and intrinsically inferior to group studies. The subsequent disregarding of individual patients as the focus of investigation has led to the neglect of an extremely useful clinical research method, and has probably impaired the pace of therapeutic innovation. The purpose of this paper is to clarify the scope and nature of case studies and promote their rehabilitation. Case studies can, in principle, be used to test any theory that has implications for individual patients. There are two crucial methodological stages. The first is to identify scientifically plausible general theories and derive from them specific hypotheses or models of sufficient precision to have implications for individual cases. The second is to test these hypothetical models against 'pure' cases, selected so as to exclude interfering variables. There are two main types of case study--those made by serendipity (unplanned case observations which challenge an implicit theoretical framework); and formal case studies (designed prospectively to collect pure cases to test a prior hypothesis). The difference between serendipity and planned case studies roughly corresponds to the difference between surveillance and screening. A worked-example of a formal case study is described here in order to illustrate the method. Individual case studies deserve fresh consideration by researchers, since they are a clinician-friendly method with a unique potential for incorporation into routine practice.

Humans↗
PubMed1997

Natural kinds, natural history and the clinician-researcher.

Recent medical research has been based on a flawed rationale of clinical innovation (here termed the 'basic-to-mega model') which neglects the human organism as a vital focus of clinical scientific study. The consequent over-concentration upon cellular and population levels of analysis has probably damaged the rate of therapeutic progress. The key role in medical research should be acknowledged to lie with clinician-researchers whose 'experimental animal' is the patient and whose 'end-points' are health and disease. The distinctive strength of the clinician-researcher derives from an ability to combine understanding of the 'natural kinds' (i.e. true biological categories) relevant to human disease, with experience of the 'natural history' of disease (i.e. its longitudinal pattern, including the response to interventions). Such knowledge is explicitly formalized by the activities of clinical science and clinical epidemiology. A sufficient supply of active clinician-researchers is the catalyst of innovation, and an insufficient supply is currently a rate-limiting factor in therapeutic progress.

Humans↗
PubMed1997

Megatrials.

Explore the source record for details and available documents.

Controlled Clinical Trials as Topic↗
PubMed1996

An "early warning system' for health needs: surveillance of the quality of clinical services by audit of extra-contractual referrals (ECRs).

Extra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainly because of their potential to generate unexpected expenditure. But ECRs can also be used as a tool for monitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington Health Authority district using a variety of methods including inter-disciplinary meetings, a series of interviews with local GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results of the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief that a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral to benefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throat services were over-represented. Questionnaire results were validated by comparison with an interview study of all GPs in the district. We conclude that trends in ECRs can be monitored as a convenient "early warning system' to alert purchasing authorities to changes in demand or perceived problems with local provider units. ECR data must be interpreted in the context of further local background information from sources such as GPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in services and contracts.

Contract Services↗
PubMed1996

The uses and abuses of meta-analysis.

Meta-analysis is a quantitative process of summary and interpretation which involves pooling information from independent studies concerning a single theme in order to draw conclusions. Greatly increased employment of meta-analysis is currently being advocated for clinical and policy decision making. However, the prestige of meta-analysis is based upon a false model of scientific practice. Interpreting empirical research is an extremely complex activity requiring clinical and scientific knowledge of the field in question; and teams of professional 'meta-analysts' with a primary skill base in information technology and biostatistics cannot take over this role. Meta-analysis is not a hypothesis-testing activity, and cannot legitimately be used to establish the reality of a putative hazard or therapy. The proper use of meta-analysis is to increase the precision of quantitative estimates of health states in populations. If used to estimate an effect, the reality of that effect should have been established by previous scientific studies. But the summary estimate from a meta-analysis can only be directly applied to a target population when the 'meta-protocol' and 'meta-population' match the target situation in all relevant particulars. These constraints can rarely be satisfied in practice, so the results of meta-analysis typically require adjustment--which is a complex, assumption-laden process that negates many of the statistical power advantages of a meta-analysis. Lacking any understanding or acknowledgement of the need for adjustment, most meta-analyses must be regarded as abuses of the technique.

Clinical Trials as Topic↗