Biomedical subjects
C Herbert
Publications and source records attributed to C Herbert.
An integrated approach to team assessment in head injury.
The development of multidisciplinary teams for the assessment and treatment of traumatic brain injury has not seen a parallel development in methods of coordinating and collating the information gathered by different professions. The team at the Head Injury Rehabilitation Centre (HIRC), Sheffield uses a process of assessment that encourages the coordination of such information, particularly across the areas that do not fall neatly into the remit of specific disciplines. The framework of the assessment is presented, together with discussion of methods of gathering information and of sharing that information. The advantages of this approach are discussed in terms of benefits for the client, for the professionals involved in the assessment and for other services that might be involved with the client.
[Mass screening for colorectal cancer in France. Experience in 165,000 people in the department of Calvados].
OBJECTIVES: Screening for colorectal cancer is a major public health problem in France as in most developed countries. Several controlled trials are on-going in Europe. The aim of the study was to determine requirements for success of mass-screening for colorectal cancer in France. METHODS: A mass-screening program has been conducted between April 1991 and June 1994 in the department of Calvados for 164,364 people aged 45-74 years. The screening test was first proposed by general practitioners and occupational doctors during appointments. Secondly, a postal invitation to obtain the test, free of charge, by doctor or chemist, was sent. RESULTS: Global participation rate was 43.4%; 40.2% of tests were distributed during the first phase, 47.1% during the second phase and 12.7% were distributed by a private health institute. Participation was higher for females (47.1%) than males (39.2%) and for urban districts (46.5%) than rural districts (24.4%). In case of positive test, colonoscopy has been more frequently achieved in urban districts and when test has been distributed by a physician. Positivity rate was 2.8%. Positive predictive value was 8.0% for a cancer and 13.5% for an adenoma larger than 1 cm. Because both positivity rate and positive predictive value were higher for males than females and increased with age, rate of cancer or large adenoma screened was almost three times higher for males than females and markedly increased with age. CONCLUSIONS: In France, different recruitment methods have to be used to reach a satisfactory participation to a mass-screening campaign. Such a program requires involvement of general practitioners and close coordination between practitioners and health care insurance agencies.
Participants' characteristics in a French colorectal cancer mass screening campaign.
BACKGROUND: Participation by the target population is clearly a key element in the success of mass screening programs for colorectal cancer. In France, involvement of general practitioners in test distribution is essential to reach a satisfactory participation rate, but other forms of recruitment also have to be organized. The aim of this study was to determine the influence of demographic characteristics such as sex, age, and place of residence on the participation rate in a French mass screening according to different recruitment methods. METHODS: The Hemoccult IIR test was proposed in three consecutive ways: spontaneously by general practitioners and occupational doctors during appointments (phase 1), by postal invitation (phase 2), and finally by direct mailing of the test (phase 3). The target population consisted of 11,947 people between 45 and 74 years of age, living in a district of the French county of Calvados, between March 1991 and April 1993. RESULTS: The overall participation rate was 51.3%. Forty-nine percent of all the tests were done during phase 1, 31% during phase 2, and 20% during phase 3. The overall participation rate varied essentially according to the place of residence, from 65.5% in urban areas and 48.9% in intermediate areas to 27.7% in rural areas. The overall participation rate was also higher for females (57%) than for males (45%) and for those 60 years and older (53.9%) than for those below this age (49.2%). The proportion of tests done during phase 1 was lowest among the youngest and the oldest age groups (37.5% in the 45- to 49-year class and 45.2% in the 70- to 74-year class) and among people living in the rural environment (respectively 55.3%, 45.5%, and 35.9% in urban, intermediate, and rural areas). CONCLUSIONS: This study shows that place of residence strongly influences the global participation rate in mass screening for colorectal cancer in France, whereas sex and age have little influence. Recruitment methods complementary to distribution by general practitioners must be organized, especially for the youngest and oldest age groups (45-49 years and 70-74 years) and above all for people living in rural areas. The social, cultural, and psychological reasons for these differences remain to be investigated, with the aim of adapting mass screening strategies to the different population groups.
Clinical health promotion and family physicians.
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Land mines: the suffering of a nation.
For two nursing students, a long summer vacation provided an opportunity to gain some first hand experience of nursing in a developing country. The Kingdom of Cambodia, a country of approximately 9.3 million people in South East Asia, was the chosen destination. Here not only was a different culture encountered but also a hazard to public health which one would not usually encounter in the UK: the land mine.
Haemoccult test properties according to type and number of positive slides in mass screening for colorectal cancer.
Despite encouraging results from recent studies, there is still no consensus to undertake mass screening using the Haemoccult test in the general population. The success of mass screening for colorectal cancer depends among other things on Haemoccult test properties. In on-going screening programmes, the Haemoccult test consists of six slides and a test is considered positive if at least one slide is coloured. The aim of this work was to study the influence of the type and number of positive slides on the Haemoccult test's positive predictive value and characteristics of screened lesions. This work focuses on 63,958 first tests in a mass screening programme in Calvados (France) among people aged 45-74 years. There was a linear relation between the positive predictive value for cancer or an adenoma larger than 1 cm and the number of positive slides (P < 10(-4)). The positive predictive value for cancer or large adenoma was significantly higher when 4-6 slides were positive (44.3%) than when only 1-3 were positive (19.1%) (P < 10(-4)). In this latter group, the subjects in whom tumours were detected were younger and had significantly less extensive cancers. Borderline tests (no slides positive and at least one slide with a blue coloration confined to the edges) had a positive predictive value for cancer or an adenoma larger than 1 cm no different to that of tests with 1-3 positive slides. Subjects with borderline results were markedly younger than the others and had less extensive cancers and rectal localisation more often than the others. Our results suggest that (1) increasing the number of positive slides required to declare a test positive leads to an increase in the positive predictive value but is not to be recommended because of the sensitivity of the test and (2) considering borderline Haemoccult tests as positive in on-going and future mass screening campaigns would allow an increase in the sensitivity of the test, especially for rectal cancer and low extensive tumours without any decrease in its positive predictive value.
How well do family physicians manage sexually transmitted diseases?
OBJECTIVE: To identify gaps in knowledge about sexually transmitted diseases (STDs) and evaluate practice. DESIGN: We compared how 49 family physicians managed 249 episodes of STDs with the recommendations of the 1988-1989 Canadian STD management guidelines. (The study took place before revised guidelines were distributed in late 1992.) SETTING: Family physicians' practices throughout Canada. PARTICIPANTS: Physicians recruited by the National Research System from among the members of the College of Family Physicians of Canada. These physicians had been in practice for a mean of 9 years; 43 were Certificants of the College. MAIN OUTCOME MEASURES: Family physicians' self-reported episodes of sexually transmitted disease evaluated in light of current Canadian guidelines. RESULTS: Of the 249 episodes studied, 215 (86.3%) were treated effectively, and 34 (13.7%) were judged to have been treated ineffectively. Of the 215 effective treatments, 67 (31.2%) were not completely in agreement with current guidelines. CONCLUSION: Experienced family physicians with postgraduate training usually manage STDs well. The number of ineffective treatments and effective treatments not following the 1988-1989 guidelines, especially for pelvic inflammatory disease, indicates that information on managing certain STDs and syndromes should be made available to all family physicians in a format that is easy to read and use.
[Objectives and means of screening of colorectal cancer].
Despite numerous publications on the subject, the debate over the merits of the various methods available for screening for colorectal cancer is continuing. Choice of the method depends on the patient being treated. In the present state of our knowledge, mass screening by Hemoccult, which is of low cost but of poor sensitivity and only fairly well accepted, cannot be used routinely but must be further evaluated and developed. In persons willing to undergo regular examinations, an annual or biannual Hemoccult examination associated with rectosigmoidoscopy every 5 years appears appropriate. In subjects having a familial history in first-degree relatives, colonoscopic examination every 5 years is adequate. Lastly, in patients with a personal history of cancer or adenoma, screening consists of colonoscopic follow-up adapted to the individual case.
Medicine and health care: a marriage of necessity.
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Beyond the hospital: the role of public information campaigns, general practitioners, pharmacists, laypersons and patient associations in patient education and counseling.
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Screening for colorectal cancer: the role of the general practitioner.
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Biopharmaceutic approach in designing a controlled release tablet of sodium monofluoro phosphate. Characterization of absorption sites and evaluation of modified dosage form.
Based on the results from in vivo study in dogs, it was decided to characterize the absorption sites of sodium monofluoro phosphate (NaMFP). It was hypothesized that bioavailability upon p.o. administration can be improved for controlled release dosage forms if the drug release is confined to segments of gastrointestinal tract responsible for absorption. To characterize the principal sites of absorption of NaMFP, in situ segmental absorption studies were carried out in rats. It was found that NaMFP is predominantly absorbed from the small intestine. The larger surface area and presence of alkaline phosphatase enzymes, are attributed to the higher absorption from the small intestine. Based on these results the delivery time was limited to 6 h to restrict the release of the drug within the principal sites of absorption. The dose was adjusted to 160 mg of NaMFP. After studying in vitro release profiles, the drug to polymer ratio was adjusted to 1: 1.1. The modified dosage form was finally subjected to bioavailability studies in humans. An immediate release dosage form was used to compare the efficacy in a two-period crossover study. The extent of bioavailability was 99% and the dosage form was effective in reducing the fluctuations.
The other side of primary care: human resources.
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Laser immunonephelometry reference intervals for eight serum proteins in healthy children.
Eight serum proteins were analyzed with the Behring nephelometer in samples from 479 healthy French children, ages three to 16 years. Girls had higher concentrations of IgM and albumin than boys had. Age appeared to be a main factor of variation for the proteins tested. Reference intervals are presented for IgG, IgA, IgM, albumin, transthyretin (prealbumin), retinol-binding protein, alpha 1-acid glycoprotein, and C-reactive protein. The significance of increased concentrations of C-reactive protein within a community is discussed.
Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET).
This study reports on 330 women aged 29 to 45 years, who underwent 411 cycles of in-vitro fertilization and embryo transfer (IVF/ET). Vaginal sonograms were performed during the late proliferative phase of natural cycles and cycles of controlled ovarian hyperstimulation (COH) with gonadotrophins, to evaluate both the thickness and echogenicity of the endometrium. Findings classified as Grade I; characterized by homogeneous echogenicity of the endometrium, and Grade II; characterized by an outer peripheral layer of dense echogenicity surrounding a central sonolucent area (i.e. a 'halo pattern'). Grades I and II were subclassified on the basis of thickness into A (greater than or equal to 9 mm) and B (less than 9 mm). Grade IIA ('optimal') was associated with a clinical pregnancy rate per embryo transfer of 33% while Grades IA, IB and IIB ('poor') were associated with a rate of only 7%. Women aged 41-45 years experienced a 25% incidence of 'poor' sonographic grades while the incidence in women less than or equal to 40 years of age was 5%. The presence of various uterine pathologies was associated with 'poor' endometrial grades in 86% of cases while only 11% of normal uteri manifested 'poor' grades. 'Optimal' endometrial grades in natural cycles were consistently associated with 'optimal' grades in ensuing cycles of COH (96%). Women with 'poor' endometrial grades in natural cycles improved in 55% of cases during subsequent COH. The results of this study indicate that sonographic assessment of the endometrial lining in the late proliferative phase during both natural and COH cycles is a valuable method for screening and managing IVF/ET candidates.
[Nuclear magnetic resonance studies of the orbit].
Magnetic resonance tomography enables sensitive and specific three dimensional imaging processes in the bulbus, the soft parts of the orbita and the optic foramen as well as their relation to intracerebral structures. Besides a very exact imaging of the morphology it is also possible to characterise the tissue, this being a decisive factor in arriving at a correct diagnosis.
The efficacy of early pregnancy monitoring with serial chorionic gonadotropin determinations and real-time sonography in an infertility population.
Ninety-one pregnancies were monitored prospectively with serial human chorionic gonadotropin (hCG) determinations and real-time sonography. The monitoring process included an initial hCG doubling time (DT) followed by sonographic examination for fetal heart motion at 7 to 8 weeks in the asymptomatic patient. In women with an abnormal DT or who developed symptoms, repeat hCG determinations and/or sonography were performed. A single DT correctly identified 95% of the successful pregnancies (58) and 64% of the abnormal pregnancies (25 abortions and 8 ectopic gestations) in asymptomatic women. With repeat hCG determinations and/or sonography, 88% of the spontaneous abortions (before aborting) and 100% of the ectopic pregnancies (before tubal rupture) were identified. As a result of the early diagnosis, conservative surgery was performed in six of eight women with tubal pregnancies. The presence of fetal heart motion was a reliable indicator that an intrauterine pregnancy will progress to viability in both the symptomatic (89%) and asymptomatic patient (93%). We conclude that the combined use of serial hCG determinations and real-time sonography provides efficacious monitoring of the early high-risk pregnancy.