Search PubMed⌕ Search

Biomedical subjects

D Evans

Publications and source records attributed to D Evans.

At least 181 records · Page 10Linked to original sources
PubMed1995

The investigation of life-threatening child abuse and Munchausen syndrome by proxy.

The use of covert video surveillance in the investigation of suspected life-threatening child abuse and Munchausen syndrome by proxy raises important ethical questions. That the recently reported provision of this facility in North Staffordshire was not presented to a Local Research Ethics Committee (LREC) for approval as a research exercise raises important questions about the ethical review of research and practice. The case made for avoiding such review is first set out and then examined. The three main premisses which form the basis of the view that LREC approval is not required are identified and tested in turn. The conclusion is that there is an undeniable element of research involved in the procedure and that the welfare of all those subjected to the surveillance would be best protected by the submission of the protocol to an independent committee for ethical assessment.

Behavioral Research↗
PubMed1995

Cost analysis of continuous intrathecal baclofen versus selective functional posterior rhizotomy in the treatment of spastic quadriplegia associated with cerebral palsy.

The purpose of the study was to analyze the relative cost of selective functional posterior rhizotomy (SFPR) and continuous intrathecal baclofen in the treatment of children with severe spastic quadriplegia related to cerebral palsy. No attempt was made to analyze the efficacy of the two types of treatment. Nine children with spastic quadriplegia secondary to cerebral palsy in whom continuous intrathecal baclofen was attempted were matched as closely as possible with a group of 10 patients with spastic quadriplegia out of a total of 100 children who had undergone SFPR in the same time period. Clinical care flow charts were created to identify the various points of contact with members of the health care team, so that cost points could be identified and costs calculated. The cost per patient up to 1 year a after treatment CDN$ 64,163.10 for patients with implanted pumps for continuous intrathecal baclofen versus CDN$ 16,913.54 for SFPR. When adjustments were made to exclude costs and savings associated with research protocols, the average for the baclofen group decreased to approximately CDN$ 63,000, with minimal change for the SFPR group. The higher cost per patient on baclofen was related to the cost associated with screening patients who did not go on to have implantation of a continuous infusion pump, and to additional hospitalization for complications in the baclofen group. It is cautioned that this cost analysis was based on the experience at British Columbia's Children's Hospital, and the results may not be generalizable to other institutions or to other patient populations.

Adolescent↗
PubMed1995

Model for the cost analysis of shunted hydrocephalic children.

This paper describes a model for forecasting the treatment costs for hydrocephalic patients with ventriculoperitoneal shunts. Modeling with institution-specific or reported failure rates allows the prediction of shunt failure in real and/or theoretical populations. The addition of costing factors (derived from hospitalization, operative and drug costs) to the model allows the derivation of partial or total cost estimates. The effects of varying the failure rate, infection rate, number of new patients, number of lost patients and costing factors can be simulated and measured. Basing this model on data from our institution, decreasing the rate of failure during the first year following shunt insertion or revision has the potential for greater cost savings over time than either decreasing the shunt infection rates or the duration of hospital stay. By combining shunt performance and financial data, an estimate of the cost of the treatment of a population with hydrocephalus, over time, can be derived. These data can be critical for institutional and program budgeting and serve as an estimate of the economic effects of treatment changes proposed in clinical trials.

Child↗
PubMed1995

Combinations of potassium, calcium, and magnesium supplements in hypertension.

Dietary intakes of potassium, calcium, and magnesium have each been reported to lower blood pressure, but the extent of blood pressure reduction in epidemiological studies and clinical trials has tended to be small and inconsistent. We hypothesized that combinations of these mineral supplements would lower blood pressure and that the reductions would be greater than that usually reported in studies of each cation alone. One hundred twenty-five patients 82 men and 43 women) with untreated mild or borderline hypertension were randomly assigned to daily treatment with one of the following four regimens: 60 mmol potassium and 25 mmol (1000 mg) calcium, 60 mmol potassium and 15 mmol (360 mg) magnesium, calcium and magnesium, or placebo. Standardized clinic blood pressure measurements were obtained on 3 days at baseline and after 3 and 6 months of treatment. At baseline, systolic and diastolic blood pressures (mean +/- SD) were 139 +/- 12 and 90 +/- 4 mm Hg, respectively, and dietary intakes of potassium, calcium, and magnesium were 77 +/- 32, 19 +/- 13, and 12 +/- 52 mmol/d, respectively. The mean differences (with 95% confidence intervals) of the changes in systolic and diastolic blood pressures between the treatment and placebo groups were not significant: -0.7 (-4.3 to +2.9) and -0.4 (-2.9 to +2.1) for potassium and calcium, -1.3 (-4.4 to +1.8) and 0.4 (-2.5 to +3.3) for potassium and magnesium, and +2.1 (-1.8 to +6.0) and +2.2 (-1.0 to +5.4) for calcium and magnesium. In conclusion, this trial provides little evidence of an important role of combinations of cation supplements in the treatment of mild or borderline hypertension.

Adult↗
PubMed1995

Settings as an important dimension in health education/promotion policy, programs, and research.

Settings--community, worksite, schools, and healthcare sites--constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.

Community Health Services↗
PubMed1995

Financial implications of noninvasive positive pressure ventilation (NPPV).

Noninvasive positive pressure ventilation (NPPV) is effective in the treatment of acute and chronic respiratory failure. However, the costs and financial balance between costs and diagnosis-related group (DRG) reimbursement for patients with moderate to severe respiratory failure treated with NPPV are unknown. We examined the costs and DRG reimbursement for 27 patients receiving Medicare referred with moderately severe respiratory failure for NPPV to the ventilator rehabilitation unit (VRU) at Temple University Hospital. This unit is one of four Health Care Financing Administration chronic ventilator-dependent demonstration sites that evaluates patients for NPPV, instructs them in home NPPV use, emphasizes rehabilitation, and uses strict cost accounting methods. Nineteen patients were treated with NPPV in the ICU and then referred to the VRU, and 8 patients were directly admitted for NPPV to the VRU. Patients were (mean +/- SE) 69 +/- 9 years age, 14 had severe COPD, and 13 had various restrictive disorders. All were hypercapneic at the time of hospital admission (restrictive 60 +/- 15; obstructive 67 +/- 3 mm Hg, PaCO2) with impaired lung mechanics and limited functional status. Patients averaged 8 +/- 15 days in the ICU, or 8 +/- 4.7 days on the medical floor prior to VRU transfer. The VRU length of stay averaged 20 +/- 18 days, for a total length of stay of 29 +/- 21 days. After implementation of NPPV, all patients had an improvement in gas exchange while spontaneously breathing and functional status that was maintained in follow-up. At 1 and 2 years of follow-up, 74% and 63% of patients were alive, respectively. Eleven patients were admitted with DRG 475 (respiratory system diagnosis with ventilator support); however, 16 of 27 patients were admitted across five different non-475 DRG codes with reimbursement rates ranging from $2,673 to $4,215. After DRG and outlier reimbursement, a total deficit of $261,948 remained (average deficit $9,701 per patient). However, individual patient deficits ranged from $1,113 to $32,892. Eighty-two percent of patients treated with NPPV incurred substantial financial losses that were underreimbursed across all assigned DRGs, including DRG 475, the highest-weighted DRG. We conclude that patients with moderate to severe respiratory failure receiving NPPV demonstrate an improvement in functional status and gas exchange that is maintained in follow-up. In addition, patients treated with NPPV incur high costs that are currently underreimbursed by the present DRG system. Newer DRG payment scales that recognize NPPV as specific treatment should be implemented.

Aged↗
PubMed1994

General anaesthesia: who decides, and why?

This study sought to determine the relative influence dentists and parents have on the decision to give a general anaesthetic to a child, and to identify the factors that influence that decision. The research involved group discussions and in-depth interviewing as a method of investigating attitudes and behaviour in greater detail. The results indicated that parents are not able to make informed choices about general anaesthesia being used on their child; the dentist has the greatest influence on the decision to use general anaesthesia; and that this decision is often influenced by non-clinical factors. These non-clinical factors were identified as: the norms of the dentist, overall attitudes to general anaesthesia and how general anaesthesia provision was structured locally. The findings suggest that any attempt to reduce the current levels of general anaesthesia further must address these factors, whilst taking into account the needs of patients and dentists.

Adolescent↗
PubMed1994

Stimulation of gastric somatostatin mRNA abundance by substance P in capsaicin-treated rats.

The spinal afferent neurons serving the stomach influence a variety of different gastric functions that together can be considered protective; it is not known whether the stomach can adapt to the loss of these neurons. We now report that in conscious rats pretreated with capsaicin to lesion small-diameter afferents, but not in control rats, i.v. infusion of substance P for 6 h increased the abundance of mRNA encoding somatostatin in antrum; there was no change in a reference mRNA, glyceraldehyde phosphate dehydrogenase. Substance P had no effect on somatostatin mRNA in the gastric corpus in either control or capsaicin-treated rats. An increased sensitivity of antral somatostatin cells to substance P may be one of the adaptive changes that occurs in the stomach of capsaicin-treated rats.

Animals↗
PubMed1994

Comparison of neurologic changes in 'successfully aging' persons vs the total aging population.

OBJECTIVE: To determine age-related changes in neurologic function in the general population. DESIGN: To administer a neurologic examination to participants in such a way that it is possible to calculate the proportion of elderly persons in the population with each abnormal finding and the proportion of persons with each finding but without evidence of the medical and neurologic diseases likely to produce neurologic abnormalities (eg, stroke and diabetes). SETTING: Individuals were selected from a community-dwelling population. PARTICIPANTS: A stratified random sample of 467 persons aged 65 years and older were evaluated. RESULTS: Many neurologic abnormalities are increasingly common with advancing age and are present in a substantial portion of the elderly population. The prevalence of abnormal neurologic findings not attributable to disease, however, is substantially lower, typically one half to one third the total prevalence. Moreover, the increase with age in the prevalence of abnormal neurologic findings not attributable to major disease varies substantially among the different measures. CONCLUSIONS: Primitive reflexes and measures of gait show statistically significant increases with age in multiple measurement domains, suggesting a selective age-related vulnerability.

Aged↗
PubMed1994

During fetal muscle development, clones of cells contribute to both primary and secondary fibers.

All mammalian muscle fibers are formed by cell fusion, but fiber formation occurs in two successive waves. Initially a small number of large fibers (primaries) are produced and are used as a scaffold for the formation of a larger number of smaller later forming fibers (secondaries). It has been reported that different populations of myoblasts are present at different ages, but it is unclear whether separate populations of cells contribute to primary and secondary fibers during the period of fetal development. We have tested this by injecting two replication-deficient retroviruses, carrying a marker gene (lacZ), into the hind limbs of Embryonic Day (E) 15 and E17 mouse fetuses. All fetuses were killed at E19. Clusters of marked fibers (assumed to correspond to single clones) found after injection at both ages contained both primary and secondary fibers. This indicates that at these ages, a single population of cells contributes to both primary and secondary fibers.

Animals↗