Biomedical subjects
D P Kernick
Publications and source records attributed to D P Kernick.
Introduction to health economics for the medical practitioner.
Against a background of increasing demands on limited resources, health economics is exerting an influence on decision making at all levels of health care. Health economics seeks to facilitate decision making by offering an explicit decision making framework based on the principle of efficiency. It is not the only consideration but it is an important one and practitioners will need to have an understanding of its basic principles and how it can impact on clinical decision making. This article reviews some of the basic principles of health economics and in particular economic evaluation.
Triptan medications to treat acute migraine.
Explore the source record for details and available documents.
A methodological framework to derive the cost of the GP consultation.
With an emphasis on a primary care-led NHS, the cost of a GP consultation will be a major element in any economic analysis. No standardized methodology is available for deriving this cost, and there are a wide range of estimates. Wherever possible, local unit costs should be derived from individual practice information, particularly when local circumstances are relevant to a study, but unless standardized methodology is used, studies undertaken in different settings or at different times will not be compatible. This paper proposes a framework which will enable each practice to determine their unit consultation costs and offers data that can be used where local information is not available.
The prevalence and treatment of headache sufficient to impact on the quality of life of undergraduate students entering university.
AIM OF STUDY: Headache has a significant impact on public health in terms of quality of life and economic consequences, but in primary care, needs often remain unmet in terms of recognition, diagnosis and treatment. Our aim was to measure the prevalence of headache sufficient to affect the quality of life of undergraduate students who were entering the University of Exeter. METHOD: 1124 consecutive undergraduate entrants aged 21 and under who registered at the Student Health Centre at the beginning of the academic year were invited to complete a questionnaire during their registration procedure. We used the Headache Impact Score to measure effect of headache on quality of life. RESULTS: A completed questionnaire was received from 1057 (94%) students registering at the Health Centre. 212 (21%) of these students had headaches that affected the quality of their life. Of these, 95 (45%) had seen a doctor previously about their headaches and 28 (13%) had headaches on more than 15 days a month. Less than 5% were taking prescription medication. The headache impact score was 56 indicating a substantial impact on quality of life of students. CONCLUSION: Headache has a considerable impact on the quality of life of students entering University which we speculate may have a deleterious effect on educational attainment. This study has confirmed the findings of other population groups that morbidity from headache is often unrecognised and under treated.
Precisely wrong rather than vaguely right.
Explore the source record for details and available documents.
Costs are as important as outcomes.
Explore the source record for details and available documents.
Minor-injury care by nurse practitioners or junior doctors.
Explore the source record for details and available documents.
Characteristics of laser Doppler perfusion imaging in vitro and in vivo.
Traditional laser Doppler flowmetry (LDF) employs continuous recording of perfusion at one point with time. In order to eliminate the large spatial and temporal fluctuations that occur in the microcirculation, laser Doppler perfusion imaging (LDI) integrates flow readings over a large area. This paper describes a number of experiments to identify some of the characteristics of the LDI, its relationship to flow and no-flow conditions and to compare it with LDF. We undertook experiments to establish the effect of scanner head height, avascular skin thickness and haematocrit on LDI output. We also investigated the contribution of the biological zero signal (the signal obtained from skin when flow is arrested) to the LDI output. LDI output increased with scanner height in vitro and in vivo. Increasing avascular skin thickness reduced the LDI output although linear output characteristics with flow were maintained over the flow range studied. Increasing the haematocrit resulted in a loss of linearity of output with flow at lower velocities. The biological zero signal contributes a similar proportion of the output signal in LDF and LDI. We have presented a series of experiments that will contribute to the understanding of the characteristics of laser Doppler perfusion imaging, its comparison to laser Doppler flowmetry and its relationship to flow and no flow situations. However, our experiments were restricted to one machine, and may not necessarily be applicable to other instruments.
Muddling through in a parallel track universe.
Explore the source record for details and available documents.
What does it cost the patient to see the doctor?
Against a background of increasing demands on limited resources, there will be an emphasis on undertaking studies that relate benefits of an intervention to the costs that are incurred in their production. Patient costs are an important, but often overlooked, part of an economic exercise and include transport costs, loss of employment, and loss of leisure time. This paper highlights the theoretical difficulties inherent in deriving patient costs and suggests a pragmatic framework to derive unit costs in these areas. We demonstrate that these costs are not inconsiderable when compared with the cost of a general practitioner consultation.
Research grants and acknowledgment of funding of published studies.
Explore the source record for details and available documents.
Evidence and primary care.
Explore the source record for details and available documents.
Misleading government information on NHS costs.
Explore the source record for details and available documents.
Laparoscopic verses open mesh repair of inguinal hernia. Costs and outcomes should always be presented in disaggregated form.
Explore the source record for details and available documents.
The biological zero signal in laser Doppler fluximetry - origins and practical implications.
This study seeks to identify the origin of the signal, known as biological zero, that is obtained using laser Doppler fluximetry when flow is arrested. It makes specific recommendations on how this signal should be measured and handled when undertaking flow studies. The experiments undertaken using flow models, animal and human tissue, organ preparations and human subjects showed that, although there may be contributions to the no-flow laser Doppler signal from vasomotion, Brownian motion from within the vascular compartment and the effects of cuff compression, the predominant contribution is from Brownian motion arising from the interstitial compartment. The biological zero signal is additive to the flow signal providing conditions within the interstitium remain constant with changes in blood flow. It is thus concluded that the biological zero signal arises from Brownian motion of the macro molecules within the interstitium. This signal should be obtained following 3-5 min of cuff occlusion with inflation applied rapidly with the smallest cuff that is compatible with flow arrest. Biological zero should be measured under each experimental condition and subtracted from the flow signal.