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Biomedical subjects

D Parkin

Publications and source records attributed to D Parkin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Measuring outpatient resource use and case mix in ophthalmology in north east England.

OBJECTIVES: To test the extent to which two existing ambulatory case mix measures (Ambulatory Visit Groups and Ambulatory Patient Groups) and other variables can explain resource use variations in ophthalmic outpatient visits. DESIGN: Three week prospective study of three consultant outpatient clinics. SETTING: One ophthalmic hospital (Sunderland Eye Infirmary, Sunderland, Tyne and Wear) and three outreach clinics (South Tyneside District Hospital, South Shields, Tyne and Wear; Dryburn Hospital, Durham, Co Durham; and Hartlepool General Hospital, Hartlepool, Cleveland). SUBJECTS: 325 patients who visited ophthalmic outpatient clinics. MAIN OUTCOME MEASURES: Mean consultation time and mean cost distributions by case mix group, analysed by analysis of variance. RESULTS: Ambulatory case mix measures can explain some of the variation in resource use for outpatient visits, but different measures differ in the extent to which they can do so. Clinicians' behaviour also accounts for a significant amount of such variation. Simpler measures of visit type, without diagnostic or procedure information, do not explain resource use variations. CONCLUSIONS: Existing measures perform reasonably well, but their data requirements may preclude their introduction in the National Health Service. Caution is required in advocating simpler measures, however. The influence of clinical practice on resource use variations is important; in this study, most differences between clinicians were not attributable to differences in case mix.

Analysis of Variance↗
PubMed1997

Less fog on the Tyne? Programme budgeting in Newcastle and North Tyneside.

Programme Budgeting (PB) has been widely promoted as a model for the better conduct of the work of Health Authorities in the National Health Service in the United Kingdom. This paper reports on a project which looked at the development of PB in Newcastle and North Tyneside Health Authority (NNTHA), concentrating on the construction of a computerised tool for the compilation and analysis of programme budgets. The main activities carried out were a survey of user requirements for PB, a survey of data availability, the collection of data to construct programme budgets, and development of a relational database for storing and manipulating PB information. The main source of data was the Contract Minimum Data Set, which was supplemented by data from a number of other sources to give comprehensive information on spending in NNTHA. Costed activity data were produced, which could be aggregated in a large number of ways, such as by care setting (inpatient, outpatient, community, general practice, etc.), disease group (ICD9 chapter headings), case mix (Healthcare Resource Groups) and socio-demographic variables (age/sex, locality of GPs practice).

Budgets↗
PubMed1996

DNA fingerprinting of benign and malignant breast lesions.

Paired blood and breast tissue samples from 96 patients undergoing surgical excision of a breast lesion were subjected to DNA fingerprint analysis using the minisatellite probes 33.6 and 33.15. The 'fingerprints' of the blood and breast DNA were compared. DNA fingerprint changes seen were classified as band additions, band deletions or changes in band intensity. Significantly more DNA fingerprint changes were seen in malignant than in benign lesions (probe 33.6, P<0.01; probe 33.15, P=0.01; both probes, P = 0.04). The frequency of the changes detected in the breast cancers was unrelated to tumour grade or the presence of invasion. DNA ploidy was measured in 70 of the breast carcinomas. DNA fingerprint changes were seen in 41 of these, but flow cytometry detected aneuploidy in only 29 tumours (P=0.04). The DNA fingerprinting technique is unlikely to be useful in differentiating between benign and malignant breast lesions as changes were detected in one of the fibroadenomas studied. However, it may be a useful technique in screening tumour DNA for abnormalities suitable for more detailed analysis.

Breast Diseases↗
PubMed1996

Mature results of a randomized trial of two doses of cisplatin for the treatment of ovarian cancer. Scottish Gynecology Cancer Trials Group.

PURPOSE: In 1992, we reported the first results of a randomized study in ovarian cancer, comprising two doses of cisplatin and indicated a significant difference (P = .0008) in median survival. Four years later, we now describe the results of this trial. PATIENTS AND METHODS: After a median follow-up of 4 years and 9 months, 115 of 159 cases of advanced ovarian cancer, originally randomized to receive six cycles of cyclophosphamide 750 mg/m2 and either a high dose (HD) of 100 mg/m2 cisplatin or a low dose (LD) of 50 mg/m2 (LD) cisplatin, have now died. RESULTS: The overall survival for HD and LD patients is 32.4% and 26.6%, respectively, and the overall relative death rate is 0.68 (P = .043). This represents a reduction in overall benefit with longer follow-up compared with the first 2 years (relative death rate of 0.52). Toxicity, particularly neurotoxicity, is still evident in the fourth year (10/31 on HD compared with 1/24 on LD). CONCLUSION: Our recommended dose of cisplatin in combination schedule is therefore 75 mg/m2, representing the optimal balance between efficacy and toxicity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Clearing the fog on the Tyne: programme budgeting in Newcastle and North Tyneside Health Authority.

When the internal market was introduced, the National Health Service Management Executive envisaged purchasing as a process by which contracts would be developed from information concerning current services, modified in the light of strategic purchasing objectives, epidemiological needs assessment and indicators of comparative performance and efficiency. Our concern in this paper is with the promotion of efficiency. We distinguish between three levels and, in particular, discuss how the programme budgeting and marginal analysis framework can be used in the promotion of efficiency at 'top-level' decision making. PB/MA can be used to give a focus to needs assessment and forge explicit links between individual contracts within a well defined health strategy. The objectives of the current research and development ongoing within Newcastle and North Tyneside Health Authority are outlined. The intention is to achieve programme budgeting which is more responsive to decision makers' needs and is consistent with the contracting cycle. However, a number of constraints are expected to impede development. They include transferability of national and international information; absence of local information on epidemiology, effectiveness and cost-effectiveness; limitations on the accuracy and precision of programme budgets; and whether purchasers make strategic decisions based on macro budgets. The contribution of each of these constraints is explored.

Budgets↗
PubMed1994

Incomplete excision of CIN in conization: further excision or conservative management?

The aim of this study was to investigate the experience of the further management in 112 cases with histological diagnosis of incomplete excision of CIN in cone biopsy. Two groups of women were studied. The women in the first group (n = 78) had a second excision while the women in the second group (n = 34) underwent conservative management with cytology and colposcopy. The histologic, cytologic and colposcopic findings in the women of both groups were compared. From the first group 38% had a second cone, 62% an hysterectomy; in 5 cases the second cone was followed by hysterectomy and the histology was negative in 75% and 65%, respectively. No indication of residual disease was found within 2-10 years of follow-up in any of the women in the second group. According to our study and being aware of the natural history of CIN, we can conclude that the decision for further excision should not be based exclusively on the histology report of involved margins, but should only be taken after careful cytological and colposcopic selection of the cases.

Adult↗
PubMed1994

Lanterns in the jungle: is the NHS driven by the wrong kind of efficiency?

The performance of the National Health Service is assessed in part by an Efficiency Index (EI) which is applied to the service as a whole as well as to individual health authorities. The EI relates increases in the amount of patient care activity to increases in total expenditure. The index can give a misleading impression of performance, creates perverse incentives and is at odds with the overall strategy of the health service which is to place greater emphasis on the promotion of health and to provide more care in primary and community-based settings. The philosophy, validity and appropriateness of the EI are discussed.

Community Health Services↗
PubMed1994

Hyperviscosity syndrome in disseminated breast adenocarcinoma.

Circulation within the bloodstream of mucin derived from mucin-producing adenocarcinomas has been documented infrequently but has been associated with vascular occlusion, organ infarction, and hyperviscosity. The nature of the mucin and the therapeutic role of plasmapheresis in this condition has not been reported. A 64-yr-old female, who had undergone a mastectomy 3 yrs previously for an infiltrating mucinous breast adenocarcinoma, presented with dementia. A blood film showed marked rouleaux and a bluish background. No abnormal bands were detected on plasma protein electrophoresis. Blood, serum and plasma viscosity were above the range of readability of the viscometer. A bone marrow biopsy showed replacement with tumor similar to the original. Repeated plasmaphereses substantially reduced viscosity and temporarily improved her mental state. Post mortem revealed numerous infarcts with eosinophilic mucoid material in the lumen of many small vessels. That the offending plasma constituent was a sialomucin was suggested by mucin stains of the tumor and peripheral blood, a plasma sialic acid level 10 x normal and a substantial fall in viscosity after in vitro treatment of plasma with neuraminidase.

Adenocarcinoma, Mucinous↗
PubMed1994

An evaluation of ambulatory visit groups in rheumatology out-patients.

The development of case mix measures for National Health Service (NHS) care has become of great importance recently. Much effort has been put into devising measures for in-patient care, but measures for ambulatory (outpatient, day care and primary care) visits are less developed. Ambulatory Visit Groups (AVGs) is an American system devised to aggregate ambulatory visits into iso-resource groups. However, some assumptions made in the construction of the AVG system may not hold for the UK health service, including the use of consultation time as a proxy for the total resource use associated with the out-patient attendance. To test AVGs in the UK context, a three-month prospective study of rheumatology out-patient attendances at two hospitals in Newcastle upon Tyne assembled a database of 3393 'visits', together with resource use data. The AVGs derived from these were analysed to evaluate the homogeneity of the groups with respect to consultation resource use, and the degree to which consultation time can be considered a proxy for resource use in this setting. Consultation time distributions were markedly skewed, and required log transformation before analysis. Variation in log consultation time was found to depend as much on the clinician as on the AVG, and the two were observed to interact. Resource use distributions were also skewed, and were similarly transformed for analysis. Non-parametric analysis of variance showed resource use to be significantly associated with AVG, but the amount of variation associated with the AVG appeared to be small and inconsistent.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1994

Out-patient case mix: a survey of user requirements.

Research and development of out-patient case mix systems, to plan and monitor resource use in the out-patient sector, has hitherto not been accorded priority in the NHS. As part of an investigation of their usefulness, a survey of NHS professionals' requirements for out-patient case mix was conducted. The results confirmed that there was support for developing out-patient case mix systems, although different users had different requirements. However, a common theme to emerge was the desirability of constructing holistic systems which cover in-patient, day-case and out-patient care. Additionally, development of care packages was seen as a necessary first step in constructing systems for out-patient care. Concludes that visit-based case mix systems are unlikely to fulfil users' requirements and recommends that case mix contracting projects by Healthcare Resource Groups should be extended to the out-patient sector, but must recognize that existing systems do not meet users' requirements.

Ambulatory Care↗
PubMed1993

Econometric analyses of national health expenditures: can positive economics help to answer normative questions?

The size of national health care expenditure is an important research and policy issue. This paper reviews theoretical and empirical analyses of an implied optimal size for a health sector. Various economic theories are explicitly or implicitly invoked, but none is fully satisfactory. Theory provides, at best, a loose justification for empirical specifications of health sector behaviour. Nevertheless, this has a large and growing empirical research industry. The complexity of the issues provides an excuse for reliance on empirical analyses using ad hoc models. The paper analyses aggregate time-series data, using the cointegration approach, on health, health care expenditures and national income. Only one national model met both statistical criteria and showed a significant relationship: between potential life years lost and health care expenditure in the UK. The case for any general relationships remains unproven. There is no objective scientific method to determine optimal health expenditure, nor should we expect one. However, positive analyses can help with normative questions. A better understanding of health expenditure determination would arise from better specification of the relationships, perhaps by analysis at a lower level of aggregation.

Bias↗
PubMed1993

The effects of leukaemia inhibitory factor on platelet function.

Leukaemia inhibitory factor (LIF) is able to promote megakaryocytopoiesis in vitro and elevate platelet counts in vivo, and is a potential new therapeutic agent for the treatment of thrombocytopenia. To determine whether platelets released under conditions of LIF-stimulated megakaryocytopoiesis have intact function, we compared aggregation responses of platelets from mice with constitutively elevated LIF levels (FD/LIF mice) and mice injected with recombinant murine LIF (rmLIF mice) with their respective control mice. We report that ex vivo platelet aggregability and thromboxane B2 release were intact in the LIF-treated mice, and were significantly enhanced in some situations. LIF-treated mice also had significantly increased platelet counts (FD/LIF mice: 1302 +/- 173 x 10(9)/l compared to 1012 +/- 99 x 10(9)/l for FD mice; rmLIF mice: 1460 +/- 193 x 10(9)/l compared to 985 +/- 67 x 10(9)/l for FCS/NS mice), increased platelet volumes and elevated plasma fibrinogen and calcium levels. The platelet hyperreactivity seen in the LIF-treated mice is likely to reflect the larger platelet volumes and/or the effect of plasma components such as fibrinogen, elevated levels of which were due to the concomitant action of LIF as a stimulant of acute phase protein synthesis.

Animals↗
PubMed1993

A comparison of diagnosis related groups and ambulatory visit groups in day-case surgery.

Case-mix measurement is a basic requirement of clinical and resource management systems within health care organisations, and offers a potentially useful tool for the setting and monitoring of contracts. Ambulatory care has particular problems in the construction of appropriate case-mix measures, and day-case surgery provides an opportunity to test two existing measures, one inpatient (Diagnostic Related Groups) and one ambulatory (Ambulatory Visit Groups). These grouping systems were applies to the same data to compare the case-mix patterns that they produce. The findings show that the ambulatory visit group appear to have advantages over the diagnostic group with respect to their underlying assumptions and labelling of the groups; in particular, they assign greater weight to procedures. However, diagnostic groups are more developed, easier to use, more familiar and allow direct comparisons with inpatient care. Nevertheless, a proper evaluation of these issues requires further data collection and analysis, together with a fundamental examination of the uses of ambulatory case-mix.

Ambulatory Surgical Procedures↗
PubMed1993

A comparison of diagnosis related groups and ambulatory visit groups in day-case surgery.

Case-mix measurement is a basic requirement of clinical and resource management systems within health care organisations, and offers a potentially useful tool for the setting and monitoring of contracts. Ambulatory care has particular problems in the construction of appropriate case-mix measures, and day-case surgery provides an opportunity to test two existing measures, one inpatient (Diagnosis Related Groups) and one ambulatory (Ambulatory Visit Groups). These grouping systems were applied to the same data to compare the case-mix patterns that they produce. The findings show that Ambulatory Visit Groups appear to have advantages over the Diagnosis Related Groups with respect to their underlying assumptions and labelling of the groups; in particular, they assign greater weight to procedures. However, Diagnosis Related Groups are more developed, easier to use, more familiar and allow direct comparisons with inpatient care. Nevertheless, a proper evaluation of these issues requires further data collection and analysis, together with a fundamental examination of the uses of ambulatory case-mix.

Ambulatory Care↗
PubMed1993

Linkage studies with 17q and 18q markers in a breast/ovarian cancer family.

Genes on chromosomes 17q and 18q have been shown to code for putative tumor suppressors. By a combination of allele-loss studies on sporadic ovarian carcinomas and linkage analysis on a breast/ovarian cancer family, we have investigated the involvement of such genes in these diseases. Allele loss occurred in sporadic tumors from both chromosome 17p, in 18/26 (69%) cases, and chromosome 17q, in 15/22 (68%) cases. In the three familial tumors studied, allele loss also occurred on chromosome 17 (in 2/3 cases for 17p markers and in 2/2 cases for a 17q allele). Allele loss on chromosome 18q, at the DCC (deleted in colorectal carcinomas) locus, was not as common (6/16 cases [38%]) in sporadic ovarian tumors but had occurred in all three familial tumors. The results of linkage analysis on the breast/ovarian cancer family suggested linkage between the disease locus and 17q markers, with a maximum lod score of 1.507 obtained with Mfd188 (D17S579) polymorphism at 5% recombination. The maximum lod score for DCC was 0.323 at 0.1% recombination. In this family our results are consistent with a predisposing gene for breast/ovarian cancer being located at chromosome 17q21.

Adult↗