Search PubMed⌕ Search

Biomedical subjects

David Jones

Publications and source records attributed to David Jones.

At least 37 records · Page 2Linked to original sources
PubMed2005

The effect of a monetary incentive on return of a postal health and development questionnaire: a randomised trial [ISRCTN53994660].

BACKGROUND: Postal questionnaires are widely used to collect data in healthcare research but a poor response rate may reduce the validity and reliability of results. There was a lack of evidence available relating to use of a monetary incentive to improve the response rate in the healthcare setting. METHODS: The MRC ORACLE Children Study is assessing the health and development of nearly 9000 seven year old children whose mothers' joined the MRC ORACLE Trial. We carried out a randomised controlled trial of inclusion of monetary incentive (five pound voucher redeemable at many high street stores) with the reminder questionnaire to parents. This trial took place between April 2002 and November 2003. When the parents were sent the reminder questionnaire about their child's health and development they were randomly assigned by concealed computer-generated allocation stratified by week of birthday to receive a five pound voucher or no incentive. The population were 722 non-responders to the initial mailing of a 12-page questionnaire. MAIN OUTCOME MEASURES: Difference in response rate between the two groups. RESULTS: Inclusion of the voucher with the reminder questionnaire resulted in a 11.7%(95% CI 4.7% to 18.6%) improvement in the response rate between the two groups. CONCLUSION: This improvement in response rate and hence the validity and reliability of results obtained appears to be justified ethically and financially.

Adult↗
PubMed2005

Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians.

BACKGROUND AND AIMS: Objectives were to develop a frailty index (FI) based on a standard comprehensive geriatric assessment (CGA) derived from a clinical examination; to assess the validity of the FI-CGA and to compare its precision with other frailty measures. METHODS DESIGN: Secondary analysis of a prospective cohort study, with five-year follow-up data. SETTING: Second phase of the Canadian Study of Health and Aging (CSHA-2); clinical examinations were performed in clinics, nursing homes, and patients' homes. PARTICIPANTS: People selected (as either cognitively impaired cases or unimpaired controls) to receive the CSHA-2 clinical examination (n = 2305; women = 1431). MEASUREMENTS: Clinical and performance-based measures and diagnostic data were extracted to correspond to the 10 impairment domains and the single comorbidity domain of a CGA. The proportion of deficits accumulated in each domain was calculated to yield the FI-CGA. The FI-CGA was validated and its predictive ability compared with other frailty measures. RESULTS: Within the seven grades of fitness/frailty identified, subjects with greater frailty were older, less educated, and more likely to be women. The FI-CGA correlated highly with a previously validated, empirically-derived frailty index (r = 0.76). Frailty was associated with higher risk of death (for each increment in frailty, the hazard ratio, adjusted for age, sex and education, was 1.23 (95% CI 1.18-1.29) and institutionalization (HR 1.20; 1.10-1.32). CONCLUSIONS: In a population survey, the FI-CGA is a valid means of quantifying frailty from routinely collected data.

Aged↗
PubMed2005

Indoor air quality in two urban elementary schools--measurements of airborne fungi, carpet allergens, CO2, temperature, and relative humidity.

This article presents measurements of biological contaminants in two elementary schools that serve inner city minority populations. One of the schools is an older building; the other is newer and was designed to minimize indoor air quality problems. Measurements were obtained for airborne fungi, carpet loadings of dust mite allergens, cockroach allergens, cat allergens, and carpet fungi. Carbon dioxide concentrations, temperature, and relative humidity were also measured. Each of these measurements was made in five classrooms in each school over three seasons--fall, winter, and spring. We compared the indoor environments at the two schools and examined the variability in measured parameters between and within schools and across seasons. A fixed-effects, nested analysis was performed to determine the effect of school, season, and room-within-school, as well as CO2, temperature and relative humidity. The levels of all measured parameters were comparable for the two schools. Carpet culturable fungal concentrations and cat allergen levels in the newer school started and remained higher than in the older school over the study period. Cockroach allergen levels in some areas were very high in the newer school and declined over the study period to levels lower than the older school. Dust mite allergen and culturable fungal concentrations in both schools were relatively low compared with benchmark values. The daily averages for temperature and relative humidity frequently did not meet ASHRAE guidelines in either school, which suggests that proper HVAC and general building operation and maintenance procedures are at least as important as proper design and construction for adequate indoor air quality. The results show that for fungi and cat allergens, the school environment can be an important exposure source for children.

Air Microbiology↗
PubMed2005

Work limitations and employer adjustments for employees with chronic illness.

This study measured work limitations and work adjustments among chronically ill employees with regard to three distinct job characteristics: physical work demands, cognitive work demands and social work demands. The study presents findings from an organizational-based survey, from which 610 respondents reported managing employees with a chronic illness. These included arthritis, musculoskeletal pain, diabetes, asthma, migraine, heart disease, irritable bowel syndrome and depression. The results indicate that depression had the largest impact in all three work demand categories, while musculoskeletal pain principally affected physical work demands and migraine and diabetes largely affected cognitive work demands. For other chronic illnesses, it was the generic symptoms of the illness (for example, fatigue) that resulted in a work limitation, rather than the specific nature of the illness itself. Employer work adjustments were available to those people with illnesses that required a physical work adjustment (for example, musculoskeletal pain). For other chronic illnesses, with the exception of depression, disclosing an illness was the strongest predictor for work adjustments in cognitive tasks and the provision of social support. Those with depression were least likely to receive a cognitive work adjustment, indicating either a low disclosure rate in this group or that employers' perceptions of depression may be a barrier to providing suitable work adjustments.

Adaptation, Psychological↗
PubMed2005

Child maltreatment, child protection and mental health.

PURPOSE OF REVIEW: This review summarizes advances in our understanding of child maltreatment and the implications thereof for physical, psychological and social development, with special emphasis on mental health aspects. RECENT FINDINGS: Methodological problems persist. These may be related in part to an over-emphasis on type of maltreatment, to the detriment of consideration of degree and extent of maltreatment. They may also be related to inadequate application of a comprehensive model of maltreatment and its consequences. Recent studies underline the inter-relatedness and cross-over between different types of child maltreatment and family violence. Research also underlines the extent to which child maltreatment is a major public health crisis internationally. Effects are seen on physical health and development as well as mental health, and it is becoming increasingly evident that these outcomes are inextricably linked to one another. There are encouraging signs that certain interventions are effective. SUMMARY: There is a need for a more sophisticated model of child maltreatment that includes not only degree but also the extent to which basic developmental needs are overridden when children are maltreated, and that includes children's responses to maltreatment as a mediating influence. More studies are needed of samples of children who have been maltreated in order to gain a better understanding of how maltreatment distorts the trajectory of normal development. Crucially, we need more research on intervention, including both case management and psychological treatment approaches.

Journal Article↗
PubMed2005

Exploring the decision-making preferences of people with colorectal cancer.

OBJECTIVES: To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions. DESIGN: Qualitative study using semi-structured interviews with patients. SETTING AND PARTICIPANTS: Three NHS Trusts in the north-west of England. Theoretical sampling including 41 patients who had been treated for colorectal cancer. RESULTS: For patients, participation in the decision-making process was about being informed and feeling involved in the consultation process, whether patients actually made decisions or not. The perceived availability of treatment choices (surgery, radiotherapy, chemotherapy) was related to type of treatment. Factors that impacted on whether patients wanted to make decisions included a lack of information, a lack of medical knowledge and trust in medical expertise. Patients perceived that they could have a more participatory role in decisions related to physical and psychological care. CONCLUSION: This study has implications for health professionals aiming to implement policy guidelines that promote patient participation and shared partnerships. Patients in this study wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions. The presentation of choices and preferences for participation may be context specific and it cannot be assumed that patients who do not want to make decisions about one aspect of their care and treatment do not want to make decisions about other aspects of their care and treatment.

Adult↗
PubMed2005

Synthesising qualitative and quantitative evidence: a review of possible methods.

BACKGROUND: The limitations of traditional forms of systematic review in making optimal use of all forms of evidence are increasingly evident, especially for policy-makers and practitioners. There is an urgent need for robust ways of incorporating qualitative evidence into systematic reviews. OBJECTIVES: In this paper we provide a brief overview and critique of a selection of strategies for synthesising qualitative and quantitative evidence, ranging from techniques that are largely qualitative and interpretive through to techniques that are largely quantitative and integrative. RESULTS: A range of methods is available for synthesising diverse forms of evidence. These include narrative summary, thematic analysis, grounded theory, meta-ethnography, meta-study, realist synthesis, Miles and Huberman's data analysis techniques, content analysis, case survey, qualitative comparative analysis and Bayesian meta-analysis. Methods vary in their strengths and weaknesses, ability to deal with qualitative and quantitative forms of evidence, and type of question for which they are most suitable. CONCLUSIONS: We identify a number of procedural, conceptual and theoretical issues that need to be addressed in moving forward with this area, and emphasise the need for existing techniques to be evaluated and modified, rather than inventing new approaches.

Bayes Theorem↗
PubMed2005

Distributed collaborative radiological visualization using access grid.

This paper describes early technical success toward enabling high quality distributed shared volumetric visualization of radiological data in concert with multipoint video collaboration using Grid infrastructures. Key principles are the use of commodity off-the-shelf hardware for client machines and open source software to permit deployment of over a large and diverse group of sites. Key software used includes the Access Grid Toolkit, the Visualization Toolkit, and Chromium.

Diagnostic Imaging↗
PubMed2005

Casebook: psoriasis.

Explore the source record for details and available documents.

Administration, Topical↗
PubMed2004

Relations between violence, calendar events and ambient conditions.

National assault injury surveillance has identified major seasonal variation, but it is not clear whether assault injury is a seasonal problem in large cities. Relationships between community violence, calendar events and ambient conditions were investigated with reference to prospective, Accident and Emergency (A&E) derived information obtained from people injured in assaults in Cardiff between 1 May 1995 and 30 April 2000. Records of daily local ambient conditions included data relating to temperature, rainfall and sunshine hours and data of major local sporting events and annual holidays were studied. Pearson correlation coefficients were used to evaluate associations between variables. Overall, 19,264 assault-related A&E attendances were identified over the 5-year period. Almost three-quarters were males. Violence was clustered predominantly on Saturdays and Sundays, New Year and rugby international days. Temperature, rainfall and sunlight hours did not correlate significantly with violence (P > 0.05). The findings indicate that injury reduction effort should be intensified at the known risk times for violence and that in a capital city/regional centre violence cannot be predicted on the basis of ambient conditions.

Adolescent↗
PubMed2004

Pacemaker diagnostics to determine treatment and outcome in sick sinus syndrome with paroxysmal atrial fibrillation.

Sequential analysis of pacemaker diagnostics has been used to help manage the treatment and pacemaker program in patients who have sick sinus syndrome with documented paroxysmal atrial fibrillation. One hundred consecutive patients were followed for an average of 18 months. Knowledge of the atrial fibrillation burden led to major changes in medical management for half of the patients and changes to pacemaker programming for all. At the end of the study, 48 patients were free of arrhythmia with pacing although 14 required antiarrhythmic medication. We advocate using pacemaker diagnostics to improve patient management.

Aged↗
PubMed2004

Reactive oxygen species and rosacea.

Although the fundamental pathogenesis of rosacea remains unknown, inflammation is a central process in this disorder. Recent evidence suggests that this inflammation is associated with the generation of reactive oxygen species (ROS) that are released by inflammatory cells such as neutrophils. In vitro studies suggest that certain core therapies for rosacea, including metronidazole and the tetracyclines, show antioxidant effects, and this may be one aspect of their mechanism of action.

Anti-Infective Agents↗
PubMed2003

Predicting reliable regions in protein alignments from sequence profiles.

For applications such as comparative modelling one major issue is the reliability of sequence alignments. Reliable regions in alignments can be predicted using sub-optimal alignments of the same pair of sequences. Here we show that reliable regions in alignments can also be predicted from multiple sequence profile information alone. Alignments were created for a set of remotely related pairs of proteins using five different test methods. Structural alignments were used to assess the quality of the alignments and the aligned positions were scored using information from the observed frequencies of amino acid residues in sequence profiles pre-generated for each template structure. High-scoring regions of these profile-derived alignment scores were a good predictor of reliably aligned regions. These profile-derived alignment scores are easy to obtain and are applicable to any alignment method. They can be used to detect those regions of alignments that are reliably aligned and to help predict the quality of an alignment. For those residues within secondary structure elements, the regions predicted as reliably aligned agreed with the structural alignments for between 92% and 97.4% of the residues. In loop regions just under 92% of the residues predicted to be reliable agreed with the structural alignments. The percentage of residues predicted as reliable ranged from 32.1% for helix residues to 52.8% for strand residues. This information could also be used to help predict conserved binding sites from sequence alignments. Residues in the template that were identified as binding sites, that aligned to an identical amino acid residue and where the sequence alignment agreed with the structural alignment were in highly conserved, high scoring regions over 80% of the time. This suggests that many binding sites that are present in both target and template sequences are in sequence-conserved regions and that there is the possibility of translating reliability to binding site prediction.

Algorithms↗
PubMed2003

Monitoring the decrease of circulating malignant T cells in cutaneous T-cell lymphoma during photopheresis and interferon therapy.

BACKGROUND: The prognosis of patients with stage IV cutaneous T-cell lymphoma (CTCL) is grim and therapeutic options are limited. Treatment of advanced-stage CTCL is aimed at suppressing the dominant T-cell clone, which is typically present in the skin, peripheral blood, and lymph nodes. OBSERVATIONS: We detected the expansion of 1 T-cell clone expressing the T-cell receptor V beta 14 in the peripheral blood of a patient with stage IVA CTCL. Before initiation of combination therapy with photopheresis and low-dose interferon alpha, the dominant T-cell clone represented 84% of the total T-cell population. After successful therapy, this clone showed a dramatic decrease to 6% of the T-cell population after 6 months of treatment. This reduction in the percentage of the malignant T-cell population in response to therapy was paralleled by clinical skin improvement from initial generalized erythroderma to undetectable skin disease. CONCLUSIONS: This case demonstrates that response to combination treatment with photopheresis and low-dose interferon alpha in patients with advanced CTCL may be accurately and quantitatively followed up by monitoring the percentage of the malignant T-cell clone (when identifiable) within the total circulating T-cell population by flow cytometry.

Antineoplastic Agents↗
PubMed2003

Cost-effectiveness of anastrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer.

BACKGROUND: In a recent trial of first-line therapy in 353 postmenopausal women with predominantly hormone receptor-positive advanced breast cancer (the North American trial), anastrozole 1 mg QD produced a significantly longer time to disease progression (TTP) than tamoxifen 20 mg QD (11.1 months vs 5.6 months; P = 0.005). Both treatments were well tolerated, but there were fewer thromboembolic events and a reduced incidence of vaginal bleeding with anastrozole. OBJECTIVE: The aim of this study was to conduct an economic analysis of anastrozole versus tamoxifen based on data from the North American trial. METHODS: Quality-adjusted TTP (QATTP) was determined by combining TTP values with uniform or graded weights for adverse events using the Quality-adjusted Time Without Symptoms and Toxicity method. Direct health care costs before and after disease progression were determined from the perspective of 4 types of health care insurers in the United States: health maintenance organizations (HMOs), indemnity plans, preferred provider organizations (PPOs), and point-of-service (POS) plans. RESULTS: Median QATTP with graded weights was 9.7 months for anastrozole, compared with 4.6 months for tamoxifen (P = 0.003). A resultant reduction in health care resource utilization was observed, particularly the requirements for hospitalization, outpatient visits, and chemotherapy, but the statistical significance of this observation was not assessed. Incremental cost savings per patient before and after disease progression were observed with anastrozole compared with tamoxifen (9064 dollars for HMO, 9678 dollars for indemnity plan, 14,273 dollars for PPO, and 12,715 dollars for POS; all P < 0.01). CONCLUSIONS: In the US managed care setting, anastrozole produced a higher QATTP and incurred lower treatment costs than tamoxifen in a population of postmenopausal women with predominantly hormone receptor-positive advanced breast cancer. Therefore, anastrozole was more cost-effective than tamoxifen as first-line endocrine therapy in the population studied.

Anastrozole↗