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Biomedical subjects

E A Paul

Publications and source records attributed to E A Paul.

At least 19 recordsLinked to original sources
PubMed1992

Equity and medical practice variation: relationships between standardised discharge ratios in total and for selected conditions in English districts.

STUDY OBJECTIVE: The aim was to investigate relationships for residents of English district health authorities between rates of discharges from acute hospitals for all conditions and variations in discharge rates for eight common conditions (five surgical, three medical). DESIGN: Hospital Inpatient Enquiry data on discharges for 1984 were analysed. Standardised discharge ratios (ratios of actual to expected numbers of discharges x 100) were derived for selected conditions and all conditions; and correlation coefficients for these statistics were calculated. Districts were grouped into quintiles according to the value of the standardised discharge ratio, and systematic variation within each quintile was calculated for the selected conditions. SETTING: The study involved all 192 English district health authorities, but 57 were excluded because the proportion of unspecified diagnoses exceeded 5%. PATIENTS: The analyses were based on 336,799 cases from 135 districts. MEASUREMENTS AND MAIN RESULTS: Discharge ratios for the medical conditions and one surgical condition were significantly correlated with the levels of total discharge rates (p less than 0.01). The medical conditions showed greater systematic variation in discharge ratios than the surgical conditions. There was no consistent pattern in the values of systematic variation for the selected conditions across the different levels of discharge ratios for all conditions. CONCLUSIONS: It is argued that the changes in the NHS introduced in April 1991 are intended to introduce greater equity in the standardised discharge ratios and increase the total numbers of discharges. The results of this analysis suggest that, even if these objectives were achieved, they may not result in increased levels of elective care, nor result in greater equity in terms of rates of discharge for individual conditions.

Acute Disease↗
PubMed1991

Portable oxygen therapy: assessment and usage.

Fifty portable oxygen assessments, based on 6-min walking tests, were reviewed to produce guidelines for assessment and prescription of portable oxygen, and to evaluate factors predicting benefit. Patients with a portable cylinder were questioned about benefits/difficulties and usage of portable oxygen. A significant improvement on the oxygen compared to the air walk was found (median 9.7%) which correlated with the oxygen desaturation on the baseline walk (r = 0.51, P less than 0.05). A placebo effect was demonstrated using an air cylinder (median improvement 6.1%). There was no correlation between improvement in walking distance and decrease in visual analogue scale (VAS) score of breathlessness. We recommend standard portable oxygen assessments based on a series of 6-min walks. Improvements of 10% in walking distance or VAS score from the oxygen to the air walk would lead to the patient being offered a portable oxygen cylinder.

Adult↗
PubMed1989

Multidimensionality of psychological recovery from anaesthesia. Analysing six recovery tests.

Six recovery tests, choice reaction time (CRT), CRT doubletask, finger tapping test (FTT), critical flicker fusion frequency (CFF), Maddox wing, and p-deletion test, which cover basic cognitive, motor and perceptive functions as well as concentration, were analysed and compared with each other. Correlation between these tests after recovery from standardised general anaesthesia was calculated in 22 patients. Moderate to high correlation was found between CRT and CRT doubletask (r = 0.62 to r = 0.73), when parameters of six different tests were compared. Finger tapping correlated moderately with the movement time of both the CRT and the CRT doubletask (r = 0.46 and r = 0.47 respectively). We concluded that the CRT test, which measures initiation and movement time, might replace the CRT doubletask and the FTT. The CFF correlated moderately with the initiation time of the CRT doubletask, but because a slightly different function seems to be involved, further research is needed. Maddox wing and the p-deletion test correlated with no other test. Results indicated that recovery is differentiated in at least four distinct psychomotor functions, which should be tested by CRT (to measure initiation and movement time), Maddox wing and p-deletion.

Adult↗
PubMed1989

Nondrug treatment of hypertension: a survey of black physicians in New York State.

A survey of 64 black physicians in New York State was completed in April 1988 concerning physicians' approach to the nondrug treatment of hypertension. The physicians clearly support the use of nonpharmacologic treatment of mild hypertension, particularly for patients with diastolic blood pressure of 90 to 94 mmHg. However, very little time appears to be spent counseling patients with respect to diet and weight reduction. There was considerable variability in the degree of confidence felt by physicians in recommending nondrug approaches to hypertension control. An overwhelming majority of physicians felt that their training did not adequately prepare them for counseling patients about diet specifically or for practicing preventive medicine generally. The findings of this survey suggest a need for significantly increased attention to training physicians during both medical school and residency in prevention, patient counseling, and health promotion.

Black or African American↗
PubMed1989

[Geographical variations in mortality due to diseases amenable to medical intervention in Europe--Commission of European Communities: atlas of avoidable deaths].

The urgent need to develop measures of the outcome of health-care services has led to the collaboration of 10 countries of the European Community in the production of the European Community atlas of avoidable death (1974-1978). Seventeen disease groups were chosen for which it was considered that death within specified age groups should be either wholly or substantially avoidable when appropriate medical care is sought and provided in good time. Mortality from these causes was compared across 360 health-service administrative areas in the participating countries. For all diseases there was considerable variation in mortality both within and between the countries of the European Community and it is suggested that high levels of mortality from these causes should be viewed by health authorities as warning signals of potential failures of health-care services. Work is in progress on a further edition of the Atlas for the years 1980-1984. Changes in avoidable mortality over time could indicate which health authorities have persistent problems and which authorities are succeeding in reducing avoidable mortality.

Adolescent↗
PubMed1988

Avoidable deaths.

Explore the source record for details and available documents.

Adolescent↗
PubMed1985

Assay of anti-cancer drugs in tissue culture: relationship of relapse free interval (RFI) and in vitro chemosensitivity in patients with malignant cerebral glioma.

One hundred and seventeen patients with cerebral glioma (Kernohan grades III and IV) were treated with adjuvant chemotherapy using procarbazine (PCB), CCNU and vincristine (VCR) following whole head irradiation. Cell cultures were prepared from 40 patients in this series and their sensitivity to each cytotoxic drug was assessed in a mictotitration assay with 35 S-methionine incorporation as the end point. Twenty-two of forty (55%) patients responded to PCB and/or CCNU in vitro, and sensitivity to these drugs was linked with increased RFI, whilst sensitivity to VCR was not. The RFI of patients who had responded to PCB or CCNU in vitro was significantly longer than the RFI of patients whose tumours failed to respond in vitro or patients who had not been tested. There was no difference in sex ratio, extent of operation, radiation dose and degree of steroid cover between responders, non-responders and untested groups. Grade III tumours tended to be more sensitive in vitro than grade IV tumours. The age of patients also influenced in vitro chemosensitivity. Patients with chemosensitive tumours in vitro tended to be younger than patients with insensitive tumours in vitro. Further statistical analysis, taking into account these prognostic factors, indicated an association between chemosensitivity in vitro and RFI.

Adult↗
PubMed1984

Mini-mental state examination in neurological patients.

The Mini-Mental State examination has been found to be a quick and valuable test for simple bedside screening, and for serial assessment of cognitive function in a population of 126 neurological patients. Amongst those with cognitive impairment, there was a close relation between the Mini-Mental State examination and the conventional Weschler Adult Intelligence Scale (WAIS). However, the Mini-Mental test was not a sensitive indicator of focal versus diffuse hemisphere disease. Further refinement in the areas of language and visuo-spatial function may improve its value.

Adolescent↗
PubMed1984

Pre- and postoperative changes in serum myelin basic protein immunoreactivity in neurosurgical patients.

In 44 patients undergoing neurosurgical procedures for intracranial tumors, subarachnoid hemorrhage, or spinal and peripheral nerve lesions, serum myelin basic protein (MBP) immunoreactivity was measured preoperatively and serially in the first 10 postoperative days. The double-antibody radioimmunoassay method was used, with a detection limit of 2.5 ng/ml in serum. Clinical evaluation was carried out at admission and on successive days during the period of neurosurgical management; outcome was assessed later. In the early postoperative phase, there was a fall in MBP immunoreactivity in all groups of patients. In the groups with intracranial tumor and subarachnoid hemorrhage, there was a subsequent rise in MBP immunoreactivity before the end of the 10-day period, which was not found in the group with spinal and peripheral nerve lesions.

Adenoma↗
PubMed1983

Dorsal column stimulation in multiple sclerosis: effects on bladder and long term findings.

The effect of dorsal column stimulation on bladder function in 15 patients with established multiple sclerosis was analysed by urodynamic tests. Significant improvement in flow rate and urethral sphincter pressure was recorded in about two thirds. Of 31 patients examined over five years only 13 showed initial benefit from stimulation and were given permanent stimulators; of these, only three appeared to receive lasting benefit. Early complications occurred in nine patients and five had a relapse of their disease. These results suggest that at present stimulation of the dorsal column does not have a place in the routine management of multiple sclerosis.

Adult↗
PubMed1982

Methacholine pupillary responses in third nerve palsy and Adie's syndrome.

In order to examine the clinical usefulness of methacholine in assessing the site of ocular parasympathetic lesions, pupillary responses in man were measured in postganglionic (Adie's syndrome) and preganglionic third nerve lesions involving the pupil and in controls. From previous work with methacholine it might have been expected that greater constriction would occur in the postganglionic lesions but similar responses were found in both. Corneal hypoxia due to ptosis appeared unlikely to affect corneal permeability significantly and it is probable that these results reflect an increase responsiveness of the iris at, or distal to, the site of muscarinic acetylcholine receptors. Pupils contralateral to third nerve palsy, when tested on a separate occasion, also constricted by an amount approximately proportional to that of the clinically abnormal pupil. The possibilities that this may result in some way from reduction in total retinal illumination, or from retrograde changes in preganglionic pupilloconstrictor neurons affecting contralateral pupilloconstrictor neurons via central pathways, are discussed. It is concluded that supersensitivity to methacholine, tested carefully in the manner described, is a useful guide to the presence of parasympathetic denervation or decentralization, but that it is not reliable in distinguishing between the two sites.

Adie Syndrome↗
PubMed1980

Effect of high haematocrit on alertness.

Patients with high-normal or above-normal haematocrit were found to have impaired alertness when compared with a control group matched for age and occupation. On retesting the controls had improved alertness scores attributable to a practice effect; but the patients, when retested after reduction of haematocrit by venesection, had improved significantly more than the controls. Improvement in alertness correlated very well with the increase in cerebral blood flow which followed venesection. Levels of venous haematocrit that are generally accepted as normal may not necessarily be optimum.

Adult↗
PubMed1979

Central nuclear counts in muscle fibres before and during treatment in hypothyroid myopathy.

Serial percutaneous needle muscle biopsies of vastus lateralis were studied in 10 patients who had varying degrees of hypothyroid myopathy. The biopsies were taken before and during treatment with l-thyroxine. Before treatment the most severely clinically affected patients showed type II muscle fibre atrophy and loss, together with increased central nuclear counts preferentially affecting the type II muscle fibre. Both the type II muscle fibre atrophy and loss and the increased central nuclear counts tended to return towards normal values during treatment with l-thyroxine. The severity of myopathic symptoms before and during treatment correlated with the biochemical evidence of hypothyroidism, a type II fibre atrophy, and increased central nuclear counts. The severity of myopathic signs before and during treatment was correlated with both a type II fibre atrophy and loss and increased central nuclear counts. There was no evidence that the myopathic signs before and during treatment were related to the biochemical parameters of hypothyroidism, except the level of thyroid stimulating hormone. It is suggested that sequential studies of muscle fibre percentages, diameters, and central nuclear counts may provide an additional method of assessing the response to treatment in hypothyroid and possibly other types of myopathy. When increased central nuclear counts are confined to a specific muscle fibre type, this may suggest a hitherto unsuspected specificity of muscle fibre damage.

Adult↗