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Biomedical subjects

G Roberts

Publications and source records attributed to G Roberts.

At least 55 records · Page 3Linked to original sources
PubMed2001

Supporting children with serious health care needs. Analyzing the costs and benefits.

Effective and efficient service delivery to children who rely on medical technology or ongoing medical care will become increasingly critical as technology and medical know-how grow more sophisticated. Presently, technology's development and application threaten to outpace systems of service delivery. This article explores the present state of affairs by considering the challenges involved in planning and evaluating programs for children with special health care needs and their families. A cost-benefit model is suggested as a meaningful framework for considering challenges related to providing service in this arena and evaluating its effectiveness.

Child↗
PubMed2001

The reproducibility of assessing radiological reporting: studies from the development of the General Medical Council's Performance Procedures.

OBJECTIVES: To investigate the reproducibility of peer ratings of consultant radiologists' reports, as part of the new General Medical Council (GMC) Performance Procedures. DESIGN: An evaluation protocol was piloted, used in a blocked, balanced, randomized generalizability analysis with three blocks of three judges (raters), each rating 30 reports from 10 radiologists, and re-rated to estimate intrarater reliability with conventional statistics (kappa). SETTING: Rating was performed at the Royal College of Radiologists. Volunteers were sampled from 23 departments of radiology in university teaching and district general hospitals. PARTICIPANTS: A nationally drawn non-random sample of 30 consultant radiologists contributing a total of 900 reports. Three trained and six non-trained judges were used in the rating analysis. RESULTS: A protocol was generated that was usable by judges. Generalizable results would be obtained with not less than three judges all rating the same 60 reports from a radiologist. CONCLUSIONS: Any assessment of performance of technical abilities in this field will need to use multiple assessors, basing judgements on an adequate sample of reports.

Clinical Competence↗
PubMed2000

A cost-outcome analysis of adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients.

PURPOSE: To calculate cost-effectiveness and cost-utility ratios for adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients and to place these ratios in the context of generally accepted medical expenditures. MATERIALS AND METHODS: A spreadsheet-based activity costing model using 1997 Canadian (cdn) capital, operating, and administrative costs has been used to identify, from the institutional perspective, the incremental cost of adding radiotherapy to surgery and chemotherapy for this group of patients. Outcome data were derived from two recently published clinical trials and were converted to discounted incremental life years and quality-adjusted life years gained. Recommended health economics principles were employed in the quantification of both costs and outcomes, and a sensitivity analysis was performed. Three referenced publications provide a context within which to evaluate the calculated cost-effectiveness and cost-utility ratios. RESULTS: The incremental cost of adjuvant radiotherapy for this group of patients is calculated to be approximately $7,000cdn in 1997 Canadian dollars and in the Canadian socialized health-care environment. Based on published work the discounted incremental outcome benefit is calculated to be 0.5 life years or 0.45 quality-adjusted life years at ten years. Thus, cost effectiveness and cost-utility ratios are estimated to be $14,000cdn and $15,600cdn, respectively. CONCLUSION: Within the context of generally accepted medical expenditures, adjuvant postmastectomy locoregional radiotherapy for premenopausal node-positive breast cancer patients would be regarded as a cost-effective treatment strategy.

Breast Neoplasms↗
PubMed2000

Detecting mannosidase activities using ribonuclease B and matrix-assisted laser desorption/ionization-time of flight mass spectrometry.

Ribonuclease (RNase) B incubated with purified enzymes, whole bacterial cultures, or their separated components-cells and supernates-have been directly analyzed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-ToF) to detect exomannosidases and to evaluate their specificities and location. Enzymatic cleavage was monitored by observing changes in RNase B glycoform population. Thus a nonspecific alpha-(1 --> 2)-mannosidase activity converts the glycoprotein to its Man(5) form, identifiable by its mass of 14,899 [M + H](+); this species subsequently is converted, by the actions of alpha-(1 --> 3) and alpha-(1 --> 6)-mannosidases, to the Man(1) form via Man(4), Man(3), and Man(2). The Man(1) glycoform (which is readily isolated) has then similarly been used for identifying beta-(1 --> 4)-mannosidase and the derived Man(0) form has served in turn as a natural substrate for beta-(1 --> 4) N-acetylglucosaminidase producing a species possessing a single asparagine-linked GlcNAc residue (mass 13,886). Mannose liberated from the actions of mannosidases can, if desired, be quantified by, for example, chromatography. The actions and specificities of endoglycosidases such as a peptide-N-glycosidase F (PNGase F) and of endo-N-acetlyglucosaminidases (e.g., endo-F and endo-H), which respectively cleave between the GlcNAc&bond;Asn and GlcNAc&bond;GlcNAc bonds of N-linked glycoproteins, are also demonstrable by MALDI-ToF analysis of RNase B (and derived products). From these digests the completely deglycosylated polypeptide corresponding to RNase A in which Asn has been converted to Asp (mass 13,684) and a species corresponding to RNase A + GlcNAc (mass 13,886) are produced, together with their corresponding free oligosaccharides which are amenable to analysis by both MALDI-ToF and by HPLC.

Amidohydrolases↗
PubMed2000

Oral health status of children in a Paediatric Intensive Care Unit.

OBJECTIVE: The aim of the present study was to examine the dental status of critically ill children in a Paediatric Intensive Care Unit (PICU) and determine the efficacy of the mouth care received. DESIGN: Prospective nonrandomized study. SETTING: The study was carried out in the PICU at Great Ormond Street Hospital for Children. PATIENTS AND PARTICIPANTS: All children admitted to the PICU during the period of the study were eligible for inclusion. A total of 54 children completed the study. MEASUREMENTS AND RESULTS: Children were examined for dental caries, plaque accumulation, gingival inflammation and gingival bleeding on admission to the PICU. The examination was repeated on discharge from the Unit. The levels of dental caries found on examination were compared with results from the most recent national surveys carried out in the United Kingdom, and analysed using the one sample t-test. The levels of plaque accumulation, gingival inflammation and gingival bleeding on admission were compared to those on discharge and analysed using the paired sample t-test. Results revealed a very highly significant increase in plaque accumulation (p = 0.001), and a highly significant increase in gingival inflammation (p = 0.006) between admission to the PICU and discharge. CONCLUSIONS: Results indicate that the present mouth care regimen is not effective in preventing the build up of plaque or maintaining gingival health. These children may therefore be at unnecessary risk from local or systemic spread of oral microorganisms.

Child, Hospitalized↗
PubMed2000

Acute disseminated encephalomyelitis--a diagnosis to consider.

UNLABELLED: The case history of an 11-year-old boy with post-infectious acute disseminated encephalomyelitis (ADEM) is presented. ADEM is a diagnosis that is increasingly being made with the advent of modern radiological techniques. However, the syndrome cannot be thought of as a discrete clinical entity as it is triggered by a wide range of factors including infections and vaccinations. Furthermore, other pathological processes may give the same radiological appearances. The aetiology, pathophysiology and management of the syndrome are discussed. CONCLUSION: Acute disseminated encephalomyelitis is a radiological diagnosis that has many precipitants. Thought must be applied in developing a differential diagnosis to allow the possibility of targeting treatment at the underlying cause.

Child↗
PubMed2000

An economic framework for evaluating a multileaf collimator.

OBJECTIVES: As health care budgets continue to face close scrutiny, any new acquisition must be evaluated for both costs and outcomes. This study was undertaken to demonstrate the application of an economic framework for the evaluation of a multileaf collimator as an example of a new technology that can have both quantifiable and nonquantifiable benefits for patients, staff, and cancer care institutions. METHODS: Using financial data from the Northeastern Ontario Regional Cancer Centre (NEORCC) and a recognized staffing model, a commercial spreadsheet, developed to economically characterize the principal radiotherapy processes has been used to determine the net incremental annual cost of a multileaf collimator (MLC). RESULTS: The incremental annual cost of purchasing an MLC is estimated at approximately $85,000 (1997 CDN $). Without increasing patient throughput, this increases the average cost of a course of radiotherapy by approximately CDN $200. Savings can be accrued by decreasing mold room activity, increasing the hourly patient capacity on each treatment machine, and decreasing sick time due to strain injuries. CONCLUSIONS: Although the clinical outcome of techniques facilitated by MLCs, such as intensity-modulated radiation therapy, are unknown at this time, an economic context within which to objectively evaluate this technology is presented. The framework presented suggests a method of quantifying outcome-justified expenditures, such as improved patient outcome and greater treatment flexibility, which, when offset against the incremental annual equipment cost, may be used to help justify the acquisition of multileaf technology.

Capital Expenditures↗
PubMed2000

Child sexual abuse II: treatment.

OBJECTIVE: To evaluate the scientific literature concerning the treatment of child sexual abuse. METHOD: A critical review of the scientific literature. RESULTS: There are only nine published research studies in which subjects were randomly assigned to an index treatment or treatments and a comparison treatment or no-treatment control group. In seven of the studies, the index treatment exceeded the control or comparison group in regard to treatment outcome; in two studies it did not. The successful treatments involved group therapy, combined individual and group play therapy and cognitive behaviour therapy. CONCLUSIONS: Treatment should be based on an explicit conceptual model of the psychopathology of sexual abuse. The University of Queensland Sexual Abuse Treatment Project, which is based on a transactional model, is described.

Adaptation, Psychological↗
PubMed2000

Tropisetron reduces postoperative vomiting in children undergoing tonsillectomy.

In this patient, parent and investigator blinded, randomized, placebo-controlled study, children undergoing tonsillectomy (mean age 6.4 years) received either intravenous placebo (n=36) or tropisetron 0.2 mg.kg-1 up to 5 mg (n=35) at induction of anaesthesia with halothane, nitrous oxide and oxygen. Morphine and paracetamol were given in theatre for postoperative pain. Episodes of vomiting were recorded during the first 24 h after surgery. Intravenous tropisetron was significantly (P<0.001, chi-squared) more effective than placebo in controlling the incidence and frequency of emesis during the first 24 h: vomiting was reduced from 89% to 46% and the mean number of vomits from 4.6 to 2.4. Minor side-effects occurred equally in both the placebo and active groups. Intravenous tropisetron is an effective and safe antiemetic for reducing postoperative vomiting in children undergoing tonsillectomy or adenotonsillectomy.

Anesthesia, Inhalation↗