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Biomedical subjects

H Buchan

Publications and source records attributed to H Buchan.

10 recordsLinked to original sources
PubMed1992

Who benefits from electroconvulsive therapy? Combined results of the Leicester and Northwick Park trials.

This paper describes the results obtained by combining data from the Northwick Park and Leicester randomised controlled trials of ECT. Patients who suffered from depression in which retardation and delusions were features and who received real ECT had a significantly improved outcome at the end of four weeks of treatment (as measured by improvement in the HRSD) in comparison with those who received simulated ECT. However, this treatment effect was not detectable at six-month follow-up. Patients who were neither retarded nor deluded did not benefit significantly from real as opposed to simulated ECT.

Antidepressive Agents↗
PubMed1992

Trends in hospital discharge rates for pelvic inflammatory disease in Scotland, 1975-1985.

This paper describes trends in hospitalisation for pelvic inflammatory disease in Scotland between 1975 and 1985. The age-standardised hospital discharge rate per 100,000 for all pelvic inflammatory disease in women aged 15-44 rose from 100.1 in 1975 to 143.8 in 1985. Rates of acute pelvic inflammatory disease increased by 58%, from 66.3/100,000 in 1975 to 104.5/100,000 in 1985, but the rate of discharge for chronic disease rose only slightly from 33.8/100,000 to 39.3/100,000. About one quarter of acute cases underwent surgery which enabled confirmation of the diagnosis, and there was no major change in this proportion between 1975 and 1985. The use of laparoscopy steadily increased, but this tended to replace other forms of surgery which could confirm the diagnosis. The percentage of chronic cases which were surgically confirmed increased steadily over the time period studied. A marked decrease in the mean duration of stay--from 9.2 days in 1975 to 4.9 days in 1985--meant that the total number of bed days used by patients with pelvic inflammatory disease fell by 16% between 1975 and 1985 despite the increase in the total number of cases.

Adolescent↗
PubMed1991

Physician, heal thy software.

This article begins with the view that computers are not essential for medical audit. There is a lot of pressure from manufacturers and enthusiasts to purchase computers as a prerequisite to undertaking medical audit. The authors challenge this view and provide a useful checklist of questions to ask before deciding to buy a computer and discuss how to choose the right system for your needs, once the decision has been made.

Decision Making↗
PubMed1990

Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use.

Up to the end of 1989, 206 parous women in the Oxford Family Planning Association contraceptive study had been referred to hospital with a first episode of pelvic inflammatory disease. Of these, 65 suffered from definite disease described as acute, 81 from definite disease not described as acute and 60 from 'other disease'. Considering all forms of disease together, referral was less common in those aged 25-29 and in those aged 45 or more than in those aged 30-44. Referral was more common in those of low social class, in those who smoked and in those who married young. All these factors were taken into account in analyses considering the effects of contraceptive methods. In these analyses, women currently using the contraceptive pill, the diaphragm, the sheath, female sterilization or an intrauterine device (IUCD) were compared with those currently using other methods or no method of contraception. IUCD ex-users were, however, placed in a separate category, irrespective of their current method of contraception. The relative risks obtained in these analyses, with 95% CI, were as follows: contraceptive pill 0.5 (0.2-0.9), diaphragm 0.6 (0.3-1.2), sheath 1.2 (0.6-2.4), female sterilization 0.7 (0.3-1.5), non-medicated IUCD 3.3 (2.3-5.0), medicated IUCD 1.8 (0.8-4.0), IUCD ex-users 1.3 (0.7-2.3). These data suggest that oral contraceptives, the diaphragm and female sterilization protect against pelvic inflammatory disease and that IUCDs increase the risk. Medicated devices, however, appear to carry only about half the risk of non-medicated devices, and the elevation of risks in IUCD ex-users appears to be small. Special analyses examined the risk associated with use of a Dalkon Shield. Among women currently using an IUCD (of any kind), those who had used a Dalkon Shield (at any time) had nearly five times as great a risk of hospital referral for pelvic inflammatory disease as those who had never used a Dalkon Shield (relative risk 4.7, 95% CI 2.1-9.0).

Acute Disease↗
PubMed1989

Management control of open-access radiology: is it possible?

This paper considers management options for limiting general practitioner use of open access radiology - a service for which there is increasing demand which is difficult to meet. In the current climate of cost containment, restriction of general practitioner access to these expensive diagnostic facilities has management appeal. However, it is difficult to justify blanket restriction of access to radiology services as there is no evidence that it would be economically or clinically sensible. An explicit quota system is unlikely to be feasible because of the small number of referrals made by general practitioners and the element of chance which will inevitably enter into the referral process. Managers should examine more closely the manipulation of incentives and costs which are used, often implicitly, to balance the conflicting desires of clinicians and managers. The best management option would appear to involve a re-evaluation of the role of the radiologist to include responsibility for managing the service. This should include assessment of appropriateness of referral by reference to guidelines for investigation and the behaviour of acknowledged good practitioners.

Costs and Cost Analysis↗
PubMed1989

Epidemiology and trends in hospital discharges for pelvic inflammatory disease in England, 1975 to 1985.

Hospital Inpatient Enquiry data were analysed to determine trends in hospital discharges for pelvic inflammatory disease in England from 1975 to 1985. Cases where the disease was thought to be related to another condition, e.g. appendicitis, were excluded from the analysis. Discharge rates for both acute and chronic disease increased over the review period and there was a 28% increase in the discharge rate for total disease. Women in their 20s were most likely to be involved and this group showed the greatest increase in the discharge rate, both for acute and chronic disease. In the 20-24-year age group the rate of discharge for acute disease rose by 50%, from 125.6/100,000 in 1975 to 189.0/100,000 in 1985. Patients with a diagnosis of chronic pelvic inflammatory disease tended to be older than those with acute disease. Women who were divorced were more at risk of both acute and chronic forms of the disease than single or married women. Increase in the use of surgery to confirm the diagnosis occurred only for those with chronic disease. About a quarter of patients with acute disease had the diagnosis confirmed surgically, and this proportion did not change in the period studied, although laparoscopy increased as laparotomy decreased.

Acute Disease↗
PubMed1984

An outbreak of meningococcal disease: implications for community medicine.

A local outbreak of five hospitalised cases of meningococcal disease, one of which was fatal, occurred over a period of three weeks in a small community in one health district. The events surrounding this outbreak illustrate many of the problems of dealing with the community medicine aspects of potentially serious infectious disease. Difficulties in the management of the outbreak are identified and contributing factors discussed.

Adolescent↗