Search PubMed⌕ Search

Biomedical subjects

H Sanderson

Publications and source records attributed to H Sanderson.

At least 19 recordsLinked to original sources
PubMed2005

A satisfaction survey of women admitted to a Psychiatric Mother and Baby Unit in the northwest of England.

A Satisfaction Questionnaire for an Inpatient Mother and Baby Unit was developed covering general psychiatric and specific perinatal aspects of the service. In a study of 41 women admitted over one year twenty returned the completed questionnaire. Among respondents overall satisfaction with the service was very high and women preferred it to a general psychiatric ward. Respondents were most dissatisfied with degree of involvement in the planning and the level of decision making about their care which is a recurring theme in surveys of psychiatric inpatients.

Adult↗
PubMed2005

Reflections on uncertainty in risk assessment and risk management by the Society of Environmental Toxicology and Chemistry (SETAC) precautionary principle workgroup.

Quantitative uncertainty assessments and the distribution of risk are under scrutiny and significant criticism has been made of null hypothesis testing when careful consideration of Type I (false positive) and II (false negative) error rates have not been taken into account. An alternative method, equivalence testing, is discussed yielding more transparency and potentially more precaution in the quantifiable uncertainty assessments. With thousands of chemicals needing regulation in the near future and low public trust in the regulatory process, decision models are required with transparency and learning processes to manage this task. Adaptive, iterative, and learning decision making tools and processes can help decision makers evaluate the significance of Type I or Type II errors on decision alternatives and can reduce the risk of committing Type III errors (accurate answers to the wrong questions). Simplistic cost-benefit based decision-making tools do not incorporate the complex interconnectedness characterizing environmental risks, nor do they enhance learning, participation, or include social values and ambiguity. Hence, better decision-making tools are required, and MIRA is an attempt to include some of the critical aspects.

Decision Support Techniques↗
PubMed2000

Constitutive death of platelets leading to scavenger receptor-mediated phagocytosis. A caspase-independent cell clearance program.

Apoptosis is a physiological program for the deletion of cells in which caspases govern events leading to safe clearance by phagocytes. However, a growing weight of evidence now suggests that not all forms of programmed cell death are caspase-dependent. We now report a complete and constitutive but caspase-independent program for the specific phagocytic clearance of intact effete platelets, anucleated blood cells of critical importance in health and disease. Platelets aged in vitro not only exhibited increased expression of proapoptotic Bak and Bax but also evidenced constitutive diminution of function such as decreased aggregation to ADP, which was accelerated by culture in the absence of plasma. This abrogation of cell function in plasma-deprived platelets was associated with morphological and biochemical features similar to those of granulocyte apoptosis, that is, cytoplasmic condensation, plasma membrane changes including exposure of phosphatidylserine and the granule protein P-selectin, and recognition by phagocyte scavenger receptors. However, and in contrast with constitutive death of other inflammatory blood cells by apoptosis, these events were not affected by caspase inhibitors, nor was there evidence of caspase-3 activation either by hydrolysis of analog peptide substrates or Western blot analysis, serving to emphasize that neither programmed cell death nor clearance by phagocytes need involve caspases.

Apoptosis↗
PubMed2000

Information requirements for clinical governance.

Clinical governance requires three main types of information--guidelines, policies and treatment options for clinicians and patients; information about the care given; and information about how the systems work. There are other key issues which impact on the above--legal issues, national standards, sophisticated analytical tools and packages and the requisite training and development of staff.

Evidence-Based Medicine↗
PubMed1996

ADP-induced P-selectin expression on platelets as a predictor of successful thrombolysis.

Unlike coronary thrombolysis, the role of platelet activity in the outcome of local thrombolytic therapy for peripheral ischaemia is not well understood. In the present study ten patients undergoing local pulse spray thrombolysis (PST) with recombinant tissue-type plasminogen activator (rt-PA), six patients undergoing conventional infusion thrombolysis (CT) with rt-PA and another six patients undergoing arteriography with iopamidol were studied. Venous blood samples obtained before and after the procedure were analysed using a flow cytometric technique for detection of platelet activation after labelling platelets with VH10, a monoclonal antibody against P-selectin. In the present study no significant differences were observed in P-selectin expression before and after any of the procedures, except that P-selectin expression following ADP stimulation was reduced in patients who had received conventional thrombolysis. Unexpectedly, we observed relatively greater P-selectin expression, particularly after ADP stimulation, both before and following thrombolysis in ten patients in whom thrombolysis was successful compared with six patients in whom thrombolysis was unsuccessful. ADP-induced P-selectin expression on platelets may therefore be a useful predictor of outcome of peripheral intra-arterial thrombolysis.

Adenosine Diphosphate↗
PubMed1991

Stage distribution of breast cancer: a basis for the evaluation of breast screening programmes.

Stage at presentation can be predictive of future mortality rates. A change in stage distribution will be indicative of the effect of a programme. All registrations for 1985 aged over 50 years were staged from case notes and, to assess whether a stage drift is already occurring, cases that presented in 1975 were also staged. The accuracy and completeness of the Wessex Cancer Register for this particular cancer was assessed and further sources of registration identified. There was a significant difference between 1975 and 1985 stage distributions. If the Southampton and Salisbury service achieves the same success as the Gavleborg County trials, 4.61 deaths will be prevented at 5 years for each annual cohort of cases. For individual breast screening programmes, effectiveness is better monitored by analysis of stage distribution than of mortality rates.

Breast Neoplasms↗
PubMed1990

Steps towards cost-benefit analysis of regional neurosurgical care.

OBJECTIVE: To determine the cost of averting death or severe disability by neurosurgical intervention. DESIGN: Retrospective analysis of one year's admissions for neurosurgery; comparison of outcome with expected outcome in the absence of neurosurgical intervention and with the cost of neurosurgery. SETTING: Wessex Neurological Centre. PATIENTS: 1026 Patients were admitted to the neurosurgical service in 1984. Of 1185 admissions, 978 case records were available and outcome was known in 919. MAIN OUTCOME MEASURES: Outcome was assessed with the Glasgow outcome scale, modified as necessary, from the case notes, or by letter follow up to the general practitioner. Expected outcomes for each of the 54 diagnoses were derived from both published reports where available and an expert panel of 18 consultant neurosurgeons. The cost of the neurosurgical service for 1983-4 was known from a separate study and the cost per patient was calculated using the length of stay. RESULTS: The cost of neurosurgery in 1983-4 was 1.8 million pounds. In all, 243 deaths or severe disabilities were estimated to have been averted at an average cost of 7325 pounds (range 5000 pounds to 70,000 pounds). The overall cost per quality adjusted life year (QALY) was 350 pounds (range 34 pounds to greater than 400,000 pounds). The cost of long term care for severely disabled survivors is at least 18-fold greater than the cost of neurosurgical intervention to avert such disability. CONCLUSIONS: In Britain neurosurgery is not expensive in comparison with the costs and benefits of other areas of medicine, and the cost per QALY is unexpectedly low except for severe diffuse head injury, malignant brain tumors, and cerebral metastases. The neurosurgical budget should be assessed in the context of managing a patient in hospital and subsequently in the community.

Brain Diseases↗
PubMed1989

Use of a cancer register for monitoring and evaluating a breast cancer screening programme.

To monitor the effectiveness of a breast cancer screening service accurate information is necessary on the incidence of breast cancer before and after screening is introduced. The Wessex Cancer Register has been used to provide data on the incidence prior to screening and arrangements are being made for the exchange of information between the Register and each screening service in Wessex in order that future registrations can be divided into screen-detected and symptomatically-detected cases. Since changes in mortality will not be apparent for some years and are not detectable in small populations, other indicators of effectiveness are required. Stage at presentation predicts mortality; a change in stage distribution as a result of screening would indicate future changes in mortality. The Cancer Register has been used to analyse stage distribution before the advent of screening. Procedures have been adopted for collecting staging data on all breast cancers diagnosed in the future, both within and without the screening service. In this way stage distribution will be compared before and after the implementation of the service and predictions made on the effect on mortality in the future. In addition, information on the incidence of interval cancers will be analysed using the Cancer Register so that, in the long term, an assessment can be made of the appropriate length of the interval between screens. These cancers will be notified to the screening office for review. A Cancer Register can provide the population base from which to measure the true effectiveness of a breast screening service on the community it serves.

Breast Neoplasms↗