Biomedical subjects
Publications and source records attributed to I Watt.
A dose study was performed of MRI intravenous contrast medium enhancement of rheumatoid synovium in the knee, comparing the enhancement with gadoteridol at doses of 0.1 and 0.3 mmol/kg. A measurable and significant difference was demonstrated which has particular relevance to the accuracy of dose calculations needed when performing quantitative studies.
The knees of forty-three patients suffering from rheumatoid arthritis (RA) were examined using pre- and post-contrast MRI in an attempt to assess the extent and frequency of all abnormalities in the RA knee. Features evaluated by MRI were: synovial thickening, joint effusion, bone destruction, popliteal cysts, periarticular soft tissue swelling, abnormal tendons and bone marrow changes. A scoring system (0-2) was used to determine the relationship between the various signs of RA in order to identify those that may be relevant for the assessment of therapeutic response. It seems that the assessment of inflamed synovium is the major criterion for the determination of disease activity in RA.
OBJECTIVE: To review the available evidence in order to identify effective interventions which health services alone or in collaboration with other agencies could use to reduce inequalities in health. METHODS: A search of the literature was undertaken using a number of databases including Medline (from 1990), Applied Social Science Index and Abstracts (1987-1994), and the System for Information on Grey Literature in Europe (1984-1994), on a large range of key words. Studies were included if they assessed interventions designed to reduce inequalities in health or improve the health of a population group relevant to the review, and could be carried out by a health service alone or in collaboration with other agencies. Only studies evaluating interventions using an experimental design were included. Papers in any language were considered. In addition, systematic reviews of the research on the effectiveness of health promotion and the treatment of conditions where there are significant health inequalities were identified in order to illustrate the potential for reducing inequalities in health. RESULTS: 94 studies were identified which satisfied all the inclusion criteria and 21 reviews were included. A number of interventions have been shown to improve the health of groups who are disadvantaged by socio-economic class, ethnicity or age and, if properly targeted, could be expected to reduce health inequalities. If a health intervention is being used, there should be evidence that it has an impact on health status. Attention should then be given to the way in which the intervention is delivered and the characteristics of a programme to promote implementation. Characteristics of successful interventions specifically aimed at reducing health differentials include: systematic and intensive approaches to delivering effective health care; improvement in access and prompts to encourage the use of services; strategies employing a combination of interventions and those involving a multi-disciplinary approach; ensuring interventions address the expressed or identified needs of the target population; and the involvement of peers in the delivery of interventions. However, these characteristics alone are not sufficient for success, nor are they universally necessary. CONCLUSIONS: Although it is likely that the most significant contributions to reducing health inequalities will be in improving economic and social conditions and the physical environment, there are interventions which health services, either alone or in collaboration with other agencies, can use to reduce inequalities in health.
The radiological and MRI appearances of 24 knees with patellar tendonitis resistant to conservative therapy were analysed to identify the characteristic MRI appearance and to determine if the patellar morphology was abnormal. A significant thickening of the tendon was found in all cases; this was a more reliable diagnostic feature than a high signal within the superior posterior and central aspect of the tendon at its proximal attachment. The site of the lesion shown by MRI is more compatible with impingement of the inferior pole of the patella against the patellar tendon than a stress overload of the tendon. There were no significant differences in the length of the patella, inferior pole or length of the articular surface when the patellar morphology was compared with that of a matched control group.
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A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflammatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter's syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular disease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration.
This 32-year-old patient with hairy cell leukaemia demonstrated extensive bony involvement in a pattern not previously described. Although the disease continued to progress during interferon treatment, a change to a regime of deoxycoformycin resulted in an excellent response.
Pre-operative cervical spine radiographs are routinely requested for patients with rheumatoid disease, prior to elective orthopaedic surgery, but no guidelines exist governing the indications for this investigation. One hundred and twenty-eight such patients were reviewed retrospectively. No patient had signs or symptoms attributable to cervical cord compression. The incidence of unsuspected C1/2 subluxation was 5.5%, and as many as 37% of examinations could have been avoided by assessing previous radiographs. The apparent lack of effect on subsequent anaesthetic management was noticeable. Techniques that do not require hyperextension of the neck were employed in 12 of 19 patients with craniocervical instability and included the laryngeal mask airway, face mask or spinal anaesthesia. However, similar variations in anaesthetic technique were observed in patients without cranio-cervical instability. It is concluded that pre-operative cervical spine assessment in asymptomatic patients with rheumatoid disease is unnecessary, prior to elective orthopaedic surgery.
The possibility of restoring fertility among some infertile couples through assisted reproductive technology has led to questions about the terms under which such treatments should be made available. Although there is now evidence on their effectiveness, there is considerable variation in the availability of these treatments under the U.K. National Health Service.
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There is an increasing interest in dissemination among researchers, policy makers and information scientists. Dissemination, in the context of health services, can be taken to mean the process of implementing the findings of research. Currently there is a considerable delay in the adoption of evidence on the effectiveness of interventions by professionals in the NHS and other health systems. The development of research designs such as randomized control trials, which can provide the most reliable information on the efficacy of interventions, is a crucial but partial step in the quest to place clinical practice on a more scientific basis. Systematic overviews of interventions bring together the relevant evidence to provide overall estimates of the effectiveness of health service interventions. However, there remains the difficulty of bringing them to the attention of health professionals in a manner which will enable them to improve the effectiveness of their clinical practice. The research evidence suggests that effective dissemination will depend upon using multiple means to communicate key messages rather than a single measure or 'magic bullet'. Information professionals have a role in ensuring the key research evidence is promoted, and that it is as reliable as possible.
Research into health behaviour among people of Chinese ethnic origin in Britain has been piecemeal and provides an inadequate basis for health prevention initiatives. A better understanding to direct future research and to facilitate the development of new health prevention initiatives among the Chinese community might be achieved by use of the Health Action Model.