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Biomedical subjects

J A Bates

Publications and source records attributed to J A Bates.

17 recordsLinked to original sources
PubMed1994

An audit of the role of the sonographer in non-obstetric ultrasound.

In order to investigate the role of the sonographer in non-obstetric ultrasound, 1046 consecutive non-obstetric ultrasound scans performed by sonographers were audited. In 94% of cases, the report prepared by the sonographer gave an accurate account of the findings. In 6.3% of reports the radiologist provided additional comments, whilst in only 0.7% of cases was the sonographer's report significantly altered. In the 630 patients in whom adequate follow-up data was available, there was a single instance of a false positive ultrasound finding but no other significant ultrasound inaccuracy. This audit indicates that the local arrangements for involving sonographers in a non-obstetric ultrasound service has resulted in agreed standards being met. It is suggested that sonographers can and should be involved more widely in the provision of non-obstetric ultrasound services.

England↗
PubMed1993

Reproducibility of Doppler ultrasound measurement of resistance index in renal allografts.

In recent years measurements of arterial blood flow in the renal allograft have been studied in an attempt to provide a non-invasive method of diagnosing and monitoring post-transplant renal dysfunction. Many studies have involved measurement of the resistance index (RI) of arterial blood flow. Although the reproducibility of the technique has been studied in other areas of application, no such studies have been performed on the renal allograft. In this study we attempted to evaluate the reproducibility of the measurement of the RI of the interlobar artery in the renal allograft. 18 renal allograft recipients with stable functioning grafts were studied twice by each of two experienced sonographers using a colour-coded duplex Doppler ultrasound scanner, in order to determine the intraobserver and interobserver variability in the measurement of RI of the interlobar arteries in the allograft. Variability was small and although interobserver variability exceeded intraobserver variability, both were within repeatability limits adopted by the British Standards Institution. The results suggest that measurement of the RI of the interlobar artery of renal allografts is repeatable and reproducible when performed by experienced operators.

Adult↗
PubMed1992

Intrarenal Doppler ultrasound studies in normal and acutely obstructed kidneys.

Renal ultrasound examinations and intrarenal arterial Doppler studies were performed on 48 patients with normal renal tracts and 20 patients presenting with acute renal colic resulting from ureteric calculus, 14 of whom had urographic evidence of renal obstruction. The mean resistance index (RI) of the Doppler waveforms obtained on the 14 obstructed kidneys (70.4 +/- 6.22) was significantly higher than the mean RI of the 96 normal kidneys (62.4 +/- 6.43). The mean difference between the RIs of the obstructed kidneys and their contralateral non-obstructed kidneys (8.37 +/- 4.43) was also significantly higher than the differences in RI seen between pairs of normal kidneys (2.70 +/- 1.71). Five out of 14 obstructed kidneys showed no pelvicalyceal dilatation and could not have been shown to be obstructed on conventional sonography. Four of these five had RI changes suggestive of obstruction and thus 13 of 14 obstructed kidneys would have been identified as obstructed by a combination of Doppler and conventional sonographic findings. 10 of the 14 obstructed kidneys were re-examined after passage of a urinary calculus and nine showed a reduction in the RI of the previously obstructed kidneys. The 10th subsequently required ureterolithotomy.

Acute Disease↗
PubMed1992

Inability of color and spectral Doppler to identify fetal renal obstruction.

Color flow Doppler imaging was used to obtain fetal renal artery flow velocity waveforms in 130 normal fetuses at various gestational ages to build a database for the establishment of normal ranges for the Pulsatility Index in the fetal renal arteries throughout pregnancy. Twenty-nine cases of fetal renal tract dilation (greater than 5 mm anteroposterior diameter of the renal pelvis) of various causes were investigated. We found that measurements of the pulsatility index were not significantly altered from the normal range, so that color flow Doppler does not appear to be helpful in the differential diagnosis of fetal renal dilation.

Blood Flow Velocity↗
PubMed1986

Revolving drug funds: conducting business in the public sector.

Pharmaceuticals are essential for preventive and therapeutic health services. Unfortunately, significant demand, limited funds and high prices contribute to frequent shortages of drugs in many public health programs. One method for financing pharmaceutical supplies has been the establishment of revolving drug funds (RDFs) in which, after an initial capital investment, drug supplies are replenished with monies collected from the sale of drugs. All too often however, the funds actually recovered are insufficient to replenish supplies and the fund is soon depleted. In this paper we consider the potential benefits and common pitfalls of revolving drug funds and then focus on the central role of financial planning in establishing drug sales programs. Experiences from a variety of countries suggest several causes for the failure of some RDFs, including: under-estimation of capitalization costs, prices set below true replacement cost, frequent failure to collect payment, delays in cash flow which make funds unavailable for replenishment of drug stocks, rapid program expansion for which additional capital funds are not available, losses due to theft and deterioration of drugs, unanticipated price increases due to inflation or changes in parity rates and foreign exchange purchase restrictions. Common to many of these problems is the lack of a businesslike orientation to RDFs and, in particular, lack of careful financial planning and management. Financial planning for an RDF includes four analytical tasks: assessment of the potential market, estimation of the costs of an RDF, establishment of the cost-recovery objectives, definition of the role of subsidies and surcharges.(ABSTRACT TRUNCATED AT 250 WORDS)

Developing Countries↗
PubMed1980

Transcutaneous electrical nerve stimulation for chronic pain.

The results of 7 years experience in treating pain with transcutaneous electrical stimulation are reported. It was used on a group of 74 patients with postherpetic neuralgia and on a mixed group of 161 patients with chronic pain due to other conditions for which other forms of treatment had been unsatisfactory. The patients were lent stimulators and electrodes of various kinds. A half of the patients returned their stimulators after one month, but a quarter of the patients were still using transcutaneous stimulation after 2 years. No particular disease responded better or less well than any other; no particular kind of pain responded particularly well or badly. One third of the patients with postherpetic neuralgia started improving from the commencement of stimulation.

Chronic Disease↗
PubMed1978

Therapeutic electrical stimulation. The transistorized placebo?

(1) Electrical stimulation therapy for patients suffering with labile signs and symptoms, and these include all varieties of acute and chronic pains, seizures and spasticity, has come into fashion and gone, and come again with each new technological advance for the past two hundred years. (2) A proportion of patients with chronic disease have their suffering made worse if they feel deprived of the latest therapy and may be relieved if they are given it in the right circumstances. In this group the relief will usually be temporary and the limited supply of such reactors will promote the cycle of fashion. In a group of 126 patients with chronic pain associated with organic disease who were offered transcutaneous stimulation, only 23 (18%) continued to use it one year after they started. (3) The cycling of therapeutic fashion is assisted not only because relief is often temporary, but also by the difficulty in establishing the normal range of variability from which significant change can be assessed and by the uncertain relationship between signs and symptoms and for the functions of daily living. For these reasons there is an inevitable tendency to temporary over-optimism and it seems impossible to counter this by the execution of a satisfactory clinical trial, since the patient cannot be "blind" and a significant variable is the enthusiasm with which a therapy is surrounded. (4) Electrical stimulation by cutaneous devices or implants can give much benefit to some patients in whom other methods have failed and there are indications, not only from anecdote and clinical impression but also now from experimental physiology, that it may benefit by mechanisms of interaction at the first sensory synapse. It is, however, an over-simplification to regard any therapy as either strictly physiological or simply fraudulent. Like other so-called placebos, physical methods of therapy can presumably act on hormonal systems associated with stress and the experience of pain.

Clinical Trials as Topic↗
PubMedDate not supplied

Evaluation of two opioid-acetaminophen combinations and placebo in postoperative oral surgery pain.

STUDY OBJECTIVE: To determine the relative analgesic potency and adverse effect liability of hydrocodone bitartrate 7.5 mg with acetaminophen 500 mg, codeine phosphate 30 mg with acetaminophen 300 mg, and placebo in the treatment of pain following oral surgery. DESIGN: Randomized, double-blind, single-dose, placebo-controlled, parallel-group study with self-ratings at 30 minutes and then at hourly intervals from hour 1 to hour 6. SETTING: Private, oral surgery practice sites. PATIENTS: Three hundred twenty-four outpatients with moderate or severe pain after the surgical removal of impacted third molars were selected. One was lost to follow-up and 32 did not need an analgesic; 232 patients had valid efficacy data. INTERVENTIONS: Patients were treated with a single oral dose of hydrocodone bitartrate 7.5 mg with acetaminophen 500 mg, codeine phosphate 30 mg with acetaminophen 300 mg, or placebo when they experienced steady, moderate or severe pain that, in their opinion, required an analgesic. Using a self-rating record, subjects rated their pain and its relief for 6 hours after medicating; estimates of peak and total analgesia were derived from these subjective reports. MEASUREMENTS AND MAIN RESULTS: This study was a valid analgesic assay. Both active treatments were significantly superior to placebo for all measures of analgesic efficacy. The hydrocodone-acetaminophen combination was significantly superior to the codeine-acetaminophen combination for total pain relief and the number of evaluations with 50% relief. Both active treatments manifested an analgesic effect within 30 minutes; the effect persisted for 5 hours for the codeine combination and 6 hours for the hydrocodone combination. Adverse effects were transient, consistent with the pharmacologic profiles of opioids, and none required treatment. CONCLUSIONS: A slight advantage in analgesic efficacy was demonstrated in this single-dose study for the hydrocodone-acetaminophen combination. Repeat-dose studies, however, should be conducted to determine the clinical significance of the difference in analgesic effect of these opioid combinations.

Acetaminophen↗