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Biomedical subjects

J A Ferguson

Publications and source records attributed to J A Ferguson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Analgesia after thoracotomy: effects of epidural fentanyl concentration/infusion rate.

After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 micrograms/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-micrograms/mL concentration infused at a rate half that used in the 5-micrograms/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-microgram/kg initial dose and an initial infusion rate of 1 microgram.kg-1.h-1 in both the 5-micrograms/mL and 10-micrograms/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Workload in trauma and orthopaedic surgery: use of linked statistics to profile a specialty.

We have used linked hospital morbidity statistics to construct a basic profile of the demographic and epidemiological features of trauma and orthopaedic surgery in a defined population. This paper reports on this profile and illustrates trends in the specialty between 1976-86. During this period episode-based inpatient admission rates rose by about 20%. Multiple admissions per person varied with age but did not increase over time. Thus the increase in admission rates in this specialty represented an increase in numbers of people who received treatment. Average length of stay per episode of inpatient care and the total time spent in hospital per person declined over time. New outpatient attendance rates increased by 19% in the 11-year period. The ratio of follow-up outpatient appointments to new appointments fell from 2.68:1 to 2.24:1; the number of inpatient beds fell by about 13% and bed occupancy remained stable at about 80%. We describe some of the major components of clinical workload in the specialty, with emphasis on conditions for which admission rates changed over time, relating the data to numbers of people treated as well as to episodes of care.

Adolescent↗
PubMed1995

In-patient workload in medical specialties: 1. Demographic profiles and time trends from linked statistics.

Admission rates, multiple admissions per individual and time spent in hospital in general medical and geriatric care are described using data from the Oxford Record Linkage Study from 1968-86. For patients aged 15-39 years, age-specific admission rates did not vary appreciably with age and were a little higher in women than in men. For patients aged 40 years and over, admission rates rose steeply with age and were considerably higher in men than in women. Admission rates, measured as episodes, increased over time by 3.4% per year in women and 3.7% in men. Measured as individual people admitted per year, they increased by 2.2% per year people in women and 2.6% in men. Expressed as age-standardized rates, they increased by 1.5% per year in women and 1.8% in men. The greater rise in episodes than in people treated reflected an increase in repeat admissions per patient admitted. Mean length of stay per hospital episode and total time spent in hospital per patient admitted per year both showed a consistent decline over time. Increases in admission rates were seen in all of the common broad clinical groupings studied, except infectious diseases which, as a group, showed a mean annual decrease of just over 2% per year.

Adult↗
PubMed1995

In-patient workload in medical specialties: 2. Profiles of individual diagnoses from linked statistics.

We analysed hospital use for 58 common clinical conditions in the medical specialties, using data from the two districts covered by the Oxford record linkage study 1968-1986. Episode rates, person rates, and ratios of multiple admissions per person were computed. In young adults, poisoning was the most common reason for admission. In older adults, the most common clinical conditions included atherosclerotic diseases and smoking-related lung diseases. Comparing the first and last time periods studied, admission rates increased by 10% or more in 37 of the 58 conditions, including 7 of the 10 conditions with the highest overall hospitalization rates. Conditions in which admissions increased by 10% or more included myocardial infarction, other ischaemic heart disease, chronic obstructive lung disease, asthma, pneumonia, diabetes, poisoning, dementia, prostate cancer and breast cancer among others. Workload declined by 10% or more in 13 conditions, including stroke, subarachnoid haemorrhage, hypertension, thyrotoxicosis, acquired hypothyroidism, and tuberculosis. Secular trends in hospital use are generally attributable either to changes in disease frequency in the population or to changes in clinic- or hospital-based technology and practice.

Adolescent↗
PubMed1993

Esthesioneuroblastoma: the role of adjuvant radiation therapy.

PURPOSE: We describe our experience with adjuvant radiation therapy in patients who underwent operation for esthesioneuroblastoma. METHODS AND MATERIALS: Between January 1951 and December 1990, 49 patients with esthesioneuroblastoma received their initial treatment at the Mayo Clinic. There were 27 male and 22 female patients; their ages ranged from 3 to 79 years (median, 54 years). The tumors were Kadish Stage A in 4 patients, Stage B in 13, Stage C in 29, and modified Kadish Stage D in three (cervical nodal or distant metastasis). The tumors were graded according to Hyams' classification. Treatment included gross total resection alone in 22 patients and gross total resection and postoperative adjuvant radiation therapy in 16. The patients treated with adjuvant radiation had a greater proportion of advanced-stage and high-grade tumors. RESULTS: The 5-year actuarial overall survival, disease-free survival, and local control rates were 69.1% + 7.0%, 54.8% + 7.6%, and 65.3% + 7.4%, respectively. The only significant predictor for overall survival, disease-free survival, and local control was Hyams' grade. Local control was improved in patients who received postoperative adjuvant radiation even though this group of patients had more advanced and higher-grade tumors (5-year rate of local control was 85.9% + 9.3%, compared with 72.7% + 9.5% for those who had operation alone, p = 0.26). CONCLUSION: Adjuvant radiation therapy for esthesioneuroblastoma improves local tumor control, particularly for high-grade and high-stage tumors. We recommend additional treatment with radiation (55.5 Gy) after complete resection of esthesioneuroblastoma.

Adolescent↗
PubMed1993

Profiles of workload in general surgery from linked hospital statistics.

Data from the Oxford Record Linkage Study between 1976 and 1986 were used to analyse statistical profiles of hospital care, taking account of multiple admissions per patient. Admission rates were higher in the elderly than the young, they were higher for men than women, and they increased over time. Episode-based admission rates increased by 15.5 per cent and person-based rates by 11.6 per cent. Most of the increase therefore represented a real rise in the number of people treated rather than an increase in multiple admissions per person. In the latest year of the study there was a mean of 125 admissions per annum per 100 male patients admitted and of 118 admissions per annum per 100 female patients admitted. The mean length of stay per admission and the total time spent in hospital per person per annum declined substantially from 1976 to 1986. Admission rates for prostatectomy, colectomy and varicose vein surgery increased significantly and those for appendicectomy, cholecystectomy and peptic ulcer decreased significantly.

Adolescent↗
PubMed1993

Computational prediction of the stability of lipid emulsions in total nutrient admixtures.

The relationships between the stability of lipid emulsions in a number of parenteral total nutrient admixtures (TNAs) and their electrokinetic properties were examined. Previous studies have attempted to measure or calculate zeta potentials of lipid emulsions in nutrient admixtures to rationalize their stability behavior, but there has been no demonstration that zeta potentials do actually determine emulsion stability or that such computational approaches can be successful. The present study demonstrates that emulsion stability in a range of TNAs is dependent on the emulsion zeta potential and also that van der Waals forces, influenced by the presence of glucose, are important. By accounting for these factors we show that it is possible to calculate the stability of TNAs by Deryaguin-Landau-Verwey-Overbeck-based methods and obtain reasonable agreement with experimental stability data in most systems.

Drug Stability↗
PubMed1992

Workload in oral and maxillofacial surgery: analysis of time trends from linked statistics in a defined population.

Data from the Oxford Region were used to study trends in hospital admission rates and demographic profiles of hospital care in the National Health Service in oral and maxillofacial surgery. In a defined population of 1.9 million people, admission rates for inpatient care, day case care, and outpatient attendance rates all almost doubled between 1975-1985. Population-based age-specific admission rates were much higher in teenagers and young adults than in other age-groups. In these age-groups admission rates for females were about double those for males. Whilst perhaps not surprising to the oral and maxillofacial surgeon, these demographic profiles of workload are strikingly different from those found in most other hospital specialties.

Adolescent↗
PubMed1992

Pain following coronary artery bypass grafting: an exploration of contributing factors.

Patients suffer pain and discomfort in ICU following coronary artery bypass grafting (CABG). While the surgical procedure causes pain, it is the psychological state of the individual which influences his perception of the pain. For the patient undergoing cardiac surgery, several stressors may influence his psychological state, including coronary heart disease (CHD) itself, impending surgery and the intensive care unit (ICU) environment. The types of pain caused by the surgical procedure are discussed. Each of these aspects are brought together in an attempt to gain a better understanding of the patient's perspective of cardiac surgery, and any pain experienced as a result. Given the major influence of the patient's mind in pain perception, there is a need for nurses to consider alternative methods of pain relief in addition to drug therapy.

Coronary Artery Bypass↗
PubMed1992

An epidemiological profile of in-patient workload in dermatology.

Trends in admission rates, patterns of readmission, lengths of stay and clinical caseload for in-patient dermatology from 1976 to 1985 are described using data from the Oxford record-linkage study. Age-specific admission rates were considerably higher in people aged 50 years and over than in younger people. Admission rates declined over time in most age-sex groups below the age of 70 years, but increased over time for the over 70s. In dermatology, unlike most other specialties, the length of patients' stay did not decrease substantially over the 10 years. In-patient workload consisted predominantly of leg ulcers, psoriasis, and eczema. This did not change appreciably over time. New out-patients at dermatology clinics rose by 41% from 1976 to 1985, and all out-patient visits rose by 20% during the 10-year period. Because the profile of in-patient workload changed relatively little over time, we speculate that the impact of innovations in dermatological practice has been much greater in the ambulatory setting than in the management of those patients requiring prolonged in-patient care. Future routine measures of workload in dermatology should include demographic and clinical data on out-patients.

Adult↗
PubMed1992

Some epidemiological observations on medicinal and non-medicinal poisoning in preschool children.

STUDY OBJECTIVE: The aim was to identify and compare rates of admission to hospital of preschool children for medicinal and non-medicinal poisoning in a defined population. DESIGN: The study was an analysis of computerised abstracts of hospital inpatient records for poisoning. SETTING: Six districts in southern England covered by the Oxford record linkage study. SUBJECTS: The subjects were children under six years of age residing in the six districts from 1975 to 1986. MEASUREMENTS AND MAIN RESULTS: 6152 children, drawn from an average annual resident population of 164,000 children in 1975-1986, experienced 6562 hospital admissions for poisoning before six years; 3702 (56.4%) were attributed to medicinal and 2860 (43.6%) to non-medicinal agents. Of the latter, 646 (9.8% of the total) were recorded under the International classification of diseases code, described as "noxious food" (almost exclusively plant material). Average annual admission rates in children under six were 1.88 per 1000 for medicinal agents and 1.45 for non-medicinal substances. Analgesics accounted for 28.1% of the admissions for medicinal poisoning; berries and mushrooms for 97.4% of the plant materials; and corrosive aromatics, acids and alkalis for 22.0% of the other non-medicinals. Admission rates were higher in males than females in each category of poisoning. In children aged 1-4 years there was a significant decrease in admission rates between 1975 and 1986, averaging per annum 5.8% for medicinal poisoning, 6.9% for non-medicinal poisoning (excluding plant material), and 12.8% for plant material poisoning. Significant seasonal variation was found for each class of poisoning. CONCLUSIONS: Admission rates for medicinal and non-medicinal poisoning in preschool children declined between 1975 and 1986. The decline could reflect a change in thresholds for admission although, if so, this would be against the general trend in paediatric medical admissions, which is upward. An alternative explanation is a decline in the incidence of poisoning.

Child, Preschool↗
PubMed1991

Occurrence and repetition of hospital admissions for accidents in preschool children.

OBJECTIVES: To examine trends over time in the rates of admission to hospital for accidents of preschool children and to study patterns of repeated admissions for accidents in these children. DESIGN: Analysis of linked, routine abstracts of hospital inpatient records for accidents. SETTING: Six districts in the Oxford Regional Health Authority covered by the Oxford record linkage study. SUBJECTS: Records for 19,427 children aged 5 years and under at the time of first recorded admission to hospital. MAIN OUTCOME MEASURE: Number of admissions to hospital. RESULTS: Records were analysed in three groups: person based annual admission rates were calculated for each calendar year; each child's first recorded admission in 1976-85 was identified, and the child's record was followed up by linkage for one year from that admission; each child's first recorded admission in 1976-81 was identified and followed up for five years. Overall, 19,427 children from an average annual resident population of 163,000 children in 1976-86 had 20,657 admissions for accidents before they were 6 years of age. Of these admissions 13,983 were for injuries, 5717 for poisonings, and 957 for burns. Admission rates declined after 1976 for poisoning, but no substantial changes over time were found in admission rates for injuries or burns. A total of 17,724 children were followed up for one year and 10,889 for five years; 470 (2.6%) of the children who were followed up for one year and 926 (8.5%) of those followed up for five years had at least one further admission for an accident. Of those followed up for one year the 4 and 5 year old children were least likely and those under 1 and 1 year old were most likely to have a further admission for an accident. The number of children who had more than one accident was greater than would be expected if accidents were random occurrences. Those who had a poisoning at first admission were more likely to have another poisoning than an injury or burn; and those who had a burn at first admission were more likely to have another burn. CONCLUSIONS: Hospital admissions for accidents in children are common: on average 1 child in 88 in this population was admitted each year. Multiple admissions are uncommon but none the less occur more often than would be expected by chance.

Accidents↗
PubMed1991

Ophthalmology in the Oxford region: analysis of time trends from linked statistics.

OBJECTIVES: to report on trends in ophthalmology workload using linked statistical data; DESIGN: analysis of linked abstracts of hospital inpatient and day case records for ophthalmology; SETTING: six districts in Southern England covered by the Oxford record linkage study; SUBJECTS: records for hospital admissions to ophthalmology from 1975 to 1985; MEASUREMENTS AND MAIN RESULTS: Over the period of study, the number of episodes of inpatient and day case care increased by 16.3%. Notable increases in age-specific admission rates were seen among the elderly. An increase in the number of individuals treated contributed about 67% and an increase in multiple admissions per individual contributed about 33% to the increase in admission rates. Both average length of stay per episode and total time in hospital per individual decreased consistently during the 11 years; and there was no increase in emergency readmissions over time. No significant changes over time were found in admission rates for retinal detachments and defects or for glaucoma. There was a statistically significant increase averaging 4.8% per annum in admission rates for cataract, and a significant decrease averaging 5.2% per annum in admission rates for strabismus and other disorders of binocular eye movement between 1975 and 1985. CONCLUSIONS: Age-specific admission rates in ophthalmology are much higher in the very young and old than in other age groups. Patterns of work in the specialty are therefore particularly affected by variation in the age distribution of the population. The increase in cataract surgery reflected both the increase in numbers of old people in the population and an increase in age-specific operation rates for cataract. Attempts to alter attitudes and behaviour of the elderly regarding eye diseases, disability, and facilities for treatment may have had a positive impact on the use of services. The decrease in admissions for children probably reflects the impact made by child health surveillance programmes. As the child screening programme has expanded, the admission rates for strabismus have decreased.

Adolescent↗
PubMed1991

Workload trends in otolaryngology: some statistical observations from medical record linkage.

Trends in admission rates, lengths of stay, and clinical case mix (adjusted for multiple admissions per person) for Otolaryngology from 1975 to 1985 are described using the Oxford Record Linkage Study. Person-based admission rates increased generally, most strikingly amongst children and adolescents. Both length of stay per episode and total number of days an individual stayed in hospital each year decreased. Operations on tonsils and adenoids decreased averaging 2.2% per annum; admissions for diagnoses for otitis media with effusion increased averaging 8.2% per annum; for the operations of myringotomy and tympanostomy tube insertion increased averaging 9.2% per annum; for other diagnoses related to the ear increased averaging 5.7% per annum; and admissions for malignant neoplasms decreased averaging 2.0% per annum. Clearly more people are being treated for a changing case mix. The largest increases are occurring with children and adolescents.

Adolescent↗
PubMed1991

Audit of workload in gynaecology: analysis of time trends from linked statistics.

OBJECTIVE: To report on trends in workload patterns in gynaecology using linked statistical data. DESIGN: Retrospective analysis of linked abstracts of hospital inpatient and day case records for patients treated in the National Health Service in gynaecology. SETTING: Six health districts in the south of England covered by the Oxford record linkage study. SUBJECTS: Records for hospital admissions to gynaecology (excluding obstetric admissions) from 1975 to 1985. MEASUREMENT AND MAIN RESULTS: Inpatient episodes increased by 23.5% and day case episodes increased by 13.1%. More people treated contributed about 90% and increased readmissions contributed about 10% to the increase in workload. The workload was decreased by strike action in 1975 and 1981-2. Average length of stay decreased substantially and consistently over the 11 years. Emergency readmissions increased annually by an average of 2.7%. Admission rates in 11 groups of surgical procedures accounting for 85% of all gynaecological inpatients are reported, and increases occurred in 10 of the 11 groups. For example, average increases in annual admission rates were 1.0% for sterilization, 1.9% for legal abortion and 8.2% for biopsy of the cervix, the rate for dilatation and curettage decreased by 1.4%. CONCLUSIONS: The increase in admission rates in gynaecology was almost entirely due to increases in numbers of people treated. The rise would have been even greater if the increase in private patients had been considered. The increase may reflect increased expectations on the part of patients and their doctors, advances in technology and increased bed availability due to declining lengths of stay.

England↗
PubMed1990

Adjusting for clustering in survey research.

The current widespread application of cluster sampling in survey design presents concerns to the researcher regarding the chosen unit of study. The statistical power of a study could be spuriously increased or decreased, sample size could be altered dramatically, and the uniqueness of the individual unit under study (e.g., a patient) could be lost and substituted by average values of characteristics depending on which unit of study is selected. The 1985 National Ambulatory Medical Care Survey of the U.S. National Center for Health Statistics was used to illustrate research methodologies that would deflate spuriously high results due to clustered sampling. Using the individual patient as the study unit, correction factors ranging from 1.99 to 35.40 were calculated in order to deflate exaggerated t-tests, chi-square, and F values of predictor variables. The effect of clustering was more marked on (1) continuous rather than binary outcome variables, as the former provide a richer environment to form clusters; and (2) on outcome variables relating to the practice-related or personal style of physicians. Using the physician (who represented a cluster of patients) as the unit of study, it was realized that correction factors were relevant to physician-specific predictors but not patient-specific predictors. Using design effect correction factors developed from a simple univariate analysis of variance, pharmacoepidemiologists can analyze accurately the currently available large survey databases of clustered samples.

Cluster Analysis↗