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Biomedical subjects

J Charlton

Publications and source records attributed to J Charlton.

65 records · Page 4Linked to original sources
PubMed1985

Measuring the impact of health interventions: a review of available instruments.

Interest in the measurement of the impact of health services has been increasing for three main reasons. Policy makers and service providers wish to be reassured that they are: (i) benefitting the public for whom the service is provided; (ii) in times of economic recession and limited resources, achieving the 'best value for money'; and (iii) given the need to make economies in health expenditures, maintaining standards of the health care. Recent developments in information for the evaluation of health services have tended to emphasis the control and monitoring of expenditure in preference to the control and monitoring of quality. There is concern that this might lead to adverse consequences for patients and for the health service as a whole in that the quality of services provided might deteriorate. Health interventions are considered to be successful if they result in a beneficial change in the health of the population for whom they are provided. If the health of the population is not improved, or maintained, questions are raised about either the appropriateness of the intervention in relation to health policies which have been selected, or about the quality of the care which has been provided. Because of this, it is necessary to monitor both the outcome of a heath intervention in terms of the change in the level of health of the population, and also to measure the quality and the effectiveness of the care provided. Health services research has, over the years, developed a number of different types of measures which can be applied to health services and has suggested a number of applications for such measures in terms of the impact on the health of patients and the general population and the quality and effectiveness of health services. The first section of this paper reviews a selection of measures for both health and the effects of health interventions and discusses their applicability as management tools. The use to which such measures are put obviously depends upon the type of decisions which they are to inform, which in turn are dependent upon the organisational level at which the decision is to be made, and the policy objectives of the service to which they relate. The second part of the paper discusses factors which must be taken into account when choosing measures to monitor the impact of the health services. In examining the suitability of a management tool, a measure must be proven to provide information which is universally acceptable and which conforms to a number of scientific standards.(ABSTRACT TRUNCATED AT 400 WORDS)

England↗
PubMed1983

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PubMed1983

A method for evaluating therapy for hay fever. A comparison of four treatments.

This study was undertaken in order to develop a method for comparing the value of different forms of treatment for hay fever. A cross-over trial was carried out in sixty-one patients, comparing four treatments: topical corticosteroids, topical cromoglycates, placebo tablets and oxatomide (a new oral treatment with antihistamine and cromoglycate-like properties). Three methods were used to compare these treatments: (1) post-treatment symptom questionnaires; (2) daily analogue line scores of symptoms; and (3) nasal FEV1. Of these, daily analogue line diary scores, with an analysis which took into account variation in pollen count, proved to be the most sensitive. By employing this diary method, it was shown that all three active treatments were significantly better than placebo and that topical corticosteroids were significantly better than topical cromoglycates. The activity of oxatomide was found to be not significantly different from that of steroids or cromoglycate, but it was associated with more frequent side-effects. It is suggested that daily diaries, combining symptom relief and freedom from side effects into a single score of 'usefulness' adjusted for pollen count, are suitable means for comparing treatments for hay fever.

Adult↗
PubMed1982

Topography, cytoarchitecture, and sulcal patterns in primary somatic sensory cortex (SmI) prosimian primate, Perodicticus potto.

The topographic organization of the primary somatic sensory projection area (SmI) in relation to cytoarchitectural fields and sulcal patterns was examined in the prosimian primate Perodicticus potto. The area of cortex responding to low threshold (LT) cutaneous stimulation of the glabrous and hairy surfaces of the hand was determined by microelectrode mapping techniques, with standardized threshold stimuli for defining receptive fields. A single somatotopic projection of the two hand surfaces was found; the glabrous projection area is rostral to that of the hairy hand. Within both the glabrous and hairy areas, receptive fields on the distal digits are found anterior to those on the proximal hand. The glabrous hand projection area is coextensive with a dense granular area typical of koniocortex. The hairy hand area corresponds to a cytoarchitectural field which is less granular than the glabrous field. While koniocortex occupies the crown of the gyrus caudal to the coronally oriented sulcus, a large more rostral field, which contains both granule and large pyramidal cells, occupies the whole of the caudal bank of the sulcus. Force thresholds of many receptive fields (RFs) in Perodicticus were high both on the borders and within the LT area (perhaps because of the advanced age of these animals). However, the receptive field sizes for both the glabrous and hairy hand areas were of the same magnitude as those of Nycticebus (Carlson and FitzPatrick, '82). From the combined studies of three species of Lorisidae, Perodicticus, Galago (Carlson and Welt, '80), and Nycticebus (Carlson and FitzPatrick, '81), using similar mapping and stimulation techniques, both general and specific features of SmI hand area organization can be illustrated. A single projection of the glabrous and hairy hand is common to Perodicticus and Galago, but two glabrous projection areas are seen in Nycticebus. The projection area for the hand in Perodicticus is twice as large (relative to brain size) as in Galago and Perodicticus. The possible behavioral significance of increased differentiation of the hand area in Nycticebus and elaboration of the area in Perodicticus could be examined by study of hand use and tactile capacity in these same species.

Animals↗
PubMedDate not supplied

IgG subclasses serum concentrations in a population of children with Down syndrome: comparative study with siblings and general population.

Serum total IgG and subclasses were determined in three different groups of children: with Down syndrome, their siblings and general pediatric population. Several cases of IgG2 and IgG4 deficiency were identified, predominantly in children with Down syndrome. The differences, considering three age groups, were statistically significant for both groups in relation to the general population group, with an increase of IgG1 and IgG3 and a decrease in serum concentrations of IgG2 and IgG4. Down syndrome children and their siblings tend o have a similar variation of the IgG4 serum concentration levels (P < 0.05). The mechanisms of this concordance are not well understood. The results point out that an adequate strategy to improve the immune status of Down syndrome children could have a positive manifestation in the immune profile of their brothers.

Adolescent↗
PubMedDate not supplied

Parallel pathways, noise masking and glaucoma detection: behavioral and electrophysiological measures.

PURPOSE: We tested the hypothesis that because of their reduced neural efficiency, glaucoma patients should have increasingly impaired thresholds as external noise is added to a stimulus. METHOD: We compared the performance of 20 normals (mean age = 39 years) with that of 15 patients with early glaucoma or at very high risk for glaucoma (mean age 45 years). All patients had normal visual acuity. Contrast thresholds were measured on two sets of tasks: (1) behavioral and (2) sweep visually evoked potentials (VEPs). Two stimuli were used (a) 7.5 Hz reversing gratings of 0.69 cpd, and (b) 5.5 cpd gratings. Noise was binary and contrast varied from 0 to 80%. Psychophysical thresholds were determined using a staircase which employed a spatial four alternative forced choice procedure (4AFC) and converged on 50% correct. Sweep VEP thresholds were determined by extrapolation to zero volts as a function of log contrast. RESULTS: Differences between normal subjects and patients with early glaucoma were not significant without noise. Both the absolute size of the difference and its significance increased as noise level increased. For the behavioral thresholds these trends were clearer with the 5.5 cpd grating, while for the sweep VEPs they were more clear for the 0.69 cpd grating. CONCLUSION: The performance deficit of glaucoma patients which may be minimal under normal testing conditions is magnified when external noise is added to the stimulus. VEPs and psychophysical thresholds show interesting differences in their sensitivity to this effect. Implications for the early detection of glaucoma are discussed.

Adult↗