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Biomedical subjects

J G Thornton

Publications and source records attributed to J G Thornton.

At least 37 records · Page 2Linked to original sources
PubMed1997

Health economics: a beginner's guide.

In a completely private health-care system we would rely on the market to ensure that money on health care was well spent. In state systems we have to use something else--health economics.

Cost-Benefit Analysis↗
PubMed1997

The relationship between laparoscopic disease, pelvic pain and infertility; an unbiased assessment.

OBJECTIVES: To measure the relationship between laparoscopically detected pelvic pathology and pelvic pain or infertility. METHODS: Women undergoing diagnostic laparoscopy either for the investigation of pelvic pain, for sterilisation or for the investigation of infertility were studied. The indication for surgery was recorded before laparoscopy. At operation a series of 35-mm slide photographs were taken of the pelvis and later scored by two independent assessors without knowledge of the indication for surgery. RESULTS: Satisfactory photographs were obtained in 298 women. Minimal endometriosis was not associated with pain (adjusted OR 1.3; 0.5-2.8), although moderate disease was non-significantly so (2.5; 0.4-7.1). Severe disease was significantly more common and never occurred in patients being sterilised (P = 0.02). The odds of pain were not increased in the presence of dilated veins > 9 mm diameter (OR 1.1; 0.4-3.2) or adhesions (OR 0.6; 0.2-4.7). The odds of infertility were non-significantly increased in the presence of minimal and moderate endometriosis (OR 2.0; 0.8-5.3, and OR 4.2; 0.6-25 respectively) and again significantly more common in the presence of advanced disease (P = 0.002). The odds of infertility tended to be lower in the presence of severely dilated veins (OR 0.2; 0.032-1.2). There was no clear effect of adhesions (OR 0.9; 0.1-5.9). CONCLUSIONS: The long established associations between severe endometriosis and pelvic pain, and between endometriosis in general and infertility are confirmed. However there is little or no association between minimal endometriosis, pelvic adhesions or dilated pelvic veins and pain. Previously reported associations may have been an artefact of the surgeon's knowledge of the indication for operation when assessing the pelvis.

Endometriosis↗
PubMed1997

Active management of labour.

There is still no strong evidence that the 'active management' package of care in labour reduces caesarean section or operative delivery rates. Psychological support has the most evidence of effectiveness, but even this comes largely from poor-quality trials. The evidence that the whole package shortens labour is stronger, but the effect is small in the methodologically stronger studies.

Adrenergic beta-Antagonists↗
PubMed1995

Clinical trials and rare diseases: a way out of a conundrum.

Currently, clinical trials tend to be individually funded and applicants must include a power calculation in their grant request. However, conventional levels of statistical precision are unlikely to be obtainable prospectively if the trial is required to evaluate treatment of a rare disease. This means that clinicians treating such diseases remain in ignorance and must form their judgments solely on the basis of (potentially biased) observational studies experience, and anecdote. Since some unbiased evidence is clearly better than none, this state of affairs should not continue. However, conventional (frequentist) confidence limits are unlikely to exclude a null result, even when treatments differ substantially. Bayesian methods utilise all available data to calculate probabilities that may be extrapolated directly to clinical practice. Funding bodies should therefore fund a repertoire of small trials, which need have no predetermined end, alongside standard larger studies.

Bayes Theorem↗
PubMed1995

A randomised trial of three methods of giving information about prenatal testing.

OBJECTIVE: To test the effect of extra non-directive information about prenatal testing, given individually or in a class. SETTING: Antenatal clinics in a district general hospital and a university hospital. DESIGN: Randomised controlled trial; participants allocated to control group or offer of extra information individually or in class. SUBJECTS: 1691 women booking antenatal care before 15 weeks' gestation. INTERVENTIONS: All participants received the usual information about prenatal tests from hospital staff. Individual participants were offered a separate session with a research midwife in which prenatal screening was described in detail. Class participants were offered the same extra information in an early prenatal class. MAIN OUTCOME MEASURES: Attendance at extra information sessions; uptake rates of prenatal tests; levels of anxiety, understanding, and satisfaction with decisions. RESULTS: Attendance at classes was lower than at individual sessions (adjusted odds ratio 0.45; 95% confidence interval 0.35 to 0.58). Ultrasonography was almost universally accepted (99%) and was not affected by either intervention. Uptake of cystic fibrosis testing, high in controls (79%), was lowered in the individual group (0.44; 0.20 to 0.97) and classes (0.39; 0.18 to 0.86). Uptake of screening for Down's syndrome, already low (34%) in controls, was not further depressed by extra information in classes (0.99; 0.70 to 1.39) and was slightly higher in the individual group (1.45; 1.04 to 2.02). Women offered extra information had improved understanding and were more satisfied with information received; satisfaction with decisions about prenatal testing was unchanged. The offer of individual information reduced anxiety later in pregnancy. CONCLUSIONS: Ultrasonography is valued for non-medical reasons and chosen even by fully informed people who eschew prenatal diagnosis. The offer of extra information has no overall adverse effects on anxiety and reduces uptake of blood tests when background uptake rate is high (but not when it is already low). High uptake of prenatal blood tests suggests compliant behaviour and need for more information.

Anxiety↗
PubMed1995

Clinical ethics committee.

An informal clinical ethics committee was set up to advise on ethical problems in prenatal diagnosis in Leeds. It was used twice in six months but was not called on again in the subsequent year, and we describe this experience. In North America similar committees are often used to advise on clinical moral dilemmas, and we review the published evidence from there and discuss some of the advantages and problems. Our committee's advice may have altered clinicians' actions considerably, but perhaps doctors in Britain are not yet ready to surrender this aspect of clinical autonomy.

Abortion, Induced↗
PubMed1995

Perinatal death as a consequence of fetal stabbing: was it murder?

At 22 weeks gestation, a fetus received a stab wound to the abdomen when the mother was subjected to a knife attack. Premature labour followed 2.5 weeks later. The baby received full intensive care, but died at 4.5 months of age from complications directly related to the premature birth. The person who committed the assault was indicted with murder of the infant according to the precept of transferred malice. In the absence of any clear legal precedent, the judge ruled that the indictment was not consistent with the principles of criminal law, since the malice directed towards the mother could not be regarded as being transferred to the fetus. This was because the wounding of a non-viable fetus with death following 4 months later did not amount to a deliberate killing, and in addition, it was not the intention of the Defendant at the time of the stabbing to kill the infant.

Journal Article↗