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J P Nicholl

Publications and source records attributed to J P Nicholl.

At least 19 recordsLinked to original sources
PubMed1998

A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy.

BACKGROUND: We have previously shown that in a randomized comparison of laparoscopic (LC) versus small incision (SC) cholecystectomy, postoperative hospital stay is comparable. This randomized prospective study compares the postoperative pain, analgesic and antiemetic consumption, perceived health, and metabolic and respiratory responses after these two procedures. METHODS: Two hundred patients were recruited; postoperative stay, pain scores, analgesic and antiemetic consumption were recorded. Nottingham Health Profile questionnaires were completed by a subgroup of 100 patients, and the metabolic and respiratory responses were also compared in a further subgroup of 20 patients. RESULTS: Pain scores in both groups were low. LC, however, was associated with lower postoperative pain scores and analgesic requirements compared with SC, but the antiemetic requirements were greater after LC. The duration of hospital stay and the perceived health after operation were the same in both groups, and both procedures were associated with a similar reduction of respiratory function. Twenty-four hours after operation the inflammatory (C-reactive protein, CRP) response to LC (22 +/- 20 mg/L) was significantly lower than after SC (68 +/- 30 mg/L), but the neuroendocrine (cortisol) response was similar (LC, 475 +/- 335 nmol/L, compared with SC, 710 +/- 410 nmol/L). Independent of the technique used, the duration of postoperative hospital stay correlated significantly with the magnitude of both the 24-hour postoperative cortisol and CRP responses (cortisol: rs = 0.678, p < 0.001; CRP: rs = 0.566, p = 0.011). CONCLUSIONS: LC appears to be associated with less tissue destruction and pain than SC, but this did not confer any advantage in the degree of postoperative respiratory impairment, length of hospital stay, or postoperative perceived health. The neuroendocrine component of the metabolic response evoked by each procedure was similar and had a significant correlation to patient's postoperative hospital stay. This finding may explain the similar postoperative recovery after LC and SC.

Adult↗
PubMed1996

Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy.

BACKGROUND: We report a prospective randomised comparison between laparoscopic and small-incision cholecystectomy in 200 patients which was designed to eliminate bias for or against either technique. METHODS: Patients were randomised in the operating theatre and anaesthetic technique and pain-control methods were standardised. Four experienced surgeons did both types of procedure. Identical wound dressings were applied in both groups so that carers could be kept blind to the type of operation. FINDINGS: There was no significant difference between the groups for age, sex, body mass index, and American Society of Anaesthesiologists grade. Laparoscopic cholecystectomy took significantly longer than small-incision cholecystectomy (median 65 [range 27-140] min vs 40 [18-142] min, p<0.001). The operating time included operative cholangiography which was attempted in all patients. We found no significant difference between the groups for hospital stay (postoperative nights in hospital, median 3-0 [1-17] nights for laparoscopic vs 3-0 [1-14] nights for small-incision, p=0.74), time back to work for employed persons (median 5-0 weeks vs 4.0 weeks; p=0.39), and time to full activity (median 3-0 weeks vs 3.0 weeks; p=0.15). INTERPRETATION: Laparoscopic cholecystectomy takes longer to do than small-incision cholecystectomy and does not have any significant advantages in terms of hospital stay or postoperative recovery.

Analgesia, Patient-Controlled↗
PubMed1996

Using the SF-36 and Euroqol on an elderly population.

An important methodological issue in measuring health-related quality of life is whether instruments such as SF-36 and EQ can be used on an elderly population. This paper aims to test the completion, reliability and validity of the SF-36 and Euroqol on an elderly female population, and to compare them with the OPCS Disability Survey. Three hundred and eighty women aged 75 and over participated in a randomized controlled trial of the use of clodronate provided the sample. As part of the trial, patients were asked to complete the UK SF-36 and Euroqol, and the OPCS disability survey instrument administered by interview in a hospital clinic at baseline. A random subsample of respondents were retested six months later. The SF-36 achieved poorer levels of completion by dimension (68.1%-88.9%) than the OPCS (99.2%) and Euroqol (84%-93.5%) instruments. There were no major floor effects in the distribution of scores, except for the role dimensions of SF-36. Correlation between test-retest were significant for all instruments, but lower for the role dimensions and social functioning of SF-36, and these dimensions also had 95% Cls for the mean differences in excess of 10 points. There was substantial agreement between the three instruments, and evidence for their construct validity against age and recent use of health services. The sensitivities of the instruments were tested through hypothetical changes in health status. There was some evidence of greater sensitivity to lower levels of morbidity in the SF-36. Where brevity is required and the health changes are expected to be substantial, then EQ may be sufficient. For greater sensitivity SF-36 seems to have an advantage, however lower completion rates and problems with consistency suggest it requires adaptation. One solution would be to use interviewer administration. Another would be to change the SF-36 to make it more suitable for use in elderly people, although this may reduce its usefulness as a generic instrument.

Age Factors↗
PubMed1996

The costs and benefits of helicopter emergency ambulance services in England and Wales.

BACKGROUND: Following the introduction of Helicopter Emergency Ambulance Services (HEAS) in the United Kingdom in the last ten years this paper examines the costs and benefits of three contrasting services in Cornwall, London and Sussex. METHODS: Pre-hospital processes of care were compared between helicopter attended patients and land ambulance patients in all three studies, and health outcomes were compared between helicopter and land ambulance patients in the Cornwall and London studies. A review of the literature on the benefits of HEAS has also been undertaken. RESULTS: There were no improvements in response times and the time on scene was longer for helicopter attended patients. Survival of trauma or cardiac patients attended by helicopter was not improved. In London there was some evidence of worse residual disability in helicopter attended survivors, but in Cornwall residual disability was better in helicopter attended patients. There was no improvement in general health status or aspects of daily living in the helicopter attended patients. The overall total operational costs for these services were [symbol: see text] 55 000 p.a. in Sussex, [symbol: see text] 600 000 in Cornwall and [symbol: see text] 1.2 million in London. CONCLUSION: The analysis suggests that Helicopter Emergency Ambulance Services are costly, the health benefits are small, and there are limited circumstances in which the pre-hospital performance of an ambulance service in England and Wales can be improved.

Adolescent↗
PubMed1995

Effects of London helicopter emergency medical service on survival after trauma.

OBJECTIVE: To assess the effect of the London helicopter emergency medical service on survival after trauma. DESIGN: Prospective comparison of outcomes in cohorts of seriously injured patients attended by the helicopter and attended by London ambulance service land ambulances crewed by paramedics. SETTING: Greater London. SUBJECTS: 337 patients attended by helicopter and 466 patients attended by ambulance who sustained traumatic injuries and died, stayed in hospital three or more nights, or had other evidence of severe injury and who were taken to any one of 20 primary receiving hospitals. MAIN OUTCOME MEASURE: Survival at six months after the incident. RESULTS: After differences in the nature and severity of the injuries in the two cohorts were accounted for the estimated survival rates were the same (relative risk of death with helicopter = 1.0; 95% confidence interval 0.7 to 1.4). An analysis with trauma and injury severity scores (TRISS) found 16% more deaths than predicted in the helicopter cohort but only 2% more in the ambulance cohort. There was no evidence of a difference in survival for patients with head injury but a little evidence that patients with major trauma (injury severity score > or = 16) were more likely to survive if attended by the helicopter. An estimated 13 (-5 to 39) extra patients with major trauma could survive each year if attended by the helicopter. CONCLUSION: Any benefit in survival is restricted to patients with very severe injuries and amounts to an estimated one additional survivor of major trauma each month. Over all the helicopter caseload, however, there is no evidence that it improves the chance of survival in trauma.

Adolescent↗
PubMed1995

The epidemiology of sports and exercise related injury in the United Kingdom.

A national study of exercise related morbidity (ERM) in England and Wales was carried out using a postal questionnaire sent to 28,857 adults aged 16-45 years. The questionnaire asked about regular participation in sports or other recreational fitness activities involving physical exercise, and for details of any injuries occurring during a 28 d reference period. A return rate of 68% was achieved. Comparisons with other national data sources indicated that the information obtained was reliable. It is estimated that each year there are 29 million incidents resulting in new or recurrent injuries, however minor, of which 9.8 million (95% confidence interval 8.1 to 11.4 million) result in new 'substantive' injuries which are potentially serious, result in treatment, or in participants being unable to take part in their usual activities. Soccer accounted for more than 25% of all ERM, but the risk of a substantive injury in rugby was three times that in soccer. Over one third of ERM occurred in men aged 16-25 years. The most frequently reported injuries were sprains and strains of the lower limbs. Treatment was sought in approximately 25% of ERM incidents and 7% of all new ERM incidents involved attendance at a hospital accident and emergency department. The treatment provider most likely to be consulted was a general practitioner, but physiotherapists and complementary medicine practitioners were also consulted frequently. To maximize the health benefits of exercise, research strategies to reduce the volume and severity of ERM and to identify the most appropriate ways of managing ERM should be set.

Adolescent↗
PubMed1994

Patient characteristics and clinical caseload of short stay independent hospitals in England and Wales, 1992-3.

OBJECTIVE: To describe and quantify the patients and clinical activities of independent short stay hospitals. DESIGN: Retrospective survey of hospital records for sampled periods of one financial year and comparison with data from 1981 to 1986. SETTING: 217 independent hospitals in England and Wales, 1992-3. MAIN OUTCOME MEASURES: Distributions of sex, age groups, and areas of residence of patients, clinical procedures, financial provision. RESULTS: Data were obtained from 201 (93%) hospitals. An estimated 429,172 inpatients (7% more than 1986) and 249,531 day cases (an increase of 154%) from 1986 were treated in the year. The number of overseas patients was half that in 1986. Clinical case mix remained similar to 1986. Abortion remained the commonest procedure (13% v 19% in 1986). Lens operations, heart operations, endoscopies, and non-surgical cases showed the largest increases from 1986. Proportionately more overseas patients had abortions (30% v 12% for England and Wales residents) and they received 41% of coronary artery bypass grafting. Three quarters of the patients were aged 15-64. The proportion of patients aged over 65 had changed little (19% v 17% in 1986). Estimated average bed occupancy was only 48%. Only one in 20 patients was treated under NHS contract; 90% of episodes were funded through private health insurance. CONCLUSIONS: The demand for treatment in private hospitals continues to increase despite additional investment in the NHS, but the overseas market is falling. Overall, the range of clinical activity has changed little.

Adolescent↗
PubMed1994

A comparison of the costs and performance of an emergency helicopter and land ambulances in a rural area.

The costs and performance of the Cornwall and Isles of Scilly Ambulance Service Helicopter Unit (CASHU) air ambulance (A/A) was assessed during 1 year (1 December 1990-30 November 1991). The helicopter, with a crew of one pilot and two paramedics, commenced 797 patient-related missions during the year, 554 (69.5 per cent) as an emergency response ambulance. Eighty-one (15 per cent) of the emergency missions were aborted with no patient attended. Compared with the activity of ground ambulances, the A/A attended more accidents (66.5 per cent vs 40.8 per cent), and more incidents occurring outside in fields, or on cliffs or beaches (47.1 per cent vs 9.5 per cent). In its role as an emergency response vehicle the helicopter performance was not better than that of ground ambulances. Activation times, response times and on-scene times were all longer on average than for ground ambulances. However, transport times to hospital were sometimes much faster by helicopter. Although total times from 999 call to arrival in hospital were similar in the two cohorts, this was principally because longer distances were involved in the helicopter missions. Standardized for distance the A/A was, on average, 10 min faster than predicted for a land ambulance. The estimated direct costs of CASHU were 595,000 pounds for the year, and the costs of carrying out the helicopter missions by road have been estimated to be 97,805 pounds. The consequent marginal cost of around 500,000 pounds must be set against any health benefits accruing from the performance improvements for patients.

Air Ambulances↗
PubMed1994

Cost effectiveness of adjuvant bile salt treatment in extracorporeal shock wave lithotripsy for the treatment of gall bladder stones.

The relative cost effectiveness of adjuvant urso and chenodeoxycholic acid treatment in extracorporeal shockwave lithotripsy (ESWL) has been assessed as part of a pragmatic randomised controlled trial of ESWL as a treatment of gall bladder stones. Of the first patients with gall stone volume < 4 cm3 randomised to ESWL in the main trial, 24 were randomised to have ESWL alone and 26 to have adjuvant bile acid treatment, one of whom died before the end of the 12 month follow up period. At 12 months after treatment, differences in gall stone clearance between ESWL alone (3/24 (13%) clear, 5 (21%) referred for surgery) and ESWL and bile acids (6/25 (24%) clear, 2 (8%) referred for surgery) were not significant (p = 0.36, log rank test). Patients in both groups had substantial and significant health gains (according to biliary pain frequency and severity, Nottingham Health Profile scores, visual analogue scale symptom scores, and complications) but there were no significant differences between the groups. Improvements in both groups usually occurred within a few weeks of treatment and were unrelated to gall stone clearance. Costs were greater in the bile salt group (95% confidence intervals for estimated cost difference: 90 pounds to 630 pounds). If the purpose of treatment is symptom relief rather than gall stone clearance then adjuvant bile salt treatment seems to be unnecessary.

Adult↗
PubMed1994

Health and healthcare costs and benefits of exercise.

To assess the value of promoting health through exercise, we review what is known about the medical and medical care resource costs and benefits of exercise. Literature searches were undertaken to derive estimates of the relative risk, in individuals who exercise regularly compared with those who do not, of each of the major disease groups for which there is good evidence that the disease can be ameliorated by exercise (coronary heart disease, stroke, diabetes, hip fracture, and mental illness). These relative risks were used to estimate the incidence of hospital admissions and mortality, and associated healthcare costs, which could be prevented if the whole population exercised. Literature on the incidence and costs of exercise-related morbidity and mortality was also reviewed to derive estimates of both the costs to health and also the healthcare resource implications of exercise in total population. Indirect costs and benefits, and also quality-of-life effects associated with exercise were not included in this assessment. The results show that in younger adults (ages 15 to 44 years) the average annual medical care costs per person that might be incurred as a result of full participation in sport and exercise (approximately 30 pounds British sterling) exceed the costs that might be avoided by the disease-prevention effects of exercise ( less than 5 pounds British sterling per person). However, in older adults ( greater than or equal to 45) the estimated costs avoided ( greater than 30 pounds British sterling per person) greatly outweigh the costs that would be incurred ( less than 10 pounds British sterling). There was little evidence that exercise leads to deferred health or health service resource benefits. We conclude that with regard to health and medical care costs, there are strong economic arguments in favour of exercise in adults aged greater than or equal to 45 but not in younger adults. Estimates derived from the international scientific literature and routine UK data sources may have limited direct application in the healthcare systems of other countries. Nevertheless, the result that exercise costs exceed the benefits in younger adults but vice versa in older people is likely to be generally true. Indeed, a similar result has been found in a study of a Dutch population.

Adolescent↗
PubMed1993

Case against targeting long term non-attenders in general practice for a health check.

A study was undertaken to describe the consequences of implementing that part of the 1990 contract for general practitioners which requires them to offer health checks to all patients aged 16-74 years not seen within the previous three years. A random sample of 679 patients who had not attended for three years and 379 patients who had attended in this period were identified from 30 practice lists (including eight inner city practices) in five family health services authority areas. All patients were sent an invitation to a health check by their own practice and an attempt was made by the research team to conduct a home interview. The results showed that a considerable proportion of non-attenders were not in a position to take advantage of such an invitation; 17% of those at inner city practices were known to have received the invitation, 68% in practices elsewhere. Interviewed non-attenders (76% of those known to have received their invitation) had sociodemographic characteristics similar to the comparison group of interviewed attenders, although women aged 55-74 years were over-represented. At interview, non-attenders reported relatively less use of accident and emergency services and preventive health care and scored significantly better on all six dimensions of the perceived health status measure. Overall, 3% of all identified non-attenders in the inner city practices and 13% elsewhere accepted the invitation to a health check. Low levels of morbidity were found at health checks for those who had and who had not attended their general practitioners in the previous three years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones.

Inpatient extracorporeal shockwave lithotripsy for treatment of gallbladder stones has not previously been compared with open cholecystectomy in terms of cost-effectiveness. In a randomised controlled trial, 163 patients, stratified by gallstone bulk (over 4 cm3 or not), were randomised to lithotripsy or cholecystectomy (38 large-bulk and 27 small-bulk cholecystectomy; 37 large-bulk and 61 small-bulk lithotripsy) and followed up for 1 year. Both treatments gave significant health gains in terms of a reduction in episodes of biliary pain, improved perceived health status, and symptom relief, but few differences between treatments were found. There was some evidence that biliary-pain episodes were less severe after cholecystectomy. Cholecystectomy patients also had greater improvements in mean health gain for three related symptoms: vomiting, feeling sick, and fatty-food upset. However, there were no differences between groups in perceived health status. Among lithotripsy patients, health gain was not related to stone clearance. Lithotripsy was more expensive than cholecystectomy, principally because of the costs of the inpatient stay and adjuvant bile-salt therapy. Conventional lithotripsy appears at least as cost-effective as cholecystectomy for patients with small-bulk stones but less cost-effective for those with large-bulk stones. To some extent treatment choice can be guided by patient preference.

Adult↗
PubMed1991

Pilot study of the epidemiology of sports injuries and exercise-related morbidity.

In the pilot phase of a national study of the incidence of exercise-related morbidity (ERM), funded by the Sports Council, a questionnaire about recent participation in 'active sports and other recreational activities involving vigorous physical exercise' and associated injuries or illnesses was sent to a sample of 6744 people aged 16 to 65 years in two areas. Interviews with 101 respondents were held to validate the questions. Return rates of 73 and 81% from the two areas were achieved and results from the interviews indicated that sports and injuries were being reported sufficiently accurately on the postal questionnaires to yield reliable information. Of the 4961 usable returns, a total of 1249 respondents (25%) reported taking part in some activity in the 4 weeks before completing the questionnaire, and 137 (3%) reported 158 injury incidents. Nearly half (76, 48%) of these incidents resulted in some restriction in activity, and 21 resulted in some restriction in activity, and 21 resulted in a visit to a hospital casualty department. It is estimated that nationally 1-1.5 million episodes of ERM result annually in attendance at a hospital casualty department, and 4-5 million episodes of ERM result in some, usually temporary, incapacity.

Adolescent↗
PubMed1990

Continuous ambulatory peritoneal dialysis and haemodialysis in the elderly.

The clinical course and outcome of 58 patients receiving haemodialysis or continuous ambulatory peritoneal dialysis aged 65 years and above at the start of dialysis treatment was examined over a six-year period. Method of presentation and mode of treatment did not affect survival, but the presence of ischaemic heart disease or congestive cardiac failure was significantly associated with increased mortality. The actuarial two-year patient survival was 54 per cent. Survival on continuous ambulatory peritoneal dialysis was 75 per cent, and the incidence of peritonitis was one episode per 7.36 patient-treatment months. The mean duration of hospital admission was 57.2 days per patient year for continuous ambulatory peritoneal dialysis, and 19.9 days per patient year for haemodialysis patients.

Acute Kidney Injury↗