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Biomedical subjects

J Wright

Publications and source records attributed to J Wright.

At least 217 records · Page 12Linked to original sources
PubMed1998

Assessing local health needs in primary care: understanding and experience in three English districts.

BACKGROUND: Assessing the health needs of a local population has been promoted as a key component in effective targeting of healthcare services and quality improvement. The understanding and experience of assessing health needs in general practice were investigated in three English districts. AIM: To identify the issues surrounding the potential for assessing health needs in primary care. METHOD: Postal survey of 347 general practices in three health authorities. Telephone interviews with a random stratified sample of 35 general practitioners. RESULTS: Although most practices identified assessing health needs as important, it is clear that this identification was typically based on an understanding of assessing needs as primarily focused on individual patient care, based on clinical priorities and involving practice held data. Most practices had not undertaken local consultation, whatever their understanding of assessing health needs. The few practices which had completed population oriented, proactive assessment of needs considered it to have led to tangible improvements in clinical or practice management. Overall, there was apparent confusion over the nature and purpose of assessing needs, although the principled aims and objectives of a population oriented, proactive component to primary care were generally upheld. The need for additional resources and support was identified. In four out of the five cases where specifically population based assessment of health needs had been undertaken, the local public health department had been involved. CONCLUSION: The value of the concept of assessing health needs in primary care holds considerable uncertainty and ambivalence. The findings from this study show that any attempts to promote assessing needs into primary care which focus either primarily or exclusively on the provision of "education" are unduly simplistic. More fundamental questions about the perceived relevance and opportunities for assessing health needs should be considered if primary care groups are to meet future commissioning challenges.

Community Health Planning↗
PubMed1998

Health-related quality of life after knee replacement.

A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision knee replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). Each sample was stratified by race, age, residence (urban or rural), and the year of the procedure. Valid and reliable questionnaires were used to elicit the participants' assessments of pain, physical function, and satisfaction two to seven years after the knee replacement. Of the 1486 patients who were eligible for inclusion in the survey, 1193 (80.3 per cent) responded. The mean age of the respondents was 72.6 years. Eight hundred and forty-nine respondents (71.2 per cent) were white, and 849 (71.2 per cent) were women. The participants reported that they had little or no pain in the knee at the time of the survey, regardless of the age at the time of the knee replacement, the body-mass index, or the length of time since the knee replacement. After adjustment for potential confounding variables, predictors of better physical function after the replacement were an absence of problems with the contralateral knee, primary knee replacement (rather than revision) (Indiana sample only), and a lower body-mass index (Indiana and western Pennsylvania samples). Four hundred and fifteen (85.2 per cent) of the 487 patients in the national sample were satisfied with the result of the knee replacement. In what we believe to be the first community-based study of the outcome of knee replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.

Aged↗
PubMed1998

Fast and slow reaction time changes reflected in ERP brain function.

A number of studies have examined the average late component Event Related Potential (ERP) and Reaction Time (RT) in response to multiple target stimuli (across-trial averages). This study demonstrates within-trial differences in ERP brain function associated with relatively fast and slow RTs in 50 normal subjects. A conventional auditory oddball paradigm (with a 1 ISI) was employed. Increased ERP N100 and N200 amplitude (and decreased P200 amplitude), as well as earlier P200, N200 and P300 latency were found in the fast compared with the slow ERP subaverages. These results show the potential to elucidate temporal and spatial dynamics of brain function associated with changes in performance, in conventional "cognitive" paradigms applicable to both health and disease states.

Acoustic Stimulation↗
PubMed1998

Fast and slow reaction times and associated ERPs in patients with schizophrenia and controls.

A number of studies have examined across-trial averaged late component. Event Related Potentials (EPR) and Reaction Times (RT) in response to multiple target stimuli. In this study, within-trial relatively fast and slow sub averages are additionally examined, in 20 patients with schizophrenia and 20 age and sex matched controls. A conventional auditory oddball paradigm. Across-trial ERP average analysis showed smaller N200 amplitude and delayed latency (but larger P200 amplitude) in patients with schizophrenia compared with controls. Within-trial ERP analysis revealed a number of additional findings. Controls showed distinctive differences in fast compared with slow ERP sub averages (smaller P200 amplitude, increased N200/P300 amplitudes and earlier latencies). The schizophrenic group on the other hand, showed relatively similar fast versus slow subaverages (no differences in P200 amplitude and N200 latency). In addition, between-group (within-trial) analyses highlighted significant differences in earlier stages of processing (compared with across-trial averages) in both fast and slow subaverages (increased N100 amplitude in controls). The complementary within-trial (compared with across-trial) data are interpreted with respect to a possible disturbance in inhibitory function in patients with schizophrenia.

Adult↗
PubMed1998

A comparison of the efficacies and duration of action of the angiotensin II receptor blockers telmisartan and amlodipine.

OBJECTIVES: To compare the antihypertensive effects and duration of action of the angiotensin II receptor antagonist, telmisartan, amlodipine, and placebo in patients with mild-to-moderate hypertension using both conventional clinic blood pressures and ambulatory blood pressure monitoring (ABPM). METHODS: After a 4-week single-blind, placebo run-in period, qualifying patients were randomly allocated in double-blind manner to be administered 40 mg telmisartan (n = 73; increased to 80 and 120 mg as necessary for patients whose diastolic blood pressure (DBP) remained > 90 mmHg); 5 mg amlodipine (n = 78; titrated to 5 mg and titrated to 10 mg for patients whose DBP remained > 90 mmHg); or placebo (n = 81). ABPM was performed at the end of the baseline period and again at the end of 12 weeks of double-blind treatment. RESULTS: Telmisartan and amlodipine treatments significantly decreased trough supine systolic blood pressure and DBP (P < 0.001, measured conventionally) to a similar extent (by 13.1/7.1 and 14.0/7.1 mmHg, respectively, at the end of 12 weeks' treatment) compared with placebo. Both drugs also significantly reduced 24 h mean systolic blood pressures and DBP compared with placebo (P < 0.0001), measured using ABPM, maintaining control of blood pressure throughout the dosing period. Reductions in DBP with telmisartan were greater (P < 0.05) than those with amlodipine during the night-time interval and the last 4 h of the dosing period. Twenty-four-hour mean ABPM DBP < 85 mmHg were observed in 71% of telmisartan patients and in 55% of patients administered amlodipine. In addition, heart rates in patients treated with telmisartan were lower than heart rates in those treated with amlodipine during the final 4 h of the dosing period (P = 0.0003) and during the morning interval (P = 0.005). Generally, both telmisartan and amlodipine were well tolerated, however, drug-related edema occurred significantly more commonly (P < 0.05) among the patients administered amlodipine than it did among patients administered either telmisartan or placebo. CONCLUSIONS: Clinic blood pressure measurements detected no difference between the antihypertensive effects and durations of action of telmisartan and amlodipine, both agents producing statistically significant reductions compared with placebo. ABPM measurements, however, revealed differences between the efficacies at specific time points within the dosing periods. These findings highlight the potential importance of the use of ABPM for evaluating and comparing efficacies of antihypertensive agents.

Journal Article↗
PubMed1998

Precise carrier diagnosis in families with haemophilia A: use of conformation sensitive gel electrophoresis for mutation screening and polymorphism analysis.

Causative mutations in the factor VIII gene of seven unrelated patients with severe haemophilia A were identified using the mutation screening procedure conformation sensitive gel electrophoresis (1) and characterised by direct sequencing. Female family members of all patients had requested either carrier status determination or prenatal diagnosis. However, lack of the factor VIII gene inversion, a prior family history or informative polymorphisms prevented diagnosis in these families. Identification of a mutation in each family enabled female carrier status to be determined in all cases. Six mutations were previously unreported. One Afro-Caribbean patient had two sequence changes; A670 2G and A6769G. The latter, resulting in Met2238Val and previously reported as a FVIII mutation, was shown to be polymorphic with a 42% heterozygosity rate in an Afro-Caribbean population. Conformation sensitive gel electrophoresis was found to be technically simple and efficient at locating previously unknown FVIII gene mutations.

Blotting, Southern↗
PubMed1998

Disposition of the antipsychotic agent CI-1007 in rats, monkeys, dogs, and human cytochrome P450 2D6 extensive metabolizers. Species comparison and allometric scaling.

The disposition of CI-1007 (I), an antipsychotic dopamine agonist, was studied after iv or po administration to rats, monkeys, and dogs and po administration to human cytochrome P450 2D6 extensive metabolizers (EMs). I was extensively metabolized after po administration, with high hepatic clearance (CL) values and negligible urinary excretion. Values for systemic plasma CL (28-40 ml/min/kg) suggested hepatic plasma flow-limited CL. The oral CL of I was similar among the species. Strong correlation was achieved in interspecies scaling for CL. After oral administration of [14C]I, the major route of 14C elimination in rats was in the bile (64%), followed by feces (29%) and urine (3.2%). Fecal excretion (64%) was the major route of 14C elimination in monkeys, followed by urine (14%). Three hydroxy metabolites, i.e. PD 147693 (II), PD 149394 (III), and PD 155144 (IV), and two sulfates, i.e. PD 163637 (VI) and PD 163639 (VIII), were identified in monkey plasma, urine, or feces. VIII was the major metabolite excreted in monkey urine, and VI was the major component in feces. Trace amounts of II, VI, and VIII were detected in the plasma and urine of human EMs but not in rats or dogs. II is an active metabolite that was present in all species. After oral administration, observed maximal plasma concentration and AUC values for II were higher than the corresponding values for I in dog plasma, approximately 20-40% of the values for I in monkeys and human EMs, and <5% of the values for I in rat plasma. Although the metabolic profiles differ among species, strong correlation was achieved in allometric scaling because the elimination of I from the body is mainly limited by hepatic blood flow.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1997

The professional perception of orthodontic treatment complexity.

OBJECTIVE: To assess the current professional concept of orthodontic treatment complexity. DESIGN: Cross sectional survey of practitioners' views towards recently completed orthodontic treatments. SETTING: Specialist and non-specialist practitioners in General Dental Services in North Western and Mersey regions. The sampling was carried out between 1993-95. SUBJECTS AND METHODS: All practitioners undertaking orthodontic treatments in the GDS in the North Western and Mersey regions were invited to participate. Practitioners submitted consecutively started cases for scrutiny by analysis of study models and pre-treatment and post-treatment questionnaires. 280 cases were collected. Data were analysed using multiple linear regression. MAIN OUTCOME MEASURES: The occlusal changes were assessed using the Index of Orthodontic Treatment Need and the Peer Assessment Rating. Self administered questionnaires employed 5-point Likert type scales to record practitioners' and patients' opinions. RESULTS: It appears that the concept of complexity is related to the occlusal changes which occur during orthodontic treatment. Attempts to define treatment complexity identifies factors which are of questionable validity and could be easily manipulated in practice setting. CONCLUSIONS: The present concepts of treatment complexity appear to be somewhat flawed. There is no occlusal index of complexity which is particularly satisfactory but as a crude interim measure 3 grades of complexity are proposed based on the PAR index.

Adolescent↗
PubMed1997

Paradigms found.

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Evidence-Based Medicine↗
PubMed1997

Economic analyses.

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Cost-Benefit Analysis↗