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Biomedical subjects

L Davies

Publications and source records attributed to L Davies.

At least 91 records · Page 5Linked to original sources
PubMed1996

An economic exploration of oral and intravenous ganciclovir in the induction and maintenance treatment of AIDS-related cytomegalovirus retinitis.

The objective of the study was to compare the impact of oral and i.v. ganciclovir on resource use and direct health care costs, from the perspective of the UK National Health Service (NHS). The analytical framework used was cost analysis. The sources of data were an open, randomized clinical trial, and additional research which collected resource use and cost data. From the perspective of the UK NHS, the expected cost of i.v. ganciclovir for initial induction and 140 days maintenance and reinduction therapy was pounds 730 higher than that of oral (pounds 8145 vs pounds 7415). Conservative estimates which did not favour oral ganciclovir were used wherever possible. Overall, the resource use and costs of maintenance therapy with oral ganciclovir calculated in the model used for this study were lower than those of i.v. ganciclovir, principally reflecting lower costs for the administration of therapy. In this model the drug cost of ganciclovir maintenance therapy was excluded.

AIDS-Related Opportunistic Infections↗
PubMed1996

Establishing the presence of the t(15;17) in suspected acute promyelocytic leukaemia: cytogenetic, molecular and PML immunofluorescence assessment of patients entered into the M.R.C. ATRA trial. M.R.C. Adult Leukaemia Working Party.

Detection of the t(15;17) or its molecular consequence, the PML-RAR alpha rearrangement, is critical for meaningful analysis of clinical trials involving patients with suspected acute promyelocytic leukaemia (APL). Its presence remains the best predictor of a favourable response to retinoids, such as ATRA, which in combination with chemotherapy confer significant improvements in disease-free survival. We have evaluated the relative efficacy of RT-PCR, cytogenetics and PML immunofluorescence staining to identify the existence of the translocation in 100 patients entered into the Medical Research Council (M.R.C.) ATRA trial. RT-PCR successfully identified PML-RAR alpha rearrangements in 93/100 patients, including 65 where only peripheral blood or post-induction marrow samples were available for analysis and in 12 patients in whom cytogenetic assessment failed to demonstrate t(15;17) due to poor-quality metaphases (10/12) or as a reflection of cryptic PML-RAR alpha rearrangements (2/12). Parallel employment of the RAR alpha-PML assay confirmed expression of del(17q)-derived transcripts in 81% and permitted determination of the PML breakpoint (a potential independent prognostic variable) in all 93 cases. Sequencing of RT-PCR products derived from 50 patients with 3' PML breakpoints revealed five bcr 2 cases, including a novel exon 5 breakpoint. 35/81 (43%) patients with cytogenetic evidence of t(15;17) possessed additional karyotypic abnormalities. In four patients with available buffy coat smears, lack of cytogenetic or molecular evidence of the t(15;17) was confirmed by a wild-type PML immunofluorescence nuclear staining pattern, in contrast to the characteristic microparticulate distribution detected in 14 patients with RT-PCR evidence of the rearrangement. However, although PML immunofluorescence staining is suitable for rapid determination of patients likely to benefit from ATRA, this approach does not obviate the need for cytogenetic and RT-PCR analysis of all patients entered into APL clinical trials, because both techniques provide additional information which may prove to be of independent prognostic significance.

Adolescent↗
PubMed1995

Ubiquitin-positive achromatic neurons in corticobasal degeneration.

A 66-year-old woman presented with an alien limb syndrome without dementia. The course of her illness was unremitting and at autopsy 6 years later her diagnosis was confirmed as corticobasal degeneration without Alzheimer-type pathology. Although the presence of ballooned achromatic cortical neurons and cell loss from the substantia nigra distinguishes such patients, the site and density of achromatic neurons has not previously been quantified. We show that immunohistochemistry for the cell stress protein ubiquitin selectively stains these achromatic neurons, whereas they do not stain for abnormally phosphorylated tau protein. Phosphorylated neurofilament antibodies recognise both ballooned and non-ballooned neurons. In this case, high densities of ubiquitin-positive ballooned neurons were found in frontal cortical regions with the highest densities in layers V and VI of the anterior cingulate cortex. In addition, high densities of ubiquitin-positive ballooned neurons were found in the insular cortex, claustrum and amygdala. These results confirm past reports of frontal pathology, but show that there is also considerable pathology in insular and parahippocampal cortical regions and some subcortical regions. Our findings suggest that the distribution and staining characteristics of ballooned neurons in corticobasal degeneration may help to differentiate these cases pathologically, while the absence of dementia appears to be an important clinical criterion.

Aged↗
PubMed1995

Hepatitis B immunisation among invasive cardiologists: poor compliance with United Kingdom guidelines.

OBJECTIVES: To assess the compliance of invasive cardiologists in the United Kingdom with recently accepted national guidelines on the protection of health care workers and patients from hepatitis B. To determine levels of awareness of the infectivity and prevalence of the virus and current attitudes towards screening of patients before cardiac catheterisation and surgery. DESIGN: Anonymous postal survey by questionnaire from the University Hospital of Wales, Cardiff. The questionnaire established the respondent's position, knowledge of hepatitis B, current immunological state, and policy towards the routine screening of patients for hepatitis B carriage. PARTICIPANTS: All British cardiologists of consultant or senior registrar grade involved in invasive procedures. RESULTS: The response rate was 78% (211/271). 20% of respondents had never been vaccinated against hepatitis B and about a third of those vaccinated had not complied correctly with the recommended immunisation regimen. There was little uniformity in practices for screening patients for hepatitis B carriage before invasive procedures, and the level of knowledge concerning the prevalence of hepatitis B and the risks of inoculation was poor. CONCLUSIONS: Invasive cardiologists are at high risk of inoculation with hepatitis B. Nationally agreed guidelines are designed to protect both medical staff and patients against the risk of infection but currently they are ill heeded.

Attitude of Health Personnel↗
PubMed1995

A closer look at gender and distress among the never married.

This study examines the relationship between gender and distress among a sample of never married and married individuals aged 18-64 years from the 1987-88 National Survey of Families and Households. The hypothesis that singlehood benefits women more than men in terms of economic and psychosocial resources, which then translate into lower levels of distress, was not completely supported. In general, single women and men appear more similar than different in resources, although gender differences in distress vary by age. The importance of recognizing conceptual distinctions among the single is discussed.

Adult↗
PubMed1994

Economic evaluation of standard heparin and enoxaparin for prophylaxis against deep vein thrombosis in elective hip surgery.

Deep vein thrombosis (DVT) is a common complication in patients undergoing elective hip surgery. Because of the associated risk of pulmonary embolism, prophylaxis with standard (unfractionated) heparin is becoming increasingly important. Recent clinical trials have shown a low molecular weight form of heparin, enoxaparin, to be more effective than standard heparin in preventing DVT, but the new drug is also more expensive. Data on clinical effectiveness and cost were combined in an economic evaluation of the two regimens. It was found that prophylaxis with enoxaparin would be expected to lead to a net saving of 20 pounds per patient. The economic results are sensitive to the costs of enoxaparin, the costs of drug administration and the probability of false clinical diagnosis of DVT or pulmonary embolism.

Decision Trees↗
PubMed1994

Current status of economic appraisal of health technology in the European Community: report of the network. The EC Network on the Methodology of Economic Appraisal of Health Technology.

The use of economic evaluation to assess the costs and consequences of health care technologies has steadily increased in recent years. However, little is known about the influence economic studies have on health care decision makers or policy at local and national level. This paper reports the results of a survey of economic evaluations in EC countries to identify the impact of the results on decision and policy making in health care. Health service researchers in 10 EC countries were identified and asked to participate in the survey. The researchers were asked to locate economic evaluations in their country and complete a standardised questionnaire for each study. The criteria for inclusion in the survey were first, the studies should have been started or reported since 1987, second, the evaluations should include a comparison of the cost and consequences of the technologies assessed and finally, the appraisals should include a comparison of alternative health care technologies or programmes. A total of 66 studies which met the survey criteria were reported. Of these, 27% were thought to have influenced health care decision makers or policy. The results suggested that method of dissemination, source of funding and purpose of the study may be important determinants of whether an economic evaluation will be used in health care policy or decision making. The results of the survey suggest that economic evaluation currently has a relatively low impact on health care policy or decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1994

Development rates of some pre-adult stages in blowflies with reference to low temperatures.

Duration of some pre-adult stages of Calliphora vicina Robineau-Desvoidy, C.alpina Zett., C. vomitoria Linn., Phormia terraenovae R.-D. and Lucilia sericata Meig. were determined at 3.5-26 degrees C, in the context of use of these insects in forensic estimates of post-mortem intervals. Egg development in C. vicina occurs down to at least 3.5 degrees C, larval growth to 4 degrees C and puparial formation, development and perfect adult emergence to 5 degrees C. Growth curves by successive weighing of individual larvae showed specific differences in rates of development of the above species at constant temperatures. Alternating temperatures for 12h periods (such as 10 degrees C and 20 degrees C) to simulate diurnal changes, usually, but not at all temperature pairs tested, caused acceleration of growth relative to the corresponding constant temperature (15 degrees C in the above case), in C. vomitoria, P. terraenovae and L. sericata, but usually caused retardation of larval growth in C. vicina. In this species, larvae as single individuals on beef liver in small tubes grew on average at the same rates as those (50-100 larvae) growing communally. All species showed variation in larval growth between individuals, more marked in C. vicina, and slower-growing larvae showed increased unexplained mortality. Because of this and to avoid complication by fast-growing larvae from later laid egg batches on a carcass, growth curves given are those of mean weights of the heaviest 25% (upper quartile) of groups of 40-90 feeding larvae.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Role of hypothalamic neuropeptide Y gene expression in body weight regulation.

Hypothalamic neuropeptide Y (NPY) may be involved in the hyperphagia that follows food deprivation associated with significant weight loss. However, it is unclear whether NPY is involved in body weight regulation under more physiological circumstances. Consequently, we measured body weight, food intake, arcuate nucleus (ARC) NPY mRNA, serum glucose, and insulin in male Wistar rats after 48 h of food deprivation and various refeeding protocols. Food deprivation produced a twofold increase in NPY mRNA, whereas 3 days of ad libitum refeeding returned body weight and NPY mRNA to control. If hyperphagia was prevented for 5 days during refeeding, then neither body weight nor NPY mRNA normalized. There were strong negative correlations between ARC NPY mRNA and both loss of body weight and serum insulin levels. These data suggest that hypothalamic NPY gene expression plays a role in control of body weight under physiological conditions. The data further suggest that NPY mRNA may be decreased by peripheral insulin levels.

Analysis of Variance↗
PubMed1994

Economic evaluation of lenograstim for prophylaxis of chemotherapy-induced neutropenia in patients with small cell lung cancer.

The impact of lenograstim, recombinant human granulocyte colony-stimulating factor, on healthcare costs was evaluated on the basis of the results of a clinical trial of the drug in patients receiving VICE (vincristine, ifosfamide, carboplatin and etoposide) chemotherapy for small cell lung cancer (SCLC). The use of lenograstim resulted in a significant (p < 0.03) increase in the cumulative chemotherapy dose intensity (125% with lenograstim vs 118% without). Lenograstim was found to have no significant impact on the use of healthcare resources for administration of chemotherapy, chemotherapy-induced neutropenia, and associated infections. The cost of healthcare for the lenograstim group (excluding lenograstim acquisition costs) was 700 pounds higher per patient than that for the group not treated with lenograstim (95% CI -930 pounds to 2300 pounds). The use of lenograstim to intensify the chemotherapy dose is likely to increase the costs of treatment for SCLC. However, any increased costs need to be balanced against the potential cost savings associated with the possible long term benefits resulting from chemotherapy dose intensification.

Adjuvants, Immunologic↗
PubMed1994

The cost of treatment for post-herpetic neuralgia in the UK.

Post-herpetic neuralgia (PHN) following acute shingles caused by the herpes simplex virus is a painful and often disabling condition. Treatment of the condition can involve a range of drug therapies. In addition, patients with continuing pain may make several visits to general practitioners and hospital outpatient departments. The costs of treatment for these patients may be substantial. The main objective of this study was to estimate the costs and consequences to the UK National Health Service (NHS) of the treatment of PHN following shingles, and the effect of the condition on patients' lives in terms of pain and time off usual activities such as work. The lifetime direct treatment costs of a cohort of people from onset of PHN to resolution of the disease or death were calculated. These costs were estimated from data on the type and quantity of health resources used, and the unit costs or prices of those resources. This study has shown that PHN can be a costly consequence of acute shingles. For patients attending a tertiary referral centre the lifetime cost was 770 British pounds sterling. For a 1-year incidence cohort of people with shingles in the UK, the lifetime costs of treating PHN are between 4.8 million British pounds sterling (incidence of 21 000 people) and 17.9 million British pounds sterling (incidence of 78 200 people). Efforts are needed to reduce the incidence or severity of PHN.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Economic evaluation of drugs in peripheral vascular disease and stroke.

Increased pressures on health-care budgets mean that governments require good value for money from the resources devoted to health care. In many countries, measures have been introduced to increase efficiency or to contain health-care costs. These include price controls, limitations on reimbursement of health technologies, budgetary reform in health-care institutions, and the encouragement of competition. Given this changing environment, it is important that drugs and other health technologies be shown to give good value for money. The methods of economic evaluation, such as cost-benefit and cost-effectiveness analysis, can be used to assess the value of drugs and other health technologies. They have been widely applied. The economic evaluation of drugs in peripheral vascular disease and stroke would compare the cost of adding the drug with its benefits. These would include improvements in length and quality of life and the savings in treating vascular events that may be postponed, or lessened in intensity, by effective drug therapy. One study, following a clinical trial of naftidrofuryl in stroke, suggested that there would be significant reductions in costs through reductions in hospital stay if recovery was aided. Further research and a large multicenter trial are under way to confirm these findings. In peripheral artery disease there are no economic data collected alongside clinical trials. It is known, however, that the costs of leg ischemia can be significant. A study in the U.K. found that arterial construction would cost around pounds 7,750 per person (1989 prices) and amputation around pounds 11,000 per person.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrovascular Disorders↗
PubMed1994

Brave new world?

Arguments in favour of embryo research Prevention of congenital defects. Reduction in number of miscarriages. Better understanding of infertility. Arguments against embryo research Morally unacceptable to take potential human life. The 14-day limit on research is arbitrary. Fears about the creation of 'superspecies' and 'designer babies'. Fear of embryo 'trade' in which embryos are bought and sold.

Embryo, Mammalian↗
PubMed1994

Vasculitic neuropathy.

Patients with vasculitic neuropathy may present with either mononeuritis multiplex, or a symmetrical or asymmetrical sensorimotor neuropathy. In those patients whose neuropathy is part of a systemic vasculitis the neuropathy can be expected to improve leaving only mild or moderate functional disability. Nevertheless, the long-term outlook for such patients is poor with a 5-year survival of around 50% with most excess deaths being due to vascular disease. The prognosis in non-systemic vasculitic neuropathy is almost certainly substantially better than this. Treatment of vasculitic neuropathy should be based on diagnosis by tissue biopsy, usually of nerve, and early use of aggressive immunosuppression.

Autoimmune Diseases↗