Search PubMed⌕ Search

Biomedical subjects

M Britton

Publications and source records attributed to M Britton.

At least 19 recordsLinked to original sources
PubMed2005

Mild head injury: reliability of early computed tomographic findings in triage for admission.

OBJECTIVE: To search the literature for case reports on adverse outcomes in patients with mild head injury where acute computed tomography (CT) findings had been normal. METHODS: Mild head injury was defined as head trauma involving amnesia or loss of consciousness, but where neurological findings are normal on arrival at hospital (GCS 15). The scientific literature was systematically searched for case reports where an early CT was normal and the patient deteriorated within two days. In these cases, early discharge despite a normal CT head scan would have been hazardous. RESULTS: Two prospective studies were found that investigated the safety of early CT in 3300 patients with mild head injury, as were 39 reports on adverse outcomes describing 821 patients. In addition, 52 studies containing over 62 000 patients with mild head injury were reviewed. In total, only three cases were deemed to have experienced an early adverse outcome despite a normal CT and GCS 15 on initial presentation. In another eight cases with incomplete descriptions, the interpretation was doubtful. Many reports of complications were not relevant to our question and excluded. These reports included cases with more severe head injury/not GCS 15 at presentation, complications that occurred after more than two days, or initial CT findings that were not fully normal. CONCLUSION: Very few cases were found where an early adverse event occurred after normal acute CT in patients with mild head injury. The strongest scientific evidence available at this time shows that a CT strategy is a safe way to triage patients for admission.

Craniocerebral Trauma↗
PubMed2004

Mild head injury: observation or computed tomography? Economic aspects by literature review and decision analysis.

OBJECTIVES: To compare the costs of two strategies for acute management of mild head injury: inhospital observation compared with acute computed tomography (CT) and home care. METHODS: Studies comparing costs for the two strategies that seem to have similar outcomes for patients were systematically reviewed. A decision tree analysis to compare the costs was also constructed, based on Swedish national costs and the risks found in a recent review on mild head injury complications. RESULTS: No studies were found that directly measured and compared risks, benefits, and costs of the two strategies. In the four studies retrieved, involving 4126 patients, the costs for hospital observation were factual, but a model was used to evaluate costs for the CT strategy. On average, costs were one third lower with CT. Also, the decision tree analysis demonstrated that the CT strategy was one third less expensive than inhospital observation. A sensitivity analysis showed this to be valid for nearly all cases. If these calculations hold true, a change of strategy could result in annual savings of pound 280,000/million inhabitants. CONCLUSION: The CT strategy seems to cost one third less than hospital observation.

Costs and Cost Analysis↗
PubMed2003

Mild head injury - mortality and complication rate: meta-analysis of findings in a systematic literature review.

BACKGROUND: Whether the strategy for care of mild head injury should be in-hospital observation or computed tomography (CT) investigation and home care has been discussed lately. A necessary requirement for guidelines and the design of clinical trials would be knowledge about the risks of the condition. These have not been reliably summarised. The study aims to estimate as accurately as possible the mortality, the complication rates, and the frequency of pathological findings on CT in patients with mild head injury. METHODS: Mild head injury was defined as head trauma involving loss of consciousness or amnesia, but where neurological findings on arrival at hospital are normal (GCS 15). Large databases were searched to find relevant scientific literature, and the retrieved studies were critically appraised. Findings were used from all representative patient data sets that met predefined standards for minimum quality. Meta-analysis using the random-effects model was performed on the data collected. FINDINGS: The search yielded 24 studies on 24249 patients fulfilling the requirements. The mean mortality of patients was low, 0.1% (CI 0.05-0.15). Complications, mostly requiring surgery, occurred in 0.9% (CI 0.6-1.2) of the cases. In approximately 8% (CI 6.1-9.5), pathological CT findings, dominated by haemorrhages, were identified in the acute phase. CONCLUSIONS: Of 1000 patients arriving at hospital with mild head injury, 1 will die, 9 will require surgery or other intervention, and about 80 will show pathological findings on CT. At least these 8% of patients will probably need in-hospital care.

Amnesia↗
PubMed2003

The burden of COPD in the U.K.: results from the Confronting COPD survey.

Chronic obstructive pulmonary disease (COPD) is a condition characterized by progressive airflow limitation and decline in lung function. As seen in other developed countries throughout the world, COPD in the U.K is associated with considerable mortality, and morbidity from the disease places a significant burden on the healthcare system and society. Despite the obvious burden of COPD in this country, there is a lack of recognition of COPD among the general public. Healthcare professionals may also fail to recognize the burden of disease, as shown by underdiagnosis and inadequate managemen. A key step in increasing awareness of the burden of COPD is obtaining comprehensive information about the impact of the disease on patients, the health service and society. The large-scale international survey, Confronting COPD in North America and Europe, aimed to address this need for information, by interviewing patients and physicians in eight countries. An economic analysis of patient responses to the survey in the U.K showed that COPD places a high burden on the healthcare system and society with annual direct costs estimated at pounds 819.42 per patient, and indirect cost at pound 819.66 per patient resulting in total per patient costs of pound 1639.08. The cost impact of the disease was particularly marked in secondary care, as a result of inpatient hospitalizations, amounting to 54% of direct costs. These results suggest that reducing patient requirement for hospital care could alleviate the burden of COPD on the U.K. healthcare system. This will require considerable improvements to the way the disease is managed by healthcare professionals in primary care, with earlier diagnosis and the use of interventions aimed at preventing exacerbations and delaying the progression of disease.

Absenteeism↗
PubMed2003

Aspirin in the prevention of progressing stroke: a randomized controlled study.

OBJECTIVES: In acute stroke, progression has a severe impact on patient outcome and no effective treatment is known. The main objective was to evaluate the efficacy of aspirin for prevention of stroke progression thereby improving outcome. DESIGN: The trial was randomized, double-blind and placebo-controlled. SETTING: The patients were treated in stroke units of four hospitals in Sweden. SUBJECTS: Patients with ischaemic stroke but not complete paresis were included. No antiplatelet drugs were allowed within the last 72 h before onset. Delay until first trial dosage was maximized to 48 h. The trial was designed to detect a 20% reduction of the rate of stroke progression, which was estimated to take place in 20% of cases. Totally, 441 patients (220 aspirin, 221 placebo) completed the trial. Baseline comparisons between the groups showed no differences. INTERVENTIONS: Aspirin (325 mg) or placebo was given once daily for five consecutive days. MAIN OUTCOME MEASURES: Neurological assessments were carried out three times daily during the treatment period to detect progression of at least two points in the Scandinavian Stroke Supervision Scale. Patient outcome was followed up at discharge and at 3 months. RESULTS: Aspirin treatment did not significantly reduce the frequency of stroke progression. Amongst aspirin-treated patients, stroke progression occurred in 15.9% as compared with 16.7% in the placebo group, which is less frequent than expected. The relative risk was 0.95 (95% CI 0.62-1.45) in the treatment group. As regards patient outcome at discharge and after 3 months, aspirin treatment did not show any difference. CONCLUSION: No positive effect of aspirin, of the expected size, could be shown on the frequency of stroke progression or patient outcome.

Acute Disease↗
PubMed2001

A test of general relativity from the three-dimensional orbital geometry of a binary pulsar.

Binary pulsars provide an excellent system for testing general relativity because of their intrinsic rotational stability and the precision with which radio observations can be used to determine their orbital dynamics. Measurements of the rate of orbital decay of two pulsars have been shown to be consistent with the emission of gravitational waves as predicted by general relativity, but independent verification was not possible. Such verification can in principle be obtained by determining the orbital inclination in a binary pulsar system using only classical geometrical constraints. This would permit a measurement of the expected retardation of the pulse signal arising from the general relativistic curvature of space-time in the vicinity of the companion object (the 'Shapiro delay'). Here we report high-precision radio observations of the binary millisecond pulsar PSR J0437-4715, which establish the three-dimensional structure of its orbit. We see the Shapiro delay predicted by general relativity, and we determine the mass of the neutron star and its white dwarf companion. The determination of such masses is necessary in order to understand the origin and evolution of neutron stars.

Journal Article↗
PubMed2001

Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial.

BACKGROUND AND PURPOSE: In small trials with control groups that receive no intervention, acupuncture has been reported to improve functional outcome after stroke. We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation. METHODS: In a multicenter randomized controlled trial involving 7 university and district hospitals in Sweden, 150 patients with moderate or severe functional impairment were included. At days 5 to 10 after acute stroke, patients were randomized to 1 of 3 intervention groups: (a) acupuncture, including electroacupuncture; (b) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions; and (c) low-intensity (subliminal) high-frequency electrostimulation (control group). A total of 20 treatment sessions were performed over a 10-week period. Outcome variables included motor function, activities of daily living function, walking ability, social activities, and life satisfaction at 3-month and 1-year follow-up. RESULTS: At baseline, patients in each group were closely similar in all important prognostic variables. At 3-month and 1-year follow-ups, no clinically important or statistically significant differences were observed between groups for any of the outcome variables. The 3 treatment modalities were all conducted without major adverse effects. CONCLUSIONS: When compared with a control group that received subliminal electrostimulation, treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction.

Activities of Daily Living↗
PubMed2000

Meta-analysis of increased dose of inhaled steroid or addition of salmeterol in symptomatic asthma (MIASMA).

OBJECTIVE: To examine the benefits of adding salmeterol compared with increasing dose of inhaled corticosteroids. DESIGN: Systematic review of randomised, double blind clinical trials. Independent data extraction and validation with summary data from study reports and manuscripts. Fixed and random effects analyses. SETTING: EMBASE, Medline, and GlaxoWellcome internal clinical study registers. MAIN OUTCOME MEASURES: Efficacy and exacerbations. RESULTS: Among 2055 trials of treatment with salmeterol, there were nine parallel group trials of >/=12 weeks with 3685 symptomatic patients aged >/=12 years taking inhaled steroid in primary or secondary care. Compared with response to increased steroids, in patients receiving salmeterol morning peak expiratory flow was greater at three months (difference 22.4 (95% confidence interval 15.0 to 30.0) litre/min, P<0.001) and six months (27.7 (19.0 to 36.4) litre/min, P<0.001). Forced expiratory volume in one second (FEV(1)) was also increased at three months (0.10 (0.04 to 0.16) litres, P<0.001) and six months (0.08 (0.02 to 0.14) litres, P<0.01), as were mean percentage of days and nights without symptoms (three months: days-12% (9% to 15%), nights-5% (3% to 7%); six months: days-15% (12% to 18%), nights-5% (3% to 7%); all P<0.001) and mean percentage of days and nights without need for rescue treatment (three months: days-17% (14% to 20%), nights-9% (7% to 11%); six months: days-20% (17 to 23%), nights-8% (6% to 11%); all P<0.001). Fewer patients experienced any exacerbation with salmeterol (difference 2.73% (0.43% to 5.04%), P=0. 02), and the proportion of patients with moderate or severe exacerbations was also lower (2.42% (0.24% to 4.60%), P=0.03). CONCLUSIONS: Addition of salmeterol in symptomatic patients aged 12 and over on low to moderate doses of inhaled steroid gives improved lung function and increased number of days and nights without symptoms or need for rescue treatment with no increase in exacerbations of any severity.

Adrenergic beta-Agonists↗
PubMed2000

Home rehabilitation after stroke. Reviewing the scientific evidence on effects and costs.

OBJECTIVES: The question addressed here is whether home rehabilitation after stroke is better and/or less expensive than the more conventional alternatives, i.e., rehabilitation during inpatient care, day care, and outpatient visits--alone or in combinations appropriate to disease stage and patient needs. Home rehabilitation is managed by teams of professionals who train patients at home. METHODS: The scientific literature was systematically searched for controlled studies comparing outcomes and costs of home rehabilitation with the more conventional strategies. RESULTS: The abstracts of 204 papers were evaluated, from which 89 were selected for greater scrutiny. From the 89 studies, we found 7 controlled studies involving 1,487 patients (6 of the 7 were randomized, 4 of the 6 assessed costs). No statistically significant differences, or tendencies toward differences, were revealed as regards the outcome of home rehabilitation versus hospital-based alternatives. Thus, home rehabilitation was neither better nor worse at improving patients' ability to manage on their own or resume social activities. Depression and reduced quality of life were common in all groups of patients and caregivers, irrespective of the rehabilitation strategy. In the four randomized studies that reported on costs, home rehabilitation was found to be less expensive than regular day care, but not less expensive than conventional strategies even though hospital stay was reduced. CONCLUSION: The outcomes and costs of home rehabilitation after stroke seem to be comparable to alternative treatment strategies.

Ambulatory Care↗
PubMed2000

Effectiveness of heparin treatment for progressing ischaemic stroke: before and after study.

OBJECTIVES: During the acute phase of stroke, symptoms progress in 25% of patients, resulting in a worse outcome. Could heparin treatment improve the situation? DESIGN: Before and after study. During the first period, no treatment was given to patients with progress of symptoms, whereas heparin was used regularly in the second period. A comparison of outcome was performed. SETTING: Patients with acute stroke cared for in stroke units of two big emergency hospitals in Stockholm. Besides heparin treatment, the groups were taken care of according to the same basic principles. SUBJECTS: Consecutive patients admitted to a stroke unit during two periods of time. The first study comprised 314 patients with ischaemic stroke and the second 907. INTERVENTION: In the treatment period, patients with ischaemic stroke and objectively recognized progression received heparin infusion for at least 5 days. MAIN OUTCOME MEASURES: Continued progression, length of stay, unaided walking at discharge, discharge destination and mortality. RESULTS: The progression rate was non-significantly higher in the first period: 28 vs. 21%. One-third continued to progress regardless of treatment given. Patients with progression, treated and untreated alike, had 40% longer stay in the stroke unit compared with stable patients, whereas mortality was unaffected. Treatment did not reduce the proportion of patients who needed aid for walking at discharge (77 vs. 74%) or those who needed further institutionalized care (65 vs. 66%). CONCLUSION: Progression of focal stroke symptoms still constitutes a serious clinical problem for which heparin has insufficient effectiveness in clinical practice. New therapies, ideally preventive, are needed.

Activities of Daily Living↗
PubMed2000

How do stroke patients fare when discharged straight to their homes? A controlled study on the significance of hospital follow-up after one month.

In our experience, stroke patients discharged straight to their homes sometimes showed marked deterioration. We investigated whether this negative course of events could be prevented by means of follow-up visits entailing extensive testing and resultant measures one month after discharge. The patients in our study included a selection of mild cases with a short length of hospital stay. Forty-six patients returned to the stroke unit on a follow-up visit, and 49 patients made up the control group. The groups were compared after 3 months, by means of questionnaires. The results did not show any definite difference between the groups. However, after 3 months we detected depressions in 13 patients in the study group and in 11 patients in the control group, most of them untreated. The study points to a need for follow-up aimed specifically at detecting depression.

Aged↗
PubMed2000

Management of minor head injuries in emergency departments in Sweden. Time for a new strategy?

OBJECTIVE: To study how patients with minor head injuries are currently managed. DESIGN: Questionnaire to senior residents in emergency departments and data from registers covering all in-hospital care in Sweden. SETTING: All 92 emergency departments in Sweden. RESULTS: The response rate to the questionnaire was 100%. In Sweden, 75 emergency departments treat patients with minor head injuries. Four departments are paediatric. General surgeons are the main providers (87%) of care for patients with minor head injuries. All hospitals admit patients with a history of unconsciousness or amnesia. Skull radiography is not used routinely. The estimated use of computed tomography (CT) varies between 2% and 80%, the mean being 22%. The need for CT, or the result thereof, is not the deciding factor for admission. In 1996, 16877 patients were treated as inpatients for minor head injuries, (191/100000 inhabitants). The admission rates varied widely among departments, and the total figures have been constant since 1987. The mean hospital stay was 1.6 days, so a large number of hospital days are consumed. The resources more than cover routine CT investigations for those seeking care, and hospital care for those with abnormal findings or special needs. CONCLUSION: In Sweden, patients with minor head injuries are routinely admitted to hospital for observation. The estimated use of CT varies considerably. No clinics report using CT to triage patients for admission, a strategy that would be consistent with effectiveness and economic arguments.

Adolescent↗