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Biomedical subjects

N Jones

Publications and source records attributed to N Jones.

At least 181 records · Page 10Linked to original sources
PubMed1994

Quality of minor surgery by general practitioners in 1990 and 1991.

BACKGROUND: The 1990 contract for general practitioners encouraged them to undertake minor surgical procedures in their practices. AIM: A study was undertaken to determine whether the subsequent expansion of general practitioner minor surgery activity was accompanied by changes in quality of care. METHOD: Data were analysed relating to minor operations conducted in 22 practices during April-June 1990 and April-June 1991. RESULTS: The volume of general practitioner minor surgery increased by 41% between the two study periods. Waiting time, accuracy of diagnosis, use of histology, adequacy of excision, complications and the need for corrective treatment in hospital did not change significantly between the two periods. CONCLUSION: The findings do not support suggestions that the expansion of general practitioner minor surgery activity following the 1990 contract has been associated with an erosion of quality of care.

Clinical Competence↗
PubMed1993

Minor surgery by general practitioners under the 1990 contract: effects on hospital workload.

OBJECTIVE: To determine the extent to which minor surgery undertaken by general practitioners after the introduction of the 1990 contract substituted for hospital outpatient workload. DESIGN: Before and after observational study. SETTING: Four English family health services authorities. SUBJECTS: Patients in 22 practice populations who were operated on by their general practitioner or referred to hospital for minor surgery during April to June 1990 or April to June 1991. MAIN OUTCOME MEASURES: Numbers of minor surgical procedures undertaken in general practice and in hospital, numbers of referrals to hospitals for conditions treatable by a minor surgical procedure, and the mix of diagnoses and procedures undertaken in each setting. RESULTS: General practitioners claimed reimbursement for 600 minor surgical procedures during April to June 1990 and for 847 during April to June 1991, an increase of 41%. Referrals to hospital for comparable conditions showed no compensatory decrease (385 during April to June 1990 and 388 during April to June 1991, 95% confidence interval for change in referrals -51 to 57), and the number of hospital procedures resulting from those referrals also remained constant (187 in the first period, 189 in the second, 95% confidence interval for change in procedures -36 to 40). The mix of procedures did not change significantly from one study period to the next in either setting. CONCLUSIONS: Many or all of the additional patients receiving minor surgery under the terms of the 1990 contract may not have previously been referred to hospital. General practitioners seem not to have systematically shifted towards treating the more trivial cases. The overall increase in minor surgical activity may reflect an improvement in accessibility of care or changes in patients' perceptions and attitudes.

Contract Services↗
PubMed1993

Economic evaluation of cardiac rehabilitation soon after acute myocardial infarction.

Although there are extensive clinical evaluations of cardiac rehabilitation after acute myocardial infarction (AMI), no full economic evaluation is available. Patients with AMI and mild to moderate anxiety or depression, or both, while still in hospital were randomized to either an 8-week rehabilitation intervention (n = 99) or usual care (n = 102). Comprehensive costs and health-related quality of life, measured with the time trade-off preference score, were obtained in a 12-month trial, and together with survival data derived from published meta-analyses, cost-utility and cost-effectiveness of early cardiac rehabilitation were estimated. The best estimate of the incremental net direct 12-month costs for patients randomized to rehabilitation was $480 (United States, 1991)/patient. During 1-year follow-up, rehabilitation patients had fewer "other rehabilitation visits" (p < 0.0001) and gained 0.052 quality-adjusted life-year more than did the group with usual care. The cost-utility ratio was $9,200/quality-adjusted life-year gained with cardiac rehabilitation during the year of follow-up. This economic evaluation of cardiac rehabilitation does not consider the important distinctions between affordability and worth of alternative health-care services. The data provide evidence that brief cardiac rehabilitation initiated soon after AMI for patients with mild to moderate anxiety or depression, or both, is an efficient use of health-care resources and may be economically justified.

Canada↗
PubMed1993

The effects of user charges on the dispensing of prescription medicines: a survey of prescription charge payment in the Wellington region.

OBJECTIVE: The study aimed to examine the impact of user charges on the dispensing of prescription medicines. The effect of social class, customer type and number of items on the incidence of payment problems was examined. METHOD: The study employed a two week survey of 26 pharmacies randomly selected from Wellington Pharmacy Guild. Pharmacists completed a questionnaire on each occasion user charges led to a problem dispensing a prescribed medicine. Data collected included: type of problem encountered and its outcome, customer information (including the customer's pharmaceutical benefit category), and prescription information (including the number of items prescribed). RESULTS: The overall incidence of payment problems was 1.5% or 1 in every 66 prescription forms processed by the pharmacists. User charges resulted in medicine dispensing failure on 56% of the problem occasions. Customers incurred debt or were funded by a social agency on the remaining 44% of problem occasions. Fifty-three percent of dispensing failures resulted in non-collection of items at the end of the survey period. Thirty-four percent of debts were outstanding at the end of the survey. The incidence of all payment problems correlated with the social "need" score of the pharmacy area and was significantly higher for children's and student's prescriptions. CONCLUSION: User charges may provide a greater barrier to children, students and people living in areas of high social need. Ongoing evaluation of the impact of user charges is required to ensure improved prescribing is achieved equitably [corrected].

Adult↗
PubMed1993

Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire.

There is an interest in the consequences of deriving a single index measure of health for validity and sensitivity. This paper presents the results of testing a recent example of a general health measure designed to derive a single index, the Euroqol (EQ), and presents a comparison with a new, influential profile measure, the Short Form 36 (SF-36) Health Survey Instrument. The EQ and an anglicised version of the SF-36 health survey, both designed for self-completion, were included in a postal survey of a random sample of 1980 patients from two practice lists in Sheffield, UK. The response rate for the EQ questionnaire was 83%, and the rate of completion over 95%. Evidence was found for the construct validity of the EQ dimension responses and the derived total EQ health score in terms of distinguishing between groups with expected health differences. Considerable agreement was found between EQ responses and the total EQ score, and the UK SF-36 profile scores. There was substantial evidence of EQ being less sensitive at the ceiling (i.e. low levels of perceived ill-health) and throughout the range of health states. A recent restructuring of the EQ, may help overcome some of the problems with the physical dimensions by reducing their skewness.

Activities of Daily Living↗
PubMed1993

Self-perceived health status of hostel residents: use of the SF-36D health survey questionnaire. Hanover Project Team.

As part of a project to assess the health needs of homeless people in Sheffield, a survey of hostel residents was undertaken with the aim of measuring self-perceived health and health service use among respondents. The survey instrument incorporated the SF-36D short-form health survey questionnaire. One hundred and four (56 per cent) adult hostel residents responded. Respondents reported high levels of health service use, and poor average perceived health in comparison with the general population. Three-quarters of respondents were identified as being at risk of major depressive illness. There was a strong association between risk of major depression and recent hospital contact, current use of prescribed medication, and low scores on the social function, mental health, energy/vitality, pain and general health dimensions of the SF-36. The implications of these findings are discussed.

Adult↗
PubMed1993

Family as client: using Gordon's health pattern typology.

The community health nursing faculty at Kent State University organized a family assessment instrument in accordance with the health pattern typology described by Gordon (1982). Students use the instrument with traditional and nontraditional families at every stage of the family life cycle. Reasons for initial visits to the families range from newborn health promotion to skilled nursing for acute and chronic conditions. The instrument helps students conceptualize the family as client and explore the concept of family nursing diagnoses.

Community Health Nursing↗
PubMed1993

Occupational exposure of Sri Lankan tea plantation workers to paraquat.

Absorption of the herbicide paraquat (1,1'-dimethyl-4,4'-bipyridinium) by mixer-loaders and spray operators on a Sri Lankan tea plantation was assessed over five consecutive days of spraying. Beginning on the day before spraying started and continuing for each of the five spraying days and for seven days after the last day of spraying, 24-hour urine samples were collected from each of the workers. Potential dermal exposure was assessed during further applications of paraquat on the day after the last day of urine collection. For this purpose two spraying replicates were conducted that involved the handling or spraying of an amount of paraquat equivalent to the maximum used per day in the assessment of absorption. The mixer-loaders and spray operators incurred, on average, approximately equivalent amounts of potential dermal exposure (66 mg and 74 mg paraquat ion, resp.); however, the distribution of the exposure differed. About 86% of the total exposure experienced by the mixer-loaders was to the hands, whereas about 90% of the exposure of the spray operators involved their hands, legs, and feet, in approximately equal proportions. In both cases, 90% or more of the total potential exposure involved parts of the body that were normally uncovered. Despite the evidence of dermal exposure, no paraquat was detected in the workers' urine. This probably was due to the very low concentration of paraquat in the solutions used for spot spraying on tea plantations (0.3-0.4 g paraquat ion per litre), the high standard of personal hygiene exercised by the workers, and the low permeability of human skin to paraquat.

Adult↗
PubMed1992

A new method for the isolation of recombinant baculovirus.

An improved method for the isolation of baculovirus recombinants is described. The method involves the replication and maintenance of the baculovirus genome in the yeast Saccharomyces cerevisiae which was accomplished by the isolation of a baculovirus recombinant containing yeast ARS and CEN sequences ensuring stable replication in yeast and a URA3 selectable marker. The viral DNA maintained its ability to replicate in insect cells. An efficient and rapid selection system was set up, to isolate viral recombinants in yeast; DNA from selected yeast colonies was transfected into insect cells to obtain recombinant virus. We demonstrate the utility of this system by isolating recombinant viruses that express two different members of the CREB/ATF family of transcription factors.

Animals↗
PubMed1992

Assessment of assays for the serodiagnosis of Venezuelan equine encephalitis.

An enzyme-linked immunosorbent assay (ELISA), an immunofluorescence assay (IFA), a plaque-reduction neutralization (PRN) assay and an immunoblot assay, all by means of an antigen prepared from the attenuated Venezuelan equine encephalitis (VEE) vaccine strain of virus, were compared with the conventional haemagglutination-inhibition (HAI) assay for the serodiagnosis of VEE. The HAI assay, which includes the use of wild type virus antigen, was less sensitive than the other assays when known-positive samples of serum from an epidemic of VEE were tested. The superior sensitivity of the IgG ELISA was confirmed by assaying both VEE epidemic samples and a bank of samples from VEE vaccinees. Samples with antibody specific for other Alphaviruses, however, cross reacted weakly in this assay. The PRN, immunoblot and HAI assays, although less sensitive than the ELISA, proved more specific. Experimental infection of guinea-pigs demonstrated the value of the IgM ELISA in the early detection of VEE virus infection. Immunoglobulin M was first found at 4 days post-inoculation (p.i.) during the viraemic phase of infection. Immunoglobulin G was detected by ELISA, PRN assay and IFA at 6 days p.i. Immunoblot and HAI assays, however, did not give positive results until 10 days p.i. The results support the diagnostic use of ELISA for detecting VEE virus-specific IgM and IgG, and the use of the specific PRN assay for confirming the diagnosis.

Animals↗
PubMed1992

New acuity test for toddlers.

Preferential looking is the technique of choice for measuring visual acuity in infants and young children. Most workers agree that the toddler age group, 1 to 3 years, is the most difficult to test. This is because of their short attention span and restlessness, but mostly because they find the grating target used in the test, frankly boring. The concept of the vanishing optotype chart offers alternative test targets, while utilizing the technique of preferential looking. We have designed a test which comprises a familiar shape (house, car etc.) on the upper or lower part of a neutral grey card. The shape is computer generated, and designed to fade completely when beyond the resolution limit. Acuity is determined by the width of the white lines making up the shape. As with conventional preferential looking, the observer notes the child's eye movements to determine the position of the target shape. Although picture naming is not required, the shapes help to maintain the child's interest in the test. The test is quick, and is successful with the toddler age group and older patients with intellectual impairment.

Child, Preschool↗
PubMed1992

Trauma: the leading cause of maternal death.

The records of the Cook County Medical Examiner were reviewed for the period January, 1986, to December, 1989. Ninety-five maternal deaths were identified. The causes of maternal death were categorized as direct maternal, indirect maternal, or nonmaternal. Direct maternal causes of death (18.9%) were the result of complications of pregnancy, labor, delivery, or its management. Indirect maternal causes of death (12.6%) occurred when pre-existing health problems were exacerbated by pregnancy. All other maternal deaths were the result of nonmaternal causes. Nonmaternal causes of maternal death were further classified as traumatic or nontraumatic. Traumatic maternal deaths (46.3%) were attributed to homicide in 57% and suicide in 9%. The mechanism of injury in traumatic maternal deaths included gunshot wounds (22.7%), motor vehicle crashes (20.5%), stab wounds (13.6%), strangulation (13.6%), blunt head injuries (9.1%), burns (6.8%), falls (4.5%), toxic exposure (4.5%), drowning (2.3%), and iatrogenic injury (2.3%). Trauma was therefore the leading cause of maternal death, accounting for 46.3% of deaths in this series.

Adolescent↗