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Biomedical subjects

P C Milner

Publications and source records attributed to P C Milner.

At least 19 recordsLinked to original sources
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↗
PubMed1992

Cost effectiveness of minor surgery in general practice: a prospective comparison with hospital practice.

The cost effectiveness of general practitioners undertaking minor surgery in their practices was determined in a prospective comparison of patients having minor surgery undertaken in five general practices over a 12 week period in 1989, and in the departments of dermatology and general surgery in Rotherham District General Hospital over a contemporaneous eight week period. There were no differences between the settings in the reported rates of wound infection or other complications and only one general practice patient was subsequently referred to hospital for specialist treatment. General practitioners sent a smaller proportion of specimens to a histopathology laboratory than hospital doctors (61% versus 90%, P less than 0.001); incorrectly diagnosed a larger proportion of malignant conditions as benign (10% versus 1%, P less than 0.05) and inadequately excised 5% of lesions where this never happened in hospital (difference not significant). General practice patients had shorter waiting times between referral and treatment, spent less time and money attending for treatment and more of them were satisfied with their treatment. The cost of a procedure undertaken in general practice was less than in hospital--pounds 33.53 versus pounds 45.54 for the excision of a lesion and pounds 3.00 versus pounds 3.22 for cryotherapy of a wart (1989-90 prices). Performing minor surgery in general practice would seem cost effective compared with a hospital setting. However, the risk of general practitioners inadequately excising a malignancy and not sending it to a histopathology laboratory must be addressed and the conclusion regarding cost effectiveness only applies where general practice is a substitute for the hospital setting and not an additional activity.

Case-Control Studies↗
PubMed1989

Ownership, availability, and use of portable syringe drivers among hospices and home-care services.

We ascertained the ownership, availability and extent of use of portable syringe drivers among 236 hospice in-patient units and home-care services for the terminally ill in the United Kingdom by means of a postal questionnaire (97% response rate). Only 11 hospices and home-care services did not use them. The rest owned a median number of 4 but had only 1 in use. However, the combined hospice with home-care services owned relatively more than either hospices or home-care teams (median number 6 compared to 3.5 and 4 respectively) and used relatively more than the others (estimated median 2 [95% CI: 1-2] compared to 1 [95% CI: 0-1] and 1 [95% CI: 1-2] respectively). The major determinants of ownership and use among units with an in-patient facility were supply factors such as the numbers of trained nurses in palliative care and doctor half-day sessions, whereas for home-care units the number of patients cared for daily was the most important determinant. There does not seem to be any unmet demand for portable syringe drivers among hospices and home-care services.

Home Care Services↗
PubMed1988

Bleeding time and platelet volume in acute myocardial infarction--a 2 year follow-up study.

The bleeding time is shortened and the mean platelet volume is increased in the acute phase of myocardial infarction. In this follow-up study we repeated the measurement of the bleeding time, the platelet count and the platelet volume distribution in 18 patients who had suffered from a definite acute myocardial infarction two years before and in 16 control patients who had been admitted with chest pain but no definite myocardial infarction at that time. At the time of follow-up the bleeding time was significantly lengthened in the myocardial infarction group (median values = 169 s and 209 s respectively), whereas it had shortened in the control group (median values = 258 s and 228 s respectively). Comparison of the platelet volume distribution curves of the myocardial infarction patients at time of infarction and 2 years later revealed a significantly higher percentage of small platelets and significantly lower percentages of both medium-sized and large platelets at the time of infarction. These changes in the platelet volume distribution could indicate consumption of medium-sized and large platelets at the time of myocardial infarction. None of the measured variables predicted which of the patients with acute myocardial infarction would subsequently re-infarct or die. In the patients studied with definite ischaemic heart disease (n = 26) a significant negative correlation between bleeding time and mean platelet volume was found. The shortened bleeding time in myocardial infarction is related to the acute event itself or proceeds it, but is reversed two years later.

Bleeding Time↗
PubMed1988

Forecasting the demand on accident and emergency departments in health districts in the Trent region.

The annual new, return and total attendances at Accident and Emergency (A and E) Departments for Trent district and the whole of the Trent region are forecast for the years 1986 to 1994 by using the autoregressive integrated moving average (ARIMA) time series model applied to the SH3 A and E returns for 1974 to 1985. The 1986 forecasts of annual new, return and total attendances in Trent districts are compared with the actual attendances observed; the new attendance forecasts were found accurate, the return attendance forecasts less so. The latter may reflect inability to predict changing policies on return attendances of individual A and E departments. The 1994 ARIMA forecasts of annual A and E new attendances for Trent districts are compared with the 1984 based regional guidelines for 1994 and the projections for individual districts. Both the ARIMA models and the health districts' own projections produce a different forecast to the 1994 regional guideline which seems to overestimate. The forecasting methodology used has other applications in health care planning.

Accidents↗
PubMed1988

Is the Jarman score better than social class at assessing the need for prevention and primary care?

This paper reports an analysis by small areas of various measures of disease and the use of cervical smear services in the city of Sheffield. The correlation of these with social class and the Jarman underprivileged area score were compared. Wide variations in mortality rates between electoral wards in Sheffield were demonstrated, particularly for deaths from diseases with a large preventable component. Social class correlated more strongly with all-cause mortality (r = 0.69) and preventable mortality (r = 0.91) than did the Jarman score. There was no significant correlation between routine cervical smear rate and either social class or the Jarman score among women under the age of 35 years. Among older women, however, there was a high degree of correlation with fewest smears being taken in the most deprived wards. Social class was more strongly correlated with the invasive cervical cancer rate in electoral wards than was the Jarman score, and was thus a better indicator of the need for cervical screening. However, the Jarman score showed a greater degree of (negative) correlation with the uptake of cervical screening than did social class with disproportionately fewer smears being taken by general practitioners in areas of highest need. Social class may be better than the Jarman score as an indicator of both ill-health and the need for preventive health services in Sheffield. Information is routinely collected decenially on social class and needs little further computation, unlike the Jarman score. Furthermore, much is already known about the relationships between social class and both ill-health and the need for preventive services.

Adolescent↗
PubMed1988

Variation in demand for accident and emergency departments in England from 1974 to 1985.

Over the period 1974-85 the range of mean annual new attendance rates at Accident and Emergency departments among English health districts was 36-673 per 1000 residents. The socio-economic diversity of these districts explained only one-third of the variation. The rates rose significantly (p less than 0.05) in 89 per cent of districts over the twelve years. Again, socio-economic variation only partly explained differences in district trends. Increases were greater among districts with higher mean rates. In order to plan first-contact care rationally we need a better understanding of the factors underlying these trends.

Emergency Service, Hospital↗
PubMed1987

Effect of socioeconomic status on survival from cervical cancer in Sheffield.

The relation between age at registration, socioeconomic status, and survival from cervical cancer for women resident in Sheffield was examined using the 556 such cases registered with the Trent Cancer Registry from 1971 to 1984. The address and electoral ward at registration were used to categorize the socioeconomic status of 99% of the women. Five year survival for all cases was 49%, increasing age having a predictable deleterious effect. Socioeconomic status seemed to have little effect on survival, especially when the covarying effect of age had been taken into account. It is hypothesised that the survival inequalities for cervical cancer demonstrated elsewhere have largely been prevented in Sheffield by good access to effective treatment from the National Health Service.

Age Factors↗
PubMed1987

Platelet count is positively correlated with white cell count and red cell count.

Platelet count is positively correlated with the white cell count in healthy males aged 20-68 years (p less than 0.002) and in healthy medical students of both sexes aged 18-22 years (p less than 0.0001). Platelet count is also positively correlated with red cell count in healthy males (p less than 0.02). Red cell count is positively correlated with white cell count in the older healthy males (p less than 0.02) and in the male medical students (p less than 0.003). These findings provide support for the concept of a single hormone-dependent pluripotent stem cell whose effect is seen concomitantly in all circulating blood cells. The white cell count and platelet count correlation is less significant in the males aged 35 or above which may represent the development of pathological mechanisms.

Adolescent↗
PubMed1986

Prolonged bleeding time, reduced platelet aggregation, altered PAF-acether sensitivity and increased platelet mass are a trait of asthma and hay fever.

In a case control study 31 asymptomatic patients with asthma and/or hay fever and 31 normal controls had their bleeding time measured using the Simplate II device and venostasis. Mean bleeding time in the atopic group (527 s) was significantly prolonged compared to the controls (393 s) (p less than 0.0005). Platelet aggregation to collagen and ADP (but not to PAF-acether) was significantly depressed in the atopics. Mean circulating platelet mass was significantly greater in atopics than in the controls (p = 0.006). Stepwise multiple regression analysis showed that within the control group bleeding time was best predicted by platelet mass (p = 0.007). No such relationship was found in the atopics. However stepwise multiple regression analysis showed that bleeding time in the atopics (but not in the controls) was best predicted by PAF-acether induced platelet aggregability (p less than 0.05). In neither group was bleeding time related to collagen induced platelet thromboxane B2 production. It is hypothesised that in respiratory atopy the depressed aggregatory function of platelets is not compensated for sufficiently by an increase in platelet mass, leading to prolongation of the bleeding time. This haemostatic imbalance, whose cause remains to be established, appears to constitute a trait of atopy.

Adenosine Diphosphate↗
PubMed1985

Shortened bleeding time in acute myocardial infarction and its relation to platelet mass.

The bleeding time, using the Simplate method, horizontal incision, and venostasis, was measured in a study of 51 patients admitted to a coronary care unit within 12 hours of the onset of chest pain. The bleeding time was significantly shorter in the 28 patients who were found to have definite myocardial infarction compared with the 23 others with chest pain but no definite infarction (p less than 0.0005). A bleeding time of less than 212 seconds correctly classified 84% of patients (sensitivity for definite myocardial infarction 89%) presenting to the coronary care unit with chest pain. Multiple regression analysis showed the bleeding time in all patients to be determined independently (and with high significance) by the following variables in order of importance: diagnostic group, platelet mass (platelet count X mean volume), and age. Packed cell volume was not a significant determinant. In the group with definite myocardial infarction considered alone the same order of variables was observed in predicting bleeding time, but none of them was significant. A major variable reducing bleeding time in acute myocardial infarction remains to be determined. There was no association between bleeding time and creatine phosphokinase activity or infarct size in the group with definite myocardial infarction.

Aged↗