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Biomedical subjects

P M Fayers

Publications and source records attributed to P M Fayers.

At least 55 records · Page 3Linked to original sources
PubMed1991

Assessment of quality of life in small-cell lung cancer using a Daily Diary Card developed by the Medical Research Council Lung Cancer Working Party.

Three hundred and sixty-nine patients in an MRC study of combination chemotherapy and radiotherapy for small-cell lung cancer of limited extent were asked to complete a Daily Diary Card which enabled an assessment of their quality of life to be made during and after treatment. The information derived from the card suggests that although cytotoxic chemotherapy has an adverse effect upon quality of life, this impairment only affects the first 2 or 3 days following each course of treatment, although there is also a small deterioration which may be associated with the 'nadir' effect of the blood counts about 10 days after each course. These results should assist physicians in counselling patients about the likely effects of treatment. Just over half of the patients (196) were subsequently randomised to either a further six courses of maintenance chemotherapy or no further chemotherapy, and it is also shown that the patients allocated to no maintenance chemotherapy experienced a gradually deteriorating quality of life, as opposed to the brief but more severe adverse effects which occurred following each course in the maintenance chemotherapy group; this supports the hypothesis of a palliative effect in this latter group. The findings demonstrate that the Daily Diary Card is a sensitive instrument capable of yielding useful information.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Cadmium fume inhalation and emphysema.

Lung function and chest radiographs of 101 men who had worked for 1 or more years manufacturing copper-cadmium alloy were compared with those of a referent group matched for age, sex, and employment status. Cigarette consumption was similar in the two groups. The cadmium workers had an excess of abnormalities of lung function and of radiographic changes consistent with emphysema. Classification of the cadmium workers by exposure categories based on either estimated cumulative cadmium exposure or liver cadmium measured by neutron activation analysis showed that abnormalities of lung function were greatest in those with the highest cumulative cadmium exposure or liver cadmium. The difference in the transfer coefficient (KCO) between cadmium workers and referents increased linearly with increasing cumulative exposure without evidence for a threshold. The estimated mean decrement in KCO for a cadmium worker employed 5 or more years with a cumulative exposure of 2000 yr.microgram.m-3 (exposure to the current UK control limit of 50 micrograms.m-3 for a working lifetime of 40 yr) lies between 0.05 and 0.3 mmol.min-1.kPa-1.l-1 (95% confidence interval). This decrement is consistent with the functional and radiological changes of emphysema observed in this group of workers.

Aged↗
PubMed1988

Improving the quality of data in randomized clinical trials: the COMPACT computer package. COMPACT Steering Committee.

One crucial component for a successful clinical trial is that the data gathered have a high level of reliability and completeness. This paper reviews some problems of data management and describes the computer package COMPACT which has been developed to deal with such problems. The package allows range and consistency checks and can monitor complex follow-up schedules. A unique feature of the package is a PROBLEMS file which has use both for identification of queries about the data and of patients with particular characteristics of interest. The ability to monitor drug dosages and to signal deviations from the protocol is of particular value. COMPACT has the syntax necessary to create a 'flat' file for transfer to statistical packages for analysis, and the variable description files for SAS, SPSS and MINITAB. The package is written in standard FORTRAN which enables transfer to different types of mini and micro computer systems.

Clinical Trials as Topic↗
PubMed1988

Relations between liver cadmium, cumulative exposure, and renal function in cadmium alloy workers.

Detailed biochemical investigations of renal function were made on 75 male workers exposed to cadmium and an equal number of referents matched for age, sex, and employment status. The exposed group consisted of current and retired workers who had been employed in the manufacture of copper-cadmium alloy at a single factory in the United Kingdom for periods of up to 39 years and for whom cumulative cadmium exposure indices could be calculated. In vivo measurements of liver and kidney cadmium burden were made on exposed and referent workers using a transportable neutron activation analysis facility. Significant increases in the urinary excretion of albumin, retinol binding protein, beta 2 microglobulin, N-acetylglucosaminidase (NAG), alkaline phosphatase, gamma-glutamyl transferase and significant decreases in the renal reabsorption of calcium, urate, and phosphate were found in the exposed group compared with the referent group. Measures of glomerular filtration rate (GFR) (creatinine clearance, serum creatinine, and beta 2 microglobulin) indicated a reduction in GFR in the exposed population. Many of these tubular and glomerular function indicators were significantly correlated with both cumulative exposure index and liver cadmium burden. Using cumulative exposure index and liver cadmium as estimates of dose, a two phase linear regression model was applied to identify an inflection point signifying a threshold level above which changes in renal function occur. Many biochemical variables fitted this model; urinary total protein, retinol binding protein, albumin, and beta 2 microglobulin gave similar inflection points at cumulative exposure levels of about 1100 y.micrograms/m3 whereas changes in the tubular reabsorption of urate and phosphate occurred at higher cumulative exposure indices. Measures of GFR, although fitting the threshold model did not give well defined inflection points. Fewer variables fitted the two phase model using liver cadmium; those that did gave threshold levels in the range 20.3-55.1 ppm. When cadmium workers with cumulative exposure indices of less than 1100 y.micrograms/m3 were compared with their respective referents only serum beta 2 microglobulin and urinary NAG were significantly increased in the exposed group and these differences were not related to the degree of cadmium exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

Alloys↗
PubMed1986

Number of patients required in lung function studies.

Tables are presented showing estimates of the number of subjects which is required to give an 80% or 90% chance of detecting various differences in forced expiratory volume in one second, forced vital capacity, total lung capacity, transfer factor, and residual volume between the mean of two groups by means of Student's t test.

Humans↗
PubMed1984

Blood pressure in four and five-year-old children: the effects of environment and other factors in it's measurement--the Brompton study.

Systolic blood pressure was measured on a total of 1855 occasions in 1307 children aged four and five years, and compared with values obtained since birth in the same children. There was a rapid rise in blood pressure in the first month of life. The mean blood pressure then only rose from 93 mmHg at six months to 98 mmHg at five years. The 95th percentile was 113 to 114 mmHg over this period. In children aged four and five years, over the ranges studied, blood pressure was not importantly affected by place of measurement, time of day, time since previous meal, or ambient temperature. However, blood pressure was approximately 1.6 mmHg higher in winter than in summer (P less than 0.01). Nevertheless, it is unlikely that these factors are of significance when making clinical measurements. Blood pressure was correlated with weight at all ages. Between the ages of four and five years, the index, weight/height 1.70 was the best function of adiposity tested that was independent of age between four and five years. It is suggested that this or the Quetelet Index (weight/height2) are suitable indices for adjusting blood pressure for body build in children aged four and five years.

Aging↗
PubMed1981

A survey of deaths in Hong Kong attributed to tuberculosis.

Records obtained for 578 (96%) of the 602 patients certified as having died from tuberculosis in Hong Kong during a 1-year period were reviewed by an expert independent assessor in London, In his opinion 14 (2% of the 578) had never had tuberculosis, and in 28 (5%) it was not possible to decide whether or not the patient had ever had tuberculosis. Tuberculosis had been no more than a contributory factor in causing death in 44 (8%), in 29 (5%) it was irrelevant, and in 33 (6%) it was not possible to determine what role it had played. The remaining 430 (74%) patients were considered actually to have died from tuberculosis, 307 from active disease and 123 from the late effects of inactive disease. If all 578 patients had died from tuberculosis this would represent a death rate for the survey year of 13.1 per 100 000 of the population. The rate falls to 9.7 per 100 000 if based on the 430 patients considered by the assessor to have died from tuberculosis, a reduction of 26%. Since the annual death rate from active disease (6.9 per 100 000 in this survey) is a better index of the current efficiency of an antituberculosis programme than the total death rate, it is suggested that efforts should be made to obtain and publish separate annual rates for deaths from active and from inactive tuberculosis. An analysis of potentially avoidable delays and failures in diagnosis showed that these were mainly due to the patient's delay in seeking or accepting advice, or inadequate investigation, particularly failure to examine the sputum, by the unofficial (non-governmental) medical services. The majority of failures in management were attributable in whole or in part to the patient.

Adolescent↗
PubMed1979

The symptoms of newly diagnosed pulmonary tuberculosis and patients' attitudes to the disease and to its treatment in Hong Kong.

A questionnaire was applied by Government Health Visitors in Hong Kong to 201 consecutive patients with smear-positive, and 199 with smear-negative pulmonary tuberculosis who were attending one of the 7 full-time Government chest clinics for the first time on account of their current illness. Information was obtained about the symptoms of the disease and its diagnosis and management outside the Government service, and about patients' knowledge and attitudes towards the Government service. Among the 343 patients who sought treatment because of respiratory symptoms, the first symptom for the great majority (81 %) was cough, 15 % having sputum and 27 % haemoptysis as well. However, treatment was sought by only 15 % because of cough alone, compared with 40 % because of haemoptysis. Most patients (76 %) attended their first source of treatment or investigation within a month of the onset of symptoms, but some allowed long delays, and only 35 % attended a Government chest clinic within a month (whether this was the first source of treatment or not). The first source attended was a private practitioner for 53 % of the patients, another private medical establishment for 4 %, a Government chest clinic for only 11 % and another Government medical establishment for 17 %, 9 % went first to a herbalist and 5 % went to a drug store or treated themselves. The delays between the patients' first attendance at a source of treatment and their first attendance at a Government clinic were important, because outside the Government chest clinics only 49 % were investigated by chest radiograph and only 7 % by sputum bacteriology. Only 33 % were even suspected of having pulmonary tuberculosis, and many were correspondingly inadequately treated. The patients were, in general, ill informed about the Government chest clinic service; 52 % did not know, before their current illness, of the existence of the service, only 9 % knew that it was free, and only 12 % that it specialised in the management of tuberculosis. This study thus revealed a need to educate the public about the symptoms of tuberculosis, and about the possibility of their being investigated and treated, free, in a Government chest clinic.

Adolescent↗
PubMed1978

Profiles of serum complement in patients with hepatobiliary diseases.

CH50 and the concentrations of C3, C4, C1 INH and factor B have been measured in sera from 34 control subjects and 178 patients with various hepatobiliary diseases, including primary biliary cirrhosis (PBC), chronic active hepatitis (CAH), cryptogenic cirrhosis (CC), alcoholic liver disease (ALD), Wilson's disease (WD), large duct biliary obstruction (LDBO) and viral hepatitis (VH). CH50 was decreased in CAH and CC. C3 was increased in PBC, LDBO and VH and decreased in CAH and CC. C4 was decreased in PBC, CAH, ALD and WD. C1 INH was increased in PBC, CAH, ALD, LDBO and VH. Factor B was increased in LDBO and VH and decreased in CC. In none of the patient groups was the mean C4 level increased or the mean C1 INH level decreased. All 5 indices of serum complement were lower in ascitic than nonascitic patients. Data on serum complement were similar in HBsAg positive and negative VH. Discriminant analysis facilitated separation of all the patient groups on the basis of complement data, except PBC and VA. Analysis of data using a within-group correlation matrix revealed a significant negative correlation between C4, the most discriminating variable of serum complement in CAH, and gamma-globulin concentration in CAH. The possible contribution of factors such as activation of complement, impaired hepatic synthesis of complement components, an acute phase response and cholestasis to altered serum complement profiles in different hepatobiliary diseases is discussed.

Adolescent↗
PubMed1971

Effect of measles vaccination on incidence of measles in the community.

A study of the effect of measles vaccination on the incidence of the disease in eight separate areas of England and Wales was begun in 1966. It showed an inverse association between the proportion of children vaccinated and the incidence of measles in the area in the following year, but measles epidemics occurred in several of the areas in subsequent years, despite continuing vaccinations.Measles vaccination was introduced on a large scale in Britain in 1968. Analysis of the notification and vaccination statistics shows that the vaccination of about 10% of the child population (under 15 years) in 1968 sufficed to "replace" the measles epidemic which had been expected in the period October 1968 to September 1969 by a low incidence of the disease, typical of that in previous "interepidemic" years. Further, the effect of the vaccinations was to prevent the development of natural measles in susceptible unvaccinated children as well as in the vaccinated subjects. Thus the number of immune subjects in the community was increased by the vaccinations, but as a result there was a reduction in the number of subjects who acquired immunity from natural measles. These opposed results can therefore explain why vaccination may be effective in the community for only a year or two, though vaccination protects the individual for much longer.It is estimated that a continuing vaccination rate of 40 to 50% of the children born each year would be necessary to replace the regular biennial measles epidemics in Britain by a continuous endemic incidence, and might perhaps lead to the disappearance of the disease without a further major epidemic, but that a continuing vaccination rate of 80 to 90% of children born each year would then be necessary to prevent its reintroduction. The long-term control of measles by vaccination will thus probably prove more difficult than for any other infectious disease.

Adolescent↗
PubMed1970

Miosis during L-dopa therapy.

The pupillary diameter of 11 patients with Parkinson's disease was significantly decreased four hours after ingestion of L-dopa. It is suggested that this miosis may be caused by diminished noradrenaline output at sympathetic nerve endings, or alternatively by an action on the central nervous system.

Aged↗
PubMedDate not supplied

Incomplete quality of life data in randomized trials: missing items.

Missing data has been a problem in many quality of life studies. This paper focuses upon the issues involved in handling forms which contain one or more missing items, and reviews the alternative procedures. One of the most widely practised approaches is imputation using the mean of all observed items in the same subscale. This, together with the related estimation of the subscale score, is based upon traditional psychometric approaches to scale design and analysis. We show that it may be an inappropriate method for many of the items in quality of life questionnaires, and would result in biased or misleading estimates. We provide examples of items and subscales which violate the psychometric foundations that underpin simple mean imputation. A checklist is proposed for examining the adequacy of simple imputation, and some alternative procedures are indicated.

Female↗
PubMedDate not supplied

Incomplete quality of life data in randomized trials: missing forms.

Analysing quality of life (QOL) data may be complicated for several reasons, such as: repeated measures are obtained; data may be collected on ordered categorical responses; the instrument may have multidimensional scales, and complete data may not be available for all patients. In addition, it may be necessary to integrate QOL with length of life. The major undesirable effects of missing data, in QOL research, are the introduction of biases due to inadequate modes of analysis and the loss of efficiency due to reduced sample sizes. Currently, there is no standard method for handling missing data in QOL studies. In fact, there are very few references to methods of handling missing data in this context. The aim of this paper is to provide an overview of methods for analysing incomplete longitudinal QOL data which have either been presented in the QOL literature or in the missing data literature. These methods of analysis include complete case, available case, summary measures, imputation and likelihood-based approaches. We also discuss the issue of bias and the need for sensitivity analyses.

Bias↗