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Biomedical subjects

Philip Clarke

Publications and source records attributed to Philip Clarke.

8 recordsLinked to original sources
PubMed2004

Why am I so itchy?

BACKGROUND: Virtually all of us experience an itch at some time. However, for some people, an intense or persistent itch can cause considerable morbidity that often affects the entire family. OBJECTIVE: This article gives an overview of the problem of itch, and discusses the assessment and management of atopic eczema, scabies, lichen planus and dermatitis herpetiformis. DISCUSSION: A good history will nearly always provide the diagnosis. Examination can then be targeted at finding specific signs. The distribution of rash is important, as is examination of the nails and mouth. Simple but helpful investigations such as microscopy and skin biopsy can be carried out in the consulting room. If a patient presents with a very itchy rash, consider four main possibilities: eczema, scabies, lichen planus and dermatitis herpetiformis, with the first two being the most common. For chronic conditions such as eczema, structured follow up is essential.

Adult↗
PubMed2004

Urticaria.

BACKGROUND: Urticaria is a very common problem that affects most of the population at some time. Acute urticaria is often allergy based and self limiting. In chronic urticaria, it is uncommon to find an allergic cause and in most cases, it is more useful to consider it as an autoimmune disease. OBJECTIVE: This article reviews the assessment of urticaria and outlines a treatment plan for chronic urticaria. DISCUSSION: In most patients, urticaria is acute and self limiting and settles with the aid of antihistamines. Chronic urticaria is more challenging for both the doctor and patient. A careful history is important in Identifying allergic causes and aggravating factors. In severe cases, immunosuppressive therapy may be required.

Acute Disease↗
PubMed2003

Missing... presumed at random: cost-analysis of incomplete data.

When collecting patient-level resource use data for statistical analysis, for some patients and in some categories of resource use, the required count will not be observed. Although this problem must arise in most reported economic evaluations containing patient-level data, it is rare for authors to detail how the problem was overcome. Statistical packages may default to handling missing data through a so-called 'complete case analysis', while some recent cost-analyses have appeared to favour an 'available case' approach. Both of these methods are problematic: complete case analysis is inefficient and is likely to be biased; available case analysis, by employing different numbers of observations for each resource use item, generates severe problems for standard statistical inference. Instead we explore imputation methods for generating 'replacement' values for missing data that will permit complete case analysis using the whole data set and we illustrate these methods using two data sets that had incomplete resource use information.

Algorithms↗
PubMed2002

Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63).

OBJECTIVE: To estimate the incremental cost of implementing policies for intensive control of blood glucose concentration and blood pressure for all patients with type 2 diabetes in England. DESIGN: Extrapolation of resource use and cost data derived from a randomised controlled trial. SETTING: General practice, outpatient care, and inpatient care. POPULATION: Trial population with diagnosed type 2 diabetes in England extrapolated to the population of England. MAIN OUTCOME MEASURES: Total costs based on use of healthcare resources including costs of management, treatment, and hospitalisation. RESULTS: The incremental net annual cost of implementing intensive control of blood glucose and blood pressure to all people with diagnosed type 2 diabetes in England is estimated to be pound 100.5m ($156m; euro;159m), which is equivalent to less than 1% of the proposed additional annual expenditure on the NHS in 2001-5. This estimate varied in sensitivity analyses from pound 67m to pound 121m. CONCLUSIONS: Policies to improve control of blood glucose and blood pressure of people with type 2 diabetes are effective in reducing complications associated with the disease and are also cost effective. The total cost represents a small fraction of the NHS's spending plans.

Adult↗
PubMed2002

Comparing health inequalities among men aged 18-65 years in Australia and England using the SF-36.

OBJECTIVE: To compare the distribution of the domains and summary scores of the SF-36 health survey by occupation-related social classes in England and Australia for employed males age 18-65 years. METHOD: Relative and absolute measures of inequality based on the concentration index were used to examine the distribution of indicators of reported health based on domains and summary scores of the SF-36 across occupation-related social classes in both countries. RESULTS: The degree of inequality is most pronounced in the domains and summary scores of the SF-36 representing aspects of physical health. In regard to comparisons between these countries, there is no significant difference in the distribution of summary scores for physical health. Although there are differences in the summary scores for mental health, there is no evidence of significant inequality in Australia in this aspect of health. CONCLUSIONS: There is a similar pattern of occupation-related health inequality in the physical health dimensions of the SF-36 health survey for employed males age 18-65 years. IMPLICATIONS: Given the similarities in the distribution of measures of physical health in the two countries, it would be useful to assess recent English policy initiatives aimed at reducing health inequalities when developing interventions to tackle inequalities in Australia.

Adolescent↗
PubMedDate not supplied

Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62).

PURPOSE: The aim of this study was to analyze quality-of-life data from the United Kingdom Prospective Diabetes Study (UKPDS) to estimate the impact of diabetes-related complications on utility-based measures of quality of life. METHODS: The EuroQol EQ-5D instrument was administered in 1996 to 3667 UKPDS patients with type 2 diabetes. Tobit and censored least absolute deviations (CLAD) regression analysis based on data from the 3192 respondents was used to estimate the impact of major complications on (1) the visual analog scale (VAS) and (2) the EQ-5D utilities derived from population-based time trade-off values. RESULTS: Using the tobit model, the effect on tariff values was as follows: myocardial infarction = -0.055 (95% confidence interval [CI] = -0.067, -0.042), blindness in 1 eye = -0.074 (95% CI= -0.124, -0.052), ischemic heart disease = -0.090 (95% CI = -0.126, -0.054), heartfailure = -0.108 (95% CI= -0.169, -0.048), stroke = -0.164 (95% CI = -0.222, -0.105), and amputation = -0.280 (95% CI = -0.389, -0.170). The impact on the VAS scores was smaller, but the ranking was identical. Estimates of these effects, based on the nonparametric CLAD estimator, are also reported and compared. CONCLUSION: These results demonstrate the magnitude of the impact of 6 complications on utility-based measures of quality of life, which can be used to estimate the outcome of interventions that reduce these diabetes-related complications.

Adolescent↗