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Biomedical subjects

R Madhok

Publications and source records attributed to R Madhok.

At least 127 records · Page 7Linked to original sources
PubMed1993

Serum interleukin 6 levels in rheumatoid arthritis: correlations with clinical and laboratory indices of disease activity.

In rheumatoid synovium interleukin 6 (IL-6) is the most abundantly expressed cytokine. Increased serum levels have been previously reported in patients with rheumatoid arthritis (RA). In this study serum IL-6 levels were measured in a well defined cohort using a bioassay (B9 cells) and levels were correlated with conventional clinical and laboratory indices of disease activity. Levels were significantly higher in serum from patients with RA (median 55 IU/ml; interquartile range 28-139) compared with serum from disease (median 7 IU/ml; 1-23) and normal controls (median 10 IU/ml; 7-12). No difference was observed between men and women. Levels did not correlate with disease duration. Significant associations were observed between IL-6 and C reactive protein and between the Ritchie articular index and duration of morning stiffness. No other correlations were observed. The value of these findings in the monitoring of RA and as an indicator of response to second line treatment needs to be established.

Aged↗
PubMed1993

Second line (disease modifying) treatment in rheumatoid arthritis: which drug for which patient?

OBJECTIVES: The objectives were to assess (a) the comparative merits of commonly used disease modifying drugs in the treatment of rheumatoid arthritis (RA) and (b) the influence of age, gender, and disease duration on the outcome of treatment. METHODS: Collected analysis (meta-analysis) was performed on results obtained during the first year of treatment in 1140 patients with RA treated with gold, penicillamine, sulphasalazine, or auranofin from a single centre. RESULTS: Gold, penicillamine, and sulphasalazine performed similarly, with about 60% of patients continuing to receive each of these drugs for at least one year. Neither gender nor age had an influence on the response to treatment, but patients with a longer disease duration showed a greater tendency to stop treatment. The median percentage improvement was 33% in visual analogue pain score and 50% in erythrocyte sedimentation rate. CONCLUSIONS: Routine use of these drugs should at least equal these results. Any new drug should either be substantially less toxic or at least as efficacious.

Adult↗
PubMed1993

An audit of distribution and use of guidelines for management of head injury.

Ensuring effective distribution of guidelines is an important step towards their implementation. To examine the effectiveness of dissemination of a guidelines card on management of head injury and determine its usefulness to senior house officers (SHOs), a questionnaire survey was performed in May 1990, after distribution of the cards in induction packs for new doctors and at postgraduate lectures and displaying the guidelines in accident and emergency departments and wards. A further survey, in March 1992, assessed the impact of modifying the distribution. All (175) SHOs working in general surgery, accident and emergency medicine, orthopaedics, and neurosciences on 1 February 1990 in 19 hospitals including two neurosurgical units in Northern region were sent self completion questionnaires about awareness, receipt, use, and perceived usefulness of the guidelines. 131 of 163(80%) SHOs in post responded (median response from hospitals 83% (range 50%-100%)). Over three quarters (103, 79%) of SHOs were aware of the guidelines and 82(63%) had ever possessed a guidelines card. Only 36(44%) acquired the card in the induction pack. 92%(98/107) found them useful and 81% (89/110) referred to them to some extent. Owning and carrying the card and referring to guidelines were associated with departmental encouragement to use the guidelines. Increasing the displays of guidelines in wards and departments and the supply of cards to consultants in accident and emergency medicine as a result of this survey did not increase the number of SHOs who received cards (52/83, 63%), but more (71/83, 86%) were aware of the guidelines. The guidelines were welcomed by SHOs and used in treating patients with head injury, but their distribution requires improvement. Increased use of the guidelines may be achieved by introducing other distribution methods and as a result of encouragement by senior staff.

Craniocerebral Trauma↗
PubMed1993

Longer term functional outcome and societal implications of upper limb fractures in the elderly.

To ascertain how they cope with upper limb fractures and the implications for health and social services (H&SS) a cohort of elderly patients was followed up. 42 of the original 51 (82%) patients were interviewed almost one and a half years after sustaining their fracture. Information was collected on ability to perform activities of daily living (ADL), general health, and use of H&SS help from informal carers. Although there was an overall improvement in the ability to perform ADL, many (26%) patients reported a residual difficulty. Informal carers provided most of the support with some contribution from the statutory agencies. Demographic changes with increasing numbers of elderly and increasing employment of married women--the traditional carers, and epidemiological changes with increasing age-specific incidence of upper limb fractures mean that H&SS provision in the future will need to be increased.

Activities of Daily Living↗
PubMed1993

Utilization of upper limb joint replacements during 1972-90: the Mayo Clinic experience.

Increasing application of expensive medical technologies, including joint replacement, is of concern in the current economic climate. Successful upper limb joint replacements (ULJRs) are being performed, but few detailed data about their utilization are available. To explore the resource implications of such surgery, the utilization of total shoulder replacement (TSR), total elbow replacement (TER) and total wrist replacement (TWR) were examined from the time these procedures first became available at the Mayo Clinic up to 1990. The age- and sex-adjusted utilization rate for TSR among Olmsted County, Minnesota, residents was 1.8 per 100,000 person-years (p-y), 0.8 per 100,000 p-y for TER and 1.1 per 100,000 p-y for TWR. Overall utilization of primary ULJR among Olmsted County residents during the 19-year study period was 3.8 per 100,000 p-y. The commonest indication for TSR was osteoarthritis (46 per cent) and for TER and TWR was rheumatoid arthritis (50 and 81 per cent respectively). There was no consistent trend in the utilization of these procedures among Olmsted County residents, but the number of referral patients receiving a ULJR at the Mayo Clinic increased steadily during the study period. The Mayo Clinic experience suggests an increasing demand for ULJR, particularly TSR and TER. With continued advances in, and diffusion of, the technology this demand may increase further.

Adult↗
PubMed1993

Urban vs rural increase in hip fracture incidence. Age and sex of 901 cases 1980-89 in Olmsted County, U.S.A.

To determine if hip fracture incidence rates are greater in urban than in rural areas of the United States, as they appear to be in Scandinavia, we undertook a study in Olmsted County, Minnesota. During the decade 1980-89, the age- and sex-adjusted incidence of proximal femur fractures among urban residents of the central city of Rochester was 36 percent greater than among residents of the rural remainder of Olmsted County. The difference was almost entirely accounted for by an excess of fractures due to moderate trauma in elderly urban women. These first detailed results from the United States confirm earlier observations from Scandinavia that hip fracture rates are lower in rural areas.

Adolescent↗
PubMed1993

Gold therapy lowers serum interleukin 6 levels in rheumatoid arthritis.

OBJECTIVE: To determine the clinical utility and the effect of sodium aurothiomalate (GSTM) on serum interleukin 6 (IL-6) levels in patients with rheumatoid arthritis (RA). METHODS: Open prospective study of 50 patients with RA treated with GSTM. Serum IL-6 measured by bioassay. RESULTS: IL-6 showed correlations with Ritchie articular index, duration of morning stiffness and C-reactive protein. GSTM significantly reduced IL-6 levels. CONCLUSIONS: IL-6 is a potentially useful additional indicator of disease activity in RA and is modulated by GSTM.

Arthritis, Rheumatoid↗
PubMed1992

Coping with an upper limb fracture? A study of the elderly.

Upper limb fractures in the elderly, usually managed by immobilisation of the arm, limit activities to an unknown extent. Fifty-one patients in Middlesbrough, aged over 60 years and who had upper limb fractures, were interviewed in the fracture clinic. Most patients had difficulty in performing various activities of daily living (ADL) following their injury. Difficulties with ADL were significantly associated with shoulder immobilisation (P = 0.03) and age (P = 0.01) but not with life satisfaction (P = 0.18) or existing poor health (P = 0.39). Relatives and friends provided most of the necessary help, the contribution of the health and social services being relatively small. Patients received more help with activities like shopping, laundry and housework than personal activities such as bathing, using the toilet and dressing. The injury increased demands on the GPs, meals on wheels, home help, nursing and warden services. Unmet demand was mostly for chiropodists, bath attendants and physiotherapists. Most patients (95%) were satisfied with the help they received from their relatives and friends. Despite difficulty with the activities of daily living most patients coped well with support following their fracture. Demographic changes and the increasing incidence of fractures mean that the burden on both carers and health and social services will increase.

Activities of Daily Living↗
PubMed1992

Perceptions about blood donation, transfusion and the risk of HIV infection: implications for the blood transfusion service.

To assess perceptions of risk of AIDS/HIV infection from donation to, and receipt of, blood from the British Blood Transfusion Service, we undertook self completion surveys (n = 1874, response rate 74%) and an interview survey (n = 300, response rate 77%) of students in three higher/further education establishments in the North East of England. In the postal survey 20.9% perceived a risk of acquiring HIV/AIDS after blood donation, and 4.8% perceived the risk to be moderate or high. Explanations for the perceived risk were usually inaccurate. Most people (62.3%) perceived that blood transfusion had a risk of HIV infection, and 13.4% reported this risk to be moderate or high. The explanations for the risk were generally correct. The interview survey largely confirmed the results of the postal survey. The perceived risk of contracting HIV infection on blood donation is not an artefact of survey method; a substantial minority perceive a risk where there is none. Some people remain unaware of the risk of HIV infection after blood transfusion and among others the risk is perceived as higher than is realistic. Further research and educational initiatives to help safeguard the efficient gathering and use of blood are warranted.

Adolescent↗
PubMed1992

Social surveys in HIV/AIDS: telling or writing? A comparison of interview and postal methods.

We compare a probability sample postal questionnaire survey and a quota controlled interview survey, and review the literature on these subjects. In contrast to other studies, where quota samples were not representative because of biased selection of respondents by interviewers, our quota sample was representative. Response rates were similar in our postal and interview surveys (74 and 77%, respectively), although many previous similar postal surveys had poor response rates. As in other comparison studies, costs were higher in our interview survey, substantive responses and the quality of responses to closed-ended questions were similar, and responses to open-ended questions were better in the interview survey. 'Socially unacceptable' responses on sexual behaviour were less likely in interviews. Quota controlled surveys are appropriate in surveys on HIV/AIDS under certain circumstances, e.g. where the population parameters are well known, and where interviewers can gain access to the entire population. Postal questionnaires are better for obtaining information on sexual behaviour, if adequate steps are taken to improve response rates, and when in-depth answers are not needed. For most surveys in the HIV/AIDS field we recommend the postal method.

Acquired Immunodeficiency Syndrome↗