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Biomedical subjects

S Birch

Publications and source records attributed to S Birch.

At least 109 records · Page 6Linked to original sources
PubMed1987

Regional distribution of family practitioner services: implications for National Health Service equity and efficiency.

In this study the total expenditure on family practitioner services in England was analysed in terms of its distribution between National Health Service regions. Expenditure was then allocated on the basis of estimated regional needs, taking into account the demographic mix of the population and the differentials in health between regions. A comparison between the two regional distributions highlighted the inequalities and inefficiencies in the current system of financing and providing family practitioner services. A coordinated approach to the planning of the separate elements of NHS provision is required which recognizes the interface between primary and secondary health care.

Family Practice↗
PubMed1986

Increasing patient charges in the National Health Service: a method of privatizing primary care.

Frequent increases in the real value of National Health Service (NHS) patient charges have been made since the Conservative Party's return to office in 1979. For those patients subject to these charges the increases have led to a substantial reduction in the level of subsidization of the cost of the service. The rationale for the subsidization of health care is shown to be unrelated to 'ability to pay' considerations. Consequently the 'backdoor privatization' of these services is inconsistent with the objectives of the NHS even though the Government has continually committed itself to these objectives. Alternative policies to increasing patient charges are suggested which would encourage the efficient use of NHS resources without compromising NHS objectives.

Family Practice↗
PubMed1986

Relationship between increasing prescription charges and consumption in groups not exempt from charges.

The further increases in National Health Service (NHS) patient charges introduced on 1 April 1985 represent a continuation of the Government's policy of requiring all except priority groups to pay an increasing proportion of the cost of their own treatment. Reductions in the use of the services on which charges are imposed would be incompatible with the stated objectives of the NHS. An analysis of the published data on NHS prescription dispensation shows that this policy has been associated with a considerable reduction in the per capita consumption of prescribed drugs in non-priority groups.

Drug Utilization↗
PubMed1985

Acute effects of aerosolized metaproterenol on breathing pattern of patients with symptomatic bronchial asthma.

We studied the effect of two sequential puffs of metaproterenol (650 micrograms each puff) delivered with an auxiliary aerosol delivery system on the breathing pattern of patients with symptomatic bronchial asthma who were monitored noninvasively with respiratory inductive plethysmography. Particular attention was directed to respiratory center drive as reflected by mean inspiratory flow and minute ventilation. Both these components were elevated in the eight patients whose mean FEV1.0 was 1.43 L (45% predicted normal). Two puffs of metaproterenol produced a maximal increase over baseline in FEV1.0 of 50 +/- 25% (SD), whereas no change took place in FEV1.0 with placebo administration. This dose of metaproterenol did not alter heart rate nor blood pressure throughout the study period of 2 hours. Neither mean inspiratory flow, minute ventilation, nor any component of the breathing pattern changed with this partial reversal of bronchoconstriction. These results suggest that the neural mechanism accounting for heightened respiratory center drive in patients with symptomatic bronchial asthma does not wholly depend on bronchoconstriction.

Adult↗
PubMed1985

Equity and efficiency in medical manpower planning: defining objectives and looking towards the future.

If medical manpower planning is to be successful in terms of providing the correct future manpower levels to produce the desired (efficient) health care services then the planners must recognise the ultimate objectives of the provision of health care services and the production relationship between the services provided (inputs) and the effects on patient health status (outputs). Furthermore the planning of medical manpower should not be done in isolation under the implicit assumption that other important inputs will be available as required but should be part of an overall planning process for the future production of improvements in health status. Having determined the objectives for outputs the future levels of different types of manpower will depend on the identification of the efficient mix of inputs. In addition the values of other variables influencing the production relationship (e.g. trends in the consumption of certain goods) should be considered in the planning process since observed trends show that they do not remain constant over time.

Efficiency↗
PubMed1985

The reliability of Doppler ultrasound techniques in the assessment of carotid disease.

The reliability of continuous wave (CW) Doppler imaging and Duplex scanning in the assessment of carotid artery disease has been evaluated prospectively in comparison with biplanar angiography. Of 130 comparisons the sensitivity of Doppler imaging was 89% and specificity 99% in the detection of greater than or equal to 50% internal carotid stenosis, and 87% and 99% respectively in the diagnosis of internal carotid occlusion. Of 118 comparisons the sensitivity of Duplex scanning was 93% and specificity 98% in the detection of greater than or equal to 50% internal carotid stenosis, and 93% and 99% respectively in the diagnosis of internal carotid occlusion. CW Doppler imaging and Duplex scanning are accurate techniques in the diagnosis and categorisation of internal carotid artery disease. CW Doppler imaging is an effective screening technique for the presence of greater than or equal to 50% internal carotid artery stenosis. Duplex scanning also has the potential for improved detection of early internal carotid artery disease and study of the natural history of atherosclerosis.

Adolescent↗
PubMed1985

Caring for the elderly: a European perspective on today and tomorrow.

There is always a temptation to suppose that one's own problems (whether personal or national) are unique. They rarely are. The "problem" of the elderly is no exception and so there is no particular point in looking to the specific characteristics of one's own health, social service, and social security systems for causes. There is, however, every reason to be looking at them for the consequences. They can also exacerbate the causes. In this paper we sketch the principal features (economic, social, and demographic) that have contributed to the "problem" of the elderly in Europe and then outline the main intellectual issues that need to be explored and resolved. That sounds a bit pompous but, if one is to avoid an intellectual morass consisting of the various assertions about needs, obligations, and so on that emanate from rival concerned parties and various professional interests on the one hand, and simplistic political slogans whose only virtue is that they cut the Gordian Knot (but provide no real enlightenment) on the other, then we need to be doing just this. We shall take a few things for granted: that cost-containment is not the be-all-and-end-all of policy; that value for money depends equally on what you get as on what you spend; that overall expenditure per head is mainly determined by income per head (though some countries have managed to get and stay below the regression line); and that it "ain't so" that all one needs to do is to "leave it to the market." To have justified each of these would have taken too much space so we can only assert them and trust that, in swallowing these camels, you won't strain at the gnats to come.

Aged↗
PubMed1985

Respiratory drive in nonsmokers and smokers assessed by passive tilt and mouth occlusion pressure. Response to rebreathing carbon dioxide.

The purpose of the present investigation was to assess respiratory center function in smokers using (1) measurement of mouth occlusion pressure during carbon dioxide rebreathing and (2) noninvasive measurement of breathing pattern during passive upright tilt. The breathing patterns of 20 normal nonsmokers and 20 smokers without major obstruction of the airways were monitored noninvasively with respiratory inductive plethysmography for 15 minutes in the supine position and then after 90 degrees head-up passive tilt to the standing position. In nonsmokers, significant increases from supine to standing positions included the following: (1) minute ventilation from 6.22 +/- 1.47 to 7.32 +/- 1.16 L/min (p less than 0.05); (2) tidal volume from 368 +/- 93 to 462 +/- 108 ml (p less than 0.01); and (3) mean inspiratory flow from 263 +/- 61 to 320 +/- 43 ml/sec (p less than 0.01). Responses of smokers to tilt were variable; 14 showed changes similar to nonsmokers, but six showed no increase of ventilation and respiratory drive upon tilting. The latter also showed blunted response to rebreathing carbon dioxide in the supine position as estimated by plotting mouth occlusion pressures against end-tidal carbon dioxide tension. These data suggest that disturbances of respiratory center control are common in smokers without major obstruction of the airways.

Adult↗
PubMed1985

Periodic breathing triggered by hypoxia in normal awake adults. Modification by naloxone.

Breathing patterns in six normal awake subjects were monitored noninvasively during progressive hypoxia accomplished with the administration of nitrogen at 2, 4, 6, and 8 L/min by nasal cannula. The lowest value of arterial oxygen saturation (SaO2) of 88 +/- 4 percent (mean +/- SD) was achieved with nitrogen at 8 L/min. At baseline, tidal volume (VT) and frequency were fairly regular; with nitrogen at 2 and 4 L/min, some subjects showed minor fluctuations of VT. At 6 and 8 L/min, periodic breathing with marked oscillations of VT, apneas, hypopneas, and intermittent large tidal breaths were consistently observed. Inspired oxygen concentration fluctuated because of the variations of tidal breaths provoked when periodic breathing took place and enhanced fluctuation in SaO2. A randomized, double-blind crossover design was used to assess the effect of pretreatment with naloxone on this periodicity. In contrast to the irregular breathing pattern observed with pretreatment with placebo, the breathing pattern after pretreatment with naloxone was regular during nasal administration of nitrogen except at 8 L/min, when minor fluctuations in VT with occasional hypopneas and large tidal breaths occurred. On another day, irregular and periodic breathing with apneas or hypopneas (or both) produced by nasal nitrogen at 8 L/min was eliminated or blunted by short-term intravenous administration of naloxone. On another day, electroencephalographic monitoring corroborated visual observations made in the previous studies that the hypoxic subjects were awake during the breathing alterations. Thus, awake adults develop irregular and periodic breathing during induction of mild hypoxia produced by nasal administration of nitrogen. The irregularity in breathing appears to be mediated through release of endorphins, since the effect is blunted or eliminated by pretreatment or short-term treatment with naloxone.

Adult↗
PubMed1985

Policy implications of contracting out care: the case of total hip replacements.

Research performed by Nicholl and his colleagues at Sheffield University has shown that private health care provision in the United Kingdom trends to be concentrated among certain activities, in particular those activities falling under the broad heading of elective surgery. Consequently although total private provision is dwarfed by the aggregate provision of health care under the national health service, whether measured in bed availability, expenditure or throughput, the private sector is found to be a much more significant supplier of certain procedures. In this paper the findings of the Sheffield "team" are considered along with the policy issues that they give rise to for one particular activity, total hip replacement (THRs).

Aged↗
PubMed1984

Breathing pattern during induced bronchoconstriction.

The breathing patterns of normal subjects monitored with respiratory inductive plethysmography were investigated after mild increases in respiratory resistance provoked by aerosolized methacholine during natural breathing and while breathing on a mouthpiece to a pneumotachograph. First, during natural breathing, comparisons of inspiratory ventilation (VI), tidal volume (VT), frequency (f), inspiratory time (TI), fractional inspiratory time (TI/TT), and mean inspiratory flow (VT/TI) were made before and after aerosolized buffered saline and methacholine in a dose that reduced specific airway conductance (sGaw) by 35% (PD35). There was a significant increase in VT/TI and VI after methacholine, whereas VT, f, TI, and TI/TT were not consistently modified by saline or methacholine. Pretreatment with bronchodilators prevented changes in respiratory resistance (Rrs) as well as in breathing pattern after PD35 methacholine. On another day, Rrs, end-expiratory lung volume level, and breathing pattern during natural breathing were monitored after administration of predetermined doses of methacholine that reduced sGaw by 25% (PD25), PD35, and 55% (PD55). Increases in VT/TI and end-expiratory lung volume level paralleled the increases in Rrs after each dose of methacholine but not with saline control. VI increased along with Rrs at the PD25 and PD35 doses but plateaued at the PD55 dose while Rrs continued to rise. There were no changes in breathing pattern in subjects who breathed on a mouthpiece to a pneumotachograph after PD55 methacholine. Thus alterations of the breathing pattern due to mild-to-moderate degrees of bronchoconstriction are characterized by progressive rises of mean inspiratory flow (an index of respiratory center drive) and end-expiratory lung volume level (a measure of pulmonary hyperinflation), but VI plateaus at the more severe degree of bronchoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Breathing pattern alterations with aerosolized buffered saline--effects of topical airway anesthesia.

Bronchoconstriction, measured by spirometry and body plethysmography, may occur with inhalation of aerosolized buffered saline (ABS) (0.5% sodium chloride and phosphate buffer) in asymptomatic patients with bronchial asthma. To estimate the prevalence and mechanism of this phenomenon, we employed continuous non-invasive monitoring of the breathing pattern to estimate changes of end-expiratory level, minute ventilation and mean inspiratory flow, which may be more sensitive albeit less specific indicators of bronchoconstriction. We studied normal and asymptomatic asthmatic subjects before and after ABS inhalation. Deep breaths of ABS had no effect on the breathing pattern in normals, but in all of the asthmatics increases of end-expiratory level, minute ventilation, tidal volume and mean inspiratory flow lasted at least 15 minutes. On another day, prior topical airway anesthesia in the asthmatic subjects prevented the changes in breathing pattern after ABS inhalation. Thus analysis of the breathing pattern suggests that bronchoconstriction or irritation of vagal airway receptors after inhalation of aerosolized buffered saline occurs to a high degree in asymptomatic asthmatic subjects because changes in breathing pattern are prevented by prior airway anesthesia which probably inactivates vagal afferent pathways.

Adult↗