Search PubMed⌕ Search

Biomedical subjects

T Fahey

Publications and source records attributed to T Fahey.

At least 55 records · Page 3Linked to original sources
PubMed1996

The prevalence and direct costs of pre-immunization testing for hepatitis A in general practice.

Two hundred and twenty patients in one general practice travelling to destinations where immunization against hepatitis A virus (HAV) is recommended were tested for their HAV immune status before immunization. Age-specific prevalence of prior immunity to HAV was estimated. The relative costs of pre-immunization testing and immediate immunization were compared. The most cost-effective testing method for this practice was found to be total population testing prior to immunization with HAV vaccine. Individual general practices can estimate the optimal age at which to commence testing for HAV in their own practice population.

Adolescent↗
PubMed1995

Evidence based purchasing: understanding results of clinical trials and systematic reviews.

OBJECTIVE: To assess whether the way in which the results of a randomised controlled trial and a systematic review are presented influences health policy decisions. DESIGN: A postal questionnaire to all members of a health authority within one regional health authority. SETTING: Anglia and Oxford regional health authorities. SUBJECTS: 182 executive and non-executive members of 13 health authorities, family health services authorities, or health commissions. MAIN OUTCOME MEASURES: The average score from all health authority members in terms of their willingness to fund a mammography programme or cardiac rehabilitation programme according to four different ways of presenting the same results of research evidence--namely, as a relative risk reduction, absolute risk reduction, proportion of event free patients, or as the number of patients needed to be treated to prevent an adverse event. RESULTS: The willingness to fund either programme was significantly influenced by the way in which data were presented. Results of both programmes when expressed as relative risk reductions produced significantly higher scores when compared with other methods (P < 0.05). The difference was more extreme for mammography, for which the outcome condition is rarer. CONCLUSIONS: The method of reporting trial results has a considerable influence on the health policy decisions made by health authority members.

Decision Making↗
PubMed1995

An outbreak of Campylobacter jejuni enteritis associated with failed milk pasteurisation.

This paper describes an outbreak of gastrointestinal illness affecting at least 110 people, of whom 41 had microbiological confirmation of Campylobacter jejuni infection. The outbreak of infection was found to have been associated with consumption of inadequately pasteurised milk from a local dairy. The problem of enforcement of food and safety regulations when milk from dairies fails the phosphatase test is discussed. The prevalence of seroconversion to campylobacter in the community is estimated from a sample of cases and controls involved in this outbreak.

Animals↗
PubMed1995

Relationship between the provision of counselling and the prescribing of antidepressants, hypnotics and anxiolytics in general practice.

BACKGROUND: The provision of counselling in general practice is increasing, despite uncertainty concerning its effectiveness. Furthermore, the relationship between counselling and prescribing of antidepressants, hypnotics and anxiolytics in general practice is not known. AIM: This study set out to assess the relationship between provision of counselling and prescribing of antidepressants, hypnotics and anxiolytics in general practice. METHOD: An observational, cross-sectional study of general practices in Oxfordshire Family Health Services Authority was undertaken. Practices were surveyed on the availability of counselling services. The quantity and cost of prescribing of psychotropic drugs over one year (April 1992 to March 1993) were compared for practices with different levels of counselling provision. RESULTS: Of the 82 (96%) respondents, 74 (90%) referred patients for counselling; of these 74 practices, the highest levels of prescribing, in terms of number of items and net ingredient cost, were seen in those practices that employed a counsellor working on the premises. The lowest levels of prescribing were seen in those practices that referred their patients to a counsellor not working on the practice premises. CONCLUSION: The relationship between the provision of counselling and the level of prescribing of antidepressants, hypnotics and anxiolytics is complex. In this study lower levels of prescribing of these drugs in practices with higher provision of counselling were not observed.

Anti-Anxiety Agents↗
PubMed1995

The detection and management of hypertension in the elderly of Northamptonshire.

BACKGROUND: The aim of this study was to apply recommendations from randomized controlled trials and guidelines on the detection and control of hypertension in the elderly to a district health authority population. METHODS: A cross-sectional audit of Northamptonshire general practitioners' (GPs') records from February to June 1993 was carried out. RESULTS: A total of 2428 notes of men and women aged 65 or over registered with their GP was audited. A large proportion of patients, 86 per cent (95 per cent CI 84.6-87.4 per cent), had a blood pressure record taken in the last 10 years. Of those with raised blood pressure (BP > or = 160/90 mmHg) 49 per cent (95 per cent CI 46.2-51.8 per cent) were untreated, and 58 per cent (95 per cent CI 54-61.9 per cent) of those labelled as hypertensive were not adequately controlled. The prevalence of labelled hypertension was 25 per cent (95 per cent CI 23.3-26.7 per cent). CONCLUSIONS: From these results it is estimated that between 11 and 29 fatal and non-fatal strokes could be prevented in the 65-74-year-old age population of Northamptonshire each year if current guidelines were followed. Improved detection and management of elderly hypertensive patients in primary care could contribute significantly towards the target for stroke reduction set in the Health of the nation strategy.

Aged↗
PubMed1995

The type and quality of randomized controlled trials (RCTs) published in UK public health journals.

BACKGROUND: Randomized controlled trials (RCTs) are increasingly being used to evaluate the effectiveness of health care interventions. Systematic reviews of RCTs form the basis of the Cochrane Collaboration, which aims to synthesize all RCTs concerned with the provision of health care. This paper reports the quantity and methodological quality of RCTs published in five UK public health journals, which were searched as part of a planned register of RCTs in public health. METHODS: Five journals were hand searched: The International Journal of Epidemiology, Health Trends, Journal of Public Health Medicine, Public Health and The Journal of Epidemiology and Community Health. All RCTs were identified and their methodological characteristics reviewed. RESULTS: Ninety-one trials were identified from the five journals. A wide variety of topics were covered, the most common being prevention strategies )46 percent of the trials). Although the actual number of reports of RCTs published increased over time, there was no detectable improvement in the quality of reports. The aspect of bias most well controlled was control of bias at entry (randomization), in 83 (91 per cent) of trials. However, even in these trials details about the process of randomization were poor. CONCLUSION: These trials will form the basis of a register of RCTs in public health. The diversity of topics covered illustrates the broad-based nature of public health. For this reason, many other RCTs relevant to the practice of public health are likely to be found in non-public health journals.

Humans↗
PubMed1994

Effect of pregnancy on prognosis for young women with breast cancer.

Breast cancer in women under 30 years old carries a poor prognosis, for reasons that have not been identified. This study aimed to identify prognostic factors in this age group. Special attention was paid to the history of pregnancy. The clinical presentation and course of breast cancer was documented for 407 women, aged 20-29 years, who registered between 1978 and 1988 at one of nine cancer centres. Eligible patients had histologically confirmed local or regional invasive breast carcinoma, and received part or all of their initial therapy at the participating hospital. For patients whose breast cancers were diagnosed during pregnancy, the risk of dying from breast cancer was significantly greater than that of women who had never been pregnant (relative risk 3.26 [95% CI 1.81-5.87], p = 0.0004). Adjustment for number of axillary nodes affected and tumour diameter reduced the relative risk only slightly (2.83 [1.24-6.45], p = 0.023). For each 1-year increment in the time between the latest previous pregnancy and breast cancer diagnosis, the risk of dying decreased by 15% (relative risk 0.85, p = 0.011). Thus concurrent or recent previous pregnancy adversely affects survival of breast cancer in young women. The size of the effect is such that it probably contributes substantially to the poor prognosis of breast cancer in this age group as a whole.

Adult↗
PubMed1994

General practitioners' knowledge of and attitudes to the management of hypertension in elderly patients.

BACKGROUND: It is not known whether the results from randomized controlled trials influence general practitioners' knowledge of and attitudes to clinical practice. AIM: This study set out to assess general practitioners' knowledge of and attitudes to the management of hypertension in patients aged 65 years and over after the publication of three randomized controlled trials. METHOD: A cross-sectional survey of principals in general practice was undertaken using a self-administrated questionnaire. The study was confined to 35 randomly selected general practices whose patient catchment area lay within the boundary of Northamptonshire Family Health Services Authority. A total of 92 general practitioners from 27 practices responded. The main outcome measures were: the reported use of a protocol to manage elderly patients with hypertension; method and frequency of blood pressure measurement; influence of patients' age on diagnosing and initiating treatment of hypertension; and use of non-pharmacological and pharmacological therapies. RESULTS: Eighty four per cent of the general practitioners reported starting treatment only after measuring blood pressure on three separate occasions; 99% measured blood pressure with the patient seated while 29% also measured blood pressure while the patient was standing. Half of the respondents reported treating patients with isolated systolic hypertension once systolic blood pressure exceeded 179 mmHg. All the general practitioners reported recommending non-pharmacological treatment prior to drug therapy; 83% would use a diuretic as their drug of first choice. CONCLUSION: It appears that despite the publication of several sets of guidelines for the management of hypertension in elderly people, based on randomized controlled trials, there is still considerable variation in the knowledge and attitudes of general practitioners. However, compared with a previous survey in Leicestershire in 1991, the general practitioners in this study reported a lower blood pressure threshold for initiating treatment of elevated blood pressure in elderly patients, including those with isolated systolic hypertension, which may in part be attributed to the introduction of the guidelines.

Aged↗
PubMed1993

Human keratinocyte growth factor effects in a porcine model of epidermal wound healing.

Keratinocyte growth factor (KGF) is a member of the fibroblast growth factor (FGF) family (hence the alternative designation FGF-7). It is produced by stromal cells, but acts as a mitogen for epithelial cells. We examined the effects of topically applied KGF on healing of wounds in a porcine model. In partial-thickness wounds, KGF stimulated the rate of reepithelialization (p < 0.0002), associated with a thickening of the epidermis (p < 0.0001). Epidermis from KGF-treated full-thickness wound sites was significantly thicker (0.31 +/- 0.22 mm) compared with mirror image control sites (0.18 +/- 0.12 mm) (p < 0.0001). Moreover, the majority (77%) of KGF-treated wounds exhibited epidermis with a deep rete ridge pattern as compared with control sites. These effects were observed as early as 14 d and persisted for at least 4 wk. KGF treatment also increased the number of serrated basal cells associated with increased deposition of collagen fibers in the superficial dermis adjacent to the acanthotic epidermis. Electron microscopy revealed better developed hemidesmosomes associated with thicker bundles of tonofilaments in the serrated cells. The pattern of epidermal thickening observed in KGF-treated wounds resembled psoriasis. Psoriasis is a disease associated with epidermal thickening, parakeratosis as well as hyperproliferation that extends beyond the basal layer. In striking contrast to psoriasis, KGF-treated wounds exhibited normal orthokeratotic maturation, and proliferation was localized to the basal cells. Our present findings have significant implications concerning the role of KGF as a paracrine modulator of epidermal proliferation and differentiation.

Animals↗
PubMed1991

The prognosis of Hodgkin's disease in older adults.

This investigation was undertaken to assess the apparent poor survival of older patients with Hodgkin's disease. The clinical course of Hodgkin's disease in 136 patients, 60 to 79 years of age, was compared with that of 223 patients, 40 to 59 years of age. The patients registered from November 1977 through December 1983 had not been previously treated, and were treated at eight cancer centers. When the prognosis of all patients was examined by age, a definite change in the pattern of survival first appeared in the 60- to 69-year-old cohort. The entire older group (60 to 79 years) experienced twice the risk of dying from Hodgkin's disease and four times the risk of dying from other causes than did the younger group. In both groups, stage of disease was the strongest factor in predicting adjusted survival. Delay in treatment and advanced stage at presentation were not characteristic of Hodgkin's disease in older patients as has been postulated. Older patients responded to therapy with a similar complete remission rate (84% v 88% in the younger group, P = .24). From this study, we conclude that (1) Hodgkin's disease in the older adult does not have a different natural history, its major risk factors are similar to those known in other age groups, and thus should be amenable to existing therapeutic approaches; and (2) the prognosis of older patients with Hodgkin's disease has been obscured in previous studies by the inclusion of deaths due to other causes in survival estimates.

Adult↗
PubMed1990

Macrophage inflammatory protein-1: unique action on the hypothalamus to evoke fever.

Macrophage inflammatory protein (MIP-1) administered systemically causes a fever not blocked by a prostaglandin (PGE) synthesis inhibitor. The purpose of this study was to examine the central mechanism of pyrexic action of this cytokine in the unrestrained rat. After guide cannulae for microinjection were implanted stereotaxically just above the anterior hypothalamic preoptic area (AH/POA), the body temperature of each rat was monitored by a colonic thermistor probe. Saline control vehicle or MIP-1 was microinjected into the AH/POA in one of eight concentrations ranging from 0.0028-9.0 ng per 0.5 mu 1 volume. MIP-1 induced a biphasic or monophasic fever of short latency characterized by an inverse dose-response curve. The potency of MIP-1 was in the femtomolar (10(-15)) range with the lowest dose of 0.028 ng producing a fever of over 2.0 degrees C with a latency of 15 min or less. To determine whether a PGE mediates MIP-1 fever, indomethacin was administered either intraperitoneally in a dose of 5.0 mg/kg or directly into the MIP-1 injection site in a dose of 0.5 microgram/0.5 mu 1, both injected 15 min before MIP-1. Pretreatment of the injection site in the AH/POA with indomethacin failed to prevent the febrile response evoked by MIP-1 injected at the same locus. Further, the dose of systemic indomethacin, which blocks PGE-induced fever in the rat, attenuated only partially the MIP-1 fever. The results demonstrate that MIP-1 is the most potent endopyrogen discovered thus far, and that its action is directly in the region of the hypothalamus which contains both thermosensitive and pyrogen-sensitive neurons. The local action of MIP-1 on cells of the AH/POA in evoking fever is unaffected by the PGE inhibitor which indicates, therefore, that a cellular mechanism operates in the hypothalamus to evoke fever independently of the central synthesis of a PGE.

Animals↗
PubMed1987

Minimal long-term cardiopulmonary dysfunction following treatment for Hodgkin's disease.

UNLABELLED: We studied the long term cardiopulmonary function, at rest and during exercise, of 57 patients who were at least 1 year (mean 5 years) post-treatment for Hodgkin's disease. To establish the maximum degree of dysfunction we studied 40 patients who had extensive intrathoracic disease treated with radiotherapy alone (Exten-X; n = 20) or combined modality therapy (Exten-XC; n = 20). Patients without intrathoracic disease given either prophylactic mantle therapy (Proph-X, n = 10) or no chest irradiation ( CONTROL: n = 7) were used as controls. An abnormal electrocardiogram, by virtue of a conduction defect, was observed in seven patients, six in the Exten-X or Exten-XC groups. Borderline abnormalities including ST-T changes, prolonged QT interval, or axis deviation occurred in 14 patients distributed evenly throughout the groups. Resting mean pulmonary function test values were normal in all treatment groups. Exercise tolerance, as indicated by peak oxygen consumption (VO2), was significantly lower for the Exten-XC group compared to Proph-X (p less than 0.01). However, the mean value of VO2 for group Exten-XC was only 15% below that predicted. Of the 12 patients with abnormally low VO2 (greater than 20% below their predicted value), 11 were in the Exten-X or Exten-XC group with no difference between the two groups. Patients who received radiotherapy to at least one lung field, using either the thin lung block technique or open field irradiation, had significantly lower exercise tolerance than those treated with full thickness blocks (p less than 0.05). Despite these abnormalities only a single patient complained of marked dyspnea. We conclude that extensive treatment to the mantle field, especially when followed by chemotherapy in patients with extensive intrathoracic Hodgkin's disease, can result in minimal cardiopulmonary dysfunction in approximately one-third of patients.

Adolescent↗