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T Sheldon

Publications and source records attributed to T Sheldon.

At least 163 records · Page 9Linked to original sources
PubMed1992

Rationality and the use of formulae in the allocation of resources to health care.

The paper describes how the apparent move towards rationality in allocating resources in the National Health Service using statistically based formulae is illusory. This is not just a technical problem of poor application of statistical techniques. The basic problem is to find a combination of factors reflecting dimensions of need and then appropriate weights with which to combine them within the context of the guiding principles of equity and efficiency. The paper explains how there has been little consistency in measuring need and how statistical methods have often masked the lack of appropriate data and models. Alternative approaches to measuring need within a policy context are discussed and a research agenda is outlined which, rather than concentrating on evermore complex statistical techniques, focuses on the necessity for more validly operationalizing 'needs' and their resource implications.

Health Resources↗
PubMed1991

Measure for measure.

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Data Interpretation, Statistical↗
PubMed1991

Designing a deprivation payment for general practitioners: the UPA(8) wonderland.

OBJECTIVE: To analyse critically the deprived area payment introduced in the new general practitioner contract. The payment formula is based on the Jarman underprivileged area index (UPA(8)) and aims at compensating general practitioners for increases in workload. DESIGN: Evaluation of the deprived area payment against the stated policy objective with a set of criteria for developing resource allocation formulas. MAIN OUTCOME MEASURES: The degree to which the components of the Jarman index predict the workload of general practitioners; whether construction of the index is sensible and comprehensible; and how the formula incorporates the index and is likely to work in practice. RESULTS: The fact that the index relies on census data and the way the weighting was derived means that the formula will not accurately reflect the workload. The use of statistical transformations obscures the original policy intent. There has been no validation to support the application of the index as part of a national policy. The payments are not linked to the quality of service provided and may have the perverse effect of increasing list size. CONCLUSION: The formula used as the basis of the deprived area payments is poorly suited to the policy objective of compensating general practitioners for increases in workload. More research is urgently needed to enable the effect of the payment to be monitored and a more empirically sound set of incentives to be developed.

Family Practice↗
PubMed1990

Great expectations.

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Delivery of Health Care↗
PubMed1989

Neoadjuvant chemotherapy in marginally resectable stage III M0 non-small cell lung cancer: long-term follow-up in 41 patients.

Forty-one patients with marginally resectable stage III M0 non-small cell lung cancer (NSCLC) were entered into a study evaluating neoadjuvant cyclophosphamide, adriamycin, and cisplatin chemotherapy (CAP) followed by radiotherapy and subsequent resection. Postoperative radiotherapy and additional CAP were also administered. The objective disease regression rate prior to surgery was 72% (2 complete, 12 partial, and 7 minimal responses). Thoracotomy was carried out in 37 patients (90%), with resection of all gross disease in 36 patients (97%). Relapse occurred in 22 (61%) of the resected patients, involving chest only (four patients), chest and extra thoracic (nine patients), and extra thoracic only (nine patients). Subsequent CNS relapse developed in 9 (25%) of 36 postop patients in association with other sites of relapse (five patients) or as a solitary location (four patients). Only one of seven patients receiving prophylactic cranial irradiation (PCI) developed CNS relapse compared with 7 (26%) of 27 patients not receiving PCI. The median long-term follow-up for 14 living patients is 53+ months, with a rang of 38+ to 71+ months. Median survival for all patients is 32 months, with 1-year survival being 75%. The survival curve shows a plateau of 31% from 3 to 5+ years. Using a log rank test, no prognostic subgroups could be identified that significantly affected response rate, disease-free survival, or overall survival. While neoadjuvant CAP followed by radiotherapy appears to improve survival, more effective chemotherapy along with randomized studies are needed to determine the role of initial chemotherapy in marginally resectable NSCLC.

Adult↗
PubMed1989

Chromosomal damage induced by caprolactam in human lymphocytes.

Caprolactam was tested in the in vitro human lymphocyte cytogenetic assay both in the presence and absence of S9 mix at dose levels up to 5500 micrograms/ml using lymphocytes obtained from a male donor and in the presence of S9 mix using lymphocytes obtained from a female donor. Statistically significant increases in chromosomal damage were observed at 5500 micrograms/ml dose level in cells from both donors. This positive response was enhanced by the inclusion of chromosomal gaps in the calculations. It was concluded that caprolactam induces chromosomal damage in human lymphocytes in vitro albeit at comparatively high dose levels.

Azepines↗
PubMed1989

An evaluation of caprolactam and benzoin in the mouse micronucleus test.

Caprolactam (CAP) and benzoin (ZOIN) were tested in the mouse micronucleus test at two dose levels, one of which was the maximum tolerated dose. The compounds were administered by the oral route to groups of 5 male and 5 female mice. No statistical significant increase over control values of the frequency of PCE-containing micronuclei was observed at any dose level or sampling time, with the exception of CAP at a dose level of 700 mg/kg at the 24-h sampling time, where a small statistically significant effect was observed both when the sexes were analysed combined and separately. Due to this observation a limited repeat was carried out on CAP at the 700 mg/kg dose level at the 24-h sampling time. In the repeat study similar trends were observed even following the analysis of 5000 cells per animal. However, when these data were compared with historical control data no such effects were observed, the effects were therefore considered to be of questionable validity. Throughout the study the positive control (cyclophosphamide) gave an elevated biologically and statistically significant increase at all sampling times, thus verifying the sensitivity of the test system. It was therefore concluded that caprolactam and benzoin are not clastogenic in the mouse micronucleus test.

Animals↗
PubMed1987

Primary radiation therapy for locally advanced breast cancer.

The optimal local-regional treatment for patients with Stage III breast cancer has not been determined. To evaluate the effectiveness of radiation therapy as local treatment for such patients, the results of 192 patients (five with bilateral disease) treated with radiation therapy without mastectomy between July 1, 1968 and December 31, 1981 were reviewed. Excisional biopsy (gross tumor removal) was performed in only 54 of the 197 breasts. Patients typically received 4500 to 5000 cGy in 5 weeks to the breast and draining lymph nodes; a local boost to areas of gross disease was delivered to 157 patients. Multi-agent chemotherapy was given to 53 patients. The median follow-up was 65 months. The actuarial probability of survival for the entire group was 41% at 5 years and 23% at 10 years. The probability of relapse-free survival (RFS) was 30% at 5 years and 19% at 10 years. The addition of multi-agent chemotherapy was associated with a significantly improved 5-year RFS (40% versus 26%, P = 0.02). The 5-year survival rate was 51% for patients who received adjuvant multi-agent chemotherapy and 38% for patients who did not (P = 0.16). The actuarial rate of local-regional tumor control (not censored for distant failure) for all patients was 73% at 5 years and 68% at ten years, and the crude incidence of local-regional control was 78%. Local-regional tumor control was principally influenced by radiation dose. Patients who received 6000 cGy or greater to the primary site had a better 5-year rate of control in the breast than did patients who received less than 6000 cGy (83% versus 70%, P = 0.06). Significant complications were seen in 15 patients (8%); these included moderate or severe arm edema in six patients and brachial plexopathy in four patients. Cosmetic results at last evaluation were excellent or good in 56% of evaluable patients, fair in 25%, and poor in 19%. It is concluded that high-dose radiation therapy without mastectomy is an effective means of controlling local-regional tumor in patients with locally advanced breast cancer.

Actuarial Analysis↗
PubMed1987

Inactivity of methylene chloride in the mouse bone marrow micronucleus assay.

Methylene chloride (MC) has been evaluated for its ability to induce micronucleated polychromatic erythrocytes (MPEs) in the bone marrow of treated mice. Groups of five male and five female C57BL/6J/Alpk mice were exposed, by gavage, to doses of 4000, 2500 and 1250 mg/kg MC in corn oil, the highest dose-level being selected to be the maximum tolerated dose. Bone marrow samples were taken 24, 36, 48 and 72 h after dosing. No significant increases in the incidence of MPEs over controls were observed for any of the test groups, and it is concluded that MC is not clastogenic in this assay.

Animals↗