PubMed HealthSearch

Biomedical subjects

A Dunlop

Publications and source records attributed to A Dunlop.

7 recordsLinked to original sources

How effective is an integrated approach to low vision rehabilitation? Two year follow up results from south Devon.

AIMS: A survey was undertaken to assess the effectiveness of an integrated approach to the provision of low visual aids (LVAs) in south Devon over a 2 year follow up period. This integrated approach includes the assessment of patient needs by low vision therapists, followed by the provision of suitable LVAs, with particular emphasis on training in their use. METHODS: A total of 125 patients were selected at random from the 445 patients seen in the low vision clinic at Torbay Hospital in the year 1991. These patients were sent questionnaires relating to the service over a 2 year period. Questionnaires from 111 patients were analysed at 1 year and 75 questionnaires together with 46 clinical reassessments, after 2 years. RESULTS: Using a similar questionnaire to one used in a previous study in the UK from a unit where LVA training was not provided, not only was a higher rate of satisfaction found with the services provided, but also the LVAs dispensed were used more frequently. The majority of the LVAs provided were of the simple, inexpensive variety and wastage was very low. CONCLUSIONS: It was concluded that this integrated approach to low vision rehabilitation with emphasis on training in the use of less complex LVAs exceeds the performance of other types of service that rely on the dispensing of more complex LVAs.

Adult

Computerisation of urothelial carcinoma records: 16 years' experience with the TNM system.

Details of 554 patients with urothelial carcinomas have been recorded on computer forms between 1973 and 1988 inclusive. Essential information from initial assessment and follow-up examinations was printed out on specially designed urothelial update sheets, copies of which were given to patients and urologists as well as being filed in the hospital notes. The survival status of all patients was established as accurately as possible in the last 2 years of the study. Multivariate analysis of 462 bladder cancer patients with adequate follow-up indicated that T category was the most important discriminating variable, followed by histological grade. After replacing T category by microscopic depth of invasion and bimanual examination, the latter was found to be the most important single variable. The omission of the findings on bimanual examination from the 1987 revision of the TNM classification therefore appears to be wrong.

Aged

Predicting phenytoin dose - a revised nomogram.

The nomogram devised by Richens and Dunlop for predicting phenytoin dose has been tested in 127 residential epileptic patients, and the data obtained were used to prepare a revised version of the nomogram. In a further 78 patients, this new version was found to be superior to the original. The mean Km value was found to be 23.8 mumoles/liter. Km was independent of age and body surface area, but Dmax correlated positively with the latter two variables.

Adolescent

Serum-phenytoin levels in management of epilepsy.

Steady-state serum-phenytoin levels were measured in five patients whose phenytoin dosage was changed three or more times for therapeutic purposes. Data from four of these patients and from fifteen others have been used to construct a nomogram which permits the clinician, given a single, accurate, steady-state phenytoin level, to adjust the dosage to achieve the desirable therapeutic concentration of 60 or 80 mumol per litre (15 or 20 mug. per ml.).

Dose-Response Relationship, Drug

Steady-state pharmacokinetics of phenytoin from routinely collected patient data.

Previously reported routine phenytoin clinical pharmacokinetic data from Japan, England, and Germany were analysed to estimate population pharmacokinetic parameters. There were 780 steady-state phenytoin concentrations and associated dosage rates (mg/day) from 322 patients. The patient group spanned paediatric and adult ages, mean age being 18.4 +/- 17.3 (SD) years; 53% were males. The data were analysed using NONMEM, a computer programme designed for population pharmacokinetic analysis. Estimates of the influence of age, gender, data source, height and weight on the maximum elimination rate (Vm) and Michaelis-Menten constant (Km) were obtained. The Vm and Km of a 70 kg adult male European were estimated to be 415 mg/day and 5.7 mg/L, respectively. Vm is not influenced by gender, age or data source. The parameters of a power function of height and weight were estimated to adjust Vm for body size. The best function adjusts Vm in proportion to weight to the 0.6 power; height contains no useful information. Km is not influenced by gender. The Km for patients less than 15 years old is 43% less than that of older patients. The Km of Japanese patients appears to be 23% less than that for European patients. Even after adjustments for age, etc., apparent Vm and Km vary unpredictably among individuals with a coefficient of variation between 10 to 20% and approximately 50% respectively.

Adolescent