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Biomedical subjects

D Challis

Publications and source records attributed to D Challis.

12 recordsLinked to original sources
PubMed1998

Congenital chylothorax in siblings.

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X-linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.

Chylothorax↗
PubMed1995

Familial myelodysplastic syndrome with onset late in life.

A family is described in which three, and possibly four members, namely, the propositus, two paternal uncles, and possibly his paternal grandfather, developed a myelodysplastic syndrome (MDS) after the age of 60 years. This late onset resembles sporadic cases which are commoner in older age, rather than the previously reported familial cases most of whom have been children or young adults. The three affected members had megaloblastoid bone marrows with an increased proportion of bone marrow blasts and developed progressive bone marrow failure without leukemic transformation. The propositus showed a dramatic but temporary response to GM-CSF therapy but eventually became unresponsive with a marked increase in bone marrow reticulin and reduction in hemopoietic elements. Affected members had no recognisable bone marrow cytogenetic abnormality but the pattern of inheritance and similarity in clinical features suggest an inherited genetic defect which predisposes to the development of MDS.

Acute Disease↗
PubMed1993

Case management in social and health care. Lessons from a United Kingdom program.

In the United Kingdom, despite a stated commitment to community care, centralized planning and financing through the Social Security System, rather than the Social Services Department, resulted in a serious distortion in policy. Social Security funded care in residential and nursing homes, and not community care. As in the United States, central government expenditures for expensive institutional care rose dramatically in the 1980s as a result. By the end of the decade, changes were implemented to decentralize the provision and funding of social care. Several projects were undertaken to demonstrate effective means of applying the new policies. In each instance, case managers worked with relatively small caseloads of the frail elderly and were responsible for allocating funds to purchase the services needed within a fixed budget. In all settings, there was a reduction in the use of institutional care facilities; the quality of life of both the clients and their caregivers improved significantly; and these gains were achieved at no greater cost than for individuals receiving the traditional services without case management. Despite the fact that issues such as what happens to costs when the system is expanded to other target clienteles remain to be resolved, the success of the projects highlights the significant gains to be achieved with case managers who have control of both service selection and budgets.

Aged↗
PubMed1991

An evaluation of an alternative to long-stay hospital care for frail elderly patients: I. The model of care.

Recent UK government policy has advocated the development of case management to provide more coordinated care at home for vulnerable people. This paper describes a service model whereby case managers, with devolved budgets, employed by the social services department, were located in a geriatric multidisciplinary team to provide an alternative for patients requiring long-stay hospital care. As well as co-ordinating packages of care, case managers were responsible for deploying the time of home care assistants, multi-purpose workers who assisted health care staff and undertook home help tasks. The role of case managers within the multidisciplinary team is explained and the tasks undertaken by home care assistants are identified. Home care assistants undertook a wider range of activities than either home helps or nurses, covering both personal and domestic care tasks.

Aftercare↗
PubMed1991

An evaluation of an alternative to long-stay hospital care for frail elderly patients: II. Costs and effectiveness.

This paper provides the main findings of an evaluation of a service to provide alternative care at home for patients receiving long-stay hospital care. Elderly people receiving the service were compared with a group of similar patients in an adjacent health district. The paper presents data on length of time at home and in hospital, changes in quality of life and care of elderly people, and effects upon informal carers for the two groups. Elderly people receiving community-based care had a higher quality of life, and there was no evidence of greater stress upon their carers. The community-based service, although it involved extra costs to the social services department, had lower costs for the health service and society as a whole than long-stay hospital provision. It is concluded that the model of care can effectively integrate the new approach of case management into an existing geriatric multidisciplinary team.

Activities of Daily Living↗
PubMed1991

Case finding in elderly people: validation of a postal questionnaire.

A continuing concern of primary care is to produce economical methods of case finding among elderly patients to reduce unmet need in practice populations. This paper reports the use of a postal questionnaire to identify high dependency groups and the use of statistical methods to produce a formula which weights the relative importance of different items in identifying patients with a high level of dependency. It appears possible to identify such high dependency cases reliably at the cost of assessing between one half and two thirds of the population aged 75 years and over.

Activities of Daily Living↗
PubMed1984

Myeloproliferative and lymphoproliferative disorders in Tasmania, 1972-80: patterns in space and time.

During the period 1972-80, 866 patients with myeloproliferative (MP) and lymphoproliferative (LP) disorders were diagnosed in Tasmania. The residential histories of these cases were compared with those of population-based controls. No space-time clustering was demonstrated by individuals of any single diagnosis or group of diagnoses, nor were any regional differences in incidence detected. However, urban-rural differences were observed. Rural exposures were important especially in early childhood and at specific intervals before onset for certain diagnoses. Farm residence in early life yielded heightened relative risks, especially for sufferers from chronic lymphocytic leukemia and acute nonlymphoblastic leukemia. Regional analysis demonstrated elevated risks of residence in orcharding and dairying regions and in an urban-industrial municipality. High risks were associated with latent periods before diagnosis. The findings suggest environmental agents, acting prenatally or in early life, as well as in adult life, as important risk factors in the later development of MP and LP disorders.

Adult↗
PubMed1976

Clinical comparison between glucose and sucrose additions to a basic electrolyte mixture in the outpatient management of acute gastroenteritis in children.

In a double-blind trial in 94 children attending outpatients the value of glucose or a sucrose addition to a basic electrolyte mixture for the management of acute gastroenteritis was compared. Of the children treated with added sucrose 10% failed to respond compared with 27% of those treated with added glucose. This difference was significant (P=0-05), but the time to recovery in those in the two groups who responded to treatment was not significantly different. Thus, despite theoretical advantages, there was no practical advantage in using glucose rather than sucrose. A 5% sucrose electrolyte solution with its relatively low osmolality, ready availability, and ease of preparation is recommended as the treatment of choice in the outpatient management of acute gastroenteritis in infancy.

Child, Preschool↗