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Biomedical subjects

D Jewell

Publications and source records attributed to D Jewell.

At least 73 records · Page 4Linked to original sources
PubMed1994

A comparison of budesonide with prednisolone for active Crohn's disease.

BACKGROUND: Patients with active Crohn's disease are often treated with corticosteroids, but the treatment has many side effects. Budesonide is a potent, well-absorbed corticosteroid, but because of a high rate of first-pass metabolism in the liver, its systemic bioavailability is low. METHODS: We conducted a randomized, double-blind, 10-week trial comparing the efficacy and safety of an oral controlled-release form of budesonide with the efficacy and safety of prednisolone in 176 patients with active ileal or ileocecal Crohn's disease (88 patients in each treatment group). The dose of budesonide was 9 mg per day for eight weeks and then 6 mg per day for two weeks. The dose of prednisolone was 40 mg per day for two weeks, after which it was gradually reduced to 5 mg per day during the last week. RESULTS: At 10 weeks, 53 percent of the patients treated with budesonide were in remission (defined as a score < or = 150 on the Crohn's disease activity index), as compared with 66 percent of those treated with prednisolone (P = 0.12). The mean score on the Crohn's disease activity index decreased from 275 to 175 in the budesonide group and from 279 to 136 in the prednisolone group (P = 0.001). Corticosteroid-associated side effects were significantly less common in the budesonide group (29 vs. 48 patients, P = 0.003). Two patients in the prednisolone group had serious complications (one had intestinal perforation and one an abdominal-wall fistula). The mean morning plasma cortisol concentration was significantly lower in the prednisolone group than in the budesonide group after 4 weeks (P < 0.001) and 8 weeks (P = 0.02) of therapy, but not after 10 weeks. CONCLUSIONS: Among patients with active Crohn's disease, both controlled-release budesonide and prednisolone are effective in inducing remission. In this trial, prednisolone reduced scores on the Crohn's disease activity index more, whereas with budesonide there were fewer glucocorticoid-associated side effects and less suppression of pituitary-adrenal function.

Adult↗
PubMed1994

Review of 39 years of randomized controlled trials in the British Journal of General Practice.

BACKGROUND: Randomized controlled trials are being used increasingly to evaluate the effectiveness of health care interventions, including those in primary care. AIM: A study was undertaken to document the topic areas addressed by randomized controlled trials conducted in primary care and the methodological characteristics of these, based on a historical review of all trials published in the British Journal of General Practice (formerly the Research Newsletter and Journal of the Royal College of General Practitioners) between 1953 and 1991 inclusive. METHOD: Trials were identified by systematically hand searching all back issues. RESULTS: A total of 90 randomized controlled trials were identified, 78% of which were undertaken in general practice. The trials covered a wide range of topics; 62% examined pharmacological interventions, 21% non-pharmacological interventions, and 16% an intervention related to provision of an aspect of health service. Among the randomized controlled trials published there was a significant trend towards more reports on non-pharmacological trials in recent years (P < 0.001). The quality of trials, judged by the extent to which bias was controlled, varied considerably. Trials of pharmacological interventions generally controlled for selection bias at entry and at assessment of outcome more effectively than trials of non-pharmacological interventions. CONCLUSION: Some imaginative solutions to the logistic difficulties of conducting randomized trials in general practice were noted. These may serve as an incentive to those undertaking such studies in the future.

Community Health Services↗
PubMed1994

An analysis of randomized controlled trials published in the US family medicine literature, 1987-1991.

BACKGROUND: Randomized controlled trials (RCTs) are frequently used to evaluate the effectiveness of health care interventions in family medicine. The value of the information obtained from RCTs depends largely on the quality of design and the way in which they are conducted and reported. Despite the increasing number of RCTs being conducted in family medicine, there is a scarcity of descriptive data on the methodological characteristics, including design features and quality of RCTs in this setting. METHODS: All 55 RCTs published in four peer-reviewed US family medicine journals between 1987 and 1991 were identified and their methodological characteristics reviewed. Three potential sources of bias were assessed in each of the trial reports: (1) control of selection bias at entry, (2) control of selection bias after entry, and (3) control of bias in assessing outcome(s). RESULTS: Fifty-five RCTs published between January 1987 and December 1991 were identified in the four journals. The absolute number of RCTs published over the 5 years increased steadily, and there was a 49% increase in the proportion of RCT articles. Measures used to control for selection bias before entry into the study were reported in 14 (25%) of the RCTs, the statistical power of the trial in 5 (9%), and whether the study had been reviewed by an institutional review board in 6 (11%). CONCLUSIONS: The RCTs analyzed offered some imaginative solutions to the logistic difficulties of conducting RCTs in general practice. Nevertheless, the methodology and reporting of RCTs in the future should be improved.

Bias↗
PubMed1991

Contribution of general practitioners to hospital intrapartum care in maternity units in England and Wales in 1988.

OBJECTIVE: To ascertain the contribution of general practitioners to hospital intrapartum care in 1988. DESIGN: Confidential postal questionnaire. SETTING: All maternity units in England and Wales. MAIN OUTCOME MEASURES: Type of general practitioner unit (if any); number of bookings, transfers, and deliveries by general practitioners; participation of general practitioners in the policy and audit of the unit. RESULTS: 277 (93%) of 297 units replied. Of 611,644 deliveries, 36,043 (5.9%) were under general practitioner care. In all, 228 units permitted general practitioners to book women under their sole care: 65 were isolated, 29 alongside, and 134 integrated general practitioner units. Alongside units had significantly more bookings (568), antenatal transfers (69), intrapartum transfers (86), and deliveries (387) compared with isolated units (185, 18, 16, and 125, respectively) and integrated units (106, 18, 18, and 52) (p less than 0.001 for all differences). The percentage of women booked by general practitioners transferred either before or during labour was independent of both the type of unit and the number of general practitioner bookings. General practitioners in consultant units were significantly less likely to attend meetings reviewing perinatal mortality (p less than 0.01), and these units were less likely to have any form of general practitioner-consultant liaison committee (p less than 0.001) compared with general practitioner units as a whole. Compared with those in isolated and alongside units, general practitioners in integrated units were less likely to have taken part in deciding the unit's booking policy (p less than 0.01) and consultants more likely to be the final determinant of whether a general practitioner should be permitted to practice within the unit (p less than 0.001). CONCLUSIONS: Both the number of deliveries booked by general practitioners and the number of isolated general practitioner units have fallen. Transfer from general practitioner to consultant care was independent of the general practitioner unit's caseload or the type of unit. General practitioner units differ from consultant units in important ways and differ among themselves as well. Except in remote areas, alongside units may be the ideal type of unit to encourage general practitioners to continue to provide intrapartum care.

Delivery Rooms↗
PubMed1991

Lymphocyte subset reference ranges in adult Caucasians.

We report here the distributions of lymphocyte populations bearing the following antigens: CD3 (T cells), CD19 (B cells), CD4 (T helper/inducer cells), CD8 (T suppressor/cytotoxic and some NK cells), and CD3-, CD16+, and/or CD56+ (NK cells). At four sites, analyses were performed on healthy, normal subjects between the ages of 18 and 70, using identical flow cytometry systems and techniques. Reference ranges (unadjusted for sex differences and age variation) are CD3 (61 to 85%), CD19 (7 to 23%), NK (6 to 29%), CD4 (28 to 58%), and CD8 (19 to 48%). The lymphocyte subpopulation distributions for all antigens were found to be similar at all sites. By combining data from all sites, it has been possible to estimate age variation and sex differences for each of these subpopulations. Age and sex associated differences are substantial for some lymphocyte subsets (CD3, CD4, NK cells), and proper accounting of these effects is essential in evaluating the individual patient, if further disease-related variation is to be accurately and consistently assessed. It appears possible to recommend reference ranges for lymphocyte population parameters applicable across national and laboratory boundaries. These ranges provide a basis for comparing results from different institutions and for combining such results on subjects and patients from several institutions, provided the methodology and equipment are identical at all sites.

Adolescent↗
PubMed1991

Medical hazards of a four-km fun run.

An observational study was conducted of participants in a 4-km race with the object of identifying risk factors for a poor outcome. Sixteen individuals were identified who required medical assistance at the end of the race. Pulse and lying and standing blood pressure were measured and a brief history was taken. Compared with 92 controls, the subjects showed a greater orthostatic drop in systolic blood pressure and were more likely to have consumed alcohol in the preceding 24 h.

Adult↗
PubMed1990

Prepregnancy and early pregnancy care.

There is ample evidence to support the familiar message offered to women early in pregnancy that they should stop smoking, limit their alcohol intake to less than two units daily, avoid all unnecessary drugs and eat a normal well-balanced diet. They may continue to take exercise and work (in almost all occupations) without any risk to the fetus. For doctors the challenge is to balance their wish to pass on the scientific evidence with the obligation to address the concerns and needs of their individual patients. Routine screening in early pregnancy should be continued for syphilis and rubella, but the benefits do not justify it for other infectious illness, including urinary tract infection. The arguments for screening for toxoplasmosis in pregnancy are finely balanced; if more effective treatment were available then screening might become worthwhile. Provided a full screening programme for cervical cancer is achieving reasonable coverage for the adult female population, there is no need for additional screening in pregnancy. Unplanned and unwanted pregnancy is a substantial problem in the United Kingdom and will continue to be so. For those that request it, termination is a safe procedure with low morbidity, especially when carried out early on. Women with unplanned pregnancies are entitled to advice from their doctors in order to help them decide whether they want a termination or not.

Abortion, Legal↗
PubMed1989

Bleeding in early pregnancy.

Bleeding in pregnancy is a distressing experience for any woman, particularly if she has had a previous miscarriage. Though often offered, hospital admission is thought to have no prognostic advantage over home management. A factor not always considered is the need for administration of anti-D immunoglobulin to rhesus-negative women.

Abortion, Threatened↗
PubMed1989

Growth hormone treatment reduces total body fat accumulation in Zucker obese rats.

Lean and obese Zucker rats were injected daily intraperitoneally with high doses (5-10 mg/kg) of human growth hormone (GH) for 3 weeks. In the obese rats after GH treatment, carcass lipid was decreased by 50 percent, and bone weight increased to levels of lean controls. During the last two weeks of GH treatment, food intake was increased in lean rats and not significantly affected in obese rats. Loss of body weight in obese animals was masked by water retention. Serum insulin concentrations were doubled in obese animals but unchanged in lean phenotypes after GH treatment. Hepatic fatty acid oxidation in obese animals was stimulated 5-fold by treatment, while hepatic lipid synthesis was stimulated 2-fold and adipose lipid synthesis was reduced 3-fold. These results suggest that growth hormone induces a partitioning of nutrients in obese rats which results in less lipid accumulation.

Adipose Tissue↗