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D Lowe

Publications and source records attributed to D Lowe.

215 records · Page 12Linked to original sources
PubMedDate not supplied

Stopping rules for clinical trials.

We describe a new method of formulating stopping rules for clinical trials, one that incorporates opinion on what difference is clinically important. We compare the method with conventional group sequential designs and illustrate it by application to a study of Pancuronium Bromide for prevention of haemorrhage in pre-term infants.

Clinical Trials as Topic↗
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A prospective, randomised trial of preoperative rectal diclofenac: are we closing the gate after the horse has gone?

BACKGROUND: Diclofenac sodium is a non-steroidal anti-inflammatory agent commonly used to provide analgesia post-surgery. It is common clinical practice to administer a diclofenac suppository at induction to contribute to pre-emptive analgesia (PEA). Diclofenac takes up to 30 minutes to attain maximal plasma level after rectal administration. AIM: To compare post-operative analgesia in patients who received diclofenac 30-45 minutes preoperatively, or at induction of anaesthesia. METHODS: A prospective, randomised, double-blind controlled trial in 157 patients undergoing varicose vein surgery. Group A (control) received a rectal placebo 30-45 minutes preoperatively, group B received diclofenac 100 mg 30-45 minutes preoperatively and group C received placebo 30-45 minutes preoperatively and diclofenac 100 mg at induction. Outcome measures were Visual Analogue Scores (VAS) and requirement for rescue analgesia. RESULTS: Patients in group A had significantly poorer analgesia than patients in groups B and C. There were no significant differences in VAS values and requirements for rescue analgesia between groups B and C 3-4 hours and 18-22 hours postoperatively. CONCLUSION: For patients undergoing varicose vein surgery preoperative administration of rectal diclofenac significantly improves post-operative analgesia and this effect is independent of whether it is given at induction or 30-45 minutes preoperatively.

Administration, Rectal↗
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An evaluation of factors affecting Helicobacter pylori prevalence in Tibetans exiled in India.

Helicobacter pylori infection is found world-wide although the epidemiology of infection has not been well defined in many geographical areas. The aims of this study were to determine the prevalence of H. pylori infection and chronic gastritis and the demographic correlates of infection in a single racial group in southern India. The sample population was selected randomly from the male population register of a Tibetan refugee settlement. Demographic data and results of endoscopy with antral mucosal biopsy were evaluated in 197 subjects (median age 28, range 21-81 years). H. pylori was present in 77.2% of subjects by histology and/or urease test. Chronic gastritis and H. pylori were closely related and there was an association between the number of bacteria present and the severity of the gastritis (P < 0.04). Infection with H. pylori was inversely associated with socio-economic factors, specifically educational level (P < 0.02) and occupation (P < 0.02). Unlike other studies, the prevalence of H. pylori was not found to rise with age, being lower in those older than 40 years (P < 0.005). This difference was still apparent when adjusted for socio-economic status. The major demographic difference between younger and older subjects of low socio-economic status was the greater proportion of early life spent outside India (and in Tibet) by older subjects. Among younger subjects, residence in India for 20 years or more was associated with a greater risk of H. pylori infection (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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Tonsillectomy technique as a risk factor for postoperative haemorrhage.

BACKGROUND: Tonsillectomy is one of the most frequent surgical procedures. "Hot" tonsillectomy techniques (eg, diathermy and coblation) have become well established, but there is little evidence to suggest that they are better than traditional "cold steel" dissection with only packs or ties for haemostasis. METHODS: We obtained data for the occurrence of complications after all tonsillectomies done since July, 2003, in England and Northern Ireland. We recorded postoperative haemorrhages and other complications, taking place within 28 days of surgery, that led to delayed discharge, return to theatre, or re-admission. By February, 2004, the audit had included 13554 patients, of whom 11796 (87%) in 252 hospitals consented to electronic submission of their tonsillectomy data. Thus, 75% of the hospitals where tonsillectomies are done submitted data for 60% of all eligible patients. FINDINGS: Haemorrhage occurred in 389 patients (3.3%). 59 patients (0.5%) had a primary haemorrhage (during initial stay), 337 (2.9%) a secondary haemorrhage (after discharge), and seven had both. The overall haemorrhage rate was 3.1 times (95% CI 1.9-5.0) higher with bipolar diathermy tonsillectomy than with cold steel tonsillectomy without any use of diathermy (p<0.001). The corresponding relative risk for coblation tonsillectomy was 3.4 (1.9-6.2; p<0.001). When cold steel was used for dissection and diathermy only for haemostasis the relative risk was 2.2 (1.3-3.7; p=0.002). INTERPRETATION: The use of techniques such as diathermy and coblation increased postoperative haemorrhage. These methods should therefore be used with appropriate caution and only after proper training.

Adolescent↗
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Multidrug resistance in the embryos and larvae of the mussel Mytilus edulis.

Cells exhibiting the multidrug resistance (MDR) phenotype demonstrate a decreased intracellular drug accumulation due to an active outward transport and decreased intracellular flux. This study demonstrates the inhibition of MDR in mussel (Mytilus edulis) embryos and larvae based on a simple bioassay. The development of embryos was assessed and abnormalities identified at key stages of development, including gastrulation, trochophore and prodissoconch stages. The incidence of developmental abnormalities was significantly increased in the presence of vinblastine, MMS, chloroquine, mitomycin-C, cadmium chloride and colchicine, compared to clean seawater. Consistently, there was a further increase in the number and severity of deformities observed when each toxin was added in the presence of verapamil. Larval growth was also significantly impaired in the presence of verapamil. Increased accumulation of fluorescent MDR dyes, such as rhodamine B, has been measured and shown to be verapamil sensitive. This bioassay encompasses a period of intense cellular activity during which the impairment of a number of critical processes results in abnormal growth and development.

Animals↗
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Histopathology of the skin of UV-B irradiated sole (Solea solea) and turbot (Scophthalmus maximus) larvae.

Larval stages of two economically important flatfish, the sole (Solea solea) and turbot (Scophthalmus maximus) were exposed to ambient and elevated levels of UV-B. Sole larvae, which naturally occur in the plankton in early spring, demonstrated skin lesions at elevated levels of UV-B. Histopathology of the sole revealed cellular changes in the integument, characteristic of sunburn damage, with a reduction in the size of mucus-secreting cells and an increased epidermal thickening, especially at the highest doses of UV-B (2.15 KJ bio eff/m2). Pigmentation in the sole is restricted to a few isolated melanocytes. The integrity of the heavily pigmented skin of turbot appeared to be unaffected by comparable doses of UV-B. Both species have protective mechanisms, which minimize the effects of naturally-occurring levels of UV-B. However, sole appear to be poorly adapted to accommodate any further increase in solar radiation.

Adaptation, Physiological↗
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A review of scaphoid fracture healing in competitive athletes.

A fractured scaphoid is a common disabling injury occurring in contact sports. Plaster immobilization is the most frequently used form of therapy. However, the rules governing most amateur sports do not allow an unyielding form of immobilization distal to the elbow. We describe a method of treating scaphoid fractures with custom-made Silastic (Dow Corning Wright, Arlington, TN) casts for competitive athletes. A retrospective review of 14 scaphoid fractures occurring in athletes competing in contact sports was completed to determine if effective immobilization could be maintained with this technique. The study covered a 10 year period with an average followup of 3.9 years (range 2 to 9 years). Ten of 11 middle third scaphoid fractures healed uneventfully. One nonunion occurred following a 7 week delay in diagnosis. Two of three proximal third scaphoid fractures went on to nonunion, while the third healed after a prolonged period of treatment. Our data indicate that nondisplaced middle third scaphoid fractures can be effectively immobilized for competition in contact sports with the custom-made Silastic cast described.

Adult↗
PubMedDate not supplied

Syringe pumps and start-up time: ensuring safe practice.

The start-up time is the delay between starting an infusion pump and the delivery of fluid at the set flow rate. Mechanical slack in syringe pumps can lead to start-up delays of an hour or more at low-flow rates. During this period no medication is delivered to the patient. The causes of the start-up time delay, its implications and methods of minimising the delay are explained.

Documentation↗
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The national sentinel audit for stroke: a tool for raising standards of care.

STUDY OBJECTIVE: To assess the quality of inpatient care and follow-up for stroke in England, Wales and Northern Ireland. DESIGN: Retrospective audit of case notes and service organisation. SETTING: 197 trust (80% of eligible trusts in England, Wales and Northern Ireland). PATIENTS: 6,894 consecutive stroke patients admitted between 1 January 1998 and 31 March 1998 (up to 40 per trust). AUDIT TOOL: The Intercollegiate Stroke Audit. RESULTS: Most patients were admitted to acute hospitals with access to the appropriate acute investigations and treatments. Only 64% of trusts had a physician with responsibility for stroke and only 50% had a stroke team. Involvement of different members of the multidisciplinary team within appropriate time-frames varied from 37% to 61%. Assessment of impairments specific to stroke was inadequate (screening for swallowing disorders in only 55%, cognitive function tests in 23% and visual field examination in 44%). Rehabilitation goals were agreed by the multidisciplinary team in only 55% of eligible cases. 41% of patients were contacted by their GP within 3 days of discharge. The best compliance with standards was achieved for the 18% of patients who spent at least 50% of their time in a stroke unit. CONCLUSIONS: This national audit demonstrates that care is suboptimal in many areas, and that there is wide variation in standards for the management of stroke across the country. This may have implications for clinical governance.

Aftercare↗