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Biomedical subjects

D Machin

Publications and source records attributed to D Machin.

At least 127 records · Page 7Linked to original sources
PubMed1991

A Medical Research Council phase II trial of alternating chemotherapy and radiotherapy in small-cell lung cancer. The Medical Research Council Lung Cancer Working Party.

In a non-randomised study in six centres in the UK, 24 patients with previously untreated small-cell lung cancer of limited extent were treated with a regimen of alternating chemotherapy and radiotherapy to assess response, toxicity, and the feasibility of applying such a regimen on a multicentre basis in the UK. The intention was to give six courses of chemotherapy on five consecutive days at 4-week intervals: etoposide 75 mg m-2 on days 1, 2, and 3; doxorubicin 40 mg m-2 on day 1; cisplatin 100 mg m-2 on day 2; and cyclophosphamide 300 mg m-2 on days 2, 3, 4 and 5. A dose of 20 Gy thoracic radiotherapy was to be given following the 2nd and the 3rd courses, and one of 15 Gy following the 4th course. After 12 patients had been admitted, the cisplatin dosage was reduced to 80 mg m-2 because of unacceptable toxicity. Two patients were withdrawn during treatment on review of their histology because their diagnosis was found to be incorrect. Only one patient of the 12 treated with cisplatin 100 mg m-2 was able to complete treatment, compared with five of the eligible ten given the lower dosage. Among the 22 patients with confirmed small-cell disease, a complete response was reported in 14 (64%) and a partial response in a further three (total response rate 77%). Myelosuppression was the commonest serious adverse effect. It occurred in 19 of the 24 patients and gave rise to septicaemia in five, four of whom were receiving the higher cisplatin dose. Sixteen patients required blood transfusion and ten platelet transfusion. Vomiting, oesophagitis, and peripheral neuropathy occurred in 12, four and four patients, respectively, and radiation pneumonitis developed in two. Treatment was considered a contributory cause of death in four. The working party concluded that the alternating regimen was feasible in only a small proportion of centres in the UK, and decided not to embark on a multicentre randomised trial comparing alternating with conventional scheduling.

Activities of Daily Living↗
PubMed1990

The use of logit models to investigate social and biological factors in infant mortality. V: A multilogit analysis of stillbirths, neonatal and post-neonatal mortality.

Infant mortality data for England and Wales, cross classified by mother's age, parity and social class were published for 1949/50 and 1975. Previous analyses of these data have been based on graphical, tabular and logit models of stillbirths, neonatal and post-neonatal deaths separately. This paper summarizes the overall changes in infant mortality using a multilogit model. The model selected is illustrated by appropriate graphical presentations.

Adolescent↗
PubMed1990

Inequalities in health: socioeconomic differences in self-reported morbidity.

Socioeconomic differences in self-reported chronic and acute illness were investigated in men and women using data from the General Household Surveys (1981-4). Logit models were used to investigate the influence of age, socioeconomic group, tenure, access to cars, area of residence and marital status on these measures of morbidity. For both measures local authority tenants, whether male or female, reported the most morbidity as did those with no access to cars. Both males and females reported increasing levels of illness the lower their socioeconomic group but similar patterns were not observed with acute illness. The significance of these present day inequalities is discussed.

Adolescent↗
PubMed1990

Improving house physicians' assessments of self-poisoning.

A questionnaire was developed to help the assessment of patients who take overdoses. Twenty-four house physicians in Southampton university hospitals were randomly divided into a group who used the questionnaire and another group who asked whatever questions they felt appropriate. One hundred and fifty patients who had taken overdoses were included in the study. After the house physician's assessment, a research assistant interviewed all of the patients and the two assessments for each patient were then compared. There was greater agreement between the research assistant and the house physicians who used the questionnaire than those who interviewed patients in an unstructured way with respect to assessments of severity of depression, purpose of the act, suicidal intent, diagnosis, and future management.

Adult↗
PubMed1989

Heart valve measurement at autopsy can distinguish cardiac from non-cardiac causes of death.

The circumferences of the four intact cardiac valves were measured during 397 coroner's autopsies using an obturator cone to assess the value of this measurement in the postmortem diagnosis of cardiac disease. Valve sizes of cases with cardiac and noncardiac causes of death were compared using logistic regression to assess the effects of confounding variables including sex, age, height, build and the presence of chronic obstructive airways disease. Mitral valve enlargement was found to be significantly associated with cardiac death, as were build, age, and sex. Measurement of the mitral valve at autopsy can help distinguish cardiac from noncardiac causes of death.

Age Factors↗
PubMed1988

The autopsy: a useful tool or an old relic?

In a combined retrospective and prospective study, clinical and autopsy data were collected to assess the changes in autopsy rate in recent years, the attitudes of clinicians and pathologists to the autopsy, and the accuracy of ante-mortem diagnosis when compared with autopsy findings. Between 1962 and 1986, the total autopsy rate for hospital patients remained relatively constant, with an increase in Coroner's and a decrease in the hospital autopsy rate. Analysis of 5064 deaths over a 6-year period showed a significantly greater number of males than females coming to autopsy and a decrease in autopsy rate with age for both sexes. Attitudes to the autopsy were assessed using a questionnaire. The majority of clinicians considered the autopsy to be an important investigation despite new diagnostic techniques and confirmed its value in teaching and research. Seventy-seven per cent agreed that autopsy findings occasionally led to modification of the treatment of subsequent patients with the same condition. Pathologists disagreed that the autopsy is outdated in its present form and considered that not enough hospital autopsies are being requested. They also upheld its use and value in education. The cause of death as given by clinicians for a group of 60 patients was inaccurate in 12 cases.

Adult↗
PubMed1988

Improving the quality of data in randomized clinical trials: the COMPACT computer package. COMPACT Steering Committee.

One crucial component for a successful clinical trial is that the data gathered have a high level of reliability and completeness. This paper reviews some problems of data management and describes the computer package COMPACT which has been developed to deal with such problems. The package allows range and consistency checks and can monitor complex follow-up schedules. A unique feature of the package is a PROBLEMS file which has use both for identification of queries about the data and of patients with particular characteristics of interest. The ability to monitor drug dosages and to signal deviations from the protocol is of particular value. COMPACT has the syntax necessary to create a 'flat' file for transfer to statistical packages for analysis, and the variable description files for SAS, SPSS and MINITAB. The package is written in standard FORTRAN which enables transfer to different types of mini and micro computer systems.

Clinical Trials as Topic↗
PubMed1988

A micro-computer software for the analysis of menstrual diaries: the menstrual diary system.

A microcomputer software was developed to analyse menstrual diaries following the reference period method as described in the article "The analysis of vaginal bleeding patterns induced by fertility regulating methods" published in this journal (Contraception, 34:253-260, 1986). The programme allows the analysis of groups of diaries selected according to subjects' characteristics recorded at commencement of the diary. It also offers flexibility in selecting options of analysis within the reference period method. The output can be presented graphically as Box-whisker plots. A tutorial is included in the package.

Contraception↗
PubMed1988

Assessing changes in vaginal bleeding patterns in contracepting women.

In clinical trials comparing alternative contraceptive methods, women often discontinue for disturbances in menstrual bleeding patterns. Vaginal bleeding diaries have been used to monitor these patterns, and this paper suggests two new methods of analysis of these data. One analysis measures trends over time in the occurrence of specific patterns and, a second analysis, the relation between a woman's current experience and the probability of continuing method use. Contrasts between these approaches and the reference period method of analysis are made. A randomised clinical trial of the relative efficacy of 100 and 150 mg doses of depot-medroxyprogesterone acetate (DMPA) is used for illustration.

Amenorrhea↗
PubMed1987

Socioeconomic differentials in the uptake of medical care in Great Britain.

Socioeconomic differentials in the uptake of medical care in men were investigated using data from the General Household Survey (1974-76 and 1979-80). Hospitalisation, attendance at out patient clinics, and consultation with doctors were higher in local authority tenants than in owner occupiers. Men belonging to the manual socioeconomic groups also used services and consulted doctors more often than those in the non-manual groups. Hospitalisation among men was highest among manual workers living in local authority properties without access to car(s) (OR 1.92). Highest attendance at outpatient clinics (OR 1.60) was seen among local authority tenants in urban areas belonging to manual groups. However, consultation with doctors was highest among urban manual workers living in local authority properties but with access to car(s) (OR 1.72). The implications of these findings for resource allocation are discussed.

Health Services↗
PubMed1986

Randomised trial of compliance with screening for colorectal cancer.

A randomised trial of compliance with screening for colorectal cancer by means of the haemoccult test was conducted in Farnborough and Basingstoke districts. In each of the 14 participating practices (41 general practitioners) 25 852 men and women aged between 40 and 70 years were randomly allocated by household to one of six groups. The group determined the method of invitation to screening: a letter and the test were sent to the patient, or a letter with an appointment to attend the surgery was sent, or during a routine consultation the general practitioner invited patients to participate, and some patients received an educational booklet about bowel disorders and screening. Of the 17 824 people who were offered screening, 7545 (42%) complied. Compliance was significantly affected by the method of invitation, but not by whether an educational booklet was received, and was highest (57%) in the group that was offered the haemoccult test during a routine consultation (the "opportunistic" approach). In this group the compliance rate achieved by individual general practitioners ranged from 26% to 82%. Compliance was significantly higher in Farnborough, in the older (55-70) age group, in women, and in households in which two or more people were offered screening. The higher compliance in Farnborough may be explained by the higher proportion of older people and by the higher proportion of people living in households of two or more in the population that was offered screening. The fact that the screening programme in Farnborough was offered to the whole community and that the researcher may have acted as a facilitator were probably also important. One per cent of the patients screened had a positive test, and 24 (38%) of the 63 patients who were positive and were investigated in hospital had neoplastic disease. The yield was 1.2 cancers and 1.2 benign adenomas (1 cm or larger in size) per 1000 people screened. This low yield is likely to be a consequence of the relatively young age group screened.

Adult↗
PubMed1986

Use of check lists in assessing the statistical content of medical studies.

Two check lists are used routinely in the statistical assessment of manuscripts submitted to the "BMJ." One is for papers of a general nature and the other specifically for reports on clinical trials. Each check list includes questions on the design, conduct, analysis, and presentation of studies, and answers to these contribute to the overall statistical evaluation. Only a small proportion of submitted papers are assessed statistically, and these are selected at the refereeing or editorial stage. Examination of the use of the check lists showed that most papers contained statistical failings, many of which could easily be remedied. It is recommended that the check lists should be used by statistical referees, editorial staff, and authors and also during the design stage of studies.

Clinical Trials as Topic↗
PubMed1986

The analysis of vaginal bleeding patterns induced by fertility regulating methods. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction.

Contraceptive methods often induce disturbances in vaginal bleeding patterns which are the main reason for women to discontinue method use. Knowledge of these changes is essential for effective counselling and product development and necessitates adequate methods of collection and analysis of vaginal bleeding data. These issues were reviewed by clinicians, medical statisticians and computer analysts during several consultations organized by the World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction and their discussions are summarized in this paper. Recommendations are made on the use of menstrual diary cards for data collection. It is suggested that the analysis of menstrual patterns be based on the reference period method developed by Rodriguez et al. in 1976 to which several modifications in terminology and choice of summary statistics are proposed. While these are presented as the minimum required for the comparability of studies, other points of analysis are identified which need further study, in an attempt to stimulate research in this field by other investigators.

Clinical Trials as Topic↗
PubMed1986

Prospective testing of a scoring system designed to improve case selection for upper gastrointestinal investigation.

A recently described scoring system designed to assess the individual risk of finding serious pathology in patients referred for upper gastrointestinal investigation has been prospectively tested in 1279 patients undergoing first-time endoscopy and 321 patients undergoing radiologic examination. The scoring system has been confirmed to give a reasonable prediction of the likelihood of finding serious pathology in two hospitals with differing endoscopic practice, and also to be applicable to patients attending for radiology. The system works best at defining a low-risk group (score less than 412, 26% of total) in which the incidence of serious pathology was 3%. All cases of malignancy (n = 55) occurred in patients scoring greater than 464 (50% of total). A simple table is described that allows for the easy calculation of score at a glance without the use of a computer. We believe that this scoring system, which can be implemented in seconds, is the simplest yet described and that it could prove to be a useful educational aid.

Age Factors↗