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Biomedical subjects

E A Paul

Publications and source records attributed to E A Paul.

15 recordsLinked to original sources
PubMed1992

Equity and medical practice variation: relationships between standardised discharge ratios in total and for selected conditions in English districts.

STUDY OBJECTIVE: The aim was to investigate relationships for residents of English district health authorities between rates of discharges from acute hospitals for all conditions and variations in discharge rates for eight common conditions (five surgical, three medical). DESIGN: Hospital Inpatient Enquiry data on discharges for 1984 were analysed. Standardised discharge ratios (ratios of actual to expected numbers of discharges x 100) were derived for selected conditions and all conditions; and correlation coefficients for these statistics were calculated. Districts were grouped into quintiles according to the value of the standardised discharge ratio, and systematic variation within each quintile was calculated for the selected conditions. SETTING: The study involved all 192 English district health authorities, but 57 were excluded because the proportion of unspecified diagnoses exceeded 5%. PATIENTS: The analyses were based on 336,799 cases from 135 districts. MEASUREMENTS AND MAIN RESULTS: Discharge ratios for the medical conditions and one surgical condition were significantly correlated with the levels of total discharge rates (p less than 0.01). The medical conditions showed greater systematic variation in discharge ratios than the surgical conditions. There was no consistent pattern in the values of systematic variation for the selected conditions across the different levels of discharge ratios for all conditions. CONCLUSIONS: It is argued that the changes in the NHS introduced in April 1991 are intended to introduce greater equity in the standardised discharge ratios and increase the total numbers of discharges. The results of this analysis suggest that, even if these objectives were achieved, they may not result in increased levels of elective care, nor result in greater equity in terms of rates of discharge for individual conditions.

Acute Disease↗
PubMed1991

Portable oxygen therapy: assessment and usage.

Fifty portable oxygen assessments, based on 6-min walking tests, were reviewed to produce guidelines for assessment and prescription of portable oxygen, and to evaluate factors predicting benefit. Patients with a portable cylinder were questioned about benefits/difficulties and usage of portable oxygen. A significant improvement on the oxygen compared to the air walk was found (median 9.7%) which correlated with the oxygen desaturation on the baseline walk (r = 0.51, P less than 0.05). A placebo effect was demonstrated using an air cylinder (median improvement 6.1%). There was no correlation between improvement in walking distance and decrease in visual analogue scale (VAS) score of breathlessness. We recommend standard portable oxygen assessments based on a series of 6-min walks. Improvements of 10% in walking distance or VAS score from the oxygen to the air walk would lead to the patient being offered a portable oxygen cylinder.

Adult↗
PubMed1989

Multidimensionality of psychological recovery from anaesthesia. Analysing six recovery tests.

Six recovery tests, choice reaction time (CRT), CRT doubletask, finger tapping test (FTT), critical flicker fusion frequency (CFF), Maddox wing, and p-deletion test, which cover basic cognitive, motor and perceptive functions as well as concentration, were analysed and compared with each other. Correlation between these tests after recovery from standardised general anaesthesia was calculated in 22 patients. Moderate to high correlation was found between CRT and CRT doubletask (r = 0.62 to r = 0.73), when parameters of six different tests were compared. Finger tapping correlated moderately with the movement time of both the CRT and the CRT doubletask (r = 0.46 and r = 0.47 respectively). We concluded that the CRT test, which measures initiation and movement time, might replace the CRT doubletask and the FTT. The CFF correlated moderately with the initiation time of the CRT doubletask, but because a slightly different function seems to be involved, further research is needed. Maddox wing and the p-deletion test correlated with no other test. Results indicated that recovery is differentiated in at least four distinct psychomotor functions, which should be tested by CRT (to measure initiation and movement time), Maddox wing and p-deletion.

Adult↗
PubMed1989

Nondrug treatment of hypertension: a survey of black physicians in New York State.

A survey of 64 black physicians in New York State was completed in April 1988 concerning physicians' approach to the nondrug treatment of hypertension. The physicians clearly support the use of nonpharmacologic treatment of mild hypertension, particularly for patients with diastolic blood pressure of 90 to 94 mmHg. However, very little time appears to be spent counseling patients with respect to diet and weight reduction. There was considerable variability in the degree of confidence felt by physicians in recommending nondrug approaches to hypertension control. An overwhelming majority of physicians felt that their training did not adequately prepare them for counseling patients about diet specifically or for practicing preventive medicine generally. The findings of this survey suggest a need for significantly increased attention to training physicians during both medical school and residency in prevention, patient counseling, and health promotion.

Black or African American↗
PubMed1989

[Geographical variations in mortality due to diseases amenable to medical intervention in Europe--Commission of European Communities: atlas of avoidable deaths].

The urgent need to develop measures of the outcome of health-care services has led to the collaboration of 10 countries of the European Community in the production of the European Community atlas of avoidable death (1974-1978). Seventeen disease groups were chosen for which it was considered that death within specified age groups should be either wholly or substantially avoidable when appropriate medical care is sought and provided in good time. Mortality from these causes was compared across 360 health-service administrative areas in the participating countries. For all diseases there was considerable variation in mortality both within and between the countries of the European Community and it is suggested that high levels of mortality from these causes should be viewed by health authorities as warning signals of potential failures of health-care services. Work is in progress on a further edition of the Atlas for the years 1980-1984. Changes in avoidable mortality over time could indicate which health authorities have persistent problems and which authorities are succeeding in reducing avoidable mortality.

Adolescent↗
PubMed1988

Avoidable deaths.

Explore the source record for details and available documents.

Adolescent↗
PubMed1985

Assay of anti-cancer drugs in tissue culture: relationship of relapse free interval (RFI) and in vitro chemosensitivity in patients with malignant cerebral glioma.

One hundred and seventeen patients with cerebral glioma (Kernohan grades III and IV) were treated with adjuvant chemotherapy using procarbazine (PCB), CCNU and vincristine (VCR) following whole head irradiation. Cell cultures were prepared from 40 patients in this series and their sensitivity to each cytotoxic drug was assessed in a mictotitration assay with 35 S-methionine incorporation as the end point. Twenty-two of forty (55%) patients responded to PCB and/or CCNU in vitro, and sensitivity to these drugs was linked with increased RFI, whilst sensitivity to VCR was not. The RFI of patients who had responded to PCB or CCNU in vitro was significantly longer than the RFI of patients whose tumours failed to respond in vitro or patients who had not been tested. There was no difference in sex ratio, extent of operation, radiation dose and degree of steroid cover between responders, non-responders and untested groups. Grade III tumours tended to be more sensitive in vitro than grade IV tumours. The age of patients also influenced in vitro chemosensitivity. Patients with chemosensitive tumours in vitro tended to be younger than patients with insensitive tumours in vitro. Further statistical analysis, taking into account these prognostic factors, indicated an association between chemosensitivity in vitro and RFI.

Adult↗
PubMed1979

Central nuclear counts in muscle fibres before and during treatment in hypothyroid myopathy.

Serial percutaneous needle muscle biopsies of vastus lateralis were studied in 10 patients who had varying degrees of hypothyroid myopathy. The biopsies were taken before and during treatment with l-thyroxine. Before treatment the most severely clinically affected patients showed type II muscle fibre atrophy and loss, together with increased central nuclear counts preferentially affecting the type II muscle fibre. Both the type II muscle fibre atrophy and loss and the increased central nuclear counts tended to return towards normal values during treatment with l-thyroxine. The severity of myopathic symptoms before and during treatment correlated with the biochemical evidence of hypothyroidism, a type II fibre atrophy, and increased central nuclear counts. The severity of myopathic signs before and during treatment was correlated with both a type II fibre atrophy and loss and increased central nuclear counts. There was no evidence that the myopathic signs before and during treatment were related to the biochemical parameters of hypothyroidism, except the level of thyroid stimulating hormone. It is suggested that sequential studies of muscle fibre percentages, diameters, and central nuclear counts may provide an additional method of assessing the response to treatment in hypothyroid and possibly other types of myopathy. When increased central nuclear counts are confined to a specific muscle fibre type, this may suggest a hitherto unsuspected specificity of muscle fibre damage.

Adult↗
PubMed1979

L4/5 and L5/S1 disc protrusions: analysis of 323 cases operated on over 12 years.

A retrospective study of the results of excision of L4/5 and L5/S1 intervertebral discs in 323 patients operated on between January 1965 and January 1977 was undertaken. In every case the amount of disc excised was weighed immediately after operation. The patients had been followed up at the hospital for periods of between one and 14 years. As assessment was made of the clinical state of each patient at the end of follow-up. There was no evidence that the weight of disc excised affected the prognosis with respect either to the clinical state of the patient at the end of follow-up, or to the probability of recurrence of disc protrusion.

Adolescent↗
PubMed1977

Microscopic counting and adenosine 5'-triphosphate measurement in determining microbial growth in soils.

A microscopic technique utilizing dispersion of fungal hyphae in a Waring blender, filtration through membrane filters (Nucleopore Corp.), and counting on a fluorescence microscope was developed for counting fungal hyphal biomass. Nonfluorescent staining techniques of the soil-filter preparation did not give quantitative recoveries. Water-soluble aniline blue, which binds to the beta-1,3-glucans of the fungal cell wall, made visualization of the hyphae by fluorescence possible. A range of fungi added to soil were quantitatively recovered. Adenosine 5'-triphosphate (ATP) was extracted from soil by lysis of the organisms with CHCl(3) in NaHCO(3), which prevented adsorption of the organic phosphorus to the soil colloids. Centrifugation and removal of CHCl(3) was followed by dilution with pH 7.8 tris(hydroxymethyl)aminomethane buffer. ATP concentrations were measured by using the luciferase-luciferin light reaction. Since NaHCO(3) interfered to some extent with this reaction, the standards were made up in equivalent mixtures of tris(hydroxymethyl)aminomethane buffer and NaHCO(3). Recovery of ATP was rapid and quantitative in a range of soils. Measurement of the ATP and bacterial and fungal numbers in an incubated soil showed that fungal and bacterial population increases were delayed by phosphorus deficiency. Microbial populations were not affected at a later date. The ATP content of the soil system was reduced by phosphorus deficiency throughout the incubation period. This indicated that ATP could be altered without major changes in the microbial populations.

Adenosine Triphosphate↗
PubMed1975

Acute lymphoblastic leukaemia: cyclical chemotherapy with three combinations of four drugs (COAP-POMP-CART regimen).

Forty-two adults and children with previously untreated acute lymphoblastic leukaemia (ALL) were entered into a programme of chemotherapy in which three combinations, each of four drugs were administered in a predetermined cyclical rotation together with cranial irradiation and intrathecal injections of methotrexate. Forty-one patients (98%) entered remission and no patient developed neuroleukaemia. Relapse of ALL occurred in 10 patients, and three patients died during remission, while eight patients stopped treatment after two and a half years and have remained in remission for two to 26 months. Comparison of remission and survival experience in this mixed group of children and adults with the experience of children treated at Memphis and in the Medical Research Council's UKALL-I trial showed no significant differences. On the other hand, analysis by prognostic factors showed that neither age nor blast cell count at presentation had any adverse effect in patients treated in this study. No relapses occurred in nine patients with blast cell counts greater than 20 x 109/1 at presentation. This regimen is effective treatment for ALL and may be of special value in patients with poor prognoses. The regiment has not as yet proved superior for the treatment of children with ALL who do not have adverse prognostic features.

Adolescent↗