Biomedical subjects

Helen Thorpe

Publications and source records attributed to Helen Thorpe.

4 recordsLinked to original sources

PubMed2006

Hand aging: patients' opinions.

BACKGROUND: The purpose of this article is to identify factors that make hands look youthful or old and to assess whether altering any of these factors could influence the perceived age of the patient. METHODS: A questionnaire showing digital images of female hands of different ages was administered. Some images were altered digitally to remove veins, blemishes, or wrinkles. Makeup and jewelry were added to others. A total of 93 questionnaires were completed. Statistical analysis of results with chi-square test was performed. RESULTS: Wrinkles, veins, prominent joints, thin skin, deformity, and spots characterized old hands. Fullness, lack of veins, and lack of wrinkles characterized young hands. Images with veins removed looked younger than the originals, and this was statistically significant in all cases. Images with added makeup and jewelry were also felt to look younger, but this was not statistically significant. Alterations to images of very elderly hands did not make them look younger. CONCLUSIONS: The authors have established factors that characterize the age of hands and established that hands with less visible veins, in general, look younger. Previous articles have claimed that fat grafting reduces the visibility of veins.

Adolescent↗

PubMed2005

Minimization--reducing predictability for multi-centre trials whilst retaining balance within centre.

Minimization is often used to assign patients to treatment groups to ensure good balance in patient numbers within centre and other prognostic factors. Balance within centre is preferable since large imbalances between treatment arms may have logistical implications for centres, such as cost and resource implications. However, recent concern over high predictability of treatment allocation by centres when using minimization has caused this method to be questioned. We used data from current clinical trials to assess predictability and summarize subsequent within-centre imbalances with the aim of finding the most effective minimization method for reducing predictability whilst still retaining sufficient balance within centre, when randomization is to one of two treatments. We compared prediction rates and imbalances for deterministic minimization, and minimization incorporating various random elements, p (p=0.95,0.90,0.80,0.75,0.70). We also compared prediction rates and imbalance when centre was and was not included as a stratification factor. Incorporating a random element proved successful in reducing prediction rates whilst minimizing the inevitable increase in within-centre imbalance, whereas excluding centre as a stratification factor incurred major within-centre imbalance. We therefore suggest that minimization can still be used, and that centre can be included as a stratification factor, but a random element has to be incorporated into the minimization algorithm. Minimization incorporating a random element of 0.80 is the most efficient method to use based upon the simulations undertaken in this study of real clinical trial data using different probabilities of allocation.

Algorithms↗

PubMed2005

Reliability of pressure ulcer classification and diagnosis.

AIM: To assess the inter-rater reliability of the PRESSURE Trial pressure ulcer diagnosis (>/=Grade 2) and skin classification for all grades between the clinical research nurse (CRN) team leader and CRNs working across different hospital sites; and CRNs and ward-based nurses. BACKGROUND: The United Kingdom National Health Service Health Technology Assessment Programme has funded a multi-centre, randomized controlled trial to compare the clinical and cost-effectiveness of alternating pressure mattress overlays and mattress replacements - PRESSURE Trial. Outcome skin assessments were recorded by qualified ward-based nurses daily, and expert CRNs twice weekly. METHOD: Paired assessments were undertaken and skin assessed on seven body sites. The per cent agreement between nurses in the diagnosis of a pressure ulcer was determined and the Kappa statistic and confidence intervals calculated. Per cent agreement between nurses in classifying skin for all grades was also determined. RESULTS: Assessments were undertaken by 378 pairs: 16 paired patient assessments (107 site comparisons) by the CRN team leader and CRNs, and 362 paired patient assessments (2396 site comparisons) between CRNs and ward-based nurses. There was 100% agreement between the CRN team leader and CRNs in the diagnosis of a pressure ulcer, and the Kappa statistics indicated 'very good' agreement. There were only two (1.9%) disagreements in classifying skin for all grades between these nurses. The agreement in the diagnosis of a pressure ulcer between CRNs and ward-based nurses varied by skin site, ranging from 93.6% to 100%, with the Kappa statistics indicating 'good' and 'very good' agreement. However, there were 508 (21.2%) disagreements in classifying skin for all grades. CONCLUSIONS: Overall agreement and Kappa statistics indicated 'very good' and 'good' agreement between expert nurses, and between expert nurses and qualified ward-based staff, respectively. However, the high prevalence of normal skin concealed clinically important disagreements in both the diagnosis of pressure ulcers and skin classification for all grades.

Buttocks↗

PubMedDate not supplied

Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.

BACKGROUND: Laparoscopic-assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use. We compared short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer to predict long-term outcomes. METHODS: Between July, 1996, and July, 2002, we undertook a multicentre, randomised clinical trial in 794 patients with colorectal cancer from 27 UK centres. Patients were allocated to receive laparoscopic-assisted (n=526) or open surgery (n=268). Primary short-term endpoints were positivity rates of circumferential and longitudinal resection margins, proportion of Dukes' C2 tumours, and in-hospital mortality. Analysis was by intention to treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN74883561. FINDINGS: Six patients (two [open], four [laparoscopic]) had no surgery, and 23 had missing surgical data (nine, 14). 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively. 143 (29%) patients underwent conversion from laparoscopic to open surgery. Proportion of Dukes' C2 tumours did not differ between treatments (18 [7%] patients, open vs 34 [6%], laparoscopic; difference -0.3%, 95% CI -3.9 to 3.4%, p=0.89), and neither did in-hospital mortality (13 [5%] vs 21 [4%]; -0.9%, -3.9 to 2.2%, p=0.57). Apart from patients undergoing laparoscopic anterior resection for rectal cancer, rates of positive resection margins were similar between treatment groups. Patients with converted treatment had raised complication rates. INTERPRETATION: Laparoscopic-assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to produce similar long-term outcomes. However, impaired short-term outcomes after laparoscopic-assisted anterior resection for cancer of the rectum do not yet justify its routine use.

Aged↗