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Biomedical subjects

J Brazier

Publications and source records attributed to J Brazier.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees].

PURPOSE OF THE STUDY: We compared on lateral X-rays of 83 healthy knees, 6 methods measuring the tibial sagittal slope. Each method determined the tibial slope according to an independent anatomical axis. The goals of the study were to: 1) detect the differences between the 6 methods; 2) determine if any mathematical relation could be observed between the 6 methods; 3) compare accuracy of proximal anatomical axis versus long anatomical axis to evaluate the tibial slope. MATERIAL: 50 healthy patients (83 knees) knees were included in the study. The patients (26 male and 24 females) were 39.3 +/- 15.8 years old. METHODS: We obtained true lateral X-rays orientated with an image intensifier in order to obtain the exact superposition of the femoral condyles. The measurements were carried out by an observer according to two procedures: 1) by manual goniometric measurements twice; the mean value between both lectures was recorded; 2) with a digitizer (Orthographics TM, Salt Lake City, Ut). We measured the angle between the tangent to the medial tibial plateau and the perpendicular direction to each of the studied anatomical axis: tibial proximal anatomical axis (TPAA); tibial shaft anatomical axis (TSAA); posterior tibial cortex (PTC); fibular proximal anatomical axis (FPAA); fibular shaft axis (FSA); anterior tibial cortex (ATC). The values obtained with the digitizer were used to compare the six methods. The values obtained with the TSAA were considered as reference. RESULTS: Tibial slope values were different with the 6 methods. ATC gave the higher values and PTC the smaller. The difference could be 5 degrees between two methods measuring the same posterior tibial slope. However different, the values obtained with the 6 methods were strongly correlated (R > 0.85; p = 0.0001). We determined mathematical relationships between the values obtained with the 6 methods according to the regression analysis. The correlation with the values obtained with TSAA (reference values) was stronger for TPAA and TPC (respectively R = 0.92 and R = 0.9). The mean error between manual and digitized measurements was 1.28 degrees, but for the same knee the error could exceed 4 degrees. The highest error was 4.64 degrees with the TSAA, likewise the error frequency was higher with the TSAA (12 knees with an error > 3 degrees versus 7 knees for the other methods (p = 0.01)). In our 33 bilateral knees, after one side measurement, the forecast of the contralateral tibial slope showed an error of 5 degrees or more in 5 patients (15.1 per cent) and an error of 3 degrees or more in 13 patients (39.3 per cent). Among the proximal anatomical axis, only the TPAA and the TPC were not influenced by age, sex, patient height or weight. CONCLUSION: Values of posterior tibial slope observed with the 6 methods were different but correlated. Among the proximal axis, the TPAA and PTC gave higher reliability. The values obtained with these two methods: 1) were not influenced by morphometric variables, 2) were strongly correlated with the references values obtained with the TSAA, 3) gave low error with manual measurements by comparing with digitized measurements. Forecast of the contralateral tibial slope after one side measurement is unreliable. Satisfactory accuracy could be obtained with a two times manual goniometric measurement, but using a digitizer improves measurement accuracy and is less time consuming.

Adolescent↗
PubMed1995

The Short-Form 36 (SF-36) Health Survey and its use in pharmacoeconomic evaluation.

The Short-Form 36 (SF-36) Health Survey is a brief self-administered questionnaire that generates scores across 8 dimensions of health. It has been found to be reliable, and valid in terms of criteria such as agreement with clinical diagnosis and disease severity, but its underlying values have not been tested against patient preferences. The SF-36 was not devised for use in economic evaluation. The SF-36 may be used in cost-minimisation analyses, where the dimension scores can be shown to reflect people's values for health at an ordinal level, but it cannot be used in either cost-effectiveness or cost-utility analyses. The dimensions scores of zero to 100 do not provide a common currency and, where there is conflict between the dimension scores, there is no basis for establishing an overall health benefit. Furthermore, in clinical trials, the usual comparison is between mean or median scores, which assumes risk neutrality and does not take adequate account of the relationship between the value of health and time. Although they are under pressure to assess the cost effectiveness of healthcare interventions, researchers and policy analysts must resist short-cut methods of deriving a single index from the SF-36 that are based on arbitrary aggregation schemes, because these ignore people's preferences and the crucial quantity/quality trade-off, and therefore cannot be used in economic evaluations. However, the rich descriptive material and multidimensionality of the SF-36 may have potential for use in economic evaluation. Multi-attribute utility theory provides a way of deriving a single index based on elicited values, but it requires a major restructuring of the scales of the SF-36. Alternatively, SF-36 responses may provide material for constructing health scenarios that could then be valued on a holistic basis.

Attitude to Health↗
PubMed1994

Quality of minor surgery by general practitioners in 1990 and 1991.

BACKGROUND: The 1990 contract for general practitioners encouraged them to undertake minor surgical procedures in their practices. AIM: A study was undertaken to determine whether the subsequent expansion of general practitioner minor surgery activity was accompanied by changes in quality of care. METHOD: Data were analysed relating to minor operations conducted in 22 practices during April-June 1990 and April-June 1991. RESULTS: The volume of general practitioner minor surgery increased by 41% between the two study periods. Waiting time, accuracy of diagnosis, use of histology, adequacy of excision, complications and the need for corrective treatment in hospital did not change significantly between the two periods. CONCLUSION: The findings do not support suggestions that the expansion of general practitioner minor surgery activity following the 1990 contract has been associated with an erosion of quality of care.

Clinical Competence↗
PubMed1993

Minor surgery by general practitioners under the 1990 contract: effects on hospital workload.

OBJECTIVE: To determine the extent to which minor surgery undertaken by general practitioners after the introduction of the 1990 contract substituted for hospital outpatient workload. DESIGN: Before and after observational study. SETTING: Four English family health services authorities. SUBJECTS: Patients in 22 practice populations who were operated on by their general practitioner or referred to hospital for minor surgery during April to June 1990 or April to June 1991. MAIN OUTCOME MEASURES: Numbers of minor surgical procedures undertaken in general practice and in hospital, numbers of referrals to hospitals for conditions treatable by a minor surgical procedure, and the mix of diagnoses and procedures undertaken in each setting. RESULTS: General practitioners claimed reimbursement for 600 minor surgical procedures during April to June 1990 and for 847 during April to June 1991, an increase of 41%. Referrals to hospital for comparable conditions showed no compensatory decrease (385 during April to June 1990 and 388 during April to June 1991, 95% confidence interval for change in referrals -51 to 57), and the number of hospital procedures resulting from those referrals also remained constant (187 in the first period, 189 in the second, 95% confidence interval for change in procedures -36 to 40). The mix of procedures did not change significantly from one study period to the next in either setting. CONCLUSIONS: Many or all of the additional patients receiving minor surgery under the terms of the 1990 contract may not have previously been referred to hospital. General practitioners seem not to have systematically shifted towards treating the more trivial cases. The overall increase in minor surgical activity may reflect an improvement in accessibility of care or changes in patients' perceptions and attitudes.

Contract Services↗
PubMed1993

Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire.

There is an interest in the consequences of deriving a single index measure of health for validity and sensitivity. This paper presents the results of testing a recent example of a general health measure designed to derive a single index, the Euroqol (EQ), and presents a comparison with a new, influential profile measure, the Short Form 36 (SF-36) Health Survey Instrument. The EQ and an anglicised version of the SF-36 health survey, both designed for self-completion, were included in a postal survey of a random sample of 1980 patients from two practice lists in Sheffield, UK. The response rate for the EQ questionnaire was 83%, and the rate of completion over 95%. Evidence was found for the construct validity of the EQ dimension responses and the derived total EQ health score in terms of distinguishing between groups with expected health differences. Considerable agreement was found between EQ responses and the total EQ score, and the UK SF-36 profile scores. There was substantial evidence of EQ being less sensitive at the ceiling (i.e. low levels of perceived ill-health) and throughout the range of health states. A recent restructuring of the EQ, may help overcome some of the problems with the physical dimensions by reducing their skewness.

Activities of Daily Living↗
PubMed1993

Protein kinase inhibitors in plants of the myrtaceae, proteaceae, and leguminosae.

Methanolic extracts of leaves, flowers, stems, bark, and other parts of representative plants of the Myrtaceae, specifically of the EUCALYPTUS, MELALEUCA, THRYPTOMENA, CALLISTOMEN, ACMENA, AND ANGOPHORA genera, variously contain high levels of inhibitors of plant Ca (2+)-dependent protein kinase (CDPK) and of Ca (2+)-calmodulin-dependent myosin light chain kinase (MLCK). In terms of the protein kinase inhibition unit (PKIU), defined as the amount in the standard protein kinase assays causing 50% inhibition of protein kinase activity, these inhibitor levels ranged from the non-detectable to 179,000 PKIU (gram fresh weight) (-1) [(g FW) (-1)] and there was no consistent pattern of inhibitor distribution. A variety of other plants tested had low or non-detectable levels of CDPK and MLCK inhibitors. Plants of the EUCALYPTUS, MELALEUCA, ANGOPHORA, and GREVILLEA genera contained inhibitors of the catalytic subunit of the cyclic AMP-dependent protein kinase (cAK), inhibitor levels ranging from 20,000 to 9,600,000 PKIU (g FW) (-1). In general, cAK inhibitor levels found in the Myrtaceae were mostly much higher than levels of CDPK and MLCK inhibitors and reversed phase HPLC of such plant extracts revealed a multiplicity of components associated with cAK inhibitory activity. These IN VITRO screening procedures enable rapid detection and quantitation of levels of bioactive plant defence compounds with medicinal potential.

Journal Article↗
PubMed1992

Production and characterization of recombinant insulin-like growth factor-I (IGF-I) and potent analogues of IGF-I, with Gly or Arg substituted for Glu3, following their expression in Escherichia coli as fusion proteins.

The development of an efficient expression system for insulin-like growth factor-I (IGF-I) in Escherichia coli as a fusion protein is described. The fusion protein consists of an N-terminal extension made up of the first 46 amino acids of methionyl porcine GH ([Met1]-pGH) followed by the dipeptide Val-Asn. The latter two residues provide a unique hydroxylamine-sensitive link between [Met1]-pGH(1-46) and the N-terminal Gly of IGF-I. Downstream processing of the fusion proteins involved isolation of inclusion bodies, cleavage at the Asn-Gly bond, refolding of the reduced IGF-I peptide and purification to homogeneity. This expression system was also used to produce two variants of IGF-I in which Glu3 was substituted by either Gly or Arg to give [Gly3]-IGF-I and [Arg3]-IGF-I respectively. Production of milligram quantities of IGF-I peptide was readily achieved. The purity of the IGF-I, [Gly3]-IGF-I and [Arg3]-IGF-I was established by high-performance liquid chromatography and N-terminal sequence analysis. [Gly3]-IGF-I and [Arg3]-IGF-I were more potent than IGF-I in biological assays measuring stimulation of protein synthesis and DNA synthesis or inhibition of protein breakdown in rat L6 myoblasts. Both analogues bound very poorly to bovine IGF-binding protein-2 and slightly less well than IGF-I to the type-1 receptor on rat L6 myoblasts. We conclude that reduced binding to IGF-binding proteins rather than increased receptor binding is the likely explanation for the greater biological potency of the analogues compared with IGF-I.

Amino Acid Sequence↗
PubMed1991

Information needs in a provider market: a case-study of ENT.

In the light of the White Paper Working for patients, this study addresses two questions: first, whether the current pattern of service use is a valid surrogate for the assessment of the service needs of a population; second, given that information systems which will provide accurate cost per case information are several years from being implemented, what differences might be made to a specialty budget by the adjustment of case costs by use of different case-mix measures. ENT has been chosen as a case study because of its relative 'market potential'. The study addresses the first question by examining the variations in the current level and type of service use across Districts in a Region. The large variation in utilization across Districts, both in total and for different degrees of case complexity, suggests that the current pattern of service use is a poor indicator of need. The second part of the study examines a Unit which has large inflows of complex patients. Adjusting for case-mix, however, produces a comparatively small effect on the overall specialty budget, whether the adjustment is made using the BUPA schedule of surgical procedures or using diagnosis-related groups. In the light of these results, it is suggested that the current emphasis on accurately costing case-mix could be misplaced, and that more resources should be diverted to scrutinizing the appropriateness of service use to health needs and priorities, in line with the aims of the NHS reforms.

Costs and Cost Analysis↗
PubMed1987

Anglicising DRGs.

Explore the source record for details and available documents.

Cost Allocation↗
PubMed1987

Accounting for cross boundary flows.

RAWP (Resource Allocation Working Party) allows for cross boundary flows by adjusting regional or district health authorities' (DHAs) targets at an average specialty cost. The previous paper in this series examined problems for an inner city district health authority arising from RAWP cross boundary flow adjustment. This paper examines the likely importance of these and other problems for the National Health Service as a whole. Cross charging has been proposed as an alternative method of funding flows. District health authorities would receive an allocation equivalent to their RAWP target and then all non-emergency flows would be agreed between the authorities where patients live and competing authorities offering treatment at previously negotiated charges based on local estimates of each type of case. The problem of cost estimation is usually cited as a difficulty with this proposed reform, but this paper also discusses other important issues that tend to be neglected.

Cost Allocation↗
PubMed1987

Financial incentives of subregional RAWP.

Accounting for the cross boundary flows of residents from one health authority treated by another has been considered by the review of the Resource Allocation Working Party (RAWP) formula by the National Health Service Management Board. A common concern is that the approximate costs used are unfair to those authorities (typically those with teaching hospitals) that are likely to treat more complex cases. This paper argues that when spending exceeds the target allowance for acute services this is more likely to be due to district residents using services at a high rate than to inadequate compensation for inflows. Districts where residents make a high use of services are often those where there are large flows across district boundaries. Since authorities cannot control outflows there is little they can do to reduce their residents' high use of services. Furthermore, curious financial incentives can be inferred for clinicians in these districts if they were to take effective action to bring their district's spending to target levels. These problems are discussed to illuminate problems of accounting for cross boundary flows that alternatives to current practice must resolve.

Health Resources↗
PubMed1982

"Montrose" Child Life Protection Unit: a treatment and assessment model in child abuse intervention.

In New South Wales, Australia, the Department of Youth and Community Services is empowered by statute to deal with cases of child abuse and neglect. Its child protection services include the Montrose Child Life Protection Unit which is designed to support and complement the work of both the Intake Service, Field Service and most importantly the work of child protective facilities in the community. The service has intake crisis counselling and call out resources; maintains a central register; provides a facility for crisis residential care for children and families, diagnostic assessment, and a day programme. The emphasis in service delivery in New South Wales in the area of child protection is on multidisciplinary intervention. The Department of Youth and Community Services is involved in promoting interagency cooperation and co-ordination. Over and above a philosophy that underlies service delivery is the Montrose Unit's involvement in sensitising the community to the difficult and often demanding role of parenting. Montrose represents an attempt to create an environment where parenting myths can be examined from a reality base and strategies implemented for reeducation.

Australia↗
PubMed1981

Cell-mediated immunity is depressed following cardiopulmonary bypass.

Sequential in vitro lymphocyte function tests in 13 patients undergoing cardiac operation were performed to determine factors that contribute to depressed cell-mediated immunity following operation. Lymphocytes were stimulated with phytohemagglutinin (PHA), pokeweed mitogen, concanavalin A (Con A), and mitomycin-treated, pooled, allogeneic lymphocytes (MLC). Mitogen responses were measured by 3H-labeled thymidine incorporation. Circulating levels of T, B, and Fc-receptor lymphocytes were determined by counting E, EAC, and EA rosettes. Serum cortisol was measured by radioimmunoassay. The T-cell-dependent lymphocyte responses (PHA, Con A, and MLC) were significantly decreased 24 hours after operation, and this was accompanied by a 60% decrease in circulating T-cell levels. The PHA, Con A, and MLC responses, and circulating T-cell levels returned to preoperative values one week following operation. Lymphocyte responses to mitogens remained significantly decreased when the number of T cells in the postoperative cultures were adjusted to preoperative levels. This indicates that the T cells remaining after operation were functionally impaired. We conclude that lymphocyte proliferative responses and antigen recognition are significantly depressed following cardiac operation, and that these responses are related to decreased numbers of circulating T lymphocytes and depressed function of the remaining T lymphocytes.

Cardiopulmonary Bypass↗