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Biomedical subjects

J Hutton

Publications and source records attributed to J Hutton.

At least 55 records · Page 3Linked to original sources
PubMed1994

Comparison of a complement fixation test, a gel diffusion test and two absorbed and unabsorbed ELISAs for the diagnosis of paratuberculosis in sheep.

A complement fixation test for paratuberculosis, a gel diffusion test and two enzyme-linked immunosorbent assays (ELISA) were evaluated using sera from Mycobacterium paratuberculosis infected and non-infected sheep. Gross pathology and histopathology were used as parameters of infection. The two ELISAs, one of which is commercially available for testing cattle, were used before and after sera had been absorbed with a soluble sonicate of Mycobacterium phlei. Differences between the various tests and between ELISAs before and after absorption were non-significant (P > 0.05) in non-infected sheep or in animals with gross or histopathological lesions. The specificity of all the tests was at least 97%. Sensitivity in histopathologically positive sheep was at least 98%. Sheep from infected flocks but without histopathological lesions showed serological results which were poorly correlated between the various tests.

Animals↗
PubMed1994

The pharmaceutical industry and health reform: lessons from Europe.

Many countries in Europe, which have significant pharmaceutical industries, recently have embarked on reforms in the organization of their health care systems and methods of regulating the pharmaceutical market. This paper describes the different systems in major European countries and the changes taking place. Although it is too early to make final judgment on the impact of these changes, it is possible to predict some of the more likely outcomes. The organizational models and regulatory approaches in Europe offer a useful store of experience for those assessing the potential impact of reform proposals in the United States.

Cost Control↗
PubMed1994

The economics of treating obesity.

Obesity has become a major contemporary public health concern. The excess burden of disease associated with obesity (e.g. cardiovascular disease, diabetes mellitus, gallbladder disease) results in considerable costs to society, while the indirect costs of obesity include decreased labour input and lower educational achievement. Obese individuals have decreased quality of life and life expectancy. Furthermore, society's stigmatisation of the obese results in decreased opportunities in education, housing and employment. Obesity may be treated by behavioural modification (dieting, exercise), or by interventionist means (pharmacotherapy, jaw-wiring, surgery). The method of weight reduction should be chosen to suit the individual patient; interventionist approaches may be required for patients with severe obesity. Studies to examine the cost and quality of life implications of the various treatment modalities are needed.

Cost of Illness↗
PubMed1993

Assessment of medical technology: the role of engineers.

Assessment of medical technologies is a multidisciplinary activity requiring the participation of engineers, clinicians and social scientists. The contribution of engineers has often been confined to the early stages of technical assessment. However, engineers have important inputs to make throughout the assessment process in their roles of developers, users and managers of technology. Engineers have found collaboration with clinical researchers possible through hospital-based work, but must also develop links with economists and other social scientists if they are to make a full contribution to comprehensive technology assessment.

Biomedical Engineering↗
PubMed1993

Randomised controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia.

OBJECTIVE: To evaluate the effectiveness of endometrial resection as a surgical treatment for menorrhagia. DESIGN: Randomised controlled trial. SETTING: Gynaecology department at a teaching hospital. SUBJECTS: Two hundred women needing surgical treatment for menorrhagia between January 1990 and May 1991. After withdrawal of four women 97 underwent hysterectomy and 99 underwent endometrial resection. MAIN OUTCOME MEASURES: Patient satisfaction 4 months after surgery; post-operative complications; length of hospital stay; duration of time before return to work, normal daily activities and sexual intercourse; change in premenstrual symptoms. RESULTS: The difference in patient satisfaction between endometrial resection (84 out of 99) and abdominal hysterectomy (89 out of 95) just reached statistical significance in favour of abdominal hysterectomy at 4 months after surgery (difference = 9%, 95% confidence intervals (CI) 1.1%-17.5%). Post-operative morbidity, length of hospital stay and time taken to return to work, normal daily activities and sexual intercourse were significantly less in the endometrial resection group. However, the premenstrual symptoms of dysmenorrhoea, bloating and breast tenderness were less frequent after hysterectomy. CONCLUSION: In the short term, endometrial resection was almost as satisfactory as abdominal hysterectomy for the surgical treatment of menorrhagia, and was associated with less morbidity. However, even at 4 months after surgery, there was a failure rate of at least 10% in those in whom endometrial resection appeared complete. Longer term comparative studies are necessary before the widespread introduction of endometrial resection as an alternative to abdominal hysterectomy for the surgical treatment of menorrhagia.

Activities of Daily Living↗
PubMed1993

An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia.

OBJECTIVE: To evaluate the relative health service cost of endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia and the value women attach to their health state before and after surgery. DESIGN: A prospective economic evaluation running alongside a randomised controlled trial. SETTING: The gynaecology department of a teaching hospital. SUBJECTS: 200 women requiring surgical treatment of menorrhagia between January 1990 and May 1991; after withdrawals, 97 women underwent hysterectomy and 99 underwent endometrial resection. MAIN OUTCOME MEASURES: The total health service cost of managing women in the two arms of the trial until 4 months after their operation. The change in women's valuation of their health state a fortnight after and a minimum of 4 months after surgery relative to that 1 month prior to their operation. RESULTS: Total health service costs are significantly higher amongst abdominal hysterectomy patients (mean 1059.73 pounds) than amongst endometrial resection patients with a mean difference of 499.68 pounds (95% CI 432 pounds-567 pounds). This significant difference exists under alternative assumptions about the difference in lengths of stay in hospital between the two treatment groups and the hotel cost per in-patient day. On a scale of 0 to 100, relative to a month before surgery, there is a statistically significant difference in favour of endometrial resection between the two groups in the increase in value women attach to their health state at a fortnight after surgery (mean difference 11.2; 95% CI 0.6-21.7), but not at a minimum of 4 months after surgery (mean difference 7; 95% CI -17.4 to 3.4). CONCLUSIONS: On the basis of health service resource cost up to 4 months after surgery, endometrial resection has a cost advantage over abdominal hysterectomy. However, given the fact that a subgroup of women requires retreatment due to resection failure and that this study considers a relatively short period of follow up, the long term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.

Endometrium↗
PubMed1992

A comparison of the costs and benefits of recombinant human erythropoietin (epoetin) in the treatment of chronic renal failure in 5 European countries.

The purpose of this study was to estimate the costs and benefits of the use of recombinant human erythropoietin (epoetin) in the treatment of anaemia arising from chronic renal failure. A 5-nation study, using an identical research protocol, was carried out by groups in France, Germany, Italy, Spain and the UK to identify the costs of the use of epoetin, the resource savings generated by such treatment and the effects of this treatment on the quality of life of patients. The latter was measured using the Rosser matrix of disability-distress states. The results show that the use of epoetin can produce a competitive cost per quality-adjusted life-year (QALY) only in patients with serious incapacity. Use of epoetin in patients who are not transfusion dependent would be an expensive way of gaining health benefits, which would be achieved at considerable opportunity cost.

Anemia↗
PubMed1991

Palliative radiotherapy--counting the costs of changing practice.

"Working for Patients', the government's review of the National Health Service (NHS) advocates reforms which have led inevitably to pressure for medical specialities to review both the outcomes of their services and the resources used in achieving these outcomes. This paper considers these issues in the context of provision of palliative radiotherapy for patients with incurable cancers and presents the results of a study which evaluated the costs of radiotherapy. In addition to producing some of the first detailed cost estimates for the delivery of radiotherapy, this exercise highlighted the methodological and practical difficulties of undertaking such studies. As increasing pressure to evaluate cancer therapy is a prominent feature of a 'post-NHS Review' world, lessons learnt from this study may also be applicable to the audit of other cancer therapies. Efficient audit practices will, of course, have to evaluate the benefits (in terms of enhancements to length and quality of life) as well as the costs of cancer therapies.

Capital Expenditures↗
PubMed1991

Economic evaluation of trends in cancer therapy. Marginal or average costs?

Evaluating the use of resources as well as outcomes in cancer therapy is increasingly becoming recognized by both clinicians and others as a legitimate and indeed even desirable activity. While this trend is to be welcomed if it facilitates the efficient use of resources for cancer care, there are dangers in applying estimates of unit costs, in particular average costs to the evaluation of trends in practice in cancer therapies. This article examines the use of appropriate measures of average and marginal cost in the economic evaluation of developments in cancer therapy, taking illustrations from radiotherapy and chemotherapy.

Antineoplastic Agents↗
PubMed1990

Desk top analysers in general medical practice: how useful are they?

In this paper we summarise the results of a study of the use by two general practices of the Reflotron dry chemistry analyser, and discuss the findings in the light of recent literature on the use of desk top analysers in general medical practice. We conclude that, in the present economic environment there is little incentive for general practitioners to carry out their own diagnostic tests. The accuracy and precision of desk top analysers operated by unskilled personnel are problematical, but with adequate back-up from the centralised hospital laboratory such equipment could be useful for the diagnosis and control of such problems as diabetes and anaemia. However, the most important factors necessary for the spread of desk top analysers are the availability of more tests, guarantees of reliability, and competitive prices. Desk top analysers could fulfil a role in practices which control their own budgets, but this would depend on the costs of hospital laboratory tests compared with those performed in the surgery.

Blood Chemical Analysis↗
PubMed1989

Evidence for a complex regulatory array in the first intron of the human adenosine deaminase gene.

Adenosine deaminase (ADA) is expressed ubiquitously by diverse mammalian cells and tissues but at levels that vary according to tissue and species. In humans, the thymus exhibits levels of the enzyme up to 100-fold higher than most other tissues. Using transgenic mice, we identified human ADA gene regulatory domains. Up to 3.7 kb of 5'-flanking and first exon DNA from the human ADA gene failed to promote the expression of a chloramphenicol acetyl transferase (CAT) reporter gene in an efficient, reproducible, or tissue-appropriate manner in transgenic mice. However, when 12.8 kb of DNA from the first intron of the human ADA gene was placed 3' of CAT-coding and -processing sequences, transgenic mice reproducibly expressed CAT activity in most tissues, with profoundly high levels in the thymus. DNase I hypersensitivity studies demonstrated that among transgenic mouse tissues, human thymus, and a variety of human cell lines, a region of the intron 4-10 kb downstream of the first exon exhibited an array of hypersensitive sites that varied according to tissue and cell type. Deletion of this region from the gene construction eliminated high-level expression in transgenic mice. In transfection-transient expression assays, the 12.8-kb intron fragment exhibited enhancer activity in several cell types. A 1.3-kb fragment encompassing two of the hypersensitive sites exhibited some of these activities. The results of these studies suggest that the diverse pattern of human ADA gene expression is determined, in part, by a cluster of cis-regulatory elements contained within its large first intron.

Adenosine Deaminase↗