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Biomedical subjects

J Le Grand

Publications and source records attributed to J Le Grand.

14 recordsLinked to original sources
PubMed2005

[Development of an intravesial oxybutynin chloride solution: from formulation to quality control].

Intravesical oxybutynin chloride has demonstrated its efficacy in children with neurogenic bladder and urinary incontinence refractory to oral anticholinergic agents. We developed a 205 microg/ml oxybutynin chloride solution in accordance with the specifications of the European Pharmacopeae. To guarantee quality, we assessed and validated formulation, the preparation process, and packaging. The solution was obtained by disolving oxybutynin chloride in 0.9% saline and sterile filtration. The solution was then packaged in syringes. Physical properies for intravesical instillation were met: pH 5.76 +/- 0.03, osmolality 281 mosmol/kg. The unit dose package guarantees sterility of the solution until use. The medication is given by adapting the syringe on the Luer Lock exteremity of the urinary catheter. The solution remains stable up to one month at 4 degrees C.

Chemistry, Pharmaceutical↗
PubMed1999

Incentives and health policy: primary and secondary care in the British National Health Service.

This paper argues that issues concerning incentives and motivation are crucial to recent reforms to the British National Health Service. It examines how the incentive structure of General Practitioners with respect to the interface between primary and secondary care changed with the introduction of GP fundholding, and how it might change further with the new Primary Care Groups. It concludes that the effectiveness of the internal incentive structure of the new groups will depend on the location of power within the PCGs, and that the external incentives involving the possibility of heavy central monitoring may affect the behaviour and motivation of GPs in potentially harmful ways.

Family Practice↗
PubMed1995

The development of quasi-markets in welfare provision in the United Kingdom.

In the late 1980s, governments in many western economies began to introduce competition between public agencies providing health, education, and other forms of social welfare. Government became a contracting agency separating funding from provision. The United Kingdom went farthest in legislation passed between 1988 and 1990. The authors review some possible explanations for this fundamental change. The article draws on public choice theory and broader political science approaches and reviews the evidence on the impact of the changes. The gains from these changes may be small, and the result may be only the build up of pressure for more spending in the longer term.

Contract Services↗
PubMed1994

A cognitive model of dangerous delusional misidentification syndromes.

The hallmark of the delusional misidentification syndromes is the presence of a misidentification delusion of the self or others. Delusional misidentification may present with an increased risk for dangerous behaviors. Individuals suffering from delusional misidentification syndromes may express hostility in ways ranging from serious verbal threats to homicidal acts. The causes of dangerous misidentification delusions remain for the most part undetermined. In this article, we report a series of six cases of individuals who harbored dangerous misidentification delusions. These individuals were studied phenomenologically and forensically. They were also studied biologically, including neuropsychological testing. A cognitive hypothesis aimed at explaining dangerousness and delusional misidentification is proposed. Implications of the hypothesis for further research are briefly outlined.

Adult↗
PubMed1993

Regional inequalities in mortality.

STUDY OBJECTIVE: To examine the hypothesis of sustained and persistent inequalities in health between British regions and to ask how far they are a consequence of using standardised mortality ratios as the tool of measurement. DESIGN, SETTING AND PARTICIPANTS: Data are regional, age specific death rates at seven points in time from 1931 to 1987-89 for the British regions, reconstructed to make them comparable with the 1981 regional definitions. Log variance is used to measure inequality; regional rankings are also used. MEASUREMENTS AND MAIN RESULTS: There has been a substantial convergence in age specific death rates between regions in younger but not in older age groups. In younger age groups the historic north/south gradient has disappeared; it persists in older groups. CONCLUSIONS: Use of standardised mortality ratios obscures differences in the convergence rates of age specific death rates between regions. Simple conclusions about the persistence of a north/south divide are not justified. Different processes of change seem to be at work in different age groups.

Adolescent↗
PubMed1985

The economic analysis of inequalities in health.

The paper explains the economist's concept of human capital, and uses it to analyse some of the problems raised in the Black Report on inequalities in health. Individuals are assumed to have an optimal 'stock' of health, defined as the level of stock for which the marginal benefits of further investment in the stock falls below its marginal cost. Differences in marginal benefits and costs between individuals will thus lead to differences in their health stocks. Use of this simple model and its associated concepts can be used to help explain, for instance, why social class differences in mortality are steepest in early adulthood and shallowest in the decade before retirement or why manual workers who 'need' more health than non-manual workers are nonetheless in general less healthy. The model can also contribute to the discussion of normative issues, for instance, to refine the concept of equality of access. However, while it has great potential in organising and analysing hypotheses concerning health behaviour, the model is in no way a substitute for other approaches; indeed it only becomes meaningful when interpreted in sociological, epidemiological and medical terms.

Cost-Benefit Analysis↗
PubMedDate not supplied

Competition, cooperation, or control? Tales from the British National Health Service.

The British National Health Service (NHS) recently underwent a massive social experiment, inspired in large part by the ideas of U.S. experts. This involved the creation of an internal or quasi-market, separating purchaser from provider and encouraging competition among providers. After reviewing the evidence concerning the impact of this experiment, I conclude that the impact in fact was minimal, partly because of the retention of central government control and partly because the experiment was based on an inadequate understanding of professional and managerial motivations. The paper draws out general lessons of the experiment for other market-oriented health care systems and examines whether the lessons are reflected in the new batch of NHS reforms initiated by the recently elected Labour Government.

Cooperative Behavior↗