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Biomedical subjects

J Ratcliffe

Publications and source records attributed to J Ratcliffe.

At least 37 records · Page 2Linked to original sources
PubMed1999

Irritancy of industrial hand cleansers tested by repeated open application on human skin.

The aim of this study was to compare the irritancy potential of 2 industrial hand cleansers with a brand leader of "mild" children's hand cleanser and with an emollient. The products were tested using repeated open application tests (ROATs) on the forearms of 40 subjects. Scoring of signs and symptoms (itching or burning), transepidermal water loss (TEWL) and stratum corneum hydration (Corneometer) evaluated responses. On all assessments, the children's hand cleanser was more irritant than the 2 industrial hand cleansers. The children's hand cleanser and industrial hand cleansers were more irritant than the emollient. The finding that a hand cleanser for children was more irritant than 2 industrial hand cleansers was surprising, and one which might hold serious implications for inducing or exacerbating atopic eczema in children. The combination of visual scoring, TEWL and Corneometer readings on ROATs is a potentially useful way of assessing irritancy strength of soap products on human skin.

Adult↗
PubMed1999

Compositae mix is a more sensitive test for Compositae dermatitis than the sesquiterpene lactone mix.

Over the past 2 decades, Compositae dermatitis has increasingly been recognized as a cause of exposure-pattern dermatitis. The introduction of the sesquiterpene lactone (SL) mix as a screening test has contributed to this improved recognition. However, there is growing evidence that the SL mix fails to detect a substantial number of genuine Compositae allergies. We therefore investigated whether another screening reagent (the Compositae mix) might be more sensitive in detecting cases of Compositae allergy than the SL mix. Over a 1-year period, we tested 656 consecutive unselected patch test patients to both SL mix and Compositae mix. 31 patients were found to have genuine Compositae allergies. Of these, 28 had reacted to the Compositae mix but only 13 had reacted to the SL mix. The Compositae mix failed to detect only 2 genuine Compositae allergies, whereas the SL mix missed 17 such allergies. On the other hand, the Compositae mix led to 9 irritant reactions, while there was only 1 irritant reaction with the SL mix. We conclude that Compositae dermatitis is still being underdiagnosed with the current screening method, and that the Compositae mix is significantly more sensitive in detecting Compositae allergy than the SL mix.

Adolescent↗
PubMed1999

Patients' preferences regarding the process and outcomes of life-saving technology. An application of conjoint analysis to liver transplantation.

The economic technique of conjoint analysis was used to assess the relative importance of health outcome versus several process attributes (e.g., waiting time, continuity of contact with the same medical staff) in determining patients' preferences for liver transplantation services. The attributes were established by reference to the literature and through initial qualitative interviews with liver transplant recipients (n = 12). Following a pilot study of 40 patients, a sample of patients (n = 213) who have received a liver transplant at the Queen Elizabeth Hospital in Birmingham were surveyed. The technique of conjoint analysis was used to ascertain the relative importance of the attributes included in the exercise and to estimate the marginal rates of substitution (MRS) between different attributes. A useable response rate of 89% was achieved. Although a small proportion of respondents (15%) exhibited dominant preferences for the chance of success attribute, the majority of respondents indicated that they would be prepared to exchange a reduction in health outcome for an improvement in the process characteristics of the liver transplantation service. The results of this study have potentially important implications for the assessment of the benefits of medical technologies since they suggest that, even in the extreme case of life-saving interventions, the preferences of respondents may not be dependent solely upon health outcomes but may also be determined by attributes associated with the process of care.

Choice Behavior↗
PubMed1998

Modelling the costs of paediatric HIV infection and AIDS: comparison of infected children born to screened and unscreened mothers.

OBJECTIVE: To estimate the cost of managing children with HIV/AIDS in the UK from a health service perspective. DESIGN AND METHODS: Epidemiological, resource use and unit cost data were combined within a decision analytic model. A Markov model was developed to predict the prognoses of HIV-infected children under different assumptions about natural history, treatment efficacy and the timing of antiretroviral therapy. Resource use estimates for various stages of HIV/AIDS were based on published data relating to the UK health service and clinical judgement; unit cost data were taken from a London centre. RESULTS: The base-case results suggest that the cost of caring for an HIV-infected child is higher if the mother's infection was known about at or before the child's birth (antenatal screened cohort): lifetime costs ranged from 46 427 pound sterling to 119 502 pound sterling per child in the screened cohort and from 38 691 pound sterling to 86 014 pound sterling in the unscreened cohort. However, the screened cohort benefited from longer life expectancy (base-case, 11.66 versus 10.09 years) and AIDS-free life expectancy (base-case, 7.13 years versus 6.22 years). Results are sensitive to assumptions about natural history and treatment efficacy: for example, if antiretroviral therapy was initiated at birth, and assuming optimistic natural history parameters, discounted costs could increase to 215 077 pound sterling and the additional lifetime cost of a child born to a screened mother could be 72 491 pound sterling. CONCLUSIONS: Results reflect the marked uncertainty regarding the cost of, and prognosis for, children with HIV/AIDS in the new era of more potent antiretroviral combination therapies. These results are part of an assessment of the relative cost-effectiveness of alternative antenatal HIV testing strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prevention of mother-to-child transmission of HIV-1 infection: alternative strategies and their cost-effectiveness.

OBJECTIVE: To estimate the cost-effectiveness of alternative interventions to reduce the risk of mother-to-child transmission of HIV. DESIGN: A model capturing the sequential nature of mother-to-child transmission in utero, at delivery and postnatally was used to determine how the effects of bottle-feeding, elective Cesarean section (CS) and zidovudine (ZDV) would combine to prevent mother-to-child HIV transmission. Parameter estimates were derived from the literature, UK health service costs applied, and incremental cost effectiveness ratios (ICER) estimated for alternative risk reduction strategies. Results can be transposed to other cost assumptions or currencies. RESULTS: In a woman who breast-feeds her baby, has a vaginal or emergency CS delivery and takes no ZDV, the estimated transmission risk is 31.6% (range, 23.7-38.1%), at a cost of 400 UK pound per woman; this falls to a risk of 3.7% (range, 1.7-6.9%) when bottle-feeding, ZDV therapy and elective CS are all implemented at a cost of 1968 UK pound per woman. From a public health perspective the ICER of ZDV and elective CS each depend on the acceptance rates of the other. In women counselled against breast-feeding, ZDV with 100% acceptance of elective CS has an ICER of 11 342 UK pound (95% confidence interval (CI), 7084-21 515 UK pound]. However, the ICER of CS ranges from 9248 UK pound (95% CI, 5072-46 913 pound sterling) at zero ZDV acceptance to 27 895 UK pound (95% CI, 10 018-154 462 pound sterling) at 100% ZDV acceptance. CONCLUSIONS: Considering the estimated cost of caring for an infected child, ZDV appears to be cost-effective under any of the circumstances examined. However, elective CS may not be cost-effective in populations where the uptake of ZDV is high, and a more precise estimate of its efficacy is required.

Anti-HIV Agents↗
PubMed1998

Health-related quality of life following liver transplantation.

The objectives of this study were to report on the health-related quality of life (QoL) experienced by patients following liver transplantation and to investigate the factors associated with its variation. A questionnaire comprising the SF-36 and EuroQol EQ-5D instruments was sent by post to 147 patients who had received a liver transplant, indicated by a chronic liver disease, in the previous 8 years. The scores of the respondents were compared to population norm scores. The variation in both the SF-36 and EQ-5D scores was explored. Many liver transplant patients experienced most satisfactory QoL levels post-transplantation although, in general terms, the levels were poorer than those seen in the general population. The variation in the post-transplant health-related QoL scores was found to be associated with a number of pre-transplant factors: disease severity (proxied by Child Pugh class), disease duration at the time of transplantation and liver transplant history (whether the patient had received a single or multiple transplants). In making clinical decisions about the use of transplantation for chronic liver diseases, consideration should be given to the key factors likely to affect subsequent health-related QoL.

Adolescent↗
PubMed1998

Role of allergies in eczema.

Contact allergies have an important role to play in eczema. Justine Ratcliffe considers how detection of the causative allergen by patch testing can improve disease management

Community Health Nursing↗
PubMed1997

De novo mutations of the Patched gene in nevoid basal cell carcinoma syndrome help to define the clinical phenotype.

The demonstration that mutations in the Patched (PTCH) gene cause nevoid basal cell carcinoma syndrome (NBCCS) has led to the identification of the exact molecular lesion in a percentage of individuals with the syndrome. In addition, it has been possible to determine, through molecular analysis of parents and other relatives of these individuals, if the mutation is inherited or has arisen de novo. We have previously reported 28 mutations in individuals with NBCCS, and here we present an additional 4 novel mutations. We have also analyzed relatives of a number of the individuals in whom we have found mutations. In total we have identified 8 individuals who carry a de novo mutation in the PTCH gene. In 5 of these cases, clinical and radiological examination had not unequivocally ruled out a diagnosis in one of the parents. This helps to define the clinical phenotype and suggests that diagnostic criteria in this complex syndrome may require review.

Basal Cell Nevus Syndrome↗
PubMed1997

Using willingness to pay to value alternative models of antenatal care.

Recent years have seen the development of different models of antenatal care, especially for low risk women. More specifically, there has been a move for more general practitioner and midwifery involvement in such care. Given the current changes that are taking place in the provision of antenatal care, it is becoming increasingly important to carry out economic evaluations of alternative models of care. This paper applies the economic instrument of willingness to pay to assess the benefits of two alternative forms of antenatal care: general practitioner/midwife routine led care versus obstetrician led care. The results suggest a willingness to pay of pounds 2500 for antenatal care, with no significant difference between the types of care provided. It is concluded that before firm policy conclusions can be reached, further studies should be undertaken to address methodological issues around the willingness to pay technique.

Adult↗
PubMed1997

The care of patients with chronic schizophrenia: a comparison between two services.

BACKGROUND: There has been a widespread development of community multi-disciplinary teams aimed to deliver coordinated comprehensive mental health care, yet there is little published evidence on the quality of care and economics of providing such care for people with severe mental illness. METHOD: This is a clustered randomized controlled economic comparison of the quality of care for patients with chronic schizophrenia by a multi-disciplinary community team with close links with primary care, and a traditional psychiatric service in a district general hospital psychiatric unit. RESULTS: Two years after it was established, patients with access to the community team had more of their needs met; they had fewer unmet needs; and they were more satisfied with the care they had received. They had more service contacts and received more interventions. The community team resulted in savings in the use of some hospital resources but these were not sufficient to offset the cost of the new service. The community team successfully directed care to patients with more needs, whereas no such relationship was evident for the traditional hospital-based service. Four years after the team was established, it met a greater proportion of needs for underactivity, daily living skills, use of public amenities and managing finances. CONCLUSIONS: Better quality care was provided at 2 and 4 years after its establishment by the multi-disciplinary community service than the traditional hospital-based service. Resources were targeted more efficiently by the community service.

Adult↗
PubMed1997

A randomized controlled trial of sedation in the critically ill.

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P < 0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/ distressed) was significantly greater in the midazolam group (Chi-squared P < 0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.

Administration, Oral↗
PubMed1997

Cost effectiveness of a mass media-led anti-smoking campaign in Scotland.

OBJECTIVE: To evaluate the costs and outcomes associated with the Health Education Board for Scotland's general public anti-smoking campaign during the developmental stage and its first year of operation. DESIGN: Cost information collected retrospectively was combined with prospectively collected effectiveness data. SUBJECTS: A panel of 970 adults were recruited from a 1-in-10 random sample of adult callers to the telephone helpline (Smokeline). Those who smoked were subsequently interviewed at three weeks, six months, and one year follow up. Information on smoking status at one year and time spent as a non-smoker was available for 587 members of the panel. MAIN OUTCOME MEASURES: Intermediate outcomes in the follow-up sample included a point prevalence and period prevalence measure of smoking cessation. Long-term outcomes were measured in terms of predicted reductions in mortality as a consequence of smoking cessation. RESULTS: At the 12-month point, 9.88% of individuals in the follow-up sample reported themselves as non-smokers and as having given up for at least six months in the previous year. Estimates of the cost per life-year saved as a result of the campaign range from 304 pounds sterling to 656 pounds sterling. CONCLUSIONS: Provided that the benefits of smoking cessation are broadly accurate, and the assumed level of quitting can be directly attributed to Smokeline, then this mass media-led anti-smoking campaign appears to have been cost effective.

Adult↗
PubMed1997

Measurement of radiation dose received by the hands and thyroid of staff performing gridless fluoroscopic procedures in children.

The aim of this study was to confirm that the radiation doses received by attendants who manually restrain infants during fluoroscopic procedures are low. Doses to the hands and neck of three radiologists and three nurses performing or assisting at all the fluoroscopic procedures in a children's hospital were measured for 1 month using thermoluminescent dosemeters. All fluoroscopy on children at this hospital is performed without an antiscatter grid. Total doses for the neck ranged from 20 to 50 microSv per week and for hands from 40 to 210 microSv per week. These doses were shared by the three radiologists and the three nurses. Individual doses received per staff member are very small when compared with the doses received by interventional radiology staff. Doses received by staff in this study were of the order of 5% of the limit advised by the National Health and Medical Research Council of Australia (NHMRC) for radiation workers. Nurses received larger doses than radiologists and steps will be taken to reduce this dose further.

Adolescent↗
PubMed1997

Measuring health-related quality of life outcomes in women with endometriosis--results of the Gynaecology Audit Project in Scotland.

The clinical management of endometriosis was addressed within the recent Gynaecology Audit Project in Scotland. The impact of endometriosis and its treatment on women's health-related quality of life was examined using a condition-specific measure and a general measure, the Short Form 36 health survey (SF-36). Postal questionnaires containing the health-related quality of life measures were sent to 273 women at diagnosis and six months later. The measurement properties, including the reliability, validity and responsiveness, of the measures were examined. The condition-specific questions and the SF-36 had a high level of reliability. The validity of the condition-specific scores was demonstrated by their high correlation with the SF-36 which is a well-validated measure. Furthermore, the condition-specific scores were related to clinicians' assessment of disease severity and the need for further treatment. At the six month follow-up, changes in scores conformed to expected hypotheses, demonstrating the responsiveness of both measures. As a general measure, the SF-36 appeared to reflect the effects of both the condition of interest (i.e. endometriosis) and other conditions affecting health at the time of measurement (i.e. treatment side effects). The condition-specific measure was more responsive than the SF-36 to the changes in pain symptoms which resulted from active treatment. A condition-specific questionnaire, together with a general measure such as the SF-36 health survey, can provide a reliable, valid and responsive package of measures for assessing health-related quality of life in women with endometriosis. Such measures should be used alongside clinical measures of outcome to assess the effectiveness of different treatment strategies for endometriosis. A similar approach combining general and specific instruments would be useful in medical audits of other conditions.

Adolescent↗