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Biomedical subjects

M F D'Souza

Publications and source records attributed to M F D'Souza.

At least 19 recordsLinked to original sources
PubMed1995

The Multifund and outcome research.

The UK health reforms, among other things, have allowed some family practitioners ('fundholders') to control part of the budget used to purchase secondary care for the patients registered with their practices. Some feared that this change in organization might threaten the equity of the National Health Service (NHS) by giving advantages to the patients of fundholding general practitioners (GPs). This has led to the formation of the first large GP 'Multifund' in the UK. Whilst the first small fundholding co-operatives were conceived simply as a way of improving the business efficiency of ordinary fundholding, the much larger Kingston and Richmond (K&R) Multifund is a professional co-operative of fundholding family practitioners who share a common management allowance, which controls pounds 32.6 million per annum, about 20% of the public funds devoted to health care in its locality, and has a broader agenda. It sets out to end any two-tier system discriminating between the patients of fundholding and other practitioners within a locality by making it possible for all GPs to become fundholders within an open, democratic doctors' co-operative. Its declared aims are to maintain equity and clinical integrity, to plan health care and to undertake scientific evaluation. Its overall goal is to preserve and improve upon the economic and ethical success of the British NHS. A brief evaluation is included which suggests that Multifund members believe their organization is currently meeting most of these aims. The essay argues for GP-led Multifund systems centred on outcome evidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Care Costs↗
PubMed1995

Physical and subjective evaluation of a three-detector (TRIAD 88) SPECT system.

The three-detector TRIAD 88 is a variable cylindrical FOV whole-body SPECT system designed for both brain as well as body organ imaging. The system performance was assessed in terms of physical indices and clinical quality. Measures of low contrast resolution using contrast-detail curves, high contrast resolution using LSFs and associated frequency descriptors, display characteristics, system sensitivity, energy resolution and uniformity analysis were utilized. In addition, images of Carlson phantom, Hoffman brain phantom and clinical brain images were used to compare two collimators subjectively. Measurements and calculations were obtained for two sets of parallel hole collimators, i.e., LEUR_PAR and LEHR_PAR. Of special interest is the consistency among the three detectors. The planar and volume sensitivities for the LEUR_PAR collimator were about 58% of those of the LEHR_PAR collimator. The planar spatial resolution of the two collimators differed by about 14%. The display was characterized by a logistic model H & D curve. The planar contrast-detail curves demonstrated no statistical difference in lesion detectability between the two collimator types, however SPECT phantom and clinical images demonstrated improved performance with the LEUR_PAR collimator. Images of Hoffman single slice brain and Carlson phantoms and Tc-99m (HMPAO) brain images demonstrated excellent image quality. There was similarity in performance parameters of the three detector heads.

Biophysical Phenomena↗
PubMed1994

Factors affecting the long-term variability of bronchial responsiveness in an adult general practice population.

There have been few longitudinal studies of bronchial responsiveness. We wanted to assess the long-term variability and associations of bronchial responsiveness in the general population. Spirometry, bronchial provocation tests, skin-prick tests for allergy, and respiratory symptom questionnaires were repeated every 4 months, for 2 years (August 1987-August 1989), in 122 volunteers recruited from a cross-sectional survey of population. Provocation dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) and dose-response slope (SL), which gives values for methacholine responsiveness, were measured in all subjects. SL correlated well with PD20FEV1 but repeatability was impaired in those subjects with unmeasurably high PD20FEV1. The 95% range for repeatability of PD20FEV1 was +/- 3.11 doubling doses and +/- 4.52 doubling slopes for SL. Bronchial responsiveness increased in those with self-reported colds and reduced FEV1 in winter 1987-1988, and in males in winter 1988-1989. Bronchial responsiveness increased during the summer (June-August) of both years, significantly in year 1. We conclude that bronchial responsiveness showed minor seasonal variability and that colds were the strongest predictors of increased bronchial responsiveness over the 2 yr period.

Adolescent↗
PubMed1990

A general practice based survey of bronchial hyperresponsiveness and its relation to symptoms, sex, age, atopy, and smoking.

The prevalence and associations of bronchial hyperresponsiveness were investigated in a general practice population. The sample was obtained by using every 12th patient on the practice age-sex register, replacing non-responders with corresponding age and sex matched individuals from up to two further 1 in 12 samples. The response rate was 43%; 366 patients were studied. Doubling concentrations of methacholine were given to a maximum of 32 mg/ml or until a 20% fall in forced expiratory volume in one second (FEV1) occurred (provocation concentration, PC20FEV1). Bronchial hyperresponsiveness was defined arbitrarily as a PC20FEV1 of 2 mg/ml or less (or 11 mumol cumulative dose, PD20FEV1). The prevalence of bronchial hyperresponsiveness was 23%. Bronchial hyperresponsiveness was not associated with age but was more prevalent in women than men (31%:13%). It was also more common in those who had ever wheezed (39%) and in those who had had an attack of rhinitis in the preceding month (45%, p less than 0.1), in atopic individuals (30%), and in smokers (32%), but it was not associated with cough or dyspnoea. There was a positive correlation between PC20FEV1 and resting FEV1 (r = 0.288) and a negative correlation between PC20FEV1 and mean daily peak flow variability (r = -0.356). Stepwise binary logistic regression analysis showed significant independent effects on PC20FEV1 for mean daily peak flow variability, gender, number of positive skin test responses, resting FEV1, and mean histamine skin weal area, but no relation with smoking or mean allergen weal area. The prevalence of bronchial hyperresponsiveness was much higher than the prevalence of diagnosed asthma in the practice in 1984 (4.9%). Analysis of case notes of 169 individuals showed that those with bronchial hyperresponsiveness had not attended the practice more frequently for respiratory complaints during the previous five years.

Adolescent↗
PubMed1987

Hay fever treatments--which should be tried first?

A series of comparative trials on nine popular and pharmacologically distinct regimens for the treatment of hay fever was undertaken in the course of normal general practice in the pollen seasons of 1981-83. One hundred and forty doctors recruited 640 patients to assess the overall usefulness of the treatments on daily diaries. ;Usefulness' was scored on a linear analogue scale weighing up the degree of hay fever symptoms during treatment, side effects and ease of use of the preparation.The regimen with the highest overall usefulness score was beclomethasone diproprionate with sodium cromoglycate eye drops (Beconase and Opticrom). Although the score was not significantly higher than those for methylprednisolone acetate (Depo-Medrone), astemizole (Hismanal) or terfenadine (Triludan), Beconase/Opticrom scored significantly better than mequitazine (Primalan), chlorpheniramine maleate (Piriton), sodium cromoglycate nasal insufflation with xylometazoline/antazoline eye drops (Rynacrom and Otrivine-Antistin) and azatadine maleate (Optimine). Beconase/Opticrom was first in rank order with respect to all the other regimens for the treatment of both mild and severe hay fever. Dimethothiazine (Banistyl), also shown to be useful, has since been withdrawn from prescription.

Adolescent↗
PubMed1984

Myocardial infarction and the emotional climate.

Within the general population people destined for myocardial infarction are found to be more obsessional and greater worriers than others. Moreover, in the year before their infarction they display high levels of sadness, anxiety-related symptoms, loss of libido, and fatigue, unrelated to angina and other physical discomforts. They also claim, more so than others, to have no fear of having an incurable illness. Derived optimum weightings to responses to items in the Crown-Crisp Experimental Index permit the development of a simple scoring system which in the present study allows a two-thirds correct identification of those due for imminent infarction and an overall 81.5% correct classification of infarct/non-infarct cases. This apparent capacity of the instrument now needs to be tested in a prospective study. In the year after infarction survivors in the present study show very high levels of dysphoria and social withdrawal.

Adult↗
PubMed1983

Confirming the diagnosis of mild hypertension.

Patients with newly found raised blood pressure are known to have lower pressures at subsequent measurements even when not treated. A study was undertaken to determine the extent to which (a) the number of follow-up measurements and (b) the duration of the intervals between them contributed to this fall in pressure. In 42 general practices 110 patients were identified as having for the first time a diastolic pressure (phase V) greater than 90 and less than 110 mm Hg. Both diastolic and systolic pressures were appreciably lower when measured at return visits when compared with the first measurement. The systolic pressure dropped appreciably in the intervals between the first and the second visits and again between the second and third visits. The diastolic pressure fell appreciably only between the first and second visits. The duration of the interval between visits was not associated with a fall in either systolic or diastolic pressure, but the number of measurements was. This pattern of fall in pressure was not affected by the patient's age or sex. From these results we conclude that patients with newly identified blood pressures that are mildly raised should be seen at two further visits before a decision about treatment is made. The timing of these follow-up visits is not crucial.

Female↗
PubMed1983

A method for evaluating therapy for hay fever. A comparison of four treatments.

This study was undertaken in order to develop a method for comparing the value of different forms of treatment for hay fever. A cross-over trial was carried out in sixty-one patients, comparing four treatments: topical corticosteroids, topical cromoglycates, placebo tablets and oxatomide (a new oral treatment with antihistamine and cromoglycate-like properties). Three methods were used to compare these treatments: (1) post-treatment symptom questionnaires; (2) daily analogue line scores of symptoms; and (3) nasal FEV1. Of these, daily analogue line diary scores, with an analysis which took into account variation in pollen count, proved to be the most sensitive. By employing this diary method, it was shown that all three active treatments were significantly better than placebo and that topical corticosteroids were significantly better than topical cromoglycates. The activity of oxatomide was found to be not significantly different from that of steroids or cromoglycate, but it was associated with more frequent side-effects. It is suggested that daily diaries, combining symptom relief and freedom from side effects into a single score of 'usefulness' adjusted for pollen count, are suitable means for comparing treatments for hay fever.

Adult↗
PubMed1976

A long-term controlled trial of screening for hypertension in general practice.

A controlled trial was undertaken to evaluate the practical consequences of screening in general practice. Of 2420 people aged 40-64 years examined in 1967-68, 191 (7.9%) had previously been told, at some time, that they had raised blood-pressure, other than during pregnancy. However, only 77 (3-2%) had any record of current antihypertensive treatment. Screening resulted in a further 50 persons (2-1%) being newly diagnosed as hypertensive in 1967-68 and a further 9 in 1969-70. Antihypertensive treatment was given to 21 of these immediately following diagnosis, while the treatment was adjusted in 23 of those already known to be hypertensive. In 1972-73 the blood-pressures of the screening population were directly compared with the control group. No significant differences in the distributions of their blood-pressure levels were observed. Over 95% of the new hypertensives discovered by the screening process in the control group in 1972-73 had visited their general practitioners for some reason during the previous five years. This suggests that "case-finding" by general practitioners would be more cost-effective than setting up separate blood-pressure screening clinics. However, the results of this study indicate that we need to know more about how raised blood-pressure can be successfully controlled over a long time, before any mass screening programmes can be actively encouraged.

Adult↗
PubMed1975

An analysis of skin prick test reactions in 656 asthmatic patients.

Of 656 asthmatic patients referred specifically for allergy assessments, 544 (84 percent) gave positive immediate skin prick tests to at least one of 22 common allergens used routinely. Comparison of these skin test positive patients with the 102 (16 percent) who were skin test negative showed a number of significant differences. The majority of the skin test positive patients (52 percent) were less than 10 years old at the time of onset of the asthma, whereas, of the skin test negative patients, 56 percent were aged over 30 years at the time of onset. Seventy per cent report rhinitis compared with 48 per cent of the skin test negative patients, and 29 per cent reported infantile eczema compared with 9 per cent. Symptoms attributed to house dust, pollens, and animals were noted two to three times more frequently by the skin test positive patients, while corticosteroid drugs had been used more commonly by the skin test negative patients (45 percent compared with 35 percent). No significant differences were observed with the other factors studied, namely, history of urticaria or angio-oedema, family history of "allergic" disease, and awareness of sensitivity to foods, aspirin or penicillin. Prick test reactions in the skin test positive patients were most commonly seen to house dust or the acarine mite, Dermatophagoides farinae (82 percent), followed by pollens (66 percent), animal danders (38 percent), foods (16 percent), Aspergillus fumigatus (16 percent), and other moulds (21 percent). There was a highly significant association of positive history with positive prick test for all allergens studied.

Adrenal Cortex Hormones↗
PubMed1975

Deafness in middle age--how big is the problem?

Screening for hearing defect by questionnaire and audiogram was undertaken in two group practices in the South-east of England in a total of 2,278 people aged 40-64 years.The prevalence of deafness in the combined populations of these two practices as measured by audiogram was found to be 5.8 per cent (+/- 0.5 per cent; one standard error). This figure is much more than estimates derived from American data for use in Britain. The prevalence of deafness was shown to increase with lower social class and age. The questionnaire was found to be unreliable for prevalence studies, but was thought to have some use as a screening instrument.There was an incidental finding of increased hearing defects in the left ears of men. The firing of rifles was felt to be a possible explanation of this.

Adult↗