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Biomedical subjects

M J Hodge

Publications and source records attributed to M J Hodge.

At least 19 recordsLinked to original sources
PubMed1999

HIV-1 incidence among opiate users in northern Thailand.

The incidence of human immunodeficiency virus type 1 (HIV-1) infection among opiate users was determined in a retrospective cohort of 436 patients with multiple admissions to the only inpatient drug treatment program in northern Thailand between October 1993 and September 1995. During 323.4 person-years of follow-up, 60 patients presenting for detoxification acquired HIV-1 infection, for a crude incidence rate of 18.6 per 100 person-years (95% confidence interval 14.4-23.9). All seroconverters were male. HIV-1 incidence varied by the current route of drug administration: 31.3 per 100 person-years for injectors and 2.8 per 100 person-years for noninjectors (smoking and ingestion). Significant differences were found by ethnicity: HIV-1 incidence was 29.3 per 100 person-years for Thai lowlanders and 8.5 per 100 person-years for hill tribes. Multivariate relative risk estimates showed that injecting opiates (vs. use by other routes), being unmarried, being under age 40 years, being a Thai lowlander, having a primary and secondary education, and being employed in the business sector were each independently associated with human immunodeficiency virus seroconversion. This HIV-1 incidence rate is double that reported for Bangkok and suggests that prevention and control programs for drug users need to be expanded throughout Thailand. Improved availability of more-effective treatment regimens and increased access to sterile injection equipment are needed to confront the HIV-1 epidemic among opiate users in northern Thailand.

Adult↗
PubMed1998

Epidemiology of HIV-1 infection in opiate users in Northern Thailand.

Characterizing the epidemiology of HIV-1 infection in Northern Thai opiate users is important in developing control strategies in this ethnically diverse and culturally distinct region. A cross-sectional survey of drug users first admitted between 1993 and 1995 at the Northern Drug Dependence Treatment Center, Mae Rim, Thailand, was conducted. Patients (n = 4197) were interviewed at intake about their history of drug use when they provided serum specimens for HIV-1 antibody testing. The HIV-1 prevalence was 18.6%, with men having a fourfold higher prevalence than women. Wide diversity in HIV-1 prevalence was seen by ethnicity; the HIV-1 prevalence among Thai lowlanders was four times greater than that among ethnic minorities (hill tribes). Differences in HIV-1 prevalence were the result of differences in opiate use; hill tribes frequently smoked or ingested opium, whereas Thai lowlanders injected heroin. The high HIV-1 prevalence suggests that preventive interventions for risk reduction are urgently needed in these populations. Education about the risks of injection drug use (IDU) as well as information concerning needle disinfection and expansion of drug treatment are required to reduce the risk of HIV-1 transmission associated with sharing injection equipment. Further, increasing sources of sterile needles should be considered for active users, especially for those in more remote settings.

Adolescent↗
PubMed1996

Quality of life research and health technology assessment--a time for synergy.

Measuring quality of life and assessing technologies are both increasingly prominent in health care systems. This growth has accompanied growing concern over aging populations and health care expenditure growth. Nevertheless, there appears to be unrealized potential for synergy between quality of life research and technology assessment. In this paper, we consider the roles and challenges facing quality of life research in three domains: research-particularly clinical trials of therapeutics; clinical situations and policy-making. We then examine the potential for synergy in these domains and conclude that expanding collaboration will strengthen both fields and intensify their impact in research, clinical practice and policy-making.

Humans↗
PubMed1995

Setting priorities and selecting topics for clinical practice guidelines.

Setting priorities and selecting topics are important steps in guidelines development, but they have received relatively little attention to date. Responses from a survey of guidelines stakeholders in Canada suggest that the health burden of a clinical condition on the population is an important factor in priority setting. Economic considerations, cast as either costs of treatment to the health care system or the economic burden of illness to society, are given varying importance by different stakeholder groups. Drawing on the literature and the survey results, the authors propose a framework for priority setting. Important issues requiring consideration include the role of public and community participation, the need for and appropriate emphasis on quantitative data regarding current practice and its variation, and mechanisms to link guidelines to health-policy development and management of the health care system.

Canada↗
PubMed1995

Report on activities and attitudes of organizations active in the clinical practice guidelines field.

The organizing committee of a workshop on clinical practice guidelines (CPGs) surveyed invited organizations on their attitudes and activities related to five topics to be covered during the workshop sessions: organizational roles, priority setting, guidelines implementation, guidelines evaluation and development of a network of those active in the CPG field. Organizational roles: The national specialty societies were felt to have the largest role to play; the smallest roles were assigned to consumers, who were seen to have a role mainly in priority setting, and to industry and government, both of which were seen to have primarily a funding role. Many barriers to collaboration were identified, the solutions to all of which appeared to be better communication, establishment of common principles and clear role definitions. Priority setting: There was considerable agreement on the criteria that should be used to set priorities for CPG activities: the burden of disease on population health, the state of scientific knowledge, the cost of treatment and the economic burden of disease on society were seen as important factors, whereas the costs of guidelines development and practitioner interest in guidelines development were seen as less important. Organizations were unable to give much information on how they set priorities. Guidelines implementation: Most of the organizations surveyed did not actively try to ensure the implementation of guidelines, although a considerable minority devoted resources to implementation. The 38% of organizations that implemented guidelines actively listed a wide variety of activities, including training, use of local opinion leaders, information technology, local consensus processes and counter detailing. Guidelines evaluation: Formal evaluation of guidelines was undertaken by fewer than 13% of the responding organizations. All the evaluations incorporated assessments before and after guideline implementation, and some used primary patient data. Barriers to evaluation included lack of money, time, data or expertise. CPG Network: Most of the respondents felt that all organizations and individuals interested or involved in guidelines should form the membership of the network. The three most important functions of such a network were deemed to be (a) to facilitate collaboration among those involved in the CPG process, (b) to maintain an information centre on CPGs and (c) to provide expertise to the CPG process. It was felt that the network should have some formal structure and communicate through e-mail and print media.

Attitude↗
PubMed1995

The lost laparoscopic stone. Potential for long-term complications.

Intraperitoneal gallstones left behind at laparoscopic cholecystectomy are not uncommon. Such stones have previously been thought to be harmless. We report three instances of delayed intra-abdominal infection and/or inflammation related to these misplaced gallstones. All three patients presented months postoperatively with vague abdominal complaints. Computed tomography revealed inflammatory foci involving intraperitoneal gallstones. All patients required percutaneous or operative drainage of the collections. Every effort should be made to locate and remove "spilled" gallstones at the time of laparoscopic cholecystectomy.

Abdomen↗
PubMed1995

Medicine, practice and guidelines: the uneasy juncture of science and art.

While physicians are often portrayed as scientists, the defining character of medical practice is its being both science and art. Indeed, despite drawing on the ever-expanding knowledge base and range of therapies, medical practice remains fundamentally an interpersonal experience, drawing on the dynamic and rich interaction between practitioner and patient. With the goal of situating clinical practice guidelines in a broader context, we briefly explore models of medicine and the nature of clinical practice. The implications of these for guideline development and implementation are then examined as we present guidelines as an opportunity for enhancing medical practice and increasing both patient and practitioner satisfaction.

Humans↗
PubMed1995

Pediatric mortality and hospital use in Canada and the United States, 1971 through 1987.

Since 1971 pediatric mortality rates have decreased markedly but differently in Canada and the United States. These trends were examined in light of changes in hospital use and health care financing. Annual mortality and hospital use rates for children aged 14 years and younger were calculated. Between 1971 and 1987, all-cause mortality in Canada fell from 165 to 74 per 100,000; the American rate fell from 172 to 96 per 100,000. American hospitalization rates remained essentially constant until 1983 and then fell by 27.5%, while Canadian hospitalization rates declined throughout. In 1987 Canadian children had higher hospitalization rates, while American children had higher mortality rates. These differences may be associated with differences in health financing; the adoption of US prospective payment systems was temporally coincident with sharp declines in hospitalization rates for American children.

Adolescent↗
PubMed1989

Amputation of the distal portion of the foot.

For 101 patients, initial amputation of 124 extremities involved some distal portion of the foot. Amputations done for atherosclerosis healed in eight of 21 cases (38%), compared with 40 of 77 extremities (52%) in diabetic patients. Presence of cellulitis (44 cases) and absence of a popliteal pulse (44 cases) had no significant effect on success of amputation, but a palpable foot pulse was significantly associated with a successful outcome (29/35 cases, or 83%) (P less than .005). Serial amputations to preserve the foot were successful for 18 of 31 extremities (58%), a success rate equal to that of the entire series, 72 of 124 (58%). Attempts to preserve viability in the distal portion of the foot were not associated with mortality. Cellulitis and absence of a distal pulse are not contraindications to attempting preservation of the extremity, although the best results occur when distal extremity pulses are palpable. In nearly six of every ten cases, amputation of the distal portion of the foot resulted in a successful outcome.

Adult↗