A practical guide to the initial evaluation and treatment of knee ligament injuries.
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Adolescent↗
Biomedical subjects
M Malek
Publications and source records attributed to M Malek.
Sickle cell hemoglobin D disease: first reported case in Iran.
A case of sickle cell Hb D disease is reported in a young Iranian male, the father of whom carried an AS sickle cell trait and the mother an AD trait. This disease was diagnosed by Hb electrophoresis, agar gel electrophoresis sickling and solubility tests. This is the first case of sickle cell HB D disease reported in Iran.
Adult↗
An economic model of the market for hospital treatment for non-urgent conditions.
This paper develops an economic model of the market for treatment of waiting list conditions, in which complainants choose between private treatment, NHS treatment and no hospital treatment. This choice depends on a number of clinical and non-clinical factors, which enter the demand functions for private and NHS treatment. Among the key influences are the price of private treatment and the expected duration of wait for NHS treatment, both of which are endogenous variables in the model. Given a pair of private sector and NHS supply functions, expressions are obtained for the price and expected wait at which demand and supply are simultaneously equated in both the private sector and the NHS. The paper concludes by exploring the responsiveness of the equilibrium to various demand side and supply side shocks.
Choice Behavior↗
A cost minimisation analysis of cardiac failure treatment in the UK using CIBIS trial data. Cardiac Insufficiency Bisoprolol Study.
The clinical benefits of beta-blockers in heart failure are currently subject to intense debate and are being investigated. The economic impact of beta-blockade, however, has largely remained unexplored. The Cardiac Insufficiency Bisoprolol Study (CIBIS), while failing to show statistically significant reduction in mortality over conventional therapy, demonstrates that the administration of bisoprolol adjuvant to standard therapy leads to a significant reduction in hospital admission. The present study is a cost minimisation analysis based on CIBIS data for the UK and is restricted to direct costs only. The costs of bisoprolol medication and inpatient treatment of heart failure are considered. The 'base case' analysis and the sensitivity analyses carried on all cost driver parameters show that administering bisoprolol to heart failure patients adjuvantly to the standard therapy is at least cost neutral. Additional drug costs incurred by bisoprolol are compensated by the inpatient treatment costs of heart failure avoided. All other non-quantifiable clinical benefits such as improvement of New York Heart Association functional class are positive extras to patients and the National Health Service.
Adolescent↗
Measuring the effects of seating on people with profound and multiple disabilities--a preliminary study.
This paper describes a preliminary study to investigate a range of approaches that might be used for measuring the effects of special seating on people with profound and multiple disabilities and their carers. A number of tools are proposed for measuring the effects on quality of life, function and carer satisfaction. The results of applying these tools to measure the effects of intervention with customized molded seating on nine people with multiple disabilities are described. The results suggest that these tools are sensitive to this intervention, showing a general beneficial effect with good carer satisfaction. The study points the way towards application of these tools to people with a wider range of disabilities and to different interventions.
Adult↗
Clinical laxity tests and functional stability of the knee: biomechanical concepts.
Biomechanical studies show one or 2 ligaments provide the primary passive restraint for each plane of knee stability with the remaining ligaments having a secondary helping role. Correct interpretation of clinical laxity tests and surgical treatment of instability requires this subdivision. Functional stability of the knee is a primary treatment goal after ligament injury, but is too often short-term, relying on muscle control alone without the fine-tuning action of the ligamentous system. If there is abnormal laxity on the clinical examination, there is an increased risk for joint wear, cartilage deterioration and arthritis on a long-term basis.
Biomechanical Phenomena↗
New patients presenting to their GP with dyspepsia: does Helicobacter pylori eradication minimise the cost of managing these patients?
Fifty-seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist-led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom-free over the six-month follow-up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow-up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.
Decision Trees↗
Phase II clinical trial of combined natural interferon-beta plus recombinant interferon-gamma treatment of chronic hepatitis B.
BACKGROUND/AIMS: Alpha-interferon (IFN-alpha) is an effective treatment for chronic hepatitis B but only 25-40% of patients will profit from a long-term beneficial response to the currently recommended schedule of 3-6 MU given 3 times a week for 6 months. Clinical trials are therefore needed to investigate alternative modifications of interferon therapy, including combinations of different antivirals or immune modulators in order to improve the therapeutic approach to chronic hepatitis B infection. In a phase II trial we evaluated whether a combination of natural interferon-beta (nIFN-beta) with strong antiviral activity plus recombinant interferon-gamma (rIFN-gamma) with a predominantly immunomodulatory activity is able to increase the response rate compared to historical controls treated with IFN-alpha in a conventional regimen. METHODOLOGY: Forty patients with chronic hepatitis B were included in this trial of combined interferon therapy at a dosage of 6 MU nIFN-beta during week 1 followed by 3 MU for weeks 2-4 plus rIFN-gamma at a daily subcutaneous (s.c.) injection of 150 microg during the entire 4 weeks of the treatment period. Patients entered the trial on the basis of the following criteria: hepatitis B surface antigen (HBsAG), HBeAG and HBV-DNA positive for at least 6 months, HDV, EBV, CMV, anti-HIV negative, and chronic hepatitis proven on biopsy taken within 4 weeks of entry as well as 6 and/or 12 months after interferon therapy. The final diagnosis and classification of chronic hepatitis has been based on guidelines according to a revised classification of chronic hepatitis (Desmet 1994). The post-treatment follow-up was 12 months. RESULTS: The combined interferon therapy achieved complete responses with seroconversion from HBeAG to anti-HBe and a negative HBV-DNA (dot blot) test, as well as normalization of ALT activity in 15 patients, and partial response with negativation of HBV-DNA concomitant to a decrease in aminotransferase activity to near normal levels in 6 patients. Nineteen patients showed no response to viral markers but showed relief of clinical symptoms as well as pronounced decrease of serumtransaminase activity. Grading of liver biopsies demonstrated an improvement of histologic parameters after the interferon regimen in half of the evaluable patients (n=22). Histological response has been quantified by a reduction in the score of histological activity (HAI-index) from 12.6 before to 7.6 after interferon therapy, and in the inflammation and cellular degeneration score (ICD) from 9.9 to 5.2. Histological response, however, failed to show a consistent correlation with serologic response. This medium-dose combination of interferon-beta and interferon-gamma was tolerated very well by the patients, this good tolerability being explained by tachyphylaxis in response to daily interferon doses. No serious side effects or decompensation of liver function were observed during the 4-week period of therapy or the follow-up, despite the special clinical situation where 60% of the patients included in the study presented with histologically proven cirrhosis (35% of them with clinical manifestation of mildly decompensated cirrhosis). CONCLUSIONS: This short-term regimen of combined nIFN-beta + rIFN-gamma therapy in patients with chronic hepatitis B proved to be equieffective to long-term treatment with interferon-alpha and combines high clinical tolerability with good practicability, as it can be administered on an in-patient basis, ensuring close patient monitoring.
Adolescent↗