Biomedical subjects
Publications and source records attributed to M Tew.
This preliminary survey was intended to collect transversal data to ensure a better understanding of the hepatitis B and C epidemiology in Mauritania. The authors have studied the seroprevalence rate of HBs antigen and HCV antibodies among 349 blood donors. Data of this study showed that anti-HCV antibody was detected in 1.1% and HBs antigen in 20.3% blood donors.
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BACKGROUND: The objective of this study was to examine the physical and emotional health status, self-perceived problems, and needs of newly diagnosed cancer patients to determine and plan supportive care strategies. METHODS: A cross-sectional survey of newly diagnosed cancer patients attending a regional cancer center during a 6-month period was performed. Patients with breast, colorectal, head and neck, lung, and prostate carcinoma as well as nonmelanoma of the skin were selected randomly. Patients were interviewed prior to their first appointment at the clinic. Physical health status was assessed using the Symptom Distress Scale, psychologic health status was assessed with the General Health Questionnaire (GHQ), day-to-day functioning with the Rapid Disability Scale, and social support with the modified Sarason's Social Support Scale. Perceived needs were assessed in a number of ways, including identification of patients' specific social concerns and informational needs, and by asking them to list their current problems or concerns. RESULTS: Of 156 eligible patients, 134 completed the interview. One hundred and twenty-nine patients (96%) reported current symptoms that included fatigue (66%), worried outlook (61%), difficulty sleeping (48%), and pain (42%). Forty-four patients (33%) were identified as psychologically distressed with a GHQ score of > or = 6. One hundred and fourteen patients (85%) had informational needs, 89 (66%) indicated > or = 1 social concerns, and 55 (41%) reported a need for assistance with day-to-day living. CONCLUSIONS: Patients with newly diagnosed cancer commonly report symptoms related to fatigue, pain, and psychologic distress. Other frequently reported issues relate to the need for information and social concerns regarding the patients' ability to take care of their home and maintain family and other relationships. Awareness of these issues is important for planning supportive care interventions for newly diagnosed cancer patients.
This is a descriptive of a census survey of telephone contacts to six unit offices of the Metro Hamilton District Canadian Cancer Society (CCS). The survey instrument was also designed to address two a priori hypotheses: that first-time contacts would be systematically different from the population of other callers; and, that some telephone contacts might represent a disguised need for emotional support. We also assessed satisfaction of CCS personnel with the outcome of telephone contacts. Over a four-day survey period, there were 946 telephone contacts of which 158 (17%) were patient related. First-time telephone contacts were more likely to be spouses or relatives/friends of patients as opposed to non-first-time contacts which were more likely to be patients (P = 0.01). A need for emotional support during telephone contact was more likely to be related to an underlying stressful prompting event for the call (P = 0.002). CCS telephone receptionist personnel were relatively less satisfied that callers' needs were met where emotional support was needed, as opposed to calls for service or information only. The results have implications for the orientation and continuing education of CCS personnel dealing with telephone contacts related to patients.
We compared the quality-of-life (QOL) dimensions after laryngectomy in patients with advanced larynx or pharynx cancer that were elicited from 20 consecutive laryngectomy patients and 20 health care professionals working in the Regional Head and Neck Oncology Service. Subjects in both groups were asked to identify important QOL items after recovery from laryngectomy and to rank and rate each on a vertical visual analogue scale. Health care professionals ranked impaired communication and self-image/self-esteem as the two most important QOL dimensions, whereas patients ranked the physical consequences of surgery, e.g., tracheal mucous production, and interference with social activities as the two most important items. The results indicate that the responses of health care professionals do not fully correlate with patient priorities. These findings are relevant to researchers developing treatment-specific QOL measures and to health care professionals when presenting treatment options to patients.
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Analysis of national perinatal statistics from Holland, 1986, demonstrates that for all births after 32 weeks' gestation mortality is much lower under the non-interventionist care of midwives than under the interventionist management of obstetricians at all levels of predicted risk. This finding confirms with great authority the conclusions of all earlier impartial analyses from Britain and other countries which agree in contradicting the claims on which the organisation of maternity services in most developed countries is now based, namely, that childbirth is made so much safer by the application of high technology that only this option should be provided.
An economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.
A randomized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario. Thirty caregivers were allocated to receive the experimental intervention consisting of: caregiver-focused health care, education about dementia and caregiving, assistance with problem solving, regularly scheduled in-home respite, and a self-help family caregiver support group. Thirty control subjects received conventional community nursing care. Before completion of the intervention, 18 (30%) were withdrawn, almost equally from each group. The most frequent reason was long-term institutionalization of the demented relative (n = 10). At baseline, caregivers in both groups were suffering from above-average levels of depression and anxiety. After the six-month intervention period, we found neither experimental nor control group improved in these areas. However, the experimental group showed a clinically important improvement in quality of life, experienced a slightly longer mean time to long-term institutionalization, found the caregiver role less problematic, and had greater satisfaction with nursing care than the control group.
We set up a trial to test whether the KT1000 arthrometer would give consistent measurements of anteroposterior laxity when used by the same and different examiners on the knees of the same subjects on the same day. The results showed substantial inter- and intra-examiner variation in the measurements both of absolute displacement in single knees and of side-to-side differences between pairs of knees. This casts doubt on the reliability of the instrument when used to compare the results of different techniques for reconstructing injured cruciate ligaments.
The advantage of potential flexion offered by total knee arthroplasty (TKA) is limited. In this review of 724 replaced knees, only one-third flexed to 105 degrees, while nearly one-half did not flex beyond 90 degrees. Postoperative flexion depended partly on preoperative flexion and partly on the prosthesis used, but these factors could not be the only determinants of results, for flexion in individual knees could increase, decrease, or remain unchanged whatever the preoperative measurement and whatever the design of prosthesis. Little difference in flexion before or after TKA was found between rheumatoid and osteoarthritic knees. Success or failure of the implant, according to the crude definition used, was not associated with degree of flexion. Patients with the lowest levels of function tended to have TKA with the least flexion and vice versa. Nevertheless, the degree of flexion is only one of the factors influencing mobility.
One of the objectives of knee replacement is to correct flexion deformity, the frequent consequence of rheumatoid arthritis and osteoarthritis. A review of 697 primary and revision replacements carried out between 1969 and 1985 and followed up from 1 to 16 years found that such deformity was present in 61% of knees before the primary operation. Replacement reduced this to 17% and the improvement was usually maintained. The deformity was present in only 21% of the replacements which required revision and the second operation reduced this to 8%. Flexion contractures affected rheumatoid knees more often and more seriously than osteoarthritic knees, but arthroplasty was more successful in correcting the deformity in the former. All of the 11 types of prosthesis used achieved some degree of correction, but the Walldius hinge and the variants of the Freeman condylar design were the most successful. Surprisingly, the best outcome, in terms of pain and reduced need for revision, was found in the rheumatoid knees most seriously deformed before operation, but this association was absent in the osteoarthritic knees. Postoperative deformity in knees without pain or extreme weakness did not appear to influence the patients' ability to walk or to use stairs or a chair, as measured by unexacting tests in the clinic.
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Impartial analyses of the evidence from official statistics, national surveys and specific studies consistently find that perinatal mortality is much higher when obstetric intranatal interventions are used, as in consultant hospitals, than when they are little used, as in unattached general practitioner maternity units and at home. The conclusion holds even after allowance has been made for the higher pre-delivery risk status of hospital births as a result of the booking and transfer policies. It holds even more strongly for births at high than at low predicted risk. It follows that the increased use of interventions, implied by increased hospitalization, could not have been the cause of the decline in the national perinatal mortality rate over the last 50 years and analysis of results by different methods confirms that the latter would have declined more in the absence of the former. Data are presented which point to the deleterious effect of interventions on the incidence of low birthweight and short gestation and their associated mortality. Also presented are data supporting the alternative explanation of the decline in perinatal mortality, namely the improvement in the health status of mothers built up over several generations. The organization of the maternity service stands indicted by the evidence. Despite the beliefs of those responsible, it has not promoted, and cannot promote, the objective of reducing perinatal mortality.
We examine the hypothesis that a knee replacement is most likely to survive successfully if it is stable with a coronal tibiofemoral angle close to 7 degrees of valgus, the accepted normal. The records of 428 knee replacements followed up for one to nine years were analysed. The highest success rate was indeed found in those so aligned at operation and such knees were most likely to remain stable. Nevertheless, half of the failures occurred in knees correctly aligned at operation and two-fifths in knees which had remained stable in this alignment; many failures must have been caused by factors other than malalignment. Some knees, well aligned at operation, deteriorated into severely varus or valgus positions; their failure rate was significantly higher than that for knees which remained normally aligned and higher also than for knees severely varus or valgus from operation onwards. Malalignment, in itself, may not be the most important cause of failure, though it probably does compound failure from other causes.
Many knee replacement prostheses, embodying various principles of design, are now available and there is need for a method by which valid comparisons of results can be made. An important criterion of success is durability, so the length of time the prostheses have been in situ must be taken into account. Such a method is proposed here and is applied to the results of 673 knee replacements, of nine different types, implanted at the same hospital between 1970 and 1983. A prosthesis was considered to have failed if it had been removed or persistently caused severe pain. Two types of prosthesis were found to be significantly less successful than the other seven, between which none consistently showed significant superiority. Results for the seven types were similar despite the facts that they had been used for knees with different degrees of damage, some as secondary implants, and that they were of different design and at different stages of technical development. The more recently introduced types of prosthesis, designed to have theoretical advantages, were found in practice to be no more successful than the models they superseded.