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Biomedical subjects

P A Lewis

Publications and source records attributed to P A Lewis.

At least 19 recordsLinked to original sources
PubMed1992

Supporting elderly dependent people at home.

OBJECTIVE: To clarify the relation between the dependency of elderly people and the assistance they receive from others by using a detailed but simple measure of dependency. DESIGN: Secondary analysis of data from a survey of people aged 70 and over. SETTING: Two general practices in south Wales. SUBJECTS: 1280 people aged 70 and over. MAIN OUTCOME MEASURES: Dependency on others to perform essential functions; detailed data on who assists with those functions. RESULTS: Increasing dependency was associated with increased use of more than one member of the family or friends and an increase in the provision of statutory services. CONCLUSION: The complexity of the relation between dependency and those who care for dependent people has previously been underestimated. The presence of providers of statutory services at the household of elderly dependent people suggests that these services can be developed further to help those caring for elderly people at home.

Activities of Daily Living↗
PubMed1992

Can health visitors prevent fractures in elderly people?

OBJECTIVES: To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over. DESIGN: Randomised, controlled trial; randomisation by household. SETTING: General practice in a market town. SUBJECTS: Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls. INTERVENTION: The people in the intervention group were allocated to the care of a health visitor. The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit. The intervention continued for four years. MAIN OUTCOME MEASURE: Fracture rate over four years. RESULTS: The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant). CONCLUSIONS: A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures.

Aged↗
PubMed1992

Transformation of microbes, plants and animals by particle bombardment.

Over the past several years, particle bombardment has evolved into a useful tool for molecular biologists, allowing direct gene transfer to a broad range of cell and tissue types. Some of the important applications of the process include the production of transgenic crop species including maize and soybean and the introduction of DNA into plastids and mitochondria. Recent results have extended the range of gene transfer by particle bombardment to animal and bacterial cells. One noteworthy newer application is the direct insertion of genes into the organs of living animals. Here we discuss these advances and the instrument developments that contributed to them.

Acceleration↗
PubMed1991

Assessing hearing problems within a community survey.

Community surveys are increasingly being used as a method of collecting health and lifestyle data. This report describes the use of a simple question on hearing difficulties within such a survey. A systematic sample of 2.5% of the electoral register of the four Parliamentary constituencies of Cardiff, Wales, was drawn. Of the 5145 individuals in the sample, 83% responded. Age and social class explained much of the variability in reported hearing difficulties. A recent fall and cigarette consumption were associated with hearing problems, but the contribution of alcohol consumption while potentially important did not reach statistical significance. This self-administered community survey provided hearing data which are consistent with other specialized studies and is a viable route for the assessment of community needs.

Activities of Daily Living↗
PubMed1991

Adjusting anticoagulation to prosthesis thrombogenicity and patient risk factors. Recommendations for the Medtronic Hall valve.

In order to determine optimum anticoagulation levels for the Medtronic Hall valve, the effect of low anticoagulation (mean International Normalized Ratio [INR] 2.5, 1979-1984) and moderate anticoagulation (mean INR 3.0, 1985-1989) was determined in 345 patients (183 low, 162 moderate) undergoing isolated mitral valve replacement (MVR) and 241 patients (91 low, 150 moderate) undergoing isolated aortic valve replacement (AVR). There were no cases of valve thrombosis. Embolic events and bleeding events were graded in severity and multiple decrement event-free survival calculated according to valve site and anticoagulation level: MVR low, MVR moderate, AVR low, and AVR moderate. In the MVR low group, 80% were free of all events and 93% free of serious events at 3 years compared with 89% and 98%, respectively, in the MVR moderate group. The AVR low group experienced a very small incidence of embolic events (one only) and no bleeding events. The AVR moderate group suffered more bleeding and more embolic events and at 3 years only 87% were event-free compared with 99% in the AVR low group. In both AVR groups, all embolic events were associated with one or more known stroke risk factors. Patients under 70, in sinus rhythm who were normotensive and were nonsmokers suffered no embolic events irrespective of their anticoagulation level. We conclude that the optimum INR for the average Medtronic Hall patient is 3.0 after MVR and 2.5 after AVR but some adjustments may be required in relation to stroke risk factor analysis.

Aortic Valve↗
PubMed1990

People's knowledge of health and disease.

A community survey based on the Cardiff electoral register was carried out in 1986. Seven hundred and ten adults were asked 10 open-ended questions about common serious illnesses in the United Kingdom and were given 18 statements about common diseases and asked to state whether they were true or false. This paper reports their responses. Amongst those gaining the highest scores there were more young people, more females, more from social classes I and II and more who had been educated to college or university level. We discuss the implications of the results for patient behaviour and for health education programmes.

Adolescent↗
PubMed1990

Precision of Larsen grading of radiographs in assessing progression of rheumatoid arthritis in individual patients.

A study was designed to evaluate observer variation in the assessment of radiographic deterioration of individual patients using the Larsen grading system. Radiographs of hands and feet of 52 patients were assessed by three observers. Each patient had paired films taken one year apart which were assessed together for change in score. To assess within-observer variation each set of films was read twice by all observers. The average progression was 11.6 (SD 9.0). Analysis of the source of variation showed the single observer replication SD to be 3.7 but that for different observers to be 5.5. This may be interpreted as indicating that to achieve 95% confidence of detecting a true change an increase in Larsen score of 8 is required if the same observer assesses or up to 11 if a different observer assesses.

Arthritis, Rheumatoid↗
PubMed1990

The relationship between dietary habits and beliefs in elderly people compared with younger people.

This study examined the habits and attitudes of a group of people aged 65 and over, in relation to their dietary beliefs and habits when compared with younger individuals. It was found that these older people had similar attitudes to food as those under 65, and these were in line with dietary advice given by health promotion experts. However they had not changed their habits to the same extent, nor did they intend to do so. Reasons for these findings are discussed.

Adolescent↗
PubMed1990

Characteristics of self-reported hearing problems in a community survey.

The Cardiff Health Survey included a question asking whether the respondents had any difficulties with their hearing and, if so, to specify the biggest difficulty. This self-completed questionnaire was administered to 4,266 individuals randomly sampled from the electoral register of Cardiff in 1986. 14.7% of those responding indicated a hearing disability; and the main specific disabilities listed are described. The commonest complaints were of difficulties hearing the television and radio, and with general conversation. A number of other specific complaints were reported similar to those found in previous studies with the 'Problems Questionnaire'. Age, social class, general health, smoking and the individual's attitudes were found to influence the pattern of response.

Age Factors↗
PubMed1990

Prevalence and treatment of symptoms of rheumatism and arthritis among over 65 year olds: a community profile.

A group of people aged 65 years and over was given a self-completion questionnaire requesting information about symptoms compatible with arthritis and rheumatism. Such symptoms were very common, more so in women than in men and were associated with marked degrees of disability and some dependency. The great majority of respondents said that they regarded their general practitioner as the best person for the treatment of such symptoms, but those with symptoms were slightly less likely than those without to suggest the general practitioner. Many people with symptoms had not reported them to any health service personnel, but had chosen to treat them themselves, suggesting a degree of scepticism about the effectiveness of professional treatment.

Aged↗
PubMed1989

Choosing who shall not be treated in the NHS.

In the face of severe resource constraints, health care systems are seeking both to control costs and to ensure maximum benefits for the resources consumed. The use of Quality Adjusted Life Years (QALYs) is becoming more widely advocated as a decision aid in the solution of resource allocation problems. The QALY combines two dimensions of health outcome--the quantity of life and its quality--in such a way that choices between different services with different purposes can be made using comparisons based on common units of measurement. The combination of these two dimensions allows comparisons between services with different objectives, such as curing and caring services. The QALY, however, lacks a third dimension which is vital to the decision-making process to which it is intended to contribute: the worth of a specific life relative to others. This paper presents results based on interviews of 719 residents of Cardiff drawn at random from the electoral register. The results suggest that further development of the novel methodology used to establish the relative value placed on various human lives is worthwhile. Evidence is given which indicates that the public consider lives to be of unequal worth. The results also show that these values are consistent for different types of choices phrased in different ways on a large number of control variables, implying the existence of a cultural stable value system which is a necessary prerequisite if consensus values of human life are to be used to assist decision-making in non-private health care systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1989

Which of two individuals do you treat when only their ages are different and you can't treat both?

A relative value of life dependent on age has been produced from a survey of 721 randomly selected individuals together with other observations of professional practice. The results are presented in diagrammatic form. If two identical people, except for age, present for medical treatment for a life-threatening condition and only one can be treated then the diagram indicates what the choice should be.

Age Factors↗