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Biomedical subjects

P J Franks

Publications and source records attributed to P J Franks.

At least 19 recordsLinked to original sources
PubMed2006

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial).

The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches. This study presents the short-term (3 month) cost analysis undertaken on a subset of patients entered into the CLASICC trial (682 of 794 patients). As expected the costs associated with the operation were higher in the 452 patients randomised to laparoscopic surgery (lap) compared with the 230 randomised to open procedure (open), Pounds 1703 vs Pounds 1386. This was partially offset by the other hospital (nontheatre) costs, which were lower in the lap group (Pounds 2930 vs Pounds 3176). The average cost to individuals for reoperations was higher in the lap group (Pounds 762 vs Pounds 553). Overall costs were slightly higher in the lap group (Pounds 6899 vs Pounds 6631), with mean difference of Pounds 268 (95%CI -689 to 1457). Sensitivity analysis made little difference to these results. The cost of rectal surgery was higher than for colon, for lap (Pounds 8259 vs Pounds 5586) and open procedures (Pounds 7820 vs Pounds 5503). The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar, lap surgery costing marginally more on average than open surgery.

Colectomy↗
PubMed2006

Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme.

BACKGROUND: Laparoscopic resection of colorectal cancer may improve short-term outcome without compromising long-term survival or disease control. Recent evidence suggests that the difference between laparoscopic and open surgery may be less significant when perioperative care is optimized within an enhanced recovery programme. This study compared short-term outcomes of laparoscopic and open resection of colorectal cancer within such a programme. METHODS: Between January 2002 and March 2004, 62 patients were randomized on a 2 : 1 basis to receive laparoscopic (n = 43) or open (n = 19) surgery. All were entered into an enhanced recovery programme. Length of hospital stay was the primary endpoint. Secondary outcomes of functional recovery, quality of life and cost were assessed for 3 months after surgery. RESULTS: Demographics of the two groups were similar. Length of hospital stay after laparoscopic resection was 32 (95 per cent confidence interval (c.i.) 7 to 51) per cent shorter than for open resection (P = 0.018). Combined hospital, convalescent and readmission stay was 37 (95 per cent c.i. 10 to 56) per cent shorter (P = 0.012). The relative risk of complications, quality of life results and cost data were similar in the two groups. CONCLUSION: Despite perioperative optimization of open surgery for colorectal cancer, short-term outcomes were better following laparoscopic surgery. There was no deterioration in quality of life or increased cost associated with the laparoscopic approach.

Adenocarcinoma↗
PubMed2006

Sociodemographic factors in chronic leg ulceration.

BACKGROUND: While there is a commonly held belief that leg ulceration is associated with social factors, the evidence to support this is mainly anecdotal. OBJECTIVES: To determine deficits in sociodemographic status in patients with chronic leg ulceration. In a matched case-control study carried out in community leg ulcer clinics and participants' homes within Wandsworth Primary Care Trust, patients with chronic leg ulceration were compared with age- and sex-matched community controls drawn from general practitioner registers. Main outcome measures were the prevalence of social class, ethnicity, marital status, living status and social support. Data were analysed by conditional logistic regression. RESULTS: In all, 113 patients were identified and matched to controls. Patients had a mean age of 75 years (range 31-94), with 72 (64%) being women. The ulcer had been present for a median of 8 months (range 0.8-144), and 29% of patients had an area of ulceration >10 cm(2) (range 0.5-171.5). Being Afro-Caribbean increased the risk of leg ulceration eightfold (95% confidence interval, CI 1.83-34.75; P < 0.001) compared with the white population. There was a gradient with social class, with patients with leg ulcers being more likely to come from social class IV and V (odds ratio, OR 2.82, 95% CI 1.19-6.74; P = 0.015). Never having married (OR 2.98, 95% CI 1.15-7.74; P = 0.025), living in rented housing (P < 0.001) and having a mobility deficit (P < 0.001) more often occurred in the ulcer patients, while living with a spouse was protective (OR 0.46, 95% CI 0.21-0.99; P = 0.048). Patients with ulceration experienced significantly poorer social support than their controls for most subscales of the medical outcomes study social support questionnaire (all P < 0.05). CONCLUSIONS: Chronic leg ulceration is associated with poorer socioeconomic status, and factors which relate to social isolation. At present it is not possible to determine whether these associations are causative or are a consequence of the ulceration.

Adult↗
PubMed2006

The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer.

OBJECTIVE: Optimizing peri-operative care using an enhanced recovery programme improves short-term outcomes following colonic resection. This study compared a prospective group of patients undergoing resection of colorectal cancer within an enhanced recovery programme, with a prospectively studied historic cohort receiving conventional care. PATIENTS AND METHODS: Sixty patients underwent elective resection within an enhanced recovery programme (ERP). This incorporated pre-operative counselling, epidural analgesia, early feeding and mobilization. Clinical outcomes were compared with 86 prospectively studied historic control patients receiving conventional care (CC). All patients completed EORTC QLQ-C30, QLQ-CR38 and health economics questionnaires up to three months after surgery. RESULTS: Baseline clinical data were similar in both groups. Postoperative hospital stay was significantly reduced in the ERP, with patients staying 49% as long as those in the CC group including convalescent hospital stay (95% CI 39% to 61%P < 0.001). There were no differences in the number of complications, readmissions or re-operations. There were no significant differences in quality of life or health economic outcomes. CONCLUSION: Patients undergoing colorectal resection within an ERP stay in hospital half as long as those receiving conventional care, with no increased morbidity, deterioration in quality of life or increased cost.

Aged↗
PubMed2005

Leg ulceration in Portugal: prevalence and clinical history.

OBJECTIVE: To determine the prevalence and clinical history of leg ulceration in Portugal. DESIGN: Case identification of patients through health professionals providing care for patients with leg ulceration. SETTING: Clinical areas in hospital, community centres and patients' homes. PARTICIPANTS: Patients registered with five health centres within Lisbon suffering from ulceration of the leg receiving care from hospital and community staff. METHODS: Patients identified by health care professionals working in one area of Lisbon were asked to complete a simple proforma on each patient with leg ulceration. Patients were followed up prospectively to determine healing rates during this baseline period of evaluation. RESULTS: In total 263 patients were identified in a population of 186,000 (total prevalence 1.41 (95%CI 1.25-1.59) per 1000 population). The prevalence was similar between men and women (1.3 and 1.46 per 1000, respectively). As expected this was highly age dependent being most common in the patients aged over 80 years (6.5 and 4.9 per 1000, respectively). Median duration of ulceration was 18 months, with 158/240 (66%) present for longer than 1 year, and 40 (17%) for longer than 5 years. The cause of ulceration was unknown to the health professional treating the patient in 86 (33%) patients. Diagnosis of aetiology was usually on the basis of clinical examination alone (145, 56%), with 21 (8%) having undergone ankle to brachial pressure index (ABPI) measurements and a further eight undergoing either echo-Doppler or arteriography. Most care was provided by community services, with 145 (55%) treated in health centres and 77 (29%) treated in the patient's home. CONCLUSIONS: The prevalence of chronic leg ulceration is similar to other reported studies in western Europe, and indicates that approximately 14,000 patients suffer from leg ulceration at any one time in Portugal. Leg ulceration causes a considerable burden on both hospital and community services.

Aged↗
PubMed2004

Prevalence of leg ulceration in a London population.

BACKGROUND: Current prevalence estimates of chronic leg ulceration are frequently based on studies from the 1980s. During the last decade, major changes have occurred in the application of evidence-based practice to this condition. AIM: To determine the prevalence and cause of leg ulceration in a defined geographical population after 8 years of providing standardized evidence based protocols of care. DESIGN: Prospective survey. METHODS: Patients with leg ulceration of >4 weeks duration) within an integrated acute and community leg ulcer service were ascertained, interviewed and clinically assessed, using a standardized questionnaire on medical history, ulcer details and non-invasive vascular investigation to describe causes. Ulcers were classified by aetiology. RESULTS: We identified 113 patients in a population of 252 000, giving a crude prevalence of 0.45/1000 (95%CI 0.37-0.54/1000): 0.34/1000 in men, 0.54/1000 in women. Rates were highly dependent on age, increasing to 8.29 (men) and 8.06/1000 (women) in those aged >85 years. Of the responders, 62/113 (55%) had their ulcer for >1 year. Uncomplicated venous ulceration was observed in only 59/138 (43%) ulcerated limbs; a further 21 had ulceration primarily due to arterial disease. Complex causes were present in 48 (35%) limbs, mostly venous disease in combination with diabetes (35%), lymphoedema (42%) and rheumatoid arthritis (26%). DISCUSSION: Our prevalence of chronic leg ulceration is approximately one-third of that predicted by previous studies using similar methodologies in the 1980s. Patients with ulceration have more complex aetiologies than previously recognized, which may be a consequence of both increasing ulcer chronicity and age.

Adult↗
PubMed2004

Implementation of a leg ulcer strategy.

BACKGROUND: The care of patients with leg ulceration has developed over the past 15 years, although there is little information available to determine how these changes have affected clinical and patient defined outcomes. OBJECTIVES: To describe and evaluate the implementation of a leg ulcer strategy. PATIENTS/METHODS: This study used a pre- and postimplementation evaluation within population-based services within the boundaries of community services providing leg ulcer care. Evidence-based leg ulcer services were developed, including standardized assessment using Doppler ultrasound, rationalization of treatment using multilayer elastic high compression, development of referral criteria and acute service support. Complete ulcer healing rates, health-related quality of life and use of health resources were evaluated after 12 weeks in both pre- and postimplementation cycles. RESULTS: A total of 955 patients were evaluated (518 preimplementation, 437 postimplementation). The levels of assessment and treatment were poor prior to the change in practice with just one patient having evidence of correct assessment and 49 (11%) receiving high compression therapy. Postimplementation, this improved to 412 of 437 (94%) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week healing rates preimplementation ranged between 9% and 24%, and postimplementation rose from 19% to 39%. Combined overall healing rates improved from 71 of 518 (14%) to 160 of 437 (37%), odds ratio =3.53, P < 0.001. Frequency of treatment visits reduced from a mean (SD) of 24.0 (16.1) over 12 weeks to 13.5 (8.6), P < 0.001. Intervention led to major improvements in health-related quality of life (measured using the Nottingham Health Profile), with significant improvements for energy, pain, sleep and mobility (P < 0.01). CONCLUSIONS: Rationalization of leg ulcer services through a total service change results in improvements in professional practice, better patient outcomes, and efficient use of current resources. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.

Aged↗
PubMed2003

Water resource partitioning, stem xylem hydraulic properties, and plant water use strategies in a seasonally dry riparian tropical rainforest.

This study investigated seasonal variation in the origin of water used by plants in a riparian tropical rainforest community and explored linkages between plant water source, plant xylem hydraulic conductivity and response to the onset of dry conditions. The study focused on five co-dominant canopy species, comprising three tree species ( Doryphora aromatica, Argyrodendron trifoliolatum, Castanospora alphandii) and two climbing palms ( Calamus australis and Calamus caryotoides). Stable isotope ratios of oxygen in water (delta(18)O) from soil, groundwater, stream water and plant xylem measured in the wet season and the subsequent dry season revealed water resource partitioning between species in the dry season. Measurement of stem-area-specific hydraulic conductivity ( K(S)) in the wet season and subsequent dry season showed a significant dry-season loss of K(S) in three of the five species ( Castanospora alphandii, Calamus australis and C. caryotoides) and a decrease in mean K(S) for all species. This loss of hydraulic conductivity was positively correlated with the difference between wet-season and dry-season midday leaf water potentials and with leaf carbon isotope discrimination, indicating that plants that were less susceptible to loss of conductivity had greater control over transpiration rate and were more water-use efficient.

Adaptation, Physiological↗
PubMed2003

Lymphoedema: an underestimated health problem.

BACKGROUND: Lymphoedema/chronic oedema is an important cause of morbidity in the population, but little is known of its epidemiology and impact on patients or health services. AIM: To determine the magnitude of the problem of chronic oedema in the community, and the likely impact of oedema on use of health resources, employment and patient's quality of life. DESIGN: Questionnaire-based survey. METHODS: Health professionals from dedicated lymphoedema services, specific out-patient clinics, hospital wards and community services (GP clinics and district nurses) were contacted to provide information on patients from within South West London Community Trust. A subset of the identified patients was interviewed. RESULTS: Within the catchment area, 823 patients had chronic oedema (crude prevalence 1.33/1000). Prevalence increased with age (5.4/1000 in those aged > 65 years), and was higher in women (2.15 vs. 0.47/1000). Only 529 (64%) were receiving treatment, despite two specialist lymphoedema clinics within the catchment area. Of 228 patients interviewed, 78% had oedema lasting > 1 year. Over the previous year, 64/218 (29%) had had an acute infection in the affected area, 17/64 (27%) being admitted for intravenous antibiotics. Mean length of stay for this condition was 12 days, estimated mean cost pound 2300. Oedema caused time off work in > 80%, and affected employment status in 9%. Quality of life was below normal, with 50% experiencing pain or discomfort from their oedema. DISCUSSION: Chronic oedema is a common problem in the community with at least 100 000 patients suffering in the UK alone, a problem poorly recognized by health professionals. Lymphoedema arising for reasons other than cancer treatment is much more prevalent than generally perceived, yet resources for treatment are mainly cancer-based, leading to inequalities of care.

Adolescent↗
PubMed2002

A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema.

This paper describes a randomized controlled crossover study examining the effects of manual lymphatic drainage (MLD) in 31 women with breast cancer-related lymphoedema. MLD is a type of massage used in combination with skin care, support/compression therapy and exercise in the management of lymphoedema. A modified version of MLD, referred to as simple lymphatic drainage (SLD), is commonly taught as a self-help measure. There has been limited research into the efficacy of MLD and SLD. The study reported here explores the effects of MLD and SLD on a range of outcome measures. The findings demonstrate that MLD significantly reduces excess limb volume (difference, d=71, 95% CI=16-126, P=0.013) and reduced dermal thickness in the upper arm (d=0.15, 95% CI=0.12-0.29, P =0.03). Quality of life, in terms of emotional function (d=7.2, 95% CI=2.3-12.1, P=0.006), dyspnoea (d=-4.6, 95% CI=-9.1 to -0.15, P=0.04) and sleep disturbance (d =-9.2, 95% CI=-17.4 to -1.0, P=0.03), and a number of altered sensations, such as pain and heaviness, were also significantly improved by MLD. The study provides evidence to support the use of MLD in women with breast cancer-related lymphoedema. The limitations of the study are outlined and future areas for study are highlighted.

Breast Neoplasms↗
PubMed2002

An exploration of patients' understanding of leg ulceration.

OBJECTIVE: This study aimed to identify patients' understanding of leg ulceration by examining their knowledge of the disease process and their expectations of their treatment outcomes. It also aimed to identify their attitudes to any patient information provided to them. METHOD: A total of 101 patients (median age: 75 years, range: 23-91; 54% female) with current leg ulceration of 16 months' median duration (range: 1-480) were asked about their understanding of their condition and treatment and their expectations of patient information provided by health-care professionals. RESULTS: The majority of patients believed they knew the cause of their ulceration (66%), most frequently attributing it to trauma (28%). The most important part of the treatment was felt to be bandaging (27%) and visiting the clinic (12%). Thirty-nine percent did not know what the term 'venous' meant. 'Trauma' was frequently described as a psychological problem, with only 7% associating the word with a knock or wound. Over half of the patients (64%) expressed an interest in acquiring further information, particularly on how they could assist ulcer healing (51%). CONCLUSION: For patient education to be effective, it must be tailored to the patients' vocabulary using simple concepts and straightforward, unambiguous messages.

Adult↗
PubMed2001

Health related quality of life in patients with venous ulceration: use of the Nottingham health profile.

INTRODUCTION: The Nottingham health profile (NHP) has been used in several studies of patients being treated for chronic venous leg ulceration, though there is a paucity of information on the validity of the NHP in this patient group. This study was carried out to determine this validity and to compare and contrast the results with a previous study that had used the MOS short form 36 (SF-36) in this patient group. METHODS: Patients in four health trusts suffering from venous ulceration were interviewed at entry and after 12 weeks of treatment using high compression bandaging. Information was collected on ulcer history, general medical history, and the NHP was completed at both time points. After 12 weeks, a record was made of whether all areas of ulceration had cleared from the patients' legs (healed) or whether some ulceration remained (unhealed). RESULTS: Of the 383 patients who made up the study population, 37% experienced complete healing of their ulceration after 12 weeks of treatment. While internal consistencies of the NHP scores were reasonable (Cronbach's alpha > 0.63), there were a high proportion of patients who scored 0 (best possible health) at entry into the study, most notably for social isolation (67.5%), emotional status (48.9%) and energy (47.4%). Despite these limitations, there was strong evidence that treatment led to significant improvements in all dimensions of the NHP for the total group (all p < 0.01). These improvements were greatest in patients whose ulcers healed compared with patients whose ulcers failed to heal for bodily pain (mean difference d = 9.4, p = 0.004). Patients whose overall health status improved had significantly greater improvements for all dimensions of the NHP (p < 0.05). CONCLUSION: The NHP, has limitations in terms of a large floor effect (best possible health), but has similar internal consistency to the SF-36 in patients with leg ulceration. However, unlike the SF-36, the NHP is sensitive to change in the patients' ulcer status, and should therefore be considered in studies of venous leg ulcer healing.

Chronic Disease↗
PubMed2001

The effect of exogenous abscisic acid on stomatal development, stomatal mechanics, and leaf gas exchange in Tradescantia virginiana.

Gas exchange parameters and stomatal physical properties were measured in Tradescantia virginiana plants grown under well-watered conditions and treated daily with either distilled water (control) or 3.0 mM abscisic acid (ABA). Photosynthetic capacity (CO(2) assimilation rate for any given leaf intercellular CO(2) concentration [c(i)]) and relative stomatal sensitivity to leaf-to-air vapor-pressure difference were unaffected by the ABA treatment. However, at an ambient CO(2) concentration (c(a)) of 350 micromol mol(-1), ABA-treated plants operated with significantly lower c(i). ABA-treated plants had significantly smaller stomata and higher stomatal density in their lower epidermis. Stomatal aperture versus guard cell pressure (P(g)) characteristics measured with a cell pressure probe showed that although the form of the relationship was similar in control and ABA-treated plants, stomata of ABA-treated plants exhibited more complete closure at P(g) = 0 MPa and less than half the aperture of stomata in control plants at any given P(g). Scaling from stomatal aperture versus P(g) to stomatal conductance versus P(g) showed that plants grown under ABA treatment would have had significantly lower maximum stomatal conductance and would have operated with lower stomatal conductance for any given guard cell turgor. This is consistent with the observation of lower c(i)/c(a) in ABA-treated plants with a c(a) of 350 micromol mol(-1). It is proposed that the ABA-induced changes in stomatal mechanics and stomatal conductance versus P(g) characteristics constitute an improvement in water-use efficiency that may be invoked under prolonged drought conditions.

Abscisic Acid↗
PubMed2001

Guard cell volume and pressure measured concurrently by confocal microscopy and the cell pressure probe.

Guard cell turgor pressures in epidermal peels of broad bean (Vicia faba) were measured and controlled with a pressure probe. At the same time, images of the guard cell were acquired using confocal microscopy. To obtain a clear image of guard cell volume, a fluorescent dye that labels the plasma membrane was added to the solution bathing the epidermal peel. At each pressure, 17 to 20 optical sections (each 2 microm thick) were acquired. Out-of-focus light in these images was removed using blind deconvolution, and volume was estimated using direct linear integration. As pressure was increased from as low as 0.3 MPa to as high as 5.0 MPa, guard cell volume increased in a saturating fashion. The elastic modulus was calculated from these data and was found to range from approximately 2 to 40 MPa. The data allow inference of guard cell osmotic content from stomatal aperture and facilitate accurate mechanistic modeling of epidermal water relations and stomatal functioning.

Fabaceae↗
PubMed2001

Nurses' evaluation of a new four-layer bandage system.

This small study was undertaken to evaluate a new four-layer bandage (4LB) system (Ultra Four, Robinson). The aim was to provide initial user information about the product and compare it with the previously used original Charing Cross 4LB system. Subjective evaluations of the comparative performance of the Ultra Four system were assessed using a weekly treatment questionnaire in 30 patients. Both patients and nurses commented on the usability of each individual layer and the overall performance of the new system over a period of up to 12 weeks or until healing. After 12 weeks 15/30 ulcers (50%) had healed. Using life table analysis, allowing for patients who failed to reach 12 weeks, the expected healing rate was 65%. The performance of each individual layer was considered similar to those of the Charing Cross 4LB in terms of wear and tear, slippage and ease of removal. However, there was an indication that the fourth layer provided superior wear and tear at the heel and better ease of application and ease of removal than the original. After one week of treatment the Ultra Four system was rated better than the original 4LB for wear and tear at the heel in 15/28 patients (54%), for overall wear and tear in 12/25 (48%), for ease of application in 9/27 (33%) and for ease of removal in 11/26 (42%). This study relied on the nurses' experience rather than a direct comparison between bandages. However, it does indicate that the relative performance of products may help nurses to make decisions when objective comparative data are not available.

Attitude of Health Personnel↗
PubMed2000

Assessing the relative costs of standard open surgery and laparoscopic surgery in colorectal cancer in a randomised controlled trial in the United Kingdom.

The role of laparoscopic surgery for the treatment of colorectal cancer is being explored in a multi-centre, randomised clinical trial in the UK, the MRC CLASICC Trial (Conventional versus Laparoscopic-assisted Surgery in Colorectal Cancer). An important end-point of the trial is the cost-effectiveness of laparoscopic surgery compared with that of conventional open surgery. The economic evaluation of this trial has been modelled on that in a similar trial being conducted in the USA in colon cancer. The aim of this paper is to discuss the rationale for modelling the UK trial on the US trial, and to describe the adaptations necessary for the UK trial. The parallel design of the economic evaluation in both trials will provide a unique opportunity to compare the cost implications of incorporating laparoscopic surgery in the UK and the USA, and to determine any cross-cultural differences. The UK trial will also provide information about the cost-effectiveness of laparoscopic surgery in rectal cancer.

Colorectal Neoplasms↗
PubMed2000

The level of need for palliative care: a systematic review of the literature.

Palliative care services have developed rapidly over the past 30 years, with little evaluation as to how needs have been met by these new services. As part of a systematic review of palliative care, evidence of the needs of patients and carers has been evaluated from the current literature. Of the total of 673 articles related to the 10 areas within the main review, 64 provided evidence on the need for palliative care services over the period from 1978 to 1997. A further nine articles were added in November 1998 after the end of the study of update the review with more recent research. Need can be assessed in one of two ways: either by adopting an epidemiological approach or by examining health service usage. In the former, evidence is provided on disease-specific mortality, and related to the duration of symptoms prior to the patient's death. As an example of this, it is suggested that services may need to provide pain control for 2800 patients per million (p/M) population dying from cancer each year and 3400 p/M with noncancer terminal illness. Using health service usage as an indicator of need, 700-1800 p/M with cancer and 350-1400 p/M with noncancer terminal illness would require a support team or specialist palliative home care nurse, with 400-700 cancer p/M and 200-700 noncancer p/M requiring inpatient terminal care. Studies indicate that at present usage, palliative care is being provided by 40-50 hospice beds/M. Despite this provision, there remains evidence that in certain areas of care such as pain control, there still remains a high degree of unmet need.

Age Distribution↗