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Biomedical subjects

R S Stevens

Publications and source records attributed to R S Stevens.

12 recordsLinked to original sources
PubMed1998

Conservative management of follicular non-Hodgkin's lymphoma in childhood.

Among 447 children with non-Hodgkin's lymphoma (NHL) on the childhood U.K. registry, seven children with follicular (NHL) were identified. Four were male and their age ranged from 4.25 to 13.5 years (median 7.5); all had localized disease, Murphy's stage I (n = 4) and II (n = 3). Sites involved at presentation were cervical lymph nodes and tonsils (n = 5), ileum (n = 1) and parotid gland (n = 1). Three had complete surgical excision only and four had complete (n = 1) or incomplete excision (n= 3) followed by a short multi-agent chemotherapy regimen (UKCCSG 9001 protocol). With a median follow-up of 1.5 years (range 0.25-5 years) from diagnosis, six are alive in complete remission (CR) including three who had no chemotherapy. These results confirm previous reports that follicular lymphomas in children are rare (1.5%) and tend to be localized at presentation. Their rarity makes it difficult to produce guidelines about treatment, but in localized cases a period of non-intervention may be justified.

Antineoplastic Agents↗
PubMed1990

Effect on a geriatric service of opening a 25-bed ward on the district general hospital site: an audit.

Notes and discharge summaries of 2,560 patients were analysed in a pre-planned study to determine how the establishment of a 25-bed assessment ward on the district general hospital (DGH) site affected the work of a geriatric unit that had previously had no DGH beds. Throughput, changes in referrals and practice, and changes in outcome were measured using a computerised programme which examined the work of the unit for a year before and a year after the opening of the assessment ward. There were no changes in overall bed numbers or staffing, so changes were likely to be the direct result of establishing the DGH beds. The second year of the study showed a 33% increased throughput, with increased referrals from the accident and emergency department and evidence of more active investigation and treatment and a tendency towards a shorter length of stay. There was an increased number of transfers from all departments to the geriatric department for rehabilitation and a shortened time interval to transfer. Admissions to the general medical unit for patients aged 65-74 and 75+ did not change.

England↗
PubMed1984

A randomized controlled trial of a stroke rehabilitation ward.

In S.E. Kent, during 1978 and 1979, 225 patients, representing 228 occurrences of hemiplegia, were referred to a new 20-bed stroke rehabilitation ward. These patients were randomly allocated to treatment in the special ward (group A 112 strokes) or to remain in conventional treatment locations (group C 116 strokes); the two groups were closely similar, except for the initial level of consciousness. Survivors were observed at four-month intervals to one year. There are indications of benefit for patients in group A by comparison with Group C in terms of treatment received (number treated by remedial therapists, the extent of treatment, and the arrangements for after-care), and in outcome (survival and the proportion returned to the community). The direction of the trend of advantage is consistent with another recent controlled trial, although not all modes of improvement are identical in the two trials. It is suggested that every health district should develop a comprehensive policy of stroke management.

Aged↗
PubMed1982

The incidence and survival of stroke patients in a defined community.

A register of strokes in South East Kent was compiled over a period of 30 months. In a population of 248 000 the register of 1267 strokes indicated a crude annual incidence of 2.04/1000, and an annual incidence adjusted to the population structure of England and Wales of 1.66/1000. For the purposes of a comparative study of stroke management in 1978 and 1979 a register of patients with hemiplegia surviving 24 hours totalled 855 cases, of which 655 (77%) were admitted to hospital and 200 remained in the care of general practitioners. Follow-up was completed in 811 hemiplegic cases; 517 (63%) survived two weeks; and 271 (33%) survived one year. Comparisons are made with five recently published stroke registers in Europe. A higher incidence among males than females over age 54 is commonly observed. Survival of one-third of hemiplegic patients to one year from onset is lower than in other reported registers.

Adolescent↗
PubMed1974

Social effects of fractures of the neck of the femur.

One-hundred-and-five patients were visited at home one year or more after they had been treated for proximal femoral fractures to assess the extent to which their social independence had been affected by the incident. Since the accident 25% had become more dependent. The principal factors contributing to this outcome included established dependence, great age at the time of injury, and a poor clinical result. The implications for social services and community care of preventing social impairment justify a more comprehensive investigation. The need for close co-operation between orthopaedic surgeons and geriatricians, already widely acknowledged, is further emphasized.

Age Factors↗
PubMedDate not supplied

Reliability of range-of-motion measurement in the elbow and forearm.

The purpose of this study was to examine intratester, intertester, and interdevice reliability of range of motion measurements of the elbow and forearm. Elbow flexion and extension and forearm pronation and supination were measured on 38 subjects with elbow, forearm, or wrist disease by 5 testers. Standardized test methods and a randomized order of testing were used to test groups of patients with universal standard goniometers, a computerized goniometer, and a mechanical rotation measuring device. Intratester reliability was high for all 3 measuring devices. Meaningful changes in intratester range of motion measurements taken with a universal goniometer occur with 95% confidence if they are greater than 6 degrees for flexion, 7 degrees for extension, 8 degrees for pronation, and 8 degrees for supination. Intertester reliability was high for flexion and extension measurements with the computerized goniometer and moderate for flexion and extension measurements with the universal goniometer. Meaningful change in interobserver range of motion measurements was expected if the change was greater than 4 degrees for flexion and 6 degrees for extension with the computerized goniometer compared with 10 degrees and 10 degrees, respectively, if the universal goniometer was used. Intertester reliability was high for pronation and supination with all 3 devices. Meaningful change in forearm rotation is characterized by a minimum of 10 degrees for pronation and 11 degrees for supination with the universal goniometer. Reliable measurements of elbow and forearm arm movement are obtainable regardless of the level of experience when standardized methods are used. Measurement error was least for repeated measurements taken by the same tester with the same instrument and most when different instruments were used.

Adolescent↗