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S Chell

Publications and source records attributed to S Chell.

5 recordsLinked to original sources
PubMed2006

Modelling 5-year functional outcome in a major traumatic injury survivor cohort.

AIM: To estimate associations between possible predictors of functional disability outcome at 5 years in a working adult population cohort of survivors of major traumatic injury and to develop a prognostic model of outcome. DESIGN: Population based retrospective cohort study. POPULATION: Persons who had experienced major traumatic injury (Injury Seventy Score >15) in the area of the former Yorkshire Regional Health Authority during the period 30 September 1988 to 1 October 1989 and who survived for 5 years (average 5.3 years). METHODS: The same interviewer saw each survivor at their home and used the OPCS Adult Disability Schedule to ascertain levels of functional disability. Disability scores for each survivor were then combined in accordance with the OPCS guidance to calculate a level of disability between 0 (no disability) to 10 (maximum disability). The OPCS level was then dichotomised with a cut-point at 4/5. Possible predictor and confounding variables from pre-injury, injury and post-injury periods were modelled in a logistic regression to identify those that predicted outcome level. Two reduced models were developed to allow early prognosis of late outcome. RESULTS: The full model correctly classified 91% of observed outcomes. Inpatient length of stay OR 1.031 (95% CI 1.014,1.048) per day predicted poorer 5-year outcome; Glasgow Coma Score OR 0.790(0.629,0.992) per 1 point increase; stay in Intensive Care Unit OR 0.931 (0.877,0.987) per day; attainment of degree-level education OR 0.014 (0.000,0.707); single civil status OR 0.110 (0.013,0.908); being taken initially to a hospital with a neurosurgical facility OR 0.064(0.010,0.420); being in paid work during the 2 weeks before index injury OR 0.093(0.009,0.969) predicted better 5-year disability outcome. Two reduced models were constructed that included a simple set of variables, one of these models excluded any rehabilitation variables but still correctly classified 85% of the observed outcomes. CONCLUSION: As well as level of traumatic brain injury (TBI) and total inpatient stay, Pre-injury educational attainment and employment, civil status, immediate care in a hospital with a neurosurgical facility and stay in an Intensive Care Unit determined 5-year outcome. It is possible to efficiently predict outcome at an early stage. Previous work on predictors of disablement have suffered from large selection and attrition biases.

Adolescent↗
PubMed2005

Prospects in NSAID-derived chemoprevention of colorectal cancer.

There is strong evidence for an important role for increased COX (cyclo-oxygenase)-2 expression and PG (prostaglandin) E2 production in colorectal tumorigenesis. PGE(2) acts through four E-prostanoid receptors (EP1-4). COX-2 has therefore become a target for the potential chemoprevention and therapy of colorectal cancer. However, any therapeutic/preventive strategy has the potential to have an impact on physiological processes and hence result in side effects. General COX (COX-1 and -2) inhibition by traditional NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin, although chemopreventive, has some side effects, as do some conventional COX-2-selective NSAIDs. As PGE2 is thought to be the major PG species responsible for promoting colorectal tumorigenesis, research is being directed to a number of protein targets downstream of COX-2 that might allow the selective inhibition of the tumour-promoting activities of PGE2, while minimizing the associated adverse events. The PGE synthases and E-prostanoid receptors (EP1-4) have therefore recently attracted considerable interest as potential novel targets for the prevention/therapy of colorectal cancer. Selective (and possibly combinatorial) inhibition of the synthesis and signalling of those PGs most highly associated with colorectal tumorigenesis may have some advantages over COX-2-selective inhibitors.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Variation in clinical decision making is a partial explanation for geographical variation in lower extremity amputation rates.

BACKGROUND: Rates of lower extremity amputation vary significantly both between and within countries. The variation does not appear to support differences in need as an explanation. This study set out to see if variations in clinical decision making might contribute to the explanation. METHODS: Based on an extensive audit database of lower extremity amputations and revascularization operations, a decision model was produced. Drawing on items in this model allowed the selection of six clinical cases that differed in their probability of having amputation as the outcome. Two cases had 80 per cent or more, two cases had 45--55 per cent and two cases had 20 per cent or less probability of amputation. Each of ten consultant vascular surgeons looked at these cases without knowledge of their probability of outcome and decided on amputation or revascularization. RESULTS: Overall the chance-adjusted level of agreement (kappa coefficient) between the decisions made by ten surgeons on the six clinical cases and the actual outcome was 0.46, indicating a moderate level of agreement. The kappa coefficient for individual surgeons showed complete agreement (kappa = 1) for four, substantial agreement (kappa = 0.66) for four, fair agreement (kappa = 0.32) for one and no agreement other than at a chance level (kappa = 0) for one surgeon. CONCLUSION: Variations in the clinical decisions made by vascular surgeons given the same patient are likely to explain at least a part of the observed geographical variation in rates of lower extremity amputation. Consensus guidelines may enable more consistent decision making for this problem.

Aged↗
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Health Promotion↗