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S M Gore

Publications and source records attributed to S M Gore.

At least 19 recordsLinked to original sources
PubMed1992

The Lancet's statistical review process: areas for improvement by authors.

The Lancet now incorporates statistical review of submitted papers which remain candidates for publication after conventional review. We summarise here criticisms noted by the statistical reviewers for 191 such papers received between November, 1990, and June, 1991. Only 54% of papers were deemed acceptable or acceptable after revision; the others were either recommended for rejection (14%) or for more substantial revision and re-review (32%). Descriptions of methods and of results were found inadequate in about half of the papers; about one-quarter of papers had inadequate abstracts and conclusions. Major errors of inference were made in 48 papers and went hand in hand with major criticisms of analysis or design in those papers. The natural focus of statistical review is whether conclusions drawn are justified by study design and statistical analysis. In this, there is room for improvement by authors.

Bias↗
PubMed1992

Organ donation from intensive care units in England and Wales: two year confidential audit of deaths in intensive care.

OBJECTIVES: Quantify possible increases in cadaveric organ donation from intensive care units; identify major sources of regional variation. DESIGN: Confidential audit of all deaths in intensive care units in England in 1989 and 1990 and in Wales in 1990. SETTING: 15 regional and special health authorities in England; Wales. PATIENTS: 24,023 audited deaths in England; 682 in Wales. MAIN OUTCOME MEASURES: Solid organ and corneal donor rates per 100 deaths; solid organ donor rate per 100 confirmed brain stem deaths; regional variation in (a) whether brain stem death was possible diagnosis, (b) general medical contraindications to donation, (c) relatives' refusal. RESULTS: Confirmed brain stem death accounted for 2389 (10%) audited deaths in England. In 438 (18%) there was a general medical contraindication to organ donation, and of 1829 (94%) families asked about donation, 557 (30%) refused. Data for England suggested that among potential donors the heart is suitable for transplantation in 65% of cases, the kidneys in 95%, the liver in 71%, the lungs in 31%, and the corneas in 92%. Reasons for any shortfall in achievement of transplantation varied with organ type. Solid organ and corneal donor rates per 100 deaths were 5.0 and 3.9 respectively in England and 4.3 and 2.1 respectively in Wales. The solid organ donor rate per 100 confirmed brain stem deaths was 50 in England and 41 in Wales. CONCLUSIONS: A 20% increase in number of cadaveric kidney donors from intensive care could be achieved by prompt testing for brain stem death and a quarter reduction in relatives' refusals.

Adult↗
PubMed1992

Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials.

OBJECTIVE: To define the benefit of rice oral rehydration salts solution in relation to the glucose based World Health Organisation oral rehydration salts solution for treating and preventing dehydration in patients with severe dehydrating diarrhoea. DESIGN: Meta-analysis using data from 13 available randomised trials that compared these two formulations. SUBJECTS: The studies compared 1367 patients with cholera, severe cholera-like diarrhoea, or acute non-cholera diarrhoea. 668 received the standard WHO solution and 699 the rice based solution. INTERVENTION: Each trial report was reviewed to determine patient eligibility, the number of patients who were randomised and the number of these excluded from analysis, details of the randomisation procedure, and the precise timing of the outcome measurements. MAIN OUTCOME MEASURES: Stool output during the first 24 hours; weighted estimates of the difference in mean stool output between treatments. RESULTS: The rice solution significantly reduced the rate of stool output during the first 24 hours by 36% (95% confidence interval 28 to 44%) in adults with cholera and by 32% (19 to 45%) in children with cholera. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only 18% (6 to 30%). CONCLUSIONS: The benefit of rice oral rehydration salts solution for patients with cholera is sufficiently great to warrant its use in such patients. The benefit is considerably smaller for children with acute, noncholera diarrhoea and should be more precisely defined before its practical value can be judged.

Bicarbonates↗
PubMed1992

Anonymous HIV surveillance in Saughton Prison, Edinburgh.

OBJECTIVES: To estimate the prevalence of HIV by anonymous saliva testing in Her Majesty's Prison, Saughton (Saughton Prison), Edinburgh, UK. To elicit linked anonymous risk factor information from which to estimate risk scores for those who had taken an HIV blood test and, among drug injectors, for those who were HIV-1-antibody-positive on saliva testing. SETTING: Saughton Prison on 15 and 16 August 1991; HIV Immunology and Regional Virus Laboratories, Edinburgh, and the Medical Research Council Biostatistics Unit, Cambridge, UK. PARTICIPANTS: Male inmates (378 out of a total of 499) of Saughton Prison. MAIN OUTCOME MEASURES: Answers to a brief questionnaire about age, usual residence, present and past custodial sentences, drug injecting and sexual behaviour prior to and in prison, HIV testing and history of acute hepatitis. HIV-1-antibody status was established by saliva testing. RESULTS: Eighteen per cent of participants were injecting drug users (IDU), of whom approximately one-half (47%) had injected while inside prison. Ninety men (26%), including 40 (14%) of 278 participants who had never injected drugs and 77% of IDU participants, had taken an HIV blood test. Nine per cent of all participants and 35% of IDU participants had had an acute attack of hepatitis. Forty-one (62%) of 66 IDU had been imprisoned five or more times before their current prison sentence. After taking account of region of residence, injecting drug history and acute hepatitis, aspects of sentencing and sexual behaviour were not determinants of those who had been tested for HIV. On the study days, 18 out of 499 (3.6%) participants were known to prison medical officers to be HIV-infected. Following saliva testing, HIV prevalence was 17 out of 375 (4.5%) inmates tested. All 17 had at some time 'taken the blood test for HIV' and all had injected non-medically prescribed drugs. Edinburgh residence, age 26-30 years, have injected in prison and having first injected before 1983 all contributed to the risk score for whether an IDU was HIV-1-antibody-positive on saliva testing. CONCLUSIONS: Documented HIV prevalence in saliva was 4.5%, which--assuming no volunteer bias (as supported by questionnaire returns)--suggests that actual HIV prevalence was 25% greater than revealed to Saughton's prison medical service. All 17 inmates who were HIV-1-antibody-positive on saliva testing had injected non-medically prescribed drugs. The high reported frequency by inmates of injecting in prison highlights the urgent requirement for drug reduction and rehabilitation programmes for injecting inmates. Linked anonymous voluntary HIV testing of saliva can provide valuable information about HIV prevalence for the planning of prison resources and policy.

Adult↗
PubMed1992

Blood cyclosporin concentrations and the short-term risk of lung rejection following heart-lung transplantation.

1. The relationship between blood cyclosporin concentration (CyACb) and a patient's risk of organ rejection following heart-lung (HL) transplantation was investigated. 2. Longitudinal data were collected for 90 days post-operation for 31 HL transplant recipients. Following exploratory analysis, a multiple logistic regression model with a binary outcome variable representing presence or absence of lung rejection (as defined on biopsy findings and/or intention to treat) in the next 5 days was fitted to the data. 3. A significant interaction between time post-transplant and CyACb was found. During weeks 1-3, the relative risk (RR) of rejection per unit increase in log(e) (5-day mean CyACb) was reduced: RR = 0.29, 95% confidence interval (CI) = (0.12, 0.72). After 3 post-operative weeks, this trend was reversed: RR = 1.61, 95% CI = (0.96, 2.70). Increases in cyclosporin dose (CyAD) and in coefficient of variation (CV) for both CyAD and CyACb over the previous 10 days significantly increased the risk of rejection: RR per unit increase in log(e) (5-day mean CyAD) = 2.72, 95% CI = (1.18, 6.25); RR per increase of 10% (i.e. from, say, 20% to 30%) in the CV for CyAD = 1.20, 95% CI = (1.07, 1.36); RR if the CV for CyACb > 40% = 1.51, 95% CI = (1.01, 2.27). Administration of high dose steroids in the previous 5 days was found to protect against further rejection: RR if steroid treatment was given = 0.23, 95% CI = (0.13, 0.38).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Rabbit diurnal ocular tension variations.

Ocular tension recorded by pneumatonography was estimated at 4-hour intervals during six consecutive 24-hour periods in 8 New Zealand rabbits. The animals had been acclimatized for more than 8 weeks to artificial light from 08.00 to 20.00 h and dark for the other 12 h. Inter- and intrarabbit consistency was enough to allow the generalization that the lowest pressure occurred at noon (mean -0.8 mm Hg from baseline average), while the highest pressures (mean + 1.2 mm Hg above baseline average) occurred at 16.00 and 20.00 h. Only three other studies have measured rabbit ocular tensions throughout 24 h, but for shorter periods: one observed a light-induced rise as in the present study, but the other two studies found a rise during darkness.

Animals↗
PubMed1992

Current status of unrelated-donor bone marrow transplantation. The International Marrow Unrelated Search and Transplant (IMUST) Study.

1. The International Marrow Unrelated Search and Transplant (IMUST) Study 1 provides novel prognostic data on outcome of unrelated-donor (UD) searches for patients with well-defined clinical characteristics. Case-types analyzed by multifactorial methods reveal the importance of HLA phenotype, ethnic mismatching, and stage of disease at search request, in predicting search outcome. White patients, with common HLA types and early disease, were least likely to suffer search failure. In contrast, searches for non-White patients with unusual HLA phenotypes and advanced disease were most likely to fail. Of importance, 70% of patients had HLA phenotypes defined as uncommon. 2. Overall donor yield at the 2 UK registries between 1989 and 1991 was 7%, significantly below expectations. Reasons for this shortfall are that theoretical predictions did not consider ethnic mismatch and logistical delays incurred by outdated UD search routines and most importantly HLA-typing inaccuracies. 3. IMUST Study 2 is a prospective multicenter-controlled cohort study comparing HLA-identical sibling donor (ID) and UD-bone marrow transplantation (BMT) for factors affecting BMT outcome. Generous support was provided by 83 BMT centers worldwide. An interim analysis of 165 UD- and 368 ID-BMT, with at least 6 months follow-up after BMT, is described. Unifactorial analysis showed a probability of engraftment at day 100 of 89% after UD- compared with 98% after ID-BMT (p < 0.001). Probability of Grades II-IV acute graft-versus-host disease (AGvHD) at 100 days was 52% after UD- compared with 42% after ID-BMT (p < 0.01). Probability of overall survival at day 400 was 42% after UD- compared with 63% after ID-BMT (p < 0.001). Survival on day 400 of those patients receiving UD-BMT for early disease was encouraging at 52%. 4. Multifactorial analysis was performed on combined data from UD- and ID-BMT cohorts to identify various factors predicting engraftment, AGvHD, and overall survival. Survival after UD-BMT was increased by center experience of UD-BMT and the use of additional pretransplant immunosuppression. Survival was decreased in UD- compared with ID-BMT, by female donor to male recipient and poor-risk disease. Engraftment was improved in ID- compared with UD-BMT, and after UD-BMT at centers experienced in UD-BMT. Engraftment worsened with the use of ex-vivo T-cell depletion for GvHD prophylaxis, in chronic myeloid leukemia, and in male recipients of female marrow.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Socio-economic factors associated with HIV infection in pregnant women.

The HIV epidemic in women in Edinburgh has characteristics which enable a total population study. We studied retrospectively all women with a known history of injection drug use or with a seropositive drug-using partner in a five year period from 1985-1990. We sought to quantitate lifestyle and environmental factors associated with HIV infection in pregnant women and to test two hypotheses: that infected women would have more adverse socio-economic features, and that there would be a change in these factors with time. There were 244 pregnant women in the study. They were slightly younger than all Edinburgh City women and much less likely to be married. They were much more likely to live in areas of multiple housing deprivation. Only 16% of women, and 28% of partners, were in paid employment; 90% of women smoked and 76% had a history of injection drug use. Some 28% of previous children were in the care of another, often a relative, 8% of women had a recent prison admission, and 58% of those tested had antibodies to Hepatitis B. Univariate analysis showed that none of these factors was significantly different in HIV seropositive women except for prison admission, previous infection with Hepatitis B, which probably all related to type of drug use. Linear logistic regression suggested two other variables which distinguished between groups, but because these are composite, and dependent on incomplete data, this must be interpreted with caution. The same overall associations were found when only women with a history of injection drug use were considered. There was no statistically significant change in these factors with time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗