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Biomedical subjects

S T Brookes

Publications and source records attributed to S T Brookes.

26 records · Page 2Linked to original sources
PubMed1998

Unilateral asymptomatic carotid disease does not require surgery.

BACKGROUND AND PURPOSE: The efficacy of carotid endarterectomy (CEA) in symptomatic patients with > 70% stenosis is accepted. The stroke risk of asymptomatic patients may not justify surgical intervention. The aim of this study is to use natural history data from a single unit to identify asymptomatic patients who would benefit from CEA. METHODS: Five hundred and sixty-four patients attending for duplex ultrasound assessment of the internal carotid artery between 1986 and 1993 were retrospectively identified as focally asymptomatic with > 40% ipsilateral stenosis. Patients were traced using hospital records, family practitioner databases and the Office of Population of Census and Surveys. The number of strokes, transient ischaemic attacks and cause of death were determined. Exclusions were 15 (2.7%) asymptomatic occlusions and 49 patients (8.7%) who underwent surgery for asymptomatic disease. RESULTS: Thirteen patients (2.6%) were not traced, leaving 487 study patients. The average follow-up was 41 months (range, 1-120 months). Mean presentation age was 69 years (S.D. 8.9), and the male to female ratio was 3:2. One hundred and fifty-six (32%) patients died. Forty-three patients suffered strokes, of whom two had bilateral strokes. In total there were 16 (i/p) strokes, 25 (c/l) strokes and four strokes undetermined. The average yearly stroke rate was 2.74 per 100 person years and the (i/p) rate 1.02 per hundred person years. There was no effect of age, sex or degree of stenosis on stroke. The presence of bilateral disease did increase the risk of stroke (rel risk 2.35, p = 0.029) but not ipsilateral stroke (rel risk 1.6, p = 0.39). Patients with unilateral asymptomatic carotid disease had an all stroke rate of less than 5% in the first year after presentation and this was unaffected by degree of stenosis. In patients with bilateral disease the stroke rate in the first year after presentation increased with degree of stenosis to a stroke rate of 9.6 per 100 person years in patients with > 90% contralateral stenosis. CONCLUSIONS: This data suggests that CEA will not benefit patients with unilateral asymptomatic disease. Patients with bilateral disease warrant inclusion in clinical trials.

Aged↗
PubMed1998

The natural history of urinary symptoms during adolescence.

OBJECTIVE: To determine the prevalence and natural history of urinary symptoms and incontinence among healthy adolescent schoolchildren. SUBJECTS AND METHODS: A prospective longitudinal study using a confidential questionnaire administered to an original cohort of 1176 local schoolchildren at 11-12 years and again at 15-16 years old. RESULTS: There was a decrease in the prevalence of urinary symptoms with age. Daywetting was reported by 12.5% of children aged 11-12 years and 3.0% of children aged 15-16 years. Nocturnal enuresis was reported by 4.7% of children at 11-12 years and 1.1% at 15-16 years. Some of the children reporting daywetting and nocturnal enuresis at 15-16 years old had not reported these symptoms at 11-12 years old. CONCLUSION: Urinary symptoms become less prevalent with age, but are reported by a significant number of healthy schoolchildren.

Adolescent↗
PubMed1998

Development of a questionnaire for measurement of vision-related quality of life.

PURPOSE: To define vision-related quality of life, to outline the development of a vision-specific quality of life instrument and to present the characteristics of a 10-item 'core' questionnaire. METHOD: A standard method included: 1. Generation of relevant issues by individual interviews with 38 visually impaired adults, consultation with 37 professionals and support workers and literature review. 2. Operationalisation, involving 58 ophthalmic patients. 3. Pre-testing, to maximise face validity and content validity, involving 184 individuals with a variety of different visual problems and social backgrounds. 4. Adoption of a modular approach to item selection. 5. Formal piloting in 92 individuals to establish reliability and construct validity. RESULTS: More than 232 items were tested of which 139 were considered suitable for a final question pool or 'parent' questionnaire (the VQOL). From this parent questionnaire individual items or groups of items can be selected. Ten broadly applicable items referring to physical, social and psychological issues were selected for the core questionnaire (the VCM1). The VCM1 has high reliability (alpha = 0.93) and validity. CONCLUSIONS: Any self-reported problem relating to vision may constitute a quality of life issue. A modular approach to item selection may provide the flexibility to investigate vision-related quality of life in a wide range of clinical settings, allowing detailed assessment of specific problems and also cross-study comparisons where appropriate.

Adult↗
PubMed1997

The Bristol Shared Care Glaucoma Study--validity of measurements and patient satisfaction.

BACKGROUND: The aims of the study were to determine (1) whether community optometrists are able to make valid measurements of visual parameters in patients with established or suspect primary open angle glaucoma and (2) patient satisfaction with follow-up by community optometrists. METHODS: A randomized study was carried out in the former county of Avon in South West England with patients allocated to follow-up by the hospital eye service or by community optometrists. The subjects were 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria. The main outcome measures were 91) measurements of key visual parameters (intraocular pressure, visual fields and cup/disc ratio) made by hospital eye service and community optometrists, compared with a research clinic reference standard at baseline, and (2) patient satisfaction at baseline and at six months. RESULTS: Community optometrists were able to make measurements of comparable accuracy to those made in the hospital eye service. Patients were significantly more satisfied with a number of aspects of care provided by community optometrists, particularly those relating to waiting times, compared with those from the hospital eye service. CONCLUSIONS: Community optometrists are able to make measurements of key visual parameters in patients with established or suspect primary open angle glaucoma which are of comparable quality to the hospital eye service. Follow-up by community optometrists is acceptable to patients. The costs of each option are reported elsewhere.

Aged↗
PubMed1995

Quality of life measurement in patients with oesophageal cancer.

Quality of life (QOL) measurement may aid decision making in the treatment of patients with oesophageal cancer but must be clinically valid to be useful. This study considered if the European Organisation for Research and Treatment of Cancer QOL questionnaire, the QLQ-C30, showed differing results in two clinically distinct groups of patients with oesophageal cancer and also investigated the correlation between dysphagia grade and various scales of QOL. Patients treated by oesophagectomy reported significantly better physical, emotional, cognitive, and global health scores than those in the palliative treatment group. Patients who received palliative treatment had significantly worse pain, fatigue, appetite loss, constipation, and dysphagia. The correlations between dysphagia grade and each of the QOL scales and items in both groups of patients were poor. This questionnaire differentiates clearly between the two clinically distinct groups of patients, but to be an entirely appropriate indicator of QOL in patients with oesophageal cancer, an additional specific oesophageal module including a dysphagia scale is required.

Aged↗
PubMed1991

Rapid, automated analysis of 13C and 18O of CO2 in gas samples by continuous-flow, isotope ratio mass spectrometry.

A rapid automated method for isotopic analysis of 13C and 18O in CO2 has been developed. A variety of gas samples containing CO2 can be swept from serological tubes into a helium carrier flow; impurities are separated on a GC column so that a pure pulse of CO2 in He flows into the mass spectrometer. Isotopic ratio determinations are carried out as the pulse passes through the mass spectrometer, allowing a sample to be measured approximately every 4 min. A double, concentric needle-probe is used to flush the sample from the tube so that 100% sample recovery is achieved, maximizing sensitivity and preventing the possibility of fractionation. The precision of the technique, sigma(m-1), is better than 0.2% (0.0002 atom per cent excess) for 13C and 0.4% (0.83 p.p.m.) for 18O for 10 micromol of CO2 at natural abundance. Samples containing only atmospheric concentrations of CO2 can also be analyzed.

Breath Tests↗
PubMedDate not supplied

Human cytomegalovirus infection and systemic lupus erythematosus.

OBJECTIVE: Viruses are considered possible aetiologic agents of autoimmune disease. Evidence suggests that human cytomegalovirus (HCMV) may be a pathogenetic factor in systemic lupus erythematosus (SLE). We undertook a seroepidemiological study to determine whether HCMV infection is increased in patients with SLE. METHODS: Sero-epidemiologic data, indicative of virus prevalence, were obtained by enzyme immunoassay. RESULTS: Eighty-eight of 97 serum samples (90.7%) taken from adult patients with SLE were seropositive for HCMV. By contrast, HCMV was detected in only 32 of 50 (64.0%) adult patients with rheumatoid arthritis (RA) and 42 of 97 (43.3%) normal controls. The odds ratio for HCMV prevalence in SLE/normal controls was 14.53 (95% CI is 6.39 to 33.04). For comparison, data for herpes simplex virus-I (HSV-I) seropositivity were obtained from the same three groups. Seventy-eight patients with SLE (80.4%), 40 patients with RA (80.0%) and 57 normal controls (58.8%) were seropositive for this closely-related herpesvirus. CONCLUSION: The data shows a specific and highly significant association between infection with HCMV and a clinical diagnosis of SLE.

Adult↗