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Biomedical subjects

T J Peters

Publications and source records attributed to T J Peters.

At least 145 records · Page 8Linked to original sources
PubMed1998

Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care.

OBJECTIVE: To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital. DESIGN: Pragmatic randomised controlled trial. SETTING: Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people. SUBJECTS: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate. INTERVENTIONS: Patients' received hospital at home care or routine hospital care. MAIN OUTCOME MEASURES: Patients' quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months. RESULTS: There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme. CONCLUSIONS: The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services.

Activities of Daily Living↗
PubMed1998

Hospital at home or acute hospital care? A cost minimisation analysis.

OBJECTIVE: To compare, from the viewpoints of the NHS and social services and of patients, the costs associated with early discharge to a hospital at home scheme and those associated with continued care in an acute hospital. DESIGN: Cost minimisation analysis. SETTING: Acute hospital wards and the community in the north of Bristol (population about 224 000). SUBJECTS: 241 hospitalised but medically stable elderly patients who fulfilled the criteria for early discharge to a hospital at home scheme and who consented to participate. MAIN OUTCOME MEASURES: Costs to the NHS, social services, and patients over the 3 months after randomisation. RESULTS: The mean cost for hospital at home patients over the 3 months was 2516 pounds, whereas that for hospital patients was 3292 pounds. Under all the assumptions used in the sensitivity analysis, the cost of hospital at home care was less than that of hospital care. Only when hospital costs were assumed to be less than 50% of those used in the initial analysis was the difference equivocal. CONCLUSIONS: The hospital at home scheme is less costly than care in the acute hospital. These results may be generalisable to schemes of similar size and scope, operating in a similar context of rising acute admissions.

Aged↗
PubMed1998

Carbohydrate deficient transferrin in the assessment of alcohol misuse: absolute or relative measurements? A comparison of two methods with regard to total transferrin concentration.

Carbohydrate deficient transferrin (CDT) is now accepted as a potentially useful marker for the detection of alcohol misuse. It is not clear whether absolute values or values expressed relative to the total transferrin concentration provide the same diagnostic efficiency. CDT was measured in 35 patients with alcohol related liver disease, 35 subjects abusing alcohol without evidence of liver disease and 35 patients with chronic viral hepatitis using two commercial methods (CDTect and %CDT). To compare the methods, results were normalised by dividing the actual result by the upper limit of the reference range. Subtracting normalised %CDT results from the normalised CDTect results demonstrated a linear relationship between CDTect and total transferrin. This linear relationship could be abolished by calculating the CDTect/total transferrin ratio. The sensitivity of the methods was similar with CDTect (43 and 57%) being slightly superior to %CDT (40 and 46%). Specificity was similar (78%) for both methods. Calculation of the CDTect/total transferrin ratio improved the sensitivity and specificity slightly. The linear relationship between CDTect and total transferrin may produce misleading results in populations with a high prevalence of abnormal total transferrin concentrations and could cause difficulties in method comparisons unless taken into account.

Adolescent↗
PubMed1998

Childhood energy intake and adult mortality from cancer: the Boyd Orr Cohort Study.

OBJECTIVE: To examine the relation between energy intake in childhood and adult mortality from cancer. STUDY DESIGN: Cohort study. SETTING: 16 rural and urban centres in England and Scotland. SUBJECTS: 3834 people who took part in Lord Boyd Orr's Carnegie survey of family diet and health in prewar Britain between 1937 and 1939 who were followed up with the NHS, central register. Standardised methods were used to measure household dietary intake during a one week period. MAIN OUTCOME MEASURES: Cancer mortality. RESULTS: Significant associations between childhood energy intake and cancer mortality were seen when the confounding effects of social variables were taken into account in proportional hazards models (relative hazard for all cancer mortality 1.15 (95% confidence interval 1.06 to 1.24), P = 0.001, for every MJ increase in adult equivalent daily intake in fully adjusted models). This effect was essentially limited to cancers not related to smoking (relative hazard 1.20; 1.07 to 1.34; P = 0.001), with similar effects seen in men and women. CONCLUSION: This positive association between childhood energy intake and later cancer is consistent with animal evidence linking energy restriction with reduced incidence of cancer and the association between height and human cancer, implying that higher levels of energy intake in childhood increase the risk of later development of cancer. This evidence for long term effects of early diet confirm the importance of optimal nutrition in childhood and suggest that the unfavourable trends seen in the incidence of some cancers may have their origins in early life.

Adolescent↗
PubMed1998

Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-"BPH" study.

Despite the lack of evidence in the literature for close relationships between lower urinary tract symptoms and bladder outlet obstruction, the majority of urologists rely on symptomatology when selecting patients for prostatic surgery. We investigated the relationships between a wide range of lower urinary tract symptoms from the ICSmale questionnaire and the results of urodynamic pressure and flow studies. We evaluated 933 patients with lower urinary tract symptoms suggestive for bladder outlet obstruction from 12 countries who participated in the ICS-"BPH" study with the ICSmale questionnaire and urodynamic pressure and flow studies. Spearman rank correlation coefficients were obtained between symptoms and measures of bladder outlet obstruction. There was little or no correlation between a wide range of symptoms and the results of free uroflowmetry and pressure and flow studies. From symptoms alone, it is not possible to diagnose bladder outlet obstruction. Pressure and flow studies and symptom profiles measure different aspects of the clinical condition that should be viewed separately in the evaluation and treatment decision of the patient presenting with lower urinary tract symptoms.

Humans↗
PubMed1998

Metabolic consequences of alcohol ingestion.

Many of the pathophysiological effects of alcohol ingestion relate to the pathways of ethanol metabolism. However, some of the acute and chronic effects of ethanol use are also attributable to the direct effects of ethanol, e.g. on membrane fluidity. Oxidation of ethanol to acetaldehyde is catalysed by alcohol dehydrogenase (ADH). There are at least six classes of ADH, some of which show inter-individual variation, i.e. genetic polymorphism, that influences the rate of ethanol oxidation. A consequence of ethanol oxidation is an increase in the NADH/NAD redox potential within the cytosol and mitochondria with subsequent alteration in several tissue metabolites. The popular hypothesis that most, if not all, of the consequences of chronic alcohol ingestion can be explained by these redox changes is still unproven. This should be considered in the context that most metabolic pathways of the liver are affected by alcohol, as are several endocrine axes in the whole body. In fact most, if not all, tissues and organs are deleteriously affected by chronic ingestion. Acetaldehyde, the product of ethanol oxidation, is chemically highly reactive, toxic and immunogenic. However, the concentrations achieved in vivo usually fall short of those used to produce these toxic effects in experimental situations. Oxidation of acetaldehyde is also coupled to redox changes, although primarily affecting the intra-mitochondrial redox. In addition, further oxidative pathways of ethanol metabolism can lead to the formation of fatty acid ethyl esters, hydroxyethyl free radicals and reactive oxygen species via the ethanol-specific cytochrome P450-2E1 system. There is no conclusive evidence that nutrient supplementation has beneficial effects on overall ethanol-mediated tissue damage.

Alcohol Drinking↗
PubMed1998

Structural and functional changes in skeletal muscle in anorexia nervosa.

Protein-energy malnutrition in anorexia nervosa is an under-recognised cause of muscle dysfunction. To characterise the skeletal myopathy that occurs in patients with severe anorexia nervosa, muscle function and structure were comprehensively examined in eight young adult female patients with severe (40%) self-induced weight loss. All of the patients showed impaired muscle function on strength and exercise measurement. The maximum voluntary contraction force for the patient group was significantly less than predicted values. Electromyography revealed myopathy in five of the patients, four of whom also had electro-physiological evidence of neuropathy. However, muscle biopsy specimens consistently showed myopathic changes with severe type 2 fibre atrophy but with no evidence of neuropathic changes. Ultrastructurally, there was separation and segmental loss of myofibrils and most biopsy samples contained abundant glycogen granules; we have previously reported that one of the most consistent biochemical abnormalities in these patients is impaired ischaemic lactate responses to forearm exercise. The result of severe protein-energy malnutrition on the musculo-skeletal system is a metabolic myopathy. Although the patients admitted to a variety of abnormal dieting behaviours, such as over-exercising and self-induced vomiting, no association was found between any of these and quantitative histological changes in the muscle biopsy samples. It is recommended that myopathy in anorexia nervosa be treated by instituting an appropriate refeeding programme.

Adult↗
PubMed1998

Comparison of the effects of theophylline and caffeine on serum erythropoietin concentration in premature infants.

UNLABELLED: Theophylline administration has been shown to attenuate erythropoietin (EP) production in adults; the effect of caffeine is not known. Our aim was to determine whether caffeine and theophylline had similar effects on EP production in the premature newborn. If caffeine was found to have a greater effect, this would influence prescribing habits. Fifty preterm infants (mean gestational age 28 weeks) who had clinically significant apnoea were randomized to receive theophylline (4 mg/kg then 2 mg/kg twice daily) or caffeine (10 mg/kg then 2.5 mg/kg once daily). The methylxanthines were continued at least until discharge from the NICU and the dosage altered to keep the levels within the therapeutic range. As an assessment of EP production, serum EP concentrations were measured. Blood for EP, haemoglobin, reticulocyte count, theophylline and caffeine levels was obtained prior to treatment and at least during weeks 3 and 7. There was no significant difference in the mean EP level in the two groups taken prior to treatment at a median age of 2 days of life. There were similar falls in haematocrit and haemoglobin in the two groups during the study period compared to pre-treatment values. At that time, however, the median reticulocyte count was higher in the caffeine compared to the theophylline treated infants (P < 0.05). This was associated with a rise compared to baseline (median 10.0-0.2 mU/ml) in the mean EP levels in the caffeine group and a decrease from a median of 10.1 to 8.3 mU/ml in the theophylline group, but the EP levels in the two groups at week 7 did not differ significantly. CONCLUSION: These results suggest that caffeine does not have a greater impact than theophylline on EP production.

Anemia↗
PubMed1998

Alcohol-related diols cause acute insulin resistance in vivo.

Epidemiological studies suggest that alcohol consumption is an independent risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Alcoholism is known to be associated with increased plasma levels of two novel diols, 2,3-butanediol and 1,2-propanediol, metabolites known to impair insulin action in isolated adipocytes. This study examines whether 2,3-butanediol and 1,2-propanediol have the capacity to impair insulin action acutely in vivo in the rat. Using the euglycemic-hyperinsulinemic clamp, it is shown that the two diols reduce whole-body glucose utilization (by approximately 30%), with the onset of insulin resistance in vivo occurring at plasma concentrations of 2,3-butanediol (33 micromol/L) at least one order of magnitude (P < .001) lower than 1,2-propanediol (432 micromol/L). Tracer methodologies using [U-14C]glucose and 2-deoxy[1-(3)H]glucose indicate that the reduction in whole-body glucose utilization is accompanied by a reduction in glucose uptake and glycogen synthesis in the skeletal muscle and heart. The association between elevated plasma diol levels and insulin resistance demonstrated in this report raises the question of whether there is a link between the high plasma diol levels in alcohol abusers and their increased susceptibility to NIDDM.

Alcoholism↗
PubMed1998

Use of the EuroQoL among elderly acute care patients.

The assessment of the validity and reliability of generic quality of life (QoL) instruments among elderly patient groups has tended to lag behind such assessments in general populations, yet it is an important methodological issue. This paper presents the findings from a study of the use of the EuroQoL among an elderly acute care patient group, focusing particularly on the ability to self-complete, construct validity and sensitivity to change. Two hundred and fourteen UK patients aged 65 years and over, participating in a randomized controlled trial comparing hospital at home and routine hospital care were asked to complete the EuroQoL and a number of other instruments at randomization and at 4 week and 3 month follow-ups. The inability to self-complete the EuroQol was found to be strongly related to both increased age and reduced cognitive function (p < 0.0001). From logistic regression, the expected probability of an acute care patient requiring interview administration at age 65 years is 11%, at age 75 years is 37% and at age 85 years is 73%. The relationships with age and limiting long-standing illness/disability were weaker than expected, but the results obtained from the EuroQoL were highly correlated with those from both the Barthel Index and the COOP-WONCA charts where this was anticipated. Preliminary evidence of sensitivity to change was found from descriptive statistics of the changes in scores for four specific subgroups of patients, but the small numbers and high variability in each sub-sample means that this should be interpreted with caution. The most important issue arising from the research concerns the impact of age on the ability to self-complete the EuroQoL questionnaire. It is argued that this research points to the need for rigorous studies (such as randomized controlled trials) to assess the impact of the format of administration of the EuroQoL on the scores obtained.

Aged↗
PubMed1998

Reconciling different measures of risk in the treatment of hypertension: a community-based study.

BACKGROUND: There is disagreement as to how cardiovascular risk in hypertensive patients should be measured. In particular, whether absolute risk measurement alone is a realistic index on which to base treatment goals. METHOD: A cross-sectional study on 895 treated hypertensive patients in 18 general practices in the UK. Reporting on the distribution and magnitude of age-specific absolute risk. The percentage of individuals with controlled hypertension whose absolute risk exceeds their age/sex absolute risk standard and the percentage of individuals with uncontrolled hypertension whose risk is less than their age/sex absolute risk standard. RESULTS: Overall, 62.8% (95% CI 59.6-66%) individuals had an absolute risk that exceeded 20% over 10 years. The magnitude of absolute risk was considerable (range 3.5-87.8%) and increasing absolute risk was significantly associated with age. Of those individuals with controlled hypertension 50.5% (95% CI 45.1-55.8%) had an absolute risk which exceeded their age/sex absolute risk standard. Conversely, 30.4% (95% CI 26.6-34.2%) of those with uncontrolled hypertension had an absolute risk that was less than their age/sex absolute risk standard. CONCLUSIONS: The distribution and magnitude of absolute risk is significantly associated with age. Appreciation of such a relationship is needed when setting realistic treatment goals according to an absolute risk standard, particularly in the elderly. In addition, the use an age/sex absolute risk standard is likely to further modify treatment goals in individuals at high and low absolute risk of cardiovascular disease.

Age Factors↗
PubMed1998

Intervening to reduce anxiety for women with mild dyskaryosis: do we know what works and why?

In the United Kingdom women are encouraged to attend their general practice for cervical smear testing. Those who subsequently receive a mildly dyskaryotic result are placed under surveillance for 6 months before a further test is carried out. Receipt of a mildly abnormal result has been found to create anxiety in some women although it is suggested that this may be relieved by a specifically designed educational intervention. The qualitative investigation reported here explored the interaction which occurred during 10 nurse-patient consultations during which a practice nurse presented an educational intervention designed to relieve anxiety delivered as part of a randomized controlled trial. The investigation highlights factors relating to aspects of the intervention perceived by patients and nurses as successful and as unsuccessful. Implications for the management of women with mildly dyskaryotic results and for future nurse-led educational interventions are proposed. The need for appropriate training for practice nurses is underlined. It is suggested that training should aim to assist the nurse to identify the patient's needs in order that interventions can be individually tailored and delivered effectively without creating anxiety with regard to other aspects of health.

Anxiety↗
PubMed1998

Socio-economic and dietary influences on leg length and trunk length in childhood: a reanalysis of the Carnegie (Boyd Orr) survey of diet and health in prewar Britain (1937-39).

Social class differences in height have been recognised for many centuries. However, few studies have examined the extent to which these differences are made up of differences in leg length or trunk length. This paper reanalyses cross-sectional information on children examined in Britain in the 1930s. We assess associations between socio-economic status and diet and the components of childhood stature. The analyses were based on the records of 2990 children aged 2 years to 14 years 9 months who were examined in the Carnegie (Boyd Orr) survey of diet and health (1937-39). z-Scores for the measures of childhood stature were calculated using polynomial regression techniques with the study population as the standard. Univariable and multivariable statistical techniques were used to assess the relationships between childhood height, leg length and trunk length, and dietary and socio-economic factors measured at the level of the household. Leg length was the component of stature most strongly associated with measures of childhood diet and socio-economic status. A greater part of the difference in stature between socio-economic groups was caused by differences in leg length rather than trunk length. In multiple regression analyses, district of residence and family food expenditure were generally the two factors most strongly related to stature. In a subsample of the surveyed children, for whom birthweight information was available, trunk length and leg length were equally strongly related to birthweight. Leg length appears to be a particularly sensitive indicator of childhood socio-economic circumstances. Although contemporary studies highlight the importance of biological factors in determining childhood height, the data analysed in this study suggest that socio-economic circumstances were also important in explaining height differentials in prewar Britain.

Adolescent↗
PubMed1998

The ICS-'BPH' Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction.

OBJECTIVE: To explore the relationship between uroflow variables and lower urinary tract symptoms (LUTS): to define performance statistics (sensitivity, specificity, positive and negative predictive values) for maximum urinary flow rate (Qmax) with respect to bladder outlet obstruction (BOO) at various threshold values; and to investigate the diagnostic value of low-volume voids. PATIENTS AND METHODS: The study comprised 1271 men aged between 45 and 88 years recruited from 12 centres in Europe, Australia, Canada, Taiwan and Japan over a 2-year period. Symptom questionnaires, voiding diaries, uroflowmetry and pressure-flow data were recorded. The relationship between uroflow variables and symptoms, Qmax and BOO, and the diagnostic performance of low volume voids were analysed. RESULTS: The relationship between symptoms and uroflow variables was poor. The mean difference between home-recorded and clinic-recorded voided volumes was -48 mL. Qmax was significantly lower in those with BOO (9.7 mL/s for void 1) than in those with no obstruction (12.6mL/s; P<0.001) and Qmax was negatively correlated with obstruction grade (Spearman's correlation coefficient -0.3, P<0.001), even when controlling for the negative correlation between age and Qmax (Spearman's partial correlation coefficient -0.29, P<0.001). A threshold value of Qmax of 10 mL/s had a specificity of 70%, a positive predictive value (PPV) of 70% and a sensitivity of 47% for BOO. The specificity using a threshold Qmax of 15 mL/s was 38%, the PPV 67% and the sensitivity 82%. Those voiding <150 mL (n=225) had a 72% chance of BOO (overall prevalence of BOO 60%). In those voiding >150 mL the likelihood of BOO was 56%. The addition of a specific threshold of 10 mL/s to these higher volume voiders improved the PPV for BOO to 69%. CONCLUSION: While uroflowmetry cannot replace pressure-flow studies in the diagnosis of BOO. it can provide a valuable improvement over symptoms alone in the diagnosis of the cause of lower urinary tract dysfunction in men presenting with LUTS. This study provides performance statistics for Qmax with respect to BOO: such statistics may be used to define more accurately the presence or absence of BOO in men presenting with LUTS, so avoiding the need for formal pressure-flow studies in everyday clinical practice, while improving the likelihood of a successful outcome from prostatectomy. This study also shows that low-volume uroflowmetry can provide useful diagnostic information and that, as such, the data from such voids should not be discarded.

Aged↗