Biomedical subjects

Tom Holland

Publications and source records attributed to Tom Holland.

6 recordsLinked to original sources

PubMed2006

Low bone mineral density measurements in care home residents--a treatable cause of fractures.

PURPOSE: to assess predictors of fracture risk and treatment for osteoporosis among elderly care home residents. SUBJECTS AND METHODS DESIGN: cross-sectional survey; SETTING: residents of care homes in Newcastle upon Tyne, UK; PARTICIPANTS: representative sample from residential care (87), nursing homes (105) and specialist homes for elderly people with dementia [elderly mentally infirm (EMI)]: residential (124) and nursing (76); MAIN OUTCOME MEASURES: dual-energy X-ray absorptiometry bone mineral density (BMD) at calcaneum; functional assessments, including cognition, using Mini-Mental State Examination (MMSE), Clifton Assessment Procedure for the Elderly-Behaviour Rating Score (CAPE-BRS) and Functional Assessment Staging Test (FAST) scores; current drug prescription. RESULTS: MMSE, CAPE, FAST (all ANOVA P < 0.001) and weight (ANOVA P < 0.02) were lower in EMI homes. Drugs with sedative effects (chi-square, P < 0.0001) were more likely and calcium and vitamin D (CaD) supplementation (chi-square, P < 0.02) less likely in EMI care. For residential care, the odds ratio (OR) for sedative drugs in EMI was 2.13 (95% CI 1.11-4.06) with no significant difference between nursing homes. For CaD supplementation, the OR for EMI nursing homes was 0.19 (95% CI 0.05-0.72) and for EMI residential homes 0.38 (NS to 95% CI 0.12-1.27). BMD was low: mean T-score was -2.29 (95% CI -2-48 to -2.09) and Z-score -0.96 (95% CI -1.16 to -0.76) with a prevalence of osteoporosis (T-score < -1.6) of 69.2%. MMSE and FAST scores did not predict BMD. In EMI residential care, a decrease of CAPE score by 5 points was associated with a decrease in T-score by 0.6 (95% CI 0.15-1.1). CONCLUSIONS: of the tools used to assess function, only CAPE predicted low BMD in EMI residential care. Rates of CaD supplementation are particularly low in EMI care, where risk factors for fracture were the greatest. We conclude that fracture risk is neglected in these homes, and targeted education and treatment are warranted.

Absorptiometry, Photon↗

PubMed2006

Taking a stand.

Explore the source record for details and available documents.

Activities of Daily Living↗

PubMed2005

The comparative power of the discriminant methods used in toxicological pathology.

It is highly desirable to use experimental methodologies in toxicological pathology that combine statistical power, practicality, and objective reviewability to detect small differences. The different ways of gathering data at the microscope can result in clear differences in power to discriminate small, but real, differences between treated and control rodent groups with nonneoplastic lesions. Six alternative methods of gathering and analysing results are compared. They are referred to as the Measuring, Ordering, Scoring (or Grading), Pair-contrast, Outside-control, and Affected methods. Measuring and Ordering methods are uniformly more powerful than other more common and highly esteemed methods, such as Scoring/Grading. From the practical perspective, Measuring and Ordering can be applied objectively, reviewed objectively, and interpreted to standards that are widely accepted as valid throughout experimental science e.g., using confidence limits and intervals. They also are intuitively natural extensions of routine toxicological histopathological examinations. Establishing a small difference between control and treated groups is commonly a problem when reporting no-observed-effect levels. Ordering is the recommended method for assessing if a small difference between treated and control groups is within chance variation or is the result of a true treatment effect, when measurement is impractical.

Animals↗

PubMed2002

Value acceleration: lessons from private-equity masters.

The most successful private-equity firms regularly spearhead dramatic business transformations, creating exceptional returns for their investors. To understand how those firms do it, the authors studied more than 2,000 PE transactions over the past ten years and discovered that the top performers' success stems from the rigor with which they manage their businesses. This article describes the four management disciplines vital to the success of the best PE firms. First, for each business, they define an investment thesis: a brief, clear statement of how to make the business more valuable within three to five years. The thesis, which guides all actions by the company, usually focuses on growth. PE firms know that the demonstration of a path to strong growth produces the big returns on investment. Second, they don't measure too much. They zero in on a few financial indicators that most clearly reveal the business's progress in increasing its value. They watch cash more closely than earnings and tailor performance measures to each business, rather than imposing one set of measures across their entire portfolio. Third, they work their balance sheets, mining undervalued assets, turning fixed assets into sources of financing, and aggressively managing their physical capital. Last, they make the center the shareholder. Corporate staffs in PE firms make unsentimental investment decisions, buying and selling businesses when the price is right and bringing in new management when performance falters. These firms also keep their corporate centers extremely lean. By adopting these four disciplines, executives at public companies should be able to reap significantly greater returns from their own business units.

Consultants↗

PubMed2002

Utilizing the ankle brachial index in clinical practice.

The ankle brachial index is one of many tests that can be used to indirectly assess lower extremity peripheral blood flow. This article reviews ankle brachial index technique and presents some of its applications for clinicians and researchers based on a literature review. The ankle brachial index is relatively simple and inexpensive and can be performed in both clinical and home care settings. Reliability level is reported to be high, with an intraclass correlation coefficient range of 0.80 to 0.99. When used with other noninvasive vascular tests such as pulse volume recordings, lower extremity segmental systolic limb pressures, and transcutaneous oximetry mapping, the ankle brachial index is a valuable screening tool to detect individuals at risk for wounds and other problems associated with poor peripheral arterial circulation.

Ankle↗

PubMedDate not supplied

Benefits of combining the sexes when evaluating data from toxicological studies.

In the assessment of the safety of a new drug, a large battery of toxicological studies is performed. In toxicological studies it is common practice to analyse the data from the sexes separately. We argue that this is not best practice and that much is to be gained from combining data from both sexes when evaluating studies. The main benefits and arguments in favour of combining the data are: (i) Improved efficiency, allowing fewer test animals and/or better precision. (ii) Other phases of drug development, clinical trials in particular, combine sexes. (iii) Most substances act similarly on both sexes and most drugs are prescribed without sex differentiation. (iv) If sex differences are of interest, combined data facilitates the quantification of the difference. (v) Reduced number of false positive and false negative findings. Although there might be some grounds to analysing the sexes separately, we argue that these are comparatively minor. We do not promote simply pooling the data and neglecting the existence of two sexes when comparing treatment groups. Rather, the analysis of combined data should allow for sex differences, for instance by using stratified procedures or by including a sex factor in a statistical model. We illustrate from real study data where the approach we propose has substantial benefits over traditional methods. A theoretical illustration is provided to quantify mathematically the potential gains and the corresponding sample size reduction, i.e. a reduction of animal use of ca. 50%, that would be possible without impairing the precision of studies.

Animals↗