A comparison of community care of elderly people in Wales and Northern Ireland.

This study compares the provision of community services for elderly people in Wales and Northern Ireland using data from two independent surveys. Despite sampling and definitional problems, certain interesting comparisons can be obtained. In general, elderly people in the Northern Ireland sample seem more likely to be dependent and more disabled than those in Wales. Northern Ireland people receive less help, but the help given is more likely to be from statutory services than in Wales; in many cases statutory help is the sole source of support. Further, in Wales there is more specialized care for very disabled elderly people living in the community, and the work is more likely to be shared by carers and the statutory services. There is however still considerable unmet need in both countries. A comparative study using common definitions and methods would be of considerable interest in relation to the debate concerning the relative shares of health care resources in the United Kingdom.     

Adolescent occupational injuries requiring hospital emergency department treatment: a nationally representative sample.

Data from a nationally representative sample of emergency departments for the 6-month period July through December 1992 were used to examine nonfatal occupational injuries sustained by adolescents aged 14 through 17 years. There were 679 occupational injuries, corresponding to an estimated 37,405 injuries nationwide. Males constituted 65.8% of the injury victims. The injury rate for males was 7.0 per 100 full-time employees, compared with 4.4 for females. Lacerations to the hand or finger accounted for 25.6% of all injuries. The majority of injuries occurred in retail trades (53.7%), which also had the highest rate (6.3 per 100 full-time employees). Seventy-one percent of the injuries in retail trade occurred in eating and drinking establishments.     

Optic disc haemorrhages and vascular abnormalities in a glaucoma population

Purpose: To retrospectively examine the optic disc photographs of a glaucoma population for optic disc haemorrhages, vascular occlusions and vascular abnormalities. Methods: The optic disc photographs of 906 eyes of glaucoma and suspect glaucoma patients were examined. Optic disc photographs were taken annually, where possible, with the follow-up period varying between 1 and 14 years duration (mean, 2.89). Glaucoma patients are regularly reviewed every 4–6 months and glaucoma suspects every 1–2 years, depending on the ophthalmologist. Low-tension glaucoma patients were reviewed more frequently (mean, every 2.6 months). The results of the findings were compared to a control group of 39 subjects with a mean follow-up period of 7 years, using Fisher's exact test. Results: It was found that during the period under review, 7.4% (n= 67) of eyes had optic disc haemorrhages. The highest frequency of optic disc haemorrhages (37.5%) was found in the low tension glaucoma group (P= 0.0001) followed by 11.4% of primary open-angle glaucoma eyes (P= 0.03). In the normal group there were three eyes with optic disc haemorrhages and one with a disc collateral, which constitutes 5.1% vascular changes in this sub-group. Of the study eyes 2.8% had central retinal vein occlusions, 1.3% branch vein occlusion, 1.2% disc vessel abnormalities (loops) and 1.1% disc collaterals. Discrete nerve fibre layer haemorrhages and microaneurysms were found in 0.8% and 1.8% of eyes, respectively. Conclusions: A total of 16.8% of the eyes observed in this study had either disc haemorrhages or vascular changes. The underlying trend of vascular and haemorrhagic changes in glaucoma are demonstrated in this sample, which is in general agreement with previous studies. The high percentage of optic disc haemorrhages in low tension glaucoma is highlighted. The presence of microaneurysms and nerve fibre layer haemorrhages is interesting but of unknown significance.     

Intensive therapy for small-cell lung cancer using carboplatin alternating with cisplatin, ifosfamide, etoposide, mid-cycle vincristine, and radiotherapy.

Forty patients with small-cell lung cancer (31 patients with limited-stage [LS] disease, and nine patients with extensive-stage [ES] disease but of good performance status) have been treated with an intensive therapy composed of carboplatin alternating with cisplatin, ifosfamide, and etoposide with vincristine on day 14 of each carboplatin cycle. A maximum of six cycles were administered at 3 weekly intervals after the cisplatin combination and 4 weekly after the carboplatin combination. Prophylactic cranial irradiation was given with the first cycle of chemotherapy and thoracic irradiation with the third cycle. The median nadir for neutrophils was 0.47 x 10(9)/L and for platelets, 40 x 10(9)/L. Chemotherapy dosages were not reduced in response to myelosuppression, but treatment was delayed to allow blood count recovery. Sixty-eight percent of patients received all six cycles of chemotherapy, and there were four deaths associated with treatment-related neutropenia. Twenty-eight patients (70%) achieved a complete response (CR) when assessed 1 month after the end of treatment, and a further five patients (12.5%) had a partial response (PR). Median duration of CR was 16 months and of PR, 8 months. Cerebral metastases occurred in 20% of all patients and was the apparent sole site of relapse in 11% of the CR patients. The median survival of the total group was 14 months with an actual 2-year survival of 30% and a minimum follow-up of 28 months.     

Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment

Treatment was provided to 53 alcoholics and their spouses in one of three outpatient behavioral treatment conditions: minimal spouse involvement (MSI) (N = 21), alcohol-focused spouse involvement (AFSI) (N = 13) or alcohol-focused spouse involvement plus behavioral marital therapy (ABMT) (N = 19). Subjects were followed for 6 months after treatment. All subjects markedly decreased their drinking and reported increased life satisfaction. ABMT subjects were more compliant than AFSI subjects with conjoint homework assignments, decreased their drinking more quickly during treatment, relapsed more slowly after treatment and maintained marital satisfaction better. ABMT subjects were more likely than MSI subjects to stay in treatment and maintained their marital satisfaction better after treatment. Clinical and theoretical significance of the findings are discussed.     

The relationship between the photoplethysmographic waveform and systemic vascular resistance

Objective The objective of this study was to determine the relationship between systemic vascular resistance (SVR), finger & ear photoplethysmographic measurements in 14 adult patients undergoing coronary artery bypass grafting (CABG). Methods Patients were monitored with photoplethysmographs of the finger and ear and continuous cardiac output (Q_T) via thermodilution catheter. The relationship between SVR, finger plethysmographic amplitude, width and ear plethysmographic amplitude, width was assessed with linear regression. Results The finger plethysmographic amplitude had a low correlation r value = −0.15, while finger plethysmographic width had a better correlation r value = 0.56. The correlation between SVR and ear plethysmographic amplitude and width were −0.24 and 0.62 respectively. Using receiver operating characteristic analysis the ear plethysmographic width had both better sensitivity and specificity than the finger plethysmographic width in identifying high and low SVR. Using a multiple regression analysis, SVR was estimated from the pulse oximeter waveforms: SVR calculated = 27.27 + (3978.53 × Ear pulse oximeter width) − (8.91 × Ear pulse oximeter area) + (1986.3 × Finger pulse oximeter width). Bland–Altman analysis was used the bias was 29.8 dynes s cm⁻⁵, standard deviation was 587.3, upper and lower limit of agreement were 1204.45, and −1144.8 dynes s cm⁻⁵ respectively. Conclusion The data indicate that pulse width of finger and ear plethysmographic tracing are more sensitive to changes in SVR than the other indices. An appreciation of changes in pulse width may provide valuable evidence with respect to changes in peripheral vascular tone. Awad AA, Haddadin AS, Tantawy H, Badr TM, Stout RG, Silverman DG, Shelley KH. The relationship between the photoplethysmographic waveform and systemic vascular resistance.     

Multiparameter calibration of a natural history model of cervical cancer

The objective of this study was to develop a comprehensive natural history model of human papillomavirus (HPV) and cervical cancer using a two-step approach to model calibration. In the first step, the authors utilized primary epidemiologic data from a longitudinal study of women in Brazil and identified a plausible range for each input parameter that produced model output within the 95% confidence intervals of the data. In the second step, they performed a simultaneous search over all input parameters to identify parameter sets that produced output consistent with data from multiple sources. A goodness-of-fit score was computed for 555,000 unique parameter sets using a likelihood-based approach, and a sample of good-fitting parameter sets was used in the model to illustrate the advantage of the calibration approach by projecting a range of benefits associated with cervical cancer prevention policies. The calibrated model had reasonable fit to the data in terms of duration and prevalence of HPV infection for high-risk types, prevalence of precancerous lesions, and incidence of cancer. The authors found that leveraging primary data from longitudinal studies provides unique opportunities for model parameterization of the unobservable nature of HPV infection and its role in the development of cervical cancer.