Why we need observational studies to evaluate the effectiveness of health care.

The view is widely held that experimental methods (randomised controlled trials) are the "gold standard" for evaluation and that observational methods (cohort and case control studies) have little or no value. This ignores the limitations of randomised trials, which may prove unnecessary, inappropriate, impossible, or inadequate. Many of the problems of conducting randomised trials could often, in theory, be overcome, but the practical implications for researchers and funding bodies mean that this is often not possible.

The effect of prostatectomy on symptom severity and quality of life.

Objective: To determine the effectiveness of prostatectomy in reducing symptom severity and bother and in improving disease-specific and general quality of life.

Patients And Methods: A prospective, cohort study was performed in National Health Service and private hospitals in the Northern, Wessex, Mersey, and South-West Thames Health Regions which comprised 5276 men undergoing prostatectomy recruited by 101 of the 106 (96%) surgeons (specialist and non-specialist) performing prostatectomy during a 6-month period. Patients were assessed using the American Urological Association (AUA) Symptom Index Score, the AUA symptom bother score, disease-specific and generic quality-of-life scores, the occurrence of adverse events (urinary incontinence, erectile impotence and retrograde ejaculation) and three global (general) questions on the results of their treatment.

Development of a symptom severity index and a symptom impact index for stress incontinence in women.

Stress incontinence is a common problem among women, yet there is no adequately validated instrument for measuring women's views of its severity (disease-specific health status). The only instrument for measuring the impact or bothersomeness of symptoms (disease-specific quality of life) has poor internal consistency. This paper describes the development and psychometric assessment of two new indexes, a Symptom Severity Index and a Symptom Impact Index.

Appropriateness of total hip replacement in the United Kingdom.

The paper discusses the use of consensus models in determining the application of Total Hip Replacement surgery. The paper notes the wide national and international variation in use of this procedure but considers it in the broader context of reaching consensus on other surgical interventions.

The feasibility and cost of a large multicentre audit of process and outcome of prostatectomy.

Objective--To determine the feasibility of performing multicentre process and outcome audits of common interventions taking prostatic procedures as an example. Design--Prospective, cohort study. Setting--All National Health Service and independent hospitals in Northern, Wessex, Mersey, and South West Thames health regions.

Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study.

Objective: To describe the indications for total abdominal hysterectomy for women with nonmalignant disease and to determine the immediate (initial ten days) and medium term outcome.

Design: A prospective cohort study.

Setting: Three district general hospitals in shire counties, two in outer London and one London teaching hospital.

Coronary revascularisation: why do rates vary geographically in the UK?

Objective: To explain the reasons for geographical variation in the use of coronary revascularisation in the United Kingdom.

Design: This was a cross sectional ecological study.

Setting: NHS and independent hospitals performing coronary revascularisation for the 11.

The impact of lower urinary tract symptoms on general health status and on the use of prostatectomy.

Our objective was to determine the extent to which lower urinary tract symptoms affect the general health status of men and contribute to the decision to undergo surgery. A cross-sectional population survey using postal questionnaires was conducted in the North West Thames health region, followed by a prospective cohort study of men undergoing prostatectomy (North West Thames and Oxford regions). The subjects in the first survey were 221 men aged 55 and over with previously reported mild, moderate or severe urinary symptoms; subjects in the second study were 388 men undergoing prostatectomy.

Heat Shock Protein Induction in Montastraea faveolata and Aiptasia pallida Exposed to Elevated Temperatures.

Frequent widespread episodes of coral bleaching have made researchers aware of the sensitivity of reef corals to moderately elevated temperatures and led us to investigate mechanisms of temperature stress tolerance in this group. One such mechanism may be the induced synthesis of heat shock proteins (hsps), which have been shown to play a role in thermotolerance in other organisms. However, induced synthesis of hsps in scleractinian corals was not reported until recently.

Recollected versus contemporary patient reports of pre-operative symptoms in men undergoing transurethral prostatic resection for benign disease.

The objective of the study was to investigate the reliability of patients' recollected pre-intervention symptom status and the impact of those symptoms compared with contemporary pre-operative reports, and to test the stability of recollected views. In design (A) a self-completed symptom questionnaire was administered before (contemporary) and 3 months after (recollected) surgery. In design (B) a self-completed symptom questionnaire on recollected pre-operative symptoms was administered 12 and 14 weeks after surgery.

Surgery for glue ear: the English epidemic wanes.

Objectives: To describe the progress of the epidemic of surgery for glue ear since 1983 and trends in the use of different operative procedures.

Design: Analysis of routine hospital data.

Setting: Thirteen health districts in the Oxford and East Anglian regions.

Health status and quality of life of British men with lower urinary tract symptoms: results from the SF-36.

Objectives: To determine the extent to which urinary symptoms, and resulting bothersomeness interfere with daily activities and affect health status, as measured using the Medical Outcomes Study 36-item short form health survey (SF-36).

Methods: Postal population survey in a British health region of 217 men aged 55 years and over known to have reported mild, moderate, or severe lower urinary tract symptoms. Outcome measures are self-reported urinary symptoms, their bothersomeness, general health status, and quality of life (measured using the SF-36).

The National Prostatectomy Audit: the clinical management of patients during hospital admission.

Objective: To determine everyday practice in the hospital management of men undergoing prostatectomy and the extent of its variation.

Patients And Methods: A total of 5361 patients, who represented 89% of all those undergoing prostatic procedures in four health regions (Mersey, Wessex, Northern and South West Thames) and one test site (within Trent) were recruited by 103 (97%) surgeons. Clinical information was collected on a pre-coded data collection form which was completed during the hospital stay by the principal operator.

Impact of non-response and of late-response by patients in a multi-centre surgical outcome audit.

Objective: To determine the impact of non-responders on the results of a multi-centre surgical outcome audit, factors associated with failure to respond and to assess the benefits of pursuing non-responders beyond two reminders.

Design: A multi-centre prospective cohort study.

Setting: English health regions of Wessex, Mersey and Northern and South-West Thames.

Computer-assisted three-dimensional reconstruction of epithelial cells attached to percutaneous implants.

It is generally accepted that cell shape plays a pivotal role in many aspects of cell behavior including proliferation, differentiation, and gene expression. Although previous reports have shown that implant-surface topography can alter cell shape in vitro, in vivo evidence for such an effect is largely based on intuitive interpretation of two-dimensional histological sections. The objective of this in vivo study was to develop a method to reconstruct in three dimensions the shape of epithelial cells attached to smooth and micromachined implant surfaces.

Information issues in telemedicine systems.

This paper examines the use of the Integrated Services Digital Network (ISDN) for telemedicine from the computer scientist's point of view. As increased bandwidth becomes available at reasonable cost, it becomes possible to employ graphical user interfaces in telemedicine systems. This means that human-computer interaction (HCI) techniques can be applied to the interface design.

International variation in intervention rates. What are the implications for patient selection?

While international variations in intervention rates are well recognized, little is known about their implications for patient selection. This paper describes an exploratory study in which the probability of undergoing an elective intervention (surgery for benign prostatic hyperplasia) in an area in the United Kingdom was compared with an area in the United States. It found that the area with high intervention rates was associated with higher levels of surgery in men with low levels of need who are unlikely to gain much benefit.

Health care sought and received by men with urinary symptoms, and their views on prostatectomy.

Background: Urinary symptoms are common among middle aged and elderly men.

Aim: A study was undertaken to describe the health care sought by men aged 55 years and over with urinary symptoms, the action taken by general practitioners and urologists, and the men's views on prostatectomy.

Method: A postal questionnaire was sent to 516 men aged 55 years and over in the North West Thames Regional Health Authority, with previously identified mild, moderate or severe urinary symptoms.

Urinary symptoms: prevalence and severity in British men aged 55 and over.

Objective: To measure the prevalence and severity of urinary symptoms among men aged 55 and over in the British population.

Design: Cross sectional population survey using a postal questionnaire.

Setting: North West Thames health region.

Trends in the age and sex of patients undergoing coronary revascularisation in the United Kingdom 1987-93.

Objectives: To describe how coronary revascularisation rates in the United Kingdom (in the public and private sectors) vary by age and sex; how these relations have changed between 1987 and 1993; whether significant differences exist between geographical areas, public and private sectors, and hospitals; and to make comparisons with trends in North America.

Designs: Secondary analysis of data on the age, sex, procedure, NHS/private, and health district of residence of patients.

Setting: Resident population of South East Thames, East Anglian, and North Western health regions and Greater Glasgow, Lanarkshire, and Ayr/Arran health boards (11.

Symptoms and health status before and six weeks after open cholecystectomy: a European cohort study.ECHSS Group. European Collaborative Health Services Study Group.

The impact of open cholecystectomy on patients' symptoms and health status and their level of satisfaction has been examined to provide a basis for comparison with newer rival treatments. A prospective cohort study using patient and surgeon completed questionnaires before and six weeks after surgery was carried out in 14 general hospitals in eight European countries. Five hundred and eighty three patients were recruited consecutively in 1990 to 1991.