Responsiveness of the SF-36 and a condition-specific measure of health for patients with varicose veins.

Approaches to measuring patient perceptions of outcome for varicose veins were tested using a postal questionnaire incorporating a clinically derived specific measure of varicose veins severity and the SF-36 health survey. The questionnaire was administered to 373 patients with varicose veins, 287 of whom had been referred to hospital for their varicose veins and 86 who had just consulted a general practitioner for the condition. The response rate exceeded 75%.

Integrated care for asthma: matching care to the patient.

The purpose of the present study was to investigate whether criteria associated with assignment of asthma patients between general practice (GP) care alone, integrated care (shared between GP care and hospital clinic) or conventional specialist review could be identified, and whether outcomes for these patients differed over the next 12 months. Seven hundred and sixty four patients with a diagnosis of asthma and previously assigned to either integrated care or clinic care were reviewed after 1 year and reassigned. These patients were then followed for another 12 months and clinical data were collected over this time.

Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects.

Objective: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding.

Design: Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital.

The use of methotrexate perioperatively in patients with rheumatoid arthritis undergoing major joint replacement surgery: will we ever have consensus about its use?

Whether methotrexate can be safely administered during the perioperative period to rheumatoid arthritis patients undergoing arthroplasties is an issue that has not been resolved to date. We are describing our attempt to conduct a case-controlled, multicenter study addressing this issue. The estimated sample size of approximately 140 patients proved to be difficult to recruit.

Estimating the point accuracy of population registers using capture-recapture methods in Scotland.

Study Objective: To estimate the point accuracy of adult registration on the community health index (CHI) by comparing it with the electoral register (ER) and the community charge register (CCR).

Design: Survey of overlapping samples from three registers to ascertain whether respondents were living at the addresses given on the registers, analysed by capture-recapture methods.

Setting: Aberdeen North and South parliamentary constituencies.

Survival on renal replacement therapy in Europe: is there a 'centre effect'?

Objective: Survival is the ultimate outcome measure in renal replacement therapy (RRT) and may be used to compare performance among centres. Such comparison, however, is meaningless if the influences of comorbidity, age and early deaths are not considered. We therefore studied survival rates on RRT in seven centres in Europe after taking into account the influence of age, early deaths, primary renal diagnoses, and comorbidity.

The effect of efferent stimulation on basilar membrane displacement in the basal turn of the guinea pig cochlea.

Tone-evoked basilar membrane (BM) displacements were measured with a laser diode interferometer from the basal turn of the guinea pig cochlea. The olivocochlear bundle (OCB) was electrically stimulated for 60--80 msec periods at rates of < 200 sec-1 via electrodes placed at the point at which the OCB crosses the floor of the fourth ventricle. For tones close to the best or characteristic frequency (CF), OCB stimulation tended to linearize the highly compressive displacement-level functions and to displace the steep, low-level region toward higher intensities along the intensity axis by < 27 dB sound pressure levels.

A survey of anaesthesia for caesarean section.

In 1993 a postal survey of maternity hospitals within the UK was carried out to obtain data on the types of anaesthesia used for caesarean section. The poor response rate (79/226, 35%) reflects the paucity of data available in many centres. The data returned indicated a wide range of anaesthetic practice: from units with a general anaesthesia rate less than 10% to those with a general anaesthesia rate approaching 90%.

Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial.

In a randomized controlled trial, 299 patients were sent a symptoms questionnaire 1 year after laparoscopic (n = 151) or minilaparotomy (n = 148) cholecystectomy for symptomatic cholelithiasis. The response rate to the questionnaire from contactable patients was 86 per cent. In both groups, at least 90 per cent of patients reported that their symptoms were improved, and at least 93 per cent rated the success of their operation as 'excellent', 'good', or 'fair'.

Developing clinically valid practice guidelines.

Valid guidelines, when appropriately disseminated and implemented, can lead to changes in clinical practice and improvements in patient outcome. Guidelines are more likely to be valid if they are developed using systematic reviews, national or regional guideline development groups (including representatives of key disciplines) and explicit links between recommendations and scientific evidence. This paper discusses the practical implications of adopting this approach for guideline development and the role of peer review guidelines as another element of the process to ensure validity.

Epidural clonidine-fentanyl combination for labour analgesia: a comparison with bupivacaine-fentanyl.

This open study of 20 women compared epidural clonidine (300 microg)/fentanyl (100 microg) with bupivacaine (25 mg)/fentanyl (100 microg) in the provision of pain relief in labour. Sensory tests in the clonidine group revealed slight alterations in the appreciation of pin prick and temperature but motor power was unchanged. Analgesia after the first dose was similar in the two groups, but thereafter the analgesia provided by clonidine/fentanyl was less than that from bupivacaine/fentanyl.

Adjuvant treatment of high-risk breast cancer using multicycle high-dose chemotherapy and filgrastim-mobilized peripheral blood progenitor cells.

Women with primary breast cancer associated with extensive axillary node involvement or large primary tumors have a very poor prognosis despite treatment with standard-dose adjuvant chemotherapy. In an attempt to improve the outlook of these patients, we investigated the safety and feasibility of delivering three cycles of high-dose epirubicin and cyclophosphamide supported with filgrastim-mobilized peripheral blood progenitor cells (PBPC). Fifteen previously untreated women, median age 50 (range, 30-58) years, with poor prognosis early stage breast cancer received filgrastim (12 microgram/kg daily for 6 days) prior to chemotherapy to mobilize progenitor cells.

Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study.

Objective: To study the efficacy and safety of Super Malic, a proprietary tablet containing malic acid (200 mg) and magnesium (50 mg), in treatment of primary fibromyalgia syndrome (FM).

Methods: Twenty-four sequential patients with primary FM were randomized to a fixed dose (3 tablets bid), placebo controlled, 4-week/course, pilot trial followed by a 6-month, open label, dose escalation (up to 6 tablets bid) trial. A 2-week, medication free, washout period was required before receiving treatment, between blinded courses, and again before starting open label treatment.

Levels of anaesthesia and intraoperative pain at caesarean section under regional block.

This prospective study recorded levels of analgesia (loss of sharp pin prick sensation) and anaesthesia (loss of touch sensation) in 220 women during caesarean section under regional anaesthesia (70 epidurals, 150 spinals). At delivery the difference between analgesia and anaesthesia varied from 0-7 segments for epidurals and 0-9 segments for spinals. During surgery the level of anaesthesia at the time pain was experienced varied between T5 and T10.

Postnatal maternal morbidity: extent, causes, prevention and treatment.

Objective: To describe the prevalence and causes of postnatal maternal morbidity.

Design: Questionnaire survey of postnatal patients. Further data extracted from SMR1 returns, case records and the Aberdeen Maternity and Neonatal Databank.

Hormone replacement therapy: compliance and cost after screening for osteoporosis.

Objective: To assess HRT compliance and cost 1 year after population screening for low bone density.

Design: Postal questionnaire sent out to women 1 year after having a bone density scan.

Main Outcome Measures: Compliance with HRT, type of HRT and cost.

Yeast Nop3p has structural and functional similarities to mammalian pre-mRNA binding proteins.

Indirect immunofluorescence shows the yeast protein Nop3p/Np13p/Mts1p to be localized both in the nucleoplasm and the nucleolus. Here we show that Nop3p can be efficiently UV cross-linked in vivo to poly(A)+ RNA. In higher eukaryotes it would therefore be classed as a heterogeneous nuclear ribonucleoprotein (hnRNP) component.

Antenatal screening for carriers of cystic fibrosis: randomised trial of stepwise v couple screening.

Objective: To perform a rigorous comparative evaluation of stepwise and couple approaches to antenatal carrier screening for cystic fibrosis.

Design: Pragmatic randomised trial.

Setting: Hospital antenatal clinic serving a regional population.