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2.  Cardiac rehabilitation in the UK: uptake among under-represented groups 
Heart  2005;91(3):375-376.
PMCID: PMC1768753  PMID: 15710728
cardiac rehabilitation; coronary heart disease; National Service Framework
4.  Familial myelodysplasia. 
BMJ : British Medical Journal  1989;299(6698):551.
PMCID: PMC1837374  PMID: 2507067
7.  Accuracy of cancer registration. 
In South Wales cancer registration is done principally by means of the Hospital Activity Analysis. Altogether 1460 hospital records of cancer patients (19% of the 1972 registrations received by May 1973) were studied and the principal items of information required for cancer registrations by the Office of Population Censuses and Surveys were copied and subsequently compared with the corresponding registrations at the Welsh Hospital Board's cancer bureau. Differences between these 're-registrations' and the original registrations were analysed item by item. There were 234 registrations with errors in the diagnostic summary (although 110 of these would cause misclassification only under the fourth digit of the ICD code), 164 with errors in date of birth (36 of which would cause classification in the wrong WHO age group) and 198 with errors in the date of registration (112 of which were wrongly ascribed to the year 1972). Error and omission rates were particularly high for NHS number, occupation, place of birth, and histology.
PMCID: PMC478962  PMID: 974439
8.  Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial. 
BMJ : British Medical Journal  1996;313(7071):1517-1521.
OBJECTIVE: To evaluate rehabilitation after myocardial infarction. DESIGN: Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months. SETTING: Six district general hospitals. SUBJECTS: All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days. INTERVENTIONS: Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses. MAIN OUTCOME MEASURES: Anxiety, depression, quality of life, morbidity, use of medication, and mortality. RESULTS: At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality. CONCLUSIONS: Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials.
PMCID: PMC2353074  PMID: 8978226
9.  Discounting the future: influence of the economic model. 
OBJECTIVE: To consider the effect of the economic discount rate on health care policy and the rationale for discounting the collective future of society generally. DESIGN: A review of the concept of discounting the future vis à vis the present from the points of view of individuals (who pass on) and of societies (that continue) and reconsideration of the application of discounting to typical public health scenarios. SETTING: A public health service, within a basically stable society, which can reasonably anticipate a nearly certain future. RESULTS: Discounting necessarily overvalues the "here and now" compared with the future. While applications of discount rates, typical of those employed in health economic studies in recent years, may seem rational in health care programmes directed at middle aged employed people, they do not for the young and the elderly, important recipients of health care. The consequences of discounting do not accord with the aims and objectives of public health. CONCLUSIONS: The "time preferences" of transient individuals within a stable society do not provide a rational basis for time preference of a stable society collectively. Discounting inevitably encourages "short termism" and hence biases public policy decision making. The neoclassical theory that gave rise to the concept of discounting requires revision.
PMCID: PMC1060277  PMID: 8935452
10.  Low molecular weight heparin. 
BMJ : British Medical Journal  1992;305(6859):906.
PMCID: PMC1883527  PMID: 1333862
11.  Vasectomy and testicular cancer. 
BMJ : British Medical Journal  1992;304(6829):729-730.
PMCID: PMC1881587  PMID: 1571675
12.  Leukaemia mortality among relatives of cystic fibrosis patients. 
Archives of Disease in Childhood  1991;66(3):317-319.
A total of 219 families of patients with cystic fibrosis living in Wales were studied for the occurrence of other diseases and for cause of death, and the findings in relation to leukaemia are reported. There were eight deaths due to leukaemia, five of the myeloid type, in first and second degree relatives; this is significantly more than the expected on the basis of national age specific mortality rates. In comparison, mortality among siblings, parents, aunts and uncles, and grandparents from all causes was within the expected. Screening the five patients with myeloid leukaemia for the delta F508 mutation showed that four were carriers of this mutation. It is concluded that carriers of the delta F508 mutation may have an increased risk of developing acute myeloid leukaemia. This could happen through the direct effect of the cystic fibrosis gene itself, or through its influence on another gene, such as the met oncogene, or gene(s) involved in granulocyte function on the long arm of chromosome 7.
PMCID: PMC1792876  PMID: 2025008
14.  Prevalence of Gardnerella vaginalis: an estimate 
To assess the prevalence of Gardnerella vaginalis in the community 300 women aged 16-59 were randomly selected from a general practice's age-sex register and invited to attend for a health check. Out of 282 women who were eligible to attend, 192 did so. They were asked whether they had any vaginal symptoms, and swabs were taken from 182 women for culture for G vaginalis. Sixty women were positive for G vaginalis, of whom 26 had symptoms.
Infections with G vaginalis may be present in women who have no symptoms. By careful questioning, examination, and side room testing general practitioners may be able to diagnose these infections in such women consulting them for other reasons.
PMCID: PMC2545627  PMID: 3132250
17.  Clinical prediction of Gardnerella vaginalis in general practice 
In a study of 162 women with vaginal symptoms the clinical features of increased discharge, yellow discharge, 'high cheese' odour and pH greater than 5 were statistically strongly associated with the presence of Gardnerella vaginalis, confirmed by microbiological culture. The sensitivities and specificities of these clinical tests, although not as high as those of previously described sideroom tests using the amine test and microscopy for 'clue cells' nevertheless allow the clinician to predict G. vaginalis reliably and initiate treatment at first consultation.
PMCID: PMC1710693  PMID: 3499508
18.  Lifestyle changes in long term survivors of acute myocardial infarction. 
A retrospective questionnaire and interview study of 10 year survivors of uncomplicated myocardial infarction examined smoking, diet, exercise, weight, medication, and treatment since discharge from hospital in 1973-4 and made comparisons with controls (using the same questionnaire) and with normal populations (as reported by others). Long term survivors of myocardial infarction previously smoked more than controls; made more dietary changes than controls; and presently eat less butter, sugar, cake, and biscuits and drink less milk than controls; previously weighed more than controls; exercised less than controls both previously and presently; use more 'non-cardiac' as well as 'cardiac' drugs than controls; and are more depressed and more anxious than controls.
PMCID: PMC1052502  PMID: 3746170
20.  Long term survival of patients mobilised early after acute myocardial infarction. 
British Heart Journal  1985;53(3):243-247.
A Welsh multicentre trial of early (fifth day) compared with late (tenth day) mobilisation in 742 patients after uncomplicated myocardial infarction, reported previously, found that there were no significant differences in survival during the first year, but a partial follow up beyond the first year survival showed a significantly reduced survival during the second and third years among patients mobilised early. A full 10 year follow up of all patients admitted to the trial was therefore carried out. A small difference in survival was confirmed, which reached about 5% at four years; but the difference was not statistically significant. Further analysis suggested the possibility of real differences in survival in certain subgroups, but the present evidence was not sufficient to provide contraindication to mobilisation five days after uncomplicated myocardial infarction.
PMCID: PMC481750  PMID: 3882106
22.  Shortening waiting lists in orthopaedic surgery outpatient clinics. 
There is a long waiting list for orthopaedic outpatient appointments in South Glamorgan Area Health Authority as elsewhere. A detailed study of that waiting list was undertaken to identify factors that might lead to its better management and reduction. One-third of patients on the list failed to attend when appointments were offered. A postal-questionnaire to all those listed as waiting confirmed that many no longer sought specialist orthopaedic consultation. Another third of the patients reported that they had been treated previously for the same orthopaedic problem. It is concluded that improved management of long outpatient waiting lists could be achieved by correspondence with referring general practitioners to weed out those patients who no longer wish to attend, to reduce the burden of reviews and re-referrals of patients with "chronic" conditions, and to request priorities fairly so that earlier appointments may be offered to truly "new" patients with treatable or with potentially serious conditions.
PMCID: PMC1496693  PMID: 6802307
23.  Variation in rates of hospital admission for appendicitis in Wales. 
British Medical Journal  1978;1(6128):1662-1664.
In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission.
PMCID: PMC1605455  PMID: 656866
24.  The water story. 
British Medical Journal  1978;1(6113):649-650.
PMCID: PMC1603379  PMID: 630273
25.  Geographical variation mortality from ischaemic heart disease in England and Wales. 
Analysis ofthe proportional mortality attributed to ischaemic heart disease, adjusted for age, reminds us that many of the well known geographical, environmental, social, and economic variations within England and Wales are not disease specific.
PMCID: PMC479035  PMID: 597678

Results 1-25 (49)