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Articles by D Lowe
Total Records ( 3 ) for D Lowe
  A Wagg , D Lowe , P Peel and J. Potter

Introduction: systematic collection of clinical outcome data remains the most difficult task in the measurement of clinical effectiveness. However, the examination of the relationship between organisational and clinical process of care may provide a surrogate measure of quality in care.

Methods: data from the 2006 National Audit of Continence Care for Older People were used to examine whether there was an association between organisational structure and standard of continence care for older people. ‘Quality’ scores were produced and the relationship between scores was examined.

Results: there were statistically significant correlations between organisational and process scores for continence care. Primary care scored higher than hospitals or care homes in regard to service organisation [median (IQR): 57 (45–68) vs 48 (36–65) vs 50 (38–55), P = 0.001]. Differences were less with clinical process scores for urinary incontinence (UI) [median (IQR): 42 (32–52) vs 40 (29–49) vs 43 (34–52), P = 0.06] and for faecal incontinence (FI) [median: 42 (34–53) vs 45 (36–55) vs 47 (41–53), P = 0.12].

Conclusion: those with an integrated service provide higher quality care to older people. The provision of high-quality care for continence appears to be dependent upon well-organised services with personnel who have the appropriate training and skills to deliver the care.

  S. N Rogers , D Lowe , B Yueh and E. A. Weymuller Jr

Objectives  To perform a factor analysis using the University of Washington Quality of Life Questionnaire version 4 (UW-QOLv4) to establish subscales; to report their normative values and variations for patients by age, sex, extent of disease, and time from treatment; and to estimate clinical effect sizes and potential for use in comparative treatment studies.

Design  Retrospective cohort.

Setting  Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, England.

Patients  Patients with primary oral and oropharyngeal cancer treated by surgery with or without adjuvant radiotherapy since 1992. A database accumulating since 1995 contains more than 2600 UW-QOLs completed by these patients. A data set of 372 patients without cancer attending 10 general dental practices provided normative data.

Main Outcome Measures  UW-QOLv4.

Results  Factor analysis indicated a 2-factor solution: (1) physical function, involving chewing, swallowing, speech, taste, saliva, and appearance, and (2) social-emotional function, involving anxiety, mood, pain, activity, recreation, and shoulder function. The best scores were for those with less advanced oral cancer tumors not requiring free-flap surgery or adjuvant radiotherapy. Older patients reported better scores, but associations were weak, and no sex differences were found. Significant differences were seen for T category, site, free-flap surgery, and adjuvant radiotherapy (P < .001). Preoperative scores were close to normative values. Patients regain social-emotional deficits by 1 year after surgery but continue with significant deficits in physical function. Comparative studies using these UW-QOL subscales as outcome measures should recruit at least 80 patients per treatment arm to detect moderately sized treatment effects.

Conclusion  With the UW-QOLv4, it is appropriate to analyze and report outcomes using the 2 subscales of physical and social-emotional function.

  C. J Hochstim , J. Y Choi , D Lowe , R Masood and D. H. Rice

Objective  To demonstrate that hematoxylin-eosin staining can be used to detect the presence of bacterial biofilm in patients with chronic rhinosinusitis (CRS).

Design  A prospective study.

Setting  The University of Southern California University Hospital and the Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles.

Patients  A total of 34 patients: 24 undergoing endoscopic sinus surgery for CRS and 10 undergoing septoplasty with or without turbinate reduction with no history of sinusitis, were enrolled in the study.

Main Outcome Measures  Contiguous sections from patient samples were examined by both hematoxylin-eosin staining and fluorescence in situ hybridization (FISH) with the bacterial-specific probe EUB338 for evidence of bacterial biofilm.

Results  Biofilm was detected by hematoxylin-eosin staining in 15 of 24 patients with CRS and 1 of 10 control patients. In all cases, hematoxylin-eosin staining was found to be an accurate predictor of the presence or absence of biofilm using FISH as a control standard.

Conclusion  Hematoxylin-eosin staining of surgical specimens is a reliable and available method for the detection of bacterial biofilm in chronic infectious disease.

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