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Biomedical subjects

C Hyde

Publications and source records attributed to C Hyde.

At least 37 records · Page 2Linked to original sources
PubMed2001

Teaching critical appraisal skills in health care settings.

BACKGROUND: Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. OBJECTIVES: To assess the effects of teaching critical appraisal skills to health professionals, on the process of care, patient outcomes and knowledge of health professionals. SEARCH STRATEGY: We searched The Cochrane Library (to Issue 2 2000), MEDLINE (1966 to 1997), EMBASE (1980 to 1997), Eric (1966 to 1997), Cinahl (1982 to 1997), Lisa (1976 to 1997), Sigle (1980 to 1997), Science Citation Index (1981 to 1997), PsycLit (1974 to 1997), the world-wide-web, and reference lists of articles. We also contacted major medical education centres. SELECTION CRITERIA: Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of educational interventions teaching critical appraisal to health professionals. The outcomes were: process of care; patient mortality, quality of life, and satisfaction; and health professional knowledge/awareness based upon objective, standardised, validated instruments. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and three reviewers independently assessed study quality. MAIN RESULTS: One USA hospital-based randomised trial was included involving 44 doctors. The outcome assessed was critical appraisal knowledge. Process of care, patient health or attitude/awareness outcomes were not assessed. Critical appraisal teaching was reported to have resulted in a 25% improvement (adjusted figure) in critical appraisal knowledge in the intervention group compared to a 6% improvement in the control group, which was statistically significant (p=0.02). REVIEWER'S CONCLUSIONS: There is evidence that critical appraisal teaching has positive effects on participants' knowledge, but as only one study met the inclusion criteria the validity of drawing general conclusions about the effects of teaching critical appraisal is debatable. There are large gaps in the evidence as to whether teaching critical appraisal impacts on decision-making or patient outcomes. It is also unclear whether the size of benefit seen is large enough to be of practical significance, or whether this varies according to participant background or teaching method. The evidence supporting all outcomes is weakened by the generally poorly designed, executed and reported studies that we found.

Decision Making↗
PubMed2001

Barriers to help seeking in people with urinary symptoms.

BACKGROUND: Urinary incontinence is a common problem but, for those experiencing significant clinical symptoms, help seeking has been reported to be as low as 20%. As many of these people could be helped by simple interventions, there is a clear need to identify barriers to help seeking and develop interventions to overcome these barriers. OBJECTIVES: This study explores help-seeking behaviour in people with urinary symptoms such as leakage, frequency, nocturia and urgency in order to identify barriers to service use. METHOD: Thirty-one people who either had agreed to treatment as part of an intervention study or who were receiving treatment at a hospital out-patient clinic for their urinary problems took part in unstructured, taped interviews. Respondents were questioned about their views on help seeking for urinary problems and their personal experiences of consultations. The data were transcribed, coded and thematic analysis carried out. RESULTS: The most common theme to emerge was a lack of knowledge of the condition and of available treatments. Urinary symptoms frequently were considered a normal part of ageing or childbirth, or it was felt that these types of symptoms were inappropriate for medical intervention. Older people were not only more likely to accept symptoms but were also less likely to want to bother their GP. Patients did not always communicate their concerns about urinary symptoms to their GP, through either embarrassment or misconceptions of what is a 'medical problem'. CONCLUSIONS: There is a clear need for health education and health promotion in this area. Future work should explore professionals' knowledge and views of these types of conditions with the aim of providing guidelines for management in primary care.

Adult↗
PubMed2001

Recent advances in the design and performance of research assistants.

Every laboratory needs personnel who work 24 hours a day 7 days a week, are efficient, obedient, capable of showing initiative, insightful and affable. Our experience of laboratory workers tells us that there is an immense way to go to achieve these goals. Having tired of the normal, Darwinian approach, a project has been initiated to achieve these ends through genetic technologies.

Humans↗
PubMed2000

Critical appraisal workshops to promote evidence-based healthcare.

We evaluated the effect of literature appraisal workshops on participants views, attitudes and knowledge about evidence-based medicine in the West Midlands region in 1998. The performance of 55 practitioners was evaluated, before and after attending the workshop. After attending the workshop, participants paid more attention to the study design (81% vs. 98%, P=0.02), they did not find research evidence confusing (35% vs. 52%, P=0.05), and they felt more confident in assessing research evidence (26% vs. 59%, P=0.0001). Their mean knowledge scores improved from 47.3 (SD12.2) to 57.9 (SD 9.0) ( P=0.0001). Our critical appraisal skills workshops improved attitudes and knowledge needed for the provision of evidence-supported healthcare. Such workshops should be incorporated in postgraduate obstetrics and gynaecology training programmes.

Journal Article↗
PubMed2000

Near-patient tests in primary care: setting the standards for evaluation.

Near-patient tests (NPT) are an area of rapid technological advance that may enhance the quality of care given by primary care physicians by enabling more accurate diagnosis or more reliable monitoring of therapy. Unfortunately, many new diagnostic technologies prove disappointing in practice, either because of limitations of the technology or because of a failure to address setting-specific issues that were not apparent during their evaluation. A recent systematic review of NPT in primary care has highlighted the methodological weaknesses of most published evaluations. There is a need for a formal statement of the criteria by which to judge the quality of evaluations in this field. In a similar fashion to Wilson and Junger's criteria for screening, seven questions need to be addressed. These cover the performance, reliability and acceptability of the test, its impact on decision-making, comparison with existing practice, cost-effectiveness of the test and integration with the practitioner's knowledge base. Evaluations of NPTs should therefore address the following methodological issues: demonstration of the need for the NPT, definition of the appropriate reference standard, calculation of sample size based on modelling of the decision problem and defining acceptable limits to the likelihood ratio, avoidance of verification bias, selection bias and treatment paradox, testing for the presence of spectrum bias, reporting the sensitivity of the results to changes in setting or prevalence or disease and calculating cost-effectiveness.

Humans↗
PubMed2000

Coronary artery stents in the treatment of ischaemic heart disease: a rapid and systematic review.

BACKGROUND: Coronary artery stents are prosthetic linings inserted into coronary arteries via a catheter to widen the artery and increase blood flow to ischaemic heart muscle. They are used in the treatment of ischaemic heart disease (IHD). IHD is a major cause of morbidity and mortality (123,000 deaths per annum) in the UK and a major cost to the NHS. Clinical effects of IHD include subacute manifestations (stable and unstable angina) and acute manifestations (particularly myocardial infarction [MI]). Treatment includes attention to risk factors, drug therapy, percutaneous invasive interventions (PCIs) (including percutaneous transluminal coronary angioplasty [PTCA] and stents) and coronary artery bypass graft surgery (CABG). In the last decade there has been a steady and significant increase in the rate of PCIs for IHD. In the UK, rates per million population increased from 174 in 1991 to 437 in 1998. Stents are now used in about 70% of PCIs. Data from the rest of Europe suggest there is potential for PCI and stent rates to increase considerably. In the UK there is evidence of under-provision and inequity of access to revascularisation procedures. OBJECTIVES: The following questions were addressed. 1. What are the effects and effectiveness of elective stent insertion versus PTCA in subacute IHD, particularly stable angina and unstable angina? 2. What are the effects and effectiveness of elective stent insertion versus CABG in subacute IHD, particularly stable angina and unstable angina? 3. What are the effects and effectiveness of elective stent insertion versus PTCA in acute MI (AMI)? 4. What are best estimates of UK cost for elective stent insertion, PTCA and CABG in the circumstances of review questions 1 to 3? 5. What are best estimates of cost-effectiveness and cost-utility for elective stent insertion relative to PTCA or CABG in the circumstances of review questions 1 to 3? METHODS: A systematic review addressing the objectives was undertaken. DATA SOURCES: A search was made for RCTs comparing stents (inserted during a PTCA procedure) with PTCA alone or with CABG in any manifestation of IHD. The search strategy covered the period from 1990 to November 1999 and included searches of electronic databases (MEDLINE, EMBASE, BIDS ISI, The Cochrane Library), Internet sites, and hand-searches of cardiology conference abstracts and 1999 issues of cardiology journals. Lead researchers and local clinical experts were contacted. Manufacturers' submissions to the National Institute for Clinical Excellence were searched. The search strategy was expanded to look for relevant economic analyses and information to inform the economic model (including searching MEDLINE, the NHS Economic Evaluation Database and the Database of Abstracts of Reviews of Effectiveness). Searches focused on research that reported costs and quality of life data associated with IHD and interventional cardiology. STUDY SELECTION: For the review of clinical effectiveness, inclusion criteria were: (i) RCT design; (ii) study population comprising adults with IHD in native or graft vessels (including patients with subacute IHD or AMI); (iii) procedure involving elective insertion of coronary artery stents; (iv) elective PTCA (including PTCA with provisional stenting) or CABG as comparator; (v) outcomes defined as one or more of: combined event rate (or event-free survival), death, MI, angina, target vessel revascularisation, CABG, repeat PTCA, angiographic outcomes; (vi) trials that had closed and reported results for all or almost all recruited patients. For the economic evaluation, studies of adults with IHD were included if they were of the following types: studies reporting UK costs; comparative economic evaluation combining both costs and outcomes; economic evaluations reporting costs and outcomes separately for the years 1998 and 1999 (to ensure current practice was included).(ABSTRACT TRUNCATED)

Adult↗
PubMed2000

Treatments for fatigue in multiple sclerosis: a rapid and systematic review.

BACKGROUND: Multiple sclerosis (MS) is an important problem both for people with the disease and for society. There is no cure, and alleviation of symptoms forms the cornerstone of care. Excessive fatigue that severely limits activity is experienced by at least two-thirds of the estimated 60,000 people with MS in the UK. OBJECTIVES: (1) To identify current treatments for fatigue in MS and their evidence-base. (2) To systematically review the evidence for those treatments that have been investigated in more than one rigorous study, in order to determine their effectiveness and cost-effectiveness. METHODS: The review was carried out in two stages: a formal scoping review (to assess the range of interventions used by people with MS), and a systematic review for treatments that had been identified as promising and that had been investigated in clinical trials (as identified in the scoping review). A systematic review of research on costs and cost-effectiveness of those interventions identified as promising was also performed. Electronic databases, including MEDLINE and EMBASE, were searched for the period 1991-June 1999 (scoping review) and 1966-December 1999 (systematic review). Reference lists from publications were also searched, and experts were contacted for any additional information not already identified. RESULTS: Interventions identified for the treatment of fatigue in MS (1) Behavioural advice. This is the main element of initial clinical management and no rigorous research of its effectiveness was identified. (2) Drugs (amantadine, pemoline, potassium-channel blockers and antidepressants). (3) Training, rehabilitation and devices (cooling vests and electromagnetic fields). (4) Alternative therapies (bee venom, cannabis, acupuncture/acupressure and yoga). Only two drugs, amantadine and pemoline, met the criteria for full systematic review. RESULTS - EFFECTIVENESS OF AMANTADINE: One parallel and three crossover trials were found, involving a total of 236 people with MS. All studies were open to bias. All studies showed a pattern in favour of amantadine compared with placebo, but there is considerable uncertainty about the validity and clinical significance of this finding. This pattern of benefit was considerably undermined when different assumptions were used in the sensitivity analysis. RESULTS - EFFECTIVENESS OF PEMOLINE: One parallel and one crossover trial were found involving a total of 126 people with MS. Both studies were open to bias. There was no overall tendency in favour of pemoline over placebo and an excess of reports of adverse effects with pemoline. RESULTS - HEALTH ECONOMIC ANALYSIS: The drug costs of amantadine and pemoline are modest (pound 200 and pound 80 per annum, respectively). No economic evaluations were identified in the systematic review, and available data were insufficient to allow modelling of cost-effectiveness in this rapid review. CONCLUSIONS: There is insufficient evidence to allow people with MS, clinicians or policy makers to make informed decisions on the appropriate use of the many treatments on offer. Only amantadine appears to have some proven ability to alleviate the fatigue in MS, though only a proportion of users will obtain benefit and then only some of these patients will benefit sufficiently to take the drug in the long term. CONCLUSIONS - RECOMMENDATIONS FOR RESEARCH: The frequency, severity and impact of fatigue, the poverty of available research, and the absence of any ongoing research, suggest that new research is an urgent priority. People with MS, clinicians and policy makers should work together to ensure that the evidence required is collected as quickly as possible by encouraging involvement in rigorous research. Research should not be restricted to the two drugs reviewed in depth in this report. All interventions identified in the scoping review (see above) should be considered, as should basic scientific research into the underlying mechanism of fatigue in MS.

Amantadine↗
PubMed1999

The significance of early postoperative duplex studies following carotid endarterectomy.

This study was conducted to evaluate the significance of duplex ultrasound performed soon after carotid endarterectomy. The records of patients with 150 carotid endarterectomies and postoperative duplex ultrasound within 24 h were reviewed. Eleven (7.3%) had abnormal studies with > or =50% stenosis. Two patients with abnormal studies sustained a perioperative stroke and three patients underwent reoperation for persistent lesions (P<0.0001). Preoperative and postoperative cerebral imaging studies (computed tomography (CT) or magnetic resonance imaging (MRI)) were performed on 114 patients. Seven of these demonstrated areas of infarction and all seven had abnormal duplex ultrasound studies. Twenty-six CT scans were performed with two positive for cerebral infarction in the two patients with clinical stroke. In the 88 MRI studies, five demonstrated small, subcortical focal areas of ischemia, which were clinically silent. The relationship of infarction on postoperative cerebral studies and abnormal postoperative duplex ultrasound was significant (P<0.0001). It was concluded that early postoperative duplex ultrasound studies of > or =50% stenosis demonstrate significant association with postoperative stroke or reoperation, as well as with ischemic changes on brain imaging studies. Earlier detection with intraoperative duplex would probably be more advantageous than postoperative duplex ultrasound.

Aged↗
PubMed1999

Older women's experience of living with chronic leg ulceration.

In this study the authors sought to gain insight into the lives of older women, to focus on the experience of living with leg ulcers and to explore women's views by talking to them about their experiences. Twelve English-speaking women aged over 70 years who had experienced leg ulceration for 3 years or more were interviewed. Analysis of the interview text revealed two overarching themes: (i) gaining and maintaining control over vulnerable limb(s); and (ii) lifestyle consequences of chronic leg ulceration and impaired mobility. These themes contained several subthemes including: (i) nagging pain; (ii) self-expertise and infection; (iii) leakage, smell and embarrassment; (iv) fighting for skin and limb integrity; (v) wearing non-preferred apparel; (vi) loneliness; and (vii) coping, determination and hope. The findings of this research show that elderly women who live with leg ulcers experience multiple consequences. While the everyday problems of living with an unhealed would are addressed by the community nurse, other more subtle consequences may be overlooked. Recognition of the complex and sometimes hidden concerns of these women could help to avert the sense of helplessness which currently exists.

Adaptation, Psychological↗
PubMed1999

Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) with underlying severe emphysema.

BACKGROUND: Lung volume reduction surgery (LVRS) has recently re-emerged as a surgical option for the treatment of end stage chronic obstructive pulmonary disease (COPD) due to underlying severe emphysema. Advocates of LVRS claim that it represents a significant breakthrough in the management of this challenging group of patients while sceptics point to uncertainty about the effectiveness of the operation. METHODS: A systematic review was conducted of the evidence on the effects of LVRS in patients with end stage COPD secondary to severe emphysema. RESULTS: The most rigorous evidence on the effectiveness of LVRS came from case series. Seventy five potentially relevant studies were identified and 19 individual series met the methodological criteria for inclusion. The pattern of results was consistent across individual studies despite a significant degree of clinical heterogeneity. Significant short term benefits occurred across a range of outcomes which appeared to continue into the longer term. Physiological improvements were matched by functional and subjective improvements. Early mortality rates were low and late mortality rates compared favourably with those of the general COPD population. However, the entire research base for the intervention is subject to the limitations of study designs without parallel control groups. CONCLUSIONS: LVRS appears to represent a promising option in the management of patients with severe end stage emphysema. However, until the results of ongoing clinical trials are available, the considerable uncertainty that exists around the effectiveness and cost effectiveness of the procedure will remain.

Dyspnea↗
PubMed1998

Cerebral microembolism in patients with retinal ischemia.

BACKGROUND AND PURPOSE: We investigated the frequency of cerebral microembolism detected by transcranial Doppler ultrasonography in patients with clinical evidence of retinal ischemia, including transient monocular blindness, central and branch retinal artery infarction, and ischemic oculopathy, and assessed its correlation with carotid artery stenosis. METHODS: Records of 331 consecutive patients examined during a 47-month period at the Neurovascular Laboratory were reviewed. Of the original 453 intracranial arteries, 186 middle cerebral arteries (MCAs) satisfied qualifying criteria that excluded patients with cardiac embolic sources. Forty-five MCAs ipsilateral to the symptomatic eye constituted the study group. The control group consisted of 141 asymptomatic MCAs. Microembolus detection studies were performed on transcranial Doppler instruments equipped with special software, and the degree of carotid artery stenosis was measured by cerebral or MR angiography or by color duplex studies. RESULTS: Microembolism was detected in 40.0% of study MCAs and 9.2% of controls (P < 0.001). In the study group, microembolic signals were detected in 61.9% of MCAs tested within a week of symptom onset and 20.8% of those tested afterward (P < 0.001). Severe (> or = 70%) carotid stenosis or occlusion was more frequent in the study group (P < 0.001). Microembolic signals were detected in 25.3% and 11.2%, respectively, of MCAs distal to carotid arteries with 70% to 100% and 0% to 69% stenosis (P = 0.013). CONCLUSIONS: In patients without cardiac embolic sources, cerebral microembolism is frequently present on the side of retinal ischemia, particularly during the week after onset of symptoms. It is often associated with severe stenosis or occlusion of the ipsilateral carotid artery.

Adult↗
PubMed1997

Cardiac rhythmicities and attention in young children.

This study examined the changes in three cardiac rhythmicities (angiotensin-renin vasomotor [ARV], Traube-Hering-Meyer [THM], and respiratory sinus arrhythmia [RSA]) during prolonged attention in preschool children. Electrocardiogram data were collected from children during resting baseline and a 5-min attention condition at ages 3, 4, and 5 years in a longitudinal study. The ARV and THM rhythmicities decreased during prolonged attention for most participants. The RSA rhythmicity did not change consistently. The results were replicated at all three ages. The ARV and THM effect sizes were large and moderate, respectively. Only the ARV decrease correlated with duration of attention.

Arrhythmia, Sinus↗
PubMed1997

Cerebral microembolism and early recurrent cerebral or retinal ischemic events.

BACKGROUND AND PURPOSE: We investigated whether cerebral microembolism as detected by transcranial Doppler ultrasonography (TCD) identifies patients at an increased risk for early, recurrent cerebral or retinal ischemic events. METHODS: Records of consecutive patients examined during a 40-month period in the Neurovascular Laboratory were reviewed for the presence of cerebral microembolism. Of the original 302 patients, 229 with 310 arteries met inclusionary criteria. Follow-up information was obtained from the laboratory's database as well as the hospital records. Microembolus detection studies were performed on TC-2000 or TC-2020 instruments equipped with special software, and criteria established a priori were used for microembolus selection. TCD testing was performed a median interval of 9 days after the initial symptoms of cerebral ischemia. Severity of arterial stenosis was determined by cerebral angiography or noninvasive methods. RESULTS: Microembolic signals were detected more frequently in symptomatic (40/140; 28.6%) than asymptomatic (21/170; 12.4%) arteries (P < .001). Ten recurrent ischemic events occurred during a median follow-up of 8 days after TCD examination, all in the territories of symptomatic arteries. Nine events occurred in the territories of microembolic signal positive arteries (9/61; 14.8%) and one in the territory of a microembolic signal-negative artery (1/249; 0.4%) (P < .00). No association was detected in the subgroup with known cardiac lesions. Microembolic signals were more frequent in arteries with lesions causing 70% or more stenosis or occlusion (26/99; 26.3%) than in those with a degree of stenosis less than 70% (17/126; 13.5%) (P = .016). CONCLUSIONS: In this retrospective study, microembolic signals were more common in the territories of symptomatic arteries and particularly those with severely stenotic lesions. During a short follow-up, recurrent ischemic events were more common along the territories of arteries with TCD-detected microembolism and previous symptoms of cerebral or retinal ischemia.

Brain↗
PubMed1996

Emphysematous cystitis and pyelitis in a diabetic renal transplant recipient.

Emphysematous cystitis is a rare complication of urinary tract infection. Patients with diabetes mellitus, neurogenic bladder, bladder outlet obstruction, and recurrent urinary tract infection are at increased risk for the disease. We present a case of emphysematous cystitis and pyelitis in a diabetic renal transplant recipient. He was treated with antibiotics alone with complete clinical and radiologic resolution. The clinical course was benign, as described in most patients. The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage.

Cystitis↗
PubMed1996

Effect of time and cerebrovascular symptoms of the prevalence of microembolic signals in patients with cervical carotid stenosis.

BACKGROUND AND PURPOSE: High-intensity transient signals (HITS) detect ed by transcranial Doppler ultrasonography correspond to microemboli in intracranial arteries. The aim of this study was to determine the time course of cerebral microembolism in patients with symptomatic internal carotid artery stenosis and to assess its relation to specific symptoms of cerebral ischemia. METHODS: On the basis of criteria established a priori, 69 middle cerebral arteries were selected from a series of consecutive studies obtained at our neurovascular laboratory. All patients had radiological evidence of cervical internal carotid artery disease and had corresponding symptoms. A TC-2000 instrument equipped with special software for microembolus detection was used. Accepted signals were unidirectional from baseline, had a chirping sound, were 9 dB higher than the surrounding blood, and lasted 25 milliseconds or more. RESULTS: HITS were identified in 20 of 69 (29%) arteries. The median interval between onset of symptoms and time of testing was 4 days for HITS-positive arteries and 12 days for those that were HITS negative (P=.0046). Fourteen of 32 (44%) arteries with transient ischemic attacks and 6 of 37 (16%) arteries with cerebral infarction were HITS positive (P=.012). CONCLUSIONS: In patients with symptomatic carotid stenosis, HITS are detected more frequently when patients are tested soon after symptoms of cerebral ischemia. HITS are also more prevalent in the territories of arteries with transient ischemic attacks rather than cerebral infarction. These findings may have diagnostic and therapeutic implications.

Adult↗