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Biomedical subjects

D Baines

Publications and source records attributed to D Baines.

At least 19 recordsLinked to original sources
PubMed2000

A prescription for improvement? An observational study to identify how general practices vary in their growth in prescribing costs.

OBJECTIVE: To identify how some general practices have low growth in prescribing costs relative to other practices. DESIGN: Observational study. SETTING: Trent region of England. PARTICIPANTS: 162 general practices: 54 with low growth in prescribing costs, 54 with average increases in costs, and 54 with large increases in costs. MAIN OUTCOME MEASURES: Changes in prescribing costs in therapeutic categories in which it has been suggested that savings can be made. RESULTS: There were significant differences between the three groups of practices in terms of their changes in prescribing costs for almost all the variables studied. For the group of practices with lowest growth in costs the most important factors were reducing numbers of prescription items and costs per item; relatively low growth in the costs of "new and expensive" drugs; increasing generic prescribing; and reducing costs for modified release products. This group of practices did not increase costs as much as the others for lipid lowering drugs (P=0.012) and hormone replacement therapy (P=0. 007). The practices with the greatest increases in costs had particularly large increases for proton pump inhibitors, selective serotonin reuptake inhibitors, and modified release products. Compared with the other groups these practices had larger increases in costs for "expensive hospital initiated drugs" (P=0.009). CONCLUSION: General practices vary in their growth in prescribing costs in many ways, with growth in costs for "new and expensive" drugs being particularly important.

Drug Costs↗
PubMed2000

National evaluation of general practitioner commissioning pilots: lessons for primary care groups.

BACKGROUND: The national evaluation of general practitioner (GP) commissioning pilots was commissioned by the Department of Health in 1997 as part of its Policy Research Programme. It was conducted by the Health Services Management Centre at the University of Birmingham. AIM: To monitor the development of the 40 national pilot sites, identify the factors that inhibited or facilitated progress, and consider the implications for the implementation and development of primary care groups (PCGs). METHOD: Semi-structured face-to-face interviews with GPs, health authority (HA) managers, and pilot managers from each of the 40 pilot sites (141 interviews in total) and focus group discussions with nurses, social services officers, and community health council officers in the 40 sites. RESULTS: Stakeholders reported the key achievements of the pilots during their first six months as being improved collaboration between GPs, the establishment of organisational arrangements, and work towards managing the group prescribing budget. Obstacles for the groups included changes to government policy regarding primary care, the workload involved for clinical staff, the pilots' relationship with the local HA, and problems with information management and technology (IM&T). A more detailed analysis of the pilots' management arrangements, prescribing work, IM&T support, and stakeholder involvement points to a set of lessons for emerging PCGs. CONCLUSIONS: In their early stages of development, PCGs are likely to focus on issues of structure and process. Prescribing will be an area receiving particular attention, prefiguring some of the challenges of clinical governance in primary care. IM&T will prove to be more problematic than first assumed. The involvement of a wider range of stakeholders will be addressed by primary care groups, particularly in relation to GPs and nurses.

England↗
PubMed1998

Primary care groups. The cultivated commissioner.

The government's proposals for primary care groups assume GPs will be able to direct commissioning organisations more successfully than their fundholder predecessors. Under the previous system, practices incapable of managing a budget and purchasing health services were, in effect, ruled out of fundholding. Guidelines are needed specifying the skills and expertise required for membership of PCGs.

Budgets↗
PubMed1998

The use of the ASTRO-PU and the ASTRO(97)-PU in the setting of prescribing budgets in English general practice.

OBJECTIVES: To examine the variation in prescribing costs explained by the Age, Sex and Temporary Resident Originated Prescribing Unit (ASTRO-PU) and its replacement, the ASTRO (97)-PU, in order to determine the appropriateness of their use in the setting of prescribing budgets in English general practice. METHODS: Linear regression analysis was used to analyse routinely collected patient and prescribing data from one English health authority (Lincolnshire Health) for the fiscal year 1995. RESULTS: The goodness-of-fit of the regression models constructed varied according to whether practices had dispensing status (i.e. rural practices that have permission to dispense drugs to their own patients as a means of compensating for the lack of pharmacies in such areas), with the ASTRO-PU and ASTROP(97)-PU explaining a higher proportion of the variation in prescribing costs amongst practices with such status. CONCLUSIONS: This paper draws two main conclusions. First, the weights embodied in the ASTRO-PU and the ASTRO(97)-PU may have been biased by the number of dispensing practices sampled during their construction. Second, the denominators may be more applicable to dispensing practices, implying that primary care groups may need to follow the principle of 'local flexibility' during the budget-setting process.

Age Factors↗
PubMed1997

Prescribing. Saving graces.

If fundholding is to be dismantled, consideration must be given to fundholders' prescribing budgets. One possibility would be budgeting by consent--involving GPs in setting budgets. More research is needed on prescribing budgets before they are abandoned.

Budgets↗
PubMed1997

Repeated administration of alpha-hederin results in alterations in maternal zinc status and adverse developmental outcome in the rat.

The administration of alpha-hederin, an inducer of metallothionein, results in a secondary zinc deficiency that may be an important maternally mediated mechanism of developmental toxicity. Previous studies have shown adverse developmental outcome with a single administration of alpha-hederin to rats on gestation day (GD) 8 or 11. The objective of this study was to determine whether dosing of alpha-hederin throughout organogenesis would result in a sustained elevation of maternal hepatic metallothionein and subsequent developmental abnormalities. Rats were administered dosage levels of 0 (vehicle only), 20, or 30 mumol/kg from GD 6-15. Maternal hepatic metallothionein levels were 10-fold higher on GD 16 in the treatment groups than the controls. Consequently, liver zinc concentrations increased 60% and 54%, whereas plasma levels decreased 23% and 33% in the 20 and 30 mumol/kg treatment groups, respectively. At GD 20, mean fetal weights of the treatment litters were 11% less than control litters. The administration of alpha-hederin resulted in a threefold increase in the number of offspring that exhibited developmental abnormalities, including visceral and skeletal malformations. Following an oral pulse of 65Zn subsequent to treatment with 0 or 20 mumol/kg of alpha-hederin, the distribution of 65Zn to the liver of treated dams was twice that of controls, whereas the radiolabeled zinc apportioned to the decidua and uterus decreased by 44%. Furthermore, the 65Zn detected in the embryos from treated dams was 70% lower than in embryos from control dams. In conclusion, low doses of a metallothionein inducer administered to the dam from GD 6-15 resulted in a sustained elevation of hepatic metallothionein and a subsequent redistribution of zinc leading to a decrease in the zinc available to the embryo and ultimately to adverse development of the offspring. Repeated dosing throughout organogenesis, as required in regulated safety assessment testing, increased the severity of the effects previously observed with single large dosages of the toxicant administered during midgestation.

Animals↗
PubMed1997

Effect of Bacillus thuringiensis toxins on the membrane potential of lepidopteran insect midgut cells.

To test whether the ability of Bacillus thuringiensis toxins to form pores in the midgut epithelial cell membrane of susceptible insects correlates with their in vivo toxicity, we measured the effects of different toxins on the electrical potential of the apical membrane of freshly isolated midguts from gypsy moth (Lymantria dispar) and silkworm (Bombyx mori) larvae. In the absence of toxin, the membrane potential, measured with a conventional glass microelectrode, was stable for up to 30 min. It was sensitive to the K+ concentration and the oxygenation of the external medium. Addition of toxins to which L. dispar is highly [CryIA(a) and CryIA(b)] or only slightly [CryIA(c) and CryIC] sensitive caused a rapid, irreversible, and dose-dependent depolarization of the membrane. CryIF, whose toxicity towards L. dispar is unknown, and CryIE, which is at best poorly active in vivo, were also active in vitro. In contrast, CryIB and CryIIIA, a coleopteran-specific toxin, had no significant effect. The basolateral-membrane potential was unaffected by CryIA(a) or CryIC when the toxin was applied to the basal side of the epithelium. In B. mori midguts, the apical-membrane potential was abolished by CryIA(a), to which silkworm larvae are susceptible, but CryIA(b) and CryIA(c); to which they are resistant, had no detectable effect. Although the technique discriminated between active and inactive toxins, the concentration required to produce a given effect varied much less extensively than the sensitivity of gypsy moth larvae, suggesting that additional factors influence the toxins' level of toxicity in vivo.

Animals↗
PubMed1996

Predicting activity and workload in general practice from the demographic structure of the practice population.

OBJECTIVES: The managerial requirements of budget-setting and performance monitoring in general practice (primary care) in the UK require an understanding of the causal relationship between practice activities and the characteristics of both the practice and its patients. This study sought to model the determinants of three major components of general practice activities (consultations, prescribing costs and referrals to secondary care), paying particular attention to the influence of the demographic structure of the patient list. METHODS: Stepwise regression analysis was carried out on data for 98 practices in the county of Lincolnshire using 12 independent variables pertaining to patient and practice characteristics plus 14 statistical measures derived from the demographic structure of the patients registered with the practice. RESULTS: Robust statistical models were estimated for the three dependent variables, of which list size emerged as the most significant independent variable. In addition, six other independent variables, including the patients' unemployment rate, fundholding status and single-handed status, were statistically significant in one or more of the equations. Variables based on the demographic structure of the practice population also appeared in each model. The Jarman score and degree of urbanization did not achieve statistical significance. CONCLUSIONS: Activity and workload in general practice can be predicted from routine data. Such models are of particular value for planning and financial management when demographic change in practice populations is anticipated.

Budgets↗
PubMed1995

Evaluation of chick embryo neural retinal cell culture as a screen for developmental toxicants.

This paper describes a study to evaluate the concordance with in vivo results of an in vitro screen for developmental toxicants. The screen is a primary culture of chick embryo neural retina cells (CERC) which undergo processes of cell-cell recognition and interaction, growth, and differentiation over a 7-day culture period. Each of these developmentally significant events is measured separately as formation of multicellular aggregates, protein content, and glutamine synthetase activity, respectively. A total of 45 chemicals, 24 of which have been shown to be teratogenic at some dosage to mammalian embryos in utero, 7 of which are embryotoxic (but not teratogenic) in utero at high dosage, and 14 of which have not produced developmental toxicity in vivo, were evaluated in this assay by investigators who were blinded to the identity of the chemicals. Chemicals were tested up to concentrations that were frankly cytolethal, or up to a maximum of 5 mg/ml. Chemicals were present only during the first 24 hr of culture. The chemicals were selected to be representative of a variety of chemical classes (e.g., solvents, metals, food additives, anticonvulsants, antineoplastics). In several cases, pairs of structurally similar compounds with different developmental toxic potencies (e.g., valproate and 2-en-valproate, formamide, and N,N-dimethylformamide) were tested. Of the 31 developmental toxicants, 25 affected at least one endpoint in the assay at concentrations which are achievable in vivo (i.e., below the systemic concentration at a lethal dose), yielding a false-negative rate of 19%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Parental presence at induction of anaesthesia: a survey of N.S.W. hospitals and tertiary paediatric hospitals in Australia.

We undertook a survey of N.S.W. hospitals and tertiary paediatric hospitals in other States to determine their practice in relation to parental presence at induction of anaesthesia of children. There were 135 responses to 174 questionnaires. Twenty-one indicated that no children were anaesthetized at their institution and one was inadequately filled out. One hundred and thirteen questionnaires were assessed. Only 44% of departments had an official policy on parental attendance. A quarter of all hospitals described their facilities as entirely suitable, and a half compromised to allow parents to be present. The remaining quarter described their facilities as unsuitable. Overall, two-thirds of hospitals never or only sometimes had parents present at induction, and this applied equally to day stay patients and inpatients. Tertiary hospitals were more likely to have parents present, however they were more likely to have suitable facilities. The most common reason cited for parental attendance was parental expectation of being present, closely followed by the individual anaesthetist's philosophy. The most common reason for parents not attending was the individual anaesthetist's philosophy, followed by inadequate staffing.

Adult↗
PubMed1994

A polymerase chain reaction study of the stability of Ig heavy-chain and T-cell receptor delta gene rearrangements between presentation and relapse of childhood B-lineage acute lymphoblastic leukemia.

Ig heavy-chain (IgH) and partial V delta 2-D delta 3 T-cell receptor (TCR) gene rearrangements were investigated, by polymerase chain reaction (PCR) amplification and sequence analysis, in 52 patients at presentation and first relapse and in 14 at both first and second relapse of B-lineage acute lymphoblastic leukemia. In combination, these techniques amplified one or more clonal markers at presentation in 90% of patients (IgH-PCR, 75%; V delta 2-D delta 3-PCR, 46%; both, 33%). Changes in the pattern of amplification between presentation and first relapse were seen in 31% of patients positive by IgH-PCR at presentation and in 25% of those positive by TCR delta-PCR. Only 3 patients showed complete change in their rearrangements, which is suggestive of relapse with a new clone. Furthermore, despite the high reported rates of oligoclonality and clonal evolution at the IgH locus, the results presented show that false-negative minimal residual disease (MRD) detection can be avoided by designing D-N-J probes to all presentation rearrangements. Using a PCR approach for both gene markers, false-negative testing because of clonal evolution would have only occurred in 3 (8%) of the IgH-positive patients, in contrast to 5 (21%) of V delta 2-D delta 3-positive patients. Combining these two systems increases the proportion of patients open to study to 90%, allows comparative studies of the sensitive of the two methods, and reduces the rate of false-negative assessment of MRD caused by clonal evolution to less than 10%. We conclude that large prospective PCR studies of MRD detection should examine gene rearrangements at multiple loci to maximize their applicability and to minimize false-negative relapse prediction.

Adolescent↗
PubMed1994

Octopamine enhances phagocytosis in cockroach hemocytes: involvement of inositol trisphosphate.

Octopamine and 5-hydroxytryptamine (5-HT) were previously shown to affect phagocytosis in cockroach hemocytes through unidentified receptor-mediated events. In the present study, we examined the ability of 5-HT and octopamine to enhance inositol trisphosphate (IP3) production using hemocyte membranes of the American cockroach, Periplaneta americana. Octopamine enhanced IP3 production with a maximal peak at 100 nM. Similarly, 5-HT enhanced IP3 production with a maximal effect at 10 nM. The effects of 5-HT and octopamine are not additive, suggesting that both are working through the same receptor. Phentolamine, a general octopamine antagonist, blocked the effects of octopamine and 5-HT, while a mammalian 5-HT2 antagonist that blocks 5-HT-sensitive receptors in insect peripheral tissue, ketanserin, did not. A pharmacological profile indicates that the receptor is similar to an octopamine1-type. Octopamine at 1 microM increased phagocytosis in cockroach hemocytes exposed to Staphylococcus aureus in vitro, and this effect was mimicked by IP3 (10 microM). The octopamine-treated hemocytes were shown to increase IP3 production in the latter stage of phagocytosis. Adult cockroaches exposed to an LD50 dose of S. aureus in conjunction with either 0.1 mM octopamine or the octopamine1 agonist, clonidine, had higher survival rates compared to saline-treated cockroaches. Correspondingly, the octopamine1 antagonist, chlorpromazine, partially blocked the octopamine-mediated increase in cockroach survival.

Analysis of Variance↗