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Biomedical subjects

F M Sullivan

Publications and source records attributed to F M Sullivan.

At least 19 recordsLinked to original sources
PubMed2005

The Tayside children's sleep questionnaire: a simple tool to evaluate sleep problems in young children.

BACKGROUND: Behavioural sleep problems in young children are relatively common with between 20% and 40% of those aged 1 to 5 years being affected. This paper describes the development of a simple questionnaire to assess disorders of initiating and maintaining sleep (DIMS) in children aged between 1 and 5 years for use as a selection tool for research purposes or as a screening instrument in primary care. METHODS: A subsection of the Sleep Disturbance Scale for Children was adapted and piloted with a small sample of children in two inner city GP practices (n = 81). Face and content validity were initially established by expert review. Discriminant validity was assessed qualitatively using interviews with mothers of identified cases and non-cases. The validity of the cut-off score was assessed by blinded case note reviews off known cases; inter-rater reliability was also calculated. Following modifications, the final questionnaire was posted to a representative sample of parents across the region with children in the appropriate age band (n = 1023). Internal reliability was assessed using Cronbach's alpha and factor analysis was undertaken to identify significant factors within the questionnaire. RESULTS: The response rate to the population questionnaire was 61.5% (n = 628) with 218 of the children having sleep scores that were indicative of DIMS (35%), echoing other figures reported in the literature. There was good internal consistency for the items (Cronbach's alpha = 0.85) with two main factors accounting for 58% of the variance. CONCLUSION: The Tayside Children's Sleep Questionnaire (TCSQ) is an easy-to-read and reliable tool that could be used both as a clinical and research instrument to assess the severity and prevalence of DIMS in young children.

Child, Preschool↗
PubMed2005

Agreement between community echocardiography and hospital echocardiography in patients suspected of having left ventricular systolic dysfunction.

BACKGROUND: Smaller echocardiography machines, when used in hospitals, are accurate for detecting left ventricular dysfunction and valvular disease. This paper assessed the detection of left ventricular dysfunction and of valvular disease in the community setting by a smaller machine. AIMS: To measure the agreement in patients with suspected heart failure between community echocardiography and traditional echocardiography in the hospital in detecting left ventricular dysfunction and significant valve disease. METHODS: Suspected heart failure patients were referred to one of the authors (SJ) for community echocardiography using a Siemens Cypress machine. The patients had a second echocardiogram in the hospital by another sonographer who was blinded to the results of the first echocardiogram. The reports of the two sonographers were assessed for agreement using kappa statistics. RESULTS: 458 patients had a community echocardiogram and 136 agreed to a second echocardiogram in the hospital. There was excellent agreement, kappa = 0.87 (0.06 SE), for the detection of left ventricular dysfunction between community echocardiography and the hospital machine. The detection of significant valvular disease was good, kappa = 0.75 (0.06) between the community echocardiogram and hospital machines. CONCLUSIONS: In suspected heart failure patients, community echocardiography gives comparable results to traditional hospital echocardiography for left ventricular dysfunction detection and for significant valvular disease detection.

Aged↗
PubMed2004

Presence of bacteriuria caused by trimethoprim resistant bacteria in patients prescribed antibiotics: multilevel model with practice and individual patient data.

OBJECTIVE: To look for evidence of a relation between antibiotic resistance and prescribing by general practitioners by analysis of prescribing at both practice and individual patient level. DESIGN: Repeated cross-sectional study in 1995 and 1996. SETTING: 28 general practices in the Ninewells Hospital laboratory catchment area, Tayside, Scotland. SUBJECTS REVIEWED: 8833 patients registered with the 28 practices who submitted urine samples for analysis. MAIN OUTCOME MEASURES: Resistance to trimethoprim in bacteria isolated from urine samples at practice and individual level simultaneously in a multilevel model. RESULTS: Practices showed considerable variation in both the prevalence of trimethoprim resistance (26-50% of bacteria isolated) and trimethoprim prescribing (67-357 prescriptions per 100 practice patients). Although variation in prescribing showed no association with resistance at the practice level after adjustment for other factors (P = 0.101), in the multilevel model resistance to trimethoprim was significantly associated with age, sex, and individual-level exposure to trimethoprim (P < 0.001) or to other antibiotics (P = 0.002). The association with trimethoprim resistance was strongest for people recently exposed to trimethoprim, and there was no association for people with trimethoprim exposure more than six months before the date of the urine sample. DISCUSSION: Analysis of practice level data obscured important associations between antibiotic prescribing and resistance. The results support efforts to reduce unnecessary prescribing of antibiotics in the community and show the added value of individual patient data for research on the outcomes of prescribing.

Adolescent↗
PubMed2002

The RCP's 'Three Key Questions' for asthma: review of practical use.

Assessment tools are a vital component of chronic disease management. The Royal College of Physicians has developed a patient-focused outcome measure for the treatment of asthma, the 'Three Key Questions'. However, in a study investigating the goals of people with asthma, several issues related to the tool emerged. Forty-seven adults of a range of ages and asthma severity but with no significant co-morbidity were interviewed. It emerged that the outcome measure may be subject to recall bias. Also, symptom reports may be conflated if daytime symptoms also occur with activity. 'Interference with activity' is a subjective term the interpretation of which varies considerably. Changes in the level of activity undertaken may be reported rather than changes in symptom severity. The 'Three Key Questions' are not fully patient-centred because they assess the presence of symptoms rather than their importance to the individual. The use of the 'Three Key Questions' as an outcome measure may not allow valid comparisons to be made between settings.

Activities of Daily Living↗
PubMed2002

What Scottish primary care researchers are doing to recover their standing in the UK.

OBJECTIVE: To compare the outputs of Scottish PC research with the rest of the UK. DESIGN: Bibliometric analysis of the research level and potential impact of research publications. Papers are categorised by level (RL) from basic research to clinical observation and potential impact category (PIC), a 5 year impact factor on a numerical scale. SETTING: Interrogation of the Wellcome Trust's Research Outputs Database 1988-97. SUBJECTS: 17,303 papers, 2,280 arising from Scottish primary care. RESULTS: Scottish primary care publications totalled 14% of the published research in the UK during 1988, by 1997 it had fallen to 10%. PC researchers in the rest of the UK produced a 60% increase (1169 to 1866 per annum) in publications compared to our 25% increase (201 to 251 per annum) over the same period. Scottish papers were less likely to be presenting basic science. The mean potential impact was slightly lower than the rest of the UK (1.89 compared to 1.94, s.e.m.0.02). CONCLUSION: Scottish PC research outputs grew more slowly than the rest of the UK during 1988-97. The research interests and journals selected by the research community contributed to this pattern. The climate, infrastructure and skills required for more effective PC research during this period were also significant factors. The Scottish School of Primary Care provides a mechanism for everyone in NHSScotland and Higher Education Institutions to address the underlying issues identified in this analysis. As a 'baseline' analysis, this report will allow progress to be monitored as the SSPC becomes increasingly effective.

Bibliometrics↗
PubMed2001

Risk assessment of the use of deltamethrin on bednets for the prevention of malaria.

Risk assessments covering the use of the pyrethroid, deltamethrin, on bednets for the prevention of malaria have been conducted The toxicity of deltamethrin in humans and animals is reviewed following both dermal and oral exposure. The no-adverse-effect level (NOEL) for exposure via the dermal route was 1000 mg/kg body weight/day. From this an acceptable exposure level (AEL) of 10 mg/kg body weight/day has been derived. The NOEL for exposure via the oral route was 1 mg/kg body weight/day, with exposures above this causing neurotoxic effects in animals. This NOEL has been used to derive margins of safety compared with predicted exposures. While direct skin contact does not seem to cause systemic toxicity in humans, it can cause burning, numbness and tingling of the skin, which is a local effect. This too is taken into account in the risk assessments. The risk assessments cover those treating bednets, on an intermittent or regular basis, the washing of treated nets, sleeping under treated nets (infants, children and adults). Worst case scenarios for each of these situations show that dermal exposures are low (one-tenth or less of the AEL) and the margins of safety for systemic exposure derived from oral data are acceptable, ranging from 10 to 3300. The benefits of the use of treated bednets in reducing morbidity and mortality from malaria are considerable and it can be concluded that the risk:benefit ratio is very favourable.

Administration, Oral↗
PubMed2001

Review of risk factors for sudden infant death syndrome.

Sudden infant death syndrome (SIDS) accounts for the largest number of deaths during the first year of life in developed countries. The possible causes of SIDS are numerous and, to date, there is no adequate unifying pathological explanation for SIDS. Epidemiological studies have played a key role in identifying risk factors, knowledge of which has underpinned successful preventive programmes. This review critically assesses information on the main risk factors and causal hypotheses put forward for SIDS, focusing on research published since 1994. The overall picture that emerges from this review is that affected infants are not completely normal in development, but possess some inherent weakness, which may only become obvious when the infant is subjected to stress. Initially there may be some minor impairment or delay in development of respiratory, cardiovascular or neuromuscular function. None of these is likely to be sufficient, in isolation, to cause death and, provided the infant survives the first year of life, may no longer be of any significance. However, when a compromised infant is confronted with one or more stressful situations, several of which are now clearly identified as risk factors, and from which the majority of infants would normally escape, the combination may prove fatal.

Adult↗
PubMed1999

Significance of excursions of intake above the acceptable daily intake: effect of time and dose in developmental toxicology.

Three major factors to be considered in assessing the possible effects on developmental toxicology of excursions above the acceptable daily intake (ADI) are discussed. If maternal toxicity occurs at lower doses than developmental toxicity, then there may be adequate protection for the fetus if the mother is protected. In other cases, the first adverse developmental effects are usually small and reversible changes in fetal weight and it is unlikely that brief excursions, for a few days, above the ADI, would induce changes in final birth weight. The importance of excursions above the ADI on teratogenic responses would likely depend on the mechanism of teratogenesis and whether the agent acted primarily as a result of a high peak plasma level, a Cmax effect, or depended more on the total body exposure, an area under the curve (AUC) effect. This type of information is usually not available from current safety study designs. Finally, the temporal equivalence factors must be taken into account. There are 10- to 100-fold differences in time span for pre- and postnatal development up to sexual maturity, in rodents compared with humans. This can be contrasted with the relatively small pharmacokinetic differences, perhaps of up to 2- or 3-fold in plasma levels of chemicals with the same administered dose in the two species. Thus, single episodes of high chemical exposure have greater opportunity to produce permanent effects on development in rodents compared with humans. The limited evidence from acute poisonings in pregnant women tends to support this hypothesis and it seems unlikely that occasional excursions by women above the ADI would result in developmental toxic effects.

Abnormalities, Drug-Induced↗
PubMed1999

Audit encourages an evidence-based approach to medical practice.

OBJECTIVES: This study was designed in order to identify any changes taking place in students' ability to incorporate research evidence into clinical practice after the introduction of an evidence-based medicine session into their audit teaching. DESIGN: We chose to look at the references cited in students' audit projects as a way of making a retrospective assessment of their ability to use evidence. Each of a sample of 221 projects was analysed for the number and accuracy of references, the phase of the audit cycle in which the references were cited, the topic chosen and the use of computers. A smaller sample were assessed for quality. SETTING: The Department of General Practice at Glasgow University. SUBJECTS: Final-year medical students. RESULTS: We found that there was an increase in quality and quantity of citation of references by the students over a 3-year period which corresponded with changes in teaching methods. CONCLUSIONS: It is possible that this increase in the quantity and quality of reference citation by final-year students was in response to a change in the content of teaching sessions, but there may be other reasons for this. The experience of researching and carrying out the projects has given students first-hand experience of the techniques of evidence-based medicine. Requiring students to state their information sources and include a copy of the abstracts from cited papers would assist further studies of this kind.

Education, Medical, Undergraduate↗
PubMed1998

Computer use by general practitioners in Scotland.

BACKGROUND: Despite the widespread adoption by general practitioners (GPs) of desktop computers, there has been very little evaluation of the way in which the computer is actually used during consultations and the way in which it affects patient satisfaction. AIM: To ascertain the extent to which the computer is used in the consultation and to investigate the possible relationship between computer use and patient satisfaction. METHOD: Six GPs completed a short questionnaire about the extent to which they use the computer during surgeries. Eighty-four consultations from the surgeries of these GPs were video recorded. Patient satisfaction data on these 84 patients were collected at the time of the surgery using the previously validated Consultation Satisfaction Questionnaire. RESULTS: All six GPs stated that they usually used the computer during consultations. However, video observation revealed that the computer was used in just 51% of surgeries. The proportion of time that the computer was used for varied from 0.03 to 0.4, with a mean value of 0.12. The commonest function for which the computer was used was prescribing. The consultations in which the computer was used (CU) were on average 148 seconds longer than the non-computerized consultations (NCU). There was no difference in patient satisfaction between the two groups. CONCLUSION: Despite this group of GPs having a self-declared interest in the use of computers, the extent to which the computer was used was much lower than expected from the GPs' self-reported use. This may be partly explained by the fact that using the computer takes up valuable time within the consultation and does not appear to contribute to patient satisfaction. If desktop computers are to be used to their full potential in general practice, more work is required to evaluate their impact on the consultation process itself.

Adolescent↗
PubMed1998

Good health care: patient and professional perspectives.

Many health needs assessment exercises are professionally led, employing complex epidemiological methods. An alternative method that gives valuable information about patient preferences is a forced-choice questionnaire, which this study used in five practices in the West of Scotland. In each practice, patient-centred care was the most highly valued attribute of service provision.

Attitude of Health Personnel↗
PubMed1997

Audit in general practice: educating medical students.

This paper describes the third stage in the evolution of methods of teaching on audit in general practice at the Department of General Practice, University of Glasgow. The authors asked the final year students to develop, carry out and submit a written report on an audit project devised by themselves, after briefing and with continued support. Every student asked was successful in producing a report and the standard was generally very high, although only two students completed the audit cycle in the 4 week period. More than half the students (51.7%) found the project valuable or very valuable. As many as 90.6% understood audit better or much better after doing the project and 83.4% thought that the project should continue to be part of the GP attachment. Seventy-eight per cent of the GP tutors thought that teaching audit to undergraduates in general practice was valuable or very valuable, 64.4% reported that the audit had been of benefit to their practice, and 89.9% thought that audit should continue to be part of the GP attachment. This method of teaching students about audit was the most successful of three methods tried. It has produced benefits both for students and for the general practices to which they were attached, ultimately producing benefits for patients.

Attitude↗