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Biomedical subjects

F Sullivan

Publications and source records attributed to F Sullivan.

At least 19 recordsLinked to original sources
PubMed2000

NHSnet in Scottish primary care: lessons for the future.

OBJECTIVE: To evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland. DESIGN: Semi-structured telephone interviews, postal questionnaire. SETTING: All 15 Scottish health boards, random sample of 1 in 3 of all Scottish general practices. PARTICIPANTS: Information management and technology managers of health boards, 355 practice managers in the general practices. MAIN OUTCOME MEASURES: Variations between health boards in styles of project management, means of connection to NHSnet, costs to general practices, and training provided. Practices' levels of participation in initiative, initial use of NHSnet, and factors acting as incentives and disincentives to use of NHSnet. RESULTS: 99% of Scottish general practices agreed to participate in initiative. Health boards varied significantly in project management styles (from minimal to total control), the nature of the networks they established (intranets or direct connections), costs to practices (from nothing to pound125 per general practitioner per year), and training provided (from none to an extensive programme). In 56% of practices someone accessed NHSnet at least once a week. Practices varied considerably in amount of internet training received and staff groups targeted and in the intention to provide desktop access to NHSnet through a practice network. CONCLUSION: The initiative has successfully introduced a network that links Scottish general practices, health boards, and hospital trusts. However local variation in this "national" initiative may affect its use in primary care. Health authorities and general practices in England and Wales may wish to note these findings in order to avoid unhelpful variation.

Computer Communication Networks↗
PubMed2000

Not so simple cystitis: how should prescribers be supported to make informed decisions about the increasing prevalence of infections caused by drug-resistant bacteria?

Trimethoprim is a safe, effective, and inexpensive treatment for cystitis. However, at least 25% of bacteria isolated from urine samples in general practice are now resistant to trimethoprim in the laboratory. The relationship between laboratory resistance and clinical outcome is complex. Cephalexin appears to be more active than trimethoprim in the laboratory but has been consistently less effective in clinical trials. There is little point in collecting data about the prevalence of drug resistance in urinary bacteria unless it is linked to evidence about the impact of resistance on clinical outcomes. Pragmatic clinical trials are required to provide practices with clear thresholds for managing their antibiotic policies; for example, 'Change from trimethoprim to drug X when the probability of trimethoprim resistance reaches Y%.' Prescribers should be aware that trimethoprim resistance is most likely to occur in patients who have been exposed to trimethoprim or other antibiotics in the previous six months, and that the risk increases with age. This information could be used to stratify women according to risk of infection by trimethoprim-resistant bacteria. Health education leaflets are an effective method for reducing the frequency of recurrent cystitis. Symptomatic treatment can control symptoms and allow time for microbiological investigation. Both of these strategies may help to reduce unnecessary prescribing of antibiotics in general and quinolones in particular.

Adult↗
PubMed1999

Stereochemical course and steady state mechanism of the reaction catalyzed by the GDP-fucose synthetase from Escherichia coli.

Recently the genes encoding the human and Escherichia coli GDP-mannose dehydratase and GDP-fucose synthetase (GFS) protein have been cloned and it has been shown that these two proteins alone are sufficient to convert GDP mannose to GDP fucose in vitro. GDP-fucose synthetase from E. coli is a novel dual function enzyme in that it catalyzes epimerizations and a reduction reaction at the same active site. This aspect separates fucose biosynthesis from that of other deoxy and dideoxy sugars in which the epimerase and reductase activities are present on separate enzymes encoded by separate genes. By NMR spectroscopy we have shown that GFS catalyzes the stereospecific hydride transfer of the ProS hydrogen from NADPH to carbon 4 of the mannose sugar. This is consistent with the stereospecificity observed for other members of the short chain dehydrogenase reductase family of enzymes of which GFS is a member. Additionally the enzyme is able to catalyze the epimerization reaction in the absence of NADP or NADPH. The kinetic mechanism of GFS as determined by product inhibition and fluorescence binding studies is consistent with a random mechanism. The dissociation constants determined from fluorescence studies indicate that the enzyme displays a 40-fold stronger affinity for the substrate NADPH as compared with the product NADP and utilizes NADPH preferentially as compared with NADH. This study on GFS, a unique member of the short chain dehydrogenase reductase family, coupled with that of its recently published crystal structure should aid in the development of antimicrobial or anti-inflammatory compounds that act by blocking selectin-mediated cell adhesion.

Carbohydrate Epimerases↗
PubMed1999

Evidence-based education: development of an instrument to critically appraise reports of educational interventions.

OBJECTIVES: Educational interventions may ultimately impact on patient care as well as affecting individuals' learning. Critical evaluation of educational literature by those involved in designing and developing educational interventions is therefore important. A checklist instrument for critically appraising reports of educational interventions is described. DESIGN: The instrument was developed by an iterative process and piloted. The instrument consists of nine questions: 1. Is there a clear question which the study seeks to answer? 2. Is there a clear learning need which the intervention seeks to address? 3. Is there a clear description of the educational context for the intervention? 4. Is the precise nature of the intervention clear? 5. Is the study design able to answer the question posed by the study? 6. Are the methods within the design capable of appropriately measuring the phenomena which the intervention ought to produce? 7. Are the outcomes chosen to evaluate the intervention appropriate? 8. Are there any other explanations of the results explored in the study? 9. Are any unanticipated outcomes explained? A worked example is given to illustrate how the instrument can be used in practice. SETTING: The Department of General Practice in Glasgow. SUBJECTS: Young general practitioners and the Educational Journal Club. RESULTS: The instrument was feasible. CONCLUSIONS: The use of the checklist allows the reader to critically appraise reports of educational interventions and helps in the practice of evidence-based education.

Educational Measurement↗
PubMed1999

An information retrieval service to support clinical decision-making at the point of care.

The information retrieval systems currently available in general practice, such as Medline, and web search engines are passive and relatively difficult to access during consultations. Emergent technologies, including the National Electronic Library for Health, offer opportunities for more active decision support. We examine the extent to which information retrieval could support primary care consultations by examining the impact of the new technology at different stages of the consultation. We advocate a system whereby professional organisations concerned with quality of care, such as the Royal College of General Practitioners, might contribute the the process.

Decision Support Systems, Clinical↗
PubMed1998

Area-wide diabetes care: the Lanarkshire experience with primary health care teams 1994-1997.

In Lanarkshire (population 560,000) an area-wide diabetes database was introduced and process of care was measured. The number of patients with diabetes identified was 11,621 (prevalence = 2.08). In 1997 50% of the diabetic population were reviewed at least once during the year. Compared to those attending hospital clinics, GP patients were significantly older, female and less likely to be on insulin. During 1994-1997 hospital clinics improved the process of care in nearly all areas, but GP patients were much less likely to have any of the process measures carried out. Initiatives are underway to support general practices, and to improve co-ordination between GP and hospital services.

Aging↗
PubMed1997

The completeness and accuracy of patient record transfer between practices.

OBJECTIVES: In addition to the paper record, most general practitioners now use a parallel electronic record system on their practice computer. When a patient changes practice at present, the written records are transferred from the patient's previous practice to the next. An up to date computer generated summary or print out should also be sent. Our aim was determine the completeness and accuracy of this process of patient record transfer. DESIGN: A survey of an opportunistic sample of one hundred patient records in transit between general practices during a single week. Accuracy of information transferred was assessed by examining the records. Further analysis of discrepancies was conducted by one of the authors (FS) to assess their clinical significance. SETTING: September 1995, primary care department of Lanarkshire Health Board. RESULTS: Only 46% of practices transfer the complete record compared to the 85% of practices with computers which would have been expected to do so. Even in those which transferred a paper copy of the electronic record, a total of 51% showed discrepancies between the computer and manual format in recording of some or all of the following: diagnoses, prescribing data and the results of investigations. CONCLUSION: Practices should ensure all relevant data is transferred when a patient moves from one practice to another. The current arrangements do not ensure that this occurs.

Continuity of Patient Care↗
PubMed1997

Attitudes of general practitioners who practice in remote island communities.

OBJECTIVE: To describe the personal, social and medical attitudes of doctors who practice on the islands off the West coast of Scotland. DESIGN: Questionnaire survey with a single follow-up. SUBJECTS: All 65 general practitioners (GPs) who practice on the 17 islands located off the West coast of Scotland. RESULTS: Fifty-two (80%) responded after a single reminder. The main advantages identified were continuity of care, personal relationships with patients and involvement with the local community. Other important reasons were the opportunity to exercise clinical skills and appreciation of their local environment such as the beauty of the scenery. Disadvantages were associated with isolation, difficulty in obtaining cover, in attending refresher courses and the burden of sole responsibility. CONCLUSION: The GPs who practice in remote island practices believe that the advantages outweigh the disadvantages. They value continuity of care and their relationships with patients and communities. This survey suggests that the difficulties of staffing remote island communities may partly be addressed by allowing undergraduate students and postgraduate colleagues access to these general practitioners.

Adult↗
PubMed1996

Confidence in performance of pediatric emergency medicine procedures by community emergency practitioners.

OBJECTIVE: To survey a cohort of physicians who work in general community emergency departments (ED) in order to assess their comfort levels in performing urgent and emergent medical procedures on children. METHODS: One hundred seventeen emergency physicians were surveyed at 23 institutions within the referral base of Hasbro Children's Hospital, a tertiary care pediatric ED. Physicians rated their comfort levels (4-point scale: 1 = comfortable, 2 = moderately comfortable, 3 = uncomfortable but would perform in an emergency, 4 = uncomfortable and would never perform) for all procedures in which the American Academy of Pediatrics recommends competence for pediatric emergency physicians. RESULTS: Sixty (51%) physicians completed the survey. Residency training included internal medicine, family practice, surgery, general practice, pediatrics, and emergency medicine, while only 32 (53%) were Board certified in emergency medicine. All respondents treated pediatric patients. Over 25% were uncomfortable (level 3 or 4) with performing certain potentially life-saving pediatric procedures. These included cardioversion, defibrillation, external pacing, nasal intubation, needle cricothyrotomy, rapid sequence intubation, laryngoscopy, tracheostomy replacement, chest tube placement, vascular cutdowns, emergency childbirth, pericardiocentesis, intraosseous line placement, infant subdural and ventriculoperitoneal (V-P) shunt taps, and upper airway foreign body removal. Over 25% of respondents were also uncomfortable with non-life-saving procedures such as temperomandibular joint (TMJ) reductions, tooth reinsertions, rape evaluations, suprapubic taps, tympanocentesis, retrograde urethrograms, thoracentesis, paraphimosis reduction, ear foreign body removal, and pain management. CONCLUSION: While emergency physicians within the catchment area of a tertiary care children's hospital feel comfortable with most pediatric procedures, they express a significant degree of discomfort with many potentially life-saving skills. Because of the infrequent need for many of these interventions in children, the high levels of discomfort are not surprising. These procedures may most comfortably be performed at pediatric centers but can be accomplished well at all EDs if personnel are adequately trained. A strong working relationship with pediatric emergency centers and an enhanced teaching of these procedures may increase comfort levels with these potentially life-saving measures.

Attitude of Health Personnel↗
PubMed1995

Has general practitioner computing made a difference to patient care? A systematic review of published reports.

OBJECTIVE: To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN: Systematic review of world reports from 1984 to 1994. SETTING: The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. SUBJECTS: 30 papers met the inclusion criteria and were included for detailed review. INTERVENTIONS: A validated scheme for assessing methodological adequacy was used to score each paper. MAIN OUTCOME MEASURES: Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. RESULTS: Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and "medical" content of consultations increased at the expense of a reduction in patient initiated and "social" content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). CONCLUSIONS: Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations.

Ambulatory Care Information Systems↗
PubMed1995

Intruders in the consultation.

A confidential consultation is the essence of family practice. That confidentiality is currently under attack from a number of disruptive influences. Several of these are physical intruders: telephone calls, undergraduate and postgraduate students, video recorders, computers, guidelines, protocols and health promotion activities. The potential benefits of each of these is analysed to elucidate why they have been allowed into consultations. Their drawbacks in the light of current published evidence is presented. Conditions which make intrusions permissible are proposed and practical suggestions are made about how to minimise their impact.

Computers↗
PubMed1995

Assessment and management of manual traumatic enucleation.

BACKGROUND: Gouging injuries represent a rare, severe form of orbital trauma. We report a case of manual traumatic enucleation. METHOD: Records of the patient were reviewed. RESULTS: The outcome of this case was loss of the globe with an uncomplicated recovery. CONCLUSIONS: Without attention to the particular principles of assessment and management outlined in this report, a satisfactory outcome is not assured.

Adult↗
PubMed1995

Examination of the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation.

BACKGROUND: A patient's satisfaction with a consultation may be influenced by many factors relating to both patient and doctor. AIM: This study set out to examine the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation. METHOD: A prospective study involving 893 adult patients attending 12 general practitioners in Glasgow was carried out. Questionnaires were completed by general practitioners after consecutive surgery consultations. Patients completed forms assessing mental state and satisfaction with inter-personal aspects of the consultation. RESULTS: Patients reporting frank psychological disturbance tended to express more dissatisfaction with the inter-personal aspects of the consultation. This effect was alleviated in the majority by recognition of the disturbance by the general practitioner. General practitioners differed markedly in their assessment of the psychological component of consultations. Fewer dissatisfied patients were found in the surgeries of doctors who tended to rate the psychological component of consultations more highly. In contrast, the general practitioner's overall accuracy of diagnosis of psychological distress was a poor predictor of the proportion of dissatisfied patients. CONCLUSION: This preliminary study suggests that a tendency among doctors to assign importance to the psychological component of consultations may enhance elements of patient satisfaction. It is not clear whether this [psychological-mindedness' is an attribute which can be learnt. To resolve this uncertainty, studies are needed of the effects on patients of educational interventions designed to increase general practitioners' sensitivity to psychological distress.

Adult↗