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Biomedical subjects

Frank Sullivan

Publications and source records attributed to Frank Sullivan.

42 records · Page 3Linked to original sources
PubMed2003

Consultation computer use to improve management of chronic disease in general practice: a before and after study.

BACKGROUND: Computers have become widespread in primary care but their potential to improve clinical effectiveness has not been completely fulfilled. One explanation for this is the difficulty in evaluating their impact on the process of care. AIM: To determine the effects of computers in consulting rooms on the management of chronic disease. METHODS: Before and after study with concurrent control group, matching six practices moving from paper-based recording to a consultation-based computer environment, with six practices using paper-based systems. Data were collected retrospectively via case note review for the year preceding the arrival of the computers and for the subsequent year. All patients with diagnosed diabetes mellitus (n = 1070) or rheumatoid disease (n = 202) were included. The main outcome measure was recording of disease management items. RESULTS: The computer group improved recording for seven of the eight diabetic and four of the seven rheumatoid items studied. Increases were significant for height (5% increase; 95% confidence interval (CI): 1.2% to 8.8%), weight (6.6%; 95% CI: 2.2% to 11.0%), foot pulses (8.7%; 95% CI: 4.1% to 13.4%), foot sensation (8.6%; 95% CI: 5.2% to 11.9%), blood pressure (12.6%; 95% CI: 2.0% to 23.2%) and urinalysis (20.2%; 95% CI: 11.0% to 29.4%). The control group improved for two diabetic and five rheumatoid items, the only significant increase being for urinalysis (1.1%; 95% CI: 0.2% to 22.0%). Computer use was associated with increased recording of each diabetes item except fundoscopy, and with increased blood pressure recording for rheumatoid disease. The larger the practice, the larger the effects observed. CONCLUSIONS: Use of computers can improve management of chronic disease in primary care. Impact is most clearly seen in those items easily recorded on computer during consultations. Effects are most evident in practices with larger patient numbers.

Arthritis, Rheumatoid↗
PubMed2003

Three steps to data quality.

BACKGROUND: The quality of data in general practice clinical information systems varies enormously. This variability jeopardizes the proposed national strategy for an integrated care records service and the capacity of primary care organisations to respond coherently to the demands of clinical governance and the proposed quality-based general practice contract. This is apparent in the difficulty in automating the audit process and in comparing aggregated data from different practices. In an attempt to provide data of adequate quality to support such operational needs, increasing emphasis is being placed on the standardisation of data recording. OBJECTIVE: To develop a conceptual framework to facilitate the recording of standardised data within primary care. METHOD: A multiprofessional group of primary care members from the South Thames Research Network examined leading guidelines for best practice. Using the nominal group technique the group prioritized the information needs of primary care organisations for managing coronary heart disease according to current evidence. RESULTS: Information needs identified were prioritized and stratified into a functional framework. CONCLUSION: It has been possible within the context of a primary care research network to produce a framework for standardising data collection. Motivation of front-line clinicians was achieved through the incorporation of their views into the synthesis of the dataset.

Comorbidity↗
PubMed2003

Quality measurement of care for people with type 2 diabetes in Tayside, Scotland: implications for the new UK general practice contract.

BACKGROUND: The new United Kingdom general practice contract proposes that up to a third of general practitioners' income will come from achieving quality targets. AIM: To examine selected quality markers in terms of their robustness to case-mix variation and chance effects, and in the attribution of quality to practices. STUDY DESIGN AND METHODS: Data were extracted from a population-based diabetes clinical information system in Tayside, Scotland, for patients with type 2 diabetes registered in 67 practices with complete ascertainment. RESULTS: Most practices would have received relatively high levels of payment for the process measures examined. Outcome measures appeared more challenging. Case-mix adjustment for age, sex, and postcode-assigned deprivation altered measured performance by up to 7%, but payment by up to 14%. Despite no strong evidence of any real difference in quality, chance effects meant that there was greater apparent variability for smaller practices from year to year. Hospital attendance was common, but highly variable between practices. CONCLUSION: Case-mix adjustment to allow fairer comparison is routine in national performance indicators, and ignoring it risks making the new contract quality framework inequitable. Because of chance effects, smaller practices may have greater year-to-year variability in income. Reflecting National Health Service structure, the new contract provides no incentives for integrated care and offers a perverse incentive to refer more patients to hospital. There are trade-offs between the validity of measures, and the cost and bureaucracy of collecting data. The planned evaluation of the new contrast should examine the effectiveness and equity of the quality framework, and rapidly act on deficiencies found.

Diabetes Mellitus, Type 2↗
PubMed2002

A pharmacogenetic study to investigate the role of dietary carcinogens in the etiology of colorectal cancer.

Susceptibility to colorectal cancer, one of the most common forms of cancer in the Western world, has been associated with several environmental and dietary risk factors. Dietary exposure to food derived heterocyclic amine carcinogens and polycyclic aromatic hydrocarbons have been proposed as specific risk factors. Many polymorphic Phase I and Phase II drug metabolizing enzymes are responsible for the metabolism and disposition of these compounds and it is therefore possible that inheritance of specific allelic variants of these enzymes may influence colorectal cancer susceptibility. In a multicenter case-control study, 490 colorectal cancer patients and 593 controls (433 matched case-control pairs) were genotyped for common polymorphisms in the cytochrome P450 (CYP1A1, CYP1A2, CYP1B1, CYP2A6, CYP2C9, CYP2C19 and CYP2D6), glutathione S-transferase (GSTM1, GSTP1 and GSTT1), sulfotransferase (SULT1A1 and SULT1A2), N-acetyl transferase 2 (NAT2), NAD(P)H:quinone oxidoreductase (NQO1), methylenetetrahydrofolate reductase (MTHFR), and microsomal epoxide hydrolase (EPHX1) genes. Matched case-control analysis identified alleles associated with higher colorectal cancer risk as carriage of CYP1A1*2C (OR = 2.15, 95% CI 1.36-3.39) and homozygosity for GSTM1*2/*2 (OR = 1.53, 95% CI 1.16-2.02). In contrast, inheritance of the CYP2A6*2 (OR = 0.51, 95% CI 0.28-1.06), CYP2C19*2 (OR = 0.72, 95% CI 0.52-0.98) and the EPHX1(His113) alleles were associated with reduced cancer risk. We found no association with colorectal cancer risk with NAT2 genotype or any of the other polymorphic genes associated with the metabolism and disposition of heterocyclic amine carcinogens. This data suggests that heterocyclic amines do not play an important role in the aetiology of colorectal cancer but that exposure to other carcinogens such as polycyclic aromatic hydrocarbons may be important determinants of cancer risk.

Adenocarcinoma↗
PubMedDate not supplied

Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis.

PURPOSE: Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care. METHODS: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other's choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the final mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2. RESULTS: There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of efficacy data showed a relative risk of 1.26 (95% CI, 1.12-1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21-1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective. CONCLUSION: This systematic review is the first comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the first to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo.

Antidepressive Agents, Tricyclic↗