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Biomedical subjects

G Barlow

Publications and source records attributed to G Barlow.

15 recordsLinked to original sources
PubMed2005

Is antibiotic resistance a problem? A practical guide for hospital clinicians.

Antibiotic resistance is an important concern for patients, physicians, healthcare managers, and policymakers. Inappropriate antimicrobial prescribing fuels the evolution of resistance, while poor basic hygiene facilitates the spread of resistant microbes between patients and healthcare staff. The development of infection with a resistant pathogen may lead to poorer health and economic outcomes. The problem for the frontline clinician, however, is how to balance the responsibility of prudent prescribing with the risk of sub-optimally treating a patient who may be infected with a resistant pathogen. This article discusses how hospital physicians can use severity and risk factor assessment, and knowledge of local microbial epidemiology, to guide empiric antibiotic prescribing. Most patients hospitalised with a community acquired bacterial infection in the UK can still be managed with a traditional first line antibiotic(s). In contrast, regimens that account for resistance are often required in patients with hospital acquired infections, particularly if the patient is critically ill.

Anti-Bacterial Agents↗
PubMed2005

Review of patients in general practice with a diagnosis of epilepsy: development of a practice nurse checklist and an assessment of resource implications.

BACKGROUND: SIGN has recommended annual review of all patients with epilepsy. Annual review is rewarded in the new GMS contract. There is no information on how or by whom reviews should be carried out, nor on resource implications for secondary care. AIMS: To determine whether a practice nurse can deliver annual review of patients with epilepsy, and to estimate the resource implications of such review. METHODS: Evaluation of a practice nurse checklist against review by neurologist in 62 patients with epilepsy identified from a practice list of 6240 from Southwest Glasgow LHCC, and audit of case records in 1259 patients with epilepsy identified from the whole LHCC population of 96,565. RESULTS: There were 8 discrepancies between nurse and doctor reviews in a first iteration, but none in the second. Changes suggested a training effect. The review process generated 19 epilepsy nurse appointments, 7 requests for cerebral imaging and 3 requests for video EEG. Twelve patients required continuing follow up. The LHCC audit identified a large number of patients who had inadequate documentation of information and advice (over 90% in some domains). 28.6% had not been seen by a specialist, 40.7% had not had cerebral imaging, and only 37.4% were seizure free. CONCLUSION: Annual reviews of patients with epilepsy can be carried out by practice nurses, but some training is required. The review process is likely to increase the burden on secondary care and have a significant adverse effect on neurology waiting times.

Adolescent↗
PubMed2002

Unnecessary peripheral intravenous catheterisation on an acute medical admissions unit: a preliminary study.

BACKGROUND: The ability to secure peripheral intravenous access is regarded as a basic medical skill that is often required for the management of patients admitted to acute medical admission wards. The decision to insert a peripheral intravenous catheter (PIC) is usually taken by relatively inexperienced members of the acute medical team and is primarily based on 'traditional' or 'routine' practice, rather than on an assessment of need. Furthermore, there appears to be little recognition of the potentially serious adverse events associated with PIC insertion. METHOD: We conducted a prospective study to evaluate unnecessary PIC insertion in a United Kingdom teaching hospital's acute medical admissions unit. RESULTS: Of the 338 patients included in the study, 272 (80.5%) received a PIC. Of these, 179 patients (66%) received a PIC that had been used by the post-on-call ward round. Of the 93 patients (34%) with an unused PIC, 30 patients (11%) had been catheterised inappropriately by the study criteria. CONCLUSIONS: Despite our use of conservative criteria for PIC insertion, a notable level of inappropriate peripheral intravenous catheterisation was identified. A hypothetical cost-minimisation analysis is presented and a care pathway for best practice proposed.

Journal Article↗
PubMed2002

The use of adult isolation facilities in a UK infectious diseases unit.

The emergence and re-emergence of communicable infections, especially those due to antibiotic resistant nosocomial pathogens, is likely to increase the burden on the limited isolation facilities of the UK. It was our perception, however, that isolation beds are not always used optimally; with patients requiring isolation sometimes being housed in open-bay beds, whilst other non-communicable patients are unnecessarily isolated. The main aim of this study was to test this hypothesis in a regional infectious diseases (ID) unit. A secondary aim was to provide useful data in the development of guidelines for the admission of patients to the new Dundee ID unit. One-third of patients (32% of all patients and 34% of total bed days) admitted to an isolation room in the current Dundee ID unit over a four-month period, were found to have low-risk or non-communicable conditions. In addition, 21 patients initially considered an infection risk, used 102 bed days following resolution of their infection. Evidence for the presence of patients with 'alert' infections housed in the open-bay beds of other wards, whilst low-risk or non-communicable patients are unnecessarily exposed to isolation in the ID unit, is presented. The findings suggest suboptimal use of the current Tayside University Hospitals' isolation facilities. Given the likelihood of high demand for the isolation of patients in the new Dundee ID unit, it is vital that these facilities are used appropriately, thereby minimizing the risk of nosocomial infection transmission and the unnecessary isolation of low-risk patients.

Adult↗
PubMed2001

Do guidelines for community-acquired pneumonia improve the cost-effectiveness of hospital care?

There is growing pressure to demonstrate the value of practice guidelines. We have reviewed the evidence that guidelines for the treatment of community-acquired pneumonia (CAP) change current practices and that the standardization of practices reduces costs and/or improves outcome. The most obvious barrier to implementation of the guidelines is lack of knowledge about their content; equally important are the attitudes and behavior of professionals, patients, and their caregivers. Guidelines may improve the outcome of CAP, provided that there is an association between variations in outcome and some specific processes of care. Conversely, when there is no such relationship, guidelines may reduce the cost of care without having an adverse effect on outcome. The cost-effectiveness of CAP guidelines in an individual hospital depends on the systems that are available to identify patients with CAP and to measure the processes of care. There is good evidence that following the recommendations of the CAP guidelines does improve the cost-effectiveness of care and, therefore, that an audit of CAP may be worth the effort.

Community-Acquired Infections↗
PubMed2000

Uptake of influenza vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland.

OBJECTIVE: To ascertain the uptake of influenza vaccination, the main prompts to vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland. DESIGN: Prospective questionnaire survey. SETTING: A small rural district general hospital. SUBJECTS: General medical inpatients and outpatients. RESULTS: The overall uptake of vaccination was 44.8% (n = 250). The main prompts to vaccination were general practitioners (48.2%), the media (11.6%), practice and district nurses (8.9%), friends and relatives (8.9%) and posters at health centres and chemists (7.1%). The main reason for non-vaccination was a lack of awareness of high-risk status (50.7%). CONCLUSION: The uptake of influenza vaccination in the Angus region of Scotland is unsatisfactorily low. This is mostly due to a lack of knowledge regarding high-risk status, although other reasons, including concerns about the side effects of vaccination, are also important.

Female↗