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Biomedical subjects

G Bury

Publications and source records attributed to G Bury.

At least 37 records · Page 2Linked to original sources
PubMed2000

Drug users attending general practice in Eastern Regional Health Authority (ERHA) area.

Dublin has an estimated 13,460 opiate drug users. The role of general practice in providing care for this group has increased over the last four years. A Central Methadone Treatment List (CMTL) registers all clients currently on treatment. To obtain a social, demographic and drug using profile of opiate users attending general practitioners (GPs) for methadone maintenance. A cross sectional survey of opiate users attending general practice for methadone maintenance in the Dublin area in early 1999. Data was collected on 571 clients (62% of total number attending general practice), of whom 97% had used heroin in the past and 12% had never injected. Although clients had been receiving methadone maintenance in general practice for a mean of 14 months, 16% were still using heroin, of whom 31% were still injecting. The mean age of first drug use was 15.5 years and of first injecting was 19.4 years. Younger clients are starting both to use drugs and inject drugs at an earlier age. Record keeping was good, with most items of information present in over 70% of the charts surveyed. A total of 17% of clients recorded on the CMTL could not be traced to the GP recorded as providing care. Despite treatment with methadone maintenance, there is a high level of continued risk activity in this group. Furthermore, a trend towards earlier initiation to drug use is apparent. The CMTL registration process requires further exploration.

Adolescent↗
PubMed2000

"Saves" project.

Explore the source record for details and available documents.

Aged↗
PubMed1999

Searching for the evidence in pre-hospital care: a review of randomised controlled trials. On behalf of the Ambulance Response Time Sub-Group of the National Ambulance Advisory Committee.

OBJECTIVES: To identify randomised controlled trials (RCTs) which evaluate aspects of pre-hospital care; to perform categorisation by theme; to compare the sensitivity and precision of the search databases. DATA SOURCES: August 1997 updates of MEDLINE and EMBASE databases, using the Datastar online system. Papers published in 1987 or later were included, with no language restrictions. STUDY SELECTION: A trial was eligible for inclusion if it was judged, by two independent and blinded assessors, that participants followed up in the trial were definitely or possibly assigned prospectively to one of two or more alternative forms of healthcare with random allocation or a quasi-random method of allocation. RESULTS: The literature search retrieved 849 papers, of which 569 (67%) were in MEDLINE and 486 (57%) in EMBASE. Forty one (5%) were confirmed as reports of RCTs or quasi-RCTs, and the total number of individual trials was 38. Ten of these trials dealt with thrombolytic drugs; 14 were concerned with other drugs, 12 with equipment, and two with other interventions. Four trials were based on a sample size of more than 1000, and seven reported a statistically significant effect on mortality. All 41 papers were in EMBASE, and all but one were also in MEDLINE. CONCLUSIONS: Evidence based policy making with respect to the organisation of pre-hospital services cannot depend on RCTs. In the current relative absence of such evidence, practitioners and decision makers must use alternative information sources. A future review could examine a broader range of literature and be based on a wider search of published and unpublished material.

Abstracting and Indexing↗
PubMed1999

Characteristics of attenders and their attendances at an urban accident and emergency department over a one year period.

OBJECTIVES: To describe (1) the characteristics of attenders to an urban accident and emergency (A&E) department over a one year period according to the frequency of their attendance and (2) the features of their attendances according to the frequency which the patient attended the department during the study period. METHODS: A dataset containing information on all new attendances to an urban A&E department in 1995 was formed. For each attendance the following information was recorded: day of the week, hour of attendance, referral source, triage category, and disposal. A second dataset, consisting of the individuals ("attenders") who made the A&E visits ("attendances") during 1995 was also produced. For each attender the following information was recorded: age, sex, postal code of residence, socioeconomic status, marital status, and number of attendances during 1995. A methodology reviewing the trends of frequency of attendance was utilised, as opposed to the use of an arbitrary cut off point. RESULTS: 34,908 patients made 46,735 visits in 1995. Increasing frequency of attendance was significantly associated with increasing age (Kruskal-Wallis < 0.001), being male (chi 2 for linear trend 14.06, p < 0.001), having a local postal address (chi 2 279.79, p < 0.0001), general medical services eligibility (chi 2 781.67, p < 0.0001), and inversely associated with being married (chi 2 33.91, p < 0.0001). Increasing frequency of attendance was significantly associated with attendance between the hours of 1700 and 0900 (chi 2 295.62, p < 0.001), being triaged as a non-emergency (chi 2 1254.33, p < 0.0001), and self referral (chi 2 141.4, p < 0.0001). CONCLUSIONS: A small group of A&E attenders accounts for a disproportionately large percentage of the total number of departmental attendances. The characteristics of frequent A&E attenders suggest that they may represent a vulnerable group of patients. A follow up study of the utilisation of all primary care services by such patients is suggested.

Adult↗
PubMed1999

A one year prospective census of workload and process at a community hospital casualty room.

A prospective census of patients attending the casualty room of Wicklow District Hospital (a general practitioner operated service) for one year was performed. A total of 1564 attendances were recorded, of which 904 (58%) were male and 953 (61%) were eligible for free medical care. Almost half, 735 (47%) attended outside daytime hours. Concerning type of presentation, 637 (41%) attended with acute trauma, 450 (29%) attended with acute medical and 477 (30%) attended with elective problems. Repeat visits accounted for 5% of the total. Concerning outcome of consultation, 409 (26%) were given a prescription, 307 (20%) had blood tests, 263 (17%) received dressings, 183 (12%) were referred to secondary care, 168 (11%) were followed up by their GP, 146 (9%) had minor surgery, and 86 (5%) had no intervention. This study indicates that the hospital is responsible for a considerable workload, with a significant out of hours component.

Emergencies↗
PubMed1999

Randomized controlled trial of general practitioner versus usual medical care in a suburban accident and emergency department using an informal triage system.

We determined if care provided by general practitioners (GPs) to non-emergency patients, in a suburban accident and emergency (A&E) department using an informal triage system, differs significantly from care provided by usual A&E staff. One thousand eight hundred and seventy-eight patients participated. By comparison with usual A&E staff, GPs prescribed significantly more often (percentage relative difference [% RD] = 12 [95% confidence interval = 1-23]) and referred more patients to hospital (% RD = 21 [95% CI = 9-33]). This is the first study to report that sessional GPs working in an A&E department utilize similar or more resources than usual A&E staff. It emphasizes the need for the continued audit of initiatives that have been introduced into new settings.

Emergency Service, Hospital↗
PubMed1999

The role of automated external defibrillators in rural general practice.

In a questionnaire survey (100% response rate) investigating the availability and use of automated external defibrillators (AEDs), it was found that the success rate (number discharged alive) compared favourably with pre-hospital defibrillation by other providers, and that AEDs aided the management of dysrhythmias not commonly seen in general practice. With appropriate training they are useful in rural general practice.

Data Collection↗
PubMed1997

Effect of the introduction of a financial incentive for fee-paying A&E attenders to consult their general practitioner before attending the A&E department.

BACKGROUND: The Health (Out-Patient Charges) Regulations 1994 were designed to encourage those Irish patients liable for their own health care costs to attend their GP before their local Accident and Emergency (A&E) department. Such patients are referred to as General Medical Services (GMS)-ineligible. Prior to the introduction of the regulations in March 1994, there was a perverse financial incentive for these patients to attend directly A&E departments instead of their GP. OBJECTIVE: The aim was to compare the number of GMS-ineligible patients referred by a GP during the year before and the year after the implementation of the Regulations. METHOD: This study involved the audit of all new attendances to a large A&E department, for 1 year before and after the introduction of the new regulations. The main outcome measures were the number of new attenders in the subsequent year, the proportion of GMS-ineligible attenders, the proportion of GMS-ineligible attenders referred by a GP and the proportion of GMS-ineligible attenders referred by a GP and categorized as having neither critical nor urgent complaints. RESULTS: The total number of new attenders in the year subsequent to the introduction of the regulations was 45,302, an increase of 4.9% on the previous year's total. The proportion of GMS-ineligible attenders decreased from 45.3 to 44% (-1.3%; 95% confidence interval (CI) -0.6 to -1.9). The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The proportion of GMS-ineligible attenders, referred by a GP with complaints categorized as neither critical nor urgent, increased by 2.5% (95%; CI 1.8-3.2). CONCLUSIONS: The introduction of the regulations was associated with a small, but statistically significant, reduction in the number of GMS-ineligible patients who attended with non-emergency conditions. The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The overall workload of the A&E department was, however, unaffected. Further evaluation of the effects of this reduction on the health status of patients is required.

Adult↗
PubMed1997

Assaults against general practitioners in Ireland.

BACKGROUND AND OBJECTIVES: Violence directed at general practitioners (GPs) is on the increase in urban areas of Ireland. However, little information has been available on the incidence, effects, or precipitants of this violence. This study documents the frequency of the problem in Ireland's capital city, Dublin. METHODS: A survey was sent to all 634 GPs in the Eastern Health Board region of Ireland. The survey asked each GP to report an incident of violence or aggression using standardized definitions and reporting forms. The survey also requested that participants provide information on their practice and its staff and setting. RESULTS: We collected information from 622 of 634 doctors (98%). The overall incidence of violence or aggression in the sample was 21%. Of the 131 incidents reported, only 7% resulted in injury to the doctor; the remainder all involved verbal abuse and/or threats. The most frequent assailant characteristics identified were alcohol or opiate abuse. CONCLUSIONS: Violence and aggression against GPs are common. Several interventions are discussed.

Adult↗
PubMed1996

A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS.

Quality of life is an increasingly important outcome measure in medicine and health care. Many measures of quality of life present patients with predetermined lists of questions that may or may not be relevant to the individual patient. This paper describes a brief measure, the SEIQoL-DW, which is derived from the schedule for evaluation of individual quality of life (SEIQoL). The measure allows respondents to nominate the areas of life which are most important, rate their level of functioning or satisfaction with each, and indicate the relative importance of each to their overall quality of life. Given its practicality and brevity, the measure should prove particularly useful in clinical situations where patient generated data on quality of life is important. This article describes the first clinical application of the measure, assessing the quality of life of a cohort of patients with HIV/AIDS managed in general practice.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Randomised controlled trial of general practitioner versus usual medical care in an urban accident and emergency department: process, outcome, and comparative cost.

OBJECTIVE: To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process, outcome, and comparative cost. DESIGN: A randomised controlled trial. SETTING: A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis. PATIENTS: All new attenders categorised by the triage system as "semiurgent" or "delay acceptable." 66% of all attenders were eligible for inclusion. MAIN OUTCOME MEASURES: Numbers of patients undergoing investigation, referral, or prescription; types of disposal; consultation satisfaction scores; reattendance to accident and emergency department within 30 days of index visit; health status at one month; comparative cost differences. RESULTS: 4684 patients participated. For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20%; 95% confidence interval 16% to 25%), referred to other hospital services less often (39%; 28% to 47%), admitted fewer patients (45%; 32% to 56%), and prescribed more often (41%; 30% to 54%). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit; 418 patients (18%) seen by accident and emergency staff similarly reattended, 435 patients (72% of those eligible) completed the consultation satisfaction questionnaire and 258 (59% of those eligible) provided health status information one month after consultation. There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction questionnaire scores or health status. For all patients seen by general practitioners during the study, estimated marginal and total savings were Ir1427 pounds and Ir117,005 pounds respectively. CONCLUSION: General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.

Adult↗
PubMed1996

Community cardiac awareness teaching in a rural area: the potential for a health promotion message.

Little information has been published on the uptake of cardiopulmonary resuscitation (CPR) training in rural areas or on the potential to associate a health promotion message with skills training. This paper describes CPR instructor and community training programmes in Ireland. Public interest in these programmes has been strongest in rural areas, which have constituted the main focus of activity to date. High-quality training of lay instructors has been a specific target of the programmes, which have included a significant health promotion message. In the pilot rural area, almost 2% of adults aged between 15 and 64 years attended a course during the first year of operation. However, the self-reported risk factor profile of participants suggests significant under-estimation of risk factors such as obesity, hypertension or raised blood cholesterol. While general population teaching programmes can attract large numbers of participants, even in isolated rural areas, the perceived relevance of an associated health promotion message may be very low.

Adolescent↗
PubMed1996

One-year prospective study of cases of suspected acute myocardial infarction managed by urban and rural general practitioners.

BACKGROUND: The role of the general practitioner in the management of patients with suspected acute myocardial infarction is important and specific. It has been recommended that eligible patients should receive thrombolysis within 90 minutes of alerting medical or ambulance services. The administration of prehospital thrombolysis by general practitioners is controversial. Most research into the management of acute myocardial infarction has been hospital based and has not explored differences between urban and rural general practice. AIM: In 1993-94 a one-year prospective survey was undertaken of samples of urban and rural general practitioners to examine their management of cases of suspected acute myocardial infarction and to determine whether differences in management existed between the two settings. METHOD: General practitioners were recruited through the continuing medical education faculty network of the Irish College of General Practitioners. Participating general practitioners completed a report form for cases of suspected acute myocardial infarction. Six-week follow-up forms were also completed. RESULTS: A total of 113 general practitioners (54 urban and 59 rural) participated in the study. A total of 57 general practitioners contributed 195 cases, 49 from urban and 146 from rural areas. The mean number of cases of suspected acute myocardial infarction per participant for urban and rural doctors was 0.9 and 2.5, respectively. Median delay time from onset of symptoms to contacting the general practitioner was 90 minutes for both urban and rural patients. Median general practitioner response times for urban and rural doctors were 10 and 15 minutes, respectively. Median estimated journey times from location of the patient to hospital for urban and rural patients were 10 and 40 minutes, respectively (P<0.001). Rural doctors were more likely, in comparison with their urban counterparts, to administer aspirin (given to 40% of patients versus 16%, P<0.01) but less likely to administer intravenous morphine (26% versus 41%, P<0.05). Twenty one patients (11%) died at the scene; follow-up forms were received for 94% of the remaining patients. Of these 163 patients, 99% were admitted to hospital; 49% were discharged with a diagnosis of acute myocardial infarction and a further 25% had final diagnoses consistent with acute coronary heart disease. CONCLUSION: This study suggests that the management of patients with suspected acute myocardial infarction differs in urban and rural settings. Delay times suggest that in order to meet current guidelines, prehospital thrombolysis must become a reality in rural areas.

Adult↗
PubMed1995

Teaching immediate cardiac care to general practitioners: a faculty-based approach.

This paper describes the development, piloting and delivery of an immediate care cardiac course (ICCC) to Irish general practitioners. The course utilizes the continuing medical education network of the Irish College of General Practitioners. This has made the course locally accessible even for remote practitioners and has facilitated rapid dissemination. In its first year, 167 GPs (8% of the total number of Irish GPs) have completed the course. Participant feedback has been positive, especially regarding the small group- and skills-based components. The introduction of more formal assessment procedures is now being undertaken. We believe this model to be a possible template for the introduction of other skills courses both in Ireland and abroad.

Education, Medical, Continuing↗
PubMed1995

Attitudes of Dublin accident and emergency department doctors and nurses towards the services offered by local general practitioners.

Good communication at the accident and emergency (A&E)-general practice interface is important. Such communication will be affected by the attitudes of A&E staff towards local general practitioners (GPs). The objectives of this study were to establish and compare, using a questionnaire, the attitudes of Dublin A&E doctors and nurses towards the services offered by local GPs. A questionnaire was sent to all nurses and non-consultant doctors working in four of the six Dublin A&E departments. Completed questionnaires were received from 57 (61%) nurses and 35 (81%) doctors. Only two activities (being accessible to patients during normal surgery hours and providing family planning services) were rated by more than one-fifth of doctors and nurses as being performed 'well'. Six activities (being accessible to patients outside surgery hours, providing long-term care for the chronically ill and debilitated, providing appropriate care for 'difficult' patients, advising patients about the appropriate use of services and performing first aid) were rated by more than 40% of both doctors and nurses as being performed 'badly'. For all activities the nurses consistently rated the performance of the 'average GP' more critically than the doctors. These results must be interpreted cautiously. The implications of these findings and how best they can be addressed are discussed.

Attitude of Health Personnel↗