Biomedical subjects

I Buchan

Publications and source records attributed to I Buchan.

8 recordsLinked to original sources

PubMed1998

Caudal epidurals: the whoosh test.

Caudal epidural injection is a simple procedure that carries a low risk of complications. The whoosh test (injection of air into the caudal epidural space with simultaneous auscultation over the thoracolumbar spine) has been recommended as an aid to correct needle placement. A 1-year prospective study, using fluoroscopic imaging to identify needle position, was conducted to compare the sensitivity and specificity of the whoosh test with that of clinical impression alone in assessing correct needle placement in the caudal space. Of 131 patients studied, correct needle placement was achieved in 121 on the first attempt (92%). Clinical impression alone had a sensitivity of 94% and a specificity of 20%. The whoosh test had a sensitivity of 80% and a specificity of 60%. The whoosh test is superior to clinical judgment in detecting incorrect caudal needle placement.

Air↗

PubMed1997

Total purchasing. Tracking down care.

Purchasers have a duty to monitor the quality of services purchased on patients' behalf; a purchasing general practice is best placed to do this effectively, especially by means of a tracker nurse. The tracker nurse should be diplomatic and experienced to earn the respect of professional staff in provider units, some of whom may see the process as threatening. The purchaser must introduce the concept of care monitoring gently but firmly, agreeing terms of confidentiality. Good practice should be highlighted and used as an example to others. Monitoring must follow the whole pathway of care, at the time and place it is given.

Budgets↗

PubMed1997

Coherent exchange of healthcare knowledge in open systems.

This paper outlines design philosophies and methods for healthcare knowledge systems. Clinical priorities for knowledge are discussed in terms of temporal and individual needs. Book centred organisation of healthcare knowledge, which has proven effective in clinical practice, is proposed as the basis of virtual libraries available at the point of care for target groups of healthcare professionals.

Artificial Intelligence↗

PubMed1996

The sperm deformity index: a reliable predictor of the outcome of oocyte fertilization in vitro.

OBJECTIVE: To evaluate a novel expression of sperm morphological parameters, the sperm deformity index, as a predictor of fertilization in vitro. DESIGN: Prospective blind clinical trial. SETTING: Academic tertiary referral center. INTERVENTION(S): Detailed sperm morphological assessment applying strict morphological criteria and a multiple entry technique for an unselected male population undergoing IVF. The sperm deformity index, defined as the average number of deformities per sperm assessed, was calculated. PATIENT(S): One hundred fifty-eight patients undergoing IVF treatment. Females with conditions negatively influencing fertilization were excluded. MAIN OUTCOME MEASURE(S): Fertilization rates and pregnancy. RESULT(S): Seventy-three percent of patients achieved fertilization. Patients achieving fertilization had a significantly higher median proportion of normal forms and a significantly lower median sperm deformity index than the nonfertilizers. The receiver operator characteristic (ROC) curves identified cutoff points that maximized the sum of sensitivity and specificity at sperm deformity index 1.6 and normal forms 4%. The sperm deformity index had a greater sensitivity (96%), specificity (72%), positive predictive value (90%), and negative predictive value (86%) than the proportion of normal sperm morphology (87%, 69%, 89%, 66%, respectively) at the optimal cutoff points. The area under the ROC curve was greater for the sperm deformity index (0.875) than for the proportion of normal sperm morphology (0.622). Achieving pregnancy did not correlated with sperm morphology. CONCLUSION(S): The sperm deformity index is a more reliable predictor of the outcome of fertilization in vitro than the proportion of normal sperm morphology and can assist to identify patients who require techniques such as intracytoplasmic sperm injection.

Adult↗

PubMed1996

Dissociation of body-temperature and melatonin secretion circadian rhythms in patients with chronic fatigue syndrome.

Many patients with chronic fatigue syndrome (CFS) display features of hypothalamic dysfunction. We have investigated aspects of circadian rhythmicity, an important hypothalamic function, in 20 CFS patients and in 17 age- and sex-matched healthy control subjects. There were no differences between the two groups in the amplitude, mesor (mean value) or timing of the peak (acrophase) of the circadian rhythm of core temperature, or in the timing of the onset of melatonin secretion. However, the CFS patients showed no significant correlation between the timing of the temperature acrophase and the melatonin onset (P < 0.5), whereas the normal significant correlation was observed in the controls (P < 0.05). Dissociation of circadian rhythms could be due to the sleep deprivation and social disruption, and/or the reduction in physical activity which typically accompany CFS. By analogy with jet-lag and shift-working, circadian dysrhythmia could be an important factor in initiating and perpetuating the cardinal symptoms of CFS, notably tiredness, impaired concentration and intellectual impairment.

Adult↗

PubMed1995

Alterations in prescribing by general practitioner fundholders: an observational study.

OBJECTIVES: To compare prescribing in general practices before and after they become fundholders to assess whether this affected prescribing patterns. DESIGN: Analysis of prescribing data (PACT) for one year before and one year after practices become first, second, or third wave fundholders and comparison with practices that were not fundholders during any part of the study. MAIN OUTCOME MEASURES: Prescribing costs (net ingredient cost per prescribing unit), prescribing volume (items per 1000 prescribing units), net ingredient cost per item, and percentage of generic prescribing. SETTING: Former Mersey Regional Health Authority. SUBJECTS: 100 fundholders (20 first wave, 31 second wave, 49 third wave) and 312 nonfundholders. RESULTS: Prescribing costs and volume rose throughout the study in all groups. In all three fundholding waves the rate of increase of prescribing costs was significantly lower than for nonfundholders. Both cost per item and prescribing volume tended to decrease, the former probably because of a significant increase in generic prescribing. Fundholding and non-fundholding practices differed in several respects. CONCLUSION: Fundholding has altered practice prescribing patterns compared with those of nonfundholders, increasing generic prescribing and reducing the rate of increase of prescribing costs.

Drug Costs↗

PubMed1995

Twelve month outcome of depression in general practice: does detection or disclosure make a difference?

OBJECTIVES: To assess the extent to which the outcome of depression among primary care attenders may be affected by medical diagnosis or by feedback of questionnaire results in unrecognised cases. DESIGN: Prospective 12 month study including a randomised controlled trial of the effects of disclosure, with data on depression status and clinical management collected by questionnaire and interview. SETTING: Two group practices in north Liverpool. SUBJECTS: 1099/1444 (76%) consecutive adult attenders completed the Beck depression inventory, of whom 179 with scores of at least 14 were followed up. INTERVENTIONS: Disclosure of a random 45% (52/116) of depression scores to general practitioners for subjects whose depression was undetected. MAIN OUTCOME MEASURES: Depression status estimated by depression score at start of study and at six and 12 months, with subsample validation against ICD-10 criteria. RESULTS: Questionnaire response rates were 76% (136/179) at six months and 68% (122/179) at 12 months and were higher for women than men. The median depression score was 19 (interquartile range 15 to 22) initially, decreasing to 16 (11 to 23) at 12 months. The median depression score decreased significantly (two sided test, P = 0.019) in subjects whose depression was unrecognised at the index consultation but increased in those whose depression had been detected by their general practitioners. Disclosure of cases of unrecognised depression to general practitioners had no effect on outcome. Intention to treat was associated with a worse prognosis, although only a minority of subjects received adequate treatment. CONCLUSIONS: Disclosure of undetected depression did not improve prognosis. A diagnosis of depression in general practice should be considered simply as a marker of its severity.

Adolescent↗

PubMed1991

Critical incidents in the intensive therapy unit.

Preventable mishaps in an intensive therapy unit were studied over 12 months by the critical incident technique. Staff were encouraged to complete confidential questionnaires describing incidents in which they had participated or had observed. This allowed classification of the events and examination of the views of staff on causes, detection, and prevention. 110 (80%) of 137 events were felt to have been due to human error; the remainder were due to equipment failure. Inexperience with equipment and shortage of trained staff were the factors most often felt to contribute to incidents. The critical incident technique is a useful way of improving standards of clinical care.

Accident Prevention↗