Search PubMed⌕ Search

Biomedical subjects

I K Crombie

Publications and source records attributed to I K Crombie.

At least 37 records · Page 2Linked to original sources
PubMed1998

Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland.

OBJECTIVE: To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group. DESIGN: 4 year follow up of a cohort of children aged 1-15. SETTING: 12 general practices in the Tayside region of Scotland. SUBJECTS: 3347 children with asthma or features suggestive of asthma registered with the general practices. MAIN OUTCOME MEASURES: Height and weight standard deviation scores. RESULTS: Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P < 0.001 for both). Children who were receiving > or = 400 micrograms daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P = 0.002, for height and -0.58 (0.94), P = 0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P = 0.003). However, no other children with asthma showed growth impairment. CONCLUSION: Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.

Adolescent↗
PubMed1998

Who takes alcohol prior to suicide?

Alcohol abuse is strongly associated with suicide. Alcoholics are at a high risk of suicide, and studies of case series of suicide show that alcoholics account for between 20% and 40% of all suicides. What is less clear is the role of alcohol in the events leading up to the suicide. This study reviews the characteristics of individuals who consumed alcohol prior to suicide. All cases of suicide assessed by the Department of Forensic Medicine, Dundee University between 1988 and 1995 were reviewed. Data were obtained on blood-alcohol levels of 349 cases, together with the method and circumstances of the suicide, demographic variables and reports of past psychiatric history. Forty-five per cent of suicide cases had consumed alcohol and 19% were drunk (BAC > 150 mg/dl) at the time of the suicide. Consumption of alcohol was not associated with a particular method of suicide, nor with social factors such as employment status, marital status or social class. However, alcohol use was more common among those with no previous psychiatric history. This study confirms that alcohol consumption is a common precursor to suicide. It suggests that alcohol may play a more important role in the events leading to suicide amongst individuals with no previous psychiatric history.

Journal Article↗
PubMed1998

Beyond health outcomes: the advantages of measuring process.

The use of process measures in the assessment of the quality of care has been neglected of late. The outcomes movement has gathered momentum and process measurement appears to have been left trailing in the wake. Yet process measures can be sensitive indicators of the quality of care and have many advantages over outcomes. They are readily measured and can easily be interpreted; comparisons are not essential (as they are with outcomes monitoring) but even if used they are little bothered by the case-mix arguments which bedevil outcomes assessment. Further, the direct measurement of process can directly indicate deficiencies of care which need to be remedied. Finally, there are some aspects of care which are only amenable to study using measures of process. These benefits come at a price: first there must be good evidence that links the processes of care to desirable outcomes. This paper explores the advantages of measuring processes of care in quality assessment and advocates a balanced approach to the process vs. outcome debate.

Adult↗
PubMed1998

Does the availability of prescribed drugs affect rates of self poisoning?

The trends in self-poisoning rates and in rates of prescribing of the major drug groups were compared. Over the period 1981-91, barbiturate prescribing and self poisoning both fell by 80%; for antidepressants, prescribing increased by over 40% and self poisoning by 30%; for antipsychotics, both rose by 30%; for benzodiazepines, poisoning fell by 30% and prescribing by 20%. Even for analgesic drugs, which are also available over the counter, there was a correspondence between changes in self poisoning and prescribing. The availability of prescribed drugs is directly related to their use for self poisoning. Restricting the availability of these drugs is a possible preventative strategy, although further research on this is needed.

Adolescent↗
PubMed1998

Getting to grips with systematic reviews and meta-analyses.

Systematic reviews and meta-analyses now form a major source of evidence on clinical effectiveness. Despite the relative recency of this approach to synthesizing research findings, a reasonable consensus has emerged as to the desirable methodological characteristics of this secondary research. Understanding these basic tenets enables readers to take a balanced view of published review findings.

Evidence-Based Medicine↗
PubMed1998

Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic.

Surgery and trauma are recognised as important causes of chronic pain, although their overall contribution has not been systematically studied. This paper reports on the contribution of surgery and trauma to chronic pain among 5130 patients attending 10 outpatient clinics located throughout North Britain. Surgery contributed to pain in 22.5% of patients, and was particularly associated with the development of pain in the abdomen and with anal, perineal and genital pain. Trauma was a cause of pain in 18.7% of patients, and was most common in pain in the upper limb, the spine and the lower limb. Patients with chronic pain associated with trauma are on average younger than those with chronic post-surgical pain. Further, and unusually for pain conditions, the trauma patients show an excess of males over females. These findings indicate that it can be unhelpful for pain classification systems to combine surgery and trauma in a single category. The results also point to areas for potentially fruitful research into the aetiology of chronic pain. In particular, studies are needed to identify the operative procedures associated with the development of pain so that preventive measures can be implemented.

Adult↗
PubMed1997

Diminishing returns or appropriate treatment strategy?--an analysis of short-term outcomes after pain clinic treatment.

In the United Kingdom patients with chronic pain are frequently managed in anaesthetist-led outpatient pain clinics. In many of these clinics the emphasis is on medical therapies (analgesics and psychotropic drugs, TENS, acupuncture and nerve blocks) with patients trying a series of different therapies until relief is achieved or further attempts at physical treatments are discontinued. The sequential trial of different treatment modalities presents clinicians with a problem. Patients who receive little benefit from (say) the first three treatments tried might be expected to be less likely to gain benefit from the next treatment modality. The presence or absence of such 'diminishing returns' from treatment will influence when therapeutic efforts based on the medical model of pain should be abandoned. This study examined basic outcome data on 1912 patients seen in a single Scottish pain clinic between 1987 and 1994. The data were analysed to assess whether the success of treatment modalities depended on whether they were used as a first-choice treatment or were given after previous therapeutic attempts had failed. Diminution in success rates was generally not large although this varied between therapies. No fall-off in success rates was seen for antidepressants, acupuncture or sympathetic nerve blocks. However, the other nerve blocks all showed falling success rates when they were used as fourth- or fifth-line treatments. That little diminution of success rates was seen warrants further investigation. Pain clinics need good information on the success or otherwise of late treatment so that they can devise rational pain management strategies covering multiple therapies and appropriate criteria for ending medical interventions. These findings suggest that allowing patients access to multiple pain therapies may well be an appropriate management strategy.

Adult↗
PubMed1997

Interpreting health outcomes.

Interest in outcomes is universal. To patients, good outcomes represent their highest hopes for therapy; to health care professionals, good outcomes are the desired end-point of a complex web of care. More recently, politicians and health care managers too have shifted their emphasis away from health service activity and towards what is termed 'health gain'. The rise of the outcomes movement appears irresistible. However, the difficulties in interpreting outcomes data will not go away. Outcomes measured using routine data are subject to numerous biases and many practical difficulties. Despite recent statistical, methodological and technological advances, comparisons of outcomes at best provide us with weak evidence of either the effectiveness or the quality of health care. And sometimes they may frankly mislead. The apparent intuitiveness of outcomes monitoring has broad public appeal. But enthusiasm for outcomes needs to be tempered with a clear understanding of their limitations.

Data Interpretation, Statistical↗
PubMed1997

What determines levels of passive smoking in children with asthma?

BACKGROUND: Children with parents who smoke are often exposed to high levels of environmental tobacco smoke, and children with asthma are particularly susceptible to the detrimental effects of passive smoking. Data were collected from parents who smoke and from their asthmatic children. The families are currently taking part in a randomised controlled trial to test an intervention designed to reduce passive smoking in children with asthma. This paper reports on the baseline data. Questionnaire data and cotinine levels were compared in an attempt to assess exposure and to identify factors which influence exposure of the children. The aim of the study was to identify the scope for a reduction in passive smoking by these children. METHODS: A sample of 501 families with an asthmatic child aged 2-12 years was obtained. Factors influencing passive smoking were assessed by interviewing parents. Cotinine levels were measured from saliva samples using gas liquid chromatography with nitrogen phosphorous detection. RESULTS: Cotinine levels in children were strongly associated with the age of the child, the number of parents who smoked, contact with other smokers, the frequency of smoking in the same room as the child, and crowding within the home. Parental cotinine levels, the amount smoked in the home, and whether the home had a garden also exerted an independent effect on cotinine levels in the children. CONCLUSIONS: Many children are exposed to high levels of environmental tobacco smoke and their cotinine levels are heavily dependent upon proximity to the parent who smokes. Parents who smoke have a unique opportunity to benefit their child's health by modifying their smoking habits within the home.

Age Factors↗
PubMed1997

The facilitator effect: results from a four-year follow-up of children with asthma.

BACKGROUND: A long-term evaluation of the process and outcomes of primary and secondary care is required to establish whether audit facilitators can improve the care of childhood asthma. AIM: To examine the long-term effect of an intervention by an audit facilitator on the management of children with asthma, and to investigate the implications for health service costs. METHOD: A 4-year follow up was conducted of an intervention and control group totalling 2557 children aged 1-15 years from 12 general practices in the Tayside region. Primary care consultations, prescriptions, hospital contacts and health service costs 1 year before and 3 years after a facilitator visited practices were recorded. The facilitator encouraged the diagnosis and treatment of childhood asthma in the intervention group. RESULTS: Favourable changes in consultation patterns, prescriptions and reduced hospital admissions seen during the intervention year did not persist in subsequent years. Two and three years after the facilitator visit the process and outcome of care was similar in both groups. The reduction in health service costs seen in the intervention group was equivalent to the cost of employing a facilitator. CONCLUSION: The effect of a facilitator lasts only for the period of intervention. Enthusiasts will say that improving patient care without increasing health service costs justifies the widespread deployment of facilitators. Others more interested in long-term outcomes may disagree.

Adolescent↗
PubMed1996

Audit in pain clinics: changing the management of low-back and nerve-damage pain.

This audit study took place in ten outpatient pain clinics and focused on the management of low back pain and nerve-damage pain. The objective was to identify and promote appropriate changes in management. An analysis of the treatment of 1236 patients with low back pain and/or nerve-damage pain highlighted wide variations in practice. Presentation of these data to the clinics was used as a means of promoting change. Data on a further 1791 patients were used to assess the extent of any changes in practice. Prior to the audit feedback, treatments were used often in some clinics, but only rarely in other clinics, for seemingly similar patients. During the feedback sessions three treatments were identified for more frequent use by several of the clinics: antidepressant and anticonvulsant drugs, and transcutaneous electrical nerve stimulation. Many changes in practice occurred after the audit intervention, with large increases in the utilisation of these three treatments. Since there is reasonable evidence to support the use of these treatments for chronic pain this represents an improvement in the process of care. The audit demonstrated that patient management can be improved by a combination of active feedback and discussions based around comparisons between centres.

Anticonvulsants↗
PubMed1996

Hospitalisation for deliberate self-poisoning in Scotland from 1981 to 1993: trends in rates and types of drugs used.

BACKGROUND: Rates of self-poisoning fell during the 1980s, although recent reports suggest this trend may have reversed. METHODS: Data on all hospital discharges with a diagnosis of deliberate self-poisoning were obtained from the Information and Statistics Division of the NHS in Scotland. Rates of self-poisoning were investigated by overall trend, and for trends by age and by type of drug. RESULTS: Deliberate self-poisoning rates for men and women began increasing in the late 1980s, and did so steadily during the early 1990s. Because the rates are increasing faster in men, the traditional excess of self-poisoning among women is being eroded. For men rates increased in all age groups up to the age of 60, but the greatest rise occurred between ages 15-29. For women the increase was largely restricted to 15-24-year-olds, and rates fell among women over the age of 50. Self-poisoning with paracetamol increased most rapidly; in contrast to aspirin which showed little change. Opiate analgesics, antirheumatics, antidepressants and antipsychotics have also shown some increase in their use in both genders. There has been a substantial fall in the use of benzodiazepines in women, but little change among men. CONCLUSION: Rapid increases in self-poisoning particularly among young adults present a serious public health problem. Controlling this epidemic is made difficult because the principal drug involved, paracetamol, is readily available.

Acetaminophen↗
PubMed1996

School absence--a valid morbidity marker for asthma?

OBJECTIVE: To determine how often children with asthma are absent from school compared to the 'average' child and to assess the validity of school absence as a marker of morbidity for asthma. DESIGN: Case control study. SETTING: Children registered with 12 general practices, attending 98 primary and secondary schools in the Tayside region. SUBJECTS: 773 children with asthma or related symptoms and 773 controls from school registers. MAIN OUTCOME MEASURES: Episodes of school absence and days absent per term, recorded from school registers. RESULTS: Comparing children taking asthma medication against their controls showed a significant difference for both days absent and episodes of absence. This increase in absence was approximately one school day each term. Severity of asthma was not related to increased school absence. Children receiving no asthma medication, but with asthma related symptoms, were absent no more than their age/sex matched controls. Applying a deprivation index to the cases on asthma medication, gave a significant difference in episodes of absence between Primary children classified as highly deprived and other Primary children. CONCLUSION: The increase in school absence of around one day per term for children with asthma is less than previously reported and could be caused by clinic attendance rather than ill health due to asthma. Recorded absence varied according to deprivation index but not asthma severity. The use of school absence as a marker of morbidity in childhood asthma needs to be reassessed.

Absenteeism↗