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Biomedical subjects

J Cairns

Publications and source records attributed to J Cairns.

At least 19 recordsLinked to original sources
PubMed1999

Nurse practitioner support for transfusion in patients with haematological disorders in hospital and at home.

We prospectively studied the effects of dedicating a nurse to manage the provision of blood product support in a hospital haematology unit and at home to 45 patients with haematological disorders requiring regular transfusion. During the study 335 home blood tests, 65 home platelet transfusions and 155 hospital transfusions were managed by the nurse who organized the whole transfusion process, made home visits for blood tests and platelet transfusions and arranged hospital visits for red cell transfusions. Two hundred clinic visits and 65 day hospital attendances were avoided. The nurse-led service resulted in a significant reduction in the waiting time from admission to transfusion and in the total length of in-patient stay. The importance of and satisfaction with different aspects of the care of the transfusion process assessed by a ranking questionnaire showed improved satisfaction scores for all aspects of care. Preference for home blood sampling instead of hospital increased from 24% before to 100% after intervention. We have shown that a dedicated transfusion nurse provides a quality service between hospital and home that is greatly appreciated by patients requiring regular transfusions.

Adult↗
PubMed1998

Modeling acute and chronic toxicity of nonpolar narcotic chemicals and mixtures to Ceriodaphnia dubia.

The response of the daphnid Ceriodaphnia dubia to six widely used industrial chemicals acting through nonpolar narcosis and a mixture was determined. Toxicological effect levels were based on reasonably steady-state, measured concentrations. Reproductive IC50S were 149 microM benzene, 82 microM trichloroethylene, 35 microM toluene, 31 microM ethylbenzene, 26 microM m-xylene, and 4 microM tetrachloroethylene. A QSAR describing 2-day LC50S as a function of log Kow accounted for 90.97% of the variation in response across chemical. A similar QSAR for chronic effects on reproduction accounted for 78.92%. Mixtures of benzene, trichloroethylene, and toluene had effects at concentrations below their individual LOELs. Observed effects of 20/24 mixtures tested fell within the 95% prediction interval for a concentration-addition model of joint action derived from tests with individual components. However, the observed response differed significantly from the predictive relationship. In general, the predictive relationship overestimated mixture toxicity. Fitted relationships reduced observed error by as much as 82% compared to the predictive model.

Animals↗
PubMed1998

Impact of a case management protocol for childhood pneumonia in a rural Zambian hospital.

This study aimed to assess the impact of adopting the WHO case management protocol for childhood pneumonia in a district hospital in rural Zambia. The subjects were children under 5 years of age with a diagnosis of pneumonia, admitted in the 9-month period following introduction of the WHO protocol. Management and outcome were compared with a historical control group admitted during the same period in the previous year. There were 158 children in the intervention group and 135 controls with similar age and sex distribution. Both groups were malnourished (mean weight-for-age Z score in subjects = -1.91, in controls = -1.83). There was no significant difference in the numbers receiving parenteral antibiotics or supplementary fluids in each group. However, children in the intervention group were significantly more likely to receive oxygen (odds ratio 4.7, 95% confidence interval 2.8-8.1, p < 0.0001). Mortality was significantly greater in the control group (case fatality rate, 25%) compared with the intervention group (case fatality rate, 15%; chi 2 = 4.6; p = 0.032). The introduction of the WHO protocol for management of childhood pneumonia and training of staff in its use was accompanied by a fall in mortality from this condition in a rural hospital. The improved survival rate may be related to the more frequent use of oxygen.

Anti-Bacterial Agents↗
PubMed1998

Establishing patient preferences for blood transfusion support: an application of conjoint analysis.

OBJECTIVE: To develop a method of determining the relative importance of waiting time and location of care for patients with haematological disorders requiring red cell transfusion. Such information is particularly relevant when evaluating interventions that affect patient well-being (e.g. by changing waiting time and location) but do not affect health outcomes. METHODS: Conjoint analysis is used to assess the relative importance of waiting time and location with respect to pre-transfusion testing and red cell transfusion. Compensation is also included as an attribute in order to estimate the monetary value of changes in waiting time and location. RESULTS: Waiting time and location are important attributes in the provision of pre-transfusion testing and red cell transfusion. Compensation is not an important attribute. On average patients are willing to wait an additional 45 minutes in order to have pre-transfusion testing in their own home and an additional 35 minutes in order to receive red cell transfusions in their preferred location. CONCLUSION: The relative importance of waiting time and location of care was established. However, it was not possible to assign monetary values since compensation was not an important attribute for these respondents. The paper highlights the scope for using conjoint analysis to analyse the non-health benefits that may result from changes in the delivery of care.

Appointments and Schedules↗
PubMed1997

Constant and decreasing timing aversion for saving lives.

The traditional model of time preferences employed by economists is characterised by constant timing aversion. The available evidence suggests that this is not an appropriate assumption. This paper examines evidence for constant and decreasing timing aversion with respect to saving lives. Three discounting models are considered: the constant discounting model; the proportional discounting model; and the hyperbolic discounting model. Data collected from the general public are used to test the constant timing aversion model. Overall, the findings suggest that there is substantial evidence for decreasing timing aversion and against the constant timing aversion hypothesis.

Attitude to Health↗
PubMed1997

Accelerated bacteriological evaluation in the management of lower respiratory tract infection in general practice.

This paper examines the use of overnight accelerated bacteriological evaluation (ABLE) in the treatment of lower respiratory tract infection in general practice. The use of ABLE is compared with the empirical prescribing of antibiotics. The results indicate that ABLE leads to a saving in resource use without a deterioration in clinical outcome. In view of there being additional benefits, such as reduced antibiotic exposure and repeat visits, it is concluded that the use of ABLE in the way described would improve the management of lower respiratory tract infection in general practice.

Anti-Bacterial Agents↗
PubMed1997

Cost effectiveness of a mass media-led anti-smoking campaign in Scotland.

OBJECTIVE: To evaluate the costs and outcomes associated with the Health Education Board for Scotland's general public anti-smoking campaign during the developmental stage and its first year of operation. DESIGN: Cost information collected retrospectively was combined with prospectively collected effectiveness data. SUBJECTS: A panel of 970 adults were recruited from a 1-in-10 random sample of adult callers to the telephone helpline (Smokeline). Those who smoked were subsequently interviewed at three weeks, six months, and one year follow up. Information on smoking status at one year and time spent as a non-smoker was available for 587 members of the panel. MAIN OUTCOME MEASURES: Intermediate outcomes in the follow-up sample included a point prevalence and period prevalence measure of smoking cessation. Long-term outcomes were measured in terms of predicted reductions in mortality as a consequence of smoking cessation. RESULTS: At the 12-month point, 9.88% of individuals in the follow-up sample reported themselves as non-smokers and as having given up for at least six months in the previous year. Estimates of the cost per life-year saved as a result of the campaign range from 304 pounds sterling to 656 pounds sterling. CONCLUSIONS: Provided that the benefits of smoking cessation are broadly accurate, and the assumed level of quitting can be directly attributed to Smokeline, then this mass media-led anti-smoking campaign appears to have been cost effective.

Adult↗
PubMed1997

A framework for the economic evaluation of telemedicine.

This paper describes the economic issues associated with the introduction of telemedicine systems and the main challenges to their evaluation. An approach to the economic evaluation of telemedicine is described based on a cost-consequence framework. The paper links these costs and consequences more formally within a set of evaluative questions which in turn forms the basis for an economic model for evaluating telemedicine. By outlining the key questions, a number of issues relevant to the evaluation of telemedicine are identified and considered. The main challenges to the economic evaluation of telemedicine include: constantly changing technology; lack of appropriate study design to manage the frequently inadequate sample sizes; inappropriateness of the conventional techniques of economic evaluation; and the valuation of health and non-health outcomes. The present study addresses these challenges and suggests ways of advancing the techniques for the economic evaluation of telemedicine.

Capital Expenditures↗
PubMed1997

Defining goals and conditions for a sustainable world.

Sustainable development is being approached component by component--socioeconomic, sustainable agriculture, transportation, forestry, energy use, cities, and the like--but, leaving a habitable planet for future generations will require the development of a widely shared paradigm. Further, the paradigm should be ecological from a scientific point of view. This development will be facilitated by a discussion of goals and those conditions necessary to meet them. The presently shared paradigm is that economic growth is the cure for all of society's problems, such as poverty, overpopulation, environmental degradation, and the increasing gap between rich and poor. A paradigm shift from growth to sustainability might result either from suffering painful consequences of continuing to follow out-moded paradigms or by discussing what sort of ecosystems will be available to future generations. The purpose of this paper is to help initiate such a discussion.

Ecosystem↗