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Biomedical subjects

J D Holden

Publications and source records attributed to J D Holden.

11 recordsLinked to original sources
PubMed1996

Auditing palliative care in one general practice over eight years.

OBJECTIVE: To document the delivery and outcome of palliative care in one practice. DESIGN: All appropriate deaths were documented over the period of the study. SETTING: One general practice of four doctors caring for 8000 patients in the North-West of England. SUBJECTS: All patients dying of malignant disease which had included a palliative phase of at least one week. MAIN OUTCOME MEASURES: Place of death; continuity of care; general practitioners' assessment of symptom relief; follow-up of bereaved relatives. RESULTS: 118 deaths from terminal malignant disease were recorded over eight years in my practice. 75% were being cared for by us (GPs) at the time of death. More detailed information was recorded on 64 of these patients showing generally "satisfactory" care. CONCLUSIONS: A simple audit can help maintain high standards of palliative care. General practitioners are encouraged to maintain registers of the care received by terminally-ill patients as an aid to quality assurance in this area.

England↗
PubMed1994

Benzodiazepine prescribing and withdrawal for 3234 patients in 15 general practices.

Benzodiazepines are still widely prescribed in general practice, despite repeated warnings about the problems associated with their use. Other studies have shown that a variety of interventions can reduce prescribing, but these have been restricted to relatively few general practices or patients. We co-ordinated an audit of benzodiazepine prescribing and withdrawal in 15 practices caring for 87,900 patients across a district. In total 3234 patients (37 per 1000 registered patients) were discovered to be taking the drugs at the start of the programme, and 16% of these people stopped taking the drugs by the conclusion of the audit 8 months later. There was no relation between success at benzodiazepine cessation and initial levels of prescribing, nor with practice size. Younger patients were significantly more likely to stop benzodiazepines than those over the age of 65.

Adult↗
PubMed1991

General practitioners and work in the Third World.

In recent years the number of general practitioners who have worked in the third world before entering general practice has fallen. The reasons for this are not clear but may include worries about future career prospects. Ninety four doctors who had entered general practice since 1984, after previously working in the third world, completed a questionnaire about their career experience and views about the value of such work. They were generally widely experienced and well-qualified and work abroad had not apparently harmed their careers, rather, many believed it had enhanced it. Work in the usually arduous conditions of poor countries was often considered by the respondents to lead to a wider perspective, increased maturity, confidence, self-reliance, adaptability and initiative. Doctors who are interested and suitable for work in the third world prior to entering general practice should be encouraged to pursue this possibility.

Career Mobility↗
PubMed1987

Benefits and risks of childhood immunisations in developing countries.

The ratio of benefit to harm from an imaginary, modest immunisation programme in a developing country and the numbers of lives likely to be saved and severe handicaps prevented have been estimated. Immunisation is much more likely to benefit children than to harm them, and health workers can be confidently encouraged not to withhold the benefits of immunisation from most children.

Child↗