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Biomedical subjects

Jon Nicholl

Publications and source records attributed to Jon Nicholl.

8 recordsLinked to original sources
PubMed2003

Acute Pain Teams in England: current provision and their role in postoperative pain management.

This survey describes the current provision of multidisciplinary Acute Pain Teams (APTs) in acute English hospitals performing adult in-patient surgery (excluding maternity). Associations between the presence of an APT and a number of organizational and clinical initiatives for the management of postoperative pain are also explored. Postal questionnaires were sent to the Clinical Director of Anaesthetics or head of the APT at every acute English hospital providing separate anaesthetic services. After written and telephone reminders, the response rate was 86% (n = 226). Eighty-four per cent (n = 190) of respondents had an APT in their hospital. The presence of an APT was associated (P</=0.05) with higher estimates of patient controlled analgesia and epidural use, regular in-service training for nurses and junior doctors, written guidelines/protocols for management of postoperative pain, routine use of postoperative pain measurement systems and audit/research in relation to postoperative pain issues. Acute Pain Teams, in which nurses play a major role, have a pivotal influence not only in relation to postoperative analgesia but also in wider service development. Since 1995, the number of hospitals offering in-patient surgery that are covered by an APT has risen. However, despite repeated endorsements from professional bodies, some acute hospitals still have no APT and recent evidence indicates that some APTs face financial problems and provide a 'token' service only. Recent policy recommendations may have little impact on the current situation.

Adult↗
PubMed2003

Evaluation of the impact of a technology appraisal process in England: the South and West Development and Evaluation Committee.

OBJECTIVES: To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process. METHODS: Two postal questionnaires examining issues of awareness, influence and quality of the DEC reports were sent to samples of clinical and managerial health service staff in S&W NHS region, the North West NHS region, and three other randomly selected health authorities elsewhere. Supplementary telephone interviews were undertaken with a subsample of staff. Trends in utilisation before and after the publication of four S&W DEC reports were examined using routine health service data. RESULTS: Survey response rates ranged between 73% and 85%. Within health authorities in the S&W, agreement about the impact of the DEC in informing policy and purchasing decisions was consistently high, although responses from clinicians were more equivocal. In the topic areas examined, the impact of the DEC reports could not be separated from wider influences on practice. The cost of each DEC report is estimated to have been pounds sterling 24659. CONCLUSIONS: Health service staff perceived that the S&W DEC process had had an impact on policy decisions and clinical practice locally; however, any actual impact on practice could not be identified with routine data. The approach used in this study would be valuable in evaluating the impact of the English NHS National Institute for Clinical Excellence.

Attitude of Health Personnel↗
PubMed2002

Determining the most effective level of TRISS-derived probability of survival for use as an audit filter.

OBJECTIVE: To determine the most effective cut-off of TRISS-derived probability of survival (TRISS-PS) for the selection of trauma deaths for audit, using a large sample of trauma deaths from the United Kingdom (UK). METHODS: TRISS-PS and avoidability of death (as judged by an independent peer review panel) were compared for a sample of 222 trauma deaths. Sensitivity, specificity and predictive values were calculated for the 0.5 screening cut-off. ROC curves were derived to assess the ability of different levels of TRISS-PS to identify avoidable deaths. Calculations were made for both the raw sample and the sample adjusted for the sampling method used. RESULTS: For the weight-adjusted sample, the sensitivity of TRISS-PS greater than 0.5 for the detection of avoidable death is 80% (95% CI 61-91%), the specificity is 86% (95% CI 80-90%), PPV 42% (95% CI 29-56%) and NPV 97% (95% CI 93-99%). Twenty percent of avoidable deaths would have been 'missed' if the 0.5 level of audit filter had been used. Based on the same sample, the best cut-off is at TRISS-PS 0.33, with a sensitivity of 90% and specificity of 80%. It is estimated that this cut-off would have selected 62 deaths for audit and failed to identify 2 out of 25 avoidable deaths. CONCLUSION: The previously accepted audit filter of TRISS-PS of greater than 0.5 fails to identify a significant proportion of avoidable deaths. This study suggests that the most effective level of audit filter cut-off of TRISS-PS for the trauma system studied is 0.33. This level would identify 90% of avoidable deaths with 80% specificity. Similar ROC curve analysis could be used to determine appropriate TRISS-PS cut-offs for institutions or other trauma systems.

Aged↗
PubMed2002

Women's perceptions of informed choice in maternity care.

OBJECTIVE: to describe the extent to which women using maternity services perceive that they have exercised informed choice. SETTING: twelve maternity units in Wales. DESIGN: postal survey of women using maternity services, covering women's views of the extent to which they exercised informed choice overall, and at eight decision points during their care. PARTICIPANTS: 1386 women at approximately 28 weeks gestation (antenatal sample) and 1741 women at approximately 8 weeks post delivery (postnatal sample). MEASUREMENTS AND FINDINGS: 54% of women perceived that they exercised informed choice overall in the antenatal sample (95% CI: 51-57%) and 54% overall in the postnatal sample (95% CI: 52-56%). Perceptions of informed choice differed by decision point, varying between 31% for fetal heart monitoring during labour and 73% for the screening test for Down's syndrome and spina bifida in the baby. There were differences by maternity unit, even when the characteristics of women attending these units were taken into account. Multiparous women, women from manual occupations and women with lower educational status were more likely to feel that they exercised informed choice during antenatal care. These sub-groups of women were also more likely to report a preference for not sharing decision-making with health professionals. CONCLUSIONS: a large minority of women felt that they had not exercised informed choice overall in their maternity care. The perception of informed choice differed by decision point, maternity unit and characteristics of the woman. IMPLICATIONS FOR PRACTICE: attaining informed choice is more of a challenge for some decision points in maternity care than others, particularly fetal monitoring. The difference in levels of informed choice between maternity units highlights the importance of maternity unit policy in the promotion of informed choice.

Adult↗