Search PubMed⌕ Search

Biomedical subjects

K Newman

Publications and source records attributed to K Newman.

At least 19 recordsLinked to original sources
PubMed2000

Comparison of efficacy and safety between flunisolide/AeroChamber and budesonide/turbuhaler in patients with moderate asthma. AER-MD-04 Study Group.

BACKGROUND: There is a limited body of evidence comparing the clinical effects of different inhaled corticosteroids in the treatment of asthma. This study compared the safety and efficacy of inhaled flunisolide and budesonide, both with unique delivery systems that may affect clinical response. OBJECTIVE: This multicenter study was carried out to compare the efficacy and safety of flunisolide, administered via AeroChamber, with budesonide, administered via Turbuhaler, in the treatment of moderate asthma. METHODS: Patients with moderate asthma, defined as an FEV1 of 40% to 85% of predicted, underwent a 2-week run-in period during which beclomethasone, 750 microg twice daily by MDI, was administered, along with salbutamol prn. Patients (n = 176) were then randomized into two groups. One group received flunisolide administered via AeroChamber, 750 microg (3 puffs), twice daily. The second group received budesonide administered via Turbuhaler, 600 microg (3 puffs), twice daily. All patients took salbutamol prn. RESULTS: At the end of the 6-week treatment period, there were no significant differences (P > .05 for all comparisons) in efficacy between the groups as evaluated by any efficacy parameter. The treatment groups also did not differ significantly in the number of adverse events or in the incidence of oropharyngeal Candida infection. CONCLUSION: Flunisolide administered by AeroChamber and budesonide administered via Turbuhaler demonstrate similar efficacy and safety in the treatment of moderate asthma.

Administration, Inhalation↗
PubMed1999

Meeting the information needs of clinicians for the practice of evidence-based healthcare.

This article reports on clinicians' use of library resources and the competencies they require to access information necessary for the practice of evidence-based healthcare. It is based on the results of a study commissioned by North Thames Region to identify the training needs of clinicians for the adoption and practice of evidence-based healthcare. Participants in this qualitative research study included librarians, clinicians (doctors, nurses and PAMs) and managers from four Acute and Community Trusts in and around London. The research indicates that the majority of clinicians recognize the need to keep up-to-date with changes in their specialty and many visit their libraries on a frequent basis, however, few appear to be searching for information with which to inform their immediate clinical decisions. Our sample acknowledged their low usage of journals such as Bandolier, the Health Effectiveness Bulletin and Journal of Evidence-Based Medicine. Similarly, low use of electronic databases, such as Cochrane and Cinahl, were reported. Examination of skill and self-efficacy levels in accessing and using information databases revealed wide variations across professions, specialities and Trusts. Qualitative research methods were employed to elicit the key competencies required to access clinically relevant research evidence, and a framework for integrating these competencies is presented.

Administrative Personnel↗
PubMed1998

Managing evidence-based health care: a diagnostic framework.

This paper proposes a diagnostic framework useful to Trust managers who are faced with the task of devising and implementing strategies for improvements in clinical effectiveness, and is based on a recent study incorporating clinicians, managers, and professional staff in four NHS Trusts in the North Thames Region. The gap framework is inspired by the gap model developed by Zeithaml, Parasuraman and Berry from their research into service quality and incorporates Dave Sackett's schema as well as a personal competency profile needed for the practice of evidence based health-care (EBHC). The paper highlights the four organisational and personal failures (gaps) which contribute to the fifth gap, namely the discrepancy between clinically relevant research evidence and its implementation in health care. To close the gaps, Trusts need to set the goal and tackle the cultural, organisational, attitudinal and more material aspects such as investment in the information infrastructure, education and training of doctors. Doctors need to go through a process from awareness to action facilitated through a combination of personal and organisational incentives and rewards as well as training in the requisite skills. Researchers should take steps to improve the quality of the evidence and its accessibility and purchasers should reinforce the use of EBHC by withdrawing funding for care which has proved to be ineffective, inappropriate or inferior.

Awareness↗
PubMed1998

For Better, For Worse.

This article addresses the extent to which provisions within Article 16 of the Universal Declaration of Human Rights have influenced subsequent developments in the field of sexual and reproductive health and rights. In particular, it assesses how the right to marry and to found a family, the requirement of free and full consent of intending spouses, and recognition of the family as the "natural and fundamental group unit of society" have affected service provision in this field. Other human rights instruments, such as the Women's Convention, have amplified these rights, but some issues within reproductive health continue to be limited by conventional interpretations of the family, as identified in the UDHR. While the language within Article 16 was clearly molded by the morality of the 1940s, it has, so far, proven to be flexible enough to encompass both social change and technological innovation.

Journal Article↗
PubMed1997

Towards a new health care paradigm. Patient-focused care. The case of Kingston Hospital Trust.

Patient-focused care (PFC) and business process re-engineering (BPR) have been advocated in the academic literature as techniques to improve both quality of service and reduce costs. Seeks to separate and delineate the components of PFC and BPR and, using the case study method, describe the adoption and implementation process of PFC in medicine and maternity by one London NHS Trust Hospital. Reports the impact of this innovation on service delivery, staff reconfiguration and multi-skilling. Identifies preconditions and key success factors and indicates lessons for the future.

Ergonomics↗
PubMed1997

Mission impossible? The definition and functions of the medical director.

Seeks to throw light on both strategic and managerial aspects of the post of medical director. The medical director is a key executive member of the Trust Board, yet the role remains ill-defined. The existing published guidance gives some indication of what medical directors should be doing but gives limited information about "best practice" or how to cope with the demands being made on them. A survey of medical directors in 1994 revealed the diversity of the tasks that they can be called on to perform, often with inadequate managerial and secretarial support. The survey also indicated that problems have occurred as a result of the heavy workload and unexpected multiple facets of the role. Concludes that, to make the job somewhat easier, there should be a clear core job specification which is tailored to suit the individual circumstances. This should be combined with generous support and training, together with a suitable reward package.

Data Collection↗
PubMed1996

Quality matters: junior doctors' perceptions.

Presents the results of an empirical study of junior doctors' views on quality and clinical audit in health care. Claims that the requirement for annual efficiency gains and rising patient expectations, together with the realization that the "costs of quality" can consume between 30 and 50 per cent of costs, has brought quality in health care to the forefront. In this context, and because much of the medical care is delivered by junior doctors, studies their perceptions on dimension of quality in health care, their knowledge of, and participation in, clinical audit and the obstacles to providing quality care. Makes a striking finding--the low priority given to patient satisfaction--a perspective which is out of alignment with the priorities of government policy, and the whole philosophy of "quality in service". Asserts that the role, significance and outcome of clinical audit as a quality improvement tool is cast into doubt by these consultants of tomorrow.

Attitude of Health Personnel↗
PubMed1996

Junior doctors and management: myth and reality.

Uses an empirical investigation based on a survey of junior doctors in five NHS trust hospitals, to examine their attitudes towards both the general principle of clinical involvement in hospital management and the particular prospect of exercising such a role themselves. Finds that junior doctors, with few exceptions and irrespective of grade, were very positive towards clinical management roles in NHS trusts and were almost universally keen to assume management responsibilities when they were more senior. At the same time, finds junior doctors to have little concept of the doctor manager role or the recognized and demanded specific preparation for assuming management responsibilities.

Attitude of Health Personnel↗
PubMed1995

Complete surgical resection combined with aggressive adjuvant chemotherapy and bone marrow transplantation prolongs survival in children with advanced neuroblastoma.

BACKGROUND: A multi-modality approach combining surgery with aggressive chemotherapy and radiation is used to treat advanced neuroblastoma. Despite this treatment, children with advanced disease have a 20% 2-year survival rate. Controversy has developed regarding the efficacy of combining aggressive chemotherapy with repeated surgical intervention aimed at providing a complete surgical resection (CSR) of the primary tumor and metastatic sites. Several prospective and retrospective studies have provided conflicting reports regarding the benefit of this approach on overall survival. Therefore, we evaluated the efficacy of CSR versus partial surgical resection (PSR) using a strategy combining surgery with aggressive chemotherapy, radiation, and bone marrow transplantation (BMT) for stage IV neuroblastoma. METHODS: A retrospective study was performed with review of the medical records of 52 consecutive children with neuroblastoma treated between 1985 and 1993. Twenty-eight of these 52 children presented with advanced disease, 24 of which had sufficient data to allow for analysis. All children were managed with protocols designed by the Children's Cancer Group (CCG). Statistical analysis was performed using Student's t test, chi 2 test, and Kaplan-Meier survival curves. RESULTS: Mean survival (35.1 months) and progression-free survival (29.1 months) for the CSR children was statistically superior to that of the PSR children (20.36 and 16.5 months, p = 0.04 and 0.04, respectively). Similar significance was demonstrated using life table analysis of mean and progression-free survival of these two groups (p = 0.05 and < 0.01, respectively). One-, 2-, and 3-year survival rates for the CSR versus the PSR group were 100%, 80%, and 40% versus 77%, 38%, and 15%, respectively. An analysis of the BMT group compared with those children treated with aggressive conventional therapy showed improvement in mean and progression-free survival. CONCLUSIONS: Aggressive surgical resection aimed at removing all gross disease is warranted for stage IV neuroblastoma. CSR is associated with prolonged mean and progression-free survival. BMT prolongs mean and progression-free survival in children with stage IV disease. These results suggest that CSR and BMT offer increased potential for long-term remission in children with advanced neuroblastoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

The pre-registration year. It's time for job reprofiling.

The pre-registration house officers' year has a dual purpose. On the one hand, there is the basic service requirement for long hours of routine assistance to senior medical staff. On the other hand, there is the educational component of the job as seen in the GMC and post-graduate deans' objectives. Reports on a study which shows there is considerable tension between these two objectives. Examines the extent and nature of this divergence. Suggests that there are two problems to be addressed: how best to generate a sense of ownership and affinity to the trust hospital, and even more fundamental, requires a strategic audit and reappraisal of the purpose of the pre-registration year and strongly suggests the desirability of reprofiling it in order to provide a rich working experience and learning environment.

Data Collection↗
PubMed1994

Aortic mural thrombus presenting as pseudovasculitis.

Three months after splenic infarct, a 50-year-old woman underwent arteriography for persistent low-grade fever and abdominal complaints. After 5 months of corticosteroid therapy for "polyarteritis nodosa," another arteriogram confirmed embolic disease; transesophageal echocardiography (TEE) showed a pedunculated mobile thrombus in the aortic arch. We suggest this represents "pseudovasculitis" from an aortic thrombus.

Aorta, Thoracic↗
PubMed1992

Pancreatoduodenectomy with preservation of the stomach and pylorus: a safe and effective alternative in children.

The time-honored surgical approach to resectable tumors of the head of the pancreas or distal common bile duct has been a Whipple operation for adults and children. In recent years, pylorus-preserving pancreatoduodenectomy has been used for adults. The postoperative physiological advantages may be enhanced in children, and for this reason the pylorus-sparing approach was used in a 15-year-old girl with a tumor of the distal common duct. The pylorus-preserving pancreatoduodenectomy was safe and effective in this patient and should be considered for children with resectable tumors of the distal common bile duct and pancreatic head.

Adolescent↗