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Biomedical subjects

M Lakhani

Publications and source records attributed to M Lakhani.

At least 19 recordsLinked to original sources
PubMed1999

Quality of care of patients with diabetes: collation of data from multi-practice audits of diabetes in primary care.

BACKGROUND: GPs are now playing a greater role in the care of patients with diabetes. The challenges described in the Saint Vincent Joint Task Force Report include achievement of a reduction in long-term complications by collecting key clinical information and systematically organizing care of patients with diabetes. The number of practices conducting audit and the number of primary care audit groups conducting multi-practice audits of diabetes have increased since the introduction of audit in 1991. OBJECTIVES: We aimed to determine the feasibility of collating data from multi-practice audits of diabetes in primary care and to describe the pattern of care for diabetes patients in primary care. METHODS: A confidential postal questionnaire was sent to all medical audit advisory groups that had completed a multi-practice audit of diabetic care. The main outcome measures studied were prevalence and treatment of known diabetes and annual compliance with key process measures. RESULTS: Data could be collated for 17 of the 25 audit groups that supplied data representing information from 495 practices with 38 288 diabetic patients. Seven audit groups supplied data from a population denominator comprising 1475512 patients giving a prevalence of 1.46% (range 1.1-1.7%), 50.7% (range 32.5-69.0%) were managed by general practice only, 19.1% (7.6-39.7%) by hospital care only and 30.2% (11.0-49.5%) by shared care. Annual mean compliance for process measures showed wide variations: glycated haemoglobin or fructosamine checked for 72.5% (range 25.3-89.3%), fundi checked for 67.5% (57.8-86.6%), urine checked for 65.8% (27.5-80.0%), blood pressure checked for 87.6% (76.9-96.5%), smoking checked for 71.45 (21.9-86.0%), feet checked for 67.7% (40.0-90.8%) and BMI checked for 52.5% (26.4-68.2%). CONCLUSION: This study shows the feasibility of collating audit data and the potential of this approach for describing patterns of care and highlighting general and local deficiencies. Information about levels of performance in large numbers of patients can be used to set standards or norms against which individual practitioners can compare their own activity. Comparison of the health needs of local populations with national data could be used to inform commissioning services. However, audits should employ uniform evidence-based criteria so as to facilitate collation and allow comparison.

Data Collection↗
PubMed1999

Approaches to the organization of multi-practice audits in primary health care in the UK.

OBJECTIVE: To investigate the approaches taken by audit groups in primary care in organizing multi-practice audits and to identify the strengths and weaknesses of the methods used. DESIGN: Postal questionnaire survey. SETTING: One hundred and six primary care audit groups in England and Wales. RESULTS: Ninety multi-practice audits had been conducted since 1993, 46 of which were audits of diabetes and 44 of asthma care. A total of 48 completed questionnaires (24 each for asthma and diabetes) were returned (response rate 53%). Audit groups reported inviting 3338 practices to take part, of which 1157 completed the audit. The commonest methods used to encourage practice participation were a personal letter (75%), audit group newsletter (63%) and sending an audit protocol to the practice (63%). Groups used various methods for selecting audit review criteria, however only three (6%) used a systematic review of available literature. Each audit group advocated a number of methods for identifying patients and for data extraction. Forty-one (85.6%) groups reported that practices received feedback of results in an individualized practice feedback report. In 19 (39.6%) audits, the audit group had not undertaken any follow-up. CONCLUSIONS: The findings indicate that multi-practice audit can encourage the participation of large numbers of practices. Audit groups are co-ordinating multi-practice audits and feeding back information to practices on a comparative basis. However, there are weaknesses in the design and conduct of some audits. Groups should pay more attention to the selection of audit criteria, methods of identifying and sampling patients, data collection procedures, and methods for implementing changes in performance. For other countries that are beginning quality improvement activities, the results of this study emphasize the need to give attention to basic methodological principles.

Asthma↗
PubMed1999

Factors relating to readmission of term and near-term neonates in the first two weeks of life. Early Discharge Survey Group of the Health Professional Advisory Board of the Greater New York Chapter of the March of Dimes.

AIMS: A multisite study of term and near term infants readmitted in the first two weeks of life to 9 New York City area hospitals in 1995 was conducted to evaluate factors related to readmission, including length of newborn stay. RESULTS: Of the 30,884 infants born at the 9 study hospitals 391 newborns were readmitted. The major admission diagnoses were infection, 40.7%, hyperbilirubinemia, 39.1%, and feeding and/or gastrointestinal problems, 10.5%. In the first week, 65.1% of readmissions were for hyperbilirubinemia and 19.1% were for infection or suspected sepsis. In the second week, 67.8% of readmissions were for infection and 7.6% were for hyperbilirubinemia. Hyperbilirubinemia was the most frequent diagnosis for White and Asian infants, while infection was most frequent for African-American and Hispanic infants. Age at readmission was younger and the interval from discharge was shorter for infants with hyperbilirubinemia. Abnormalities which should have precluded early discharge included feeding difficulties, cyanotic congenital heart defects, hemolytic disease of the newborn, early jaundice or early high bilirubin levels. CONCLUSION: Attention to identification of infants at risk and programs such as lactation counseling and universal screening for bilirubin (with appropriate interpretation) prior to discharge could have reduced the necessity for readmission regardless of the newborn length of stay.

Adolescent↗
PubMed1997

In vitro effect of furosemide on the chemiluminescence of polymorphonuclear neutrophils in preterm infants.

We tested the hypothesis that the phagocytic activity of polymorphonuclear neutrophils (PMNs) of neonates is more sensitive to furosemide (FU) in vitro than that of adults. Phagocytosis was monitored by chemiluminescence of PMNs in cord blood of full-term (n = 10) and preterm (n = 8) neonates in the presence of 0, 6, 9, and 12 micrograms/ml of FU. Venous blood from adults (n = 10) was used for comparison. Random motility and chemotaxis were also determined in the three groups. The peak chemiluminescence of PMNs in preterm neonates was significantly decreased at a FU concentration of either 6, 9, or 12 micrograms/ml when compared to full-term infants. In contrast, no difference was observed between full-term infants and adults. Random motility and chemotaxis were comparable in all groups, regardless of the FU concentration. The results of this study suggest that preterm infants may be more sensitive to FU, as indicated by the adverse effect of this drug on chemiluminescence activity of their PMNs, in vitro.

Adult↗
PubMed1997

Effective audit in general practice: a method for systematically developing audit protocols containing evidence-based review criteria.

Though many general practitioners (GPs) now take part in audit, there is still concern about the extent to which participation in audit leads to improvements in practice. Improved methods are needed for the incorporation of research evidence into criteria for use in audit. In this paper, a six-stage systematic method is described for developing audit protocols containing prioritized evidence-based criteria. The stages are: selection of a topic, identification of key elements of care, focused literature reviews, prioritization of the criteria on the strength of the evidence and impact on outcome, preparation of full documentation, and peer review.

Clinical Protocols↗
PubMed1990

Ethical dilemmas of health care in the developing nations.

Limited resources, widespread poverty, and the absence of health insurance pose daily ethical problems for Third World physicians, who must balance their roles as individual patient advocates against a desire to provide health care to the greatest number of children. Pakistan has a per capita income of Rs. 7,220 (US$ 380) per year, or Rs. 800 (US$ 32) per month. The annual population growth of the country is 3.1%, and approximately 360,000 infants are born each year in Karachi, the largest city in the country. The Aga Khan University Hospital, a private teaching institution, is the only hospital in Karachi with a Level III Neonatal Intensive Care Unit (NICU). The financial and medical data of 200 infants admitted to the NICU in 1988 were reviewed retrospectively, and compared with those of two specific subgroups. (1) Among 15 infants who underwent surgical intervention, the average total cost of hospitalization was Rs. 36,040 (US$ 1,900) per patient, with an average daily cost of Rs. 923 (US$ 49). The longest hospital stay was 6 months, for a child who had total colonic aganglionosis associated with a short gut syndrome. There were two deaths in this group. (2) Of the 21 premature neonates admitted having Idiopathic Respiratory Distress Syndrome (IRDS) during this period, the total hospitalization cost per patient was Rs. 23,260 (US$ 788), with a daily cost of Rs. 1,050 (US$ 55). Eleven patients required ventilatory support. There were 16 survivors. Among both groups, 6% of all revenues generated in the NICU were used to help families pay for the bills under a welfare scheme.

Developing Countries↗
PubMed1989

Neonatal screening for congenital hypothyroidism in Pakistan.

Congenital hypothyroidism is a preventable cause of mental retardation. Since clinical signs of congenital hypothyroidism do not generally become obvious before three months of age, screening programmes have been introduced in North America and Europe, which consist of T4 or TSH screening on newborn infants on the third day of life. The screening for congenital hypothyroidism was initiated in Pakistan by the Aga Khan University Hospital (AKUH) in March 1987. By April 1988, 5000 neonates were screened and five cases of congenital hypothyroidism were diagnosed. The study revealed the incidence of hypothyroidism to be one case per 1000 newborns which is about 4 times more than that in the West.

Congenital Hypothyroidism↗
PubMed1987

A comparison of verapamil and digoxin in the treatment of atrial fibrillation.

Twelve patients (including 2 females) with chronic atrial fibrillation were entered into a randomized, double blind crossover study to compare the effects of digoxin and verapamil upon heart rate, exercise tolerance and symptom control. The dose of digoxin was adjusted so as to give serum concentrations within the range 1.3 to 2.6 nmol l-1 between four and six hours after dosing, and was continued for six weeks. The dose of verapamil was increased from 40 mg tds to 80 mg tds to 120 mg tds at fortnightly intervals. Three patients did not complete the study; two because of adverse effects attributable to verapamil. In the remaining nine patients, mean post exercise heart rates were significantly lower during treatment with verapamil 80 mgs tds (126.7 bpm) than with verapamil 40 mg tds (148.6 bpm) or digoxin (146.7 bpm). However, exercise tolerance was similar with both verapamil and digoxin and the superior control of exercise induced tachycardia achieved with higher doses of verapamil was not associated with improved exercise endurance. Visual analogue scale scores for constipation were significantly higher during treatment with verapamil; scores for other possible side effects and for overall wellbeing were similar. The results do not confirm the findings of others who have reported that verapamil is superior to digoxin in the treatment of atrial fibrillation.

Aged↗