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Biomedical subjects

M Lloyd-Williams

Publications and source records attributed to M Lloyd-Williams.

At least 37 records · Page 2Linked to original sources
PubMed1999

A survey of antidepressant prescribing in the terminally ill.

Depression is a symptom in a quarter of patients admitted to a palliative care unit, but little is known of how depression in terminally ill patients is treated. We reviewed 1046 consecutive patient admissions, of whom 106 (10%) were prescribed antidepressant medication while under the care of a palliative care team. Of these patients, 21 were prescribed antidepressants when under the care of the home care team, but 80 patients (76%) were started on medication during the final 2 weeks of life. There was consequently insufficient time for the medication to have any therapeutic effect. Seventeen patients were discharged home on antidepressant medication. Three patients were referred for a psychiatric assessment. Patients prescribed antidepressants were significantly younger (P = 0.002) than those who were not. There were no prescriptions for psychostimulants. Although the numbers of patients prescribed antidepressant medication were low in all disease groups, it was notable that patients with breast cancer were prescribed antidepressant medication more frequently than any other patient group. We conclude that there appears to be a need for a coordinated approach to both the assessment and the treatment of depression in terminally ill patients.

Antidepressive Agents↗
PubMed1999

When health information systems fail.

The failure of health care information systems is a topic of critical importance for information management professionals. Such failure is also important for the consumers of health services who rely on the informed activity of health care workers for their well-being. This article presents case studies of two information systems projects within the British National Health Service that are generally viewed as having failed. The article provides an analysis of these failures, and examines whether the British National Health Service is particularly prone to the phenomenon of information systems failure.

Ambulances↗
PubMed1998

Do bereaved children consult the primary health care team more frequently?

It is known that 2% of all children are bereaved of a parent before the age of 18, but there is little support available for these bereaved children in the community. It is not known if these children consult the primary health care team more frequently than their non-bereaved peers. A record-based, case-controlled pilot study of 13 bereaved children over a 2-year period was carried out in a group general practice. All children had been bereaved of a father through malignant disease, and were from seven families. Children who had been bereaved of a parent attended the surgery more frequently than their age/sex-matched controls. There was an observed increase in the frequency of consultations both in the year preceding and following the bereavement. Post-bereavement, over one-third of consultations were for symptoms for which no organic cause could be found. The support needs of these bereaved children did not appear to be addressed. Further research is required to investigate the optimum means of providing support by the primary health care team for the small but significant number of children who are bereaved each year.

Adolescent↗
PubMed1998

The information concerns of spouses of women with breast cancer: patients' and spouses' perspectives.

A user-centred study employing focus group methodology was conducted in the United Kingdom in order to establish the key information concerns of spouses of women with breast cancer from both patients' and spouses' perspectives. Four unstructured focus group discussions were convened, three with women with breast cancer (n=11, n=7 and n=12) and one with spouses (n=9). The discussions were audio-taped and transcribed in full. All transcripts were analysed manually using theme analysis and considered patterns common to the data. Themes were established and corresponding quotations used to support all themes. Emergent themes were grouped into the following categories: information needs of spouses; sources of information for spouses; and family information. Several important points emerged within each of these categories and these are discussed. Validity was established by participant evaluation of the findings. Findings clearly indicate the key information concerns of spouses from patients' and spouses' perspectives. These findings are of value to health care professionals and have a number of nursing implications. The study also highlights particular areas where further research and development are needed.

Adult↗
PubMed1998

Community hospitals.

Explore the source record for details and available documents.

Health Services Accessibility↗
PubMed1996

An audit of palliative care in dementia.

A retrospective case note audit was conducted in order to determine the most prevalent symptoms in terminal dementia and to assess the palliation given. Seventeen case notes were audited. Pain and dyspnoea were the most common symptoms. The palliation and treatment of constipation and oral candidiasis was within current accepted practice. Palliation of other symptoms were inadequate compared to current accepted practice. There appears to be a reluctance to prescribe opiate analgesia, and when this was prescribed the doses were not modified to achieve full pain or symptomatic relief. Many patients were unable to take medication orally, but syringe drivers were not used. The conclusions include the need for education of both nursing and medical staff as to the current principles of palliative care.

Aged↗
PubMed1996

Palliative care teaching and today's general practitioners--is it adequate?

Although only 25% of patients die at home, more than 90% of the terminally ill patient's last year of life is at home under the care of their own general practitioner (GP). In the United Kingdom, doctors training for general practice undergo a 3-year training with 2 years in hospital posts and a year in general practice. This questionnaire study of 33 GPs who had recently completed their vocational training was carried out to ascertain the teaching given on palliative care during the general practice component of training. Very few GPs (15%) had received tutorials on palliative care from within their practice. Less than a third felt they had received adequate teaching on pain and symptom control and fewer than 10% perceived the teaching on psychological support to be adequate. Compared to previous studies, the knowledge of specific therapeutics in palliative care had improved, but several were uncertain of basic principles such as the maximum dose of oral opiates which could be prescribed. The majority (85%) wished to have a placement in a hospice as part of their vocational training. This survey suggests that today's GPs would be very receptive to more focused teaching on palliative care encompassing both symptom control and psychological care during their GP training and would also welcome the opportunity of a hospice placement.

Clinical Competence↗
PubMed1996

A neural network approach to analyzing health care information.

The article describes an investigation into the use of artificial neural networks for the analysis of health information. The Kohonen self-organizing map technique was used to group 39 European countries according to data extracted from the World Health Organization's Health for All database. The groups were seen to exhibit significantly different characteristics with respect to life expectancy, probability of dying before 5 years of age, infant mortality rate, standardized death rate (SDR) for diseases of the circulatory system, and SDR for external causes of injury and poisoning. Results obtained using the technique were subsequently confirmed by the use of traditional statistical tests.

Cardiovascular Diseases↗
PubMed1996

Education review: A professional development program in health information management.

The article describes the professional development program in health information management offered at the University of Sheffield. The program leads to the award of either the Diploma or the Master of Science in Health Information Management. The aims and objectives of the program are presented, along with the overall program structure, entry, registration, and attendance requirements. The available modes of study are described, along with the assessment methods employed. An outline of the modules offered by the program is provided. Finally, the current status of the program and proposed future developments are discussed.

Education, Graduate↗
PubMed1995

Bereavement referrals to a psychiatric service: an audit.

The majority of people who are bereaved will work through their grief with support from family and friends. Over 30%, however, may require professional support, and studies have shown that most people contact their General Practitioner and primary health-care team for counselling/support. Effective support and counselling can also be given by voluntary agencies. It was decided to audit the referrals made to a bereavement service for bereavement counselling to ascertain the level of support given prior to the referral and whether information had been given to the bereaved regarding the services available to them in the voluntary sector. Twelve referrals were received in the allotted time period, 10 of which were made within the first year of bereavement. Only one referral had been offered counselling by the primary health-care team and one other had been informed of voluntary bereavement support/counselling agencies. Two referrals had abnormal grief reactions requiring psychiatric intervention. Conclusions include raising the awareness of general practitioners and primary health-care teams of the normal grieving process, and increasing the provision of support for the bereaved. It is also suggested that the bereaved are made more aware of the services that voluntary agencies can provide.

Adult↗
PubMed1994

Treatment of depression with flupenthixol in terminally ill patients.

In recent years, there has been much interest in the psychological well-being of cancer patients (Buckberg et al., 1980; Plumb & Holland, 1977; Razavi et al., 1990; Grassi et al., 1989). It is recognized that if depression is detected and treated, the quality of life for the patient is improved (Holland, 1987; Valentine & Saunders, 1989). Many patients are treated with tricyclic anti-depressants which work well in some cases, but these drugs can have the disadvantage of taking 3 weeks before any improvement in the mood of the patient is observed. They can also cause unpleasant side-effects, e.g. dry mouth, urinary retention and constipation. These symptoms are often already present in the terminally ill and their exacerbation can make these drugs unacceptable to such patients. Two cases of depression which were detected on admission to a hospice and which were successfully treated with flupenthixol dihydrochloride are reported.

Aged↗