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Biomedical subjects

M McKee

Publications and source records attributed to M McKee.

At least 145 records · Page 8Linked to original sources
PubMed1997

Deaths from cirrhosis in Poland and Hungary: the impact of different alcohol policies during the 1980s.

OBJECTIVE: To compare patterns of deaths from cirrhosis in Poland and Hungary in the context of differing alcohol policies in the 1980s. DESIGN: Cohort analysis of deaths from chronic liver disease and cirrhosis between 1959 and 1992 using mortality data from the World Health Organization database. RESULTS: The pattern of alcohol related mortality in these countries is quite different. In both countries, death rates increased in the 1960s and 1970s. In Poland, this increase was arrested in 1980 and death rates have levelled out, with the exception of those in young females. In Hungary, rates have continued to climb, although the rate of increase decreased in the 1980s. This change coincides with the introduction of a policy, following the introduction of martial law, to reduce alcohol consumption. CONCLUSIONS: The countries of central and eastern Europe display many similarities in both political history and measures of health such as overall life expectancy. When examined more closely, substantial differences emerge. Policy makers must be cautious about adopting global solutions to health challenges that fail to take into account national variations.

Adult↗
PubMed1997

What happened to life expectancy in Spain in the 1980s?

BACKGROUND: Life expectancy at birth in Spain improved between 1972 and 1982, by 2.5 years for males and 3.2 years for females. This slowed considerably in the following decade, with increases of only 0.5 and 1.7 years respectively. OBJECTIVE: To determine the causes of death that have been responsible for the failure by Spain to maintain in the 1980s and 1990s the rate of improvement in life expectancy seen during the 1970s. DESIGN: Data from WHO mortality tapes grouped in a series of clinically meaningful categories were used to calculate the contribution of each category, in five year age groups, to the changing life expectancy at birth in the two periods. SETTING: Spain. RESULTS: The trend in life expectancy at birth in Spain over this 20 year period can be considered to have two components, both with important consequences for public health policy. Underlying trends include a steady negative contribution from respiratory cancer in men and a reduction in cardiovascular disease. More recent trends include a considerable deterioration in deaths among young adults, most notably from accidents and, possibly, AIDS. CONCLUSION: The failure to maintain the rate of earlier gains in life expectancy in Spain can be attributed largely to a few conditions, although these may indicate less obvious underlying problems. These findings have important consequences for prioritising public health policies.

Accidents↗
PubMed1997

Who decides which pharmacy services are provided in UK National Health Service hospitals?

An interview survey of 129 UK National Health Service doctors, nurses, pharmacists and managers at eight acute care hospitals was conducted in 1994. The survey examined several topics including whether the introduction of the internal market had affected hospital pharmacy services and what those effects had been. An internal market has been introduced and it has had significant effects on the nature and structure of hospital pharmacy services. Directorate pharmacy services were available at six sites. Contracts for specific, usually novel, services had been implemented at one site and contracts had been introduced widely at another hospital. However, all the features of a market were not present at any site. Market orientation also has implications for the equity of service provision, primarily because decision-making regarding service provision is increasingly in the hands of the clinical directors, rather than pharmacy managers. The effects of this change are not yet clear.

Contract Services↗
PubMed1997

Models of hospital drug policy in the UK.

OBJECTIVES: Pharmacists in UK National Health Service (NHS) hospitals have a long tradition of involvement in the development of drug policy. This paper describes various approaches that have been employed in the development and implementation of drug policy in hospitals and examines the evidence for their effectiveness and acceptability in the context of a changing health service. METHODS: A series of focused interviews was conducted with a range of staff, including doctors, nurses, pharmacists and managers at eight hospitals. Interview sites were selected on the basis of a national survey of clinical pharmacy roles and were broadly representative of UK NHS hospitals. Interview data were analysed using constant comparison and analytic induction. RESULTS: Three models used in the development of drug policy were identified: a 'traditional' model, in which a drug and therapeutics committee establishes a hospital-wide formulary which is implemented by pharmacists; a 'combined' model, in which there is much more emphasis on tailoring policies and feedback to specialties or clinical directorates; and a 'medical control' model, in which prescribing decisions are made by individual doctors without reference to explicit policies and with little active pharmacy involvement. Pharmacy involvement was seen as vital to the development of effective policies but hospital-specific factors influenced the choice of model at particular sites. CONCLUSIONS: Hospitals may be moving towards the 'combined' model which could have advantages in the current internal market within the NHS. However, evaluations of the various approaches to drug policy should help inform this decision.

Drug Utilization Review↗
PubMed1997

Surgical outpatients: challenges and responses.

BACKGROUND: Faced with upward pressure on costs from ageing populations and new technologies, those responsible for funding health care are seeking innovative ways of providing that care at lower cost. A common strategy is to shift care from the inpatient to the outpatient setting. This, taken with pressure for greater accountability and improved training, is creating great challenges for those responsible for organizing outpatient care. This paper seeks to review these challenges and the various responses to them. METHODS: A critical review of literature on the changing role of outpatient care, with an emphasis on the current situation in the United Kingdom. RESULTS: Many diverse responses have been developed to address the changing nature of outpatient care. These have certain features, including the recognition that clinicians have the ability to initiate, rather than simply react to change, and an appreciation of the value of clear and definable objectives for outpatient care. They range from discrete interventions addressing a single concern to wholesale restructuring of the system of care, such as one-stop clinics. CONCLUSION: There is now considerable evidence on what can and should be done to improve the existing system of outpatient care.

Ambulatory Surgical Procedures↗
PubMed1996

Setting priorities, can Britain learn from Sweden?

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.

Advisory Committees↗
PubMed1996

Use of a miniaturized test system for determining acute toxicity of toxicity identification evaluation fractions.

A miniaturized test system was developed and used to determine the acute toxicity of effluent fractions separated by HPLC to Daphnia magna and Pimephales promelas. The miniaturized test system consists of exposing test organisms in 1 ml of test solution using 48-well microtiter plates for the test vessels. Several factors were investigated to determine the acceptability of this test system. These factors included organism biomass to test solution ratio, toxicity of the microtiter plates to the organisms, dissolved oxygen in the test solution, partitioning of the test chemicals to the walls of the test vessels, and dilution of the test solution when the organisms are transferred. Toxicity of four reference chemicals to D. magna and P. promelas was also determined using the miniaturized test systems. It was concluded that the test system could be miniaturized and still provide results comparable to those obtained when standard U.S. EPA test procedures were used. The major benefit of using the miniaturized test system is that less solution is required for conducting a toxicity test. This becomes important when only a small amount of test solution is available, as might occur during a toxicity identification evaluation, after an effluent has been fractionated by HPLC. Other benefits include less space required to conduct a test, less time necessary to prepare test solutions, and a reduced volume of waste for disposal.

Animals↗
PubMed1996

What impact do annual public health reports have?

Each district health authority is required to produce an annual report on the health of their population. Although they consume considerable resources, there is little evidence as to their impact on their intended audiences. We describe the results of a postal survey of how these reports are viewed by health authority and local government managers in one region. Eighty-nine out of 139 responded (64%). Over half of the managers had read the reports in their entirety. Most were discussed by health authorities but few by relevant local government committees. There was some disagreement between directors of public health and other health authority managers about the impact of the reports on commissioning. The paper discusses the difficulties in evaluating the impact of annual public health reports. The survey reveals a fundamental disagreement about whether the intended audience should be health care purchasers or the public. This reflects an underlying tension about the role of public health and the debate about its independence.

Administrative Personnel↗
PubMed1996

Preventing sudden infant deaths--the slow diffusion of an idea.

The sudden infant death syndrome (SIDS) is among the leading causes of post-neonatal mortality in industrialised countries. Research has highlighted that many of these deaths are avoidable by adopting a few simple precautions. These include sleeping in the supine position, avoiding exposure to tobacco smoke, breast feeding where possible, and avoiding over heating. The paper traces the development of understanding of the role of sleeping position in the aetiology of SIDS and the diffusion of this knowledge among and within industrialised countries. In retrospect, evidence began to become available in the early 1980s but it was several years before it was acted upon, initially in The Netherlands and subsequently in New Zealand, the United Kingdom and Scandinavia. Several countries have mounted major national preventive campaigns, of various kinds, each of which has been associated with a reduction in deaths from SIDS, but others have not. The reasons for these differences are explored. The evidence for a causal link between sleeping position and SIDS is now very strong and the costs of implementing a policy to change behaviour is small, compared with other health care interventions. This information is now widely available in the international literature. The example of SIDS provides information on the barriers to adoption of knowledge as well as the factors that promote it.

Developed Countries↗
PubMed1996

X-ray film measurements for healed distal radius fractures.

In order to understand the effect of malunion on functional outcome, it is essential that deformity be measured in a consistent manner. A standardized method of measuring eight anatomic parameters at the distal radius was developed. By this method, six x-ray films of healed distal radius fractures were subsequently measured by 16 raters. Rater agreement was quantified by using the intraclass correlation coefficient. Tolerance limits were developed in order to estimate the expected margin of error for each parameter. Parameters measured with high rater agreement include ulnar variance, palmar tilt, and radial shift; however, even experienced clinicians did not readily agree on the size of step and gap deformity. Using the method of tolerance limits, one would expect that two randomly chosen clinicians measuring step and gap deformity on a random x-ray film will differ by more than 3 mm at least 10% of the time. Similarly, repeat step or gap measurements by the same observer are expected to differ by more than 2 mm at least 10% of the time. In view of our inability to measure deformity more accurately, the concept of a specific relationship between a given degree of deformity and outcome must be questioned. Prospective research is needed in order to improve our understanding of the precise relationship between malunion and functional outcome.

Fracture Healing↗
PubMed1996

Changing life expectancy in central Europe: is there a single reason?

BACKGROUND: During the 1980s, at a time that life expectancy at birth in western Europe has increased by 2.5 years, it has stagnated or, for some groups, declined in the former socialist countries of central and eastern Europe. METHODS: A study was carried out to ascertain the contribution of deaths at different age groups and from different causes to changes in life expectancy at birth in Czechoslovakia, Hungary and Poland between 1979 and 1990. RESULTS: Improvements in infant mortality have been counteracted by deteriorating death rates among young and middle-aged people, with the deterioration commencing as young as late childhood in Hungary but in the thirties or forties in Czechoslovakia and Poland. The leading contributors to this deterioration are cancer and circulatory disease but, in Hungary, cirrhosis and accidents have also been of great importance. CONCLUSIONS: The patterns observed in each country differ in the age groups affected and the causes of death. Further work is required to explain these differences.

Adolescent↗
PubMed1996

Challenges of monitoring use of secondary care at local level: a study based in London, UK.

STUDY OBJECTIVE: To provide those working at district level with practical guidance on using hospital data linked to small geographic areas to explore patterns of care. DESIGN: Examination of the association between age standardised hospital episode rates for the commonest diagnostic categories and deprivation levels (Carstairs index) of the electoral ward of residence. SETTING: An inner London district, Kensington, Chelsea and Westminster, with a population of approximately 325,000. POPULATION: All finished consultant episodes recorded in NHS hospitals for the district population in the year to April 1994. MAIN RESULTS: Many, but not all, disease categories were associated strongly with deprivation, with high episode rates in the most deprived electoral wards. This is partly due to more of those in deprived areas being admitted to hospital and to them being admitted more often. CONCLUSIONS: A wide range of factors needs to be taken into account in interpreting these data. They include the contribution of the private sector and artifacts of both the numerator and denominator. This paper provides a framework for those working at district level to begin to analyse the association between hospitalisation and deprivation locally. It also identifies some of the issues that must be taken into account when seeking to interpret these data.

Episode of Care↗