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M Petticrew

Publications and source records attributed to M Petticrew.

53 records · Page 3Linked to original sources
PubMed1997

Systematic review of the effectiveness of laxatives in the elderly.

OBJECTIVES: To determine the effectiveness and cost of laxatives in the prevention and treatment of constipation in the elderly. HOW THE RESEARCH WAS CONDUCTED: Randomised controlled trials (RCTs) of treatment or prevention of constipation were included in the review. INTERVENTIONS: The four classes of laxatives, bulk, osmotic, stimulant laxatives and faecal softeners, were covered by the review. The main laxatives included in the trials were bran, psyllium, prucara, cascara, dioctyl sodium, lactulose, and lactitol. PARTICIPANTS: Elderly people suffering from chronic functional constipation. A trial was eligible for inclusion if all participants were aged 55 years or older and being treated for chronic constipation. The trials reviewed did not provide further subcategorisation by aetiology. MAIN OUTCOMES: Number of bowel movements per week; symptom improvement; stool consistency; abdominal pain. DATA SOURCES: The recent systematic review by Tramonte and colleagues was used as a source of trials (J Gen Intern Med 1997;12:15-24). In addition, the following databases were searched: Embase, Psychlit, Medline, the Cochrane library, the nursing database CINAHL, International Pharmaceutical Abstracts, and the alternative therapies database, AMED. Authors and manufacturers were also asked for information. Studies in any language were eligible for inclusion. Decisions on the relevance of primary studies were made independently by two reviewers. Economic information was searched for in Current Contents/Clinical Medicine, Medline, and the NHS Economic Evaluation Database (NEED). VALIDITY ASSESSMENT: The quality of primary studies was summarised on a 6-item scale. This covered reporting of inclusion and exclusion criteria, randomisation method, standardised assessmment of adverse effects, double-blind design, description of withdrawals, and statistical analysis. The assessment of validity of included studies was carried out independently by two reviewers. Data were extracted from studies independently by two reviewers. Authors were contacted for more information where necessary to obtain unpublished information. CLINICAL TRIALS INCLUDED: Ten trials comparing single agents with placebo were identified, with a total of 367 patients were identified, with a total of 367 patients who had a mean age of about 74 years. Two of these presented no information on the numbers of men and women (54%) in the remaining eight trials. The majority of patients were in an institutional setting, such as a nursing home or hospital. Ten trials compared one laxative agent with another. The mean age of participants in these trials was estimated at 77 years. Only one trial examined patients in an outpatient setting; the other trials were carried out in nursing homes or hospitals. (ABSTRACT TRUNCATED)

Adult↗
PubMed1995

Coronary revascularisation: why do rates vary geographically in the UK?

OBJECTIVE: To explain the reasons for geographical variation in the use of coronary revascularisation in the United Kingdom. DESIGN: This was a cross sectional ecological study. SETTING: NHS and independent hospitals performing coronary revascularisation for the 11.6 million residents of the south east Thames, East Anglian and north western health regions in England plus Greater Glasgow, Lanarkshire, Ayr and Arran health boards in Scotland were included. SUBJECTS: All residents aged > or = 25 years in 1992-93 who underwent coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) in either the public or private sector were included. MAIN MEASURES: Crude and age-sex standardised intervention rates for residents of the 42 constituent districts and boards were determined. Variation was measured using the systematic component of variation. RESULTS: Considerable systematic variations in district rates of CABG and PTCA existed. These variations mostly arose from differences in supply factors. Higher rate districts were characterised by being close to a regional revascularisation centre and having a local cardiologist. Demand factors such as the level of need in the population (measured by coronary heart disease mortality) and the lack of use of alternative treatments not only failed to explain the observed variation but were inversely associated with the rate of intervention--an example of the inverse care law. The finding that the residents of more socially deprived districts experienced higher intervention rates was probably subject to confounding due to their close proximity to specialist centres. CONCLUSIONS: If greater geographical equity of use for the same level of need is to be achieved, attention must be paid to the supply factors that determine levels of utilisation. As responsibility for purchasing these procedures is decentralised, utilisation might become even more unequal.

Adult↗
PubMed1994

Trends in the age and sex of patients undergoing coronary revascularisation in the United Kingdom 1987-93.

OBJECTIVES: To describe how coronary revascularisation rates in the United Kingdom (in the public and private sectors) vary by age and sex; how these relations have changed between 1987 and 1993; whether significant differences exist between geographical areas, public and private sectors, and hospitals; and to make comparisons with trends in North America. DESIGNS: Secondary analysis of data on the age, sex, procedure, NHS/private, and health district of residence of patients. SETTING: Resident population of South East Thames, East Anglian, and North Western health regions and Greater Glasgow, Lanarkshire, and Ayr/Arran health boards (11.6 million; 20% United Kingdom population). PATIENTS: All 19,665 residents who underwent either coronary artery bypass grafting or percutaneous coronary angioplasty without any concomitant procedure during 1987-8, 1989-90, 1991-2 and 1992-3 in either NHS or independent hospitals. MAIN MEASURES: Population based rates of revascularisation by age, sex, area of residence, and NHS/private treatment. Secular trends in the age (mean, standard deviation, range), and sex ratio (male to female) of patients. RESULTS: Revascularisation rates in men were about four times higher than in women (1992-3: 1340 v 362/10(6) aged 25 years or more). The highest rates were in those aged 55-64 years (for men) and 55-64 and 65-74 years (for women). In 1992-3 the mean age of female patients was three years older than that for men (61.2 v 58.3) and that for coronary artery grafting was over two years older than for angioplasty (59.4 v 56.9). Between 1987-8 and 1992-3 the male to female ratio decreased (4.2:1 to 3.55:1) and the mean age of patients increased steadily by about six months each year. Intervention rates for the older groups increased faster than those for the younger, particularly in high rate regions. The age and sex mix of patients varied between regions and districts/boards. The mean age of patients varied by nine years and the sex ratio varied twofold between NHS hospitals. The male to female ratio was higher in private than NHS patients (1992-3: 5.5:1 v 3.6:1), suggesting greater access to care for men than women in the private sector. The trends observed in the United Kingdom are similar to those that have occurred in North America, with the exception of a decrease in the male to female ratio, which has not previously been reported. CONCLUSION: The increase in the revascularisation rate has been accompanied by an increasing proportion of women and older people. The extent of these changes varies between geographical areas. The change in the sex ratio has occurred despite an increasing contribution by the private sector, to which women have less access than men.

Adult↗
PubMed1993

Coronary artery surgery: are women discriminated against?

OBJECTIVE: To determine whether the sex differences in access to cardiac surgery observed in the United States exist in the United Kingdom. DESIGN: Retrospective analysis of routinely collected data. SETTING: South West Thames and North West Thames regional health authorities. SUBJECTS: 8564 patients discharged from hospital with a principal diagnosis of coronary heart disease in 1987-8 in South West Thames region and 15243 discharges in North West Thames region in 1990-1. MAIN OUTCOME MEASURES: Performance of angiography or coronary artery bypass surgery. RESULTS: In all age groups and among patients with a principal diagnosis of either angina or chronic ischaemia men were significantly more likely than women to undergo revascularisation in both regions. Using multiple logistic regression to control for potential clinical and demographic confounders, the male to female odds ratio for revascularisation among all cases was 1.59 (95% confidence interval 1.25 to 2.03) in South West Thames region and 1.47 (1.32 to 1.63) in North West Thames region. CONCLUSION: There appears to be a systematic difference in the treatment received by men and women in the United Kingdom. The reasons for this are uncertain.

Adult↗
PubMed1993

Disease staging--a case-mix system for purchasers?

The National Health Service (NHS) internal market has directed renewed attention at hospital activity data. Purchasers require information on the cost of care provided for them, the quality of service and the extent to which their population's needs are being met. There is a need for a means of condensing the large number of diagnostic codes into groups containing patients with similar outcome or resource use, i.e. case-mix systems. These systems have been developed in the United States to overcome this problem. Unfortunately, they may not be valid or acceptable in other countries. We describe the evaluation of one such system, Disease Staging, in the United Kingdom. We conclude that it can be used with UK data to produce groups that are homogeneous both in terms of length of stay and mortality. Its logic is acceptable to UK clinicians. We discuss the major issues involved in using routine hospital data and suggest ways in which Disease Staging might be used by purchasers in the UK internal market.

Contract Services↗
PubMed1993

Economic burden of treated benign prostatic hyperplasia in the United Kingdom.

Recent epidemiological studies suggest that much urological disease is untreated. However, the overall economic burden of urological diseases has never been systematically studied. This report estimates the economic burden of treated benign prostatic hyperplasia (BPH) in the United Kingdom by considering the direct costs falling on the health service, the indirect costs in lost production, and the intangible costs in reduced quality of life. Depending on the assumptions made, the economic burden in 1990 is estimated to have been between 62 million pounds and 91 million pounds annually, excluding the intangible costs. The maximum cost to the National Health Service (NHS) represents approximately 0.4% of total NHS expenditure. This finding is therefore consistent with the results of recent epidemiological studies, which suggest that the main burden of BPH is borne by sufferers in terms of reduction in quality of life and is not reflected in consumption of health care resources. However, this balance may change as a result of the new General Practitioner contract and new treatment options.

Adult↗
PubMed1993

Day surgery: development of a national comparative audit service.

OBJECTIVES: To develop software for hospitals to analyse their own survey data on patients' experiences of day surgery and to create and test the feasibility of a national comparative audit service. DESIGN: Software development and testing; database analysis. SETTING: Eleven general hospitals in England. PATIENTS: 1741 day surgery patients undergoing procedures during 1991-2. MAIN MEASURES: Postoperative symptoms, complications, health and functional status, general satisfaction, and satisfaction with specific aspects of care. RESULTS: Software for data entry and analysis by hospitals was successfully used at the pilot sites. The overall response rate for the 11 hospitals using the questionnaire was 60%, ranging from 33% to 90% depending on the way the survey was managed. Data from all 11 hospitals were included in the national comparative audit database. Hospitals showed little variation in measures of patients' overall satisfaction (around 85%), but significant differences were apparent for specific aspects such as receiving adequate written information before admission (range 50%-89%), provision of adequate parking facilities (14%-92%) and experiencing a significant amount of postoperative pain (8%-42%). The proportion of day case patients undergoing procedures that could have been performed in outpatient departments varied from 0 to 27% between hospitals. Further comparisons of outcome, in particular measures of effectiveness, must await the development of validated case mix adjustment methods. CONCLUSION: Establishing a comparative audit database is feasible but several methodological problems remain to be resolved.

Ambulatory Surgical Procedures↗
PubMed1991

Reliability of questionnaire responses as compared with interview in the elderly: views of the outcome of transurethral resection of the prostate.

Three hundred and eighty-eight men undergoing transurethral resection of the prostate for benign prostatic hypertrophy completed a presurgical questionnaire and three follow-up questionnaires 3, 6 and 12 months after surgery. The questionnaires covered details of prostatic symptoms, general health, and expectations and results of surgery. At each follow-up point 40 randomly selected patients were interviewed by two female research assistants. The response rate to the questionnaires was over 90% at each follow-up point while that for the interviews was lower at around 80%. We examine the reliability of the postal questionnaires in assessing health status by comparing questionnaire and interview responses, with a view to the wider employment of such a method in the follow-up of surgical patients. In general, and as reported elsewhere, responses to questions on easily defined topics are highly comparable between questionnaire and interview. Responses to more subjective questions are moderately reliable, but with a tendency for postal questionnaires to underestimate a patient's health problems. It is difficult to assess the reliability of the questionnaires with regard to questions of an intimate nature since such questions caused embarrassment during interview with consequent incomplete responses.

Adult↗
PubMed1991

Do doctors and patients agree? Views of the outcome of transurethral resection of the prostate.

In an attempt to establish the extent to which patients and doctors agree on the outcome of health care, the pre- and postoperative states of health of 388 men undergoing transurethral resection of the prostate for benign disease were studied. Generally, high levels of concordance (greater than 70%) were obtained. The strongest agreement was for clearly defined events, such as episodes of acute retention (95%); the weakest agreement occurred over the most subjective symptoms, prognostic expectations, and ambiguous terms (around 60%). The level of agreement was not associated with any characteristics of the patient, surgeon, or treatment.

Cystoscopy↗
PubMedDate not supplied

The National Psychiatric Morbidity Surveys of Great Britain--strategy and methods.

This paper describes the rationale and methodology of the first National Psychiatric Morbidity Surveys to be carried out in Great Britain. The objectives of the surveys were to estimate the prevalence of psychiatric morbidity among adults aged 16-64 living in Great Britain; to identify the nature and extent of social disabilities associated with psychiatric morbidity; to describe the use of health and social services by people with psychiatric morbidity and to investigate the association between mental illness and potential environmental risk factors in a household sample. Four separate surveys were carried out in order to meet the objectives; a private household sample (n = 10,108), a sample of institutions caring for the mentally ill (n = 1191), a sample of homeless people (n = 1166), and a supplementary sample of patients with psychosis living in private households (n = 350). A two-stage assessment procedure was used, in which all subjects were given the Revised Clinical Interview Schedule (CIS-R) administered by lay interviewers to assess neurotic symptoms and disorders and a psychosis screen, including the Psychosis Screening Questionnaire. Those who were positive on the psychosis screen were then interviewed by psychiatrists using the SCAN (incorporating the tenth edition of the Present State Examination). Large scale national surveys such as this augment the inadequate data on psychiatric morbidity that are routinely available and are, therefore, an important source of information upon which to base policy and generate aetiological hypotheses. These surveys provide a possible model for similar surveys in other countries.

Adolescent↗
PubMedDate not supplied

The prevalence of psychiatric morbidity among adults living in institutions.

This paper presents prevalence data from the 1994 OPCS survey of psychiatric morbidity among adults permanently resident in institutions catering for people with mental health problems in Great Britain. It describes briefly the survey methods used, and how diagnoses of psychiatric morbidity were derived. Its main aim is to show the prevalence of psychiatric morbidity in different types of institutional settings. Residents were eligible for the survey if they were aged 16 to 64 at the date of sampling and were permanently resident at the establishment. Residents were defined as permanently resident if they had been living in the sampled establishment for six months or more, or had no other permanent address, or were likely to stay in the establishment for the foreseeable future. In 1994, about 33,200 adults aged 16 to 64 were permanently resident in accommodation for people with mental health problems. About a third of residents were in NHS hospitals, while about two-thirds were in residential care facilities. About two-thirds of adults interviewed suffered from schizophrenia, delusional and schizoaffective disorders. About 8% suffered from neurotic disorders and 8% suffered from affective psychoses (mainly bipolar affective disorder). The prevalence of schizophrenia, delusional, and schizoaffective disorders was higher in hospitals than in residential care, while the prevalence of neurotic and related disorders was higher in residential accommodation. The prevalence of schizophrenia, delusional, and schizoaffective disorders was higher in NHS psychiatric hospitals and general hospital units than in private hospitals, clinics or nursing homes.

Adolescent↗
PubMedDate not supplied

Treatment of constipation in older people.

Constipation is a common experience for a wide range of client groups. However, it is often badly managed, and research into effective treatment of constipation is sparse. This article summarises a systematic review carried out for the NHS health Technology Assessment programme. There is some evidence that laxatives can improve frequency and consistency of defecation and symptoms in older people with constipation.

Aged↗