Search PubMed⌕ Search

Biomedical subjects

Mike Richards

Publications and source records attributed to Mike Richards.

9 recordsLinked to original sources
PubMed2006

A new approach to treatment of resistant gram-positive infections: potential impact of targeted IV to oral switch on length of stay.

BACKGROUND: Patients prescribed intravenous (IV) glycopeptides usually remain in hospital until completion of this treatment. Some of these patients could be discharged earlier if a switch to an oral antibiotic was made. This study was designed to identify the percentage of inpatients currently prescribed IV glycopeptides who could be discharged earlier if a switch to an oral agent was used, and to estimate the number of bed days that could be saved. We also aimed to identify the patient group(s) most likely to benefit, and to estimate the number of days of IV therapy that could be prevented in patients who remained in hospital. METHODS: Patients were included if they were prescribed an IV glycopeptide for 5 days or more. Predetermined IV to oral antibiotic switch criteria and discharge criteria were applied. A multiple logistic regression model was used to identify the characteristics of the patients most likely to be suitable for earlier discharge. RESULTS: Of 211 patients, 62 (29%) could have had a reduced length of stay if they were treated with a suitable oral antibiotic. This would have saved a total of 649 inpatient days (median 5 per patient; range 1-54). A further 31 patients (15%) could have switched to oral therapy as an inpatient thus avoiding IV line use. The patients most likely to be suitable for early discharge were those with skin and soft tissue infection, under the cardiology, cardiothoracic surgery, orthopaedics, general medical, plastic surgery and vascular specialities, with no high risk comorbidity and less than five other regularly prescribed drugs. CONCLUSION: The need for glycopeptide therapy has a significant impact on length of stay. Effective targeting of oral antimicrobials could reduce the need for IV access, allow outpatient treatment and thus reduce the length of stay in patients with infections caused by antibiotic resistant gram-positive bacteria.

Administration, Oral↗
PubMed2006

Heart surgery in infants with hemophilia.

We describe 2 infants with hemophilia A who had heart surgery under cardiopulmonary bypass with factor VIII replacement therapy, and we recommend a guideline for factor VIII support for cardiac surgery. One child had repair of total anomalous pulmonary venous connection. The second had cardiac catheterization followed by repair of ventricular septal defect and total anomalous pulmonary venous connection. Close collaboration between hematologist, laboratory, cardiologist, and cardiac surgeon is crucial in successful management of coagulation abnormalities during and after surgery.

Blood Loss, Surgical↗
PubMed2005

Clinical management. Failure is not an option.

The deadline for targets to start treatment for cancer within 31 days of a decision to treat, and 62 days of an urgent GP referral is at the end of the year. The health secretary is concerned over lack of progress towards the targets. Problems hampering progress include data collection issues and overly complicated waiting lists. Whittington Hospital and University of Leicester Hospitals trusts have made marked progress by redesigning the care pathway.

Efficiency, Organizational↗
PubMed2004

The use of recalcified citrated whole blood -- a pragmatic approach for thromboelastography in children.

BACKGROUND: Thromboelastography (TEG) is an established way of monitoring the coagulation status of children and adults requiring blood products during surgery. Serial measurements are performed using a nearside machine and blood product prescription may be titrated against changes in TEG. There may also be useful applications when the patient is remote from the TEG machine but these are limited because TEG is usually performed on fresh native whole blood within 6 min of venepuncture. Citrated whole blood can be used for TEG if transport time is more than 6 min. We wished to establish whether TEG parameters for citrated whole blood were comparable with those of native whole blood in healthy children. METHODS: Blood was obtained from 14 healthy children undergoing minor surgical procedures, at the time of intravenous cannula insertion for anaesthesia. Each sample was divided: TEG was performed on part of the sample in its fresh native state at 6 min and second portion of the sample was citrated, kept at room temperature and TEG was performed at 30 min after recalcification. RESULTS: There was a significant difference in TEG parameters (r, k, alpha, MA and LY30) for fresh native whole blood and recalcified citrated whole blood (paired t-test). CONCLUSIONS: The normal range for fresh native whole blood TEG parameters is well established, which is routinely used in practice. There was a significant difference between TEG parameters for fresh native whole blood and citrated whole blood. We recommend that a specific normal range be established for citrated whole blood to enable it to be used in clinical practice.

Adolescent↗
PubMed2004

Prevention.

Explore the source record for details and available documents.

Health Promotion↗
PubMed2003

Very high cost treatment for a single individual--a case report.

A Health Authority was requested to fund immune tolerance induction for a young haemophiliac at a potential cost of up to 2 million pounds sterling over a year. The decision-making process adopted included an external review of the case, literature review to establish the evidence base for treatment, and extensive discussions with the clinicians involved. The Health Authority agreed to fund treatment, but with continuous review of the case and explicit criteria for abandoning treatment if it was not working. After 11 months these criteria were met, and the treatment was abandoned. The decision-making process and ethical issues involved in deciding whether or not to fund extremely high cost treatment for an individual patient are discussed. Cases such as this present a stark contrast between rights-based and utilitarian ethical approaches. Primary Care Trusts (PCTs) are more vulnerable (because of their smaller populations and budgets) than Health Authorities were to the financial destabilization that high-cost cases can cause. PCTs are advised to make arrangements to enter risk-sharing arrangements to spread the cost of such high-cost treatments.

Child↗
PubMed2002

Comparison of a specialist haematological malignancy database against a regional cancer registry: case ascertainment and diagnostic accuracy.

No large-scale study has been performed to assess the problem of registering all subtypes of haematological malignancies. We compared registration of haematological malignancies between 1994 and 1996 by haematologists in 14 National Health Service Trusts in the Eastern part of the South Thames Region with data for the same area recorded by the Thames Cancer Registry (TCR). Case ascertainment and diagnostic accuracy were the two main outcome measures. A combined total of 4714 haematological malignancies were recorded over the 3-year period. Of these, 1329 (28%) were common to both databases, 1975 (42%) were recorded only by the TCR and 1410 (30%) were recorded only by the haematologists. Nearly one-third (31%) of all cases recorded by the TCR were death certificate-only registrations. The TCR records were obtained from 30 clinical specialities. Haematology only accounted for 35% of these cases. Discordant diagnoses were recorded in 20% of the cases that were recorded in both databases. Our data suggests that both registers have deficiencies in collecting and validating data on the incidence of haematological malignancies. To address this, a partnership was established in 1998 between haematologists in the South Thames Region and the Thames Cancer Registry. It is anticipated that engaging clinicians in the collection and validation of data will enhance the completeness of case ascertainment and improve the quality of data on haematological malignancies.

Adolescent↗