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Biomedical subjects

P Davey

Publications and source records attributed to P Davey.

At least 55 records · Page 3Linked to original sources
PubMed1999

Clinical record keeping in patients receiving antibiotics in hospital.

BACKGROUND: Antibiotic prescribing is associated with the growth of antibiotic resistance in micro-organisms. Prescribing therefore needs to be restricted by well-designed antibiotic protocols. Audit of such protocols is only possible if clinical information about infection is properly recorded. OBJECTIVE: To assess the quality of clinical data recording in case notes of patients receiving antibiotics in hospital and to assess the effect of feedback of this information on clinical practice. DESIGN: Four point prevalence surveys. SETTING: Directorate of General Medicine, Dundee Teaching Hospitals NHS Trust. SUBJECTS: Inpatients receiving antibiotics. INTERVENTION: Feedback of results from the first two surveys to clinicians. MAIN OUTCOME MEASURES: Proportion of patients in the Medical Directorate with the recording of an antibiotic indication and the temperature in the case notes before, immediately after, and three months after, feedback of survey results. RESULTS: In each survey one third of patients were receiving antibiotics. The antibiotic indication was recorded in 64% of patients prior to feedback and in 86.5% after feedback (p = 0.004). Three months later this had fallen to 74%. Temperature recording improved between 2nd and 3rd surveys (57% to 86.1%, p < 0.001) and declined to 61% in the 4th survey (p < 0.001). Respiratory infection was the commonest recorded indication for an antibiotic; recording of this indication improved between the 2nd and 3rd surveys but declined by the 4th survey. CONCLUSIONS: Audit and feedback of information about clinical record keeping improves standards but improvements are not sustained. Clinical record keeping must be improved so compliance with antibiotic protocols can be properly audited. An "antibiotic sticker" in addition to immediate concurrent feedback may improve such deficiencies.

Anti-Bacterial Agents↗
PubMed1999

Audit of antibiotic prophylaxis for surgical patients in three hospital trusts in Tayside. Tayside Area Clinical Audit Commitee.

OBJECTIVE: To compare achievement of previously agreed standards for administration of antibiotic prophylaxis for surgical patients in the three acute trusts in Tayside. SETTING: Angus, Dundee Teaching Hospitals and Perth & Kinross Trusts. MAIN OUTCOME MEASURES: Administration of antibiotic prophylaxis and achievement of three general standards of administration. STUDY DESIGN: Prospective case note audit. RESULTS: In total, 341 operations were audited. The range of operations performed in each trust was different and the achievement of standards was sensitive to case mix. For example, prophylaxis was given to 82% of all eligible orthopaedic patients but only 64% of eligible patients in obstetrics & gynaecology. Comparison between trusts was therefore confined to six procedures (166 operations) which were performed regularly in all three. There were significant differences between trusts in the rate of administration to patients undergoing operations for which prophylaxis was indicated (from 84% [95% CI 75-92] to 93% [CI 89-98]) and in the proportion of patients in whom prophylaxis was continued for less than 24 hours (from 78% [CI 68-89] to 97% [CI 93-100]). Administration of prophylaxis within two hours of surgery was achieved following more than 95% of operations in all three trusts. However, second doses were given to only five of 44 (11%) of patients whose operations lasted more than two hours. CONCLUSIONS: Achievement of standards in all three trusts was good in comparison with recently published audits from other UK and European centres but there was still room for improvement, particularly in administration of second doses for prolonged operations. Regular audit of prophylaxis administration and duration should be implemented. Comparisons between trusts or units should be based on a common set of operations.

Antibiotic Prophylaxis↗
PubMed1998

Regional assignment and expression analysis of 29 expressed sequence tags mapped to chromosome 3.

Of 311 expressed sequenced tags (ESTs) mapped to single human chromosomes by analysis of a monochromosome somatic cell hybrid panel, 29 were localized to chromosome 3. Analysis of somatic cell hybrid lines containing different regions of chromosome 3 has enabled the regional assignment of these 29 ESTs to 13 of 23 intervals covering chromosome 3. Northern analysis of 25 of the EST clones has provided information on the pattern of expression of potential genes represented by these transcripts in 16 human tissue types. Nine of the clones hybridized solely to a transcript(s) in the testis, 12 hybridized to transcripts in testis and other tissues, and 4 hybridized with transcripts in testis and other tissues but in addition have testis-specific transcript sizes. These ESTs will provide useful markers throughout chromosome 3 for the development of physical and transcription maps. In addition, they provide candidate genes for disease loci mapping to the intervals defined by the chromosome 3 deletion panel.

Chromosome Mapping↗
PubMed1998

Strategies to rationalize sepsis management--a review of 4 years' experience in Dundee.

Hospitals worldwide are facing an unprecedented crisis of rising cost of antibacterials due to the increasing rapid emergence and dissemination of antibiotic-resistant organisms, improper use of antibiotics and the use of broad spectrum parenteral agents. The last 25 years has seen the introduction of many measures to improve the quality of sepsis management, and specifically antimicrobial use. The present paper reviews the development, implementation and evaluation of some of the key strategies employed within the Dundee Teaching Hospitals NHS Trust (DTHT) to enhance recognition and assessment of sepsis and to rationalize the early and often empiric antibiotic treatment of patients in hospital with infection. Particular emphasis is given to optimizing the use of expensive parenteral agents in conjunction with promotion of oral switch therapy where appropriate.

Administration, Oral↗
PubMed1998

Sequential antibiotic therapy: the right patient, the right time and the right outcome.

The aim of sequential therapy should be to provide better quality of care at lower cost. In comparison with i.v. therapy, oral administration is safer, more acceptable to the patient, facilitates early discharge from hospital and reduces the cost of consumables. However, if given to the wrong patient, oral antimicrobial therapy could both increase the cost and reduce the quality of care, either because of ineffective treatment, or unnecessary prolongation of treatment. Hospitals must develop policies for sequential therapy which define standards against which clinical care can be audited. The standards will need to be revised as new data become available from local audit and from research. Further research on sequential therapy is undoubtedly required, with particular emphasis on the reliability of absorption of oral drugs by hospitalized patients.

Administration, Oral↗
PubMed1998

Eradication of nasal carriage of Staphylococcus aureus--is it cost-effective?

In cardiothoracic surgery, the costs of surgical-site infection (SSI) arise from additional postoperative procedures (approximately US $5000 per patient) and prolonged hospital stay (approximately $11,500 per patient). Application of nasal mupirocin reduced SSIs by 63% compared with historical controls. This would have resulted in savings provided that the attributable cost of an SSI was more than $245. Mupirocin was estimated to reduce the risk of bacteraemia in haemodialysis patients by 84% compared with historical controls. A model using data on Medicare payments for haemodialysis admissions was used to estimate the impact on hospital costs. The conclusion was that mupirocin would have been cost-saving but the model did not provide sufficient detail about hospital costing to allow assessment of its relevance in other settings. In a prospective, randomized, placebo-controlled trial in continuous ambulatory peritoneal dialysis (CAPD) patients, mupirocin reduced the risk of staphylococcal exit-site infection (ESI) from 0.42 to 0.14 per patient-year. However, as in a previous comparison with historical controls, there was an increase in the rates of ESIs caused by Gram-negative bacteria in patients who received mupirocin, bringing the rate of total ESIs up to that observed in the placebo group. There was some evidence that infections caused by Gram-negative bacteria had less severe consequences than staphylococcal infections. It is concluded that application of nasal mupirocin to nasal carriers of Staphylococcus aureus may be cost-saving in patients undergoing cardiac surgery or haemodialysis but, if the analysis is restricted to the cost of management of ESIs, it may not be cost-saving in CAPD. However, reducing the risk of staphylococcal ESI may reduce the risk of catheter loss and subsequent transfer to haemodialysis and this merits further study.

Anti-Bacterial Agents↗
PubMed1998

Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis.

A prospective investigation is described which sought to test the role of illness cognitions in determining patient responses to a surgical intervention for osteoarthritis. Illness cognitions were assessed amongst a consecutive sample of patients with osteoarthritis of the knee or hip prior to undergoing joint replacement surgery. Functional activity and depression were assessed pre-operatively, and at 3 and 9 months post surgery. At pre-operative assessment, functional activity and depression were univariately associated with the perceived consequences of osteoarthritis. Path analyses using longitudinal data demonstrated that illness cognitions had predictive value in explaining outcomes. Depression at 3 months was associated with higher pre-operative perceived control beliefs suggesting that patients who have high control pre-operatively may be at risk for temporary depressed mood in the immediate aftermath of surgery. This effect was not maintained at 9 months. Depression at 9 months was lower amongst patients who were more active at 3 months, who did not attribute their condition to wear and tear and who had higher expectations of surgery. Functional activity at 9 months was higher amongst those who did not attribute their condition to growing older and who perceived more control over symptoms. Socio-demographic variables were not associated with change in functional activity or depression over the course of surgery. The results provide support for an illness cognition approach in explaining functional activity and depression outcomes following surgery.

Adult↗
PubMed1998

A UK Perspective.

Making decisions on lipid-lowering treatment varies across Europe. Legislation differs from country to country, so it is difficult to generalize about European policy. From the perspective of the United Kingdom, this paper addresses the impact of rationing, cost containment, information feedback, fund-holding and drug expenses. Primary versus secondary prevention for cardiovascular disease is also discussed, including current recommendations for prescribing statins and other interventions.

Journal Article↗
PubMed1998

Effectiveness and cost effectiveness of single bolus treatment with abciximab (Reo Pro) in preventing restenosis following percutaneous transluminal coronary angioplasty in high risk patients.

OBJECTIVE: To assess the clinical effectiveness and cost effectiveness of abciximab in preventing restenosis after percutaneous transluminal coronary angioplasty (PTCA). DESIGN: Data from a previous study, the EPIC trial, were used because only this trial was able to provide event data capable of constructing a cost effectiveness analysis over six months. All other study data reviewed supported the findings of the EPIC trial. To provide indicative results on long term health outcomes, survival and event-free survival were extrapolated using US epidemiological data in a Markov modelling process. SETTING AND PATIENTS: Patients who were at high risk for ischaemic complications after PTCA, treated in the standard manner. INTERVENTIONS: Abciximab was added to the regimen of intravenous heparin and aspirin. RESULTS: The EPIC study (n = 2099) indicated an 8.1% absolute reduction in serious cardiovascular events (95% confidence interval 3.1% to 12.7%) and a 23% relative risk reduction (p = 0.001). Based on the six month trial period, the additional cost per patient free from a serious event (Australian dollars) is $13,012 and for a special risk/benefit measure of outcome, the additional cost is $14,243. Epidemiological data support extended survival and ischaemic event-free survival with clinically successful PTCA. The results of the modelled analysis indicate a cost per additional life-year gained of $5547 and a cost per additional year event-free of $4285. CONCLUSIONS: At up to six months abciximab offers improvements in clinically important outcomes. A modelling exercise explores and highlights the likelihood of significant long term health benefits. The analysis provides information for decision makers and funders to consider the value for money of abciximab.

Abciximab↗
PubMed1998

Accuracy and precision of the TAS analyser for near-patient INR testing by non-pathology staff in the community.

AIMS: To assess the accuracy and precision of INR measurement by trained practice and district nursing staff using the Thrombolytic Assessment System (TAS) analyser. METHODS: Seventeen nurses from four practices were trained to measure INR using the TAS analyser on citrated capillary blood samples. Quality control (QC) consisted of: daily internal QC using normal and abnormal commercial plasmas; monthly local external QC scheme using fresh citrated venous blood; and registration of all analysers in the NEQAS (national external quality assessment scheme) main users scheme. RESULTS: Analysis of internal QC results demonstrated satisfactory interanalyser and intra-analyser precision with no evidence of analytical drift in any of the four practice analysers over an eight month period. Local and national external QC results confirmed the interanalyser precision but INR was underestimated by the TAS analysers compared with the CA 1000 using either Diagen rabbit brain thromboplastin or Innovin, and with other NEQAS users. CONCLUSIONS: The TAS analyser has many features to commend it for use by nonpathology staff to determine INR. Local internal and external QC and entry into the NEQAS main users group are possible because the TAS analyses citrated plasma or blood. The TAS analyser underestimates INR when the geometric mean normal prothrombin time (GMNPT) is determined by conventional methods. A local correction factor can be introduced by adjusting the normal PT to give INR results comparable with the local laboratory. This is particularly desirable when INRs are measured using both near-patient and laboratory analytical systems on different occasions.

Anticoagulants↗
PubMed1998

Economic evaluation of insulin lispro versus neutral (regular) insulin therapy using a willingness-to-pay approach.

This willingness-to-pay (WTP) analysis is the first study of its kind undertaken in Australia to support an application for listing of a new drug on the Australian national formulary. The technique offers the advantage of being able to summarise diverse outcomes of therapy in a single unit of measure. Willingness to pay is used to value benefits in cost-benefit analysis (CBA), and CBA represents an absolute decision rule. An open-ended question with a bid-up approach was used to minimise bias and elicit the maximum amount patients would be willing to pay for insulin lispro. The WTP study incorporated scenarios describing the outcomes from insulin lispro and neutral (regular) insulin, the results from a formal metaanalysis and a description of the injection characteristics of the therapies. A sample of 83 patients with type I or II diabetes mellitus were surveyed using an open questionnaire to determine their maximum willingness to pay for the therapy they preferred. Overall, 92% of patients preferred insulin lispro (referred to as insulin A) and 8% preferred neutral insulin (referred to as insulin B). The incremental benefit per patient was calculated as 452.16 Australian dollars ($A) per year. Insulin lispro was listed on the Australian national formulary at a 36% premium over neutral insulin, so the additional cost per patient would be $A70.32 per year. Therefore, costs were exceeded by the benefits and insulin lispro was deemed to offer a net benefit. A multivariate analysis indicated that those patients who were middle-aged had the strongest preference for insulin lispro.

Australia↗
PubMed1998

Skin and soft tissue infections: development of a collaborative management plan between community and hospital care.

The commonest indication in the US for referral to an outpatient/home i.v. antibiotic therapy programme is the management of skin and soft tissue infections. In the UK, however, these infections account for 10% or more of admissions to infection units. The main indication for hospitalisation is to receive parenteral antibiotics. A retrospective audit of one year of admissions to a regional infection unit revealed that, although most of these patients do not progress to complications ('low risk'), they occupy a mean time of five days in hospital and for nearly half of that time they receive parenteral antibiotics. This period in hospital reflected 11.4% of the unit's bed occupancy. Even if 75% of these patients were treated in the community with parenteral therapy, this would result in bed savings of 8.55%, nearly one-tenth of the unit's occupied capacity. This type of audit should help key decision makers thinking of developing similar services in their region. Outpatient or home parenteral antimicrobial therapy (OHPAT) should be delivered as part of a complete disease management programme in collaboration with primary care.

Algorithms↗
PubMed1997

Social interaction alters attraction to competitor's odour in the mouse Mus spretus Lataste

When animals defend territories that are large and structurally complex, scent marks alone are unlikely to be reliable signals of a resident's dominance and competitors should require initial proof through direct interaction. This was tested using freshly captured Mus spretus which occupy large non-overlapping ranges in grassland but are strongly attracted to substrate odours from unfamiliar competitors. Choice tests measured time spent investigating and chewing to gain access to paired nestboxes when the entrances were blocked with mesh. Experiment 1 established that mice of both sexes were more strongly attracted to their own odour than to a clean site. Experiment 2 examined choice between the subject's own odour and that of an unfamiliar same-sex competitor both before and after meeting the competitor in a neutral (clean) arena. Prior to interaction, males exerted much effort to gain access to both their own and their unfamiliar competitor's odour. Once relative dominance had been established through agonistic interaction, subordinates avoided their dominant competitor's odour in favour of their own while dominants continued to be attracted to both. There was little aggressive competition between unfamiliar females and relative status did not affect their attraction to a competitor's odour. Females tended to be more attracted to a competitor's odour than to their own prior to interaction but showed less attraction to a competitor's odour post-interaction. A third experiment showed that the odour of an unfamiliar male was more attractive than that from an unfamiliar female, especially to males. The consequences of these responses for maintaining spatial dispersion in this species are discussed.Copyright 1997 The Association for the Study of Animal Behaviour1997The Association for the Study of Animal Behaviour

Journal Article↗
PubMed1997

A prospective study of short course radiotherapy in elderly patients with malignant glioma.

Elderly patients with malignant glioma have a poor prognosis and the benefit of standard radical radiotherapy is equivocal. Twenty-two percent of the adult referral base with malignant glioma at our centre is of age 70 years or greater. A phase II study was undertaken to determine if a shorter course of therapy yields a comparable median survival to radical radiotherapy and thus constitutes an appropriate investigational palliative regimen. 25 patients were accrued between 1988-1995, all of whom had histologically proven malignant glioma, 23 glioblastoma multiforme and 2 anaplastic astrocytoma. The median age was 73 (range 70-78) and median Karnofsky Performance Status (KPS) was 70.40% had a stereotactic biopsy only for diagnosis. Radiotherapy was delivered to limited fields to a dose of 37.5 Gy in 15 daily fractions over 3 weeks. An intention-to-treat analysis was undertaken with survival determined from date of initial consultation. The median survival of the whole group was 8.0 months (95% CI 4.8-9.6). Patients with good performance status (KPS > 70) had a median survival of 10.4 months (95% CI 9.6-14.7). 37.5 Gy in 15 daily fractions appears to yield comparable median survival to that of other series of radical radiotherapy. A phase III study of this regimen is recommended in investigating optimal palliation of elderly malignant glioma patients.

Aged↗