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Biomedical subjects

P M Reilly

Publications and source records attributed to P M Reilly.

72 records · Page 4Linked to original sources
PubMed1984

Generic alternatives in general practice.

Using a standard analysis of one month's prescribing in a general practice we showed a potential saving of 8.8% (pounds 883.22) of the net cost of ingredients through substituting exact generic alternatives. Our results confirm the possible reduction in cost of drugs to the National Health Service by the use of generic substitution as suggested in the Greenfield report. Although substitution was theoretically available in most therapeutic classes, two thirds of the potential savings pertained to two classes, preparations acting on the nervous system and preparations acting on the cardiovascular system and diuretics. Of the prescriptions (31%) with potential generic alternatives, less than three quarters were actually available.

Aged↗
PubMed1984

Treatment of serious gram-negative infections with aztreonam.

Aztreonam (SQ 26,776) is the first parenteral monobactam agent to be used in patient trials. The agent has significant activity in vitro against facultative aerobic gram-negative bacteria but not against gram-positive or anaerobic bacteria. Aztreonam was used for a year to treat 106 hospitalized patients with a total of 131 documented gram-negative infections. Important exclusion criteria included granulocytopenia, hyperbilirubinemia, meningitis, patients less than 13 years of age, pregnancy, and history of anaphylaxis to penicillin. In this study of 35 men and 71 women, there were 67 cases of pyelonephritis (25% bacteremic), 19 of pneumonia (16% bacteremic), 10 of skin or soft-tissue infections, 9 cases of osteomyelitis, and 6 cases of postpartum endometritis. During the study period, 159 facultative aerobic gram-negative bacteria were tested for aztreonam susceptibility, and 144 (91%) were found to be susceptible. Eighty percent of infections were cured by both clinical and microbiological criteria and each of the other 26 infections showed clinical improvement. Eradication of the infecting organism was achieved in 89% of infections without adverse reaction or drug toxicity.

Adolescent↗
PubMed1983

Laboratory and radiological investigations in general practice. I-Type requested and rate of use.

The use that 30 general practitioners in four group practices made of open access laboratory and radiological facilities was studied for one year. We were particularly interested in whether general practitioners hoped to exclude rather than confirm abnormality when requesting investigations. All but two of the general practitioners studied used investigations to exclude abnormality to a greater extent than to confirm it. The rate at which the practices investigated patients and the number of investigations requested were appreciably different and were different for individual general practitioners, part time general practitioners requesting more investigations than trainees and full time general practitioners. Haematological investigations accounted for over 30% of requests for investigations in all but one practice, biochemical investigations being requested as often as bacteriological investigations in two of the four practices. The ratio of expected to unexpected results varied among general practitioners; no general practitioner had more unexpected results and the range of ratios was similar for full time and part time general practitioners and for trainees. The proportion of patients with abnormalities uncovered by each practice increased disproportionately as the use of investigations increased, supporting a higher rather than lower rate of investigation among general practitioners. Compared with the results of other studies the use of the radiological facilities available was low. X ray examinations of the skeleton were requested more than chest and contrast media examinations by three of the four practices. Most x ray examinations were used to exclude rather than confirm abnormality by all the practices, with over 85% of results confirming the general practitioner's initial diagnosis.

Clinical Laboratory Techniques↗
PubMed1983

Primary care teams and the elderly in Northern Ireland.

The results of a questionnaire were used to examine how primary care workers set about the management and surveillance of their elderly patients. The majority of practices had attached visitors (76 per cent) and attached district nurses (59 per cent), while 61 per cent of general practitioners worked in health centres. Over half of the responding practices had agesex registers. Few of the practices (14 per cent) had screened their elderly patients in the last five years and maintained an ;at-risk' register. Twenty per cent of practices held a regular meeting concerning their elderly patients but only half of these reviews involved the available health visitors and district nurses.At least half of the general practitioners and district nurses plus three quarters of the health visitors felt dissatisfied with the care of the elderly.A single and systematic review of elderly patients conducted jointly by general practitioners, health visitors and district nurses would do much to improve the care of this group of patients and the morale of these workers.

Aged↗
PubMed1982

Psychotropic drug use in Northern Ireland 1966-80: prescribing trends, inter- and intra-regional comparisons and relationship to demographic and socioeconomic variables.

A study of psychotropic drug prescribing, derived from the computerized pricing data in Northern Ireland from 1966, showed that the use of these drugs reached a peak in 1975, when about 12.5% of the adult population were estimated to have been receiving them, and declined in the following 5 years. Benzodioazepines accounted for three-quarters of all psychotropic drugs prescribed in 1980. Benzodiazepine tranquillizer prescribing was consistently 20-30% higher than in the rest of the United Kingdom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing was greater than in other European countries, but the level remains lower than in Iceland and Denmark. The influence of a number of demographic and socioeconomic variables was studied in an intra-regional analysis of the 1978 data for the 17 health districts in the province, using multivariate and multiple regression statistics. The prescribing of benzodiazepine hypnotics was almost entirely accounted for by the proportion of elderly (over 65 years) and women aged 45-59 years: neuroleptic prescribing was largely a function of factors associated with rural areas (overcrowding and unemployment) and the proportion of elderly; but neither tranquillizer, antidepressant, barbiturate hypnotic nor psychostimulant prescribing were satisfactorily explained by these variables.

Anti-Anxiety Agents↗
PubMed1981

Primary care and accident and emergency departments in an urban area.

During one year all initial attendance from one Belfast general practice to local accident and emergency departments was studied. Of the 784 attenders, 616 (78.4 per cent) referred themselves; the remaining 168 (21.6 per cent) were referred by the general practitioners. The clinical and social characteristics of both groups are compared. The discussion focuses on the appropriate use of primary care and accident and emergency services.

Adolescent↗
PubMed1981

Terminal care in the home.

We report on a 16-week study of the terminal care given to 118 patients who died at home at the end of a chronic illness. We describe the clinical features of the care and how these were managed, we compare the doctors' and relatives' view of the patients' suffering and awareness of death, and we explore the implications of death at home for general practitioner, nursing and other support services and for the relatives who care for the patient.

Aged↗
PubMed1978

An audit of prescribing by peer review.

This study describes how a group of general practitioners were made aware of their own prescribing habits. This was done by analysing carbon copies of prescriptions and reporting the analysis to a meeting of the doctors. The effects of this knowledge on subsequent prescribing were monitored.

Drug Utilization↗
PubMed1977

Audit of a general practice.

During a period of one full week, an analysis was made of the activities of patients (demand) and workers (service) in a suburban general practice. A data collection system was constructed and used by all the health centre workers. We sought to measure demand and service and to show the value of measurement (audit) of an aspect of service, i.e. prescribing.

Family Practice↗
PubMedDate not supplied

Low (40 mg) versus high (80 mg) dose methadone in a 180-day heroin detoxification program.

Methadone Transition Treatment (MTT) is a treatment program for opioid-addicted individuals that takes advantage of a 1989 change in federal guidelines permitting the establishment of 180-day detoxification programs. Thirty-eight subjects were assigned to either high-dose (80 mg) or low-dose (40 mg) methadone in a double-blind design. Both conditions showed initial dramatic decreases in illicit drug use and distress symptoms (opioid craving, withdrawal symptoms, and dysphoria). The high-dose condition showed a nonsignificant trend toward less frequent illicit drug use during the period of stable methadone dosing. We speculate that intensive psychosocial treatment, including weekly individual counseling and three-times a week group therapy, may have dampened outcome differences between high- and low-dose methadone conditions. Treatment retention was high for both dosage conditions.

Adult↗
PubMedDate not supplied

Balloon catheter tamponade of exsanguinating facial hemorrhage: a case report.

A 42-year-old man sustained a gunshot wound to the frontal process of the left maxilla just lateral to the nasal bone medial to the maxilla that caused profuse hemorrhage. Anterior and posterior nasal packing along with packing of the gunshot wound with Vaseline gauze did not control the hemorrhage. A 28 French (30-cc balloon) Foley catheter was placed directly into the wound, and bleeding stopped immediately upon inflation of the balloon with 30 cc of sterile water. Arteriography identified bleeding from an anterior branch of the maxillary artery that was successfully embolized.

Adult↗
PubMedDate not supplied

Anger management and temper control: critical components of posttraumatic stress disorder and substance abuse treatment.

Recent studies have shown associations among combat experience, PTSD, anger and hostility, and involvement in violence. Clinical observations of veterans enrolled in the Substance Use/Posttraumatic Stress Disorder Team (SUPT) program at the San Francisco Veterans Affairs Medical Center revealed relatively high levels of anger and aggressive behavior, including physical assaults and property damage. In response to this anger and aggressive behavior, an anger management treatment was added to the SUPT program's treatment of substance abuse and PTSD. Anger management consisted of a 12-week cognitive-behavioral group treatment. Session topics included identifying the physical, emotional, and situational cues to anger, developing individualized anger-control plans, recognizing and altering destructive self-talk, utilizing time-out, practicing conflict resolution techniques, and using the group to discuss and evaluate high-risk anger situations. Special attention was given to self-monitoring anger-escalating behavior (using an anger meter) and avoiding negative consequences. This article describes the components of the anger management treatment. A clinical vignette is also presented to illustrate the benefits of anger management treatment.

Anger↗
PubMedDate not supplied

The angry patient: an intervention for managing anger in substance abuse treatment.

Patients who have problems controlling anger and aggression can pose special problems for substance abuse treatment providers. Levels of anger and violence are higher in substance abusers than in the general population. Although anger management treatments have been studied extensively, few treatments have been developed and studied with substance abusers. In this article, we evaluated an anger management treatment based on Novaco's (1983) cognitive-behavioral stress inoculation procedures. The treatment was delivered as individual sessions and evaluated in a study of six substance abuse patients with a single-subject multiple-baseline design. Preliminary findings suggest that the treatment is effective for substance abuse patients and that this mode of treatment should be explored further.

Adult↗