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Biomedical subjects

P Priest

Publications and source records attributed to P Priest.

At least 19 recordsLinked to original sources
PubMed2006

Pathways to diagnosis of cervical cancer: screening history, delay in follow up, and smear reading.

BACKGROUND: The aim of this study was to determine the most important ways to reduce incidence of and mortality from cervical cancer by a nationally co-ordinated screening programme. DESIGN: Descriptive study. SETTING: The New Zealand National Cervical Screening Programme: a nationally organised and co-ordinated programme. SAMPLE: Women aged younger than 80 years with histologically proven primary invasive cervical cancer, including microinvasive disease, diagnosed between 1 January 2000 and 30 September 2002. Consent for access to medical records was gained for 371 of 445 eligible women (83%). A total of 359 (81%) of eligible women or their next of kin consented to interview. METHODS: Data on events prior to diagnosis were obtained from routine sources, interview, medical record review and slide reread. MAIN OUTCOME MEASURES: Frequency of screening in the 7 years prior to diagnosis, time from abnormal smear or symptoms to appropriate diagnostic confirmation, proportion of negative smears upgraded to high grade on reread. RESULTS: Half of the 371 participants (83% of 445 eligible women) had not had a screening smear in the 3 years prior to diagnosis, and 80% were defined as inadequately screened. A maximum of 17% of women overall or within any defined subgroup experienced delays in follow up of abnormal smears or bleeding. Only 11% of women overall had had a high-grade smear, which was originally read as negative. CONCLUSIONS: The most important factor in women's pathways to a diagnosis of cervical cancer was inadequate screening. While delays in diagnosis could be reduced and laboratory performance improved, priority must be given to improving uptake and frequency of screening.

Adult↗
PubMed2001

Antibacterial prescribing and antibacterial resistance in English general practice: cross sectional study.

OBJECTIVE: To quantify the relation between community based antibacterial prescribing and antibacterial resistance in community acquired disease. DESIGN: Cross sectional study of antibacterial prescribing and antibacterial resistance of routine isolates within individual practices and primary care groups. SETTING: 405 general practices (38 groups) in south west and north west England. MAIN OUTCOME MEASURES: Correlation between antibacterial prescribing and resistance for urinary coliforms and Streptococcus pneumoniae. RESULTS: Antibacterial resistance in urinary coliform isolates is common but the correlation with prescribing rates was relatively low for individual practices (ampicillin and amoxicillin r(s)=0.20, P=0.001; trimethoprim r(s)=0.24, P=0.0001) and primary care groups (ampicillin and amoxicillin r(s)=0.44, P=0.05; trimethoprim r(s)=0.31, P=0.09). Regression coefficients were also low; a practice prescribing 20% less ampicillin and amoxicillin than average would have about 1% fewer resistant isolates (0.94/100; 95% confidence interval 0.02 to 1.85). Resistance of S pneumoniae to both penicillin and erythromycin remains uncommon, and no clear relation with prescribing was found. CONCLUSIONS: Routine microbiological isolates should not be used for surveillance of antibacterial resistance in the community or for monitoring the outcome of any change in antibacterial prescribing by general practitioners. Trying to reduce the overall level of antibiotic prescribing in UK general practice may not be the most effective strategy for reducing resistance in the community.

Anti-Bacterial Agents↗
PubMed2000

Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated.

OBJECTIVE: To estimate the impact of using thresholds based on absolute risk of cardiovascular disease to target drug treatment to lower blood pressure in the community. DESIGN: Modelling of three thresholds of treatment for hypertension based on the absolute risk of cardiovascular disease. 5 year risk of disease was estimated for each participant using an equation to predict risk. Net predicted impact of the thresholds on the number of people treated and the number of disease events averted over 5 years was calculated assuming a relative treatment benefit of one quarter. SETTING: Auckland, New Zealand. PARTICIPANTS: 2158 men and women aged 35-79 years randomly sampled from the general electoral rolls. MAIN OUTCOME MEASURES: Predicted 5 year risk of cardiovascular disease event, estimated number of people for whom treatment would be recommended, and disease events averted over 5 years at different treatment thresholds. RESULTS: 46 374 (12%) Auckland residents aged 35-79 receive drug treatment to lower their blood pressure, averting an estimated 1689 disease events over 5 years. Restricting treatment to individuals with blood pressure >/=170/100 mm Hg and those with blood pressure between 150/90-169/99 mm Hg who have a predicted 5 year risk of disease >/=10% would increase the net number for whom treatment would be recommended by 19 401. This 42% relative increase is predicted to avert 1139/1689 (68%) additional disease events overall over 5 years compared with current treatment. If the threshold for 5 year risk of disease is set at 15% the number recommended for treatment increases by <10% but about 620/1689 (37%) additional events can be averted. A 20% threshold decreases the net number of patients recommended for treatment by about 10% but averts 204/1689 (12%) more disease events than current treatment. CONCLUSIONS: Implementing treatment guidelines that use treatment thresholds based on absolute risk could significantly improve the efficiency of drug treatment to lower blood pressure in primary care.

Adult↗
PubMed1999

Randomised studies of income supplementation: a lost opportunity to assess health outcomes.

BACKGROUND: Despite the wealth of evidence linking low income to ill health, there is little information from randomised studies on how much and how quickly these risks can be reversed by improvements in income. OBJECTIVE: To conduct a systematic review of randomised studies of income supplementation, with particular reference to health outcomes. DESIGN: Extensive searches of electronic databases and contact with previous authors. As well as searching for trials that were specifically designed to assess the effects of increased income, studies of winners and losers of lotteries were also sought: if winning is purely chance, such studies are, in effect, randomised trials of increased income. RESULTS: Ten relevant studies were identified, all conducted in North America, mostly in the late 1960s and 1970s. Five trials were designed to assess the effects of income supplementation on workforce participation and randomised a total of 10,000 families to 3-5 years of various combinations of minimum income guarantees and reduced tax rates. Two trials were designed to assess re-offending rates in recently released prisoners and randomised a total of 2400 people to 3-6 months of benefits. One trial was designed to assess housing allowances and randomised 3500 families to three years of income supplements. One trial assessed the health effects of 12 months of income supplementation in 54 people with severe mental illness. Finally, one study compared three groups of people who won different amounts of money in a state lottery. In all these studies the interventions resulted in increases in income of at least one fifth. However, no reliable analyses of health outcome data are available. CONCLUSIONS: Extensive opportunities to reliably assess the effects of increases in income on health outcomes have been missed. Such evidence might have increased the consideration of potential health effects during deliberations about policies that have major implications for income, such as taxation rates, benefit policies, and minimum wage levels. Randomised evidence could still be obtained with innovative new studies, such as trials of full benefit uptake or prospective studies of lottery winners in which different sized winnings are paid in monthly installments over many years.

Health Services Research↗
PubMed1996

One year of tuberculosis in Auckland.

AIM: To describe the recent epidemiology of tuberculosis in Auckland and the outcome of contact investigations. METHOD: Routine public health data were used to review the experience of tuberculosis (TB) in the Auckland region during a twelve month period in 1992-3. RESULTS: There were 152 cases, an age-standardised rate of 2.7 per 100,000 for Europeans, 37.8 for Maori, 70.9 for Pacific Island Polynesians and 131.3 for other ethnic groups. Fifty-two (35%) were born in New Zealand; 46 (31%) in Asia; 44 (30%) in the Pacific Islands. Forty-seven percent of foreign-born cases (28% of all cases) arrived in New Zealand in the 4 years preceding their notification. Forty-one per cent of cases appear not to have been diagnosed until 3 months or longer after the onset of their symptoms. Fifteen cases (including three sputum smear-positive cases) took 4 weeks or longer from diagnosis to be notified to the public health office. 12.5% of isolates were not notified. Two per cent of the 1079 contacts examined had tuberculosis. CONCLUSION: This review highlights the need for tuberculosis and the importance of timely comprehensive screening of immigrants from high incidence countries; reducing the interval between onset of symptoms and diagnosis; improving the notification rate of tuberculosis; and focusing contact investigation on those at highest risk.

Adolescent↗
PubMed1996

New Zealand guidelines for the management of dyslipidaemia: implications for treatment in an urban New Zealand population.

AIMS: The paper uses coronary heart disease risk factor prevalence data from a defined urban population to assess the potential impact of implementing the New Zealand National Heart Foundation "Guidelines for detection and management of dyslipidaemia" on the treatment of dyslipidaemia in New Zealand. METHODS: Coronary heart disease risk factor data was collected on an age stratified random sample of Auckland residents aged 35-74 years. The 10 year absolute risk of coronary heart disease was calculated for each participant aged between 35-64 years and management options determined from the National Heart Foundation guidelines. The Framingham equation used in these guidelines was used to extrapolate the 10 year risk of a coronary event in the 65-74 year age group. The proportions of participants potentially requiring treatment with lipid modifying medication were identified and extrapolated to the New Zealand European population. A sensitivity analysis was undertaken to assess the impact of 5% and 10% reductions in total cholesterol following dietary intervention on numbers meeting the drug treatment criteria. RESULTS: The proportion of participants potentially requiring lipid modifying treatment based on the guidelines was considerably higher than estimates of current treatment rates in each age group. The number meeting the treatment criteria increased dramatically with age. By the age of 65-74 years one in five participants met the drug treatment criteria. A 5% and 10% reduction in total cholesterol following dietary intervention reduced the proportion of participants potentially requiring drugs by almost one quarter and one half respectively. CONCLUSION: The approach taken by the New Zealand National Heart Foundation guidelines appropriately gives highest priority to patients at highest risk of a coronary event. If this high risk approach is extrapolated to older age groups, it will lead to more drug treatment among the elderly. Further evidence from randomised controlled trials on benefits of using cholesterol modifying medication in older age groups is required. Future guidelines need to address specifically criteria for use of lipid modifying medications in older age groups. Reductions in the numbers meeting drug treatment criteria following 5% and 10% reductions in total cholesterol reinforces the importance of dietary management.

Adult↗
PubMed1996

Predictors of family anxiety in the weeks before bereavement.

There has been little research to date on the factor which predict high anxiety in family members or carers before bereavement. Our study used data on 302 patients for whom the family's anxiety had been recorded by cancer palliative care teams in the last weeks of the patient's life. Variables known at the time of the patient's referral to the teams were entered into a discriminant analysis. A predictive function with a sensitivity of 0.75 and a specificity of 0.51 identified those families whose anxiety was rated as severe (3-4 on a scale of 0-4) during the month before the patient's death. Important predictors were: whether the family member was a spouse, a diagnosis of breast cancer, young age, the time from diagnosis and low patient mobility. There was a small significant correlation between a longer time in palliative care and lower family anxiety. The predictive model could be used oncologists to identify cases where greater psychological support will be needed.

Adult↗
PubMed1995

Trends in coronary heart disease risk factors in Auckland 1982-94.

AIMS: This paper describes trends in major coronary heart disease risk factors over the period 1982 to 1994 in the city of Auckland, New Zealand. METHODS: Coronary heart disease risk factor levels were measured in three cross-sectional surveys in Auckland in 1982, 1986-8 and 1993-4, following a standardised protocol. Random samples of nonMaori, nonPacific Island adults aged 35-64 years were selected from the Auckland general electoral rolls using similar methods in all three surveys. Participants attended a study centre for interview and risk factor measurement. RESULTS: The analyses presented are based on samples of 1029 men and 569 women in 1982, 541 men and 365 women in 1986-8, and 712 men and 685 women in 1993-4. The data are directly age-standardised to the 1986 New Zealand population. Over the 12 year period the prevalence of self-reported cigarette consumption declined significantly from 28.6% to 16.9% in men and from 24.5% to 14.8% in women. Mean serum total cholesterol showed little change between 1982 and 1986-8 but declined significantly between 1986-8 and 1993-4 by approximately 6% from 6.12 mmol/L to 5.73 mmol/L in men and by 9% from 6.17 mmol/L to 5.60 mmol/L in women. Mean serum high density lipoprotein (HDL) cholesterol showed a modest increase between 1982 and 1986-8 but declined significantly between 1986-8 and 1993-4 by 12% from 1.25 mmol/L to 1.10 mmol/L in men and by 9% from 1.55 mmol/L in women to 1.40 mmol/L in women. The total cholesterol to HDL cholesterol ratio increased significantly between 1986-8 and 1993-4 by 6% in men but showed little change in women. Mean blood pressure levels fell by 4-6 mmHg systolic and 6-7 mmHg diastolic over the 12 year period in men and women. Mean body mass index increased significantly from 25.6 to 26.4 in men and from 24.5 to 25.1 in women during this period. CONCLUSIONS: Over the 12 year period, 1982-94 there have been substantial reductions in the prevalence of self reported cigarette smoking, mean serum total cholesterol levels and mean blood pressure levels in middle aged Aucklanders. Of concern, the prevalence of obesity has increased and mean serum HDL cholesterol levels have fallen over the period. Coronary heart disease prevention and control programmes appear to have been successful in reducing the prevalence of most major coronary heart disease risk factors however some reorientation will be required to redress the adverse trends in HDL cholesterol levels and obesity.

Adult↗
PubMed1994

Are bereaved family members a valid proxy for a patient's assessment of dying?

OBJECTIVE: To compare assessments made retrospectively by bereaved family members (or the nearest carer to the patient) with assessments made before death by palliative staff and, where available, by patients themselves or the family member. METHODS: SETTING--two palliative care support teams. ASSESSMENTS--were recorded prospectively by team staff, patients and their family members for consecutive patients referred, and then were recorded retrospectively by family members during interview seven months after bereavement. MEASURES--seven items each rated 0 (best) to 4 (worst) using standard definitions. The rater was asked to average the severity over one week. ANALYSIS--ratings were tested for percentage agreement, for Cohen's Kappa (which controls for chance agreement) and for Spearman correlations. RESULTS: Staff ratings and family members' retrospective ratings, which described the last week of life, were available for 35 patients. Six patients and seven family members had also been interviewed shortly before the patient's death. The main problems identified by all raters were similar: family anxiety, symptom control, patient anxiety and pain control. For three items, practical aid, wasted time and communication, agreement was good--all cases except one were equal or within one score. However, problems were rarely identified for these items. For the other four items: pain control, other symptom control, family anxiety and patient anxiety, there was little agreement, Cohen's Kappa ranged 0.05-0.22. Agreement for one item (patient anxiety) was significantly improved if a patient had died at home. Comparison of ratings made by the family members before the death and seven months after bereavement suggests that family members alter their assessments during bereavement. CONCLUSION: Retrospective assessments by bereaved family members may be valid for some items related to service provision, but not as the sole assessment of a patient's pain, symptoms or anxiety. We suggest that studies which rely on these retrospective ratings should assess the validity of their responses and record more information about the mood and grief of the family member.

Anxiety↗
PubMed1993

What is the requirement for out-of-hours operating in orthopaedics?

Recent reports have emphasized the need to reduce the amount of unsupervised surgery performed at night by junior doctors. However there is little guidance about when an operation must be performed urgently and when it can be postponed safely. This study describes the existing pattern of out-of-hours trauma and orthopaedic surgery in four hospitals and reports the views of a panel of surgeons and anaesthetists on the extent to which operating could be postponed until the following day. Operations at night are uncommon--a mean of 0.6 per night and occurring on only 40% of nights--though their frequency shows two-fold variation between hospitals. With certain assumptions it is estimated that up to a third of out-of-hours operations could be postponed safely to the following day. Further evaluation is required of those operations about which the panel failed to reach agreement. While most of the procedures undertaken at night are within the competence of a registrar, some require the direct involvement of a consultant.

Humans↗
PubMed1992

Which tasks performed by pre-registration house officers out of hours are appropriate?

This paper seeks to identify tasks performed out of hours by pre-registration house officers and to determine whether they could be performed by someone other than a doctor. It was conducted in two parts: a descriptive study in four hospitals using diaries and interviews and a consensus panel consisting of four consultants, three junior doctors, and two nurses. The panel agreed that one-third of the tasks performed by house officers at night could be done by someone other than a doctor. The work-load of house officers could be reduced considerably by providing additional clerical and administrative support and a more widespread adoption of an extended role for nurses. However, the greater professional independence of nurses which may result might require doctors to redefine some of their roles.

Humans↗
PubMed1992

Can out-of-hours work by junior doctors in obstetrics be reduced?

OBJECTIVE: Against a background of concerns about the hours of work of junior doctors, this study examines how the night-time work of junior staff in obstetrics may be reduced by giving greater responsibility to midwives. DESIGN: In the first phase of the study, the tasks undertaken at night in four hospitals were identified. In the second phase a nominal group technique was used to seek the extent of agreement among professionals about the appropriateness of postponing surgery to the following day in certain circumstances. RESULTS: There were considerable variations between hospitals in the rate of obstetric intervention and the division of tasks between doctors and midwives. The panel concluded that many tasks currently performed by senior house officers could be undertaken by midwives. CONCLUSION: This study suggests that there scope for reducing the workload of junior obstetricians at night through the adoption of an extended role by midwives.

Attitude of Health Personnel↗
PubMed1992

Can out-of-hours operating in gynaecology be reduced?

Against a background of concerns about future hospital medical staffing and the safety of unsupervised operations at night, this study examines which gynaecological operations now undertaken at night may be safely postponed until the following day. In the first phase of the study, the operations taking place at night in four hospitals were identified. In the second phase a nominal group technique was used to seek the extent of agreement among professionals about the appropriateness of postponing surgery to the following day in certain circumstances. There were considerable variations between hospitals in the volume of work and the grade of staff involved. The panel concluded that most operations now performed at night should not be postponed. This study suggests that there is limited scope for postponing gynaecological operations currently undertaken at night.

Female↗
PubMed1992

Achieving consensus on out-of-hours laboratory tests.

Many reports on guidelines for investigation describe either the guidelines themselves or their implementation. Implicitly these assume that there has been general agreement about the guidelines, whereas there may be uncertainty about the appropriateness of a particular investigation in a given situation. We report the use of a technique for developing guidelines which explicitly seeks to identify areas of agreement and disagreement, and focuses on the reasons that particular decisions were made and the causes of disagreement.

Clinical Laboratory Techniques↗