Search PubMed⌕ Search

Biomedical subjects

R G Neville

Publications and source records attributed to R G Neville.

At least 37 records · Page 2Linked to original sources
PubMed1993

National asthma attack audit 1991-2. General Practitioners in Asthma Group.

OBJECTIVE: To describe the frequency and characteristics of asthma attacks in the United Kingdom and to compare actual management with recommended guidelines for the management of attacks. DESIGN: Correspondence survey. SETTING: 218 general practices in the United Kingdom. SUBJECTS: 1775 patients of all ages who had a total of 1805 asthma attacks over three months. MAIN OUTCOME MEASURES: Patient characteristics, place of management of attacks, comparison of actual management with recommended guidelines. RESULTS: Of the 1805 attacks, 300 occurred in boys aged 0-9, 144 in girls aged 0-9, and 118 in women aged 20-29. The estimated frequency of attacks in the community was 14.3 per 1000 patients per year. 1546 (86%) patients with attacks were managed within general practice, 225 (12%) were admitted to hospital, and 34 (2%) were discharged from an accident and emergency department. Two patients died. On initial presentation, 248 (14%) patients were "not breathless," 900 (50%) were "moderately breathless," 535 (30%) were "breathless and distressed," 68 (4%) were "too breathless to talk," and 2 were "moribund." Recording of clinical data was variable. Underuse of nebulised bronchodilators and systemic steroid was apparent in all grades of clinical severity. Contrary to current guidelines for asthma management, "step up" in maintenance therapy after an attack was often not practised. CONCLUSION: Reported management was at variance with recommended guidelines. This has major implications for the design and distribution of future guidelines.

Acute Disease↗
PubMed1992

Diagnosis and treatment of asthma in children: usefulness of a review of medical records.

In order to tackle the problems of underdiagnosis and undertreatment of asthma in childhood general practitioners need to be aware of which children in their practices have or might have asthma. In an effort to identify a cohort of asthmatic or potentially asthmatic children a trained audit facilitator studied all the medical records of children aged between one year and 15 years who were registered with 12 Tayside general practices. From a total of 10,685 medical records the frequency of 'key items' sometimes associated with asthma were as follows: one or more episodes of bronchospasm or wheeze 23.7% of children, persistent cough 23.2%, treatment with anti-asthma therapy in the past 20.0%, exercise induced cough or wheeze 5.2% and history of 'wheezy bronchitis' 4.6%. However, in only 896 children (8.4%) had a formal diagnosis of asthma been made. Of all the children, 5.4% had received a prescription for anti-asthma medication within the past three months. Only 1.2% were taking an inhaled corticosteroid and 1.0% sodium cromoglycate, but many more were taking inhaled bronchodilators (3.1%) and oral bronchodilators (1.7%). The findings suggest that a systematic review of medical records by a trained facilitator can identify those children who could benefit from clinical review. Practices who wish to know which of their children have or might have asthma should consider using medical record review to search for key items associated with asthma.

Adolescent↗
PubMed1991

A double-blind placebo-controlled trial of theophylline in general practice.

Patients with moderate to severe asthma, from two urban general practices, entered a double-blind randomised placebo-controlled crossover trial of sustained-release theophylline versus placebo. Theophylline was given in therapeutic dosage (to ensure serum levels of between 10 and 20 micrograms/ml) for two months, followed by two months of placebo or vice versa. The results from the 24 patients who entered both theophylline and placebo treatment arms were compared, using outcome measures relevant to general practice care. Theophylline is shown to be of value in the management of asthma in general practice.

Adult↗
PubMed1991

Clinical audit of theophylline use in general practice.

The use of therapeutic drug monitoring for theophylline therapy was evaluated in two urban general practices. Of 55 patients studied, 44 (80%) had a sub-therapeutic serum theophylline concentration, 11 (20%) had a therapeutic concentration (10-20 micrograms/ml), and none had an above therapeutic concentration. Patients were reviewed at weekly intervals and had their theophylline dosages adjusted according to serum levels. A therapeutic concentration was achieved in 37 patients (67%). This task proved to be 'laborious but not difficult'. Side-effects were less common than previous reports suggest. The general practice workload involved in adjusting theophylline dosage was approximately four consultations, one dose change and two serum assays per 'average' patient.

Adolescent↗
PubMed1989

Biologic variation of common hematologic laboratory quantities in the elderly.

Analytic, within-subject, and between-subject biologic variations were estimated for leukocytes, erythrocytes, hemoglobin, hematocrit, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin content (MCHC), platelets, and a three-component differential count (lymphocytes, monocytes, and granulocytes in terms of both concentration and percentage of leukocytes) in cohorts of 12 male and 12 female healthy elderly subjects. The assays were performed with an Ortho ELT-800 automated analyzer. The estimates of within-subject biologic variation were similar to published data on young subjects, indicating that this aspect of homeostasis is not compromised in the elderly. The data were used to derive objective analytic goals; goals were surpassed except for assays of erythrocytes, hematocrit, and the derived MCV, MCH, and MCHC. The changes required for serial results to be significantly different were determined and found to be generally valid because most quantities have no heterogeneity of within-subject variation. All quantities had significant individuality; in consequence, conventional population-based reference values are of limited utility, and screening using reference limits will not detect latent or early disease in many subjects.

Aged↗
PubMed1989

A classification of prescription errors.

Three independent methods of study of prescription errors led to the development of a classification of errors based on the potential effects and inconvenience to patients, pharmacists and doctors. Four types of error are described: type A (potentially serious to patient); type B (major nuisance - pharmacist/doctor contact required); type C (minor nuisance - pharmacist must use professional judgement); and type D (trivial). The types of frequency of errors are detailed for a group of eight principals from one health centre. There were a total of 504 errors from 15,916 prescription items (3.17%) during a three month observation period. A close correspondence was found between individual doctor's types of error rates, suggesting that doctors who make type C and D errors are also likely to make type B (major nuisance) errors. A system of feedback of errors from each doctor was devised. No significant reduction was seen in error rates, possibly because the group of self selected doctors taking part had low error rates initially. It is suggested that pharmacists and doctors should work closely together to prevent the potentially harmful consequences of prescription errors.

Drug Prescriptions↗
PubMed1989

Biological variability of 26 clinical chemistry analytes in elderly people.

Analytical, within-subject, and between-subject components of variation were estimated for 26 clinical chemistry analytes from duplicate analyses of 10 specimens collected from 27 healthy elderly subjects over a period of 20 weeks. Within-subject variations were similar to those generated previously by us in younger subjects. We conclude, therefore, that homeostasis is not compromised by age alone, and biological variability does not increase simply with age. All analytes except serum water had marked individuality, showing that conventional population-based reference values are of limited utility. The critical differences required for two results to be significantly (P less than or equal to 0.05) changed are not the same as those that prompt action by clinicians. Although heterogeneity of within-subject variation does exist, we believe that the critical differences generated will be useful in routine clinical decision making.

Adult↗
PubMed1988

Heroin users in general practice: ascertainment and features.

A case-control study of heroin users in general practice showed a prevalence of roughly two per 1000 of the urban population or four per "average" general practice list of patients. A method of studying heroin users who attend general practice was used that has advantages over existing techniques. Thirty six heroin users had a statistically significantly higher yearly doctor-patient consultation rate than a group of matched controls. More heroin users also failed to attend appointments than controls. When consultations directly related to heroin and its effects were excluded, however, the consultation rates in the two groups were similar. The heroin users did not have an excess of psychiatric disorder or disturbed family background compared with controls but had a noticeable history of dishonest and violent behaviour towards medical staff. A high proportion of heroin users in the study were antibody positive for the human immunodeficiency virus. General practitioners should take advantage of their frequent contacts with heroin users and their families to give them support and counselling about the acquired immune deficiency syndrome.

Family Practice↗
PubMed1987

Evaluation of portable haemoglobinometer in general practice.

The HemoCue system for estimating haemoglobin was evaluated within urban general practice. It gave excellent results when used within a laboratory environment (on 103 paired samples) but disappointing ones when evaluated by practice nurses within general practice (on 235 paired samples). The most likely source of error was inadequate mixing of the blood specimens before sampling, which might be obviated by using a rotating mixer. It is emphasised that equipment intended for use in general practice should be evaluated under normal working conditions envisaged.

Ambulatory Care Facilities↗
PubMed1987

Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme).

Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group's DRAMS (drinking reasonably and moderately with self-control) scheme. The scheme was evaluated by randomly assigning 104 heavy or problem drinkers to three groups - a group participating in the DRAMS scheme (n = 34), a group given simple advice only (n = 32) and a non-intervention control group (n = 38). Six month follow-up information was obtained for 91 subjects (87.5% of initial sample). There were no significant differences between the groups in reduction in alcohol consumption, but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only. Only 14 patients in the DRAMS group completed the full DRAMS procedure. For the sample as a whole, there was a significant reduction in alcohol consumption, a significant improvement on a measure of physical health and well-being, and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume. The implications of these findings for future research into controlled drinking minimal interventions in general practice are discussed.

Adolescent↗
PubMed1987

Notifying general practitioners about deaths in hospital: an audit.

Information from hospital doctors about the death of a patient in hospital is important to general practitioners. Six general practices in the Dundee district recorded the date and place of death for all 272 practice patients dying over a 14-month period. In the 193 cases (71%) for which the hospital was responsible for informing the practice of the death the method by which the practice first learned of the death and the time interval between death and the writing of the official hospital letter was also recorded. An immediate telephone call, the established method of informing practices of deaths occurring in hospital took place in only 58% of cases and the letter from hospital was sent within one week in only 49% of cases. These proportions were unaltered by the issue of a unit medical circular to hospital staff informing them of the problem and requesting more prompt notification.The ability of general practitioners to help bereaved relatives is compromised by the present inadequacies in communication between hospitals and general practice. The unit medical circular - the standard method of resolving interprofessional problems - would appear to be ineffective.

Bereavement↗