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T Marshall

Publications and source records attributed to T Marshall.

At least 55 records · Page 3Linked to original sources
PubMed2001

Implementing best practice models by using a consensus-building process.

The Family Education Project is an example of how the consensus-building model can be used to gain acceptance of evidence-based practice, and adapt and implement it on the local level. The authors describe the consensus-building process and the lessons learned from implementing family education in one community in order to show how this process may be used to adapt best practice models to meet unique needs within local communities.

Adult↗
PubMed2001

The extent and implications of sphygmomanometer calibration error in primary care.

AIM: The sphygmomanometer is an essential piece of diagnostic equipment, used in many routine consultations in primary care. Its accuracy depends on correct maintenance and calibration. This study was designed to: (1) assess the maintenance and calibration of sphygmomanometers in use in primary care; (2) assess the clinical, ethical, legal and public health implications of our findings. METHOD: A researcher assessed the accuracy of mercury and aneroid sphygmomanometers in use in 231 English general practices. He also made enquiries about arrangements for the maintenance and calibration of sphygmomanometers. We conducted a small telephone survey in general practices across the country to determine maintenance and calibration arrangements across the country. We carried out a modelling exercise to explore the clinical, ethical and public health implications of our findings. RESULTS: Of 1462 sphygmomanometers, 9.2% gave readings were more than 5 mm Hg inaccurate. No practice had arrangements for maintenance and calibration of sphygmomanometers. Nationally, one of 54 practices had an arrangement for maintenance and calibration. True hypertension is very uncommon in women under 35, a blood pressure which is measured as high is much more likely to be caused by calibration error than by hypertension. CONCLUSION: It is rare for sphygmomanometers used in primary care to be maintained and calibrated. Because of this women under 35 are at risk of misclassification and inappropriate treatment. This has ethical and public health implications. Clinicians using equipment which has not been maintained and calibrated may be medically negligent.

Adolescent↗
PubMed2001

Evaluation of a comprehensive home-based midwifery programme in South Kalimantan, Indonesia.

We report the findings of an evaluation of a programme in three districts in South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district-based maternal and perinatal audit (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% were attended by a skilled attendant. By 1998-99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Through in-service training, continuous supervision and participation in the audit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a caesarean section declined from 1.7 to 1.4% and the proportion admitted to hospital with a complication requiring a life-saving intervention declined from 1.1% to 0.7%. The strategy of a midwife in every village has dramatically increased skilled birth attendance, but does not yet provide specialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care.

Delivery of Health Care↗
PubMed2001

Malaria in pregnancy: adverse effects on haemoglobin levels and birthweight in primigravidae and multigravidae.

BACKGROUND: In areas of endemic transmission, malaria in pregnancy is associated with severe maternal anaemia and low birthweight babies. The prevalence of infection is highest in primigravidae (PG), and hence control efforts are usually geared towards this high risk group. Using a sensitive measure of placental infection, we investigated the relationship between active-acute, active-chronic and past placental infection with maternal anaemia and low birthweight in women of all gravidities. METHODS: Between January 1996 and July 1997, 912 women delivering in Kilifi District Hospital, Kenya, were recruited. Haemoglobin and peripheral malaria slides were taken prior to delivery, placental biopsies and smears were taken at the time of delivery and birthweight and maternal height and weight were measured soon after birth. Information was obtained on socio-economic and educational status. The association between placental malaria, severe anaemia and low birthweight was investigated for women of different gravidities. FINDINGS: By placental histology, the prevalence of active or past malaria in all gravidities was high, ranging from 64% in PG to 30% in gravidities 5 and above. In gravidities 1-4, active malaria infection was associated with severe maternal anaemia, adjusted OR 2.21 (95% CI 1.36, 3.61). There was a significant interaction between chronic or past malaria and severe anaemia in their effects on birthweight, whereby the risk of low birthweight was very high in women with both chronic or past placental malaria and severe anaemia: OR 4.53 (1.19, 17.2) in PG; 13.5 (4.57, 40) in gravidities 2-4. INTERPRETATION: In this area of moderate malaria transmission, women of all parities have substantially increased risk of low birthweight and severe anaemia as a result of malaria infection in pregnancy. The risk of low birthweight is likely to be particularly high in areas with a high prevalence of severe anaemia.

Adolescent↗
PubMed2001

Health care needs assessment in prisons: a toolkit.

BACKGROUND: Since 1999, prison health services and health authorities have been jointly responsible for assessing the health care needs of the prison population. To facilitate this process, the Department of Public Health and Epidemiology at the University of Birmingham developed a toolkit for carrying out a health care needs assessment of the prison population. METHODS: This paper describes the principles of the epidemiological approach to needs assessment and presents a stepped approach to carrying out a health care needs assessment in prisons. Some examples of the kind of health care needs to be found in prisons are presented. RESULTS: A systematic approach to the assessment of the health care needs of prisoners ensures that all the essential components of this important planning exercise are considered. The prison population is described, health problems are identified and quantified, and a review of current services is carried out. This allows the most effective solutions to addressing the health problems to be established. The process can be time consuming and is reliant on good data sources, but it does ensure that health problems and service elements are considered and addressed together rather than in a disjointed manner. CONCLUSION: The stepped approach to epidemiological needs assessment allows health problems and current services to be identified. It also allows these to be matched to appropriate service requirements.

Adolescent↗
PubMed2001

Indoor rock climbing: who gets injured?

OBJECTIVES: To determine the frequency of overuse injury in indoor climbers, the common sites of such injury, and the factors that influence the probability that a climber will have sustained an overuse injury while climbing indoors. METHOD: A semisupervised questionnaire was used to survey overuse injury in 295 spectators and competitors at the Entre-Prises World Climbing Championships held in Birmingham 3-5 December 1999. Statistical analysis included simple cross tabulations, calculation of odds ratios, and multiple logistic regression to explore the effect of several factors simultaneously. RESULTS: Some 44% of respondents had sustained an overuse injury, 19% at more than one site. The most common site of injury was the fingers. Univariate analysis showed that the probability of having sustained a climbing injury is higher in men (p = 0.009), those who have climbed for more than 10 years (p = 0.006), those who climb harder routes (p<0.0005), and those who boulder or lead more than they top rope (p<0.0005). The relation between lead grade and climbing injury is linear. Multivariate analysis removed the effect of sex as an independent predictor. CONCLUSIONS: Many climbers sustain overuse injury. The most at risk are those with the most ability and dedication to climbing. Climbers should be aware of the risk factors that influence injury and be able to spot the signs and symptoms of injury once they occur.

Adult↗
PubMed2001

Comparative accuracy of cardiovascular risk prediction methods in primary care patients.

OBJECTIVE: To compare the relative accuracy of cardiovascular disease risk prediction methods based on equations derived from the Framingham heart study. DESIGN: Risk factor data were collected prospectively from subjects being evaluated by their primary care physicians for prevention of cardiovascular disease. Projected cardiovascular risks were calculated for each patient with the Framingham equations, and also estimated from the risk tables and charts based on the same equations. SETTING: 12 primary care practices (46 doctors) in Birmingham. PATIENTS: 691 subjects aged 30-70 years. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of the Framingham based risk tables and charts for treatment thresholds based on projected cardiovascular disease or coronary heart disease risk. RESULTS: 59 subjects (8.5%) had projected 10 year coronary heart disease risks >/= 30%, and 291 (42.1%) had risks >/= 15%. At equivalent projected risk levels (10 year coronary heart disease >/= 30% and five year cardiovascular disease >/= 20%), the original Sheffield tables and those from New Zealand have the same sensitivities (40.0%, 95% confidence interval (CI) 26.6% to 57.8% v 41.2%, 95% CI 28.7% to 57. 3%) and specificities (98.6%, 95% CI 97.2% to 99.3% v 99.7%, 95% CI 98.8% to 100%). Modifications to the Sheffield tables improve sensitivity (91.4%, 95% CI 81.3% to 96.9%) but reduce specificity (95.8%, 95% CI 93.9% to 97.3%). The revised joint British recommendations' charts have high specificity (98.7%, 95% CI 97.5% to 99.5%) and good sensitivity (84.7%, 95% CI 71.0% to 93.0%). CONCLUSIONS: The revised joint British recommendations charts appear to have the best combination of sensitivity and specificity for use in primary care patients.

Adult↗
PubMed2001

The value of MRI in the assessment of an elbow injury in a neonate.

We describe the use of MRI to establish the exact diagnosis in a swollen elbow in a neonate. Urgent diagnosis was needed for medical and social reasons. We accomplished this without the use of an invasive procedure or anaesthesia for a fracture that is recognised to be difficult to diagnose in patients of this age group.

Humans↗
PubMed2001

Meeting the National Service Framework for coronary heart disease: which patients have untreated high blood pressure?

BACKGROUND: The National Service Framework for coronary heart disease requires primary care teams to identify patients who are at high risk of cardiovascular events and treat those with high blood pressure. However, there are no data on how many must be assessed, how much cardiovascular disease can be prevented or which patients are most likely to benefit. AIM: To estimate the potential number of patients who are eligible for blood pressure assessment, the number of preventable cardiovascular disease events and the relative efficiency of the strategy in different age groups. DESIGN OF STUDY: Modelling exercise. SETTING: Hypothetical population of 100,000. METHOD: The age-sex specific prevalence of cardiovascular risk factors and of current anti-hypertensive treatment were obtained from published sources and combined with published estimates of the effectiveness of anti-hypertensive treatment. From these data were calculated numbers of persons eligible for assessment and treatment, and numbers of preventable cardiovascular events. RESULTS: There were 79,607 persons eligible for assessment and 5888 eligible for treatment. Treatment could prevent between 101 and 139 cardiovascular events annually. There were 11,571 persons aged over 65 years and eligible for assessment and 4655 eligible for treatment. Treatment could prevent 85 to 117 cardiovascular events annually. No cardiovascular events are prevented in persons aged under 45 years. CONCLUSION: Confining assessment to the 16% who are aged over 65 years prevents 85% of the population's avoidable cardiovascular disease. Primary care teams should assess and treat persons aged over 65 years before assessing younger patients. No health benefit results from assessing persons aged under 45 years.

Adolescent↗