Mostrando recursos 141 - 160 de 316
Mccowan, C.; Neville, R.G.; Hoskins, G.
AIMS: To investigate whether a patient review service changes the management of asthma in accordance with BTS/SIGN Guidelines. METHODS: An observational study of routine review consultations for patients with asthma registered at 862 practices throughout the United Kingdom. Practices recorded reviews on a computer template and returned the information to an academic unit for analysis. RESULTS: 41,493 patients had data returned with 14,790 (36%) patients reporting symptoms at rest or on a daily basis and 15,840 (38%) patients overusing their short-acting ?2-agonist. 4,556 (74%) of patients with symptoms who had a subsequent consultation reported a reduction in their symptoms, whilst...
Mccowan, C.; Hoskins, G.; Neville, R.G.
A UK-wide database of structured asthma review consultations was used to investigate the prevalence of 'off-label' anti-asthma prescriptions in relationship to clinical symptoms of asthma control. The 1050 children (6.1%) aged 16 years or under issued with an off-label prescription reported more nighttime, daytime and activity asthma symptoms, and used more short-acting beta(2)-agonist medication than their peers. Off-label prescribing for children with asthma in UK primary care is associated with worse levels of self-reported asthma control.
Diagnosis of left ventricular systolic dysfunction (LVSD): development and validation of a clinical prediction rule in primary care
Fahey, T.; Jeyaseelan, S.; Mccowan, C.; Carr, E.; Goudie, B.M.; Pringle, S.D.; Donnan, P.T.; Sullivan, F.M.; Struthers, A.D.
Background: Diagnosing suspected left ventricular systolic dysfunction (LVSD) in the community is a challenge for GPs. We developed and validated a clinical prediction rule (CPR) for LVSD based on history, examination and electrocardiogram (ECG). Methods: Prospective cohort studies of 458 symptomatic patients (derivation cohort) and 535 patients (validation cohort) in 26 general practices in Tayside and Fife, Scotland. All patients underwent a structured clinical examination and ECG and the ‘reference standard’ investigation of echocardiography to establish the presence of LVSD. Results: Four elements from the clinical history and examination were all independently associated with LVSD—male sex [adjusted odds ratio (OR) 2.5; 95%...
Easton, P.M.; Marwick, C.A.; Williams, F.L.W.; Stringer, K.; Mccowan, C.; Davey, P.; Nathwani, D.
Objectives The aim of the study was to establish knowledge and understanding of methicillin-resistant Staphylococcus aureus (MRSA) among patients, visitors and members of the general public accessing health services and to identify public education needs in relation to MRSA. Participants and methods Survey participants were recruited through 15 general practice surgeries across Tayside and through a young people’s health and information project in Dundee city centre and at a health information facility at Ninewells Hospital and Medical School, Dundee. Results There were 1000 responses. The majority (86%) had heard of MRSA, 59% knew that it is a bacterium and 47% were aware...
Jones, R.; Jones, R.O.; Mccowan, C.; Montgomery, A.A.; Fahey, T.
Background - A criticism of Randomized Controlled Trials (RCTs) in primary care is that they lack external validity, participants being unrepresentative of the wider population. Our aim was to determine whether published primary care-based RCTs report information about how the study sample is assembled, and whether this is associated with RCT characteristics. Methods - We reviewed RCTs published in four primary care journals in the years 2001–2004. Main outcomes were: (1) eligibility fraction (proportion eligible of those screened), (2) enrolment fraction (proportion randomised of those eligible), (3) recruitment fraction (proportion of potential participants actually randomised), and (4) number of patients needed...
Windsor, P.M.; Potter, J.; McAdam, K.; Mccowan, C.
Aims - An observational cohort study in patients undergoing treatment at a single cancer centre to evaluate the usefulness of providing written information on exercise and fatigue to patients at the start of their treatment, to assess whether patients exercised during treatment and their level of fatigue before and after treatment. Materials and methods - Participants were 205 patients of mean age 63.4 years (115 men and 90 women), starting a course of radical radiotherapy, postoperative radiotherapy and palliative radiotherapy or chemotherapy between October 2004 and June 2005 for genitourinary, gynaecological or breast cancer. A patient-held folder was provided, containing written...
Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer
Olde Bekkink, M.; Mccowan, C.; Falk, G.A.; Teljeur, C.; Van de Laar, F.A.; Fahey, T.
Background: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. methods: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced...
The effect of aerobic exercise on treatment-related acute toxicity in men receiving radical external beam radiotherapy for localised prostate cancer
Kapur, G.; Windsor, P.M.; Mccowan, C.
We retrospectively analysed acute radiation toxicity data for patients who had participated in a randomised controlled study in our centre in order to assess the impact of aerobic exercise on acute rectal and bladder morbidity during treatment. Data from 65 of 66 patients were analysed: 33 allocated into a control group (standard advice) and 33 into an exercise group (aerobic walking for 30 min at least three times per week) during 4 weeks of external beam radiotherapy; one patient in the exercise group withdrew after randomisation before starting radiotherapy. There was a trend towards less severe acute rectal toxicity in...
Guthrie, B.; Clark, S.; Mccowan, C.
Objective: to compare psychotropic prescribing in older people with dementia and the general elderly population. Design and setting: retrospective population database study in 315 General Practices. Subjects: there were 271,365 patients aged ≥ 65, of which 10,058 (3.7%) recorded as having dementia. Methods: epidemiology of psychotropic prescribing in older people with and without dementia; multilevel modelling of patient and practice characteristics associated with antipsychotic prescribing. Results: people with dementia were currently prescribed an antipsychotic drug (17.7%), an antidepressant (28.7%) and a hypnotic/anxiolytic (16.7%). Compared to the general elderly population, antipsychotic prescribing was 17.4 [95% confidence interval (CI) 16.4–18.4], antidepressant prescribing 2.7 (95% CI 2.6–1.8) and...
The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study
Crawford, F.; Mccowan, C.; Dimitrov, B.D.; Woodburn, J.; Wylie, G.H.; Booth, E.; Leese, G.P.; Bekker, H.L.; Kleijnen, J.; Fahey, T.
Recommendations for annual diabetic foot check in low-risk, community-based patients should be reviewed as absolute events of ulceration are low. The accuracy of foot risk assessment tools to predict ulceration requires evaluation in randomized controlled trials with concurrent economic evaluations.
Risk of drug-related mortality during periods of transition in methadone maintenance treatment: a cohort study
Cousins, G.; Teljeur, C.; Motterlini, N.; Mccowan, C.; Dimitrov, B.D.; Fahey, T.
This study aims to identify periods of elevated risk of drug-related mortality during methadone maintenance treatment (MMT) in primary care using a cohort of 3,162 Scottish drug users between January 1993 and February 2004. Deaths occurring during treatment or within 3 days after last methadone prescription expired were considered as cases "on treatment." Fatalities occurring 4 days or more after leaving treatment were cases "off treatment." Sixty-four drug-related deaths were identified. The greatest risk of drug-related death was in the first 2 weeks of treatment (adjusted hazard ratio 2.60, 95% confidence interval 1.03-6.56). Risk of drug-related death was lower after...
Importance of long-term follow-up of women receiving adjuvant therapy for breast cancer in the community
Mccowan, C.; Dewar, J.A.; Thompson, A.M.
A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: the DQIP study protocol
Dreischulte, T.; Grant, A.; Donnan, P.; Mccowan, C.; Davey, P.; Petrie, D.; Treweek, S.; Guthrie, B.
Background - High-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents accounts for a significant proportion of hospital admissions due to preventable adverse drug events. The recently completed PINCER trial has demonstrated that a one-off pharmacist-led information technology (IT)-based intervention can significantly reduce high-risk prescribing in primary care, but there is evidence that effects decrease over time and employing additional pharmacists to facilitate change may not be sustainable.
Methods/design - We will conduct a cluster randomised controlled with a stepped wedge design in 40 volunteer general practices in two Scottish health boards. Eligible practices are those that are using the...
What do we know about who does and does not attend general health checks? Findings from a narrative scoping review
Dryden, R.; Williams, B.; McCowan, C.; Themessl-Huber, M.
Routine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.
Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer
McCowan, C.; Shearer, J.; Donnan, P.T.; Dewar, J.A.; Crilly, M.; Thompson, A.M.; Fahey, T.P.
Increasing duration of tamoxifen therapy improves survival in women with breast cancer but the impact of adherence to tamoxifen on mortality is unclear. This study investigated whether women prescribed tamoxifen after surgery for breast cancer adhered to their prescription and whether adherence influenced survival. A retrospective cohort study of all women with incident breast cancer in the Tayside region of Scotland between 1993 and 2002 was linked to encashed prescription records to calculate adherence to tamoxifen. Survival analysis was used to determine the effect of adherence on all-cause mortality. In all 2080 patients formed the study cohort with 1633 (79%)...
Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study
McCowan, C.; Kidd, B.; Fahey, T.
Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person's risk of death.
A randomized trial of brief intervention strategies in patients with alcohol-related facial trauma as a result of interpersonal violence
Goodall, C.; Bowman, A.; Smith, I.; Ayoub, A.
Facial trauma is associated with male gender, low socioeconomic status, alcohol misuse, and violence. Brief intervention (BI) for alcohol is effective at reducing consumption in patients presenting with facial trauma. Singlesession control of violence for angry impulsive drinkers(SS-COVAID) is a new intervention that attempts to address alcohol-related violence. This study assessed the effect of SS-COVAID and BI on drinking and aggression in facial trauma patients. Male facial trauma patients who sustained their injuries as a result of interpersonal violence while drinking and who had Alcohol Use Disorders Identification Test (AUDIT) scores of ≥8 were randomized to either BI or SS-COVAID....
Quality and safety of medication use in primary care: consensus validation of a new set of explicit medication assessment criteria and prioritisation of topics for improvement
Dreischulte, T.; Grant, A.M.; McCowan, C.; McAnaw, J.J.; Guthrie, B.
Background: Addressing the problem of preventable drug related morbidity (PDRM) in primary care is a challenge for health care systems internationally. The increasing implementation of clinical information systems in the UK and internationally provide new opportunities to systematically identify patients at risk of PDRM for targeted medication review. The objectives of this study were (1) to develop a set of explicit medication assessment criteria to identify patients with sub-optimally effective or high-risk medication use from electronic medical records and (2) to identify medication use topics that are perceived by UK primary care clinicians to be priorities for quality and safety...
McCowan, C.; Thompson, A.M.
Nonpharmacogenetic factors may play a key role in the success of oral endocrine therapy for breast cancer. Adherence, defined as following medical advice as well as persistence and duration of use for patients prescribed endocrine therapy, may impact significantly on recurrence and survival. Side effects from tamoxifen or aromatase inhibitors may lead to patients stopping or switching therapy, while comorbidities, consequent coprescribing and patient perceptions may also influence outcomes. Interventions to improve adherence and persistence are required and could have as great an effect on survival as applying pharmacogenetic principles to the endocrine management of breast cancer.
Use of aspirin post-diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer specific mortality
McCowan, C.; Munro, A.J.; Donnan, P.T.; Steele, R.J.C.
OBJECTIVE: Aspirin is associated with a reduced risk of developing colorectal cancer. This study examined whether patients with colorectal cancer prescribed aspirin had improved survival.
DESIGN: An observational population cohort study was undertaken using data linkage of cancer registry, dispensed prescriptions and death certificate records in Tayside, Scotland. All community prescribed aspirin pre- and post-diagnosis was extracted and periods of aspirin use post-diagnosis for each individual were analysed using Cox proportional hazard models. Main outcome measures were all-cause and colorectal mortality from death certificates.
RESULTS: Two thousand nine hundred ninety patients were identified with colorectal cancer between 1st January 1997 and 30th...