School absence--a valid morbidity marker for asthma? - Mccowan, C.; Bryce, F.P.; Neville, R.G.; Crombie, I.K.; Clark, R.A.
To determine how often children with asthma are absent from school compared to the 'average' child and to assess the validity of school absence as a marker of morbidity for asthma.
Case control study.
Children registered with 12 general practices, attending 98 primary and secondary schools in the Tayside region.
773 children with asthma or related symptoms and 773 controls from school registers.
MAIN OUTCOME MEASURES:
Episodes of school absence and days absent per term, recorded from school registers.
Comparing children taking asthma medication against their controls showed a significant difference for both days absent and episodes of absence. This increase in absence was approximately one...
Asthma and growth--cause for concern? Asthma & growth in Tayside children - Neville, R.G.; Mccowan, C.; Thomas, G.; Crombie, I.K.
This project aimed to investigate the height and weight of children with asthma in the community. The Tayside Childhood Asthma Project examined medical records of 3143 children drawn from 12 general practices, for details of asthma morbidity and management. Concurrently, but independent from it, the Tayside Growth Study measured heights and weights of children aged 3-5, 5, 7, 9, 11 and 14 years. This paper reports on a cross-sectional analysis of 699 children who were known to be receiving some form of asthma medication during the school years 1990-91 and 1991-92 when a growth measurement was recorded. A standard deviation...
The facilitator effect: results from a four-year follow-up of children with asthma - Mccowan, C.; Neville, R.G.; Crombie, I.K.; Clark, R.A.; Warner, F.C.
A long-term evaluation of the process and outcomes of primary and secondary care is required to establish whether audit facilitators can improve the care of childhood asthma.
To examine the long-term effect of an intervention by an audit facilitator on the management of children with asthma, and to investigate the implications for health service costs.
A 4-year follow up was conducted of an intervention and control group totalling 2557 children aged 1-15 years from 12 general practices in the Tayside region. Primary care consultations, prescriptions, hospital contacts and health service costs 1 year before and 3 years after a facilitator visited practices...
Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland - Mccowan, C.; Neville, R.G.; Thomas, G.E.; Crombie, I.K.; Clark, R.A.; Ricketts, I.W.; Cairns, A.Y.; Warner, F.C.; Greene, S.A.; White, E.
Objective: To investigate whether asthma or its treatment impairs children’s growth, after allowing for socioeconomic group.
Design: 4 year follow up of a cohort of children aged 1-15.
Setting: 12 general practices in the Tayside region of Scotland.
Subjects: 3347 children with asthma or features suggestive of asthma registered with the general practices.
Main outcome measures: Height and weight standard deviation scores.
Results: Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score −0.26 (SD 1.02) and −0.18 (1.15) respectively, P<0.001 for both). Children who were receiving 400μg daily of inhaled steroids...
Risk factors and costs associated with an asthma attack - Hoskins, G.; Mccowan, C.; Neville, R.G.; Thomas, G.E.; Smith, B.; Silverman, S.
BACKGROUND A study was undertaken to identify asthma patients at risk of an attack and to assess the economic impact of treatment strategies.
METHODS A retrospective cohort analysis of a representative data set of 12 203 patients with asthma in the UK over a one year period was performed. Logistic multiple regression was used to model the probability of an attack occurring using a set of categorised predictor factors. Health service costs were calculated by applying published average unit costs to the patient resource data. The main outcome measures were attack incidence, health service resource use, drug treatment, and cost estimates for...
Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma - Mccowan, C.; Neville, R.G.; Ricketts, I.W.; Warner, F.C.; Hoskins, G.; Thomas, G.E.
Primary objective : To investigate whether computer decision support software used in the management of patients with asthma improves clinical outcomes. Research design : Randomized controlled trial with practices each reporting on 30 patients with asthma over a 6 month period. Methods and procedures : 447 patients were randomly selected from practice asthma registers managed by 17 general practices from throughout the UK. Intervention practices used the software during consultations with these patients throughout the study while control practices did not. Main outcomes and results : Practice consultations, acute exacerbations of asthma, hospital contacts, symptoms on assessment and medication use....
Pragmatic 'real world' study of the effect of audit of asthma on clinical outcome - Neville, R.G.; Hoskins, G.; Mccowan, C.; Smith, B.
AIMS: To test whether participation in clinical audit is associated with improved care of a long-term health condition. METHODS: Real world study comparing 1339 patients of all ages and severity of asthma managed by 77 self-selected highly motivated general practices in Scotland with 9617 patients from 319 practices from a national sample. RESULTS: Patients managed by audit practices had more structured clinical reviews by nurses [817 (61%) versus 4301 (45%) OR 0.52, 95% CI 0.46?0.58] and less acute GP contacts [440 (33%) v 4161 (43%) OR 1.56, CI 1.38?1.56]. Consequently they experienced more checking of inhaler technique, use of peak...
An academic, pharmaceutical and practice collaboration to implement asthma guidelines - 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...
Clinical symptoms and 'off-label' prescribing in children with asthma - 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%...
A survey on public knowledge and perceptions of methicillin-resistant staphylococcus aureus - 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...
The external validity of published randomized controlled trials in primary care - 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...
Evaluation of a fatigue initiative: information on exercise for patients receiving cancer treatment - 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...
The burden of psychotropic drug prescribingin people with dementia: a populationdatabase study - 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...
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...