Biomedical subjects

A L Bhasale

Publications and source records attributed to A L Bhasale.

3 recordsLinked to original sources

PubMed2006

Bronchodilators for bronchiolitis.

BACKGROUND: Bronchiolitis is an acute, highly infectious lower respiratory tract infection. Bronchodilators are commonly used in the management of bronchiolitis in North America but not in the United Kingdom. OBJECTIVES: The objective of this review was to assess the effects of bronchodilators on clinical outcomes in infants with acute bronchiolitis. SEARCH STRATEGY: In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to October 2005), EMBASE (2003 to September 2005) and the reference lists of articles. The files of one author (AG) were also reviewed. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo in the treatment of bronchiolitis. DATA COLLECTION AND ANALYSIS: For this updated review, one author assessed trial quality and extracted data. Unpublished data were requested from study authors when necessary. MAIN RESULTS: Twenty-two clinical trials with 1428 infants with bronchiolitis were included in this review. In eight trials, with 468 infants, there was no improvement in clinical score for 43% of those treated with bronchodilators compared to 57% of those treated with placebo (odds ratio (OR) for no improvement 0.45, 95% confidence interval (CI) 0.15 to 1.29). There was a statistically significant but clinically modest improvement in the overall average clinical score (standardized mean difference (SMD) -0.48, 95% CI -0.62 to -0.33). However there was no statistically significant improvement in oxygenation overall (weighted mean difference (WMD) -0.57, 95% CI -1.17 to 0.03). Subgroup analyses showed a slightly greater effect size in outpatient studies, where there were shorter follow up durations, than in inpatient studies for both oximetry (outpatients WMD -0.84, 95% CI -1.59 to -0.10 versus inpatients WMD -0.25, 95% CI -1.18 to 0.67) and average clinical score (outpatients SMD -0.68, 95% CI -0.87 to -0.49 versus inpatients SMD -0.23, 95% CI -0.44 to -0.01). Bronchodilator recipients showed no improvement in the rate of hospital admission after treatment as outpatients (18% versus 26%, OR 0.70, 95% CI 0.36 to 1.35) or duration of hospitalization for inpatients (WMD 0.02, 95% CI -0.32 to 0.36). The inclusion of studies that enrolled infants with recurrent wheezing may have biased the results in favor of bronchodilators. AUTHORS' CONCLUSIONS: Bronchodilators produce small short-term improvements in clinical scores. This small benefit must be weighed against the costs and adverse effects of these agents.

Acute Disease↗

PubMed1998

Analysing potential harm in Australian general practice: an incident-monitoring study.

OBJECTIVE: To collect data on incidents of potential or actual harm to general practice patients and to evaluate the possible causes of these incidents. DESIGN: An observational study of incidents of potential harm based on a modified critical incidents technique. A non-random sample of general practitioners (GPs) anonymously submitted incident reports contemporaneously. SETTING AND PARTICIPANTS: Australian general practices between October 1993 and June 1995. During the study period, 324 GPs participated at some time. MAIN OUTCOME MEASURES: GP-reported free-text descriptions of incidents and structured responses for preventability, potential for harm, immediate consequences, predicted long-term outcomes, type of incident, contributing factors, mitigating factors, and additional resource use. RESULTS: 805 incidents were reported--76% were preventable; 27% had potential for severe harm. No long term harm was predicted for 66% of incidents. Incidents could relate to pharmacological management (51 per 100 incidents), nonpharmacological management (42 per 100 incidents), diagnosis (34 per 100 incidents) or equipment (5 per 100 incidents). The most common contributory factors were poor communication between patients and healthcare professionals and actions of others (23 per 100 incidents each) and errors in judgement (22 per 100 incidents). CONCLUSION: Human error and preventable system problems were identified. The incident monitoring technique provided useful data which could be applied to incident prevention strategies.

Adolescent↗

PubMed1997

Collecting data on potentially harmful events: a method for monitoring incidents in general practice.

OBJECTIVE: The prediction and subsequent prevention of errors, which are an integral element of human behaviour, require an understanding of their cause. The incident monitoring technique was developed in the study of aviation errors in the Second World War and has been applied more recently in the field of anaesthetics. This pilot study represents one of the first attempts to apply the incident monitoring technique in the general practice environment. METHOD: A total of 297 GPs across Australia anonymously reported details of unintended events which harmed or could have harmed the patient. Reports were contemporaneously recorded on prepared forms which allowed a free text description of the incident, and structured responses for contributing and mitigating factors, immediate and long-term out-comes, additional costs etc. RESULTS AND DISCUSSION: The first 500 reports were analysed using both of qualitative and quantitative methods and a brief overview of results is presented. The methodological issues arising in the application of this technique to such a large, widely spread profession, in which episodes of care are not necessarily confined to a single consultation, are discussed. This study demonstrated that the incident monitoring technique can be successfully applied in general practice and that the resulting information can facilitate the identification of common factors contributing to such events and allow the development of preventive interventions.

Australia↗