PubMed Health⌕ Search

Biomedical subjects

A Millard

Publications and source records attributed to A Millard.

8 recordsLinked to original sources
PubMed2005

Randomised, crossover comparison of the single-use SoftSeal and the LMA Unique laryngeal mask airways.

We performed a randomised, crossover, single-blind trial among 168 patients, to compare the single-use SoftSeal and LMA Unique laryngeal mask airways in spontaneously breathing adults. Size-3 and -4 laryngeal mask airways, inserted by experienced anaesthetists, performed equivalently for successful first-time placement (148 (91%) vs 155 (96%) for the SoftSeal and LMA Unique, respectively). The SoftSeal was more often rated as difficult to insert (27 (17%) vs 4 (3%); p < 0.001) and was more likely to show evidence of mucosal trauma after the first insertion (14 (10%) vs 5 (4%); OR 1.3 (95% CI 1.3-11.3); p < 0.05). The fibreoptic view of the larynx was better through the SoftSeal (vocal cords not visible in 27 (17%) vs 44 (27%); p < 0.05) and it more frequently provided a ventilation seal at 20 cmH(2)O (93 (59%) vs 62 (39%); OR 2.15 (CI 1.44-3.21); p < 0.001). In contrast to the LMA Unique(trade mark), its cuff pressure did not increase during nitrous oxide anaesthesia (median (IQR [range]) decrease 3 (- 20-23 [-40-94]) cmH(2)O vs increase of 16 (-2-39 [-54-112]) cmH(2)O; p < 0.01). Both devices were equivalent for the success of first-time insertion and performed satisfactorily clinically. There were some performance differences, but either appears suitable for airway management in spontaneously breathing patients.

Adult↗
PubMed2003

Double respiratory sequelae of head injury: subglottic stenosis and bilateral pneumothoraces.

An 18-yr-old man with insulin-dependent diabetes developed severe subglottic stenosis after a very brief period of intubation. Emergency tracheostomy was complicated by the development of bilateral pneumothoraces. This case highlights the importance of making an early diagnosis to minimize the risk of complications and examines postintubation subglottic stenosis in the context of poorly controlled insulin-dependent diabetes mellitus.

Adolescent↗
PubMed2000

Reviewing audit: barriers and facilitating factors for effective clinical audit.

OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

Attitude of Health Personnel↗
PubMed1999

Attitudes to audit.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1998

Planned and reported implementation of clinical practice guidelines.

The aim of this project was to compare the intentions with reported action of Health Trusts in Scotland to prioritise and implement published SIGN clinical guidelines. All health Trusts in Scotland were asked about plans for implementation, and resurveyed 15-18 months later for confirmation. Specific guideline implementation groups led by medical doctors were the most common implementation structure. Implementation usually consisted of baseline audit, development of a local version, and reaudit. In one case a successful link between acute and primary care through an area level GP audit facilitator was thought to increase implementation. More research is required to: find out what influences the ability of an organisation to implement guidelines; identify particular facilitating factors or barriers; and on factors influencing the ability of a health organisation to implement guidelines.

Communication Barriers↗
PubMed1997

Evidence-based clinical guidelines--implementation plans in Scotland.

Presents a study which investigates how it was planned to implement guidelines from the Scottish intercollegiate guidelines network (SIGN). The study aimed to describe the activity in planning the implementation of SIGN guidelines in Scottish Health Service Trusts in 1996, and to provide a baseline for evaluation. A postal questionnaire was sent to the Clinical Audit lead person in 46 Scottish Health Service Trusts. The response rate after two reminders ranged from 60-72 per cent across different categories of Trust. The questionnaire asked for plans to implement individual guidelines, adaptation, professions involved, timeframes, dissemination, and evaluation methods. Reveals that local consensus was the main factor in deciding priorities. Most Trusts wished to see other local versions of guidelines produced, and to evaluate implementation collaboratively. Most expected to have reviewed baseline practice before implementation.

Evidence-Based Medicine↗