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Biomedical subjects

Anthony Harrison

Publications and source records attributed to Anthony Harrison.

13 recordsLinked to original sources
PubMed2005

Do English NHS waiting time targets distort treatment priorities in orthopaedic surgery?

OBJECTIVES: To assess and quantify the impact of guarantees on maximum waiting times on clinical decisions to admit patients from waiting lists for orthopaedic surgery. METHODS: Before and after comparative study, analysing changes in waiting times distributions between 1997/8 and 2001/2 for waiting list and booked inpatients and day cases admitted for elective treatments in trauma and orthopaedics in English hospitals. RESULTS: The 2001/2 maximum waiting time target of 15 months did change the pattern of admissions for trauma and orthopaedic elective inpatients, with a net increase in admissions in that year, compared with 1997/8 (and over and above the 30,259 (7.6%) overall increase in all admissions) of patients who had waited around 15 months, of 9333. There was little indication that these additional admissions displaced shorter wait patients. In absolute and proportional terms, admissions increased for all waiting time categories except very short waiter-- one to two weeks (an absolute fall of 2901 and a relative fall of 6591), and those waiting 40--41 weeks. The latter fall was only 111 patients in absolute terms (or 577 relative to the expected increase), however. The former much larger reduction may be an indication of clinical distortions, but it is unclear why very short wait (presumably more urgent) patients should disproportionately suffer compared with longer wait (presumably less urgent) cases. In addition, there was little indication that more minor cases usurped more major cases: 57% of the increase consisted of knee and hip replacement procedures, for example. CONCLUSIONS: While the 2001/2 waiting times target demonstrably changed admission patterns (and was a major contribution to the reduction in long waits), the extent to which this represented significant and clinically relevant distortions is questionable given the lack of widely accepted admission criteria. However, as targets become progressively tougher, there is a need to monitor consultants' concerns more closely.

England↗
PubMed2004

Nonlinear oral pharmacokinetics of the alpha-antagonist 4-amino-5-(4-fluorophenyl)-6,7-dimethoxy-2-[4-(morpholinocarbonyl)-perhydro-1,4-diazepin-1-yl]quinoline in humans: use of preclinical data to rationalize clinical observations.

4-amino-5-(4-fluorophenyl)-6,7-dimethoxy-2-[4-(morpholinocarbonyl)-perhydro-1,4-diazepin-1-yl]quinoline (UK-294,315) is an antagonist of the human alpha1-adrenoceptor and exhibits nonlinear oral pharmacokinetics in humans. Superproportional increases in Cmax occur (220-fold, over a 1- to 50-mg dose range), area under the curve increases linearly, but time to maximum concentration decreases with dose, suggesting variation in rate but not extent of absorption. Oral absorption in humans is extensive, with only 14% of an orally administered (20 mg) radiolabeled dose excreted unchanged in the feces. In rats and dogs, UK-294,315 is partially eliminated as unchanged drug in feces (29 and 14% of an intravenous dose, respectively). Oral bioavailability is low in rats (11%) and high in dogs (71%), in keeping with systemic clearance. Fecal elimination of unchanged drug was 60% after oral administration to rats, indicating incomplete absorption in this species, whereas absorption in dogs is complete. UK-294,315 is a P-glycoprotein (P-gp) substrate (Km, 15 microM) exhibiting polarized flux in Caco-2 cell monolayers, saturable across a concentration range of 5 to 200 microM. Furthermore, the observations in vitro occurred at similar concentrations to those estimated in the gut lumen in clinical trials (dose range, 1-100 mg). It is considered that P-gp acts as a saturable absorption barrier to UK-294,315, slowing the rate of absorption at low doses, and is responsible for the observed nonlinearity in oral disposition in humans. Rat and dog pharmacokinetic studies offered limited insight into the process(es) driving nonlinear pharmacokinetics in humans. Our current understanding of the functional effects of P-gp in the human intestine, in combination with in vitro studies at clinically relevant concentrations, has helped rationalize the clinical data for UK-294,315.

Administration, Oral↗
PubMed2003

Waiting times. Catch up, keep up.

Trusts vary greatly on their progress in achieving waiting-list targets, particularly for 2005. A study of trusts with a range of performances identified four key criteria: information use, managerial focus, capacity and long-term efficiency. Actions that help a trust 'catch up' rarely help them 'keep up; strategies may need to change once waiting lists have fallen markedly. Flexibility, forward planning and 'expecting the unexpected' are characteristics of successful trusts.

Efficiency, Organizational↗
PubMed2002

Franchising. Where's the beef?

Franchising is most appropriate to services which can be simply defined. Introducing it to the NHS will raise issues about accountability. Those taking on franchises may feel they need more freedom than is currently available. The scope for franchising in the NHS seems limited.

Economic Competition↗
PubMedDate not supplied

A guide to risk assessment.

Mental health service users experience increased risk in relation to a number of specific problems, including an increased risk of suicide, self-injury, neglect, exploitation (physical, financial or sexual) and violence towards others. Risk assessment is linked to the practice of risk management, whereby a mutually agreed plan, aimed at reducing identified risks, is negotiated with the individual concerned. The plan incorporates specific therapeutic strategies and is a collaborative, interactive and dynamic process rather than something that is 'done to' the person. Although risk assessment is a core nursing skill, it needs to occur within the multi-professional context and involves other relevant disciplines.

Humans↗
PubMedDate not supplied

Benchmarking mental health care in a general hospital.

Benchmarking is a tool that allows practitioners to compare and measure their own performance against best practice. Two trusts took a joint approach to benchmarking mental health in a general hospital. They set up a benchmarking comparison group, whose members explored the six elements of the mental health benchmark and identified examples of best practice. The group then scored practice and compared scores. Finally, guidance sheets were produced on assessing and planning care in a general hospital for people with mental health needs. These are included as part of a mental health resource pack for each clinical area in the general hospital.

Benchmarking↗