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Biomedical subjects

C Cull

Publications and source records attributed to C Cull.

14 recordsLinked to original sources
PubMed2001

Cost-effectiveness analysis of intensive blood-glucose control with metformin in overweight patients with type II diabetes (UKPDS No. 51).

AIMS/HYPOTHESIS: To estimate the economic efficiency of intensive blood-glucose control with metformin compared with conventional therapy primarily with diet in overweight patients with Type II (non-insulin-dependent) diabetes mellitus. METHODS: Cost-effectiveness analysis based on patient level data from a randomised clinical controlled trial involving 753 overweight (> 120% ideal body weight) patients with newly diagnosed Type II diabetes conducted in 15 hospital-based clinics in England, Scotland and Northern Ireland as part of the UK Prospective Diabetes Study. Subjects were allocated at random to an intensive blood-glucose control policy with metformin (n = 342) or a conventional policy primarily with diet (n = 411). The analysis was based on the cost of health care resources associated with metformin and conventional therapy and the estimated effectiveness in terms of life expectancy gained from within-trial effects. RESULTS: Intensive blood-glucose control with metformin produced a net saving of 258 Pounds per patient (1997 United Kingdom prices) over the trial period (median duration of 10.7 years) due to lower complication costs, and increased life expectancy by 0.4 years (costs and benefits discounted at 6%). CONCLUSIONS/INTERPRETATION: As metformin is both cost-saving in the United Kingdom and extends life expectancy when used as first line pharmacological therapy in overweight Type II diabetic patients, its use should be attractive to clinicians and health care managers alike.

Adult↗
PubMed2001

An economic evaluation of atenolol vs. captopril in patients with Type 2 diabetes (UKPDS 54).

AIMS: To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or beta blocker (atenolol) in patients with Type 2 diabetes. DESIGN: A cost-effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting. SETTING: Twenty United Kingdom Prospective Diabetes Study Hospital-based clinics in England, Scotland and Northern Ireland. SUBJECTS: Hypertensive patients (n = 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the beta blocker atenolol. MAIN OUTCOME MEASURES: Life expectancy and mean cost per patient. RESULTS: There was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was 6485 UK pounds in the captopril group, compared with 5550 UK pounds in the atenolol group, an average cost difference of 935 UK pounds (95% confidence interval 188 UK pounds, 1682 UK pounds). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group. CONCLUSIONS: Treatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group. Diabet. Med. 18, 438-444 (2001)

Adrenergic beta-Antagonists↗
PubMed2001

High and low perceived self-control of epileptic seizures.

PURPOSE: To define behaviours and to identify psychological, demographic, and epilepsy-related variables associated with high as opposed to low perceived self-control of seizures. METHOD: In a semistructured interview, 100 adults with intractable seizures were asked about their seizure precipitants and attempts at self-control of seizures. They also completed four psychological questionnaires. Latent Class Analysis was used to analyse the interview data to create two groups, High Controllers and Low Controllers, who were then compared on demographic, epilepsy, and psychological characteristics. RESULTS: Being able to identify and seeking out low-risk-for-seizure situations, avoiding high-risk-for-seizure situations, and making attempts at seizure inhibition were seizure behaviours that discriminated High from Low Controllers. The general probability of being a High Controller was greater than that of being a Low Controller. Perceived high self-control of seizures was associated with low chance-health locus of control. For Low Controllers, current age, age at onset of seizures, and duration of epilepsy history were related to psychological variables. A significantly higher proportion of the Low Controllers than High Controllers were women. CONCLUSIONS: Many people with intractable seizures do not accept their epilepsy as a condition over which they have no control. Perceived self-control of seizures, however, involves a complex interaction between epilepsy and psychological factors, with health locus of control an apparently important discriminator between High and Low Controllers.

Adult↗
PubMed2000

Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41). United Kingdom Prospective Diabetes Study Group.

OBJECTIVE: To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. DESIGN: Incremental cost effectiveness analysis alongside randomised controlled trial. SETTING: 23 UK hospital clinic based study centres. PARTICIPANTS: 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). INTERVENTIONS: Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. MAIN OUTCOME MEASURES: Incremental cost per event-free year gained within the trial period. RESULTS: Intensive glucose control increased trial treatment costs by pound 695 (95% confidence interval pound 555 to pound 836) per patient but reduced the cost of complications by pound 957 (pound 233 to pound 1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was pound 478 (-pound 275 to pound 1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was pound 1166 (costs and effects discounted at 6% a year) and pound 563 (costs discounted at 6% a year and effects not discounted). CONCLUSIONS: Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications.

Adult↗
PubMed2000

Seizure precipitants and perceived self-control of seizures in adults with poorly-controlled epilepsy.

This study was set up in order to investigate the prevalence and nature of seizure precipitants and self-control behaviours in adults with intractable seizures. A semi-structured interview was conducted with 100 patients attending neurology or neuropsychiatry epilepsy out-patient clinics. The interview included six questions regarding seizure precipitants, the extent to which the patients seek and avoid precipitants, and their ability to induce or abort seizures. The study revealed that over 90% of the participants could identify at least one seizure precipitant. Stress, depression, tiredness and the menstrual cycle were the most common precipitants reported. In addition, 65% of the participants could identify at least one 'low-risk' situation in which seizures were unlikely to occur. Fifteen percent reported they could induce a seizure, 52% said that they consciously try to avoid seizure precipitants and 47% said they could sometimes stop their seizures from happening. These results indicate that the majority of the sample could identify factors which trigger their seizures, and that some of the participants engage in attempts to reduce their seizure frequency by avoiding these factors and by controlling the onset of their seizures. The possible mechanisms involved in the relationship between precipitants and seizure genesis are discussed.

Adult↗
PubMed1999

Reduction in seizure frequency following a short-term group intervention for adults with epilepsy.

A preliminary investigation of the efficacy of a group intervention combining a range of psychological approaches and techniques for seizure management in adults with poorly controlled epilepsy. An uncontrolled AB group design was employed. Seven adults with intractable seizures took part in 8, weekly group sessions which included providing information, employed cognitive-behavioural techniques and addressed emotional difficulties. Weekly seizure logs were kept by participants during the intervention and the following 3 months. Five questionnaires were administered before and after the intervention and at 2-months follow-up to provide an indication of psychosocial well-being. Seizure frequency and scores on the questionnaires were used as outcome measures. There was a significant reduction in seizure frequency in the group, which persisted at follow-up. There were no significant changes on any of the questionnaires. The results suggest that a group-based intervention incorporating a range of psychological techniques may be effective for improving seizure control. The link between seizure reduction and psychological and psychosocial well-being needs further investigation.

Adaptation, Psychological↗
PubMed1999

Extubation in ICU: enhancing the nursing role.

UKCC guidance gives a clear framework within which nurses can enhance their practice. Enhanced nurses can extubate patients with appropriate training and suitable protocols. Cost-effective, high-quality care can be provided by nurses working to the best of their professional knowledge and skill.

Clinical Protocols↗
PubMed1999

Weaning patients from mechanical ventilation.

Enhancing the nursing role can allow staff to provide more individualised care. Nurses in ICU can become involved in weaning patients from ventilators. Multidisciplinary team communication is vital in such advanced nursing practice.

Communication↗
PubMed1997

Defibrillation.

More nurses are now learning the skill of defibrillation. Nurses are the staff most likely to discover a patient in cardiac arrest and should be able to perform defibrillation. Nurses have a responsibility to maintain and update their skills in this area.

Clinical Competence↗
PubMed1996

United Kingdom Prospective Diabetes Study 17: a 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin-dependent diabetes mellitus.

PURPOSE: To report the progress (after 9-year follow-up) of a study designed to determine whether improved glucose control in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) is effective in reducing the incidence of clinical complications. DATA SOURCE: A multicenter, randomized, controlled trial of different therapies for NIDDM. After initial diet therapy, 4209 asymptomatic patients who remained hyperglycemic (fasting plasma glucose levels, 6.0 to 15.0 mmol/L) were assigned to either a conventional therapy policy, primarily with diet alone, or to an intensive therapy policy, aiming for fasting plasma glucose levels of less than 6.0 mmol/L, with assignment to primary therapy with sulfonylurea or insulin (which increased insulin supply) or metformin (which enhanced insulin sensitivity). RESULTS: All three modes of pharmacologic therapy in the intensively treated group-sulfonylurea, insulin, and metformin-had similar efficacy in reducing the fasting plasma glucose and glycated hemoglobin levels. Over 9 years, patients assigned to intensive therapy with sulfonylurea or insulin had lower fasting plasma glucose levels (median, 7.3 and 9.0 mmol/L, respectively) than patients assigned to conventional therapy. Regardless of the assigned therapy, however, the fasting plasma glucose and hemoglobin A1c levels increased, and maintaining near-normal glycemia was, in general, not feasible. Even insulin therapy did not achieve the therapeutic goal of near-normal glycemia because of the difficulty in treating marked hyperglycemia and the risk for hypoglycemic episodes. Nine years after the diagnosis of diabetes, 29% of the patients had had a diabetes-related clinical end point, 20% had had a macrovascular complication, and 9% had had a microvascular complication. CONCLUSIONS: A report will be published in 1998 after a median duration from randomization of 11 years (range, 6 to 20 years) with an 81% power at a 1% level of significance of detecting whether the obtained improvement in glucose control causes a 15% decrease or increase in the incidence of major complications and whether any specific therapy is advantageous or disadvantageous.

Adult↗
PubMed1988

Children of school age: the influence of antiepileptic drugs on behavior and intellect.

The role of antiepileptic drugs in behavior and cognitive function in children is well documented in the literature. In general, behavioral problems occur most frequently with phenobarbital and clonazepam, and appear least often with valproate and carbamazepine. Cognitive impairments occur with phenytoin, are less evident with valproate, and minimal with carbamazepine. Monotherapy, as with adults, leads to improvements in both cognitive abilities and behavior.

Anticonvulsants↗
PubMed1984

Memory function of children with spina bifida and shunted hydrocephalus.

A group of 10 children with spina bifida and shunted hydrocephalus, aged between 7 1/2 and nine years, was tested for memory of two types of verbal material and two types of pictorial material. Their performance was compared with a group of children with matched IQ and with a group of average IQ, all matched for age and sex. The parameters investigated were learning ability; immediate and delayed recall, and also long-term recall/recognition; and reacquisition of material learned after a period of 24 hours. The hydrocephalic children and the matched IQ group were significantly poorer than the average IQ group on all tasks except for 'Memory for a Short Story' Comparisons between the hydrocephalic and matched IQ groups showed that the former group was significantly poorer only in a 'Memory for Words' test. It is suggested that this discrepancy in the performance of hydrocephalic children in learning unrelated, as opposed to connected, meaningful verbal material may reflect a deficit in their ability to use appropriate semantic strategies at the level of encoding.

Cerebrospinal Fluid Shunts↗