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Biomedical subjects

David Oliver

Publications and source records attributed to David Oliver.

At least 19 recordsLinked to original sources
PubMed2006

Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses.

OBJECTIVES: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. DATA SOURCES: Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005. RESULTS: 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment. CONCLUSION: There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

Accident Prevention↗
PubMed2006

Electronically swept millimeter-wave interferometer for spatially resolved measurement of plasma electron density.

We report the development and initial implementation of what we believe to be a new rapid- spatial-scan millimeter-wave interferometer for plasma density measurements. The fast scan is effected by electronic frequency sweeping of a wideband (180-280 GHz) backward-wave oscillator whose output is focused onto a fixed blazed diffraction grating. The system, which augments the rotating-grating scanned multiview H-1 heliac interferometer, can sweep the plasma cross section in a period of less than 1 ms with a beam diameter in the plasma of 20 mm and phase noise of the order of 0.01 rad.

Journal Article↗
PubMed2006

Management of respiration in MND/ALS patients: an evidence based review.

This systematic review comprises an objective appraisal of the evidence in regard to the management of respiration in patients with motor neuron disease (MND/ALS). Studies were identified through computerised searches of 32 databases. Internet searches of websites of drug companies and MND/ALS research web sites, 'snow balling' and hand searches were also employed to locate any unpublished study or other 'grey literature' on respiration and MND/ALS. Since management of MND/ALS involves a number of health professionals and care workers, searches were made across multiple disciplines. No time frame was imposed on the search in order to increase the probability of identifying all relevant studies, although there was a final limit of March 2005. Recommendations for patient and carer-based guidelines for the clinical management of respiration for MND/ALS patients are suggested on the basis of qualitative analyses of the available evidence. However, these recommendations are based on current evidence of best practice, which largely comprises observational research and clinical opinion. There is a clear need for further evidence, in particular randomised and non-randomised controlled trials on the effects of non-invasive ventilation and additional larger scale cohort studies on the issues of initial assessment of respiratory symptoms, and management and timing of interventions.

Amyotrophic Lateral Sclerosis↗
PubMed2006

National breast cancer audit: overview of invasive breast cancer management.

BACKGROUND: The National Breast Cancer Audit is an initiative of the Breast Section of the Royal Australasian College of Surgeons collecting surgical information in early breast cancer. It is managed in conjunction with the Australian Safety and Efficacy Register of New Interventional Procedures - Surgical. An overview of results for invasive breast cancer from January 1999 until December 2004 is presented to provide preliminary data for participating surgeons. METHODS: Invasive breast cancer cases were retrieved from the National Breast Cancer Audit database for the 274 participating breast surgeons in Australia and New Zealand. Data for a variety of clinical parameters were analysed to provide an overview of the diagnostic, histological, surgical and adjuvant therapy management issues. RESULTS: There were 25,026 cases of invasive breast cancer. Annual percentages of mammographically detected cancers from 1999 to 2004 did not differ significantly. Breast-conserving surgery rates also remained stable at 60%. Margins were involved in 5% of patients; an additional 9% had final margins of less than 1 mm. Radiotherapy followed breast-conserving surgery in most cases (86%). Patients undergoing mastectomy with large tumours (>5 cm) underwent radiotherapy in 71% of cases. When at least four lymph nodes were positive, radiotherapy followed mastectomy in the majority (75%) of cases. The most frequently carried out axillary procedure was a level 2 dissection. Chemotherapy was received by 78% of oestrogen receptor negative, axillary node positive, postmenopausal patients. Tamoxifen was used in the majority (83%) of oestrogen receptor positive cases. CONCLUSION: Surgeons contributing their invasive breast cancer data show a high quality of treatment. Some further improvement may be possibly related to excision margins and tamoxifen prescription for oestrogen receptor negative cancers. Chemotherapy prescription might also warrant further investigation.

Aged↗
PubMed2004

Ventilation in motor neuron disease: difficult decisions in difficult circumstances.

The care of people with MND/ALS can raise difficult ethical dilemmas. The ventilatory support of patients may involve difficult decisions and complex discussions, to allow patients and their families and carers to make truly autonomous decisions. A case is presented of a patient who asked for invasive ventilation to be withdrawn and the problems for all involved--patient, family and professionals--are explored. The need for careful forward planning and discussion is emphasised so that decisions can be made after careful consideration and not in an emergency situation.

Adult↗
PubMed2004

Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review.

OBJECTIVE: To identify all published papers on risk factors and risk assessment tools for falls in hospital inpatients. To identify clinical risk assessment tools or individual clinical risk factors predictive of falls, with the ultimate aim of informing the design of effective fall prevention strategies. DESIGN: Systematic literature review (Cochrane methodology). Independent assessment of quality against agreed criteria. Calculation of odds ratios and 95% confidence intervals for risk factors and of sensitivity, specificity, negative and positive predictive value for risk assessment tools (with odds ratios and confidence intervals), where published data sufficient. RESULTS: 28 papers on risk factors were identified, with 15 excluded from further analysis. Despite the identification of 47 papers purporting to describe falls risk assessment tools, only six papers were identified where risk assessment tools had been subjected to prospective validation, and only two where validation had been performed in two or more patient cohorts. CONCLUSIONS: A small number of significant falls risk factors emerged consistently, despite the heterogeneity of settings namely gait instability, agitated confusion, urinary incontinence/frequency, falls history and prescription of 'culprit' drugs (especially sedative/hypnotics). Simple risk assessment tools constructed of similar variables have been shown to predict falls with sensitivity and specificity in excess of 70%, although validation in a variety of settings and in routine clinical use is lacking. Effective falls interventions in this population may require the use of better-validated risk assessment tools, or alternatively, attention to common reversible falls risk factors in all patients.

Accidental Falls↗
PubMed2004

The development of an interdisciplinary outpatient clinic in specialist palliative care.

The interdisciplinary team approach is essential in the assessment and management of the palliative care of patients and their families. An innovative approach has been developed to allow the interdisciplinary team to see patients and their families in an outpatient clinic setting. This has allowed an improved assessment and has demonstrated to patients that a wider approach is undertaken. These interdisciplinary outpatient clinics have been audited and appear to be effective, and acceptable to patients and families.

England↗
PubMed2003

Use of a pro forma and overhead projector to improve multidisciplinary team communication.

Good communication among the members of the multidisciplinary team is essential in the provision of specialist palliative care. It allows the patient's and family's care to be coordinated and all team members to be involved in planning care. In multidisciplinary team meetings at the Wisdom Hospice in the UK, a pro forma has been used with an overhead projector to show details of the patient, their family, history and problems. An audit of team members' views found the pro forma to be effective and useful in encouraging interdisciplinary workings.

Audiovisual Aids↗