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Biomedical subjects

J Tully

Publications and source records attributed to J Tully.

7 recordsLinked to original sources
PubMed2000

The new system of review by multicentre research ethics committees: prospective study.

OBJECTIVE: To assess the function of the new system of review by multicentre research ethics committees and to highlight areas where improvement is still needed. DESIGN: Prospectively collected data from a multicentre study was examined with respect to the ethics review process. Administrative, financial, and time elements of the review process were audited. SETTING: A single multicentre research ethics committee and 125 local ethics committees from six regions of England. MAIN OUTCOME MEASURES: Time to reply, time to approval, and number of non-local changes to the application requested. RESULTS: Only 40% of local ethics committees considered our study in the manner specified in the 1998 directive. Less than a third of committees replied within the 21 day period stipulated, although committees acting by executive subcommittee replied more quickly than those not acting by executive subcommittee. There was a tendency for executive subcommittees to approve studies in a shorter time. Local ethics committees asked for a large number of non-local changes to the application. The financial cost of applying to multiple ethics committees remains high, mainly because multiple copies of research applications are being requested. CONCLUSIONS: The new system of approval by multicentre research ethics committee for multicentre studies was introduced to reduce administrative costs, speed up the process of reviews by multiple research ethics committees, and standardise the conclusions of the local research ethics committees. Since its introduction an improvement has been seen, but the system is not yet universally functioning as intended. Ethics review still remains a hindrance to the financial resources and commencement of national studies. We strongly support the structure of review by multicentre research ethics committees but suggest that the system has yet to achieve its aims.

Costs and Cost Analysis↗
PubMed1996

Prandial aspiration and pneumonia in an elderly population followed over 3 years.

The purpose of our study was to prospectively determine pneumonia frequency and correlate it with prandial liquid aspiration and feeding status in frail elderly nursing home residents. Initially, 152 patients had video swallowing examinations (81 oropharyngeal dysphagia, 19 thoracic dysphagia, 52 without dysphagia). Those diagnosed with oropharyngeal impairment were subsequently managed with swallowing therapy or artificial feeding modalities. Patients were followed for 3 years (unless they expired earlier) and clinical courses were categorized according to the degree of prandial aspiration and feeding (PAF) status. Subjects with new lung infiltrates persisting for at least 5 days with appropriate clinical findings were diagnosed as having pneumonia and were classified according to the PAF status months in which these findings occurred. Fifty-six pneumonias were diagnosed during 4,280 months with the following frequencies: no aspiration months 0.6%; minor aspiration months 0.9%; major aspiration/oral feeding months 1.3%; major aspiration/artificial feeding months 4.4%, p < 0.001. Our results indicate that there is not a simple and obvious relation between prandial liquid aspiration and pneumonia. Artificial feeding does not seem to be a satisfactory solution for preventing pneumonia in elderly prandial aspirators.

Aged↗
PubMed1992

Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management.

Oral and pharyngeal function in 131 institutionalized elderly patients with advanced dementia was evaluated by means of videofluoroscopic deglutition examination (VDE). Findings were normal in only nine (7%) patients. Oral-stage dysfunction was observed in 93 (71%) patients, pharyngeal dysfunction in 56 (43%), and pharyngoesophageal-segment abnormalities in 43 (33%). Multiple-stage dysfunction was noted in 55 (42%) patients. Major aspiration of contrast medium was present in 31 patients, and minor aspiration in 66. Evaluation of VDE findings prompted a change in clinical staging (degree of impairment) in 40 patients and substantial alteration in treatment planning in 28. At clinical bedside evaluation, the degree of bolus misdirection was overestimated in 19 patients with minor aspiration and underestimated in seven with major aspiration. Dementia is often associated with oral and pharyngeal impairment, and VDE can be important in diagnosis and treatment.

Aged↗
PubMed1990

Aspiration and the elderly.

Aspiration is prevalent in the elderly but its association with impairment of oral intake and gastroesophageal reflux is often misunderstood. This paper describes the causes, pathophysiology, and consequences of aspiration and their unique features in aged persons. It also explains how videofluoroscopic evaluation can assess current function while limiting factors that result in misinformation. The management of aspiration is discussed, emphasizing the importance and difficulties in maintaining functional well-being and possible complications of therapy.

Aged↗
PubMedDate not supplied

Routine use of ultrasound 24 hours before laparoscopic cholecystectomy can predict the need for intraoperative cholangiogram: results of a 12-month prospective audit.

Intraoperative cholangiograms and exploration of the common bile duct (CBD) during laparoscopic cholecystectomy are technically more demanding than during open cholecystectomy. This has led to many surgeons using a selective policy for cholangiography. In this study we prospectively assessed whether biliary ultrasound (CBD diameter > or = 6 mm) or one or more abnormal liver function tests (LFTs) performed in the 24 hours preoperatively could predict the need for cholangiography. Forty-five patients were studied (14 male, 31 female), mean age 47.8 years. All patients with one or both tests abnormal preoperatively (19 patients) underwent intraoperative cholangiograms. Seven CBD stones were identified (16%). There was no evidence of CBD stones in patients not undergoing cholangiography at a median follow-up of 18 months. In patients with stones, three underwent open CBD exploration, and four underwent endoscopic retrograde choledochopancreatography (ERCP) and sphincterotomy in the early postoperative period without complications. CBD diameter > or = 6 mm is a useful predictor of CBD stones. These may be treated successfully by postoperative ERCP.

Adult↗