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Biomedical subjects

J Urquhart

Publications and source records attributed to J Urquhart.

At least 19 recordsLinked to original sources
PubMed2007

The electronic, 'paperless' medical office; has it arrived?

Modern information technology offers efficiencies in medical practice, with a reduction in secretarial time in maintaining, filing and retrieving the paper medical record. Electronic requesting of investigations allows tracking of outstanding results. Less storage space is required and telephone calls from pharmacies, pathology and medical imaging service providers to clarify the hand-written request are abolished. Voice recognition software reduces secretarial typing time per letter. These combined benefits can lead to significantly reduced costs and improved patient care. The paperless office is possible, but requires commitment and training of all staff; it is preferable but not absolutely essential that at least one member of the practice has an interest and some expertise in computers. More importantly, back-up from information technology providers and back-up of the electronic data are absolutely crucial and a paperless environment should not be considered without them.

Computer Security↗
PubMed2002

Incidence and determinants of sildenafil (dis)continuation: the Dutch cohort of sildenafil users.

Sildenafil utilization was prospectively evaluated among 153 men with a history of erectile dysfunction (ED)-prescription drug use prior to starting sildenafil and 164 men who were new starters of ED-prescription drugs. Further, some determinants of sildenafil discontinuation were identified. During a median follow-up period of 18 months 45% of all patients discontinued sildenafil treatment, regardless of earlier treatment history. However, patients with a history of drug treatment for ED were nearly eight times as likely to switch or re-start another ED-prescription drug after discontinuing sildenafil compared to previously untreated users. Age >60 y, diabetes medication, nitrate use, and use of incontinence pads (a proxy for disease/surgery in the pelvic region) were associated with an increased likelihood of discontinuing sildenafil. Although the introduction of sildenafil reduced the barrier to seek medical help for erectile problems, sildenafil treatment failure in previously untreated patients results in a high dropout rate from further ED drug treatment of any kind.

Aged↗
PubMed2002

Information for community hospitals.

OBJECTIVE: To design and test a revised data collection system for routine patient based data in the Community Hospital setting in Scotland. DESIGN: A two part qualitative study was designed to identify the requirements for Community Hospital information, develop a data set to meet these requirements and pilot a proposed Community Hospital Information System. SETTING: Identification of the information deficit (Stage 1) involved administering face to face questionnaires in all relevant Health Board areas in Scotland; piloting of the proposed information system (Stage 2) was carried out in four Community Hospitals in Scotland. RESULTS: Stage 1 of the study highlighted the information requirements as including: who is being treated; why they are there; how complex their needs are; what is being done and by whom; and what is happening next. The additionally required data included: admission reason--medical/social; type of care--intended and provided; all relevant diagnoses and social factors; medication--on admission and discharge; interventions--nursing/GP/consultant; dependency throughout stay; delayed discharge information; and discharge plan. The summary of recommendations that flowed from this part of the study includes: incremental electronic record; link with GP and acute systems; interface with other community systems; duplication of recording; accessibility at local level with variable levels of access (to protect patient confidentiality). Stage 2 of the study piloted the collection of the proposed dataset and permitted development of suitable feedback information, in particular the patient summary screens. Economic evaluation of the proposed dataset compared to the existing data was carried out in parallel with the study and is reported elsewhere. CONCLUSION: It is feasible and highly desirable to collect clinically useful information at little additional cost and to provide relevant feedback, including useful patient summary screens, representing the patient stay in hospital.

Data Collection↗
PubMed2001

Some economic consequences of noncompliance.

The twin problems of poor compliance and poor persistence with prescribed antihypertensive drug regimens appear to be responsible for much of the huge shortfall in the proportion of hypertensives whose treatment brings their blood pressure down to satisfactory levels. A further problem is the confounding of nonresponse and poor compliance in patients with "drug-resistant hypertension," in that about half of such patients are poor compliers, whose response to simple regimens usually proves satisfactory once their compliance with prescribed regimens is corrected. Electronic means for compiling ambulatory patients' drug dosing histories have now made it both technically and economically feasible to distinguish clearly between noncompliers and nonresponders, which clinical judgment cannot do because it is no better at making this crucial distinction than a coin toss. With the advent of reliable, economical measurements of patient compliance with prescribed drug dosing regimens, we can probably eliminate most of the compliance problems. The problem awaiting us after that is poor persistence with prescribed regimens for antihypertensive and other cardiovascular medicines that are meant for long-term or life-long use. A recent study has shown that median persistence with fully reimbursed drugs of the statin class is only 6 months, which is about one fortieth of the length it should be to realize full benefits of such therapy.

Antihypertensive Agents↗
PubMed2001

The Dutch cohort of sildenafil users: baseline characteristics.

OBJECTIVE: To identify a Dutch cohort of sildenafil users and describe their baseline characteristics. PATIENTS AND METHODS: Each pharmacy in The Netherlands (n = 1571) was asked to identify prospectively the first 20 sildenafil prescriptions in their pharmacy over 1 year, and to complete and return a registration form. The collected data included patient characteristics, the details of the sildenafil prescription (date, prescriber, number of prescriptions, dosing), and the use of co-medication by the patient in the year preceding the sildenafil prescription. RESULTS: Data were collected from 4460 sildenafil prescriptions during the year under study, relating to 3477 individual patients. Most of the cohort had cardiovascular morbidity or diabetes. Sildenafil seems to have been used by a new, previously untreated population of patients with erectile dysfunction. In addition, 69 men were identified who could have been using nitrates and sildenafil concomitantly. CONCLUSION: A cohort of patients using sildenafil was identified and characterized; they appeared to be representative of sildenafil users in The Netherlands. This cohort will be followed prospectively to evaluate the medical status (particularly cardiovascular) of the patients with time.

Adult↗
PubMed2001

Spontaneous lapses in dosing during chronic treatment with selective serotonin reuptake inhibitors.

BACKGROUND: In previous research, lapses in dosing of paroxetine or sertraline were associated with significantly more discontinuation symptoms and deterioration of depressive symptomatology compared with fluoxetine. AIMS: To evaluate dosing lapses in patients chronically treated with selective serotonin reuptake inhibitors (SSRIs) in uncontrolled circumstances. METHOD: In a prospective observational study we evaluated compliance data in chronic users of SSRIs using electronic drug exposure monitors. RESULTS: During a 3-month follow-up we found that 50/69 (72.5%) patients missed at least one dosing day and 20/69 (29.0%) missed two or more consecutive days. CONCLUSIONS: About 30% of patients treated with short-acting SSRIs had dosing lapses of 2 or more days, which, as described in prior studies, is long enough to result in clinically relevant deterioration of mental status.

Adolescent↗
PubMed2000

INTERNAL MEDICINE IN THE 21ST CENTURY: Controlled drug delivery: therapeutic and pharmacological aspects.

Concerted work to develop human pharmaceuticals based on rate-controlled drug delivery systems began in 1970. Today there are over three dozen such products, plus a few for veterinary use. In addition, osmotic minipumps have been extensively used since 1978, resulting in over 6000 publications in the pharmacological, endocrinological and physiological literature. Rate-controlled delivery provides for drug entry into the bloodstream continuously at either a constant or a modulated rate. By this means, one avoids the usual peak and trough pattern of drug concentrations in plasma, with its echoing peak and trough pattern of drug actions, during the interval between successive doses. In contrast to the happenstance release kinetics of rapid-release dosage forms, rate-controlled delivery systems can be designed to provide specific temporal patterns of drug concentration in plasma, for the purpose of optimizing the selectivity of drug action, the interval between successive administerings of drug and the likelihood that the next administering will occur at the proper time.

Administration, Cutaneous↗
PubMed2000

Impact of bovine oocyte maturation media on oocyte transcript levels, blastocyst development, cell number, and apoptosis.

The objectives were 1) to investigate the effects of oocyte maturation in serum-free and amino acid-supplemented defined media on oocyte transcript levels, blastocyst cell number, and apoptosis; 2) to investigate the influence of oocyte maturation culture atmosphere on blastocyst development, total cell number, and apoptosis; and 3) to examine the influence of epidermal growth factor (EGF) during oocyte maturation on blastocyst cell number and apoptosis. The results demonstrate that blastocysts derived from in vitro maturation, fertilization, and embryo culture protocols undergo apoptosis but that apoptotic levels are not greatly influenced by the oocyte maturation environment. Amino acid supplementation of oocyte maturation media was associated with enhanced developmental frequencies, increased blastocyst cell number, and elevated oocyte maternal mRNA levels. Oocyte maturation with supplemented synthetic oviduct fluid medium (cSOFMaa) resulted in blastocyst cell numbers comparable to those observed with Tissue Culture Medium 199 + newborn calf serum. Blastocyst development was reduced following oocyte maturation under a 5% CO(2), 7% O(2), 88% N(2) culture atmosphere. EGF supplementation of oocyte maturation medium resulted in a concentration-dependent increase in blastocyst development but did not influence blastocyst total cell number or apoptosis. Our findings indicate that cSOFMaa medium is an effective base medium for bovine oocyte maturation.

Amino Acids↗
PubMed2000

Academic stress and secretory immunoglobulin A.

Immediately before and after giving an oral presentation and taking examinations 10 final-year students provided saliva samples for immunoglobulin A assay. Compared with 'baseline', levels of immunoglobulin A were lower surrounding the examination conditions and before the presentation.

Adult↗
PubMed1999

Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix instrument.

OBJECTIVE: to create a casemix measure with a limited number of categories which discriminate in terms of resource use and will assist in the development of a currency for contracting for the provision of health care. DESIGN: nursing staff completed a questionnaire providing clinical data and also gave estimates of relative patient resource use; ward-based costs were collected from appropriate unit managers. SETTING: National Health Service continuing-care wards in 50 Scottish hospitals. SUBJECTS: 2783 long-stay patients aged 65 years and over. RESULTS: inter-rater reliability was assessed using 1402 patients; percentage agreement between raters for individual variables varied from 68% for feeding to 97% for clinically complex treatments. Nursing costs gave 62% agreement given categories of high, medium and low. The Scottish health service resource utilization groups (SHRUG) measure was developed using 606 cases, and 67% consistency was achieved for the five categories. The relative weights for the SHRUG categories ranged from 0.56 to 1.41. The five categories explain 35% of variance in costs. CONCLUSIONS: the five SHRUG casemix categories show good discrimination in terms of costs. The SHRUG measure compares favourably with diagnosis-related groups in the acute sector and with other casemix instruments for long-term care previously piloted in the UK. SHRUG is a useful measurement instrument in assessing the resource needs of elderly people in long-term care.

Aged↗
PubMed1999

Millennium babies.

Explore the source record for details and available documents.

Delivery, Obstetric↗
PubMed1999

Pharmacoeconomic consequences of variable patient compliance with prescribed drug regimens.

Variable compliance with prescribed drug regimens is a leading source of variability in drug response. Specifics differ by drug and disease. The role of variable compliance was clearly defined in 2 trials of lipid-lowering agents, cholestyramine and gemfibrozil, in which exceptionally careful measurements of compliance were made, which has not been done in later trials. Economic consequences of variable compliance are estimated by converting dose-dependent changes in absolute risk of incident coronary disease into the unicohort format, which designates how many patients must be treated to prevent, in a given time, a defined 'coronary event'. Two strong influences on the costs of treatment are: (i) the shape of the relation between drug intake and risk reduction; and (ii) the strength of the linkage between intake and prescription refills. The intake-effect relation for cholestyramine is linear, making compliance-neutral the cost to prevent 1 coronary event, provided that refills match intake. If refills exceed intake, treatment costs rise. The intake-effect relation for gemfibrozil is more typically nonlinear, so poorer compliers purchase and take the drug in amounts that have little benefit, increasing the cost to prevent 1 coronary event. If refills run at a higher rate than intake, costs increase still further. A key question for future study is: do policies that encourage timely refills increase compliance enough to offset their potential to waste money in the purchasing of an untaken drug?

Cost of Illness↗
PubMed1998

Pharmacodynamics of variable patient compliance: implications for pharmaceutical value.

Pharmaceutical value, a multidimensional factor that includes proven efficacy, is now crucial to market success. A key parameter of value is reliability in use, determined by the several sources of variance in drug response, e.g. the Harter-Peck model, based on linear pharmacometrics of theophylline, whose dose-response has an estimated 80% coefficient of variation, due mainly to variable pharmacokinetics and non-compliance. The main forms of non-compliance are multiday intervals between doses, the impact of which is difficult to assess because too little is known of the time-course of drug actions after dosing stops ('off-responses'). Omeprazole, the best-selling drug, is an exception, and its off-response data reveal markedly non-linear pharmacodynamics that appear to filter most of the variance that a linear model passes, projecting a big gain in reliability. The impact of variable compliance is attenuated by 'forgiveness', the post-dose duration of effective action (4-5 days for omeprazole) minus its recommended dosing interval.

Journal Article↗