Biomedical subjects

Jason Hall

Publications and source records attributed to Jason Hall.

17 recordsLinked to original sources

PubMed2006

Why don't trained community nurse prescribers prescribe?

AIMS AND OBJECTIVES: (i) To identify barriers that could either prevent community nurses from prescribing altogether or reduce the number of times that a nurse might prescribe. (ii) To determine how wide spread the barriers identified above were. BACKGROUND: Many community nurses who are trained to prescribe are either not prescribing at all or not routinely doing so. METHOD: (i) Qualitative semi-structured interviews with nurses prescribers and Trust prescribing leads. (ii) Postal questionnaires sent to the nurse prescribing leads in each Primary Care Trust across three strategic health authorities in England. RESULTS: Several barriers were identified in this study. Those that (i) prevented prescribing included roles with no patient contact, prescription pads not issued, opposition from general practitioners and lack of confidence; (ii) prevented some prescribing included lack of time in clinics, inability to prescribe for patients registered with another Trust, security concerns, lack of access to patient medical records and the use of alternative methods of supply; (iii) made prescribing more difficult included keeping records, informing general practitioner of items prescribed, delivering prescribed items to housebound patients and situations requiring items from more than one prescriber. CONCLUSION: Many barriers have been identified that have the potential to reduce the impact of nurse prescribing on patient care. Trusts should monitor the prescribing of their nurse prescribers, target appropriate support and encouragement to address problems with prescriber confidence, develop strategies to integrate their nurse prescribers into the healthcare team to improve access to patient's medical notes, and improve the efficiency of the prescribing process. RELEVANCE TO CLINICAL PRACTICE: There is a danger that the anticipated benefits to patient care resulting from the introduction of nurse prescribing may not materialize if the barriers identified in this study are not addressed.

Community Health Nursing↗

PubMed2005

Cardiovascular medications in primary care: treatment gaps and targeting by absolute risk.

AIM: To measure the use of three major types of cardiovascular medications (antiplatelet, blood pressure lowering, and cholesterol lowering) in primary care, and their level of targeting to individuals at high absolute risk of a cardiovascular event. METHODS: Demographic, risk factor, and prescribing data from the Dunedin Royal New Zealand College of General Practitioners Research Unit database were analysed. The data set consisted of 25,384 individuals, men aged at least 45 years and women at least 55 years, who consulted a doctor in 2000 in a practice which supplied electronic clinical notes. People with congestive heart failure were excluded. Five-year risk of a cardiovascular event was estimated using a history of vascular disease or the Framingham risk equation, and correlated with prescribed medications. RESULTS: Cardiovascular risk could be estimated for only one-third of the study population due to missing risk factor information. Data were largely unavailable on antiplatelet agents and so lipid lowering and blood pressure lowering medications were used to assess the 'treatment gap'. This combination was prescribed to only 28% of those with documented cardiovascular disease. For the remainder without a history of disease and for whom 5-year absolute risk of cardiovascular disease could be estimated, prescription of combination therapy ranged from 8% in the lowest risk group (<5% 5-year risk) to 14-16% in the other risk categories. CONCLUSIONS: Among this primary care population, more than two-thirds of people with vascular disease were not receiving guideline-recommended medications and there was little evidence of targeting by absolute risk for those without disease. However limited conclusions can be made for the latter group because of lack of documented risk factor information. While these treatment gaps may be less now, for example due to increased access to statins, it is probable that substantial gaps remain.

Aged↗

PubMed2005

Documentation of family violence in New Zealand general practice.

AIM: To determine the rate of family violence documented during general practice consultations and describe clinical presentations. METHOD: A dataset of 447,809 computerised consultations involving 143,634 patients from 41 general practices throughout New Zealand was examined to identify consultations recording family violence issues. The documentation rate was determined and the subset analysed. RESULTS: A subset of 337 consultations from the 447,809 examined (0.075%) involved a family violence issue. This subset included 311 patients, 0.2% of the 143,634 patients in the original 6-month dataset. 225 (81%) of the patients in the subset were female. Family violence was the main reason for presentation in 137 (40%) consultations. The perpetrator was identified as the partner in 134 (40%) consultations, as the parent in 54 (16%) consultations and the patient identified themselves as the possible abuser in 17 (5%) consultations. Physical abuse (42%) and sexual abuse (26%) was most commonly mentioned. Past abuse (42%) was discussed as often as current abuse (41%). Depression and anxiety disorders were documented in 59 (18%) of these consultations. CONCLUSIONS: The number of consultations documenting family violence is low in this dataset. Such information is not always recorded, however GPs can also be reluctant to ask about, and patients can be hesitant to disclose family violence issues. The number of consultations involving the perpetrator was higher than expected. GPs require training to deal with both the victim and the perpetrator of family violence.

Documentation↗

PubMed2005

Fascial ultrasound for evaluation of anterior abdominal stab wound injury.

BACKGROUND: Local stab wound (SW) exploration to assess abdominal fascial integrity is a highly invasive procedure frequently performed under demanding circumstances in the Emergency Department (ED). We hypothesized ultrasound (U/S) may be useful in the detection of fascial defects resulting from anterior abdominal stab injury, eliminating the need for local wound exploration METHODS: Thirty-five hemodynamically normal patients evaluated at a Level I trauma center for anterior abdominal stab wounds were examined by U/S (8 mHz probe) for evidence of fascial violation. All patients were subsequently evaluated by local wound exploration RESULTS: Fascial U/S had an overall sensitivity of 59% and specificity of 100%, (PPV 100%, NPV 59%) for detection of fascial SW defects compared with local wound exploration. The sensitivity of fascial U/S for stab wound evaluation varied directly with experience of the sonographer CONCLUSIONS: A positive fascial U/S obviates the need for invasive SW exploration; however, a negative fascial U/S does not preclude the need for local wound exploration. Resident U/S training for specific penetrating injuries may reduce the need for abdominal SW fascial exploration in the ED.

Abdominal Injuries↗

PubMed2004

The burden of rheumatic disorders in general practice: consultation rates for rheumatic disease and the relationship to age, ethnicity, and small-area deprivation.

AIMS: To estimate the burden of rheumatic disorders in the New Zealand population by calculating general-practice consultation rates--as well as the influence of age, gender, ethnicity, and small-area deprivation on these consultation rates. METHODS: Cases were identified from the Royal New Zealand College of General Practitioners database using search-strings of typical words used in consultation notes (for each of 10 rheumatic disorders). Rates were calculated from a denominator of the number of people attending at least once over a 12-month period to any of 22 contributing general practices. The independent effect of age, sex, ethnicity, and small-area deprivation was modelled using multiple logistic regression. RESULTS: Of 29,152 people attending their general practitioner, 20.4% consulted with a rheumatic disorder. Older people, males, people who lived in more deprived areas, and Europeans were more likely to consult with a rheumatic disorder. With all rheumatic disorders, age was a significant influence upon consultation--especially osteoarthritis, gout, osteoporosis, and joint surgery. Maori were more likely than Europeans to consult with gout, but they were slightly less likely to consult with back pain or regional pain disorders. Small-area deprivation had small influences upon people consulting with gout, regional pain, and back pain. CONCLUSIONS: Rheumatic disorders form a significant part of the workload of general practitioners and this is significantly influenced by local demographic factors. Most of these conditions seen in general practice are non-inflammatory and non-surgical. If a community-needs approach was taken, it is likely that the workload and associated costs would be even greater.

Adolescent↗

PubMed2004

Linking primary and secondary healthcare databases in New Zealand.

AIM: To investigate the effectiveness of linking primary and secondary care data using an encrypted national health index (ENHI). METHODS: Primary care patient registers from 106 practices collected by the Dunedin Research Unit of the Royal New Zealand College of General Practitioners (RNZCGP) for the year 2001 were linked to the entire National Minimum Data Set (NMDS) for 2001 using an ENHI. The success of matching using the ENHI was measured, and primary and secondary care populations were compared in terms of hospital utilisation (number of discharges, length of stay, major diagnostic category [MDC]). RESULTS: 86,608 unique general practice ENHIs were successfully linked to the NMDS for the study period. Date of birth was matched on ENHIs (96.6%), sex (99.1%), and ethnicity (84.0%). Hospital morbidity and hospital utilisation (in terms of number of discharges and length of stay) were similar for general practice patient admissions and the entire NMDS admission data set. CONCLUSIONS: Data collected in general practice linked well to secondary care data using the ENHI. Linked primary and secondary care data sets will provide a sound basis for research into publicly funded healthcare.

Databases as Topic↗

PubMed2003

Prescribing for teenagers in New Zealand general practice.

AIM: To describe patterns of prescribing in general practice for New Zealanders aged 13 to 19 years. METHODS: The computerised records of 225 348 consulting patients from 48 general practices from around New Zealand were examined. A subset of 20 216 consulting patients (53.2% female) aged 13 to 19 years was selected and their prescribed medications analysed. General practice prescribing was described in terms of demographic characteristics and health-card eligibility. RESULTS: Patients aged 13 to 19 consult and are prescribed to less than the population as a whole (3.2 consultations versus 5.0, and 2.4 scripts versus 4.9 per annum). Females were prescribed to more frequently than males (2.7 prescriptions per consulting patient per annum versus 2.0). Patients with a community services card were prescribed to more frequently than those without (2.9 prescriptions per consulting patient per annum versus 2.0). Respiratory drugs were most frequently prescribed (primarily anti-asthma medications), followed by medications for the treatment of infections, the genito-urinary system (mainly oral contraceptives), dermatological medications, and medications for treatment of the nervous system (mainly analgesics). CONCLUSIONS: Patients aged 13 to 19 consult and are prescribed to less frequently than the population as a whole. Asthma appears to be the major source of chronic illness for this population. Prescribing data presented here provide valuable baseline data for further research.

Adolescent↗

PubMed2003

Trends in the use of inhaled corticosteroids for childhood asthma in New Zealand.

OBJECTIVE: To compare the dispensed volumes and prescribed doses for inhaled corticosteroids (ICS) for children in New Zealand. DESIGN: Longitudinal analysis of prescribing trends using the Royal New Zealand College of General Practitioners Research Unit database and the Pharm Warehouse database of the New Zealand Health Information System. SETTING: New Zealand from 1993 to 2001. SUBJECTS: Children aged 0-5 years and 6-17 years. MAIN OUTCOME MEASURES: The ratio of potency-adjusted mean daily dose of fluticasone propionate (FP) to beclomethasone (BDP) and dispensed volumes of FP, BDP and budesonide. RESULTS: The ratio of potency-adjusted mean daily dose of FP to BDP prescribed to children aged 0-17 years ranged from 1.22 to 1.91. With the introduction of FP, the total amount of ICS dispensed to children aged 0-5 years in New Zealand nearly doubled, when adjusted for potency. CONCLUSIONS: The introduction of FP into New Zealand corresponds with an increase in the total amount of ICS dispensed and an increase in the adjusted daily dose prescribed.

Administration, Inhalation↗

PubMed2003

Differential prescribing of inhaled corticosteroids in New Zealand general practice.

AIM: To determine how inhaled budesonide, beclomethasone and fluticasone are prescribed by general practitioners in New Zealand. METHODS: Retrospective study of computerised clinical records from 42 general practices in New Zealand for the period 1 July 1997 to 30 June 1998. The study population comprised 174 929 consulting patients, of whom 9878 patients were prescribed budesonide, fluticasone, or beclomethasone with full dosing instructions. RESULTS: The mean daily prescribed dose was higher for patients receiving inhaled budesonide (886 microg) than beclomethasone (547 microg), a difference of 339 microg (95% CI 311 microg to 367 microg), and fluticasone (508 microg), a difference of 378 microg (95% CI 344-412). The difference between mean daily prescribed doses of beclomethasone and fluticasone was 39 microg (95% CI 15-63). The overall difference was consistent across age groups and with different types of inhalation device. Evidence of systematic prescribing of higher doses of budesonide to patients with more severe asthma was not found. Patients prescribed fluticasone were more likely to have been prescribed oral steroids in the preceding year. CONCLUSIONS: Conclusions about the relative potencies of inhaled corticosteroids cannot be made with the data presented. However, data presented show that inhaled corticosteroids have not been prescribed in line with their reported relative potencies. This study provides benchmark data for the prescribing of inhaled steroids in New Zealand general practice.

Administration, Inhalation↗

PubMed2003

Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis.

HYPOTHESIS: Certain clinicopathologic factors predict improved survival after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. DESIGN: Prospective clinical trial. SETTING: Surgical oncology service at a university academic hospital. PATIENTS: A population of 109 consecutive patients with peritoneal carcinomatosis treated between December 1991 and November 1997. INTERVENTION: All patients underwent resection of gross disease followed by 2-hour intraoperative perfusion of mitomycin C (20-40 mg) into the peritoneal cavity at a temperature of 40.5 degrees C. MAIN OUTCOME MEASURES: Clinicopathologic factors that independently predicted improved overall survival rates. RESULTS: Overall survival at 1 and 3 years was 61% and 33%, respectively. With median follow-up of 52 months, median overall survival was 16 months. Four factors were significant independent predictors of improved survival by multivariate analysis: nonadenocarcinoma histologic features (P =.001), the appendix as a primary site (P =.003), the absence of hepatic parenchymal metastases (P =.01), and complete resection of all gross disease (R1/0 resection) (P<.001). Patients with an R1/0 resection vs an incomplete resection of gross disease (R2 resection) had 3-year overall survival of 68% vs 21% (P<.001). CONCLUSIONS: Patients with peritoneal carcinomatosis have a uniformly poor prognosis. However, in select patients, the natural history of this disease condition may be altered by using the multimodality approach of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. These results require confirmation in prospective randomized studies.

Antibiotics, Antineoplastic↗

PubMed2003

Integrating biological and social processes in relation to early-onset persistent aggression in boys and girls.

This study examined the relationship between biological and social risk factors and aggressive behavior patterns in an Australian high-risk sample of 370 adolescents. Perinatal, temperamental, familial, sociodemographic, and behavioral data were collected during interviews completed during pregnancy. immediately postpartum, and when the children were 6 months old and 5, 14, and 15 years old. Youths were given tests of verbal and neuropsychological functioning at the age 5 and age 15 follow-ups. Youths were divided into early-onset persistent aggression, adolescent-onset aggression, and nonaggressive behavior groups. Results revealed that the interaction of biological and social risk factors was significantly related to early-onset persistent aggression. Gender and developmental phase of measurement moderated the relationship between biosocial risks and the outcomes of early-onset persistent aggression and adolescent-onset aggression.

Adolescent↗

PubMed2002

Prescribing for patients aged 65 years and over in New Zealand general practice.

AIM: To describe patterns of prescribing in general practice for New Zealanders aged 65 years and over. METHODS: The computerised records of 139 359 consulting patients from 31 general practices from around New Zealand were examined. A subset of 17 497 consulting patients aged 65 years and over was selected and their prescribed medications examined. Utilisation was described in terms of demographic characteristics and health card eligibility. RESULTS: 84.6% of all consulting patients received one or more prescriptions during the study period. Patients were prescribed a mean of 19.7 medication items per annum. Females were prescribed to significantly more times than males for patients aged 79 and under. Community services card (CSC) holders were prescribed to more frequently than patients without a CSC in all age groups. 29.5% of all medication items were from the cardiovascular system Anatomical Therapeutic Chemical (ATC) grouping. CONCLUSIONS: There is a high level of exposure to medication in populations of older people. This is a reflection of older persons' morbidity and also indicates an urgent need to examine the data further for potential drug interactions and side effects.

Aged↗

PubMed2002

A general practice minimum data set for New Zealand.

AIM: To assess the completeness of primary care data collected by the Royal New Zealand College of General Practitioners' (RNZCGP) Dunedin Research Unit, and assess the feasibility of creating a New Zealand national minimum data set for primary care. METHODS: Patients from 42 practices contributing data to the Dunedin Research Unit made up the study population. A six-month sample of data was evaluated for completeness, and compliance to a minimum data set structure. Rates of recording patient identifiers, sex, ethnicity, community services card status, consultation identifier and date, prescriptions and Read codes were calculated for each practice and registered patient. RESULTS: Patient demography, NHI and community services card status were all well recorded (date of birth 99.3%, sex 98.9%, NHI 94.8%, CSC 100.0%). Read codes and ethnicity were still poorly recorded, although there was wide variation between practices. CONCLUSIONS: The completeness of data collected by the Dunedin Research Unit appears to be improving, although there is wide variation between contributing practices. The capability to create a primary care national minimum data set exists, but this will not become a reality until suitable education programmes and support are supplied for general practitioners and other staff members who record patient information.

Data Collection↗

PubMedDate not supplied

A comparison of tibolone and hormone replacement therapy on coronary artery and myocardial function in ovariectomized atherosclerotic monkeys.

OBJECTIVE: Tibolone is used to prevent osteoporosis and to treat climacteric symptoms. The objectives of these studies were to measure and compare the effects of tibolone with hormone replacement therapy on coronary artery vascular reactivity and myocardial function and to relate these outcomes to treatment-induced plasma lipid/lipoprotein concentrations and atherosclerosis. DESIGN: One hundred forty-eight adult ovariectomized cynomolgus monkeys were fed an atherogenic diet for 24 months while receiving one of five oral treatments: no treatment (control, n = 31); conjugated equine estrogens (CEE), given at the equivalent of 0.625 mg/day ( n = 27); CEE (same dose) plus medroxyprogesterone acetate (MPA), given at the equivalent of 2.5 mg/day ( n = 29); low-dose tibolone (LoTib; 0.625 mg/day equivalent, n = 30); or high-dose tibolone (HiTib; 2.5 mg/day equivalent, n = 31). RESULTS: Quantitative coronary angiography showed that endothelium-mediated dilation was enhanced (17.5 +/- 5%, p = 0.002) in the CEE-treated group (but not other treatment groups) compared with the control. Both doses of tibolone and CEE reduced the incidence of dobutamine-induced ST-segment depression (LoTib: 33%, HiTib 25%, and CEE: 23%) compared to the control (79%) ( p = <0.05). Neither vascular reactivity nor dobutamine-induced myocardial ischemia were associated with treatment-induced changes in atherosclerosis or plasma lipid/lipoprotein concentrations. CONCLUSIONS: Tibolone, unlike CEE, has no benefit for endothelium-mediated dilation. Despite these differences, both tibolone and CEE reduced the incidence of myocardial ischemia, whereas CEE+MPA had no effect. It is speculated that tibolone may have direct effects on the myocardium that protect against myocardial ischemia.

Animals↗

PubMedDate not supplied

Effects of tibolone and conventional hormone replacement therapies on arterial and hepatic cholesterol accumulation and on circulating endothelin-1, vascular cell adhesion molecule-1, and E-selectin in surgically menopausal monkeys.

OBJECTIVE: Menopause and aging are associated with a marked increase in the incidence of coronary heart disease as well as reductions in circulating estrogen, progestogen, and androgen levels. The synthetic compound tibolone and its metabolites have estrogenic, progestogenic, and androgenic characteristics. In the present study, we compared the effects of tibolone, estrogen replacement therapy, and estrogen plus progestogen replacement therapy on arterial and hepatic lipid accumulation and on circulating soluble adhesion molecule and endothelin-1 concentrations in surgically postmenopausal cynomolgus monkeys. DESIGN: Animals were fed an atherogenic diet for 2 years while receiving either no hormone treatment (control, n = 31) or the following treatments at doses designed to mimic the human dose on a daily caloric intake basis: tibolone at 2.5 mg/day (HiTib, n = 31), tibolone at 0.625 mg/day (LoTib, n = 29), conjugated equine estrogens (CEE) alone at 0.625 mg/day (CEE, n = 29), or CEE plus continuous medroxyprogesterone acetate (MPA) at 2.5 mg MPA/day (CEE + MPA, n = 30). RESULTS: Relative to the control group, iliac artery total cholesterol content was not different in the HiTib, LoTib, and CEE + MPA groups but was significantly lower in the group receiving CEE only (P < 0.05). In contrast, hepatic free cholesterol content was reduced in all treatment groups [HiTib (P < 0.01), LoTib (P < 0.05), CEE (P < 0.01), and CEE + MPA (P < 0.05)], whereas hepatic total and esterified cholesterol content were reduced in the HiTib, CEE, and CEE + MPA groups (all P < 0.05). HiTib and CEE groups had lower hepatic triglyceride levels per milligram of protein (P < 0.05). Iliac arterial cholesterol content was highly correlated with hepatic cholesterol content and with previously published histomorphometrically determined coronary artery atherosclerosis, supporting the use of the iliac artery as a surrogate for the coronary artery in the monkey. Circulating levels of soluble vascular cell adhesion molecule-1 were significantly reduced in the HiTib (P < 0.02) and CEE (P < 0.05) groups, whereas soluble E-selectin was reduced in the CEE group only (P < 0.01). Plasma endothelin-1 was significantly reduced in the LoTib (P < 0.05), CEE (P < 0.01), and CEE + MPA (P < 0.01) groups. CONCLUSIONS: These results suggest that while tibolone caused marked depression of high-density lipoprotein cholesterol and a resultant twofold increase in the total plasma cholesterol/high-density lipoprotein cholesterol ratio, those effects did not result in exacerbation of iliac artery atherosclerosis, perhaps because of beneficial effects on vascular biology or hepatic metabolism.

Androgen Antagonists↗

PubMedDate not supplied

The information sources used by community nurse prescribers.

A purposive sample of 22 community nurse prescribers and five prescribing leads were interviewed to determine how nurses both access and assess the reliability of pharmacological information. Prescribers used both printed material and other professionals to obtain pharmacological information. The most commonly mentioned sources of printed material were journals and the British National Formulary. Other people that nurses obtained information from included pharmaceutical company representatives, community pharmacists, nurse specialists, colleagues, and GPs. Nurses described the attributes that they associated with reliable information (previous vetting, up-to-date and used by other healthcare professionals) and unreliable information (produced by those with a vested interest). Much of the pharmacological information supporting prescribers is aimed at doctors and may not be accessible for nurse prescribers. Organizations seeking to influence evidence-based practice should consider the method of communication in addition to the message.

Community Health Nursing↗

PubMedDate not supplied

Supplementary prescribing for nurses.

The three classifications of nurses that can prescribe are community nurses, extended nurse prescribers and supplementary prescribers. Supplementary prescribers can prescribe almost any medicine provided it has been specified in the clinical management plan. Supplementary prescribing is likely to benefit those patients with uncomplicated chronic conditions and is open to all registered nurses who have completed the appropriate training. Both nurses and their managers should be aware of potential pressures on clinical decision-making and appropriate support and encouragement should be provided.

Attitude of Health Personnel↗