Biomedical subjects
John Rees
Publications and source records attributed to John Rees.
Developing a prioritisation framework in an English Primary Care Trust.
BACKGROUND: In the English NHS, Primary Care Trusts (PCTs) are required to commission health services, to maximise the well-being of the population, subject to the available budget. There are numerous techniques employed to make decisions, some more rational and transparent than others. A weighted benefit score can be used to rank options but this does not take into account value for money from investments. METHODS: We developed a weighted benefit score framework for use in an English PCT which ranked options in order of 'cost-value' or 'cost per point of benefit'. Our method differs from existing techniques by explicitly combining cost and a composite weighted benefit score into the cost-value ratio. RESULTS: The technique proved readily workable, and was able to accommodate a wide variety of data and competing criteria. Participants felt able to assign scores to proposed services, and generate a ranked list, which provides a solid starting point for the PCT Board to discuss and make funding decisions. Limitations included potential for criteria to be neither exhaustive nor mutually exclusive and the lack of an interval property in the benefit score limiting the usefulness of a cost-value ratio. CONCLUSION: A technical approach to decision making is insufficient for making prioritisation decisions, however our technique provides a very valuable, structured and informed starting point for PCT decision making.
Methods of delivering drugs.
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A qualitative study of the perceptions and experiences of Pre-Registration House Officers on teamwork and support.
BACKGROUND: Following the implementation of a new final Year 5 curriculum in one medical school we carried out a study to explore the experience of the transition from final student year to Pre-Registration House Officer (PRHO). This study looks at the experiences of two successive cohorts of PRHOs in relation to team work, support and shared responsibility in their transition from final year students to qualified doctors. The involvement of PRHOs in teams is likely to change in the development of Foundation programmes. METHODS: A qualitative study with semi-structured interviews with 33 PRHOs, stratified by gender, ethnicity and maturity, from two study cohorts, qualifying in 2001 and 2002, from one medical school in the UK, in their first three months following medical graduation. RESULTS: Most PRHOs reported positive experiences for their inclusion as a full member of their first ward teams. This contributed to their increasing confidence and competence in this early period of career transition. However, a number of organisational barriers were identified, e.g. incomplete teams, shift work, which produced problems in their integration for one third of newly qualified doctors. CONCLUSION: Recently introduced policies, intended to improve the working lives of newly qualified doctors have produced both benefits and unintended adverse impacts on PRHOs. The changes of the new PRHO Foundation programme will have further impact. Foundation doctors may need to relate to wider teams with more interaction and less protection. Such changes will need to be managed carefully to protect the PRHO at a vulnerable time.
Sirolimus-induced pneumonitis: three cases and a review of the literature.
Interstitial pneumonitis is a rare disease that is seen in the context of some infections (e.g. PCP and CMV pneumonia), as side-effects of drugs (e.g. beta-blockers, amiodarone) and rarely in the context of renal transplantation. It manifests itself usually as a pneumonic illness; with symptoms of dyspnea, cough, fatigue and sometimes fever. Characteristic radiological changes are bilateral lower zone haziness. Interstitial pneumonitis is now emerging in solid organ transplant patients secondary to sirolimus). We describe three cases of sirolimus-induced pneumonitis in two patients who started sirolimus to permit cyclosporin withdrawal and in one patient initially started on sirolimus. The presentations in these cases ranged from insidious to fulminant; there was a rapid response to sirolimus withdrawal. This is an important syndrome, with an unknown frequency.
Impact of educational preparation on medical students in transition from final year to PRHO year: a qualitative evaluation of final-year training following the introduction of a new year 5 curriculum in a London medical school.
This study is a qualitative evaluation of PRHOs' perceptions of a new final year of the MB BS programme at Guy's, King's and St Thomas' (GKT) School of Medicine, undertaken in 2001 as a precursor to a prospective study. One-to-one interviews were carried out with 16 PRHOs two to four months after starting. These were independently thematically analysed, cross-referenced and joint agreement on the themes reached. PRHOs felt they were well prepared in clinical skills, history taking and examination. They reported lack of knowledge in pathology and therapeutics. The initial 1-4 weeks were stressful because of new responsibility for patients. Relationship with patients and staff changed through acquisition of a definite professional role. They adopted a number of coping strategies to control demands of the post. The PRHOs perceived the course as relevant and good preparation for their posts, with a better balance than the previous curriculum. Greater appreciation of aspects of professionalization in the final year may help the transition further.
Integration of shelf evolution and river basin models to simulate Holocene sediment dynamics of the Humber Estuary during periods of sea-level change and variations in catchment sediment supply.
Three modelling elements and sedimentary evidence provide an understanding of sediment characteristics, river basin processes, tidal regimes and sea-level changes to explain sediment supply to the Humber Estuary through the Holocene (the last 10,000 years). An upscaled cellular catchment model simulates water and sediment fluxes from river basins, illustrating significant variations in response to climate change, especially precipitation and vegetation changes, principally deforestation. Much of the sediment mobilised remains in stores within the catchment and only a small fraction reaches the Humber tidal system. An empirical model helps to explain sediment erosion, transport and deposition from the offshore and coastal zones through the Holocene and sea-level rise caused the transgression of the continental shelf of the North Sea. Comparison with the sediment fill of the lowlands around of the Humber estuary, that represent the extent of the estuary during the Holocene, demonstrates that most of the fill (approximately 95-98%) was derived from non-fluvial sources. A shelf evolution model, with reconstructions of sea level, palaeogeography and palaeobathymetry for 1,000 year time steps through the Holocene predicts significant changes in tidal regimes, first over wide areas of the coast as the transgression of the continental shelf progresses. The most significant changes occur with the inner reaches of the palaeo-estuaries, especially those of the Humber and the Fenland. Throughout the mid-Holocene they are characterised by significantly lower tidal ranges (MWHST approximately 2.5 m less than present) and low tidal currents. The simulated patterns of tidal currents concur with the transport of fine grain sediment from the coastal zone into the estuaries. The major tidal range changes revise estimates of late Holocene and ongoing relative sea and land level changes.