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Biomedical subjects

M Dewey

Publications and source records attributed to M Dewey.

At least 19 recordsLinked to original sources
PubMed2006

Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study.

BACKGROUND: Protected learning time (PLT) schemes have been set up in primary care across the UK. There is little published evidence of their effectiveness. OBJECTIVE: To investigate the effect of a PLT intervention for general practice to increase prescribing of ramipril for prevention of cardiovascular outcomes. DESIGN: Quasi-experimental, interrupted time series. SETTING: Lincolnshire, UK. METHODS: Prescribing data were analysed one year before and after the education for change in rate of increase of prescribing of ramipril, whether change in prescribing was related to postulated explanatory variables and to determine intervention costs. MAIN OUTCOME: The primary outcome was the rate of change of ramipril (10 mg) prescription items 12 months after compared with before the educational intervention. Secondary outcomes included cost. RESULTS: Ramipril prescribing at therapeutic dosage increased significantly (odds ratio 1.50, 95% CI 1.07-1.93) following education by 52,345 items (31,132 items at 10 mg) at a cost of pound 292k to pound 460k depending on formulation. This occurred despite a background of secular change. Most practices were represented by GPs, nurses or both during the education. Single-handed GPs were less likely to attend. Practices showed considerable variation in response to the educational intervention. The only predictor of whether practices increased in prescribing rate after the education was whether a practice nurse had undertaken specific diabetes training. Total list size, dispensing, training or single-handed status and GP attendance did not predict a change in prescribing. CONCLUSION: PLT schemes can contribute to beneficial changes in prescribing across a large geographical area.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries.

PURPOSE: To investigate the influence of sublingual glycerol trinitrate (1.2 mg, Nitrate [nitroglycerine], Nitrolingual N Spray) on the coronary artery diameter on multislice computed tomography (MSCT) coronary angiography. MATERIALS AND METHODS: Out of our database of patients who underwent MSCT (slice thickness of 0.5 mm, Aquilion, Toshiba) coronary angiography between July 2003 and November 2005 (950 patients) we retrospectively identified patients with follow-up examinations who received Nitrate for one examination while another examination was performed without Nitrate (10 patients). Another 10 patients who underwent two MSCT examinations with sublingual Nitrate administration were randomly selected from this database to serve as control group. For the resulting 40 MSCT examinations, blinded MSCT datasets were prepared, which were randomly evaluated by a reader blinded to the patient information and whether or not Nitrate had been given. The proximal coronary artery diameters were measured for the left main coronary artery (LMA), the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA) in all 40 datasets, resulting in altogether 160 measurements. RESULTS: The proximal diameters of all four coronary arteries were significantly larger on the MSCT coronary angiograms obtained after sublingual administration of Nitrate compared with the examinations in the same 10 patients without Nitrate (p < 0.001). The average diameters without and with Nitrate for the LMA, LAD, LCX, and RCA were 4.3 +/- 1.1 vs. 4.8 +/- 0.9 mm (12 % increase, p < 0.005), 3.0 +/- 0.6 vs. 3.5 +/- 0.5 mm (17 % increase, p < 0.001), 2.7 +/- 0.6 vs. 3.2 +/- 0.7 mm (19 % increase, p < 0.005), and 2.9 +/- 0.9 vs. 3.5 +/- 0.7 mm (21 % increase, p < 0.005), respectively. In the control group of 10 patients who underwent two MSCT coronary angiographies after sublingual Nitrate, no significant difference in the proximal diameter of all four main coronary vessels was observed. CONCLUSION: Sublingual administration of Nitrate results in significantly larger proximal coronary artery diameters on MSCT coronary angiography and might thus be recommended for routine examinations.

Administration, Sublingual↗
PubMed2006

[Questionnaire study on the acceptance of a student initiative for computer-based medical education].

BACKGROUND AND PURPOSE: Computer-based teaching and learning are getting more and more important in medical education. To integrate this type of training into the curricula, medical faculties must provide supervised computer labs. The present study was conducted to evaluate the acceptance and efficiency of the student-organised concept of computer labs established at the Charité Hospital in Berlin. METHODS: An electronic online questionnaire comprising 25 items was distributed to all users of the two computer labs at the Charité to ask their opinions about the quality of the student-organised concept and their satisfaction with the working conditions in the labs and to compare them longitudinally with the results obtained 4 years ago. RESULTS: A total of 1275 users worked in the labs during the survey period and 702 answered the questionnaire (return rate: 55.1%). The users assigned good to very good ratings to different components of the concept with student self-administration and helpfulness of the student tutors achieving the highest rating (both 1.5 +/- 0.7). In the longitudinal study no component of the concept was rated worse in the current questionnaire, whereas the opening hours were assigned significantly higher ratings than 4 years ago (1.6 +/- 0.8 vs. 2 +/- 0.9; p < 0.001). Over 20% of all users stated they would be interested in actively participating as tutors in the project. Students used the computer labs for a mean of 3.1 hours per week. The support of students working on a voluntary basis allowed for weekly opening hours of the labs of 146 hours with the personnel expenditure costs that would be necessary for the position of one faculty member. CONCLUSIONS: The good to excellent ratings, the high acceptance by users, and the low costs of the project presented here suggest that this student initiative can be recommended to other medical faculties to serve as a basis for integration of computer-based education into the curriculum.

Attitude↗
PubMed2005

[Surgery for congestive heart failure--the role of computed tomography in the pre- and postoperative diagnostic evaluation].

The treatment of advanced, drug resistant congestive heart failure gains in importance in the field of cardiac surgery. Cardiac imaging for preoperative assessment and follow-up focuses on the determination of ventricular volumes and function as well as on the detection of postoperative complications. Computed tomography (CT) is highly accurate irrespective of the individual patient's anatomic situation, has a low examiner dependence and short examination time, does not require an arterial vascular access and can be performed in patients with metal implants. CT is the modality of choice in the follow-up of heart transplants to detect extracardiac and cardiac complications including coronary calcifications as an early sign of transplant vasculopathy. In addition, CT visualizes the elements of mechanical assist devices and can identify their possible local cardiac and mediastinal complications. CT can detect fibrolipomatous involution of the mobilized muscle flap in dynamic cardiomyoplasty and can depict fibrous reactions along the epicardial mesh implant in passive cardiac containment. Further indications include assessment of typical local postoperative complications, such as intrathoracic infection and mediastinal bleeding, intracardiac thrombus formation or pericardial effusion. CT is routinely used for evaluating bypass patency but is limited in assessing associated valve defects since it does not visualize flow.

Cardiovascular Surgical Procedures↗
PubMed2005

CHHIPS (Controlling Hypertension and Hypotension Immediately Post-Stroke) Pilot Trial: rationale and design.

RATIONALE: High and low blood pressure (BP) levels are common following acute stroke, with up to 60% of patients being hypertensive (SBP > 160 mmHg) and nearly 20% having relative hypotension (SBP < or = 140 mmHg), within the first few hours of ictus, both conditions being associated with an adverse prognosis. At present, the optimum management of blood pressure in the immediate post-stroke period is unclear. OBJECTIVE: The primary aim of the Controlling Hypertension and Hypotension Immediately Post-Stroke (CHHIPS) Pilot Trial is to assess whether hypertension and relative hypotension, manipulated therapeutically in the first 24 h following acute stroke, affects short-term outcome measures. DESIGN: The CHHIPS Pilot Trial is a UK based multi-centre, randomized, double-blind, placebo-controlled, titrated dose trial. SETTING: Acute stroke and medical units in teaching and district general hospitals, in the UK. PATIENTS: The CHHIPS Pilot Study aims to recruit 2050 patients, with clinically suspected stroke, confirmed by brain imaging, who have no compelling indication or contraindication for BP manipulation. STUDY OUTCOMES: The primary outcome measure will be the effects of acute pressor therapy (initiated < or = 12 h from stroke onset) or depressor therapy (started < or = 24 h post-ictus) on death and dependency at 14 days post-stroke. Secondary outcome measures will include the influence of therapy on early neurological deterioration, the effectiveness of treatment in manipulating BP levels, the influence of time to treatment and stroke type on response and a cost-effectiveness analysis.

Acute Disease↗
PubMed2004

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients.

BACKGROUND AND PURPOSE: Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred. METHODS: Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control. RESULTS: We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL. CONCLUSIONS: Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.

Activities of Daily Living↗
PubMed2004

[Comparison of the cost-effectiveness of the most common diagnostic methods for coronary artery disease].

BACKGROUND AND OBJECTIVE: The cost-effectiveness of medical procedures is becoming a crucial factor besides their efficacy in clinical decision-making. We performed a cost-effectiveness analysis of the most common diagnostic modalities used in assessing coronary artery disease (CAD). METHODS: A decision tree model for determining the cost-effectiveness in CAD diagnosis was applied to the situation in Germany to calculate the cost-effectiveness of exercise ECG (ExECG), stress echocardiography (ECHO), myocardial scintigraphy (SPECT), and coronary angiography (ANGIO). The cost-effectiveness was defined as direct and induced costs per correctly identified patient. A sensitivity analysis was performed varying the predictive accuracies, the complication-related costs, and costs and complication rates of ANGIO. RESULTS: The costs per correctly identified patient decreased in a hyperbolic fashion as the pretest likelihood of CAD increased due to the higher incidence of positive findings. For a pretest likelihood between 10 and 40%, ExECG and ECHO were most cost effective with costs per CAD patient of 5,880 - 2,500 EUR and 6,410 - 2,280 EUR, respectively. The combination of ExECG und ECHO (application of the second modality in case the first one was nondiagnostic) further improved the cost-effectiveness up to a pretest likelihood of 35%. For a pretest likelihood of 50% or greater, ANGIO costing 1,880 - 940 EUR per correct diagnosis was most cost-effective. Sensitivity analysis revealed no significant changes demonstrating the robustness of the model. CONCLUSION: ANGIO is the most cost-effective procedure for a pretest likelihood of 50% or greater. At lower pretest likelihoods, ExECG, ECHO and the combined ExECG/ECHO strategy based on economic considerations are the preferred modalities for diagnosis of CAD.

Cohort Studies↗
PubMed2004

Multislice CT coronary angiography: evaluation of an automatic vessel detection tool.

PURPOSE: To investigate the potential of a new detection tool for multislice CT (MSCT) coronary angiography with automatic display of curved multiplanar reformations and orthogonal cross-sections. MATERIALS AND METHODS: Thirty-five patients were consecutively enrolled in a prospective intention-to-diagnose study and examined using a MSCT scanner with 16 x 0.5 mm detector collimation and 400 ms gantry rotation time (Aquilion, Toshiba). A multisegment algorithm using up to four segments was applied for ECG-gated reconstruction. Automatic and manual detection of coronary arteries was conducted using the coronary artery CT protocol of a workstation (Vitrea 2, Version 3.3, Vital Images) to detect significant stenoses (> or = 50 %) in all segments of > or = 1.5 mm in diameter. Each detection tool was used by one reader who was blinded to the results of the other detection method and the results of conventional coronary angiography. RESULTS: The overall sensitivity, specificity, nondiagnostic rate, and accuracy of the automatic and manual approach were 90 vs. 94 %, 89 vs. 84 %, 6 vs. 6 %, and 89 vs. 88 %, respectively (p = n. s.). The vessel length detected with the automatic and manual approach were highly correlated for the left main/left anterior descending (143 +/- 30 vs. 146 +/- 24 mm, r = 0.923, p < 0.001), left circumflex (94 +/- 35 vs. 93 +/- 33 mm, r = 0.945, p < 0.001), and right coronary artery (145 +/- 36 vs. 144 +/- 37 mm, r = 0.925, p < 0.001). The time required to create reformations along the coronary arteries was significantly shorter with the automatic tool compared to the manual approach (203 +/- 77 vs. 391 +/- 104 sec, p < 0.005). In 90 % of the coronary branches automatic detection required less time than the manual approach. CONCLUSION: Automatic coronary vessel detection is feasible and reduces the time required to create reformations by a factor of approximately two without deteriorating the diagnostic accuracy.

Aged↗
PubMed2004

Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors.

OBJECTIVE: To evaluate the effectiveness of injury prevention training. DESIGN: Cluster randomised controlled trial. SETTING: Primary care facilities in the East Midlands area of the United Kingdom. SUBJECTS: Midwives and health visitors. INTERVENTION: Evidence based training session on the risks associated with baby walkers. MAIN OUTCOME MEASURES: The primary outcome measures were knowledge of baby walker use and walker related injury, attitudes towards walkers and towards walker education, and practices relating to walker health education. RESULTS: Trained midwives and health visitors had greater knowledge of the risks associated with baby walkers than untrained midwives and health visitors (difference between the means 0.22; 95% confidence interval (CI) 0.12 to 0.33). Trained health visitors had more negative attitudes to baby walkers (difference between the means 0.35; 95% CI 0.10 to 0.59) and more positive attitudes towards baby walker health education (difference between the means 0.31; 95% CI 0.00 to 0.62) than untrained health visitors. Midwives who had been trained were more likely to discuss baby walkers in the antenatal period than those who were not trained (odds ratio 9.92; 95% CI 2.02 to 48.83). CONCLUSIONS: Injury prevention training was associated with increased knowledge, more negative attitudes towards walkers, and more positive attitudes towards walker education. Trained midwives were more likely to give advice antenatally. Training did not impact on other practices. Larger trials are required to assess the impact of training on parental safety behaviours, the adoption of safety practices, and injury reduction.

Attitude of Health Personnel↗
PubMed2002

[Medical dissertation: differences between successful and aborted research projects].

BACKGROUND AND OBJECTIVE: To obtain the title "Doctor medicinae" in Germany a dissertation is required. There are no data currently available to compare successful and unsuccessful student research projects. This study's aim was to determine observational differences between the two groups of successful and unsuccessful dissertations pursued by medical students. METHODS: All medical students of the 11 (th) to 14 (th) terms of study at the Charité Hospital in Berlin (n = 1036; 560 females [54.1 %] and 476 males [45.9 %]) received a questionnaire, which invited them to describe the current and/or up to two aborted dissertations. The returned questionnaires were classified into "successful" and "unsuccessful" dissertations. RESULTS: 324 (31 %) students responded, describing 348 dissertation projects at the Charité. Of these, 72 were identified as successful and 65 as unsuccessful. Successful dissertations were significantly better supervised (the supervisor was available more often [64 % vs. 29 %]; the supervisor was more often helpful [57 % vs. 9 %]). Further, planning of successful projects was significantly better (dissertation faithful to agreed-on specifications [42 % vs. 5 %]; financially supported [39 % vs. 8 %]). In addition, efforts to attract the student as a future research partner were significantly more frequent when the dissertation was successful (50 % vs. 17 %). CONCLUSION: Successful dissertations are clearly the result of better preparation and continuous close supervision. To improve the chances of success, better planning and supervision are essential. Moreover, financial support and proper preparation for scientific work, e. g., by special courses, maybe promising instruments to increase the fraction of successful dissertations.

Academic Dissertations as Topic↗
PubMed2002

Cognitive rehabilitation for spatial neglect following stroke.

BACKGROUND: Unilateral spatial neglect is a failure to attend to one side of space. Various strategies have been used to treat these problems but evidence of their benefit has been lacking. OBJECTIVES: To determine the effects of cognitive rehabilitation for spatial neglect following stroke as measured on impairment and disability level assessments, and destination on discharge from hospital. To determine whether any effects persist at follow-up assessment. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched February 2001), MEDLINE (1966-December 2000), EMBASE (1980-February 2001), CINAHL (1983-January 2001), PSYCLIT and CLINPSYCH (1974-February 2001). We handsearched relevant journals, screened reference lists from relevant articles and tracked citations using SCISEARCH. SELECTION CRITERIA: Controlled trials of cognitive rehabilitation for spatial neglect in stroke. Studies with mixed patient groups were excluded unless more than 75% of their sample were stroke patients or separate stroke data were available for stroke patients. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials, extracted data, and assessed trial quality. MAIN RESULTS: We included 15 studies with 400 participants. A large number of different outcome measures were reported. Only six studies included a measure of disability and only four (111 participants) investigated persisting effects on any outcome. There was evidence that cognitive rehabilitation resulted in significant and persisting improvements in performance on impairment level assessments, although this varied depending on the test used. There was insufficient evidence to confirm or exclude an effect of cognitive rehabilitation at the level of disability or on destination following discharge from hospital. REVIEWER'S CONCLUSIONS: There is some evidence that cognitive rehabilitation for spatial neglect improves performance on some impairment level tests but its effect on disability is unclear. Further well-designed RCTs are warranted as well as basic research to develop valid outcome measures.

Cognitive Behavioral Therapy↗
PubMed2001

Effectiveness of home based support for older people: systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. DESIGN: Systematic review and meta-analysis of 15 studies of home visiting. PARTICIPANTS: older people living at home, including frail older people at risk of adverse outcomes. OUTCOME MEASURES: Mortality, admission to hospital, admission to institutional care, functional status, health status. RESULTS: Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term institutional care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, "at risk" older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; -0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; -0.07 to 0.17). CONCLUSION: Home visits to older people can reduce mortality and admission to long term institutional care.

Aged↗
PubMed2001

Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms.

OBJECTIVES: To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference. DESIGN: Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes. SETTING: 31 general practices in Trent region. PARTICIPANTS: Patients aged 18-70 who met research diagnostic criteria for major depression; 103 patients were randomised and 220 patients were recruited to the preference arms. MAIN OUTCOME MEASURES: Difference in mean Beck depression inventory score; time to remission; global outcome assessed by a psychiatrist using all data sources; and research diagnostic criteria. RESULTS: At 12 months there was no difference between the mean Beck scores in the randomised arms. Combining the randomised and patient preference groups, the difference in Beck scores was 0.4 (95% confidence interval -2.7 to 3.5). Patients choosing counselling did better than those randomised to it (mean difference in Beck score 4.6, 0.0 to 9.2). There was no difference in the psychiatrist's overall assessment of outcome between any of the groups. 221/265 (83%) of participants with a known outcome had a remission. Median time to remission was shorter in the group randomised to antidepressants than the other three groups (2 months v 3 months). 33/221 (15%) patients had a relapse. CONCLUSIONS: Generic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness, although patients receiving antidepressants may recover more quickly. General practitioners should allow patients to have their preferred treatment.

Adult↗