PubMed Health⌕ Search

Biomedical subjects

M Rawlins

Publications and source records attributed to M Rawlins.

At least 19 recordsLinked to original sources
PubMed2005

NICE discrimination.

Explore the source record for details and available documents.

Academies and Institutes↗
PubMed2003

Reducing prescribing error: competence, control, and culture.

Medication errors are probably the most prevalent form of medical error, and prescribing errors are the most important source of medication errors. In this article we suggest interventions are needed at three levels to improve prescribing: (1) improve the training, and test the competence, of prescribers; (2) control the environment in which prescribers perform in order to standardise it, have greater controls on riskier drugs, and use technology to provide decision support; and (3) change organisational cultures, which do not support the belief that prescribing is a complex, technical, act, and that it is important to get it right. Solutions involve overt acknowledgement of this by senior clinicians and managers, and an open process of sharing and reviewing prescribing decisions.

Clinical Competence↗
PubMed2000

Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti-inflammatory drugs.

AIMS: To determine risk factors for peptic ulcer bleeding other than non-steroidal anti-inflammatory drugs (NSAIDs). Methods-Data on possible antecedent risk factors obtained in a large case control study of 1121 patients admitted to hospitals in Glasgow, Newcastle, Nottingham, Oxford, and Portsmouth with bleeding peptic ulcers were compared with the same information obtained in 989 population controls. Data were analysed by logistic regression with the calculation of odds ratios (OR) and 95% confidence intervals (CI). RESULTS: From a logistic regression model, oral anticoagulants (OR 7. 8; 95% CI 2.8-21.5), previous peptic ulcer (3.8; 2.6-4.9), treatment for heart failure (5.9; 2.3-13.1), oral corticosteroid use (2.7; 1. 3-4.5), treatment for diabetes (3.1; 1.2-4.3), and current smoking (1.6; 1.2-2.0) were all independent risk factors. No association was found with use of calcium channel antagonists. Odds ratios for concomitant NSAID usage were multiplicative with the exception of current smoking. CONCLUSIONS: Some 45% of admissions for peptic ulcer bleeding in England and Wales in those aged 60 or more are calculated to be attributable to, or associated with, these accessory risk factors, which, together with those associated with aspirin or other NSAID use will account for over 80% of predisposing factors to ulcer bleeding.

Aged↗
PubMed1999

In pursuit of quality: the National Institute for Clinical Excellence.

In the UK, as elsewhere in the world, there is abundant evidence of unacceptable inequalities and inefficiencies in health care. These failures are manifest in various ways including inappropriate variations in the uptake and use of health technologies of proven value, the too frequent failure to provide patients with optimum care for the treatment of common diseases, and the too ready adoption of health technologies with no established clinical benefits. Healthcare systems worldwide are therefore struggling to find ways to ensure that their health professionals are able to provide patients with the highest possible (and affordable) standards of clinical care. The British government has committed itself to a programme of enhancing the quality of care given to National Health Service (NHS) patients. The new National Institute for Clinical Excellence (NICE) has been charge with providing NHS staff with clear and robust advice that will help them meet their own, and their patients', aspirations. The Institute's guidance will cover individual technologies as well as the management of a wide range of conditions. NICE will also advise on appropriate methods of clinical audit in those areas where it has provided guidance.

Health Priorities↗
PubMed1999

Central hemodynamic changes in experimental muscle crush injury in pigs.

To investigate central and pulmonary hemodynamics in a standardized normovolemic experimental muscle injury model, 8 anesthetized and mechanically ventilated test pigs were intracavally infused with 100 ml of autologous muscle extract over a period of 100 min; 8 control pigs received Ringer's solution. The cardiac index decreased 20% and the heart rate decreased 10% within 30 min of starting the infusion in the muscle extract group and remained depressed. Mean arterial pressure increased significantly in both groups. The pulmonary capillary wedge pressure and central venous pressure remained relatively unchanged during the 5-hour study. A 2-fold increase in mean pulmonary arterial pressure and a nearly 4-fold increase in the pulmonary vascular resistance index was seen in the muscle extract infusion group, which however returned to normal. Arterial hemoglobin concentration and systemic vascular resistance index remained fairly stationary in both groups. Immediate significant decreases in both arterial oxygen saturation and arterial oxygen tension were observed in the muscle extract group, however both variables recovered towards the end of the experiment. A slight increase in arterial blood pH value was noted during the experiment. In conclusion, autologous muscle extract infusion causes decreases in heart rate and cardiac index, as well as a significant increase in pulmonary vascular tone and systemic hypoxemia, emphasizing the detrimental effects of skeletal muscle injury following severe trauma.

Animals↗
PubMed1999

Conservative treatment of scaphoid fractures: a follow up study.

BACKGROUND AND AIMS: This investigation was made to elucidate the outcome of conservatively treated scaphoid fractures. MATERIAL AND METHODS: 63 patients with a scaphoid fracture were treated initially conservatively and examined retrospectively. The mean follow up time was 54 months. RESULTS: In this group bone union was achieved in 56 cases (89%). Three of the patients ended up to operation because of delayed union soon after conservative treatment and three nonunions were found in the follow up appointment. One fracture did not heal because of dislocation during cast treatment and was treated with operation. Incidence of osteoarthrosis and residual symptoms were studied in the group with totally conservative treatment. Osteoarthrosis was found in 19 (32%) wrists, but no correlation with wrist problems (pain, reduced grip strength or problems at work) was found. 20 (34%) of the patients complained residual symptoms. Most of the symptoms were mild and did not impair their ability to work or cause serious problems during free time. CONCLUSION: According to the present study conservative treatment is a safe method for the treatment of undislocated stabile scaphoid fractures.

Adolescent↗
PubMed1995

Prophylactic aspirin and risk of peptic ulcer bleeding.

OBJECTIVE: To determine the risks of hospitalisation for bleeding peptic ulcer with the current prophylactic aspirin regimens of 300 mg daily or less. DESIGN: A case-control study with hospital and community controls. SETTING: Hospitals in Glasgow, Newcastle, Nottingham, Oxford, and Portsmouth. SUBJECTS: 1121 patients with gastric or duodenal ulcer bleeding matched with hospital and community controls. RESULTS: 144 (12.8%) cases had been regular users of aspirin (taken at least five days a week for at least the previous month) compared with 101 (9.0%) hospital and 77 (7.8%) community controls. Odds ratios were raised for all doses of aspirin taken, whether compared with hospital or community controls (compared with combined controls: 75 mg, 2.3 (95% confidence interval 1.2 to 4.4); 150 mg, 3.2 (1.7 to 6.5); 300 mg, 3.9 (2.5 to 6.3)). Results were not explained by confounding influences of age, sex, prior ulcer history or dyspepsia, or concurrent non-aspirin non-steroidal anti-inflammatory drug use. Risks seemed particularly high in patients who took non-aspirin non-steroidal anti-inflammatory drugs concurrently. CONCLUSION: No conventionally used prophylactic aspirin regimen seems free of the risk of peptic ulcer complications.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Drugs on trial.

Explore the source record for details and available documents.

Drug Approval↗
PubMed1990

Tracer kinetics and actions of oral and intraperitoneal 1,25-dihydroxyvitamin D3 administration in rats.

Tracer kinetic parameters of [3H]-1,25(OH)2D3 were calculated from data obtained following its acute oral (p.o.) or intraperitoneal (i.p.) administration. In normal rats studied after the tracer had distributed into the body, the slope and intercept of the log-serum [3H]-1,25(OH)2D3 versus time relationship were not significantly influenced by the route of administration. Pretreatment with 1,25(OH)2D3 (0.2 micrograms/100 g/day) by the same route as the tracer resulted in the following changes: in p.o. rats the serum [3H]-1,25(OH)2D3 intercept was much lower but the slope was not changed; in i.p. rats the intercept was not changed but the slope was increased. Both p.o. and i.p. treatment with 1,25(OH)2D3 lowered the weight gain and diet consumption, and increased serum calcium, kidney tissue calcium and urinary excretion of orally administered 45Ca. All the measures of bioactivity were greater in the i.p. dosed rats than in the p.o. dosed rats. We conclude that the p.o. 1,25(OH)2D3 was less potent because of diminished bioavailability due to self induction of its presystemic metabolism and inactivation.

Administration, Oral↗
PubMed1983

Characterization of the glucocorticoid receptor in rat skin.

Using an exchange assay to measure occupied and unoccupied binding sites the interaction between [3H]triamcinolone acetonide and rat skin cytosol proteins was studied. A binding site with a high affinity (dissociation constant = 7 x 10(-10) mol/l) and a low capacity (400-600 fmol/mg protein) for triamcinolone acetonide was detected. The binding was specific to corticosteroids; fluorinated steroids showed a higher affinity than natural steroids. Non-corticosteroids, with the exception of progesterone, had little or no affinity for the binding site. At 0 degrees C the second-order rate constant of association was 2.23 x 10(6) mol/l per min and the first-order rate constant of dissociation was 1.6 x 10(-4) per min. In the absence of dithiothreitol and molybdate the specific binding was rapidly abolished. The binding was also labile to heating and proteolytic enzymes. One day after adrenalectomy there was a significant increase in the number of assayable binding sites in the cytosol. The results are consistent with the binding protein being the physiological glucocorticoid receptor in rat skin.

Adrenalectomy↗
PubMed1976

Aftercare on narcotic antagonists: prospects and problems.

This study examines the problems and prospects of aftercare of the multiple treatment failure opiate addict who is being treated with narcotic antagonists (primarily naltrexone). At the time of this paper, 21 patients had been admitted to the Drug Addiction Research Project at McLean Hospital, with a retention rate of 42%. "Completers," "noncompleters," and "dropouts" could not be differentiated on the basis of demographic or psychiatric variables, thus making it impossible to define the population most suited for antagonist treatment. The degree of carry-over into the first month in the community, for those who successfully completed the inpatient segment of the program, disappeared over time. The nonreinforcing (lack of euphoric effect) properties of the antagonists and the resultant high level of motivation necessary for the continuation of its use by the patient make this form of treatment suitable for only a small percentage of the "hard core" addict population.

Adult↗