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Biomedical subjects

N Currie

Publications and source records attributed to N Currie.

6 recordsLinked to original sources
PubMed1998

Evaluating innovation in general practice: a pragmatic framework using programme budgeting and marginal analysis.

BACKGROUND: Innovation in primary care in the UK, in terms of new service developments, is occurring at a fast pace. However, little information is available on the costs and benefits of these changes. OBJECTIVES: We aimed to illustrate the use of programme budgeting and marginal analysis (PBMA) as a framework for evaluating innovation in primary care, using an example of practice-based diabetes care. The aim was to examine changes in the use of practice resources and the changes in benefits to patients, following the introduction of a diabetes clinic. METHODS: PBMA is a form of pragmatic economic evaluation combining practice data for the 'before' period and data from the literature to model the 'after' period. RESULTS: In 1995/6, the total amount of resources devoted to diabetes care in the two practices was 145813 pound sterling (634 pound sterling per patient). Of this sum, 62% was allocated to out-patient visits, 28% to prescribing, 5% to hospital admissions, 2% to GP consultations and 2% to tests. The literature suggests that a nurse-run diabetes clinic would result in similar health outcomes and better access for patients. The introduction of such a clinic could potentially save each practice between 2000 pound sterling and 16000 pound sterling per year. This result takes into account a wide range of assumptions about changes in resource use, but does depend on the findings of previous studies. CONCLUSIONS: The results of this study show that PBMA is a useful framework for helping practices be accountable and make 'evidence-based' decisions about service innovations in primary care.

Adult↗
PubMed1998

Domiciliary nebuliser therapy--a valuable option in chronic asthma and chronic obstructive pulmonary disease?

Domiciliary nebulisers are in widespread use for patients who have severe chronic airways disease, both asthma and chronic obstructive pulmonary disease (COPD). We report a study of the use of domiciliary nebulisers designed to assess practical problems and the value of such therapy in preventing hospital admissions. A total of 405 patients underwent a structured interview at home and their case records were reviewed. Technical performance of the nebuliser compressors was assessed. The mean (SD) age of those interviewed was 64.5 (12) years. 185 patients had a physician diagnosis of asthma, and 208 had COPD. 87% patients used their nebuliser at least once daily. Side effects, reported by 54%, were related to frequency of use and commoner in younger patients. 29 subjects (7%) died within 2 years of receiving their nebuliser. Among the survivors, the 2 year periods before and after supply of the nebuliser were compared. The percentage of patients requiring hospital admission for exacerbations of lung disease fell from 56% to 46% (p < 0.01) but the number and duration of admissions was unchanged. Those whose admission duration increased had more severely impaired spirometry when the nebuliser was supplied and had lower activity scores and higher breathlessness scores at the time of interview indicating more severe disease. Approximately half of the compressors were malfunctioning and patients' understanding of the principles of nebuliser treatment was poor. The provision of domiciliary nebuliser can influence hospital admission in patients with obstructive airways disease. There is also a need for improved patient education and for technical support which may require the development of a nurse-run nebuliser service.

Administration, Inhalation↗
PubMed1989

Malignant angioendotheliosis--an unusual cause of stroke.

We report a case of malignant angioendotheliosis in a 63-year-old female who presented with a right hemiparesis. This diagnosis should be considered when multi-focal neurological signs develop in association with a progressive deterioration of mental state and conscious level.

Brain Ischemia↗
PubMed1969

Sodium ions and the secretion of catecholamines.

1. Perfusion of bovine adrenal glands with a potassium-free Tyrode solution results in an increased spontaneous release of catecholamines and an increased response to stimulation with carbamylcholine.2. Perfusion with a Tyrode solution containing 70 mM-KCl causes a marked secretion of catecholamines and a subsequent inhibition of secretion in response to stimulation with carbamylcholine.3. Perfusion with sodium-free media abolishes or severely reduces the secretory response of the gland to carbamylcholine and to 70 mM-KCl although the basal secretion shows an initial rise.4. Perfusion with sodium-deficient media permits some retention of the secretory response.5. A possible role for intracellular sodium ions in the secretion of catecholamines is discussed.

Adrenal Glands↗