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Biomedical subjects

N Goodwin

Publications and source records attributed to N Goodwin.

At least 19 recordsLinked to original sources
PubMed2006

Flexibility and light emission of disposable paediatric Miller 1 laryngoscope blades*.

With the emergence of Creutzfeldt-Jakob disease and the discovery of prions in tonsillar material, there has been an increase in the number of available disposable laryngoscope blades. This has led to non-conformity over many aspects of blade design. Miller 1 disposable blades have been produced in both metal and plastic and appear to have different properties of rigidity. We examined the rigidity of 11 disposable Miller 1 blades in three different axes of force. There was a significant difference in flexibility between metal and plastic blades in both primary and torsional axis (p = 0.006). We also studied the blades' light intensity and angle of light emission, finding up to an eightfold difference in the level of illumination provided at a distance of 10 mm from the tips of the blades. The area of maximal illumination varied, with some blades providing narrow beams of light, and others provided a more dispersed field of illumination. In addition, the angle of maximal illumination varied between the blade types from a central position to one directed to the right-hand side.

Disposable Equipment↗
PubMed2005

Effect of breathing low concentrations of volatile anaesthetic agents on incidence of adverse airway events.

The effect of breathing 0.1 minimum alveolar concentrations (MAC) of desflurane or isoflurane for three minutes on the incidence of adverse airway events on a subsequent breath of 2 MAC was investigated. Twenty-five volunteers known to develop an adverse airway event to desflurane or isoflurane took part in the study. Each volunteer was exposed to isoflurane and desflurane at least 24 h apart. Volunteers were assessed for adverse airway events while breathing 2 MAC inhalational anaesthetic following breathing 100% O(2) for 3 min. This was repeated with 0.1 MAC inhalational anaesthetic in oxygen instead of 100% O(2). Adverse airway events decreased from 88% to 40% when tests were conducted with desflurane (p = 0.002). With isoflurane, the reduction from 60% to 52% was not statistically significant (p = 0.774). Breathing low concentrations of desflurane decreases the incidence of adverse airway events on subsequent inhalation of higher concentration of desflurane.

Adult↗
PubMed2004

A comparison of 8% and 12% sevoflurane for inhalation induction in adults.

Sevoflurane is a non-pungent volatile anaesthetic agent with a low blood-gas solubility coefficient. It has been studied in concentrations of up to 8% for induction of anaesthesia. Previous work has suggested that there may be a ceiling effect with increasing concentration of sevoflurane above 6%, but there are no published studies using 12% sevoflurane. This study compared 8 and 12% sevoflurane to induce anaesthesia in adults. Sevoflurane was administered using two adapted datum vaporisers with the interlock removed. Induction with 12% sevoflurane compared to 8% sevoflurane produced a significant decrease in the time to achieve central pupils, corresponding to surgical anaesthesia and the third part of Guedel's stage 3 of anaesthesia (mean time (SD) 201 s (81) and 247 s (39), respectively, p < 0.05). Twelve-percent sevoflurane produced a similar stable cardiovascular profile to 8% sevoflurane, and there was no increase in respiratory complications.

Adult↗
PubMed2004

Managing or managed? Experience of general practitioners in English Primary Care Groups and Trusts.

This article presents findings from a wider UK Department of Health funded evaluation of English Primary Care Groups (PCGs) and Trusts (PCTs). It presents qualitative research into the experiences of general practitioners (GPs) in these PCG/Ts and explores the extent to which GPs manage, or are managed by, these new organizations. Using the framework of stratification theory, the paper explores whether there is any evidence to suggest PCTs will strengthen collective medical control over resource allocation whilst fending off management control of clinical decision-making. It also examines whether individual GPs not involved at board level feel a loss of control over decisions and their own clinical practice. A stratified random sample of 20 GPs was selected for in-depth interview. The in-depth interviews were designed to capture the full complexity and variety of GPs' experiences that routinely available data could not capture. GPs were anxious that clinical decisions were, or could, be overridden by other concerns such as cost control. The extent to which primary care professionals leading PCGs and PCTs could fend off managerial control was doubted. However, whilst GPs felt under threat, this was more an anticipated threat than a reality. GPs within PCG/Ts seem prepared to accept a degree of standardization if they feel that this is consistent with good clinical care. However, although there was the impression of greater central control, PCGs and PCTs and Government policies did not appear to have made an impression on clinical autonomy.

Decision Making↗
PubMed2003

The rigid nasendoscope as a tool for difficult tracheal intubation: a manikin study.

We examined the use of the 30 degrees rigid nasendoscope in aiding difficult tracheal intubations. A Cormack and Lehane grade 4 difficult intubation (no view of glottis or epiglottis) was set up on a manikin. After 10 s of tuition, 40 anaesthetists attempted to pass a standard gum elastic bougie between the cords, with and without the nasendoscope, in randomised order. A bougie curved to an 'optimal curve' was also tested. Using the standard bougie 13/40 (33%) passed the bougie between the cords without the nasendoscope, compared with 31/40 (78%) when using the nasendoscope (p < 0.001). The 'optimal curve' bougie resulted in 29/40 (73%) and 39/40 (98%) success rates without and with the nasendoscope, respectively (p = 0.004). The nasendoscope is a simple and easy to use tool in grade 4 intubation, and results are improved further by the use of an 'optimal curve' bougie.

Attitude of Health Personnel↗
PubMed2003

Serum concentrations of leptin in six genetic lines of swine and relationship with growth and carcass characteristics.

The objective of this study was to evaluate the relationship between serum concentrations of the hormone leptin with growth and carcass traits insix distinct breeds of pigs entered into the 2000 National Barrow Show Sire Progeny Test. Breeds evaluated were Berkshire (n = 131), Chester White (n = 33), Duroc (n = 40), Landrace (n = 23), Poland China (n = 26), and Yorkshire (n = 41). Serum samples were collected and assayed for concentrations of leptin at entry into test (On-Test Leptin) at 34 +/- 6.7 kg of live weight and again 24 h prior to harvest (Off-Test Leptin) at 111 +/- 3.1 kg of live weight. Carcass measurements taken included hot carcass weight, carcass length, backfat, longissimus muscle area (LMA), longissimus pH, Hunter L-value, chemically determined intramuscular fat (IMF), and subjective color, marbling, and firmness scores. Average daily gain, IMF percentages, and water-holding capacity (WHC) were also determined. On-Test Leptin concentrations were not different (P > 0.10) between swine breeds; however, Off-Test Leptin concentrations did differ (P < 0.001) across genotype. Berkshire had the greatest Off-Test Leptin concentrations (6.58 +/- 0.43 ng/mL), and Duroc and Yorkshire had the lowest (3.49 and 3.96 +/- 0.68 ng/mL; respectively). In addition, Off-Test Leptin concentrations were correlated with average daily gain (r = 0.29; P < 0.001), last-rib fat thickness (r = 0.48; P < 0.001), 10th rib backfat (r = 0.52; P < 0.001), LMA (r = -0.33; P < 0.001), percent fat-free carcass lean (r = -0.51; P < 0.001), and WHC (r = 0.15; P < 0.05). Off-Test Leptin concentrations also differed by gender, with barrows having greater (P < 0.001) serum concentrations of leptin than gilts (6.55 +/- 0.48 vs 3.35 +/- 0.44). Differences exist between breeds of pigs in a manner consistent with breed-specific traits for growth, leanness, and quality; thus, leptin may serve as a useful marker for selection or identification of specific growth and carcass traits.

Adipose Tissue↗
PubMed2001

Public health. How to get promoted.

Public health professionals are uncertain about the future of the specialty. Organisational changes will require developing the public health capacity of those outside the profession. Public health professionals will need to develop influencing skills.

Career Mobility↗
PubMed2001

Measuring the success of primary care organizations: is it possible?

Primary care in the UK has been the subject of numerous changes and reorganizations since 1990. Each innovation in organization, with the exception of fundholding, has been the subject of evaluation. However, the complexities of some innovations make the evaluation process problematic and this is further complicated by the trend towards central policy decision making being subject to local interpretation and implementation, by means of simultaneous devolution and centralization. This paper discusses the challenges and problems posed by attempting to evaluate these new organizations, particularly with regard to whether or not they can be considered to be "successful". It draws specifically on the national evaluation of the total purchasing pilots and indicates how the findings can be applied to primary care groups.

Contract Services↗
PubMed2001

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

PURPOSE: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. THEORY: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. METHOD: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. RESULTS: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. CONCLUSIONS: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

Journal Article↗
PubMed2000

Leadership and the UK health service.

This paper explores future leadership requirements for health services in the context of relevant leadership theory and the changing environment for health services in the UK. The output of leadership research is both prolific and confusing and its applicability to health services management uncertain especially in the context of constraints on the strategic managerial behaviour and choices of public service managers. The introduction of general management to the UK NHS in the 1980s, followed by an internal market for health care in 1990 should have provided the opportunity for managers to work differently and to create personal space for leadership. However, it is not known whether sustainable , new ways of leadership working have emerged although it is reasonable to hypothesis from studies elsewhere that a number of contextual and behavioural leadership models are likely to be found in the NHS. Although management researchers have explored networking and referred to the impact of the external environment of leadership, insufficient importance has been attached to-date to the impact of future trends in health services on the leadership of change in the health sector. The paper argues that in future health services leadership will require much more than traditional networking with other organizations and groups and will need to focus on developing and securing external agreement to an agenda for positive change turning the apparent constraints of the external environment, determined primarily by government policies,into opportunities. In other words, the demands of external or contextual leadership will increase forcing a stronger focus on having to achieve change through others.

Health Services Needs and Demand↗
PubMed2000

The British quasi-market in health care: a balance sheet of the evidence.

OBJECTIVES: To summarise the findings from a comprehensive review of research on the effects of the three main elements of the quasi-market reforms of the UK National Health Service (NHS) introduced in 1991/92: General practices becoming fundholders by volunteering to purchase elective care for their patients; Health authorities becoming purchasers of emergency, unplanned and elective services, together with a range of alternatives to fundholding operating under their auspices; The conversion of providers of hospital and community health services to NHS trusts separate from their local health authorities. METHODS: Published and unpublished studies which included any data on the impact of the three main planks of the quasi-market changes, produced between 1991 and late 1998, were identified using a combination of electronic databases, library catalogues at the King's Fund, London, bibliographies, reference lists of individual studies, a survey of NHS directors of public health and consultations with subject area experts. Each main element of the quasi-market was assessed in relation to its impact on: efficiency (primarily productivity); equity; quality; choice and responsiveness; and accountability. RESULTS: There was relatively little measurable change that could be related unequivocally to the core mechanisms of the quasi-market. CONCLUSIONS: The incentives were generally too weak and the constraints too strong to generate the consequences predicted by either proponents or critics of the quasi-market. On the other hand, the way in which the NHS operates was changed irrevocably by the reforms.

Budgets↗
PubMed1998

Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data. The Total Purchasing National Evaluation Team.

OBJECTIVES: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. DESIGN: Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. SETTING: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. MAIN OUTCOME MEASURES: The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. RESULTS: The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. CONCLUSION: The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government.

Budgets↗
PubMed1998

Leadership in the UK NHS: where are we now?

The introduction of changes to the UK National Health Service from the 1980s onwards, coupled with recognition that successful improvement to health and health services places greater pressure on developing good inter-personal and inter-organisational relationships, underlines the need for greater leadership of health services in the future. Argues that insufficient attention has been paid to the development of external leadership, the growing importance of which is emphasised by the most recent proposals for change to health services from the 1997 Labour government. Comparisons of managerial life between the public and private sectors are made and surveys of NHS managerial work, carried out over a number of years, seem to have produced similar conclusions. Finally a paradigm shift is called for in the leadership of health services in the future if the impact of the external environment is to be managed more effectively and no longer to be seen as a constraint on public sector managerial activity.

Administrative Personnel↗