PubMed Health⌕ Search

Biomedical subjects

N Graves

Publications and source records attributed to N Graves.

15 recordsLinked to original sources
PubMed2001

The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed.

Between April 1994 and May 1995 4000 adult patients admitted to selected specialties of a district general hospital were recruited to this study. Hospital-acquired infections presenting during the in-patient stay were identified using previously validated methods of surveillance, and information on daily resource use by both infected and uninfected patients was recorded and estimates of their cost derived. Linear regression modelling techniques were used to estimate how much of the observed variation in resource use and costs could be explained by the presence of an infection. Complete in-patient data sets were obtained for 3980 patients. Of these, 309 patients (7.8%; 95% CI; 7.0, 8.6) presented with one or more hospital-acquired infections during the in-patient period. Infected patients, on average, incurred hospital costs 2.9 (regression model estimate: 2.8; 95% CI; 2.6, 3.0) times higher than uninfected patients, equivalent to an additional pound3154 (regression model estimate pound2917). Both the incidence and the economic impact varied with site of infection and with admission specialty. Estimates of the burden of hospital-acquired infections occurring in adult patients admitted to similar specialties at NHS hospitals in England were derived from the results of this study. An estimated 320 994 (95% CI; 288 071, 353 916) patients per annum acquire one or more infections which present during the in-patient period, and these infections cost the hospital sector an estimated 930.62 million pounds (95% CI; 780.26 pounds; 1080.97 million pounds) per annum. The results presented represent the gross economic benefits that might accrue if these infections are prevented. Further research is required to establish the net benefits of prevention.

Adolescent↗
PubMed2001

An economic model to assess the cost and benefits of the routine use of silver alloy coated urinary catheters to reduce the risk of urinary tract infections in catheterized patients.

Prevalence studies generally find nosocomial urinary tract infections to be the most common type of nosocomial infection, accounting for between 21% and 45% of all HAIs. The main risk factor appears to be the presence of a urinary catheter, with an estimated 80% of these infections being associated with their use. This paper describes a model which quantifies the extent of the burden of these infections in terms of the number of patients affected and the costs incurred by the hospital sector; and identifies the potential benefits of the routine use of silver alloy coated catheters, as a means of reducing the incidence of this type of infection. An illustrative model of the annual costs and benefits associated with the routine use of this intervention in adult, non-day case patients admitted to the medical and surgical specialties of NHS hospitals throughout England is presented. The results suggest that a 14.6% reduction in the incidence of urinary tract infections in catheterized medical patients, and a 11.4% reduction in catheterized surgical patients, would cover the cost of the intervention. Any further reduction in incidence would result in net positive benefits.

Adult↗
PubMed2000

Factors associated with antiepileptic drug use among elderly nursing home residents.

UNLABELLED: BACKGROUND. Epilepsy, a chronic condition defined as two or more recurrent, unprovoked seizures, has the highest incidence at the end of life. Antiepileptic drugs (AEDs) are the primary therapeutic mode. Approximately 10%-11% of elderly nursing home residents receive one or more AEDs, a higher prevalence than would be expected in this age group. In the research literature, there is not a clear explanation of variations in AED use in nursing homes. The purpose of this study was to examine the prevalence and variations in use of AEDs by resident characteristics, AEDs used, drug dosage, and AED combinations in treatment regimens. METHODS: This was a retrospective, cross-sectional study of residents (N = 21,551) in a convenience sample of nursing homes in 24 states and the District of Columbia. The unit of analysis was the individual resident. The study period was a single day in 1995. Bivariate and multivariate analyses were used to test differences. RESULTS: The prevalence of AED use was 10.5% across all elderly residents. In a multivariate analysis, factors associated with AED treatment included seizure indication, age group, and geographic region. AED use by age group showed declining use as the residents aged, from 65-74 to 75-84 to > or =85 years. CONCLUSIONS: The inverse relationship between AED use and age group was unexpected because the incidence of epilepsy increases with advancing age. This finding raises important questions about the future use of these drugs in elderly nursing home residents.

Aged↗
PubMed1999

The costs of treating rheumatoid arthritis patients with complementary medicine: exploring the issue.

OBJECTIVES: To measure the marginal costs of providing complementary medicine services (mostly homoeopathy) in outpatient clinics for patients with rheumatoid arthritis (RA) and to illustrate how parameters to which the cost of complementary medicine may be sensitive can be identified. DESIGN: Retrospective, observational costing study. SETTING: The outpatient clinic of the Royal London Homoeopathic Hospital. SUBJECTS: Random sample of 89 patients from the 427 (RA) patients attending outpatient clinics from April 1995 to March 1996. MAIN OUTCOME MEASURES: The marginal costs incurred by the hospital of treating 89 patients attending outpatient clinics and the relative contribution of the different resources to the total costs. RESULTS: The total costs of treating 89 patients were 7,124 Pounds of which 543 Pounds was assumed to be fixed and the remainder variable. The marginal costs of treating additional patients, starting from zero patients treated, are presented. Consultation time (doctors and dietician) contributed to 29% of the total costs, non-conventional drugs contributed to 22% of the total costs. CONCLUSIONS: Understanding the marginal costs of providing complementary care to RA patients will inform the debate over whether these therapies are likely to be cost-effective. In addition, those who would like to explore the practicalities of establishing a service involving complementary medicine will gain an understanding of the likely provider costs. The cost of complementary medicine appears to be most sensitive to the time spent with the patient by the doctor.

Arthritis, Rheumatoid↗
PubMed1998

Pharmacoeconomic considerations in treatment options for acute seizures.

Two pharmacoeconomic studies on the treatment of acute seizures have been conducted. In 1991, Kriel and colleagues surveyed parents of children with a history of cluster seizures, prolonged seizures, or status epilepticus who had been instructed in the use of rectal diazepam. A comparison of data before instruction with data after instruction showed a reduced need for emergency department visits with rectal diazepam. Instruction thus provided a pharmacoeconomic benefit, despite the cost of the product. In 1996, Marchetti and coworkers found that intravenous fosphenytoin was associated with fewer adverse events than intravenous phenytoin. Fosphenytoin thus reduced the need for adverse event management and provided a substantial pharmacoeconomic benefit, despite its higher cost, compared with phenytoin. This study had a number of limitations, however, and hospital pharmacists remain resistant to the use of fosphenytoin. Additional studies may provide more pharmacoeconomic data to support the greater use of fosphenytoin in the treatment of acute pediatric seizures.

Anticonvulsants↗
PubMed1997

Spreading costs.

Explore the source record for details and available documents.

Cross Infection↗
PubMed1993

New antiepileptic medications.

Several new compounds are undergoing extensive investigation in the United States and Europe. The available animal and human studies suggest that these new antiepileptic drugs are very promising. Some or all of them will be approved for clinical use during the next decade. New antiepileptic drugs offer new options in the treatment of epilepsy. Although there already has been considerable testing of these drugs, additional studies that incorporate traditional medical outcome measures and quality of life measures remain to be done to establish the ultimate role of the new antiepileptic drugs in the treatment hierarchy for epilepsy.

Animals↗
PubMed1987

A controlled study of progabide in partial seizures: methodology and results.

The results of a multicenter, double-blind, placebo-controlled clinical trial of the efficacy and safety of progabide (PGB) in the treatment of partial seizures are presented. This study was performed with a number of rigorous controls not usually present in clinical trials. These included uniform co-medication in which all patients received only phenytoin and carbamazepine; concentrations of these two drugs were maintained within narrow, predefined concentration ranges. There was no statistically significant difference between PGB and placebo in seizure frequency and seizure duration for most of the analyses performed. One patient was withdrawn from the study because of hepatotoxicity. PGB was associated with a significant inhibition of phenytoin but not carbamazepine clearance. The results of this study indicate that PGB was not a potent antiepileptic drug in this population of persons with intractable epilepsy.

Adolescent↗
PubMed1986

Renal cell carcinoma and angiomyolipoma in tuberous sclerosis: case report.

We report a case of renal failure in a solitary kidney with manifestation of tuberous sclerosis, synchronous renal cell carcinoma and angiolipomatosis. A review of the literature disclosed the rare coexistence of these 2 tumors in tuberous sclerosis and the diagnostic difficulties in distinguishing these neoplasms.

Adult↗
PubMed1984

Evolution to eosinophilic leukemia with a t(5:11) translocation in a patient with idiopathic hypereosinophilic syndrome.

The idiopathic hypereosinophilic syndrome (HES) comprises a diverse group of diseases that may ultimately lead to multiorgan dysfunction and death. We present a case of a man who was followed for over 9 years with HES that underwent malignant transformation to acute leukemia with eosinophilic features. The patient's clinical acceleration was accompanied by the development of a malignant clone that was identified with banding techniques as 46,XY,t(5:11)(p15;q13). Electron microscopy reaffirmed findings reported in earlier cases of eosinophilic leukemia. At no time during his illness were cytotoxic drugs administered. In addition to delineating the natural evolution and cytostructural details of the case, we emphasize the role of cytogenetics in the predicting of malignant variants of the hypereosinophilic syndrome and in identifying eosinophilic leukemia.

Aged↗