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Biomedical subjects

P R Ward

Publications and source records attributed to P R Ward.

At least 19 recordsLinked to original sources
PubMed2004

Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England.

STUDY OBJECTIVE: To analyse the associations between proxies of healthcare need and GP practice prescribing rates for five major coronary heart disease (CHD) drug groups. DESIGN: Cross sectional secondary analysis. SETTING: Four primary care trusts (PCTs 1-4) in the north west of England, encompassing 132 GP practices. RESULTS: Prescribing rates were generally positively associated with the percentage of patients aged 55-74 years and PASS-PUs (regionally specific prevalence, age, and sex standardised prescribing units). However, the percentage of patients aged over 75 years showed a lack of association with prescribing rates in all PCTs other than PCT2. Correlations with the proportion of South Asian patients were generally negative, particularly in PCT2, PCT4, and the combined dataset. There was a general lack of association with deprivation proxies and SMRs for CHD, although there were negative associations with both variables in PCT4 and the combined dataset. Scatter plots showed that GP practices with similar prescribing rates had widely differing levels of comparative healthcare need, and GP practices with similar levels of healthcare need had widely differing prescribing rates. CONCLUSION: GP prescribing rates in some PCTs were negatively associated with proxies of healthcare need based on patient age (patients aged over 75 years), ethnicity, levels of deprivation, and SMRs for CHD. As such, this study suggests that prescribing rates in these PCTs may be inequitable as they are not positively associated with healthcare need. This study may form the baseline for further studies to assess the effectiveness of the NSF for CHD in reducing the inequities in prescribing rates.

Age Factors↗
PubMed2003

Developing prevalence-based prescribing units for analysing variations in general practitioner prescribing: a case study using statins.

OBJECTIVE: To develop regionally specific prevalence-, age- and sex-standardized prescribing units (PASS-PUs) and to relate these to statin prescribing. DESIGN: Cross-sectional. SETTING: Ninety-four general practitioner (GP) practices within one health authority in the north-west of England. MAIN OUTCOME MEASURES: Comparisons between specific therapeutic group age-sex-related prescribing units (STAR-PUs) and PASS-PUs for statin prescribing. RESULTS: STAR-PUs and PASS-PUs were calculated for all GP practices and there was a high degree of correlation (Spearman's rank coefficient 0.88; P < 0.001). Using actual prescribing data for statins for a 12-month period, a statistically significant correlation was found between net ingredient cost per patient and STAR-PUs per patient (Spearman's rank coefficient 0.36; P < 0.01). However, the correlation between average daily quantities per patient and PASS-PUs per patient was not statistically significant. A scatter plot revealed a pattern whereby GP practices with high proportions of patients aged over 75 years exhibited low statin prescribing in relation to the expected prevalence of treated coronary heart disease (CHD) in their patient population. CONCLUSIONS: Low weightings for patients aged over 75 years in calculating STAR-PUs lead to a much lower number of prescribing units within GP practice populations when compared with PASS-PUs. Current statin prescribing across GP practices in this study correlates with national prescribing cost patterns (as measured by STAR-PUs) although not with expected prevalence of treated CHD (as measured by PASS-PUs). PASS-PUs reflect prevalence of treated CHD and may therefore be used to monitor and predict GP prescribing arising from the implementation of the National Service Framework targets for CHD. In addition, PASS-PUs maybe derived for a wide range of therapeutic areas.

Adolescent↗
PubMed2000

Appropriateness measurement: application to advice-giving in community pharmacies.

Awareness of variations in the delivery of medical care has resulted in considerable research activity focused on developing measures to assess the appropriateness of health service provision both internationally and within Great Britain. As in other areas of health service provision there is evidence of variation in advice provided alongside sales of non-prescription medicines and variation in response to requests for advice about the treatment of minor ailments within community pharmacies in Great Britain. However, there is little research which has explored the extensive methodological problems associated with developing criteria to assess the appropriateness of these-two activities. Following a critical review of relevant existing research, this paper describes a methodology and empirical findings from a study which aimed to develop criteria to measure the appropriateness of advice provided in community pharmacies. Firstly, details of advice-giving episodes occurring between consumers and pharmacists or medicines counter assistants were captured and documented using a combination of audio tape-recording and non-participant observation. Secondly, the nominal group technique was used to develop a set of explicit criteria for assessing the appropriateness of advice. Thirdly, an assessment instrument was developed in order to operationalise the criteria. The devised criteria include both process and output components. We discuss the utility of these criteria in relation to developments in self-medication practice affecting community pharmacy and the deregulation of medicines within the UK. The criteria have been subject to rigorous statistical testing to establish standards of validity and reliability (Ward, Bissell & Noyce, 2000a [Ward, P. R., Bissell, P. & Noyce, P. R. (2000a). Criteria for assessing non-prescription drug therapy in community pharmacy, Annals of Pharmacotherapy (in press).]). The developed criteria will allow us to identify dimensions of both appropriate and inappropriate advice provided in community pharmacies and provide the basis for education and training initiatives identified as a result of the research. In addition, we suggest that this research is highly relevant to informing the content, structure and operationalisation of protocols and/or guidelines associated with the management of minor ailments and the sale of medicines through community pharmacies.

Community Pharmacy Services↗
PubMed2000

Criteria for assessing the appropriateness of patient counseling in community pharmacies.

OBJECTIVE: To develop valid, reliable criteria for assessing the appropriateness of the management of common ailments and nonprescription drug therapy in community pharmacies in the UK. METHODS: The criteria were developed by an expert panel using the nominal group technique. The validity of the criteria was tested by surveying a random sample of pharmacists who were asked to rate the importance of each criterion on a semantic differential scale from 1 (low) to 7 (high). Subsequently, the reliability of the criteria was assessed: a random sample of pharmacists were each asked to apply the criteria to four vignettes of patient counseling on two separate occasions. RESULTS: All assessment criteria exceeded our predefined level of face, content, and consensual validity. In reliability testing, the overall assessment of appropriateness, along with five component assessment criteria, surpassed our predefined level of reliability. Three criteria, however, did not meet our predefined standard. These criteria were rational content of advice, rational product choice, and referral to another health professional. CONCLUSIONS: This represents the first systematic attempt to develop an instrument of general applicability for assessing the appropriateness of patient counseling and to subject it to rigorous validity and reliability testing. We suggest that further work is required to refine the criteria that did not meet reliability standards and to understand the decision-making processes underlying the assessment of vignettes of patient counseling.

Communication↗
PubMed2000

Identification of benzodiazepine binding site residues in the gamma2 subunit of the gamma-aminobutyric acid(A) receptor.

gamma-Aminobutyric acid(A) receptor gamma-subunits are important for benzodiazepine (BZD) binding and modulation of the gamma-aminobutyric acid-mediated Cl(-) current. Previously, by using gamma2/alpha1 chimeric subunits, we identified two domains of the gamma2-subunit, Lys-41-Trp-82 and Arg-114-Asp-161, that are, in conjunction, necessary and sufficient for high-affinity BZD binding. In this study, we generated additional gamma2/alpha1 chimeric subunits and gamma2 point mutants to identify specific residues within the gamma2 Lys-41-Trp-82 region that contribute to BZD binding. Mutant gamma2 and gamma2/alpha1 chimeric subunits were expressed with wild-type alpha1 and beta2 subunits in HEK 293 cells, and the binding of several BZDs was measured. We present evidence that the gamma2 region Met-57-Ile-62 is important for flunitrazepam binding and that, in particular, gamma2 Met-57 and gamma2 Tyr-58 are essential determinants for conferring high-affinity binding. Furthermore, we identify an additional residue, gamma2 Ala-79, that not only is important for high-affinity binding by flunitrazepam (a strong positive modulator) but also plays a crucial role in the binding of the imidazobenzodiazepines Ro15-1788 (a zero modulator) and Ro15-4513 (a weak negative modulator) in the BZD binding pocket. Results from site-directed mutagenesis of gamma2 Ala-79 suggest that this residue may be part of a microdomain within the BZD binding site that is important for binding imidazobenzodiazepines. This separation of drug-specific microdomains for competitive BZD ligands lends insight into the structural determinants governing the divergent effects of these compounds.

Amino Acid Sequence↗
PubMed1997

Health care rationing: can we afford to ignore euthanasia?

Explicit rationing decisions are being made to encompass a wide range of health care issues. Voluntary euthanasia has largely been excluded from this debate due to, in my view, the emotive nature of the issue. Euthanasia is an issue in which economists have been largely excluded and in which ethicists and philosophers dominate. It is the purpose of this paper to review the economic and ethical literature on euthanasia and to discuss their compatibility within the debate on euthanasia. The potential cost savings by the use of advance directives, do-not-resuscitate orders, and futile care withdrawal are then reviewed, as are the potential cost savings created by hospice care. As a conclusion, the ethical and economic arguments are then balanced to assess their compatibility. It is the contention of this paper that reducing medical care costs near the end of life should not be a taboo subject, and that rationing decisions could focus on an exploration of this area and the approaches to it, which are ethically justifiable and economically worthwhile. The introduction of a policy of voluntary euthanasia could have a large impact on the rationing of health care resources whilst also promoting patient choice and an arena for a more dignified death.

Advance Directives↗
PubMed1985

The results of coronary arteriography in young men after myocardial infarction in north-east Scotland.

The case records of 50 consecutive male patients aged 40 years or under who were investigated by selective coronary arteriography after myocardial infarction were reviewed. Fourteen patients had normal coronary vessels and 36 patients had significant occlusive disease. Eighteen were considered to be in need of surgical treatment. The features of myocardial infarction on the ECG were less marked in the group of patients with normal coronary arteriograms. Many of these patients were asymptomatic and had complete resolution of the ECG changes. As well as having normal coronary arteries, many also had normal left ventricular angiograms. Cigarette smoking was very common in the whole group, 86 per cent of patients being moderately heavy cigarette smokers. Five of the 14 patients in the 'non-occlusive' group were non-smokers and only two of the 36 patients in the 'occlusive' group were non-smokers (P less than 0.01). The fasting serum cholesterol was significantly lower in the 'non-occlusive' group than in the 'occlusive' group. There was no significant difference between the two groups regarding blood pressure, family history of ischaemic heart disease, obesity or alcohol consumption. There was, however, a high incidence of heavy alcohol consumption amongst patients who subsequently required coronary artery surgery. Many of the patients in the 'non-occlusive' group were considered to have had smaller, more localised myocardial infarctions and a lesser degree of coronary disease which may not be detected by coronary arteriography. Others, with more widespread cardiac damage, could be explained on the basis of thrombosis and subsequent recanalisation.

Adult↗
PubMed1981

Effectiveness of aftercare for older people prescribed a hearing aid for the first time.

The evidence of the effects of various aspects of the organisation of hearing aid services are reviewed. It is concluded that evidence is becoming available of the importance of the range of aids in determining level of use achieved by patients. However little is known about the effects of aftercare. Two different forms of aftercare service are compared, one of which provided a routine visit at two weeks to a sample of first-time hearing aid users and the other of which provided help only to those who sought it by returning to the hospital. The patients who had the former service showed significantly higher levels of use of their hearing aids compared with the latter group. This data also confirmed that the new National Health Service (NHS) BE10 series aids are used substantially more than was the body worn OL56 and irrespective of aftercare. Implications for the organisation of services are that a first essential is an acceptable range of hearing aids. Secondly, it is essential that the fitting, care and use of the aids are effectively taught. Finally the organisation of aftercare should be such that the patients' performance is monitored against specific criteria in an on-going fashion using senior staff economically to deal with the most difficult patients.

Aged↗
PubMed1980

Treatment of elderly adults with impaired hearing: resources, outcome, and efficiency.

The general relationship between treatment and response is illustrated with reference to the response of elderly people to rehabilitation treatment after a hearing aid has been prescribed. The evidence of the effects of treatment is reviewed and a tentative empirical relationship is proposed between treatment input (therapist time) and effect (hours of use of the hearing aids). This illustrates a rapid improvement in the effect of treatment for up to about one hour of therapist time but very little improvement with increasing input thereafter. The resource implications are discussed and it is concluded that an input of an average of one hour of follow-up would be a very worthwhile investment and should be a priority for expenditure by health authorities.

Aged↗
PubMed1980

Fitting hearing aids: the effects of method of instruction.

An experiment was conducted to examine the effect of teaching method, age and sex on older people's ability to fit their hearing aids. Four methods of teaching were examined, three of which used visual material developed in conjunction with the Exeter College of Art. As a result of the experiment self-instruction is the method recommended for use at Hearing Aid Centres as it reduces instructor time, leads to greater success and naturally differentiates those who are having substantial difficulty from those who manage. It can both save technician time and reveal those on whom they need to concentrate their effort. In this way it is evidently the most efficient.

Age Factors↗
PubMed1979

Problems with handling the BE10 series hearing aids among elderly people.

Seven items of activity related to patients' ability to handle behind-the-ear hearing aids (BE11/12) were investigated to establish the effects of age, sex and functional disability. One hundred and thirty-six patients were examined; all were first-time users of hearing aids. Over two-fifths of the sample had problems with manipulating the volume control and over a third had difficulty with inserting the earmould and changing the battery. For both men and women, the difficulties with the volume control and earmould were significantly associated with functional disability. Difficulties with these tasks were also significantly related to age and sex. Patients aged 75 years of age or more had greater difficulties than those who were younger and women had more difficulty than men.

Age Factors↗
PubMed1978

Evaluation of follow-up services for elderly people prescribed hearing aids: report of a pilot project.

The first stage of a programme to determine the effectiveness of different types of follow-up service for elderly people prescribed hearing aids is described. Follow-up sessions of two hours each were held at fortnightly intervals and were given to groups comprising six patients. Three treatments were compared, one consisting of two follow-up sessions, the second of four sessions, and the third none (the control group). Two groups received each treatment. The results failed to demonstrate any advantage from the treatments. The men, who were more handicapped by their hearing loss, did better than women and there was a predominance of men in the control groups. The necessity of some follow-up service was demonstrated since a substantial proportion of patients were not utilising their aids satisfactorily at six months after issue and had problems which were then resolved. Any follow-up programme must concentrate very heavily on basic handling and maintenance of the aid, for most of the difficulties experienced were with these.

Aftercare↗
PubMed1977

Self-assessment of hearing impairment: test of the expanded hearing ability scale questionnaire on hearing impaired adults in England.

The National Center for Health Statistics developed a questionnaire for self-assessment of hearing impairment which has been widely tested in the United States. The performance of this questionnaire was tested on a sample of 131 people in England, known to have hearing impairment and gave results very similar to those obtained in the United States. These results are compared with a randomly selected sample from the general population. Characteristics of the hearing ability scale derived from the questionnaire are discussed and some suggestions made for a modified version of the questionnaire. The relationship between the average pure tone threshold and the score derived from the hearing ability scale questionnaire is described and takes the form of a bounded relationship with scale score indicating the minimum threshold level.

Adolescent↗
PubMed1976

Hydroxyapatite - a reagent for the separation of free and antibody-bound steroid during the radioimmunoassay.

The use of hydroxyapatite to absorb antibody-bound steroid and thus separate free and antibody-bound steroid during radioimmunoassay has been examined using three steroid antisera (to testosterone, to 17-hydroxyprogesterone and to estradiol-17beta). For all three antisera studied the separation was shown to be independent of length of time in contact with hydroxyapatite (up to 1h); temperature variations from 4 degrees -37 degrees and pH over the range 4.9-8.0. The presence of protein affected the absorption of antibody-bound steroid but this effect could be overcome by the addition of increasing amounts of hydroxyapatite. Further increase in the amount of hydroxyapatite added had no effect on the separation of free and bound steroid. Sodium phosphate buffers of molarity greater than 0.01M eluted antibody-bount steroid from hydroxyapatite, but Tris-HC1 buffers up to molarities of 0.1 M had no effect. Hydroxyapatite when used as a dry powder had the same effects as suspensions. No effect on the cross-reactivities of the antisera used could be demonstrated when hydroxyapatite was used and plasma testosterone assays on 22 plasma samples using hydroxyapatite gave essentially the same results as assays on the plasma using a coated-tube assay. Hydroxyapatite can also be successfully pumped along small bore plastic tubing without settling and can thus be used in automated immunoassay systems.

Estradiol↗