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Biomedical subjects

Paul Harper

Publications and source records attributed to Paul Harper.

9 recordsLinked to original sources
PubMed2005

Combining data mining tools with health care models for improved understanding of health processes and resource utilisation.

Variability and uncertainty are inherent characteristics of most health care processes. Patient pathways and dwelling times even within the same process typically vary from patient to patient, such as the flow of patients through a particular health care provider or patient progression through the natural history of a given disease. The challenge for the OR modeller is to adequately handle and capture the stochastic features within developed models. This paper will discuss the benefits of combining patient classification tools (data mining techniques) with developed OR models, such as simulation tools, to more accurately capture patient outcomes, risks and resource needs. Illustrative applications will demonstrate the approach.

Decision Support Systems, Management↗
PubMed2004

Moving on from 'patient dependency' and 'nursing workload' to managing risk in critical care.

The contribution nurses make to the management of critically ill patients is usually appraised through the use of concepts such as 'patient dependency' or 'nursing workload'. These concepts fail to address the knowledge, skills and experience of nurses and consequently fail to acknowledge the risk presented by critically ill patients. This paper describes the development of a tool that attempts to measure risk and the process of risk management undertaken by nurses who coordinate the shifts and lead the nursing team. The results of this pilot study indicated that the tool was valid, but reliability has not yet been demonstrated. Thus the tool requires further refinement and testing. We chose to publish at this time because we feel the paper offers a new way of examining the contribution of nurses working in critical care.

Activities of Daily Living↗
PubMed2004

Mutations within the protein Z-dependent protease inhibitor gene are associated with venous thromboembolic disease: a new form of thrombophilia.

Protein Z-dependent protease inhibitor (ZPI) is a serpin that inhibits the activated coagulation factors X and XI. The precise physiological significance of ZPI in the control of haemostasis is unknown although a deficiency of ZPI may be predicted to alter this balance. The coding region of the ZPI gene was screened for mutations using denaturing high-performance liquid chromatography. 16 mutations/polymorphisms within the coding region of ZPI were identified including two mutations, which generated stop codons at residues R67 and W303. We observed nonsense mutations within the ZPI gene in 4.4% of thrombosis patients (n = 250) compared with 0.8% of controls (n = 250). The difference in distribution of stop codon mutations between thrombosis patients and controls was significant (P = 0.02) with an odds ratio of 5.7 (95% confidence interval, 1.25-26.0). Our results suggest an association between ZPI deficiency and venous thrombosis and we propose that ZPI deficiency is potentially a new form of thrombophilia.

Adult↗
PubMed2004

Long-term planning to meet UK government coronary heart disease revascularization targets.

The National Service Framework (NSF) for Coronary Heart Disease, published in the UK in 2000, gave target intervention rates of 750 procedures per million population (pmp) for both percutaneous transluminal angioplasty (PTCA) and coronary artery bypass graft (CABG). This paper describes how one Regional Office of the Department of Health, with CABG and PTCA rates of around half the NSF target levels, designed a strategy to plan rationally to meet the derived population need for these procedures. A bottom-up needs assessment model was used to predict the population need for these procedures for the Eastern Region of the UK. The Excel-based model took account of the effects of demographic change, anticipated reduction in incidence of heart disease due to primary prevention programmes and the expected improvement in cardiology and cardiac surgery technologies. The model predicted that excess procedures would be required across the region over the next 20 years. Further access study modelling was used to determine the best location for additional tertiary cardiac centres. Further, a commissioning tool was produced that could compare the predicted need, including additional procedures needed to meet waiting list targets, with capacity available from a range of providers. These tools have been used successfully in the Eastern Region to increase the regional revascularization rates from 371 pmp CABG and 322 pmp PTCA in 2000 to planned rates of 453 pmp CABG and 447 pmp PTCA in 2002/2003, to recommend the building of a new tertiary cardiac centre in Essex in the next decade and to inform the commissioning of revascularization rates in three coronary heart disease networks.

Angioplasty, Balloon↗
PubMed2003

The challenge arising from the cost of haemophilia care: an audit of haemophilia treatment at Auckland Hospital.

AIMS: To compare treatment patterns in adults and children with haemophilia and to estimate the financial impact of the changing practice of haemophilia care. METHODS: A retrospective audit of replacement coagulation factor usage in all patients with haemophilia treated at the Auckland Haemophilia Centre during 2001. RESULTS: A total of 69 males with haemophilia were included in the audit. Twelve children under 16 years old (nine on recombinant products) and six adults (all on plasma products) received prophylactic treatment. The remaining patients used treatment on demand. The cohort included eight patients with factor VIII inhibitors. The estimated cost of replacement products used was around 3 million dollars for the 23 children and 2.2 dollars million for the 46 adults. CONCLUSIONS: Children with severe haemophilia are predominantly treated with recombinant products on regular prophylaxis, whereas adults are largely treated on demand with plasma-derived products. This is in line with international practice as regular prophylaxis has been shown to improve the quality of life for people with haemophilia and in the long term is cost effective. The problem in the short term is that prophylaxis is significantly more expensive than on-demand treatment. We estimate that the cost of replacement product will increase by at least 5% per annum as the children with haemophilia grow.

Adult↗
PubMed2002

'Slide whistle' breath sounds: acoustical correlates of variable tracheal obstruction.

We report a case of a man who developed severe shortness of breath and the finding of breath sounds that rose in frequency during inspiration and fell during expiration. These unusual sounds were caused by a spherical tumour arising from the main carina that nearly completely obstructed the distal trachea. The frequency variation disappeared after the removal of the mass. We evaluated this phenomenon using a modelling technique that we had previously developed to analyse the human airways as acoustical tubes. This analysis revealed that the acoustical conditions in the trachea were substantially modified by the presence of the solid mass as the trachea slightly dilated during inspiration, partially relieving the obstruction. Most of the anomalous characteristics of the breath sounds could be explained using this model. We conclude that a detailed understanding of the acoustic conditions of the airways allows correlation with anatomical and physiological conditions and may be of use in diagnosis or evaluation of the airways in health and disease.

Acoustics↗