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Biomedical subjects

Peter Griffiths

Publications and source records attributed to Peter Griffiths.

At least 37 records · Page 2Linked to original sources
PubMed2004

An application of the mini review to a complex methodological question: how best to research public health nursing and service quality?

This paper describes a mini review which enabled the identification of a suitable methodology to undertake a study about quality in the public health nursing in the Republic of Ireland. Reviews of literature increasingly adopt the methods of systematic review. In general, these methods have been developed to answer clearly focussed clinical questions. In this paper, we adopt the key elements of systematic review, comprehensive identification of relevant material and selection based on objectively defined validity, to a different type of question, that of an appropriate methodology to examine quality in the public health nursing service. In doing so, we demonstrate that questions of clinical effectiveness are but one application for systematic review.

Bias↗
PubMed2004

Use of strong opioids for non-cancer pain in the community: a case study.

The continued extension of prescribing rights among nurses may necessitate that effective pain management will require more involvement of nurses in the prescription of controlled drugs. The prescription of strong opioid analgesic drugs for chronic non-cancer pain (CNCP) is viewed as controversial. Misconceptions about opioid drugs fuel this controversy. This case study highlights the knowledge gap that exists between pain and addiction medicine and highlights the problems that CNCP patients treated in the community with opioid therapy may encounter. Community nurses are in an ideal position to be instrumental in identifying such vulnerable patients and ensuring that appropriate interventions are available.

Analgesics, Opioid↗
PubMed2004

Statins and secondary prevention of coronary heart disease.

A mini-review (Griffiths, 2002) of double-blind randomized controlled trials (RCTs) was undertaken to assess the long-term effect of lipid lowering treatments (statins versus placebo) in secondary prevention of myocardial infarction (MI). The population sample was adult patients with a history of MI, documented coronary heart disease or coronary artery disease. The Cochrane Library and the database Medline were searched and three RCTs appeared to possess all of the stipulated inclusion and exclusion criteria. The trials all compared statins against a placebo; one trial was of simvastatin--the Scandinavian Simvastatin Survival Study (1994)--and the other two were of pravastatin--the Cholesterol and Recurrent Events Trial (CARE) (Sacks et al, 1996) and Long Term Intervention with Pravastatin Ischaemic Disease (LIPID) (Anon, 1998). The trials demonstrated that statins had a clear and consistent effect in significantly reducing the risk of MI. Overall an approximate decline of 30% in MI was produced from the three trials.

Adult↗
PubMed2004

The effectiveness of pin site care for patients with external fixators.

The aim of this mini-review was to establish if cleaning, dressing and removing crusts from external fixator or skeletal pin sites affected the risk of infection. A systematic search was conducted using Cochrane, Medline, CINAHL and Embase databases. Inclusion criteria were orthopaedic patients with skeletal pins or external fixator devices applied to either upper or lower limbs. The databases were searched for controlled studies comparing at least one aspect of pin site care (cleansing, dressing or crust removal) with a control group of 'observation only'. Only one study met the inclusion criteria. It focused on cleansing external fixator pin sites. The study included two treatment groups, one using 0.9% normal saline and one using 70% alcohol, and a control group which had no cleansing. While the control group had a more favourable outcome than the treatment groups, there is still insufficient evidence from this one study to recommend no cleansing. It is also important to note that the most frequently recommended solution for cleansing pin sites in UK protocols (0.9% normal saline) had the worst outcome, therefore its efficacy in this population may need to be challenged.

Bandages↗
PubMed2004

Acupressure for nausea and vomiting in cancer patients receiving chemotherapy.

Practitioners working with patients undergoing chemotherapy regularly encourage them to use acupressure in the form of Sea Bands for the relief of treatment-related nausea and vomiting. This mini-review sets out to uncover and examine the evidence base for this recommendation. A mini systematic review was carried out to identify randomized controlled trials comparing the use of acupressure plus usual care with usual care alone. The population was adult patients receiving cancer chemotherapy. The outcome was nausea or vomiting duration or intensity. Searches on Medline, Embase, AMED, the Cochrane Library, Cancerlit and Cinahl identified two randomized controlled trials involving 482 patients with compared acupressure to no intervention control. The results suggest that acupressure may decrease nausea among patients undergoing chemotherapy but further work is required before conclusively advising patients on the efficacy of acupressure in preventing and treating chemotherapy-induced nausea.

Acupressure↗
PubMed2003

The M-C-M' cycle and social capital.

Social capital has become a popular term over the past two decades amongst researchers, policy makers and practitioners from varied disciplines. This popularity, however, has resulted in a great deal of confusion over the nature and application of social capital in different contexts. This confusion has made it difficult to identify and measure social capital within the evaluation of specific social and health programmes, one of the aims of which may be to stimulate social capital. This paper identifies a theoretical model that seeks to capture the dynamic nature of social capital to assist in the development of research methods that will facilitate its measurement and exploration within such programmes. The model reported in the paper identifies the key components of social capital and expresses the relationship between those components in a dynamic system based on Marx's description of the process of capital (economic) exchanges expressed in the M-C-M' cycle. The M-C-M' cycle is the transformation of money (M) into commodities (C), and the change of commodities back again into money (M') of altered value. The emphasis within the paper is on the capital element of the concept and its transactional nature with the aim of avoiding the pitfall of attributing social capital in relation to social behaviours in isolation of context and interaction. Importantly, the paper seeks to distinguish the central elements of social capital from some of the antecedent factors and outcomes often attributed to and confused with social capital adding to the problem of providing valid measurement. The model is presented as the basis for the measurement of social capital within a transactional process involving the investment of social resources in a cyclical process, which may result in net gains or losses. This process is described as the R-C-R' cycle following Marx's model of economic capital, with the focus being on the transfer of social resources (R) rather than money (M). R represents an internal resource held by individuals, C the external resource or commodity they obtain from the network and the R' the internal resource of altered value. The possibilities of the model in assisting in the measurement of social capital specifically in assessing formal networks are explored.

Commerce↗
PubMed2003

Impact of clinical nurse specialists in multiple sclerosis--synthesis of the evidence.

BACKGROUND: Multiple sclerosis is a chronic neurological condition demanding a broad range of interventions and support. Multiple sclerosis nurse specialists are emerging as a leading force in providing care to this group of patients. AIM: This review aimed to identify and synthesize the evidence on the role of clinical nurse specialists in meeting the care needs of people with multiple sclerosis. METHODS: A systematic review of the literature addressing the role of the multiple sclerosis nurse specialist was undertaken. The review examined both the appropriateness and effectiveness of the multiple sclerosis nurse specialist role. The content of each item identified in the review was analysed, examining the structure, process and outcomes variables associated with the role. Materials containing an explicit methodology were critically appraised using established schedules and graded as strong, moderate or weak. The data were then synthesized in tables, thematically and using a quasi-judicial approach called the 'System of Reasoning'. FINDINGS: Fifty-five items were examined and most (53%; n = 18) were descriptive in nature. There was insufficient evidence to demonstrate that the multiple sclerosis nurse role makes a difference to care. However, evidence was found to support current descriptions of the role - meaning? and there appeared to be a good fit between the role and the care needs of people with multiple sclerosis. CONCLUSION: A systematic overview of the attributes of the multiple sclerosis nurse role is provided which should help service providers, nurses and other professionals consider how multiple sclerosis nurse specialists roles can contribute to the care of people with this condition. While there is little current evidence of effectiveness for the multiple sclerosis nurse specialist role, there is evidence for its appropriateness, although more rigorous primary research is required to test this.

Humans↗
PubMed2003

A survey of chronic noncancer pain patients prescribed opioid analgesics.

OBJECTIVES: Opioid analgesic drugs are sometimes advocated for chronic noncancer pain (CNCP). However, due to the paucity of studies assessing problematic opioid drug use in this population, evidence for such is inconclusive, and this issue remains controversial. This survey assessed problematic drug use among CNCP patients. PATIENTS/SETTING: Patients (N=104) prescribed opioids (mean duration of treatment 14.1 months) for severe CNCP at a pain clinic within a National Health Service hospital in London, United Kingdom. DESIGN: A review of pain clinic records to identify CNCP patients who had been prescribed opioids and subsequent assessment of those patients for problematic drug use using a substance use questionnaire. RESULTS: A total of 90 (86.5%) patients reported stopping opioid therapy at some point and, of these, 59 (65%) had ceased opioid therapy permanently. Of those patients who stopped opioids, 13 reported opioid withdrawal symptoms, two with severe and two with very severe symptoms. However, 72.5% of all patients derived benefit from opioids, although 77% of all patients reported opioid side effects. The addiction rate was 2.8%. CONCLUSION: These findings indicate that opioid therapy for CNCP does not necessarily lead to problematic drug use. Some problematic side effects are likely to be surmountable through appropriate prescribing. Further research is required into the long-term use of opioids in CNCP.

Adult↗
PubMed2003

Is modified cow's milk formula effective in reducing symptoms of infant colic?

To determine the effectiveness of modified cow's milk formulas on the symptoms of infant colic, a mini-review (Griffiths, 2002) of double-blind randomized controlled trials was undertaken. The population was infants diagnosed with colic and the outcome was a reduction in infant distress. Medline, Embase, CINAHL and the Cochrane Library were searched and seven clinical trials and two systematic reviews were identified. After applying inclusion criteria, two studies were examined in the review. One study compared the effects of a modified formula and a standard cow's milk formula on bottle-fed infants. The other examined the effects of a low-allergen diet on breast-fed and bottle-fed infants. Results could only be retrieved from one study, which showed that hydrolysed formulas have a positive effect on reducing the symptoms of infant colic although sample sizes were small and the magnitude of benefit unclear. There is evidence to support advice to parents of bottle-fed infants with colic to consider changing to such formulas.

Animals↗
PubMed2003

Does the use of pacifiers shorten breastfeeding duration in infants?

Breastfeeding has a number of benefits for both mother and baby, which appear to increase with longer duration of breastfeeding. The use of pacifiers has been negatively associated with shortened breastfeeding duration. The aim of this review was to determine whether the use of pacifiers actually shortens breastfeeding duration in infants. The Cochrane library, Medline, CINAHL and Embase databases were searched for systematic reviews, randomized controlled trials and cohort studies examining the effect of pacifier use on breastfeeding duration. After applying appropriate inclusion criteria only two cohort studies were identified. In one the overall breastfeeding duration was longer in non pacifier-using infants compared to those given pacifiers (10 months vs. 7.5 months). The mean breastfeeding duration in children who were given pacifiers before 6 weeks of age was 168.5 days compared to 196.0 days for children who had a pacifier introduced later or never. However, there is no evidence to suggest any effect from occasional pacifier use, and it remains unclear whether pacifiers are an independent causal factor for reducing breastfeeding duration in infants.

Breast Feeding↗
PubMed2003

The role of cranberry juice in the treatment of urinary tract infections.

There has long been an interest in the use of cranberry, usually as a juice, to prevent and treat urinary tract infections (UTI). This mini-review examined the evidence available using a simple search on an internet-based resource designed to make evidence readily available to practitioners in the South Eastern NHS regions of the UK. The resource, known as KA24, provides access to a range of databases and full text of journal articles. The first stage of the review identified two existing Cochrane Reviews, one examining cranberry as a treatment, the other as prevention. Both concluded that there was insufficient evidence to recommend the use of cranberry in treating UTIs, although some weak research did offer support for cranberry juice in preventing UTIs. A search for further evidence not included in the Cochrane review identified several new reviews and two randomized controlled trials (RCTs) of cranberry as prevention. The reviews were not systematic and came to contradictory conclusions. They were based on a selective reading of the evidence base and gave no criteria for determining the inclusion or validity of studies. One of the RCTs was available for full scrutiny and was appraised as a valid study. Both RCTs found that cranberry (as juice or capsule) significantly reduced the rate of UTI in sexually active women. There is evidence to support the use of cranberry to prevent UTI in some populations but none to support its use as a treatment.

Beverages↗
PubMed2003

Preventing blockage of long-term indwelling catheters in adults: are citric acid solutions effective?

Community health practitioners are frequently faced with the problem of indwelling catheters failing to drain. This mini-review examines the evidence regarding the effectiveness of citric acid-based bladder washout solutions (solution G, solution R), compared with saline for preventing blockage of long-term catheters in older adults. Although there is some evidence on the effect of citric acid solutions in laboratory conditions, the search yielded no evidence measuring catheter patency in humans. Only one randomized controlled trial addressing the use of citric acid solutions with human subjects was found. This provided some confirmation that solution G had immediate effect but gave no evidence of long-term benefit. No difference was apparent on examination of catheter tips. As the evidence is weak, practitioners should consider the use of citric acid maintenance solution as non-routine and only following formal evaluation in a one-off trial on appropriate patients.

Adult↗
PubMed2003

Fluticasone and beclometasone: what are their effects on children's growth?

Fear of growth retardation may account for the underuse of inhaled corticosteroids in children with asthma, despite compelling evidence of their effectiveness. This fear may be reduced with newer agents with lower oral bioavailability if their theoretical advantage of fewer systemic adverse effects than the standard treatment of inhaled beclometasone is realized in practice. This review aims to determine if one of the newer agents, inhaled fluticasone, has less effect on the growth of pre-pubertal asthmatic children than inhaled beclometasone. The outcome measure was growth velocity. Two double blind, randomized controlled trials were identified. In one of the studies the mean growth velocity in the fluticasone group was 0.7 cm/year greater than in the beclometasone group. In the second, smaller study the mean growth velocity in the fluticasone group was 0.8 cm/year greater. There is therefore some evidence that fluticasone has less (if any) adverse effect on growth.

Androstadienes↗
PubMed2003

What type of eye drops should be given to a toddler with conjunctivitis?

This mini-review describes a parent's search for evidence on the relative merits of two commonly used treatments for conjunctivitis. It was conducted in a very limited period of time with access to free databases (Pub Med, Cochrane Library) and only the abstracts of papers. Five relevant studies were identified that compared fusidic acid eye drops to chloramphenicol. Three of the five studies reported no difference in effectiveness between the two preparations with both drugs performing equally well. Two studies undertaken in less-developed countries showed fusidic acid to be far more effective but the cure rate with chloramphenicol was low, suggesting resistance or different causal agents. However, there was some evidence that chloramphenicol was less well tolerated and so fusidic acid may be the drug of choice. The review illustrates that evidence for practice can be found rapidly with access to limited facilities by an appropriately skilled practitioner.

Administration, Topical↗
PubMed2002

A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients.

Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concluded that fears of problematic drug use are often unfounded. In contrast, others claim the existence of significant problems.'Problematic drug use' includes the following definitions; addiction, abuse, physiological dependence and tolerance.We present a case study and the results of a pilot, longitudinal, cohort study, via a pilot questionnaire, of 22 chronic pain clinic patients following a trial of opioid drugs. The results suggest that chronic non-cancer pain patients can be maintained on opioids with few problems, and likewise can withdraw with minimal adverse effects, other than a return of pain.

Adult↗
PubMed2002

The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial.

BACKGROUND: Because of the widely presumed association between heart disease and psychological wellbeing, the use of so-called 'complementary' therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbe ing, which could be practicably delivered by nurses to patients in the postoperative recovery period following coronary artery bypass graft (CABG) surgery. Aim. To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery. METHOD: Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered. RESULTS: No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA, P=0.014). Dunnett's multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (nonsignificant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects. CONCLUSIONS: These interventions appear to be effective, noninvasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated.

Adult↗