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Biomedical subjects

Peter Griffiths

Publications and source records attributed to Peter Griffiths.

46 records · Page 3Linked to original sources
PubMed2002

Nursing-led in-patient units for intermediate care: a survey of multidisciplinary discharge planning practice.

The effectiveness of post-acute intermediate care in nursing-led intermediate care in-patient units (NLIU) has been studied over the past 20 years. Accounts, both positive and negative, have tended to view it as a uni-disciplinary intervention. The previous studies are in effect a series of single case studies and as such need to be accompanied by richer descriptions of care processes in order to be useful. A survey was conducted, in parallel with a randomized-controlled trial (n=177), to compare multidisciplinary care and discharge planning practice on the NLIU with 16 wards that referred patients to it. The findings identify that a wide range of professions participate in care on the NLIU with physiotherapists and occupational therapists most widely involved. In general the team composition and care processes differed little between the NLIU and control wards. There was some evidence that there was lower participation in care on the NLIU from occupational therapy and social work. It is concluded that the NLIU is a complex multidisciplinary intervention. Positive results from some NLIUs may only be generalizable to settings with similar skill mix across the multidisciplinary team as that found in the acute hospital. Reduced skill mix may be a causal factor leading to extended stays and increased total care costs. This caution should be extended to other models of intermediate care, whether or not they are nursing-led.

Humans↗
PubMed2002

Methodological strategies for the identification and synthesis of 'evidence' to support decision-making in relation to complex healthcare systems and practices.

This paper addresses the limitations of current methods supporting 'evidence-based health-care' in relation to complex aspects of care, including those questions that are best supported by descriptive or non-empirical evidence. The paper identifies some new methods, which may be useful in aiding the synthesis of data in these areas. The methods detailed are broadly divided into those that facilitate the identification of evidence and those that enable the interpretation of the data retrieved. To illustrate some of the issues involved, reference is made to a multimethod review recently completed by the authors, which aimed to identify factors that promote continuity in the transition from child to adult health and social care. It is argued that as healthcare organisations are becoming increasingly preoccupied with the evidence base of practice, such methods may help ensure that aspects of care and approaches that are outside the dominant pharmaco-medical domain maintain a prominent position on the healthcare agenda while remaining open to external scrutiny. Healthcare professionals who use such approaches need to know their relative utility and benefits to inform clinical decisions, so as to ensure that best practice is observed.

Adolescent↗
PubMed2002

Self-monitoring of glucose levels for people with type 2 diabetes.

To determine the most effective way of monitoring glucose levels as an indicator of glycaemic control in people with type 2 diabetes in the community, we conducted a criteria-based review of randomized controlled trials and systematic reviews of randomized controlled trials that studied the efficacy of various glucose monitoring strategies. We searched the Cochrane Library, Medline, Embase, CINAHL and BNIPlus databases for relevant studies. The journals 'Diabetes', 'Diabetic Medicine', 'Diabetologica', 'Evidence-Based Medicine' and 'Evidence-Based Nursing' were hand searched. The outcome of interest was glycaemic control, as measured by glycated haemoglobin (HbA(1c)). A total of 642 titles were identified from the search; three studies answered the question criteria and only one study met all the quality criteria. The study that met the criteria was a systematic review of four trials measuring the efficacy of self-monitoring of glucose levels. The reduction in HbA(1c) in those who monitored glucose levels was estimated to be -0.25% (95% Cl -0.61 - +0.10). This result shows a small improvement, but it is not statistically significant. A meta-analysis was also performed on three studies (n=278) comparing HbA(1c) in subjects who performed blood glucose monitoring with those who performed urine monitoring. The reduction in HbA(1c) when monitoring blood glucose rather than urine glucose was -0.03% (95% Cl -0.52 - +0.47). This result is not statistically significant. The efficacy of blood and urine glucose monitoring testing, for people with type 2 diabetes, in improving glycaemic control as measured by HbA(1c) levels is still questionable. A rigorous randomized controlled trial is needed to establish these answers although there is no evidence of harm. Clinical protocols that make recommendations for glucose monitoring strategies for people with type 2 diabetes should acknowledge that the evidence is weak. There is no basis to recommend one method above another.

Blood Glucose Self-Monitoring↗
PubMed2002

Do baby walkers delay onset of walking in young children?

Baby walkers have been a source of considerable controversy. Some people suggest developmental benefit from their use while others focus on the potential harm that stems from accidents and even suggest developmental delay. This mini-review aimed to determine if use of a baby walker delays affects the onset of walking. The Cochrane library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) and cohort studies, which compared the onset of walking in infants who used baby walkers with a group who did not. Two RCTs and two cohort studies were identified and available for consideration. All of the studies examined the effect of infant walkers on the onset of walking. The results of the two RCTs did not demonstrate a significant effect on the onset of walking. The cohort studies suggest that the use of infant walkers delayed the onset of walking in young children and a pooled analysis of the four studies suggested a delay of between 11 and 26 days. Although the quality of the studies was relatively poor these studies lend no support to the argument that walkers aid the development of walking. The significance of a delay of this magnitude is however unclear. Further work is required to determine whether walkers are an independent causal factor in accidents.

Age Factors↗
PubMed2002

Glucosamine therapy compared to ibuprofen for joint pain.

To determine the effectiveness of oral glucosamine with ibuprofen for the relief of joint pain in osteoarthritis a mini-review (Griffiths, 2002) of double-blind randomized controlled trials comparing the two was undertaken. The population was adult patients diagnosed with osteoarthritis at any site. The outcome was arthritic pain reduction. Searches on Medline, Embase, AMED, the Cochrane Library and the Merck index identified four trials. Of these, two studies were obtainable and were included in the review. Both compared 1.2 g ibuprofen daily with 1.5 g glucosamine sulphate daily, in three divided doses. The combined number of participants in the studies was 218. The results of these studies showed glucosamine to be of similar efficacy to ibuprofen. The conclusion is that glucosamine is effective in relieving joint pain associated with osteoarthritis. Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties; these disease-modifying effects are not seen with simple analgesics and are of particular benefit. In practice glucosamine can be used as an alternative to anti-inflammatory drugs and analgesics or as a useful adjunct to standard analgesic therapy.

Arthralgia↗
PubMed2002

Does pacifier use cause ear infections in young children?

The aim of this review was to identify whether, in children under 2 years of age, pacifier (dummy) use results in an increased risk of ear infection (acute otitis media). The Cochrane Library, Medline, CINAHL and Embase databases were searched for cohort studies and randomised controlled trials that compared infants who used pacifiers with those who didn't or examined the effect of reducing pacifier use in a group of infants. One cluster randomised trial and two cohort studies met the review criteria and were available to be included in the body of the review. These studies show a clear increase in risk of ear infection to be associated with use of a pacifier that may well be causal. The risk of ear infections is up to three times higher in those who use a pacifier and there does appear to be a 'dose response' with continual users more at risk than occasional users. However, this relationship may be confounded by socio-demographic factors. Rather than advising a parent not to use a pacifier for fear of causing otitis media, advice in relation to this issue might best be restricted to pacifier users suffering from the problem in order to reduce the chances of recurrence.

Acute Disease↗
PubMed2002

Community leg ulcer clinics vs home visits: which is more effective?

District nurses manage the care of the majority of patients with leg ulcers, but there have been reports of variations in the practice and effectiveness of treatment provided by district nurses (Audit Commission, 1999). Evidence-based health care aims to promote clinical and cost-effective care/treatment through the explicit, conscientious, and judicious use of the currently available best evidence from research to guide decisions (Sackett et al, 1996). Following the method of Griffiths (2002), a mini-systematic review was undertaken, to find out whether leg ulcer clinics provide more effective treatment to patients with leg ulcers than care provided in patients' homes by district nurses. Five databases were searched to find valid randomised controlled trials (RCTs) or systematic reviews to answer the question. The search was supplemented by hand searching of relevant publications. Only one trial met the inclusion criteria of the review. Although it concluded that leg ulcer clinics delivered improved outcomes the evidence provided was limited due to the comparison treatment being outdated, inadequate information regarding costs, and that as a relatively small isolated RCT it provided insufficient evidence to answer the question.

Clinical Trials as Topic↗
PubMedDate not supplied

A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine.

OBJECTIVES: The long-term use of strong opioid analgesics among chronic noncancer pain (CNCP) patients remains controversial because of concerns over problematic drug use. However, previous surveys suggest that this is not necessarily the case. Therefore, we designed a controlled study to generate evidence in support of these findings. PATIENTS/SETTING: Ten CNCP patients attending the pain clinic in a district general hospital had been taking an average daily dose of 40 mg controlled-release morphine sulphate (mean 40, range 10-90, SD 21 mg), for an average of 2 years (mean 2.175, range 2-2.25, SD 0.2 years). DESIGN: Randomized, double-blind, placebo controlled cross-over study. The study was based on the premise that abrupt cessation of opioid drugs is most likely to highlight problematic use and the consequent inability to stop using opioids. Morphine was substituted with placebo for 60-hour periods to compare the effects of abstinence with those of continued use. Assessment of morphine cessation and abstinence effects was through direct observation, physiological measurements, questionnaire responses, and Brief Pain Inventory scores. RESULTS: Following cessation and abstinence, there were no indications of psychological dependence or drug craving, but there was evidence of the detrimental effects of pain intensity on activity, mood, relationships, sleep, and enjoyment of life. Three patients (30%) reported opioid drug withdrawal symptoms. Pharmacokinetic data demonstrated compliance with abstinence by all patients. CONCLUSION: The results suggest the existence of a group of CNCP patients whose long-term opioid consumption can be beneficial and remain moderate without them suffering from the consequences of problematic opioid drug use.

Aged↗
PubMedDate not supplied

Early postoperative feeding and abdominal gynaecological surgery.

Since the 1990s, the traditional postoperative feeding protocol has been challenged for patients who have undergone major abdominal gynaecological surgery, and value of extended delays in commencing oral intake has been questioned. This review aims to determine whether early rather than delayed postoperative feeding following major abdominal gynaecological surgery has an impact upon recovery as measured by length of hospital stay. The Cochrane Library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) which compared early postoperative oral intake with delayed (traditional) postoperative oral intake for patients who had undergone major abdominal gynaecological surgery. Three RCTs were identified and available for consideration. Although study quality was variable, they suggest that early postoperative feeding appears to be safe and well tolerated after most abdominal gynaecological surgery and leads to a considerable reduction in hospital stay of approximately one day. However, patients' preference and costs remain unclear. Therefore, further well-designed studies are needed to identify the comprehensive effectiveness of early postoperative feeding protocol.

Abdomen↗