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Biomedical subjects

Philip James

Publications and source records attributed to Philip James.

6 recordsLinked to original sources
PubMed2006

Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records.

CONTEXT: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. OBJECTIVES: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care. DESIGN AND SETTING: Cross-sectional analysis combining nurse survey data with discharge abstracts. PARTICIPANTS: Nurses (N=3984) and general, orthopaedic, and vascular surgery patients (N=118752) in 30 English acute trusts. RESULTS: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals. CONCLUSIONS: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.

Adult↗
PubMed2006

Identification and characterisation of the high-risk surgical population in the United Kingdom.

INTRODUCTION: Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. METHODS: Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. RESULTS: There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9-29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8-3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10-30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. CONCLUSION: A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU.

Adult↗
PubMed2006

Marabou 2005: nutrition and human development.

Nutrition is now becoming once more of intense interest to biological and medical scientists working on the control of development and human health. It is also now of ever greater public health interest. Few scientists, however, recognize that the same interest for those involved in fundamental science and public health developed a century ago focusing on the way in which nutrition and specific micronutrients, as well as general energy and protein intakes, were crucial to infant growth and appropriate development. The discovery of vitamins was matched by the proposition that stunted children in poor communities in the Western world were suffering from poverty-related poor diets. The critical role of nutrition was established by feeding studies, which then led to major food and agricultural policy changes during the Second World War, when food supplies were scarce throughout Europe. The success of these wartime policies led to a revolution in governmental thinking and a cheap food policy, together with a major boost in national agricultural production as an issue of national security. Nutritionists transferred their scientific interest to the study of childhood malnutrition in the developing world. The promotion of intensive agriculture and the food industry led to a revolution in food supplies, with the intense promotion of meat, milk, butter, and sugar production and consumption. The resulting escalation in cardiovascular disease related to the dietary change slowly altered public health policies, but as cardiovascular deaths decreased in the developed world, obesity and diabetes progressively increased. Now the lower- and middle-income countries (i.e., the developing world) have far more cardiovascular disease as Western diets and cultural habits are imported. The remarkable escalation of diabetes and cardiovascular disease, particularly in populations currently and previously subjected to malnutrition, now reveals unusual susceptibility to these diseases. This susceptibility is increasingly related to the conjunction of fetal malnutrition and later inappropriate diets. The alarming escalation in the health burden suggests that two-thirds of the world's population is super-sensitive to weight gain, diabetes, cardiovascular disease, and perhaps many cancers. New evidence on epigenetics and the structural changes in the fetus in response to inappropriate maternal diets provides mechanisms to explain this. Unfortunately, a vicious intergenerational cycle of maternal and fetal epigenetic change seems to herald markedly increased future burdens of disease. The nutrition field is therefore challenged not only in terms of science, but also in new dimensions of public health of immense economic significance.

Africa↗
PubMed2004

Red blood cell nitric oxide as an endocrine vasoregulator: a potential role in congestive heart failure.

BACKGROUND: A respiratory cycle for nitric oxide (NO) would involve the formation of vasoactive metabolites between NO and hemoglobin during pulmonary oxygenation. We investigated the role of these metabolites in hypoxic tissue in vitro and in vivo in healthy subjects and patients with congestive heart failure (CHF). METHODS AND RESULTS: We investigated the capacity for red blood cells (RBCs) to dilate preconstricted aortic rings under various O2 tensions. RBCs induced cyclic guanylyl monophosphate-dependent vasorelaxation during hypoxia (35+/-4% at 1% O2, 4.7+/-1.6% at 95% O2; P<0.05). RBC-induced relaxations during hypoxia correlated with S-nitrosohemoglobin (SNO-Hb) (R2=0.88) but not iron nitrosylhemoglobin (HbFeNO) content. Relaxation responses for RBCs were compared with S-nitrosoglutathione across a range of O2 tensions. The fold increases in relaxation evoked by RBCs were significantly greater at 1% and 2% O2 compared with relaxations induced at 95% (P<0.05), consistent with an allosteric mechanism of hypoxic vasodilation. We also measured transpulmonary gradients of NO metabolites in healthy control subjects and in patients with CHF. In CHF patients but not control subjects, levels of SNO-Hb increase from 0.00293+/-0.00089 to 0.00585+/-0.00137 mol NO/mol hemoglobin tetramer (P=0.005), whereas HbFeNO decreases from 0.00361+/-0.00109 to 0.00081+/-0.00040 mol NO/mol hemoglobin tetramer (P=0.03) as hemoglobin is oxygenated in the pulmonary circulation. These metabolite gradients correlated with the hemoglobin O2 saturation gradient (P<0.05) and inversely with cardiac index (P<0.05) for both CHF patients and control subjects. CONCLUSIONS: We confirm that RBC-bound NO mediates hypoxic vasodilation in vitro. Transpulmonary gradients of hemoglobin-bound NO are evident in CHF patients and are inversely dependent on cardiac index. Hemoglobin may transport and release NO bioactivity to areas of tissue hypoxia or during increased peripheral oxygen extraction via an allosteric mechanism.

Allosteric Regulation↗