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Biomedical subjects

T Fahey

Publications and source records attributed to T Fahey.

At least 19 recordsLinked to original sources
PubMed1998

Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults.

OBJECTIVES: To assess whether antibiotic treatment for acute cough is effective and to measure the side effects of such treatment. DESIGN: Quantitative systematic review of randomised placebo controlled trials. DATA SOURCES: Nine trials (8 published, 1 unpublished) retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language. MAIN OUTCOME MEASURES: Proportion of subjects with productive cough at follow up (7-11 days after consultation with general practitioner); proportion of subjects who had not improved clinically at follow up; proportion of subjects who reported side effects from taking antibiotic or placebo. RESULTS: Eight trials contributed to the meta-analysis. Resolution of cough was not affected by antibiotic treatment (relative risk 0.85 (95% confidence interval 0.73 to 1.00)), neither was clinical improvement at re-examination (relative risk 0.62 (0.36 to 1.09)). The side effects of antibiotic were more common in the antibiotic group when compared to placebo (relative risk 1.51 (0.86 to 2.64)). CONCLUSIONS: Treatment with antibiotic does not affect the resolution of cough or alter the course of illness. The benefits of antibiotic treatment are marginal for most patients with acute cough and may be outweighed by the side effects of treatment.

Adult↗
PubMed1998

Reconciling different measures of risk in the treatment of hypertension: a community-based study.

BACKGROUND: There is disagreement as to how cardiovascular risk in hypertensive patients should be measured. In particular, whether absolute risk measurement alone is a realistic index on which to base treatment goals. METHOD: A cross-sectional study on 895 treated hypertensive patients in 18 general practices in the UK. Reporting on the distribution and magnitude of age-specific absolute risk. The percentage of individuals with controlled hypertension whose absolute risk exceeds their age/sex absolute risk standard and the percentage of individuals with uncontrolled hypertension whose risk is less than their age/sex absolute risk standard. RESULTS: Overall, 62.8% (95% CI 59.6-66%) individuals had an absolute risk that exceeded 20% over 10 years. The magnitude of absolute risk was considerable (range 3.5-87.8%) and increasing absolute risk was significantly associated with age. Of those individuals with controlled hypertension 50.5% (95% CI 45.1-55.8%) had an absolute risk which exceeded their age/sex absolute risk standard. Conversely, 30.4% (95% CI 26.6-34.2%) of those with uncontrolled hypertension had an absolute risk that was less than their age/sex absolute risk standard. CONCLUSIONS: The distribution and magnitude of absolute risk is significantly associated with age. Appreciation of such a relationship is needed when setting realistic treatment goals according to an absolute risk standard, particularly in the elderly. In addition, the use an age/sex absolute risk standard is likely to further modify treatment goals in individuals at high and low absolute risk of cardiovascular disease.

Age Factors↗
PubMed1998

Systematic review of the treatment of upper respiratory tract infection.

OBJECTIVES: To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI). DESIGN: Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo. DATA SOURCES: Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language. MAIN OUTCOME MEASURES: The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects. RESULTS: 1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21). CONCLUSIONS: In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.

Anti-Bacterial Agents↗
PubMed1998

A systematic review of the use of computers in the management of hypertension.

STUDY OBJECTIVE: To assess the effect of computers and computer-based clinical decision support systems on the management of hypertension. DESIGN: Systematic review of randomised controlled trials. SETTING: Ambulatory hypertension clinics, community-based health centres, and general practices. PARTICIPANTS: 11,962 patients enrolled in seven trials retrieved from a systematic search (electronic databases, contact with authors, reference lists; no restriction on language). MAIN RESULTS: Individual trials report on a diverse population of patients (newly diagnosed or established hypertensive patients), interventions (computers used for case finding, recall and registration, feedback on quality of blood pressure control and prescribing information), and outcomes (administration, physician performance and blood pressure control). Four of five trials reported an improvement in patient administration using a computer. Two of three trials reported an improvement in physician performance using a computer. Two of six trials. reported an improvement in blood pressure control in patients using a computer. However, positive findings in two trials should be regarded cautiously because of the potential effects of cluster randomisation. CONCLUSIONS: It seems that computers have a favourable effect on the uptake and follow up of patients in hypertension management. The effect of computers on physician knowledge, recording of information, and blood pressure control in patients is less conclusive and further studies are required.

Decision Making, Computer-Assisted↗
PubMed1998

Applying the results of clinical trials to patients to general practice: perceived problems, strengths, assumptions, and challenges for the future.

Randomized controlled trials (RCTs) and systematic reviews of RCTs now provide the most robust external evidence about the effectiveness of patient care. There are, however, several assumptions made when applying the results of RCTs to individual patients. This paper aims to outline the perceived barriers against the use of RCTs in practice, while emphasizing the rationale and advantages underlying the approach. A critical discussion concerning the assumptions made when applying evidence from RCTs to individual patients will be presented, with a worked example derived from a patient with acute sinusitis. Finally, proposals concerning the effective implementation of evidence derived from RCTs in the context of individual patient care will be discussed.

Adult↗
PubMed1998

The content and methodology of research papers published in three United Kingdom primary care journals.

BACKGROUND: With the expansion of academic departments, the National Research and Development initiative, and the Culyer report, United Kingdom (UK) general practice research is undergoing a period of investment and change. AIM: To examine the content and methodological quality of UK-published general practice research, and in particular to focus on the quantity and proportion of studies that were of high methodological quality, namely randomized controlled trials (RCTs). METHOD: We manually searched three UK-published journals over a five-year period: the British Journal of General Practice (BJGP), Family Practice, and the British Medical Journal (BMJ), which has a section devoted to general practice research. Studies were classified according to the International Classification of Health Problems of Primary Health Care (ICHPPC-2). RESULTS: Nearly half of published studies in UK primary care journals were concerned with either organization and administration issues in primary care or social problems (509 studies, 48%). Just over half were either qualitative studies or surveys of opinion or attitudes (528 studies, 50%). The overall number of RCTs was low (67 studies, 6%), and the proportion published has not changed over time (chi 2 for trend = 3.79, df = 1, P = 0.051). In contrast to surgical journals, nearly one-fifth of studies in general practice followed a longitudinal design (186 studies, 18%). CONCLUSIONS: The content and design of published general practice research in the UK is varied and broad. The most robust methodological design should be the aim of all prospective researchers in general practice.

Humans↗
PubMed1997

Clinical guidelines and the management of hypertension: a between-practice and guideline comparison.

It has previously been demonstrated that individual general practitioners (GPs) diagnose and treat at different levels of blood pressure and according to different risk factor profiles. This study sought to examine the variation in the achievement of control of hypertension in a sample of 20 treated hypertensive patients in 18 UK general practices. There was a marked between-practice variation in the percentage of patients with controlled hypertension. Practices appear to apply different hypertension guidelines to patients consistently, with significant correlations across practices in seven out of ten possible guideline combinations. There remains marked variation in the management of hypertension between different general practices in the UK. Factors other than recommendations in guidelines appear to be responsible for this variation.

England↗
PubMed1996

The prevalence and direct costs of pre-immunization testing for hepatitis A in general practice.

Two hundred and twenty patients in one general practice travelling to destinations where immunization against hepatitis A virus (HAV) is recommended were tested for their HAV immune status before immunization. Age-specific prevalence of prior immunity to HAV was estimated. The relative costs of pre-immunization testing and immediate immunization were compared. The most cost-effective testing method for this practice was found to be total population testing prior to immunization with HAV vaccine. Individual general practices can estimate the optimal age at which to commence testing for HAV in their own practice population.

Adolescent↗