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Biomedical subjects

T Fahey

Publications and source records attributed to T Fahey.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Evidence based purchasing: understanding results of clinical trials and systematic reviews.

OBJECTIVE: To assess whether the way in which the results of a randomised controlled trial and a systematic review are presented influences health policy decisions. DESIGN: A postal questionnaire to all members of a health authority within one regional health authority. SETTING: Anglia and Oxford regional health authorities. SUBJECTS: 182 executive and non-executive members of 13 health authorities, family health services authorities, or health commissions. MAIN OUTCOME MEASURES: The average score from all health authority members in terms of their willingness to fund a mammography programme or cardiac rehabilitation programme according to four different ways of presenting the same results of research evidence--namely, as a relative risk reduction, absolute risk reduction, proportion of event free patients, or as the number of patients needed to be treated to prevent an adverse event. RESULTS: The willingness to fund either programme was significantly influenced by the way in which data were presented. Results of both programmes when expressed as relative risk reductions produced significantly higher scores when compared with other methods (P < 0.05). The difference was more extreme for mammography, for which the outcome condition is rarer. CONCLUSIONS: The method of reporting trial results has a considerable influence on the health policy decisions made by health authority members.

Decision Making↗
PubMed1995

An outbreak of Campylobacter jejuni enteritis associated with failed milk pasteurisation.

This paper describes an outbreak of gastrointestinal illness affecting at least 110 people, of whom 41 had microbiological confirmation of Campylobacter jejuni infection. The outbreak of infection was found to have been associated with consumption of inadequately pasteurised milk from a local dairy. The problem of enforcement of food and safety regulations when milk from dairies fails the phosphatase test is discussed. The prevalence of seroconversion to campylobacter in the community is estimated from a sample of cases and controls involved in this outbreak.

Animals↗
PubMed1995

Relationship between the provision of counselling and the prescribing of antidepressants, hypnotics and anxiolytics in general practice.

BACKGROUND: The provision of counselling in general practice is increasing, despite uncertainty concerning its effectiveness. Furthermore, the relationship between counselling and prescribing of antidepressants, hypnotics and anxiolytics in general practice is not known. AIM: This study set out to assess the relationship between provision of counselling and prescribing of antidepressants, hypnotics and anxiolytics in general practice. METHOD: An observational, cross-sectional study of general practices in Oxfordshire Family Health Services Authority was undertaken. Practices were surveyed on the availability of counselling services. The quantity and cost of prescribing of psychotropic drugs over one year (April 1992 to March 1993) were compared for practices with different levels of counselling provision. RESULTS: Of the 82 (96%) respondents, 74 (90%) referred patients for counselling; of these 74 practices, the highest levels of prescribing, in terms of number of items and net ingredient cost, were seen in those practices that employed a counsellor working on the premises. The lowest levels of prescribing were seen in those practices that referred their patients to a counsellor not working on the practice premises. CONCLUSION: The relationship between the provision of counselling and the level of prescribing of antidepressants, hypnotics and anxiolytics is complex. In this study lower levels of prescribing of these drugs in practices with higher provision of counselling were not observed.

Anti-Anxiety Agents↗
PubMed1995

The detection and management of hypertension in the elderly of Northamptonshire.

BACKGROUND: The aim of this study was to apply recommendations from randomized controlled trials and guidelines on the detection and control of hypertension in the elderly to a district health authority population. METHODS: A cross-sectional audit of Northamptonshire general practitioners' (GPs') records from February to June 1993 was carried out. RESULTS: A total of 2428 notes of men and women aged 65 or over registered with their GP was audited. A large proportion of patients, 86 per cent (95 per cent CI 84.6-87.4 per cent), had a blood pressure record taken in the last 10 years. Of those with raised blood pressure (BP > or = 160/90 mmHg) 49 per cent (95 per cent CI 46.2-51.8 per cent) were untreated, and 58 per cent (95 per cent CI 54-61.9 per cent) of those labelled as hypertensive were not adequately controlled. The prevalence of labelled hypertension was 25 per cent (95 per cent CI 23.3-26.7 per cent). CONCLUSIONS: From these results it is estimated that between 11 and 29 fatal and non-fatal strokes could be prevented in the 65-74-year-old age population of Northamptonshire each year if current guidelines were followed. Improved detection and management of elderly hypertensive patients in primary care could contribute significantly towards the target for stroke reduction set in the Health of the nation strategy.

Aged↗
PubMed1995

The type and quality of randomized controlled trials (RCTs) published in UK public health journals.

BACKGROUND: Randomized controlled trials (RCTs) are increasingly being used to evaluate the effectiveness of health care interventions. Systematic reviews of RCTs form the basis of the Cochrane Collaboration, which aims to synthesize all RCTs concerned with the provision of health care. This paper reports the quantity and methodological quality of RCTs published in five UK public health journals, which were searched as part of a planned register of RCTs in public health. METHODS: Five journals were hand searched: The International Journal of Epidemiology, Health Trends, Journal of Public Health Medicine, Public Health and The Journal of Epidemiology and Community Health. All RCTs were identified and their methodological characteristics reviewed. RESULTS: Ninety-one trials were identified from the five journals. A wide variety of topics were covered, the most common being prevention strategies )46 percent of the trials). Although the actual number of reports of RCTs published increased over time, there was no detectable improvement in the quality of reports. The aspect of bias most well controlled was control of bias at entry (randomization), in 83 (91 per cent) of trials. However, even in these trials details about the process of randomization were poor. CONCLUSION: These trials will form the basis of a register of RCTs in public health. The diversity of topics covered illustrates the broad-based nature of public health. For this reason, many other RCTs relevant to the practice of public health are likely to be found in non-public health journals.

Humans↗
PubMed1994

Effect of pregnancy on prognosis for young women with breast cancer.

Breast cancer in women under 30 years old carries a poor prognosis, for reasons that have not been identified. This study aimed to identify prognostic factors in this age group. Special attention was paid to the history of pregnancy. The clinical presentation and course of breast cancer was documented for 407 women, aged 20-29 years, who registered between 1978 and 1988 at one of nine cancer centres. Eligible patients had histologically confirmed local or regional invasive breast carcinoma, and received part or all of their initial therapy at the participating hospital. For patients whose breast cancers were diagnosed during pregnancy, the risk of dying from breast cancer was significantly greater than that of women who had never been pregnant (relative risk 3.26 [95% CI 1.81-5.87], p = 0.0004). Adjustment for number of axillary nodes affected and tumour diameter reduced the relative risk only slightly (2.83 [1.24-6.45], p = 0.023). For each 1-year increment in the time between the latest previous pregnancy and breast cancer diagnosis, the risk of dying decreased by 15% (relative risk 0.85, p = 0.011). Thus concurrent or recent previous pregnancy adversely affects survival of breast cancer in young women. The size of the effect is such that it probably contributes substantially to the poor prognosis of breast cancer in this age group as a whole.

Adult↗