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T Stokes

Publications and source records attributed to T Stokes.

At least 37 records · Page 2Linked to original sources
PubMed1998

Hospital readmission after cardiac surgery. Does "fast track" cardiac surgery result in cost saving or cost shifting?

BACKGROUND: Intense medical and economic pressures have created "fast track" cardiac surgery in which clinical services are streamlined and early discharge is encouraged. Does this strategy promote significant cost saving or merely cost shifting? In a global system of reimbursement, the economic benefit of decreasing patient length of stay may be offset by high rates of patient readmission. This study was undertaken to determine the 30-day readmission rate after cardiac surgery and to analyze trends of readmission diagnoses. METHODS AND RESULTS: From October 1, 1996 to July 31, 1997, 460 consecutive cardiac surgical operations were performed at 1 institution. There were 25 deaths and 8 patients who remained as inpatients at the 30-day postoperative deadline for readmission. Two patients had 2 operations. Therefore, 527 operations were performed on 525 patients. There were 110 readmissions after 527 operations for a readmission rate of 20.9%. A significant number of readmissions (49%) were to outside hospitals. Readmission diagnoses were: atrial fibrillation (23%); angina, congestive heart failure, or ventricular tachycardia (20%); leg wound (15%); sternal wound (5%); pneumonia (5%); gastrointestinal complaints (5%); neurologic event (2%); and miscellaneous (25%). Patients discharged > or = 7 days postoperatively were twice as likely to be readmitted as those discharged on postoperative days 4, 5, or 6. CONCLUSIONS: Readmission after cardiac surgery is common and frequently (49%) to outside institutions. Patients discharged > or = 7 days postoperatively represent the patients at greatest risk of readmission and, therefore, warrant closer scrutiny before discharge.

Adult↗
PubMed1998

A model for the development of evidence-based clinical guidelines at local level--the Leicestershire Genital Chlamydia Guidelines Project.

Clinical guidelines can be effective in achieving health gain when they are validly developed, disseminated and implemented appropriately. There is, however, a potential conflict between the need for validity through use of expert resources available at a national level, and implementation, which is undertaken at local level and depends on the local relevance of the guideline. This paper presents a model by which valid guidelines for the management of a given disease (genital chlamydial infection) by general practitioners can be developed at local level using the resources available to a district health authority department of public health. The model has three elements. First, a district-wide postal questionnaire survey was used to document current clinical practice. Secondly, a critical review of the evidence relating to the management of genital chlamydial infection as it relates to British general practice was performed. Thirdly, the information gained from the critical review and survey was used by a multidisciplinary group to develop evidence-based guideline recommendations. It is argued that the Leicestershire Genital Chlamydia Guidelines compare favourably with other recently published national guidelines in terms of their development and content. Local guideline development of guidelines for selected topics can be practical and appropriate.

Chlamydia Infections↗
PubMed1997

GP's management of genital Chlamydia: a survey of reported practice.

BACKGROUND: Genital chlamydial infection is the commonest curable sexually transmitted disease in the industrialized world. Little is known about how GPs manage this condition. OBJECTIVES: We aimed to determine current knowledge concerning genital chlamydia among GPs and to establish how patients with this infection are managed in primary care. METHODS: A confidential self-administered postal questionnaire survey was sent to all 494 GPs in one English health district (Leicestershire). RESULTS: Completed questionnaires were returned by 290 GPs (a response rate of 59%). A much higher proportion of GPs had tested and/or treated female patients for chlamydia [70%, 95% confidence interval (CI) 64-75%] as opposed to male patients (20%, CI 15-25%). Female patients (70%, CI 64-75%) were also more likely to be managed in general practice than male patients (56%, CI 50-62%). A majority of GPs (66%, CI 60-72%) routinely used an appropriate method of testing for chlamydia although a high vaginal swab, an inappropriate method of testing, was used by a fifth of GPs (19%, CI 15-24%). A large number of different treatment regimes were used by GPs. The majority of GPs (85%, CI 79-89%) prescribed an appropriate antibiotic although few GPs (19%, CI 14-25%) specified a chlamydia treatment regime in accordance with accepted international guidelines with respect to drug, dosage and duration of therapy. CONCLUSIONS: Female patients with known or suspected genital chlamydial infection are commonly managed in UK general practice. There is scope to improve the management of this infection in general practice.

Anti-Bacterial Agents↗
PubMed1997

Screening for Chlamydia in general practice: a literature review and summary of the evidence.

Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is one of the chief causes of pelvic inflammatory disease (PID) in women. Infection in women is complicated by the fact that the majority of women with this infection are asymptomatic. It is feasible for general practitioners (GPs) to test for this infection, and there has been debate as to which is the most appropriate screening strategy. In the absence of any national UK guidelines, the purpose of this systematic literature review is to appraise critically and summarize the evidence for screening for genital chlamydia infection in sexually active women attending UK general practice. The four areas to be reviewed are: prevalence of genital chlamydia infection in women attending UK general practice; evidence for routine screening of women attending general practice; evidence for selective screening of women attending general practice; evidence for screening women requesting termination of pregnancy (TOP) or intrauterine device (IUD) insertion. This review should allow GPs and public health practitioners to become aware of the quality of evidence underlying various screening strategies and inform any local guideline development.

Chlamydia Infections↗
PubMed1990

Improving dietary habits of children: effects of nutrition education and correspondence training.

Evidence that a significant number of children are exposed to risk factors associated with coronary heart disease has prompted health care professionals to develop programs designed to encourage the early development of a healthy life style. The present study used a multiple baseline approach to examine the effects of two procedures on the snack selection behavior of 25 third grade children. In children who selected non-nutritious rather than nutritious snacks for more than 40% of the baseline observations, nutrition education alone had little or no impact on their selection of snacks. However, with the implementation of correspondence training, in which a reward was made contingent upon carrying out a stated intent to choose a nutritious snack, the children consistently chose nutritious snacks. These results indicate that correspondence training may be an efficient and cost-effective way to improve dietary habits of young people.

Behavior Therapy↗
PubMed1989

Acrivastine in two doses compared with placebo in a multicentre, parallel group study for the treatment of seasonal allergic rhinitis.

In a placebo controlled, randomised, multicentre study the efficacy and safety of multiple doses of acrivastine, a derivative of the antihistamine tripolidine (Actidil) were evaluated in patients exhibiting symptoms of seasonal allergic rhinitis. Over the 10 day treatment period, 103 patients received, twice daily, either 4 mg and 8 mg of acrivastine or a placebo. Three patients withdrew from the study due to poor symptom control and two due to adverse experiences. The reporting of adverse experiences was evenly distributed between the treatment and placebo periods. Acrivastine did not affect the haematological, biochemical or urinalysis screens. Both 4 mg and 8 mg acrivastine alleviated the symptoms of seasonal allergic rhinitis with significant improvements in the symptom scores for sneezing, running nose and the calculated overall score. In addition, 8 mg acrivastine reduced the symptom scores for watery eyes and itchy throat. Acrivastine was both well tolerated and effective in the treatment of seasonal allergic rhinitis.

Adolescent↗