Biomedical subjects
Publications and source records attributed to William Little.
The healthcare outside hospitals white paper laid emphasis on provision of a range of services in a primary care setting. But there is no specific commitment from the Department of Health to 'polyclinics' in the white paper. Many of the new-style surgeries are being funded via the local improvement finance trust programme.
OBJECTIVES: To evaluate the incidence of contrast-induced nephropathy (CIN) with the use of an automated contrast injection system in conjunction with contemporary measures to prevent CIN after cardiac catheterization and percutaneous coronary intervention (PCI). BACKGROUND: The use of automated contrast injection systems can reduce the volume of procedural contrast, but whether lower contrast volume is associated with a lower incidence of CIN is uncertain. METHODS: The incidence of CIN was assessed in 1,798 patients after diagnostic catheterization or PCI at Wake Forest University Baptist Medical Center from April 2002 to November 2004 using traditional handheld manifold injection systems, and in 377 subsequent patients using an automated contrast injection system. Preprocedural hydration was used on a routine basis, and N-acetylcysteine and bicarbonate infusion were used on an ad hoc basis. Outcomes were adjusted by standard logistic regression modeling. RESULTS: Mean contrast volume (+/- standard deviation) per case was reduced from 204 +/- 147 ml to 146 +/- 108 ml, p < 0.05 by use of automated contrast injection. The incidence of CIN was 19.3% using manifold injection, and was 13.3%, p < 0.05, after use of automated contrast injection. The use of automated contrast injection was associated with a reduced relative risk of CIN, 0.66 (0.47-0.93), compared to manual injection, even after adjustment for baseline clinical and procedural covariates. CONCLUSIONS: The use of an automated contrast injection system in conjunction with contemporary hydration and pharmacologic strategies to prevent CIN during diagnostic catheterization and PCI was associated with a significant reduction in the use of contrast volume, as well as in the incidence of CIN.
Primary care trusts will be able to retain some provision functions in the restructured NHS. Some PCTs, such as in Greater Manchester, have plans to identify and develop services with community providers.
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Public health professionals have expressed concern at the decision to give the NHS overall control of joint services. For joint working to be effective management has to be set from both the primary care trust and local authority. Pooling information between the two organisations allows a better understanding of the population and its health.
Mental health services for older people tend to be neglected by policy in favour of general adult mental health services. Inadequate staffing, lack of capacity and insufficient intermediate care are all contributing factors. Salford and Trafford trust now has accredited training for primary care nurses in the identification and initial management of mental health problems in older people.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Chronic heart failure (CHF) can be caused either by a predominant abnormality in systolic function (systolic heart failure) or a predominant abnormality in diastolic function (diastolic heart failure). Randomized clinical trials have identified a number of pharmaceutical agents that can reduce morbidity and mortality in patients with systolic heart failure. Despite significant therapeutic advances, systolic heart failure continues to result in high rates of morbidity and mortality. In contrast to systolic heart failure, no randomized clinical trials have been performed in patients with diastolic heart failure. Common to the mechanisms causing both systolic and diastolic heart failure are abnormalities in calcium homeostasis. Mitsubishi Pharma Corporation has developed a compound (MCC-135, INN; caldaret) whose mechanism of action is proposed to be modulation of calcium homeostasis at the sarcoplasmic reticulum and cellular membrane. The purpose of this study was to test the safety, tolerability, and efficacy of MCC-135 in patients with mild to moderate heart failure. METHODS: This was a phase II, multicenter, randomized, double-blind study of parallel group design comparing 3 oral dose regimens of MCC-135 (5 mg, 25 mg, 50 mg, twice daily) with a placebo control. The treatment period was 24 weeks. A total of 511 patients were recruited from 69 centers in the United States and Europe. One hundred and twenty-five patients were recruited in each of the 4 treatment groups. Patients in each treatment group were divided into 2 cohorts: those with an ejection fraction < or = 40%, and those with an ejection fraction >40% as determined by core laboratory analysis of echocardiographic studies. CONCLUSION: Patient recruitment was completed in September 2002. Patient follow-up was completed by February 2003; the results will be available for release in 2004.
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