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Dundee, United Kingdom

Murphy D.J.,University of Dundee | Guthrie B.,University of Dundee | Sullivan F.M.,University of Dundee | Mercer S.W.,University of Glasgow | And 2 more authors.
BMJ Quality and Safety | Year: 2012

Background: Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback. Setting and participants: 60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK. Methods: A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a 'good doctor' were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice , defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory. Main outcome measures: Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation. Results: Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83). Conclusions: Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed.

Deakin C.D.,Clinical Directorate | Deakin C.D.,University of Southampton | Fothergill R.,Clinical Audit and Research Unit | Moore F.,London Ambulance Service NHS Trust HQ | And 2 more authors.
Resuscitation | Year: 2014

Introduction: The relationship between the neurological status at the time of handover from the ambulance crew to a Heart Attack Centre (HAC) in patients who have achieved return of spontaneous circulation (ROSC) and subsequent outcome, in the context of current treatment standards, is unknown. Methods: A retrospective review of all patients treated by London Ambulance Service (LAS) from 1st April 2011 to 31st March 2013 admitted to a HAC in Greater London was undertaken. Neurological status (A - alert; V - responding to voice; P - responding to pain; U - unresponsive) recorded by the ambulance crew on handover was compared with length of hospital stay and survival to hospital discharge. Results: A total of 475 sequential adult cardiac arrests of presumed cardiac origin, achieving ROSC on admission to a HAC were identified. Outcome data was available for 452 patients, of whom 253 (56.0%) survived to discharge. Level of consciousness on admission to the HAC was a predictor of duration of hospital stay (P<. 0.0001) and survival to hospital discharge (P<. 0.0001). Of those presenting with a shockable rhythm, 32.3% (120/371) were 'A' or 'V', compared with 9.1% (9/99) of those with non-shockable rhythms (P<. 0.001). Conclusion: Patients with shockable rhythms achieving ROSC are more likely to be conscious (A or V) compared with those with non-shockable rhythms. Most patients who are conscious on admission to the HAC will survive, compared with approximately half of those who are unconscious (P or U), suggesting that critical care is generally appropriate at all levels of consciousness if ROSC has been achieved. © 2014 Elsevier Ireland Ltd.

Sicras-Mainar A.,Badalona Serveis Assistencials SA | Rejas J.,Pfizer | Navarro-Artieda R.,Hospital Germans Trias i Pujol | Aguado-Jodar A.,Primary Health Care Directorate | And 3 more authors.
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2014

Introduction and hypothesis: Treatment persistence is low in patients with overactive bladder (OAB), but persistence may vary among antimuscarinic agents. This study compared treatment persistence in patients with OAB receiving fesoterodine, solifenacin, or tolterodine as their initial OAB prescription in a routine clinical practice setting. Methods: This retrospective study used medical records from primary healthcare centers in three locations in Spain; records from patients aged ≥18 years with a diagnosis of OAB who initiated antimuscarinic treatment for OAB (fesoterodine, tolterodine, or solifenacin) were included. The first prescription of one of the OAB study medications was considered the index date; patients were followed for ≥52 weeks. Persistence was estimated using Kaplan-Meier curves and Cox proportional hazard regression models, adjusting for covariates. Results: A total of 1,971 records of patients (58.3 % women; mean age 70.1 years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952), or tolterodine (n = 717) were included. Unadjusted mean (±SD) treatment duration was 31.5 ± 17.6 weeks for fesoterodine, 29.9 ± 21.4 for solifenacin and 29.0 ± 21.6 for tolterodine (p = 0.217). At week 52, 35.8 % of fesoterodine-treated patients remained on their initial therapy, versus 31.9 % of solifenacin-treated (hazard ratio [HR], 1.24; 95 % CI, 1.05-1.47; p = 0.011) and 30.9 % of tolterodine-treated (HR = 1.28; 95 % CI, 1.07-1.52; p = 0.006) patients. Findings were consistent when the definition for discontinuation was varied. Conclusions: Overall persistence at week 52 was low, but the cumulative probability of persisting with initial therapy was significantly higher for fesoterodine than for solifenacin or tolterodine in clinical practice in Spain. © 2013 The International Urogynecological Association.

White C.,Transplant | Mcdonnell H.,Medical Directorate
Journal of Renal Care | Year: 2014

SUMMARY: This is the first paper in a two-part Continuing Education (CE) series focusing on psychosocial care of patients with end-stage kidney disease (ESKD), which addresses a variety of psychological responses experienced by patients when adapting to the challenges posed by living with this long-term condition. The second paper will examine further the issues of coping and adjustment to ESKD and the need for renal supportive care to ensure person-centred holistic care is provided to patients. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Kersten P.,University of Southampton | Ellis-Hill C.,Bournemouth University | McPherson K.M.,University of Auckland | Harrington R.,Medical Directorate
Disability and Rehabilitation | Year: 2010

Background. Rehabilitation is highly complex, involving multiple processes, outcomes and stakeholders. The way we deliver our services and work with our clients and their families should be informed by research approaches that produce the wide range of knowledge needed. This article aims to explore the degree to which the dominant approach to 'evidence' (the randomised clinical trial or RCT) meets those needs and discuss alternate/additional ways of gaining evidence. Methods. A critical review of the literature allowing exploration of problems encountered in rehabilitation RCTs and alterative approaches. Findings. We discuss some problematic issues related to using RCTs in rehabilitation research (for example the large number of people excluded from trials, and the small numbers of people with some neurological conditions making RCTs non-viable). Alternative approaches are discussed including clinical practice improvement studies (sometimes called practice-based evidence or PBE), which provide data on patients treated in routine practice; qualitative research, which can provide an understanding of the users of health care services to ensure they are meeting their needs; and metasynthesis, which can be used to summarise several qualitative studies to enhance our understanding of the principles underlying service delivery. Finally, we explore how clinicians and commissioners often use evidence generated by forms of research other than the RCT. Conclusion. The best answers about how to enhance rehabilitation outcomes are likely to come from a combination and integration of the most appropriate methods. In conclusion, we urge for more joined up thinking, for learning from different fields so that we can develop more effective and appropriate health care and rehabilitation.

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