bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community economic development through partnerships
Authors: Mount Joan , Mulc Helen 
Published: October 2007

PurposeThis paper seeks to present a partnering model pioneered in Sudbury, Canada, that combats fragmentation in the delivery of business support services. Partnerships form the backbone of a comprehensive business support centre. The Sudbury Regional Business Centre brings together banking, government, communications, education, legal, and accounting partners. These partners coordinate their efforts to provide services to area businesses, striving to improve the odds for a dynamic and resilient local economy. This model has been replicated and adapted by various communities across Ontario, Canada's most populous province.Design/methodology/approachThe methodology consists of qualitative research by two participant‐observers.FindingsIf a solid business case can be made, banks and three levels of government can be persuaded to act in concert with other partners through a community business support centre; economic upheaval in the Sudbury area precipitated urgency and resolve; several postulates regarding key success factors were supported.Research limitations/implicationsThe reporting is retrospective; the postulates are examined in a single context.Practical implicationsDisparate players can form a working partnership so that business support services from various quarters blend effectively, and are easily accessed to give clients the best help available.Originality/valueThis paper describes how a community forged partnerships designed to overcome fragmentation in the delivery of business support services. Comprehensive enterprise support offered by committed public and private sector partners can be channelled through a physically accessible centre. The factors which proved most critical to success are discussed.
Can lean save lives?
Authors: Fillingham David 
Published: October 2007

PurposeThe purpose of this paper is to show how over the last 18 months Bolton Hospitals NHS Trust have been exploring whether or not lean methodologies, often known as the Toyota Production System, can indeed be applied to healthcare.Design/methodology/approachThis paper is a viewpoint.FindingsOne's early experience is that lean really can save lives. The Toyota Production System is an amazingly successful way of manufacturing cars. It cannot be simply translated unthinkingly into a hospital but lessons can be learned from it and the method can be adapted and developed so that it becomes owned by healthcare staff and focused towards the goal of improved patient care.Originality/valueWorking in healthcare is a stressful and difficult thing. Everyone needs a touch of inspiration and encouragement. Applying lean to healthcare in Bolton seems to be achieving just that for those who work there.
Can Six Sigma be the “cure” for our “ailing” NHS?
Authors: Antony Jiju , Downey‐Ennis Kay , Antony Frenie , Seow Chris 
Published: October 2007

PurposeThe purpose of this research is to analyse whether Six Sigma business strategy can be used to improve the financial and operational performance of the NHS. The paper will also look at some of the major challenges and barriers in the implementation of this powerful process improvement strategy within the healthcare sector.Design/methodology/approachThis paper discusses whether Six Sigma DMAIC methodology can be a useful and disciplined approach to tackle process‐ and quality‐related problems in the NHS.FindingsThe paper presents some key findings from other researchers in the field, followed by some comments on whether Six Sigma is a useful approach to be considered by the NHS for cost reduction and defect reduction strategies.Originality/valueThe paper illustrates the point that Six Sigma is not confined just to manufacturing industry, rather it is equally applicable to service industry, especially the healthcare and financial sectors. The application of Six Sigma in the UK health sector is relatively new and the purpose of the paper is to increase the awareness of this powerful business strategy in healthcare discipline.
Should doctors stop taking the generic history?
Authors: Gudena R. , Khetan N. , Luwemba S. , Jenkinson L.R. 
Published: October 2007

PurposeThe purpose of this paper is to show how the implementation of the European Working Time Directive in August 2004 has dramatically decreased junior doctors' working hours, as a consequence of which new ways of working will need to be found. Traditionally both doctors and nurses record the same generic history (past medical history, social and family history, drug history and allergies) in their own notes. This is unnecessary duplication and maybe only nursing staff should record this information. This study is undertaken to identify the differences between junior doctors' and nurses' clerking to assess whether they are comparable.Design/methodology/approachA prospective study of 100 case notes from elective and emergency admissions was undertaken. The completeness of various parts of the history and the recording of the vital signs were compared between nurses and house officers.FindingsThe Past Medical History was complete in only 30 per cent of the house officers' notes and 42 per cent of nursing records. The social history was complete in all the nursing records but only 35 per cent of the doctors' notes. Nurses recorded a complete personal history more than doctors (62 per cent v. 13 per cent respectively). The drug history was poorly recorded in house officers' notes, being complete in 22 per cent, whereas this was complete in 73 per cent of nursing records. The record of the history of allergies was poor in both groups at just over 10 per cent. Finally 87 per cent of nurses managed to record vital signs but these were missing from nearly half of the house officers' notes.Originality/valueThe study has shown that details of the generic medical history are recorded more completely by the nursing staff and only they should record this information. This will allow junior doctors more time to deal with the increased demands and reduced hours of work.
The effect of cannula material on the incidence of peripheral venous thrombophlebitis
Authors: Gupta A. , Mehta Y. , Juneja R. , Trehan N. 
Published: October 2007

SummaryThe incidence of thrombophlebitis following the use of two types of cannulae, a new generation polyurethane cannula Biovalve PUR and a polyurethane hybrid co‐polymer Vialon cannula, was compared in a randomised trial. Seventy patients scheduled for elective cardiac surgery were randomly assigned to have either a Biovalve cannula or a Vialon cannula inserted before induction of anaesthesia. Postoperatively, the cannulae were removed either as soon as signs of thrombophlebitis were observed or at the end of seven days, whichever was earlier. There was a significantly lower incidence of thrombophlebitis in the Biovalve PUR group (17%) compared to the Vialon group (60%) at the end of seven days (p < 0.001). None of the cannulae tip cultures resulted in the growth of micro‐organisms. There was also a lower incidence of the need for re‐siting with the Biovalve than with the Vialon cannulae.
Interpleural block – part 2
Authors: Dravid R. M. , Paul R. E. 
Published: October 2007

SummaryInterpleural blockade is effective in treating unilateral surgical and non‐surgical pain from the chest and upper abdomen in both the acute and chronic settings. It has been shown to provide safe, high‐quality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes, thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contra‐indications and a low incidence of complications. In the second of two reviews, the authors cover the applications, complications, contra‐indications and areas for future research.
Identification of the correct lumbar level using passive intersegmental motion testing
Authors: Chakraverty R. C. , Pynsent P. B. , Westwood A. , Chakraverty J. K. 
Published: October 2007

SummaryThis study aimed to assess the accuracy and agreement between examiners when attempting to identify a single lumbar spinal level using passive intersegmental motion testing, a technique commonly used by physical therapists. Thirty‐five adults were examined independently by an experienced and a novice clinician. Each examiner was asked to identify and note the interspace between the fifth lumbar vertebra and the first sacral vertebra, and to mark it. The mark was invisible to the second clinician asked to identify the same lumbar interspace. The true level was then identified by fluoroscopic imaging and was correct in 54–57% of cases. Interobserver agreement was poor. A significant learning effect was found for the experienced examiner, with proportionately more correct levels identified during the second part of the study (79%) when compared to the first (31%). The results show that intersegmental motion testing is a relatively unreliable method of identifying the correct spinal level.
The pressure effects of facemasks during noninvasive ventilation: a volunteer study
Authors: Munckton K. , Ho K. M. , Dobb G. J. , Das‐Gupta M. , Webb S. A. 
Published: October 2007

SummaryNoninvasive ventilation by facemask is commonly used for patients with respiratory failure. We evaluated the pressure exerted by two types of facemask on the faces of 12 healthy volunteers while they were being given different levels of continuous or bi‐level positive airway pressure ventilation. The mean (SD) pressure recorded on the bridge of the nose was much higher than that on the cheek (nose: 65.8 (21.2) vs cheek 15.4 (7.2) mmHg, p < 0.0001). Progressive tightening of the harness and increasing of the volume of air in the facemask cushions increased the pressure on the bridge of the nose, and the effect of these two factors was additive. Some commercially available facemasks can produce substantial pressure on the bridge of the nose and this explains why pressure complications on the bridge of the nose are common during noninvasive ventilation.
A comparison of the disposable vs the reusable laryngeal tube in paralysed adult patients
Authors: Amini A. , Zand F. , Sadeghi S. E. 
Published: October 2007

SummaryA disposable laryngeal tube (LT‐D) with dimensions identical to, but physical properties different from (stiffer tube/thicker cuff), the reusable laryngeal tube (LT‐R) has recently become available. We performed a randomised, single blind trial among 100 anaesthetised and paralysed patients to compare these devices in terms of ease of insertion, airway sealing pressure, position assessed fibreoptically and postoperative throat complications. Anaesthesia was administered with midazolam, fentanyl, propofol, atracurium, oxygen and isoflurane. The LT‐D and LT‐R showed similar clinical performances, as shown by their insertion times (28.4 and 23.6 s, respectively). Successful insertion at the first attempt was achieved in 90% with LT‐D and 96% with LT‐R. There were no differences in airway sealing pressure, fibreoptic position or post operative sore throat and dysphagia. The intra cuff pressure remained stable for the LT‐R but decreased slightly for the LT‐D. In paralysed, anaesthetised patients, the single use and reusable laryngeal tubes are similar in clinical performance.
Drug selection errors in relation to medication labels: a simulation study
Authors: Garnerin P. , Perneger T. , Chopard P. , Arès M. , Baalbaki R. , Bonnabry P. , Clergue F. 
Published: October 2007

SummaryThe aim of this study was to assess the impact of differences in drug label information on injectable drug selection errors. Differences in the display of drug strength information were assessed in a randomised controlled trial involving ward nurses, intensive care nurses, nurse anaesthetists, ward physicians, and anaesthetists. A set of 24 on‐screen tasks were constructed. For each task, a label corresponding to an instruction consisting of two from three possible pieces of information (concentration, quantity, volume) had to be selected from a list of 10 items. The set was presented three times to participants using three different label formats. Format A provided two pieces of strength information different from those in the instruction. Format B and C provided all three pieces in a random and a fixed sequence, respectively. The frequency of errors was statistically higher with formats A and B than with format C, and greater in nurses than in anaesthetists. Regulatory bodies should therefore implement a standard requiring that the concentration (expressed in ‘mg.ml−1’), the amount and the volume of drug be displayed on medication labels in fixed locations.
A comparison of direct and indirect laryngoscopes and the ILMA in novice users: a manikin study
Authors: Maharaj C. H. , McDonnell J. G. , Harte B. H. , Laffey J. G. 
Published: October 2007

SummaryDirect laryngoscopic tracheal intubation using the Macintosh laryngoscope is taught to many healthcare professionals as it is a potentially life‐saving procedure. However, it is a difficult skill to acquire and maintain. Several alternative intubation devices exist that may provide a better view of the glottis and require less skill to use. We conducted a prospective, randomised trial of four different laryngoscopes and the ILMA in 30 medical students who had no prior airway management experience. The devices were tested in both normal and cervical immobilisation laryngoscopy scenarios. Following brief didactic instruction, each participant took turns performing laryngoscopy and intubation using each device under direct supervision. Each student was allowed up to three intubation attempts with each device, in each scenario. The Airtraq, McCoy, and the ILMA each demonstrated advantages over the Macintosh laryngoscope. In both the easy and difficult airway scenarios, the Airtraq, McCoy, and the ILMA reduced the number of intubation attempts, and reduced the number of optimisation manoeuvres required. The Airtraq and ILMA reduced the severity of dental trauma in both scenarios. The performance of the other devices studied was more variable. Overall, participants found that only the Airtraq was less difficult to use and they were more confident using it compared to the Macinosh laryngoscope.
Use of thromboelastography to demonstrate persistent anticoagulation after stopping enoxaparin*
Authors: Simons R. , Mallett S. V. 
Published: October 2007

SummaryPeri‐operative guidelines exist for neuraxial anaesthesia and anticoagulant therapy. We describe the use of thromboelastography to assess the coagulation status of a patient with moderate renal impairment who had been receiving enoxaparin and was being managed in accordance with current recommendations. This report demonstrates that current guidelines for discontinuing treatment with enoxaparin may not allow a sufficient safety margin in all patient groups and that thromboelastography is a useful tool in such situations.
Multiple system atrophy as a cause of upper airway obstruction
Authors: Lim Y. S. , Kennedy N. J. 
Published: October 2007

SummaryA patient presented to the ear, nose and throat department with inspiratory stridor, dysphagia and a sore throat. Clinical and radiological examination was normal. During induction of anaesthesia for a planned microlaryngoscopy, the patient developed complete upper airway obstruction that was overcome by applying positive pressure via a facepiece until awake. He subsequently developed respiratory failure, requiring mechanical ventilatory support. An elective tracheostomy was inserted for his symptoms. Neurological opinion confirmed the diagnosis of multiple system atrophy with akinetic rigid syndrome. We review this obscure condition and how it may occasionally present to anaesthetists.
A comparison of dexmedetomidine and midazolam for sedation in third molar surgery*
Authors: Cheung C. W. , Ying C. L. A. , Chiu W. K. , Wong G. T. C. , Ng K. F. J. , Irwin M. G. 
Published: October 2007

SummaryThis randomised, double‐blind study compared dexmedetomidine and midazolam for intravenous sedation during third molar surgery under local anaesthesia. Sixty patients received either dexmedetomidine (up to 1 μg.kg−1) or midazolam (up to 5 mg), which was infused until the Ramsay Sedation Score was four or the maximum dose limit was reached. Intra‐operative vital signs, postoperative pain scores and analgesic consumption, amnesia, and satisfaction scores for patients and surgeons, were recorded. Sedation was achieved by median (IQR (range)) doses of 47 μg (39–52 (25–76)) or 0.88 μg.kg−1 (0.75–1.0 (0.6–1.0)) dexmedetomidine, and 3.6 mg (3.3–4.4 (1.9–5.0)) or 0.07 mg.kg−1 (0.055–0.085 (0.017–0.12)) midazolam. Heart rate and blood pressure during surgery were lower in dexmedetomidine group. There was no significant difference in satisfaction or pain scores. Midazolam was associated with greater amnesia. Dexmedetomidine produces comparable sedation to midazolam.
Combining multiple comorbidities with Acute Physiology Score to predict hospital mortality of critically ill patients: a linked data cohort study
Authors: Ho K. M. , Finn J. , Knuiman M. , Webb S. A. R. 
Published: October 2007

SummaryWe investigated whether replacing the Acute Physiology and Chronic Health Evaluation (APACHE) II weighted comorbidity score with other measures of prior comorbidity would improve the prediction of hospital mortality in critically ill patients. Clinical data of 24 303 critically ill patients were linked to the Western Australian hospital morbidity database to identify prior comorbidities. Minor comorbidities as described in the Charlson comorbidity index and Elixhauser comorbidities were prevalent in critically ill patients. Among 24 303 admissions, 3615 (14.9%), 10 223 (42.1%), and 11 597 (47.7%) patients had at least one comorbidity as defined in the APACHE II score, Charlson comorbidity index, and Elixhauser comorbidities, respectively. The ability of comorbidity alone to discriminate between hospital survivors and non‐survivors was poor. Replacing the APACHE II weighted comorbidity score with other more comprehensive measures of comorbidity did not significantly improve the discrimination of the APACHE II score.
Evaluation of medication reviews conducted by community pharmacists: a quantitative analysis of documented issues and recommendations
Authors: Krska J. , Avery A. J. ,   The Community Pharmacy Medicines Management Project Evaluation Team
Published: October 2007

What is already known about this subject? • There is conflicting evidence concerning the potential benefits of pharmacist‐led medication review.• Little work has been published on the completeness of medication reviews provided by community pharmacists. What this study adds • The 60 community pharmacists taking part in a large randomized controlled trial showed considerable variation in the completeness of the reviews they recorded for intervention patients.• Overall, pharmacists recorded only a minority of the potential issues present in these patients.• The frequency with which pharmacists recorded issues was not related to key characteristics or to the number of reviews completed.AimsTo describe issues noted and recommendations made by community pharmacists during reviews of medicines and lifestyle relating to coronary heart disease (CHD), and to identify and quantify missed opportunities for making further recommendations and assess any relationships with demographic characteristics of the pharmacists providing the reviews.MethodsAll issues and recommendations noted by 60 community pharmacists during patient consultations were classified and quantified. Two independent reviewers studied a subsample of cases from every participating pharmacist and identified and classified potential issues from the available data. The findings of the pharmacists and the reviewers were compared. Relevant pharmacist characteristics were obtained from questionnaire data to determine relationships to the proportion of potential issues noted.ResultsA total of 2228 issues and 2337 recommendations were noted by the pharmacists in the 738 patients seen, a median of three per patient (interquartile range 2–4). The majority of the recommendations made (1719; 74%) related to CHD. In the subsample of 169 patients (23% of the total), the reviewers identified 1539 potential issues, of which pharmacists identified an average of 33.8% (95% confidence interval 30.1, 36.4). No relationship was found between the proportion of issues noted and potentially relevant factors such as pharmacists' characteristics and their experience of doing reviews.ConclusionsThe majority of issues and recommendations noted by pharmacists related to CHD, although pharmacists recorded only a minority of the issues identified by reviewers. Variation between pharmacists in the completeness of reviews was not explained by review or other relevant experience.
Identifying how age and gender influence prescription drug use in a primary health care environment in Catalonia, Spain
Authors: Fernández‐Liz Eladio , Modamio Pilar , Catalán Arantxa , Lastra Cecilia F. , Rodríguez Teresa , Mariño Eduardo L. 
Published: October 2007

What is already known about this subject • Knowledge of prescription patterns in primary health care is an important tool in rational drug therapy.• Age and gender are the principal determining factors of cost variability between medical practices, due to drug prescriptions.• Age and gender are the principal determining factors of cost variability in relation to the therapeutic group. What this study adds • This study provides specific information on the use of drugs in the primary health care environment of the Catalan Health System, and the differences observed are analyzed with respect to age and gender of the population receiving care.• The study shows that there is a high prevalence of drugs in the under 5 year old age group, and also in persons over 54 years of age.• The variability found in the cost per patient suggests that adjustment should be made for age in practitioners' prescription evaluation procedures in primary health care in Catalonia.AimsTo determine the prevalence and usage patterns of prescription drugs according to patients' age and gender, and to identify their relative importance in the prescription costs, in primary health care within the Catalan Health Institute.MethodsThis was a cross‐sectional study using computerized pharmacy dispensing records for 5 474 274 members registered, during 2002. Twenty age‐gender categories were established. Use of a drug group was defined as filling at least one prescription. The variables studied were age, gender, number of prescriptions and net cost. The prevalence of use, the number of prescriptions and cost issued to each age category were reported.ResultsThe overall prevalence of drug use was 74.53% (women 80.93%, men 67.84%). This was higher in the group of 0–4 year‐olds, and in the ≥ 55 year‐olds. Age (P < 0.001) produced a statistically more significant effect than gender (P < 0.05). The most used therapeutic groups were analgesics, nonsteroidal anti‐inflammatory drugs, antiulcer drugs, anxiolytics, expectorants and mucolytics. The number of prescriptions and costs per patient rose with age and showed great variation in the use of these groups for patients in different age groups. The risk of prescription in women was 23% higher than in men (RR 1.23, 95% CI 1.11, 1.37, P < 0.001).ConclusionsThe majority of subjects were exposed to one or more drugs. The variability in the number of prescriptions and in the prescribing cost per patient between the different age groups suggests that adjustments should be made for age in practitioners' prescription evaluation processes in primary health care in Catalonia.