69 results on '"Osman LM"'
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2. Patients' experience of asthma
- Author
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Osman, LM
- Published
- 2016
3. Reducing hospital admission through computer supported education for asthma patients. Grampian Asthma Study of Integrated Care (GRASSIC)
- Author
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Osman, LM, Abdalla, MI, Beattie, JA, Ross, SJ, Russell, IT, Friend, JA, Legge, JS, and Douglas, JG
- Abstract
OBJECTIVE: To evaluate a personalised computer supported education programme for asthma patients. DESIGN: Pragmatic randomised trial comparing outcomes over 12 months between patients taking part in an enhanced education programme (four personalised booklets, sent by post) and patients receiving conventional oral education at outpatient or surgery visits. SETTING: Hospital outpatient clinics and general practices in north east Scotland. SUBJECTS: 801 adults attending hospital outpatient clinics, with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. MAIN OUTCOME MEASURES: Numbers of hospital admissions, consultations with general practitioner for asthma, steroid courses used, bronchodilators and inhaled steroids prescribed, days of restricted activity, and disturbed nights. RESULTS: Patients with asthma judged too severe for randomisation between clinic care and integrated care and thus retained in clinic care had 54% fewer hospital admissions after receiving enhanced education than did the control group (95% confidence interval 30% to 97%; P < 0.05) over the study year. Patients had not all spent a full year as "educated" patients within the study year: when "educated days" were controlled for, annual admission rates for the entire enhanced education group were 49% (31% to 78%) of those in the control group. Among patients with sleep variation, sleep disturbance in the education group in the week before a regular review was 80% (65% to 97%) of that in the control group. There was no significant difference in days of restricted activity, prescription of bronchodilators or inhaled steroids, use of oral steroids, or number of general practitioner consultations for asthma, and no significant interaction between ownership of a peak flow meter and education. CONCLUSIONS: An asthma education programme based on computerised booklets can reduce hospital admissions and improve morbidity among hospital outpatients.
- Published
- 2016
4. Minor illness education for parents of young children
- Author
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Robbins, H, Hundley, V, and Osman, LM
- Abstract
BACKGROUND: A number of previous studies on minor illness have concentrated on nurse-led clinics and the role of nurse practitioners. This study examines the effect of a minor illness education programme which aimed to increase parents' confidence and knowledge in managing childhood illnesses. AIM: The primary aim of this study was to evaluate the effectiveness of a home visit and booklet in providing education to parents about minor infant illnesses. DESIGN: A randomized controlled trial was conducted. The intervention involved a home visit to discuss parents' concerns and provide advice and information, and a booklet advising parents what to do and when to consult about infant illnesses. METHOD: A total of 120 parents of 6 week old babies were identified over a 6 month period, using health visitors' caseloads, and randomized to an intervention group (60), that received a visit and a booklet, or a control group (60) that received standard care. Groups were compared on entry to the study and at 7 months, in terms of parental knowledge and confidence about childhood illnesses, the intended use of home care activities, intention to consult professionals and actual use of health services. Data were collected by self-completed questionnaire and case note review. FINDINGS: The educational intervention resulted in a reduction in visits to the child health clinic but had little effect on use of other services. Parents in the intervention group showed a general trend towards greater certainty about the home care options they would choose, and a reduction in intention to consult a doctor. However, they also indicated a feeling of reduced confidence and knowledge. CONCLUSION: The trial showed no effect on use of services but did demonstrate reduction in parents' intentions to consult a doctor, which appeared to be because of increased certainty about home care. However, it is of concern that they indicated feeling less confident and knowledgeable. It is not possible to clarify whether this represented anxiety that was constructive, enhancing decision-making or was destructive. Further work into the role of education in parental decision-making, anxiety levels and enhancement of confidence is required.
- Published
- 2016
5. Treatment of sleep apnoea/hypopnoea syndrome (SAHS): A randomised trial of standard care versus enhanced nurse intervention in a district general hospital
- Author
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Palmer, S, Selvaraj, S, Dunn, C, Osman, LM, Cairns, J, Franklin, D, Hulks, G, and Godden, DJ
- Published
- 2016
6. Parents' quality of life and respiratory symptoms in young children with mild wheeze
- Author
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Osman, LM, Baxter-Jones, ADG, Helms, PJ, and Grp, EASES
- Subjects
Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Asthma symptoms ,medicine.disease ,Clinical trial ,Quality of life (healthcare) ,El Niño ,Parental anxiety ,Wheeze ,medicine ,Respiratory sounds ,medicine.symptom ,business ,Asthma - Abstract
The Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), measures the impact of child asthma symptoms on family activity (CGAct) and parental anxiety (CGEmot). It has not been validated for families of children On entry, mothers ≤30 yrs had worse scores than those >30 (pIt is concluded that the Paediatric Asthma Caregiver's Quality of Life Questionnaire is sensitive to group measures of child symptom change over 3 months, among preschool children, and this supports its use as an outcome measure in clinical trials. The absolute impact of child symptoms on parent quality of life varies among parents.
- Published
- 2001
7. Attitudes to fertility issues among adults with cystic fibrosis in Scotland
- Author
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Fair, A, Griffiths, K, Osman, LM, and Collaborative, GSAC
- Subjects
Pulmonary and Respiratory Medicine ,Infertility ,Response rate (survey) ,medicine.medical_specialty ,Pregnancy ,business.industry ,media_common.quotation_subject ,Early adolescence ,Fertility ,medicine.disease ,Cystic fibrosis ,Collaborative group ,Endocrinology ,Family medicine ,Internal medicine ,medicine ,Life expectancy ,business ,media_common - Abstract
BACKGROUND—With increasing life expectancy, issues of fertility and pregnancy are pertinent to patients with cystic fibrosis. For this reason, the four Scottish Cystic Fibrosis centres asked men and women with cystic fibrosis about their attitudes to fertility and to information given to them by health professionals. METHODS—A postal questionnaire was sent to 116 men and 79 women aged 16 years and over attending four Scottish Cystic Fibrosis clinics. RESULTS—There was a 70% response rate (82 men, 54 women). All but two men knew that they were likely to be infertile. 37% of respondents lived with a partner; 14 women (26%) and five men (6%) had children. For 85% of men and 72% of women having children was important now or would be in the next 10 years. 43% of men and 26% of women had never had any discussion on fertility issues with cystic fibrosis health professionals. 56% of men thought that first discussion with a health professional about infertility should be before the age of 16 years; 12% remembered having a first discussion at that age. Learning of their infertility was associated with strong negative emotions for most men. Women were more likely than men to have initiated first discussion (17 (32%) versus eight (10%); p
- Published
- 2000
8. Integrated care for asthma: matching care to the patient
- Author
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Osman, LM, primary, Abdalla, MI, additional, Russell, IT, additional, Fiddes, J, additional, Friend, JA, additional, Legge, JS, additional, and Douglas, JG, additional
- Published
- 1996
- Full Text
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9. Factors influencing dispensing of psychotropic medications to patients with asthma: a community pharmacy-based survey.
- Author
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Laforest L, Van Ganse E, Devouassoux G, Osman LM, Pison C, El Hasnaoui A, Bauguil G, and Chamba G
- Published
- 2008
- Full Text
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10. Asthmatic patients' poor awareness of inadequate disease control: a pharmacy-based survey.
- Author
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Laforest L, Van Ganse E, Devouassoux G, Osman LM, Brice K, Massol J, Bauguil G, and Chamba G
- Published
- 2007
11. Minor illness education for parents of young children.
- Author
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Robbins H, Hundley V, and Osman LM
- Abstract
Background. A number of previous studies on minor illness have concentrated on nurse-led clinics and the role of nurse practitioners. This study examines the effect of a minor illness education programme which aimed to increase parents' confidence and knowledge in managing childhood illnesses.Aim. The primary aim of this study was to evaluate the effectiveness of a home visit and booklet in providing education to parents about minor infant illnesses.Design. A randomized controlled trial was conducted. The intervention involved a home visit to discuss parents' concerns and provide advice and information, and a booklet advising parents what to do and when to consult about infant illnesses.Method. A total of 120 parents of 6 week old babies were identified over a 6 month period, using health visitors' caseloads, and randomized to an intervention group (60), that received a visit and a booklet, or a control group (60) that received standard care. Groups were compared on entry to the study and at 7 months, in terms of parental knowledge and confidence about childhood illnesses, the intended use of home care activities, intention to consult professionals and actual use of health services. Data were collected by self-completed questionnaire and case note review.Findings. The educational intervention resulted in a reduction in visits to the child health clinic but had little effect on use of other services. Parents in the intervention group showed a general trend towards greater certainty about the home care options they would choose, and a reduction in intention to consult a doctor. However, they also indicated a feeling of reduced confidence and knowledge.Conclusion. The trial showed no effect on use of services but did demonstrate reduction in parents' intentions to consult a doctor, which appeared to be because of increased certainty about home care. However, it is of concern that they indicated feeling less confident and knowledgeable. It is not possible to clarify whether this represented anxiety that was constructive, enhancing decision-making or was destructive. Further work into the role of education in parental decision-making, anxiety levels and enhancement of confidence is required. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
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12. Newer approaches to gemcitabine-based therapy of pancreatic cancer: fixed-dose-rate infusion and novel agents.
- Author
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Edwards CA, Osman LM, Godden DJ, Douglas JG, and Hochster, Howard S
- Abstract
To review the use of gemcitabine-based therapy in pancreatic cancer, including fixed-dose-rate (FDR) infusion and novel combinations. On the basis of pharmacokinetic data, studies have been performed using an FDR of gemcitabine of 10 mg/m(2)/min in an effort to maintain a critical plasma concentration of gemcitabine, and thus increase tumor cytotoxicity and therapeutic efficacy. The dose-limiting toxicities in Phase I studies were mucositis and myelosuppression. A multicenter Phase II study compared two schedules of gemcitabine in patients with pancreatic cancer, a single dose of 2200 mg/m(2) infused for 30 min, and a constant infusion of 1500 mg/m(2) given at 10 mg/m(2)/min. A somewhat improved response rate and survival for the FDR arm compared with the 30-min-infusion arm was observed. In addition, a wide variety of new compounds targeting specific molecules involved in cell control, cell growth, and apoptosis have been used in combination with gemcitabine and are reviewed. Further development of FDR gemcitabine in combination with other chemotherapeutic agents is ongoing. Because none of the new compounds investigated has as yet shown improvement compared with single-agent gemcitabine in prospectively randomized trials, gemcitabine remains the standard of care in pancreatic cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2003
13. Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial.
- Author
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Lennox AS, Osman LM, Reiter E, Robertson R, Friend J, McCann I, Skatun D, and Donnan PT
- Published
- 2001
- Full Text
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14. Adult asthma review in general practice: nurses' perception of their role.
- Author
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Roberston, R, Osman, LM, and Douglas, JG
- Abstract
Background. Asthma clinics have become widespread in general practice with nurses now playing an important role in asthma review. However, little is known about training of nurses carrying out reviews and how this affects the nurse role in patient management. [ABSTRACT FROM PUBLISHER]
- Published
- 1997
15. Clinical and Diagnostic Aspects of Diabetic Nephropathy
- Author
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Sabour Ms, Osman Lm, and El-Mahallawy Mn
- Subjects
medicine.medical_specialty ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Diabetes Complications ,Diabetic nephropathy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Diabetic Nephropathies ,Kidney Diseases ,030212 general & internal medicine ,business ,Diabetes Mellitus Complications - Published
- 1960
16. A randomised trial of home energy efficiency improvement in the homes of elderly COPD patients.
- Author
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Osman LM, Ayres JG, Garden C, Reglitz K, Lyon J, and Douglas JG
- Subjects
- Aged, Aging, Female, Heating, Housing, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Pulmonary Disease, Chronic Obstructive therapy, Quality of Life, Residence Characteristics, Scotland, Conservation of Natural Resources, Energy-Generating Resources, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
A randomised trial of 178 patients in Aberdeen, UK with a previous hospital admission for chronic obstructive pulmonary disease (COPD) was carried out in order to determine whether improving home energy efficiency improves health-related quality of life in COPD patients. 118 patients were randomised and 60 agreed to monitoring only. Energy efficiency upgrading was carried out in 42% of homes randomised to intervention. Independent energy efficiency action was taken by 15% of control participants and 18% in the monitoring group. The main outcome measures were respiratory and general health status, home energy efficiency and hospital admissions. Intention-to-treat analysis found no difference in outcomes between the two groups. In 45 patients, who had energy efficiency action independent of original randomisation, there were significant improvements in respiratory symptom scores (adjusted mean 9.0, 95% CI 2.5-15.5), decreases in estimated annual fuel costs (- pound65.3, 95% CI - pound31.9- - pound98.7) and improved home energy efficiency rating (1.1, 95% CI 0-1.4). COPD patients are unlikely to take up home energy efficiency upgrading, if offered. Secondary "pragmatic" analysis suggests that those who do take action may achieve clinically significant improvement in respiratory health, which is not associated with an increase in indoor warmth.
- Published
- 2010
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17. Asthma patients' self-reported behaviours toward inhaled corticosteroids.
- Author
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Laforest L, El Hasnaoui A, Pribil C, Ritleng C, Osman LM, Schwalm MS, Le Jeunne P, and Van Ganse E
- Subjects
- Administration, Inhalation, Adolescent, Adult, Aged, Asthma drug therapy, Cross-Sectional Studies, Female, Health Behavior, Humans, Male, Middle Aged, Surveys and Questionnaires, Truth Disclosure, Young Adult, Adrenal Cortex Hormones administration & dosage, Anti-Asthmatic Agents administration & dosage, Asthma psychology, Medication Adherence psychology
- Abstract
Background: Patient adherence to recommended use of ICS is questionable in asthma, with irregular use or interruptions occurring frequently. Factors explaining discontinuation of controller therapy could orientate interventions. The characteristics of patients with interruptions of inhaled corticosteroids (ICSs), intentional or accidental, were investigated., Methods: Asthma patients regularly prescribed ICS by GPs (Cegedim network) were included. Patients' characteristics and behaviours toward ICS (accidental/intentional interruptions, less frequent use of ICS and change in dosing) were identified from self-report questionnaires, and linked to data prescription database. Interrelations between declared behaviours toward ICS were studied with a Multiple Component Analysis (MCA) and the correlates of ICS interruptions were identified., Results: During the past 3 months, 31.6% of 204 patients (mean age: 53.8 years, females: 59.3%) intentionally interrupted ICS when feeling better, 25.4% forgot ICS and 18.3% deliberately changed the doses. A quarter of patients considered constant use of respiratory medicines as unhealthy. MCA revealed that intentional, accidental interruptions and less frequent use of ICS were closely correlated. Risk of intentional interruption was increased when patients considered constant use of respiratory therapy to be unhealthy (OR=3.36, 95%CI=[1.47-7.66]). Conversely, risk was significantly lower when ICS was associated or combined with another controller (OR=0.24, 95%CI=[0.08-0.73]), compared to ICS in monotherapy. Less frequent interruptions were observed in patients older than 65 (OR=0.35, 95%CI=[0.13-0.89])., Conclusions: Our study suggests that discontinuation of use of controllers is associated with other inadequate behaviours or beliefs about inhaled controllers. Efforts should be targeted at patients' perceptions and behaviours toward controller therapy.
- Published
- 2009
- Full Text
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18. Home warmth and health status of COPD patients.
- Author
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Osman LM, Ayres JG, Garden C, Reglitz K, Lyon J, and Douglas JG
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- Aged, Cross-Sectional Studies, Female, Forced Expiratory Volume, Humans, Male, Smoking, Socioeconomic Factors, Temperature, Health Status, Heating, Housing, Microclimate, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
Background: Home Energy Efficiency guidelines recommend domestic indoor temperatures of 21 degrees C for at least 9 h per day in living areas. Is health status of patients with Chronic Obstructive Pulmonary Disease (COPD) associated with maintaining this level of warmth in their homes?, Methods: In a cross-sectional observational study of patients, living in their own homes, living room (LR) and bedroom (BR) temperatures were measured at 30 min intervals over 1 week using electronic dataloggers. Health status was measured with the St George's Respiratory Questionnaire (SGRQ) and EuroQol: EQ VAS. Outdoor temperatures were provided by Met Office., Results: One hundred and forty eight patients consented to temperature monitoring. Patients' mean age was 69 (SD 8.5) years, 67 (45%) male, mean percentage of predicted Forced Expiratory Volume in one second (FEV(1)) 41.7 (SD 17.4). Fifty-eight (39%) were current smokers. Independent of age, lung function, smoking and outdoor temperatures, poorer respiratory health status was significantly associated (P = 0.01) with fewer days with 9 h of warmth at 21 degrees C in the LR. A sub analysis showed that patients who smoked experienced more health effects than non-smokers (P < 0.01)., Conclusion: Maintaining the warmth guideline of 21 degrees C in living areas for at least 9 h per day was associated with better health status for COPD patients. Patients who were continuing smokers were more vulnerable to reduction in warmth.
- Published
- 2008
- Full Text
- View/download PDF
19. Dispensing of antibiotics, antitussives and mucolytics to asthma patients: a pharmacy-based observational survey.
- Author
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Laforest L, Van Ganse E, Devouassoux G, El Hasnaoui A, Osman LM, Bauguil G, and Chamba G
- Subjects
- Adolescent, Adult, Anti-Asthmatic Agents adverse effects, Anti-Bacterial Agents adverse effects, Antitussive Agents adverse effects, Asthma complications, Female, Guideline Adherence standards, Humans, Male, Middle Aged, Multivariate Analysis, Polypharmacy, Practice Guidelines as Topic, Treatment Refusal, Anti-Asthmatic Agents administration & dosage, Anti-Bacterial Agents administration & dosage, Antitussive Agents administration & dosage, Asthma drug therapy
- Abstract
Background: Antibiotics, antitussives and mucolytics are commonly used in asthma, despite limited evidence for their effectiveness. The correlates of use for these medication classes in asthma were identified., Methods: Asthma patients aged 18-50 who were regular customers of pharmacies were included in an observational study. Patients completed a questionnaire, which was complemented by computerised pharmacy records of previously dispensed medications. Users of each drug class were compared to non-users in terms of demographics, asthma characteristics and management., Results: Among 886 patients (mean age: 37; 55% females), 63.2%, 55.8% and 27.2%, respectively, were users of antibiotics, mucolytics and antitussives during the previous 12 months. In multivariate analysis, dispensing of >2 units of oral corticosteroids was the major correlate of receiving antibiotics (OR=5.47; 95% CI=[3.00-9.97]), mucolytics (OR=3.93; 95% CI=[2.38-6.50]) and antitussives (OR=1.86; 95% CI=[1.18-2.94]). Compared to well-controlled patients, the probability of receiving antibiotics was significantly higher for poorly controlled patients (OR=2.01; 95% CI=[1.28-3.15])., Conclusions: Our results suggest that these drugs are mainly used during asthma exacerbations. A better understanding of the use of co-medication in asthma is required.
- Published
- 2008
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- View/download PDF
20. Indoor air quality in homes of patients with chronic obstructive pulmonary disease.
- Author
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Osman LM, Douglas JG, Garden C, Reglitz K, Lyon J, Gordon S, and Ayres JG
- Subjects
- Aged, Air Pollution, Indoor adverse effects, Dust analysis, Endotoxins analysis, Female, Humans, Male, Nitrogen Dioxide analysis, Particle Size, Pulmonary Disease, Chronic Obstructive etiology, Regression Analysis, Scotland epidemiology, Smoking adverse effects, Smoking epidemiology, Tobacco Smoke Pollution adverse effects, Air Pollution, Indoor analysis, Health Status, Pulmonary Disease, Chronic Obstructive epidemiology, Residence Characteristics, Tobacco Smoke Pollution analysis
- Abstract
Rationale: Outdoor air quality is associated with respiratory morbidity and mortality. Less is known of the relationship of indoor air quality to respiratory health of groups vulnerable to outdoor air, such as those with chronic obstructive pulmonary disease (COPD)., Objectives: To investigate among patients with COPD the association of health status with indoor air quality in their homes., Methods: Observational study of indoor environmental characteristics of homes of 148 patients with severe COPD in North East Scotland., Measurements and Main Results: Airborne living room levels of particulate matter with a diameter of 2.5 microm or less (PM(2.5)) (microg/m(3)) were measured over 8 to 14 hours using DustTrak monitors. Nitrogen dioxide exposure (ppb) in living rooms was measured over 1 week. Endotoxin (EU [endotoxin units]/mg) in living room dust was measured. Health status of participants was assessed by the St. George's Respiratory Health Questionnaire (symptoms, activity limitation, and disease impact). The mean age of participants was 69 years. Approximately 45% were male, 39% were smokers, and 49% lived in smoking households. Average indoor PM(2.5) levels were 18 mug/m(3), nitrogen dioxide was 7.8 ppb, and endotoxin levels were 95.8 EU/mg of dust. PM(2.5) was significantly higher in smoking households (P < 0.001) and was associated with higher levels of endotoxin and NO(2). PM(2.5) was significantly associated with increased symptom burden (P < 0.01), with greater effect for current smokers. Endotoxin and nitrogen dioxide exposure were not related to health status., Conclusions: Higher levels of PM(2.5) are associated with worse health status of these patients with severe COPD. Indoor levels of PM(2.5) are significantly higher in homes with smokers.
- Published
- 2007
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21. Patient-reported adverse events under asthma therapy: a community pharmacy-based survey.
- Author
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Laforest L, Van Ganse E, Devouassoux G, Osman LM, Bauguil G, and Chamba G
- Subjects
- Administration, Oral, Adolescent, Adrenal Cortex Hormones administration & dosage, Adrenal Cortex Hormones adverse effects, Adrenal Cortex Hormones therapeutic use, Adult, Anti-Asthmatic Agents administration & dosage, Anti-Asthmatic Agents therapeutic use, Arrhythmias, Cardiac chemically induced, Fatigue chemically induced, Female, France, Histamine H1 Antagonists administration & dosage, Histamine H1 Antagonists adverse effects, Histamine H1 Antagonists therapeutic use, Humans, Male, Middle Aged, Multivariate Analysis, Self Disclosure, Treatment Outcome, Anti-Asthmatic Agents adverse effects, Asthma drug therapy, Community Pharmacy Services statistics & numerical data, Surveys and Questionnaires
- Abstract
The characteristics of patients who report adverse events (AEs) attributed to asthma therapy have been little investigated. Asthma patients aged 18-50 years were surveyed in pharmacies. Patients completed a questionnaire linked to computerized records of dispensed medications. Patients reported all AEs that they attributed to asthma therapy. The correlates of reporting 2+ AEs were identified. Almost 59% of the 1,351 patients (mean age: 37, 56% females) attributed AEs to asthma therapy, and 35% at least two. Most common AEs included tiredness (21.8%) and palpitations (21.1%). Poor asthma control and perception of asthma as a handicap were the major correlates of reporting 2+ AEs (odds ratio (OR)=2.5, 95% confidence interval (CI)=[1.7-3.7] and OR=1.9, 95% CI=[1.4-2.5]). Other significant correlates included age >30 years, female gender, and receiving psychotropic therapy. Inadequate control may partly account for AEs attributed by patients to asthma therapy. Improving patients' education may help to improve acceptability of asthma therapy.
- Published
- 2007
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- View/download PDF
22. Health status of professional divers and offshore oil industry workers.
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Ross JA, Macdiarmid JI, Osman LM, Watt SJ, Godden DJ, and Lawson A
- Subjects
- Absenteeism, Health Surveys, Humans, Male, Middle Aged, Occupational Diseases epidemiology, Prevalence, Quality of Life, Diving, Extraction and Processing Industry, Health Status, Occupational Health, Petroleum
- Abstract
Aims: To compare the health status of UK professional divers and age-matched non-divers and to contrast offshore divers (OSDs) with non-offshore divers (NOSDs)., Methods: A postal survey sent to 2958 male professional divers, registered with the UK Health & Safety Executive (HSE) before 1991, and 2708 men who had worked in the offshore oil industry in 1990-92 (non-divers). The questionnaire addressed lifestyle, occupation and health status., Results: In all, 56% of divers and 51% of non-divers responded. Three per cent of participants reported ill-health retirement or being off-work on sickness benefit with no difference between groups. Divers were less likely to report asthma or hypertension. Health-related quality of life (SF-12) was within normal limits for both groups but the mental component summary was higher in divers who were also less likely to be receiving medical treatment. Divers were more likely than non-divers to report 'forgetfulness or loss of concentration' (18% versus 6%, OR 3.8, 95% CI 2.7-5.3), musculoskeletal symptoms (41% versus 34%, OR 3.8, 95% CI 2.7-5.3) and 'impaired hearing' (16% versus 11%, OR 1.6, 95% CI 1.2-2.0). These differences were attributable to increased symptom reporting in OSDs and were not present for NOSDs, with the exception of cognitive symptomatology which was commoner in both OSDs (22%, OR 4.8, 95% CI 3.4-6.8) and NOSDs (9%, OR 1.9, 95% CI 1.1-3.3) than in non-divers (6%)., Conclusions: There was increased symptom reporting in OSDs. However, there was no evidence to suggest any major impact on long-term health of UK divers who had started their career before 1991.
- Published
- 2007
- Full Text
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23. Increases in asthma hospital admissions associated with the end of the summer vacation for school-age children with asthma in two cities from England and Scotland.
- Author
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Julious SA, Osman LM, and Jiwa M
- Subjects
- Adolescent, Child, Child, Preschool, England epidemiology, Female, Humans, Male, Scotland epidemiology, Seasons, Asthma epidemiology, Patient Admission statistics & numerical data, Schools statistics & numerical data
- Abstract
In school-age asthmatics, an increase in hospitalizations has been reported in early autumn. This increase in admissions is conjectured to be associated with the return back to school. In the UK schools in England complete their summer vacations 2 weeks later than in Scotland and so there should be a lag between the two countries in the increase in asthma episode. Daily hospital asthma admission data from Aberdeen (in Scotland) and Doncaster (in England) for the period July 23rd to October 8th for years 1999-2004 were included in the analysis. There are peaks in hospitalization after the return back to school for both Aberdeen and Doncaster with the peak for Doncaster appearing 2 weeks after Aberdeen. This study has demonstrated peaks in admissions in school-age children around the return back to school in two cities where different school return dates were reflected in a 2-week lag effect. These data therefore provide strong evidence that peaks in admissions are associated with the end of the summer holidays.
- Published
- 2007
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24. Objective neuropsychological test performance of professional divers reporting a subjective complaint of "forgetfulness or loss of concentration".
- Author
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Taylor CL, Macdiarmid JI, Ross JA, Osman LM, Watt SJ, Adie W, Crawford JR, and Lawson A
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- Adult, Aged, Case-Control Studies, Diving physiology, Humans, Male, Memory Disorders physiopathology, Middle Aged, Multivariate Analysis, Neuropsychological Tests, Wechsler Scales, Diving adverse effects, Memory Disorders etiology
- Abstract
Objective: This study attempted to determine whether the higher prevalence of reported "forgetfulness or loss of concentration" among professional divers can be confirmed using objective neuropsychological tests. Secondary aims were to qualify the functional nature of the complaints and to ascertain whether reduced performance was linked to diving history., Methods: In a case-control study, the neuropsychological test performance of divers complaining of moderate or severe "forgetfulness or loss of concentration" was compared with two age-matched control groups reporting no or slight "forgetfulness or loss of concentration" ("nonforgetful" divers and "nonforgetful" nondivers). The group differences were analyzed using a multivariate analysis of co-variance, followed by canonical discriminant function analysis. Altogether 102 divers with a complaint, 100 nonforgetful divers, and 100 nonforgetful nondivers completed the study., Results: The overall neuropsychological performance differed significantly between the groups [Pillai's trace: F(24,484)=2.04, P=0.003]. Verbal memory (Logical Memory and the California Verbal Learning Test), current intelligence (Wechsler Abbreviated Scale of Intelligence), and sustained attention (rapid visual processing) were poorer among the divers with a complaint than among the nonforgetful divers or the nonforgetful nondivers. The tests of memory, but not those of executive function, differentiated the divers with complaints from the two control groups. Mixed gas bounce diving and surface oxygen decompression diving, but not other techniques, were negatively associated with memory performance., Conclusions: A cognitive complaint of divers was confirmed using objective tests of neuropsychological performance. Memory, rather than executive function, was affected at the group level, but only to a mild degree. The relationships between diving experience and neuropsychological test performance were small and only seen with diving techniques used in the offshore oil and gas industry.
- Published
- 2006
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25. Results of a national asthma campaign survey of primary care in Scotland.
- Author
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Hoskins G, McCowan C, Donnan PT, Friend JA, and Osman LM
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- Child, Health Care Surveys, Humans, Practice Guidelines as Topic, Scotland, Surveys and Questionnaires, Asthma therapy, Attitude of Health Personnel, Child Health Services standards, Family Practice standards, Guideline Adherence statistics & numerical data, Medical Audit, Primary Health Care standards, Process Assessment, Health Care
- Abstract
Objective: To identify within primary care in Scotland how far procedures for asthma review and patient education match guideline recommendations., Design and Setting: Telephone survey of a one in four stratified random sample of all 1058 general practices in Scotland., Participants: Practice nurses, general practitioners., Main Outcome Measures: Number of practices matching guideline recommendations for asthma review, targeting of care, use of structured asthma records, provision of management plans, education, and regular audit., Results: Of 276 general practices contacted 91% (251) completed the questionnaire; 93% (228) ran an asthma review service; 74% (166) employed a specially trained asthma nurse; 39% (106) had a policy for providing action plans; 63% (155) had carried out an asthma audit in the previous 3 years; 76% (218) used a structured tool in consultations, 46% with use of computer technology, 34% used only a manual stamp. Sixty-six per cent (173) had searched for patients overusing beta2 agonists; 32% (79) had searched for patients on medication treatment step 3 and above. Single- or two-partner practices were less likely to follow guideline recommendations but neither rurality nor deprivation was related to guideline compliance., Conclusions: Three-quarters of Scottish general practices have trained asthma nurses and offer patients asthma review, but only a minority have proactive care procedures for targeting patients or a policy for providing patients with action plans. Practice systems are underused for identifying 'at-risk' patients. There is a need for proactive procedures and provision of self-management materials to patients. Access to trained asthma nurses needs to be improved.
- Published
- 2005
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26. True device compliance: the need to consider both competence and contrivance.
- Author
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Brennan VK, Osman LM, Graham H, Critchlow A, and Everard ML
- Subjects
- Administration, Inhalation, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Humans, Infant, Middle Aged, Nebulizers and Vaporizers, Self Administration methods, Self Administration standards, Anti-Asthmatic Agents administration & dosage, Asthma drug therapy, Glucocorticoids administration & dosage, Health Knowledge, Attitudes, Practice, Patient Compliance
- Abstract
Inability to use inhalers effectively is known to adversely affect the delivery of drug. It is assumed that increasing competence to use inhalers will lead to improved drug delivery. However many subjects appear competent (are able to use a device effectively) but contrive to use the device in a sub-optimal way in routine use. This study aimed to explore levels of True device compliance, that is the extent to which devices are used effectively in routine use, and to explore the influences of age and device on this parameter. The ability of 53 asthmatic patients aged 1-88 years to use their corticosteroid inhaler was assessed by a single investigator. In addition information regarding patient behaviour in routine practice was explored in a structured interview. True device compliance was defined to occur when a subject was rated competent and did not report contrivance. Competence was related to device type. All subjects using a holding chamber [pMDI + HC] (N = 21) or breath activated inhaler (N = 5) could demonstrate an adequate technique compared with only 9 (47%) of those prescribed a pMDI. However only 4 (19%) prescribed a pMDI + HC were true device compliant with the majority regularly using the pMDI alone while (42%) of those prescribed a pMDI were True device compliant. Since 82% of patients over 65 were prescribed pMDI alone, and 92% of patients up to 5 years were prescribed pMDI + HC, True device compliance was low among both groups. Only 33% of patients over 65 prescribed pMDIs were able to use them competently. Lack of competence, particularly in the elderly, and contrivance, particularly common amongst those using holding chambers, are two important but independent impediments to effective inhaled therapy.
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- 2005
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- View/download PDF
27. GP discussion of prognosis with patients with severe chronic obstructive pulmonary disease: a qualitative study.
- Author
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Halliwell J, Mulcahy P, Buetow S, Bray Y, Coster G, and Osman LM
- Subjects
- Adult, Female, Humans, Male, Middle Aged, New Zealand, Prognosis, Communication, Family Practice, Physician-Patient Relations, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Background: Recent research shows that health professionals do not communicate about prognosis with patients with chronic obstructive pulmonary disease (COPD) as openly as with patients who have cancer., Aim: To identify strategies that general practitioners (GPs) can use to facilitate discussion of prognosis with patients who have COPD., Design of Study: Telephone interviews of 15 GPs and five respiratory consultants on the topic of discussing prognosis with patients who have severe COPD., Setting: Participating doctors worked in the Auckland region of New Zealand., Method: GPs and consultants were selected purposively to detect unique and shared patterns from diversity in how prognosis is discussed with patients with severe COPD. An interview guide was developed from a literature review and results of our earlier postal survey of GPs. Transcripts of audiotaped interviews were analysed independently and then together by three authors, using a general inductive approach., Results: Seven strategies were identified that GPs had used or could use to facilitate discussion of prognosis with patients with COPD. These were: be aware of implications of diagnosis; use uncertainty to ease discussion; build relationship with patients; be caring and respectful; begin discussion early in disease course; identify and use opportunities to discuss prognosis; and work as a team., Conclusion: A number of suggested strategies can be used to facilitate discussion of prognosis with patients who have severe COPD.
- Published
- 2004
28. Implementing asthma education programmes in paediatric respiratory care: settings, timing, people and evaluation.
- Author
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Osman LM and Calder C
- Subjects
- Adolescent, Asthma diagnosis, Child, Humans, Parents, Pediatrics, Time Factors, Asthma therapy, Patient Education as Topic organization & administration
- Abstract
Randomised controlled trials have shown that asthma education programmes in paediatric care can improve the ability of children and their parents to control their asthma. This paper discusses the implementation of asthma education within pragmatic care. Key times for implementation are suggested: at the initial diagnosis, after acute asthma events such as hospitalisation, at the time of medication change and at regular review. Special issues, such as implementing programmes for teenagers, are discussed. Evaluation is recommended for processes (does the practice have an agreed protocol for education, does it have a key person with responsibility for co-ordinating education within the clinic or practice, does it have agreed outcomes for audit of education?). Evaluation is also recommended for individual outcomes (clinical improvement and increase in perceived asthma control and confidence in management).
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- 2004
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29. Annual review of patients with sleep apnea/hypopnea syndrome--a pragmatic randomised trial of nurse home visit versus consultant clinic review.
- Author
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Palmer S, Selvaraj S, Dunn C, Osman LM, Cairns J, Franklin D, Hulks G, and Godden DJ
- Subjects
- Annual Reports as Topic, Female, Home Nursing economics, House Calls economics, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Positive-Pressure Respiration economics, Positive-Pressure Respiration methods, Sleep Apnea Syndromes economics, Sleep Apnea Syndromes epidemiology, Surveys and Questionnaires, Home Nursing statistics & numerical data, House Calls statistics & numerical data, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes therapy, Utilization Review
- Abstract
Background: This pragmatic randomised, controlled trial investigated annual review of patients with sleep apnea/hypopnea syndrome (SAHS). Clinical outcomes and costs were compared for consultant clinic review versus specialist nurse home visit., Method: One hundred and seventy-four patients were randomised to annual review by consultant clinic appointment or by specialist nurse home visit. SAHS symptoms, Epworth score, hospital anxiety and depression scale (HADS), Short Form-36 (SF-36) and hours of use of constant positive airway pressure (CPAP) were measured before and 3 months after review. The costs and patient preference for review were determined., Results: After review, both groups significantly increased CPAP use (mean (SD) increase: nurse, 0.66 (1.71) h; consultant, 0.45 (1.69) h) and reduced symptom scores (nurse, -2 (7); consultant, -3 (9)), compared to baseline. There were no differences between groups in these improvements, or in HADS or SF-36 scores. Average duration of a nurse home visit, excluding travel time, was 26 (6) min. Total NHS cost per visit was 52.26 UK pounds (49.85) ($83.62 (79.76)), of which 6.57 UK pounds (1.43) ($10.51 (2.29)) reflected time spent with the patient and the remainder was travel cost. Average duration of consultant review was 10 (6) min, total NHS cost 6.21 UK pounds (3.99) ($9.94 (6.38)). However, the cost to the patient of attending the clinic was 23.63 UK pounds (23.21) ($37.81 (37.13)). Patient preference for review was nurse 16%, consultant 19%, and no preference 65%., Conclusion: Following annual review, use of CPAP increased and symptoms improved. Outcomes were similar for consultant and nurse led review. Home visits were expensive for the healthcare provider, whereas clinic attendance incurred substantial costs to the patient. The majority of patients would accept nurse review for their sleep apnea management.
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- 2004
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30. Relationship between birth weight and adult lung function: controlling for maternal factors.
- Author
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Edwards CA, Osman LM, Godden DJ, Campbell DM, and Douglas JG
- Subjects
- Adult, Body Height, Body Weight, Cohort Studies, Female, Forced Expiratory Volume physiology, Gestational Age, Humans, Infant, Newborn, Lung Diseases physiopathology, Male, Maternal Age, Maternal Exposure, Middle Aged, Parity, Pregnancy, Prenatal Exposure Delayed Effects, Retrospective Studies, Smoking adverse effects, Smoking physiopathology, Tobacco Smoke Pollution, Vital Capacity physiology, Birth Weight, Lung Diseases embryology
- Abstract
Background: There is conflicting evidence on the "fetal origins hypothesis" of association between birth weight and adult lung function. This may be due to failure to control for confounding maternal factors influencing birth weight. In the present study access to birth details for adults aged 45-50 years who were documented as children to have asthma, wheezy bronchitis, or no respiratory symptoms provided an opportunity to investigate this association, controlling for maternal factors., Methods: In 2001 the cohort was assessed for current lung function, smoking status, and respiratory symptoms. Birth details obtained from the Aberdeen Maternity and Neonatal Databank recorded birth weight, gestation, parity, and mother's age and height., Results: 381 subjects aged 45-50 years were traced and tested for lung function; 323 (85%) had birth details available. A significant linear trend (p<0.01) was observed between birth weight and current forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) values (adjusted for height, age, sex, weight, deprivation category (Depcat), childhood group, and smoking status). This trend remained significant after adjusting birth weight for gestation, parity, sex, mother's height and weight (p = 0.01). The relationship between birth weight and FEV(1) and FVC remained significant when adjusted for smoking history. There was no association between birth weight and current wheezing symptoms., Conclusion: There is a positive linear trend between birth weight, adjusted for maternal factors, and lung function in adulthood. The strength of this association supports the "fetal origins hypothesis" that impairment of fetal growth is a significant influence on adult lung function.
- Published
- 2003
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31. Wheezy bronchitis in childhood: a distinct clinical entity with lifelong significance?
- Author
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Edwards CA, Osman LM, Godden DJ, and Douglas JG
- Subjects
- Adolescent, Asthma epidemiology, Child, Female, Forced Expiratory Volume, Humans, Longitudinal Studies, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive epidemiology, Respiratory Function Tests, Smoking epidemiology, Socioeconomic Factors, Spirometry, Time Factors, Bronchitis epidemiology, Respiratory Sounds
- Abstract
Background: Historically, clinicians have recognized the existence of the clinical syndrome of childhood wheezy bronchitis. In the late 1960s, children with this syndrome were relabeled as having asthma, and the term wheezy bronchitis was abandoned. In a 1989 study of a cohort that originally had been studied in 1964, we reported that those who had childhood wheezy bronchitis had as adults attained lung function similar to that of healthy control subjects and had less significant symptoms than did those who had experienced childhood asthma, in whom lung function was reduced. In this study, we reexamined these subjects 12 years later to determine whether the improved outcome of the wheezy bronchitis group had been maintained., Methods: In 2001, we followed up the 283 participants of the 1989 study, who were now aged 45 to 50 years. In interviews, respiratory symptoms and smoking status were assessed. Spirometry was measured., Results: One hundred seventy-seven subjects (63%) completed the study. After adjusting for age, height, gender, socioeconomic status, smoking status, and number of pack-years smoked, the current FEV(1) in the childhood asthma group (mean, 2.45 L; 95% confidence interval, 2.29 to 2.62) was significantly lower than the wheezy bronchitis group (2.78 L, 95% confidence interval, 2.64 to 2.91; p < 0.01) and the control group (2.96 L; 95% confidence interval, 2.83 to 3.1; p < 0.01). The difference between the wheezy bronchitis group and the control subjects was not significant (p = 0.06). Between 1989 and 2001, both the childhood wheezy bronchitis group (p < 0.01) and the childhood asthma group (p = 0.01) had greater declines in FEV(1) than did the control group (asthma group decline, - 0.75 L [95% confidence interval, - 0.66 to - 0.84]; wheezy bronchitis group decline, - 0.75 L [95% confidence interval, - 0.68 to - 0.83]; control group decline, - 0.59 L [95% confidence interval, - 0.52 to - 0.67]). In 2001, the asthma group had more symptoms than did the wheezy bronchitis group (p < 0.01), who were more symptomatic than the control group (p < 0.01)., Conclusion: Those with childhood wheezy bronchitis, having achieved normal lung function in earlier adulthood, now show a more rapid decline in lung function than did control subjects. If this rate of decline persists, these subjects may develop obstructive airways disease in later life.
- Published
- 2003
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32. Factors affecting adherence to asthma treatment: patient and physician perspectives.
- Author
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van Ganse E, Mörk AC, Osman LM, Vermeire P, Laforest L, Marrel A, and Ståhl E
- Abstract
Aims: To identify important factors affecting treatment adherence of patients with asthma and to summarise this information as a guide for physicians., Methods: Information from literature and interviews with 12 respiratory physicians (four each from France, Spain and UK) and 46 asthma patients was obtained. Factors affecting adherence to asthma treatment were identified, reviewed and a flow chart developed to indicate the relationship between key factors., Results: Major factors influencing adherence included: the patient-physician relationship; the patient's understanding of the disease and its treatment; the patient's beliefs and perception of the disease and its treatment, and, importantly, the patient's willingness to take an active part in his/her asthma management., Conclusion: Patient adherence to asthma can be improved, and the likelihood of treatment success increased, by paying attention to the factors that influence patients' willingness to participate in their treatment., (Copyright © 2003 General Practice Airways Group.)
- Published
- 2003
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33. A randomised trial of self-management planning for adult patients admitted to hospital with acute asthma.
- Author
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Osman LM, Calder C, Godden DJ, Friend JA, McKenzie L, Legge JS, and Douglas JG
- Subjects
- Acute Disease, Adolescent, Adult, Asthma physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Readmission, Patient Satisfaction, Peak Expiratory Flow Rate physiology, Recurrence, Risk Factors, Surveys and Questionnaires, Treatment Outcome, Asthma therapy, Self Care methods
- Abstract
Background: There is still debate over the benefit of self-management programmes for adults with asthma. A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission., Method: A randomised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months. Patients on the self-management programme (SMP) received 40-60 minutes of education supporting a written self-management plan. Control patients received standard care (SC)., Results: One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze (OR 2.6, 95% CI 1.5 to 5.3), no night disturbance (OR 2.0, 95% CI 1.2 to 3.5), and no activity limitation (OR 1.5, 95% CI 0.9 to 2.7). Over 12 months 17% of SMP patients were re-admitted compared with 27% of SC patients (OR 0.5, 95% CI 0.3 to 1.0). Among first admission patients, OR readmission (SMP v SC) was 0.2 (95% CI 0.1 to 0.7), p<0.01. For patients with a previous admission, OR readmission was 0.8 (95% CI 0.4 to 1.6), p=0.6. SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge (99% v 92%, p=0.03), oral steroids (98% v 90%, p=0.06), and to have hospital follow up (98% v 84%, p<0.01) but adjustment for these differences did not diminish the effect of the self-management programme., Conclusions: A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients. The benefit of the programme may have been greater for patients admitted for the first time. The programme also had a small but significant effect on medical management at discharge.
- Published
- 2002
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34. Psychological factors in asthma control and attack risk.
- Author
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Osman LM
- Subjects
- Anxiety complications, Asthma prevention & control, Attitude to Health, Humans, Risk Factors, Asthma psychology
- Published
- 2002
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35. Parental education and guided self-management of asthma and wheezing in the pre-school child: a randomised controlled trial.
- Author
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Stevens CA, Wesseldine LJ, Couriel JM, Dyer AJ, Osman LM, and Silverman M
- Subjects
- Caregivers, Child, Preschool, Emergency Service, Hospital statistics & numerical data, Family Practice statistics & numerical data, Follow-Up Studies, Humans, Infant, Pamphlets, Parents psychology, Patient Acceptance of Health Care, Prognosis, Prospective Studies, Quality of Life, Surveys and Questionnaires, Asthma therapy, Health Education methods, Parents education, Respiratory Sounds, Self Care methods
- Abstract
Background: The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze., Methods: A prospective, randomised, partially blinded, controlled trial was designed at two secondary care centres. Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children's ward or attendance at an accident and emergency department or children's (emergency) assessment unit (A&E/CAU) with a primary diagnosis of acute severe asthma or wheezing were recruited. 101 children were randomised into the control group and received usual care and 99 were assigned to the intervention group and received: (1) a pre-school asthma booklet; (2) a written guided self-management plan; and (3) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s) and child. Subjects were assessed at 3, 6, and 12 months. The main outcomes were GP consultation rates, hospital re-admissions, and attendances at A&E/CAU. Secondary outcomes included disability score, caregivers' quality of life, and parental knowledge of asthma., Results: There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures., Conclusions: These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months.
- Published
- 2002
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36. Patient weighting of importance of asthma symptoms.
- Author
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Osman LM, McKenzie L, Cairns J, Friend JA, Godden DJ, Legge JS, and Douglas JG
- Subjects
- Adult, Age Factors, Asthma complications, Asthma physiopathology, Cough complications, Dyspnea complications, Humans, Lung physiopathology, Middle Aged, Morbidity, Peak Expiratory Flow Rate, Regression Analysis, Respiratory Sounds, Sickness Impact Profile, Sleep Wake Disorders complications, Surveys and Questionnaires, Asthma psychology, Quality of Life
- Abstract
Background: Quality of life measures are increasingly important in evaluating outcomes in asthma. If some asthma symptoms are more troublesome to patients than others, this may affect their contribution to outcome measures. This study was designed to assess the relative importance of common symptoms in adults with asthma., Methods: A postal survey using conjoint analysis was performed in 272 adults attending hospital outpatient clinics with moderately severe asthma. Patients were asked to chose between "symptom scenarios" offering different combinations of levels of five common asthma symptoms over one week. Two versions of the questionnaire were used with identical scenarios presenting symptoms in different orders. Different patients answered the two versions. Regression analysis was used to calculate symptom weights for daytime cough, breathlessness, wheeze and chest tightness, and sleep disturbance., Results: Symptom order, percentage predicted peak expiratory flow (PEF), and symptoms in the week before the survey did not influence the choice of scenario. In both questionnaires patients were more likely to choose scenarios with low levels of cough and breathlessness than low sleep disturbance, wheeze or chest tightness. Regression weights for cough (-0.52) and breathlessness (-0.49) were twice those of wheeze (-0.25), chest tightness (-0.27), and sleep disturbance (-0.25). For 12% of patients cough dominated patient preferences, regardless of all other symptoms. Age was inversely related to weight given by patients to breathlessness., Conclusions: The prominence of cough among other asthma symptoms was unexpected. Daytime cough and breathlessness had greater impact for patients than wheeze or sleep disturbance. Age influenced symptom burden, with younger patients giving greater weight to breathlessness than older patients. Conjoint analysis appears to be a useful method for establishing the relative importance of common symptoms.
- Published
- 2001
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37. Symptoms, quality of life, and health service contact among young adults with mild asthma.
- Author
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Osman LM, Calder C, Robertson R, Friend JA, Legge JS, and Douglas JG
- Subjects
- Adolescent, Adult, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Asthma epidemiology, Family Practice statistics & numerical data, Female, Humans, Male, Middle Aged, Scotland epidemiology, Sickness Impact Profile, Asthma diagnosis, Quality of Life, Referral and Consultation statistics & numerical data
- Abstract
This report assesses Quality of Life (QoL) and its relationship to current symptoms and prospective medical contact among 396 adult patients with asthma. Patients were 16 to 52 yr of age and in the care of family physicians in the northeast of Scotland. All patients had been prescribed asthma medication within the previous 3 mo. Mean %pred FEV(1) was 87.4, mean %pred PEF was 85.1; 41% reported respiratory symptoms every week in the month before interview. Patients completed the SF-36, SF-12, and St. George's Respiratory Questionnaire (SGRQ) scales. Although mean scores on the SF-36 and SF-12 were close to population norms for patients without chronic illness, the presence of any respiratory symptoms in the month before interview was related to significantly lower QoL scores on the SF-36 scales of Physical Functioning, Energy, Mental Health, Pain, and Health Perception: the SF-12 Physical Functioning scale, and the SGRQ Symptoms, Impact and Activities scales. Physician contact for asthma in the 12 mo after interview was significantly related to SF-36, SF-12, and SGRQ scores at time of interview; however, when adjusted for symptoms at time of interview, only the SGRQ scales remained significant predictors of prospective physician contact. We conclude that respiratory symptoms have significant impact on QoL among patients with mild asthma, measured by generic and respiratory QoL scales, but that a specific respiratory scale is better able to discriminate patients who will seek physician care for asthma.
- Published
- 2000
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38. Early asthma prophylaxis, natural history, skeletal development and economy (EASE): a pilot randomised controlled trial.
- Author
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Baxter-Jones AD, Helms PJ, Russell G, Grant A, Ross S, Cairns JA, Ritchie L, Taylor R, Reid DM, Osman LM, Robins S, and Fletcher ME
- Subjects
- Adolescent, Anthropometry, Asthma economics, Asthma psychology, Bone Density, Child, Child, Preschool, Cost-Benefit Analysis, Female, Fluticasone, Health Care Costs, Humans, Infant, Longitudinal Studies, Male, Pilot Projects, Quality of Life, Regression Analysis, Respiratory Function Tests, Statistics, Nonparametric, Surveys and Questionnaires, Treatment Outcome, United Kingdom, Androstadienes therapeutic use, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Asthma physiopathology, Bone and Bones metabolism, Bronchodilator Agents therapeutic use, Budesonide therapeutic use
- Abstract
Objectives: (1) To establish recruitment rates of newly presenting asthmatic children. (2) To establish acceptability of study protocols. (3) To pilot age-specific quality of life (QoL) assessment. (4) To assess short-term (6 months) outcomes of inhaled corticosteroids (ICS) treatment. (5) To refine sample size calculations for a definitive study., Design: A randomised pragmatic longitudinal trial design was used, with no blinding or placebo, to examine early ICS introduction similar to its use in practice. Subjects were assessed at entry, 3 and 6 months., Setting: Subjects were recruited from six general practices. Children under 6 years were assessed at the Craig Research and Investigation Unit, Royal Aberdeen Children's Hospital, or their family home, and subjects 6 years and over were assessed at their general practice., Subjects: Children (aged 6 months-16 years) with symptoms suggestive of asthma/wheeze that had commenced no longer than 12 months before were identified retrospectively and prospectively from general practices. Subjects were also required to be naïve to prophylactic therapy with no other lung disease/concomitant illness., Interventions: Subjects were randomised to ss2-agonist (ss2-only group) or ss2-agonist and ICS (ICS group) for 6 months. Physicians could later prescribe ICS in controls if needed., Main Outcome Measures: (1) Pulmonary function. (2) Asthma symptom diary. (3) Symptomatic health status questionnaire. (4) Caregiver's and child's QoL. (5) Growth. (6) Bone mass. (7) Bone turnover. (8) Economic issues., Results: Of over 15,000 children yielded from general practice records, 11% had symptoms suggestive of asthma/wheeze, and two-thirds of these already used ICS. Of the remaining, 141 subjects met the criterion of early asthma, and 86 were randomised. Two-thirds of those randomised were < 6 years old, the males:females ratio was 2:1, and 67% had a family history of atopy. RESULTS - PHYSIOLOGICAL DEVELOPMENT: Pulmonary function did not significantly improve in the older children. Although tidal breathing measures in the pre-school children were significantly higher at 6 months in the ss2-only group, there was great variability. Incidence of wheeze and night-time cough reduced equally in both groups. Reduction of night-time symptom score and reliever use, and increase in symptom-free days were only significant in the ss2-only group. No significant differences were found in growth and bone mass between the two groups, but bone metabolism was significantly reduced at 6 months in the ICS group. RESULTS - PSYCHOLOGICAL DEVELOPMENT: The caregiver's QoL questionnaire was sensitive to child symptom changes over 3 months, but absolute impact of child symptoms on their QoL varied, whereas the child-centred questionnaire was not sensitive to change. RESULTS - ECONOMICS: There were no significant differences in medical consultation costs between the groups, but, as expected, prescription costs in the ICS group were higher over 6 months. Combined healthcare costs were significantly higher for patients assigned to ICS, but there were no significant differences in any effectiveness measures between the groups., Conclusions: Most (96%) of the proposed sample was recruited, and the low drop-out rate (8%) demonstrated acceptability of the study protocol. Most children first presenting with symptoms suggestive of asthma were < 6 years old and represented a group biased towards mild to moderate asthma, or virally induced wheeze. The caregiver's QoL questionnaire was found to better reflect a child's symptom changes than a child-centred instrument. In the short term, no adverse effects were seen on growth, but ICS treatment significantly reduced bone metabolism. Most of the young children with asthma/wheeze improved over time with ss2-agonist treatment alone, and clinical benefits of early ICS intervention amongst these children were not detected; however, there was inadequate power in this pilot study to establish this. (AB
- Published
- 2000
39. Requests for repeat medication prescriptions and frequency of acute episodes in asthma patients.
- Author
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Osman LM, Friend JA, Legge JS, and Douglas JG
- Subjects
- Acute Disease, Administration, Inhalation, Anti-Inflammatory Agents administration & dosage, Asthma epidemiology, Bronchodilator Agents administration & dosage, Delivery of Health Care statistics & numerical data, Drug Prescriptions statistics & numerical data, Family Practice, Female, Humans, Male, Middle Aged, Risk Factors, Steroids, Anti-Inflammatory Agents therapeutic use, Asthma drug therapy, Bronchodilator Agents therapeutic use
- Abstract
This study was conducted to determine if suboptimal use of inhaled steroid and over-reliance on bronchodilator medication to control asthma symptoms is associated with higher risk of acute asthma episodes. Details of repeat prescriptions for medication and use of health services over 12 months were collected for 754 adult outpatients with asthma; all were prescribed inhaled corticosteroid. Patients who requested less than five prescriptions per year were considered suboptimal users. Patients who requested seven or more bronchodilator prescriptions and less than five inhaled steroid prescriptions had significantly more family physician consultations for asthma episodes (p < 0.05), more hospital admissions (p < 0.05), and more disturbed nights in the week before hospital or family physician review (p < 0.05). Some patients with more severe asthma put themselves at risk by relying on bronchodilator medication rather than regular inhaled steroid for asthma control. Among patients who were low bronchodilator users, those who requested few inhaled steroid prescriptions were younger and more anxious but did not have an increased risk of acute asthma episodes.
- Published
- 1999
- Full Text
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40. How do patients' views about medication affect their self-management in asthma?
- Author
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Osman LM
- Subjects
- Conflict, Psychological, Health Knowledge, Attitudes, Practice, Humans, Patient Education as Topic, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Asthma psychology, Attitude to Health, Patient Compliance psychology, Self Care psychology
- Abstract
Successful management of asthma increasingly depends on decisions by patients about when and how to use inhalers and tablets prescribed for their asthma control. Patients with negative attitudes to asthma medication may not be willing to follow their management plan's advice to increase medication when their symptoms worsen. Patients do not always believe their doctors' reassurance about side effects. Although patient dislike of steroid medication is sometimes believed to be the main influence on reluctance to take medication, studies suggest that patients dislike taking any medication regularly. Evidence shows that patients are no more likely to use a combined inhaler regularly than separate steroid and relief inhalers. A proportion of patients with difficult to control asthma follow a chaotic self-management style. Attitudes among these patients may reflect personal styles, and be difficult to change. Among the majority of patients studies now show that patient self-management, and outcomes for patients can be improved by structured behavioural interventions. For most patients attitudes to medication will follow control of symptoms. The experience of successful control by medication, in the ways that patients think are important, are most likely to influence patients in positive attitudes to medication.
- Published
- 1997
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41. Adult asthma review in general practice: nurses' perception of their role.
- Author
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Robertson R, Osman LM, and Douglas JG
- Subjects
- Adult, Asthma prevention & control, Attitude of Health Personnel, Case Management organization & administration, Chi-Square Distribution, Chronic Disease, Education, Nursing, Continuing statistics & numerical data, Family Practice statistics & numerical data, Health Care Surveys, Health Knowledge, Attitudes, Practice, Humans, Nurse Practitioners education, Nursing Audit, Office Nursing statistics & numerical data, Patient Education as Topic organization & administration, Primary Nursing statistics & numerical data, Professional Practice organization & administration, Self Care, United Kingdom, Asthma nursing, Family Practice organization & administration, Nurse Practitioners standards, Office Nursing organization & administration, Professional Practice statistics & numerical data
- Abstract
Background: Asthma clinics have become widespread in general practice with nurses now playing an important role in asthma review. However, little is known about training of nurses carrying out reviews and how this affects the nurse role in patient management., Objectives: We aimed to discover the level of asthma training of practice nurses carrying out review of adult asthma patients in one Health Authority and to see if this has any effect on their perception of their role., Method: All 187 practice nurses in Grampian were sent a postal questionnaire investigating how asthma review is organized in general practice, their role in review and the asthma training they had received. Personal interviews were carried out with 17 nurses, exploring in more depth the topics covered in the questionnaire., Results: A total of 167 nurses from 92% of the practices in Grampian responded, of whom 61% carried out asthma reviews. Among nurses carrying out reviews 71% did so on their own. 49% of nurses had or were training for advanced asthma qualification. Nurses without an asthma qualification were significantly more likely to feel that their training was not sufficient for their asthma related tasks (54% versus 11%, P = 0.0002). Nurses without advanced asthma qualifications were less likely to provide or review a self-management plan (29% versus 49%, P = 0.01), to review patient PEF recording (38% versus 65%, P < 0.01), to discuss patient worries (75% versus 94%, P < 0.05) or to make the initial diagnosis of asthma (24% versus 76%, P < 0.005). Nurses were unlikely to view their role as fully responsible unless they had an asthma qualification (13% versus 49%, P < 0.001)., Conclusion: Nurses without advanced asthma qualifications do not feel fully confident in responsibility for patient management. Nurses without training are more likely to only carry out routine monitoring at reviews while nurses with asthma training are more likely to actively develop patient self-management skills. This suggests that nurses should be supported to obtain asthma qualifications if they are to give the best possible care to asthma patients.
- Published
- 1997
- Full Text
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42. Factors influencing mothers' decisions to consult a general practitioner about their children's illnesses.
- Author
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Osman LM and Dunt D
- Subjects
- Child, Preschool, Female, Humans, Infant, Nurse-Patient Relations, Pharmacists, Physician-Patient Relations, Pilot Projects, Family Practice, Maternal Behavior
- Abstract
Background: In the management of childhood illness only a small proportion of symptoms result in a medical consultation., Aim: This pilot study set out to assess the influence of sociodemographic factors, social network, reason of choice of doctor and contact with allied health professionals on mothers' decisions to consult a general practitioner about their children's illnesses., Method: In one suburb of Melbourne, Australia all mothers with children aged 11 to 26 months were identified from the maternal and child health centre register. Mothers were invited for interview and if they attended were asked to keep a health diary for their child for four weeks. Logistic regression was used to test a multivariate model of factors predicting consultation with the general practitioner., Results: A total of 150 mothers were identified. Interviews were carried out with 81% of target mothers and diary data collected for 72% of target children. Over the four-week diary period, consultation rates with the general practitioner were significantly higher if symptoms were recorded on 15 days or more, or the general practitioner had been recommended by a friend or was the mother's own doctor before the child's birth. Contact with a maternal and child health nurse was also a significant predictor of medical contact. Contact with friends and relatives, whether or not the study child was the first child in the family, mother's education, husband's occupational status or contact with a chemist were not significantly related to medical consultation rates., Conclusion: Choice of doctor (current doctor same as doctor before birth of child, or doctor recommended by a friend) resulted in significantly more consultations as did contact with a maternal and child health nurse. These factors would seem to require further study and inclusion in future models of consulting behaviour.
- Published
- 1995
43. Computer skills and attitudes to computer-aided learning among medical students.
- Author
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Osman LM and Muir AL
- Subjects
- Computer User Training, Computer-Assisted Instruction, Female, Humans, Male, Professional Competence, Scotland, Teaching methods, Attitude to Computers, Students, Medical psychology
- Abstract
One hundred and forty-four third-year medical students at the University of Edinburgh were surveyed as to levels of computing skills and confidence in carrying out computing tasks. Attitudes to computer-aided learning for clinical teaching were also measured. Thirty-one per cent of students had not used a computer in the previous year and 38% had not used a computer outside supervised laboratory work. Twenty-two per cent had never used the university library computerized catalogue and 43% had never carried out a medline search using the library CD-ROM. Students were not confident of their ability to carry out simple computing tasks. Fifty-four per cent said they would need support or instruction in printing out a document, 69% were not confident they could copy a file onto a disk and 74% did not believe they could independently create a graph in a document. Students who had completed an intercalated honours year were significantly more skilled and confident in computing tasks. Attitudes to computer-aided learning were related to computing confidence. Medical students who have not acquired basic computer information technology (IT) skills by the third year of undergraduate training are unlikely to do so in the final hospital-based years. Undergraduate curricula for medical students must incorporate specific computer (IT) training.
- Published
- 1994
- Full Text
- View/download PDF
44. Reducing hospital admission through computer supported education for asthma patients. Grampian Asthma Study of Integrated Care (GRASSIC).
- Author
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Osman LM, Abdalla MI, Beattie JA, Ross SJ, Russell IT, Friend JA, Legge JS, and Douglas JG
- Subjects
- Ambulatory Care, Family Practice, Female, Humans, Male, Middle Aged, Monitoring, Physiologic methods, Program Evaluation, Referral and Consultation, Scotland, Therapy, Computer-Assisted, Treatment Outcome, Asthma therapy, Computer-Assisted Instruction, Patient Education as Topic methods
- Abstract
Objective: To evaluate a personalised computer supported education programme for asthma patients., Design: Pragmatic randomised trial comparing outcomes over 12 months between patients taking part in an enhanced education programme (four personalised booklets, sent by post) and patients receiving conventional oral education at outpatient or surgery visits., Setting: Hospital outpatient clinics and general practices in north east Scotland., Subjects: 801 adults attending hospital outpatient clinics, with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%., Main Outcome Measures: Numbers of hospital admissions, consultations with general practitioner for asthma, steroid courses used, bronchodilators and inhaled steroids prescribed, days of restricted activity, and disturbed nights., Results: Patients with asthma judged too severe for randomisation between clinic care and integrated care and thus retained in clinic care had 54% fewer hospital admissions after receiving enhanced education than did the control group (95% confidence interval 30% to 97%; P < 0.05) over the study year. Patients had not all spent a full year as "educated" patients within the study year: when "educated days" were controlled for, annual admission rates for the entire enhanced education group were 49% (31% to 78%) of those in the control group. Among patients with sleep variation, sleep disturbance in the education group in the week before a regular review was 80% (65% to 97%) of that in the control group. There was no significant difference in days of restricted activity, prescription of bronchodilators or inhaled steroids, use of oral steroids, or number of general practitioner consultations for asthma, and no significant interaction between ownership of a peak flow meter and education., Conclusions: An asthma education programme based on computerised booklets can reduce hospital admissions and improve morbidity among hospital outpatients.
- Published
- 1994
- Full Text
- View/download PDF
45. Predicting patient attitudes to asthma medication.
- Author
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Osman LM, Russell IT, Friend JA, Legge JS, and Douglas JG
- Subjects
- Administration, Inhalation, Adolescent, Adult, Aged, Aged, 80 and over, Asthma prevention & control, Bronchodilator Agents therapeutic use, Female, Humans, Male, Middle Aged, Self Administration psychology, Asthma drug therapy, Asthma psychology, Attitude to Health
- Abstract
Background: Studies of patient attitudes to asthma and its control have focused on crisis action, and little attention has been paid to attitudes to regular preventive medication. It is not clear whether attitudes to regular medication are related to the degree of distress or interference with life perceived by patients as being caused by their asthma. For this reason this study examined how far dislike of medication related to dislike of other aspects of interference of asthma with daily life., Methods: Three hundred and ninety one patients were surveyed with a questionnaire which assessed their dislike of the interference of asthma with their physical, social, and emotional functioning, together with dislike of regular asthma medication. A response was received from 320 patients (82%)., Results: Four attitude clusters were identified. Recorded in descending factor order, these were (1) dislike of asthma medication, (2) dislike of disability, (3) dislike of public life interference, and (4) dislike of social and emotional interference. The attitude clusters were not related: in particular, dislike of asthma medication could not be predicted from other dislikes, or from asthma best function ratio (ratio of best recorded peak expiratory flow rate in the previous year to predicted value), age, or sex. The most significant predictors of the patients' dislike of taking their own inhaled steroid were (1) dislike of using bronchodilator, (2) dislike of steroids generally, and (3) dislike of taking medicine every day., Conclusions: Patient attitudes to regular asthma medication are not related to general anxieties and dislikes about asthma, nor to the potential for asthma control as judged by the best function ratio. Patients were not always consistent in their attitude to inhaled steroids in general, nor to their own named inhaled steroid in particular. A general cluster of antimedication attitudes existed, independent of whether the medication was for prophylaxis or relief. Attitudes to asthma medication may be helpful in predicting patient behaviour.
- Published
- 1993
- Full Text
- View/download PDF
46. Experience with interferon in chronic hepatitis B in Egypt.
- Author
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Waked I, Amin M, Abd el Fattah S, Osman LM, and Sabbour MS
- Subjects
- Adolescent, Adult, Child, Chronic Disease, Egypt, Female, Hepatitis B blood, Hepatitis B Surface Antigens blood, Hepatitis B e Antigens blood, Humans, Interferon alpha-2, Liver Function Tests, Male, Middle Aged, Recombinant Proteins, Hepatitis B therapy, Interferon-alpha therapeutic use, Transaminases blood
- Abstract
Forty patients with compensated chronic active hepatitis B and elevated aminotransferases who were HBsAg and HBeAg positive were randomised to a treatment group receiving recombinant interferon alpha-2b (rIFN alpha-2b) or no treatment as a control group. The treated patients were divided into 2 groups, group I (n = 12) received IFN in a dose of 5 MU/m2 thrice weekly by subcutaneous injection for 16 weeks, and group II (n = 8) received the same dose daily for the same duration. Patients were followed up for 12 months after therapy ended. Initiation of IFN therapy was associated with an increase in aminotransferases, reaching a peak at 4-6 weeks in most patients, associated with clearance of HBeAg. At end of follow-up, 81% of the treated patients had cleared HBeAg vs 33% of the control group (p less than 0.01). Changes in other HBV markers were more frequent in the treated patients, though insignificantly. The type of response to therapy was significantly related to the duration of illness, being shortest in those who cleared HBsAg. A complete response to therapy with loss of HBsAg was associated with marked reduction in biochemical and histological activity. A partial response with clearance of HBeAg was associated with moderate improvement in biochemical parameters and ongoing activity in liver histology; whereas persistence of HBeAg was associated with elevated aminotransferases and histological deterioration in most cases. The rise in aminotransferases during seroconversion was associated with hepatic decompensation and death on 3 occasions: one during spontaneous seroconversion, and the other 2 during IFN therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1990
- Full Text
- View/download PDF
47. Experience with ofloxacin in enteric fever.
- Author
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Sabbour MS and Osman LM
- Subjects
- Administration, Oral, Adolescent, Adult, Clinical Trials as Topic, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Ofloxacin administration & dosage, Ofloxacin adverse effects, Paratyphoid Fever drug therapy, Ofloxacin therapeutic use, Typhoid Fever drug therapy
- Abstract
Ofloxacin 200 mg b.i.d. for 8 days was employed in 28 patients with enteric fever with a positive blood culture. All patients were cured clinically and bacteriologically. The fever subsided within a mean of 3.1 days (range 1.6.5.3). No relapse, clinical or bacteriological, was observed when patients were followed up for 12 weeks.
- Published
- 1990
- Full Text
- View/download PDF
48. In vitro susceptibility of urinary pathogens to quinolones compared to other antimicrobial agents.
- Author
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Osman LM, Sabbour MS, and el-Baz F
- Subjects
- Enterobacteriaceae isolation & purification, Humans, Microbial Sensitivity Tests, Pseudomonas aeruginosa isolation & purification, Anti-Bacterial Agents pharmacology, Enterobacteriaceae drug effects, Norfloxacin pharmacology, Ofloxacin pharmacology, Pseudomonas aeruginosa drug effects, Urinary Tract Infections microbiology
- Published
- 1987
49. Experiences on the efficacy and safety of nalidixic acid, oxolinic acid, cinoxacin and norfloxacin in the treatment of urinary tract infections (UTI).
- Author
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Sabbour MS, El Bokl MA, and Osman LM
- Subjects
- Adolescent, Adult, Aged, Child, Cinoxacin therapeutic use, Clinical Trials as Topic, Drug Tolerance, Female, Humans, Male, Middle Aged, Nalidixic Acid analogs & derivatives, Norfloxacin, Oxolinic Acid therapeutic use, Nalidixic Acid therapeutic use, Urinary Tract Infections drug therapy
- Abstract
The purpose of this study was to determine the effectiveness and tolerability of norfloxacin, cinoxacin and oxolinic acid in the treatment of urinary tract infections (UTI) in comparison to nalidixic acid. 125 patients were given the drugs in the appropriate doses for 10-14 days and 30 patients were treated for six weeks. Clinical, bacteriological, hematological and chemical checks were made on all patients before and after treatment. It was found that norfloxacin, cinoxacin and oxolinic acid are safe and effective against Escherichia coli, Klebsiella and Proteus, the commonly encountered organisms in urinary tract infections. The cure rate for norfloxacin was 93%, for cinoxacin 83%, for oxolinic acid 80% and for nalidixic acid 70% in the short course. However, these differences were not statistically significant. Oxolinic acid, cinoxacin and norfloxacin have the advantage over nalidixic acid of being administered only twice daily.
- Published
- 1984
- Full Text
- View/download PDF
50. Comparative study of different types of treatments in chronic active hepatitis.
- Author
-
Bahgat MH, Sabbour MS, Osman LM, Ghali AF, and Gadallah MA
- Subjects
- Adrenal Cortex Hormones therapeutic use, Age Factors, Azathioprine therapeutic use, Chlorambucil therapeutic use, Colchicine therapeutic use, Drug Therapy, Combination, Fluorouracil therapeutic use, Hepatitis B Surface Antigens analysis, Hepatitis, Chronic immunology, Hepatitis, Chronic pathology, Hepatitis, Chronic physiopathology, Humans, Inosine Pranobex therapeutic use, Hepatitis, Chronic therapy
- Abstract
Ninety-six patients with pathologically-proven, chronic, active hepatitis were studied to evaluate different lines of treatment. Patients were divided into the following groups: control (followed without specific active treatment), corticosteroid group, azathioprine group, corticosteroid and azathioprine group, chlorambucil group, 5-fluorouracil group, colchicine group and isoprinosine group. Patients were followed clinically, biochemically, and histopathologically. Results showed that patients put on any therapeutic regimen did either the same or worse than the control group left without active therapy. There was no difference in response to treatment between HBsAg +ve or -ve patients; both groups showed no improvement. Some patients given active treatment developed the side effects and complications from the drug used.
- Published
- 1985
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