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Search Results: 1 - 10 of 469206 matches for " Scott A. Murray "
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Palliative Care Looking Towards 2010
Scott A. Murray
Australasian Medical Journal , 2010,
Abstract: What are the key challenges facing medicine internationally in the next 10 years to maximise the quality of people’s lives when they are living with progressive life-threatening illnesses? This paper flags up 5 important challenges and areas for development which are relevant internationally, and which may also be relevant in Australasia.
Due caution using early β-blockers for acute myocardial infarction
Scott McKee, Holt Murray, John A Kellum
Critical Care , 2007, DOI: 10.1186/cc5145
Abstract: Despite previous randomised trials of early β-blocker therapy in the emergency treatment of myocardial infarction (MI), uncertainty has persisted about the value of adding it to current standard interventions (e.g., aspirin and fibrinolytic therapy), and the balance of potential benefits and hazards is still unclear in high-risk patients.Prospective blinded randomized controlled trial in 1250 hospitals in China.45,852 patients admitted within 24 h of suspected acute MI onset. 93% had ST-segment elevation or bundle branch block, and 7% had ST-segment depression.Subjects were randomly allocated metoprolol (up to 15 mg intravenous then 200 mg oral daily; n = 22,929) or matching placebo (n = 22,923). Treatment was to continue until discharge or up to 4 weeks in hospital (mean 15 days in survivors) and 89% completed it.The two pre-specified co-primary outcomes were: (1) composite of death, reinfarction, or cardiac arrest; and (2) death from any cause during the scheduled treatment period. Comparisons were by intention to treat, and used the log-rank method. This study is registered with ClinicalTrials.gov, number NCT 00222573.Neither of the co-primary outcomes was significantly reduced by allocation to metoprolol. For death, reinfarction, or cardiac arrest, 2166 (9.4%) patients allocated metoprolol had at least one such event compared with 2261 (9.9%) allocated placebo (odds ratio [OR] 0.96, 95% CI 0.90–1.01; p = 0.1). For death alone, there were 1774 (7.7%) deaths in the metoprolol group versus 1797 (7.8%) in the placebo group (OR 0.99, 0.92–1.05; p = 0.69). Allocation to metoprolol was associated with fewer people having reinfarction (464 [2.0%] metoprolol vs. 568 [2.5%] placebo; OR 0.82, 0.72–0.92; p = 0.001) and ventricular fibrillation (581 [2.5%] vs. 698 [3.0%]; OR 0.83, 0.75–0.93; p = 0.001). Overall, these reductions were counterbalanced by more subjects developing cardiogenic shock (1141 [5.0%] vs. 885 [3.9%]; OR 1.30, 1.19–1.41; p < 0.00001). This excess of car
Using consecutive Rapid Participatory Appraisal studies to assess, facilitate and evaluate health and social change in community settings
Colin S Brown, Simon Lloyd, Scott A Murray
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-68
Abstract: Rapid Participatory Appraisal involves communities in identifying and challenging their own health-related needs. Information on ten health and social aspects was collated from existing documentation, neighbourhood observations, and interviews with a range of residents and key informants, providing a composite picture of the community's structure, needs and services.The perceived needs after 10 years encompassed a wide construct of health, principally the living environment, housing, and lack of finance. Most identified upstream determinants of health rather than specific medical conditions as primary concerns. After the initial Rapid Participatory Appraisal many interviewees took the recommendations forward, working to promote a healthier environment and advocate for local resources. Interventions requiring support from outwith the community were largely not sustained.Rapid Participatory Appraisal proved valuable in assessing long-term change. The community's continuing needs were identified, but they could not facilitate and sustain change without the strategic support of key regional and national agencies. Many repeatedly voiced concerns lay outwith local control: local needs assessment must be supported at higher levels to be effective.In 1992, we assessed the health and social needs of over 1100 residents of a deprived housing estate in Edinburgh, using Rapid Participatory Appraisal [1]. Ten years later we repeated this assessment to investigate how the needs of a defined, local community had changed over time, establish what recommendations from the initial assessment had been implemented and sustained, and consider factors which may have influenced this.The method provides a unique means of involving the community in identifying its own health-related needs, important both as a democratic goal and as a potentially useful means of achieving improvements in health [2]. It can provide timely, relevant information, placing such needs within the community's social
Palliative care in urgent need of recognition and development in general practice: the example of Germany
Nils Schneider, Geoffrey K Mitchell, Scott A Murray
BMC Family Practice , 2010, DOI: 10.1186/1471-2296-11-66
Abstract: For the vast majority of people with incurable, progressive diseases, good palliative care delivered by General Practitioners and community nurses, with access to specialist support when needed, is the optimal response. In Germany, specialist palliative care in the community was established in the 2007 health care reforms. However actual and potential delivery of palliative care by general practitioners and community based nurses has been sorely neglected. The time-consuming care of palliative patients and their families is currently far from accurately reflected in German, indeed most European primary care payment systems. However, it is not just a question of adequate financial compensation but also of the recognition of the fundamental value of this intense form of holistic family medicine.It is imperative palliative care carried out by community nurses and general practitioners is better recognised by health professionals, health insurers, government and the scientific community as a central part of the delivery of health care for people in the last phase of life. Health systems should be arranged so that this critical role of general practice and primary care is intentionally fostered. Palliative care carried out by generalists needs an identity at an academic and practical level, developing in concert with specialist palliative care.Delivering appropriate care for people with incurable progressive diseases in the last phase of life is an important, but largely neglected, role of the health system in many countries [1,2]. In recent years deficits in this field have increasingly come to the attention of the public, politicians and professionals, as have insistent demands for the development of palliative care.Measured in terms of the number of palliative care units, hospices and outpatient palliative care services (palliative care teams), specialist palliative care has grown considerably. However, according to expert estimates, the need remains far from met [3].
Enumeration of Strength Three Orthogonal Arrays and Their Implementation in Parameter Design  [PDF]
Julio Romero, Scott H. Murray
Journal of Applied Mathematics and Physics (JAMP) , 2015, DOI: 10.4236/jamp.2015.31006
Abstract:

This paper describes the construction and enumeration of mixed orthogonal arrays (MOA) to produce optimal experimental designs. A MOA is a multiset whose rows are the different combinations of factor levels, discrete values of the variable under study, having very well defined features such as symmetry and strength three (all main interactions are taken in consideration). The applied methodology blends the fields of combinatorics and group theory by applying the ideas of orbits, stabilizers and isomorphisms to array generation and enumeration. Integer linear programming was used in order to exploit the symmetry property of the arrays under study. The backtrack search algorithm was used to find suitable arrays in the underlying space of possible solutions. To test the performance of the MOAs, an engineered system was used as a case study within the stage of parameter design. The analysis showed how the MOAs were capable of meeting the fundamental engineering design axioms and principles, creating optimal experimental designs within the desired context.

Effectiveness of Holistic Interventions for People with Severe Chronic Obstructive Pulmonary Disease: Systematic Review of Controlled Clinical Trials
Ulugbek Nurmatov, Susan Buckingham, Marilyn Kendall, Scott A. Murray, Patrick White, Aziz Sheikh, Hilary Pinnock
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046433
Abstract: Background Despite a well-recognised burden of disabling physical symptoms compounded by co-morbidities, psychological distress and social isolation, the needs of people with severe chronic obstructive pulmonary disease (COPD) are typically poorly addressed. Aim To assess the effectiveness of interventions designed to deliver holistic care for people with severe COPD. Methods We searched 11 biomedical databases, three trial repositories (January 1990-March 2012; no language restrictions) and contacted international experts to locate published, unpublished and in-progress randomised controlled trials (RCTs), quasi-RCTs and controlled clinical trials (CCTs) that investigated holistic interventions to support patients with severe COPD in any healthcare context. The primary outcome was health-related quality of life (HRQoL). Quality assessment and data extraction followed Cochrane Collaboration methodology. We used a piloted data extraction sheet and undertook narrative synthesis. Results From 2,866 potentially relevant papers, we identified three trials: two RCTs (from United States and Australia), and one CCT (from Thailand): total 216 patients. Risk of bias was assessed as moderate in two studies and high in the third. All the interventions were led by nurses acting in a co-ordinating role (e.g. facilitating community support in Thailand, providing case-management in the USA, or co-ordinating inpatient care in Australia). HRQoL improved significantly in the Thai CCT compared to the (very limited) usual care (p<0.001), in two sub-domains in the American trial, but showed no significant changes in the Australian trial. Exercise tolerance, dyspnoea, and satisfaction with care also improved in the Thai trial. Conclusions Some 15 years after reports first highlighted the unmet needs of people with severe COPD, we have been unable to find robust trial evidence about interventions that can address those needs. There is an urgent need to develop and evaluate holistic care interventions designed improve HRQoL for people with severe COPD. Systematic Review Registration PROSPERO (CRD42012002430).
Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies
Liz Grant, Judith Brown, Mhoira Leng, Nadia Bettega, Scott A Murray
BMC Palliative Care , 2011, DOI: 10.1186/1472-684x-10-8
Abstract: Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics.We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home.In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks.Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.Living and dying with incurable illness in poverty and pain is all too common in sub-Saharan Africa [1,2]. With minimal resources huge shortages of health workers, national health systems in a number of African countries have focussed primarily on preventive, curative and maternal health services, responding to a set of immediate (and development agency identified "best buys" in healthcare through their Essential (or Basic) health packages. In many countries minimal or no resources have been dedicated to supportive or palliative care. However various national and pan-Afri
An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice
Kathrin M Cresswell, Stacey Sadler, Sarah Rodgers, Anthony Avery, Judith Cantrill, Scott A Murray, Aziz Sheikh
Trials , 2012, DOI: 10.1186/1745-6215-13-78
Abstract: Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework.We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent. However, important concerns were identified about the likely sustainability of this new model of delivering care, in the absence of an appropriate support network for pharmacists and career development pathways.This embedded qualitative inquiry has helped to understand the complex organizational and social environment in which the trial was undertaken and the PINCER intervention was delivered. The longitudinal element has given insight into the dynamic changes and developments over time. Medication errors and ways to address these are high on stakeholders’ agen
Identifying Acute Coronary Syndrome Patients Approaching End-of-Life
Stephen Fenning, Rebecca Woolcock, Kristin Haga, Javaid Iqbal, Keith A. Fox, Scott A. Murray, Martin A. Denvir
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0035536
Abstract: Background Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL. Methods and Findings 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with ≥10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.6±0.7 vs. 1.2±0.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88). Conclusions This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.
Conjugacy classes in maximal parabolic subgroups of general linear groups
Scott H. Murray
Mathematics , 2000,
Abstract: We compute conjugacy classes in maximal parabolic subgroups of the general linear group. This computation proceeds by reducing to a ``matrix problem''. Such problems involve finding normal forms for matrices under a specified set of row and column operations. We solve the relevant matrix problem in small dimensional cases. This gives us all conjugacy classes in maximal parabolic subgroups over a perfect field when one of the two blocks has dimension less than 6. In particular, this includes every maximal parabolic subgroup of GL_n(k) for n < 12 and k a perfect field. If our field is finite of size q, we also show that the number of conjugacy classes, and so the number of characters, of these groups is a polynomial in $q$ with integral coefficients.
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