Archive | June, 2015

The Drugs Don’t Work – the importance of using antibiotics responsibly

26 Jun

by Christian Thomas, PhD student in Medication Safety theme

Antibiotic Guardian _Christian Thomas blog_June 15

This summer saw the Chief Medical Officer of the NHS, Professor Dame Sally Davies present at the annual Cockroft Rutherford alumni lecture at the University of Manchester. The theme of the lecture was ‘The Drugs Don’t Work’ and focused on the real threat that the misuse of antibiotic medication poses to patient safety both nationally and worldwide (view the full lecture). Antibiotic medicines work by killing or preventing the growth of bacteria. When antibiotic medicines are used inappropriately bacteria can fight back and become ‘resistant’. This can happen when we take antibiotics that we don’t need (such as for a cold which is caused by a virus), or when we don’t take antibiotics the correct way (such as not finishing the whole course of a prescription). When bacteria become resistant, antibiotics are no longer effective at killing them. This means that the drugs used to treat bacterial infections are less likely to work and that infections could get worse or be passed on to others. Bacterial resistance is a growing problem and over 23,000 people die each year from bacterial infections that are resistant to antibiotics (1).

HowAntibioticResistanceHappens_CT_June15

1. Prevention CfDCa. About Antimicrobial Resistance 2013 [cited 2015 16th of June].

Before antibiotics were discovered, infections could often be life-threatening. Simple operations and procedures were more risky due to the infection risk, and as late as the 1930s people died from infections. Today, not only do we rely on antibiotics when we have an infection, many patients rely on antibiotics to survive including patients receiving chemotherapy, dialysis, organ transplants and caesareans. Whilst researchers are trying to find new antibiotics, little progress has been made over the last over thirty years. Therefore, it is very important that we do everything that we can to ensure that the antibiotics we have remain as effective as possible. Sadly, not doing so risks taking us back to a time where common infections and minor injuries pose a serious threat to patient safety.

There are many ways in which we can help to slow antibiotic resistance. One simple thing that we can all do is wash our hands thoroughly as this helps to stop the spread of bacteria. Other important steps we can all take are to use antibiotics only when they are deemed necessary by a health professional. We should not expect antibiotics to be prescribed for a common cough or cold, as these are more likely to have been caused by a virus rather than a bacterial infection. If antibiotics are given, we should make sure to finish the whole course, even if we are feeling better. Finally, we should never share antibiotics with friends or family or use leftover prescriptions. Visit the Antibiotic Guardian webpage for more information on antibiotic resistance and to pledge to become an antibiotic guardian.

Can computer software programmes be used to help clinicians with their diagnoses?

23 Jun

by Rahul Alam, Research Associate in General Practice theme

Isabel screenshot

Figure 1 Screenshot of a differential diagnosis list

General Practitioners (GPs) and nurse practitioners in general practice are required to recall a large number of illnesses and diseases as well as a large number of tests and drugs that can be ordered and prescribed. Given such breadth, arriving at the correct diagnoses can be a difficult task, particularly when patients present with unusual symptoms. As a result, diagnostic errors can, and do, occur. One potential resource for helping clinicians to make the correct diagnoses are specialised computer software programmes, otherwise known as differential diagnosis (DDx) generators. They are aimed at helping clinicians with the diagnostic process to reduce the possibility of clinicians missing, delaying or making incorrect diagnoses. In principle, clinicians can enter the patient’s clinical symptoms and the DDx generator produces a list of potentially relevant diagnoses the clinician might want to consider (please see figure 1). This information may be utilised by clinicians as part of the differential diagnostic process to whittle the potential diagnoses down to those most likely. Isabel is one such commercially available web-based DDx generator.

However, little is known about how DDx generators will be viewed and whether they can be used by clinicians in routine practice.  There is also limited evidence on how accurate programmes like Isabel are. In order to ascertain the potential feasibility and utility (benefits) of using this program, we are conducting a small one-practice study divided into two separate components.

The first component of the study will investigate the diagnostic ‘accuracy’ of Isabel in relation to cases of diagnostic uncertainty. Two situations that are likely to involve elements of diagnostic uncertainty relate to referrals to secondary care for follow-up investigations and people who frequently attend the practice (those whose attendance rate is in the top 3% of the practice). Two GPs will review and select all cases of diagnostic uncertainty and the patient details will be entered into Isabel and compared to the final discharge diagnosis from the hospital or the final recorded diagnosis to determine Isabel’s accuracy rate.

In the second component we aim to ascertain the feasibility of clinician’s using Isabel in routine practice when diagnosing patients. We have conducted 11 interviews with 9 GPs and 2 nurse practitioners to ascertain their views and experiences of using a differential diagnosis tool such as Isabel.  We then trained all clinical staff at the practice to use Isabel and they have now had a 6-month opportunity to use Isabel. A remote monitoring system captured wider data such as usage rates, links accessed and time taken to use. We are now conducting post-use interviews with the clinicians to obtain their feedback and opinions on Isabel as a diagnostic aide in routine general practice.

We hope that the findings of the two components of this study can help assess the diagnostic accuracy of Isabel in UK general practice as well provide useful insights in to the feasibility of utilising Isabel in routine clinical practice.

Collaboration “Down Under”

1 Jun

by Sally Giles, Research Fellow in Core theme

Australia workshop_group photo_cropped

Myself and Stephen Campbell, PI of the NIHR Greater Manchester PSTRC, were invited to present some of the work of the Centre at a recent patient safety workshop hosted by Deakin University in Melbourne. Stephen gave an overview of the work of the Centre, whilst I gave a talk on patient involvement in patient safety. Following on from this I was invited to spend 10 days working closely with Andrea Hernan (Research Associate) and colleagues at Flinders University in Warrnambool, rural Australia.   

This collaboration builds on some work that I undertook to develop a Patient Measure of Safety (PMOS) within a hospital setting.  Whilst I was in Warrnambool, Andrea and I worked on analysing some data from the field testing of the Primary Care Patient Measure of Safety (PC_PMOS) questionnaire and wrote a paper on the development of the PC_PMOS.  This paper builds on our recently published work* and is currently under review in BMJ Quality and Safety.  We were also able to make plans for a further study to validate the PC_PMOS.   Future plans include validating a primary care version of PMOS and hopefully conducting a joint workshop at North American Primary Care Research Group (NAPCRG) later this year.  

I was also able to make new connections  and links with other researchers in Australia, some of whom will be using the Patient and Public Involvement (PPI) evaluation questionnaire developed by myself and Jill Stocks within the Greater Manchester PSTRC.

 *Hernan A, Giles S J, Fuller J et al.  Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study.  BMJ Quality and Safety (in press).