Health bulletin最新文献

{"title":"Acquired immune deficiency syndrome (AIDS).","authors":"R. Siliciano","doi":"10.1038/NPG.ELS.0003998","DOIUrl":"https://doi.org/10.1038/NPG.ELS.0003998","url":null,"abstract":"","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"46 5 1","pages":"260-2"},"PeriodicalIF":0.0,"publicationDate":"2006-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1038/NPG.ELS.0003998","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58398382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting research into practice","authors":"Collette Clifford, Jenny Clark","doi":"10.4135/9781473913844.n7","DOIUrl":"https://doi.org/10.4135/9781473913844.n7","url":null,"abstract":"Part 1: The Context: 1. Background. 2. Research in health care: establishing a National Research and Development Programme. 3. Developing a research programme to meet a national agenda. 4. Managing the local agenda - planning to get research/evidence-based care into practice. 5. Research for Practice... Part 2: Practical experiences. 6.. The physiotherapy experience. 7. The midwifery experience. 8Experiences in child care nursing. 9. Experiences in mental health nursing. 10. Undertaking feasibility studies in Primary Care. 11. A Personal Journey Part 3 Implications:12. Research and development in practice . Resource section.","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"226 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2004-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70598433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unnecessary out-of-hours biochemistry investigations--a subjective view of necessity.","authors":"A A McConnell,&nbsp;P Bowie","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the extent to which pre-registration house officers (PRH0s) admit to requesting 'unnecessary' out-of-hours biochemistry tests and assess the reasons why this occurs.</p><p><strong>Design: </strong>Semi-structured interviews conducted over a 2-year period covering 1998/99.</p><p><strong>Setting: </strong>Inverclyde Royal District General Hospital</p><p><strong>Subjects: </strong>79 PRHOs.</p><p><strong>Results: </strong>Seventy-nine PRHOs were interviewed. Eighty-seven percent admitted requesting 'unnecessary' out-of-hours tests in between 5% and 50% of cases. The reasons cited include uncertainty about the diagnosis (80%), the need for medico-legal protection (79%), to avoid leaving work for colleagues (66%), and to prevent criticism from consultant staff and others (71%). Seventy six percent of PRHOs indicated that ordering 'unnecessary' tests helped to lessen anxiety and reduce stress levels associated with their work. Seventy one percent agreed an attempt should be made to reduce 'unnecessary' tests.</p><p><strong>Conclusions: </strong>This study has shown that a significant proportion of PRHOs admits to requesting 'unnecessary' out-of-hours tests. A better understanding of why these tests are requested has been established. The need for self-protection and a fear of criticism from senior staff are prominent factors affecting stress levels amongst junior medical staff in the hospital workplace.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"40-3"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22313174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A waste of time: non-attendance at out-patient clinics in a Scottish NHS Trust.","authors":"A M Hull,&nbsp;D A Alexander,&nbsp;F Morrison,&nbsp;J S McKinnon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>The Patient's Charter states that patients have a responsibility to attend out-patient appointments or to notify the hospital if they are unable to do so. Non-attendance without notification has substantial financial costs for the NHS and may have clinical implications to the non-attender and other patients on the waiting list.</p><p><strong>Objective: </strong>To identify reasons for non-attendance of patients for their first appointment after referral.</p><p><strong>Design: </strong>A survey by questionnaire of a random sample of non-attenders of an NHS trust.</p><p><strong>Setting: </strong>Aberdeen Royal Hospitals NHS Trust.</p><p><strong>Subjects: </strong>Ten per cent of all non-attenders to the Trust out-patient clinics over a twelve month period.</p><p><strong>Results: </strong>One hundred and fifty five (32%) patients contributed to the survey. Cancellations accounted for 22% (34) of missed appointments with factors relating to illness or treatment, being the most common reason (14; 44%). Patients failing to attend without prior notification stated that hospital administrative problems (75; 57%) and personal administrative problems (31; 23%) were the primary reasons. Clinical speciality, day of the week, the month, availability of a telephone or car, and socioeconomic group were not significantly associated with non-attendance.</p><p><strong>Conclusion: </strong>The majority of patients show a responsible attitude to attendance at outpatients when appointments were received. Non-attendance was found to be due to a combination of institutional factors (commonly administrative) and patient factors such as forgetting about the appointment.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"62-9"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed opportunities? Management of patients with alcohol problems in a surgical ward.","authors":"A Aarvold,&nbsp;T Crofts","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with alcohol problems necessitate treatment with counselling, and hospital admission for alcohol related complaints presents an ideal opportunity for this. This paper aims to examine the management of patients with alcohol related complaints on a surgical ward. Patients were interviewed to analyse the extent of their alcohol problem and counselling received, and doctors completed a questionnaire about counselling they offered. Forty seven out of 435 patients (10.8%) had alcohol related complaints; 28 of these 47 were alcohol dependent; 22 out of 28 alcohol dependent patients were not spoken to about their alcohol consumption on this admission. Thirteen doctors responsible for hospital admissions completed the questionnaire: although an alcohol history was almost always taken, counselling was rarely offered. In conclusion, the management of patients with alcohol problems in the emergency admission was sub-optimal. The treatment most needed was counselling, and this ideal opportunity for intervention was almost always missed.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"55-61"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22313177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Scottish primary care researchers are doing to recover their standing in the UK.","authors":"F M Sullivan,&nbsp;G Lewison,&nbsp;J Clarkson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To compare the outputs of Scottish PC research with the rest of the UK.</p><p><strong>Design: </strong>Bibliometric analysis of the research level and potential impact of research publications. Papers are categorised by level (RL) from basic research to clinical observation and potential impact category (PIC), a 5 year impact factor on a numerical scale.</p><p><strong>Setting: </strong>Interrogation of the Wellcome Trust's Research Outputs Database 1988-97.</p><p><strong>Subjects: </strong>17,303 papers, 2,280 arising from Scottish primary care.</p><p><strong>Results: </strong>Scottish primary care publications totalled 14% of the published research in the UK during 1988, by 1997 it had fallen to 10%. PC researchers in the rest of the UK produced a 60% increase (1169 to 1866 per annum) in publications compared to our 25% increase (201 to 251 per annum) over the same period. Scottish papers were less likely to be presenting basic science. The mean potential impact was slightly lower than the rest of the UK (1.89 compared to 1.94, s.e.m.0.02).</p><p><strong>Conclusion: </strong>Scottish PC research outputs grew more slowly than the rest of the UK during 1988-97. The research interests and journals selected by the research community contributed to this pattern. The climate, infrastructure and skills required for more effective PC research during this period were also significant factors. The Scottish School of Primary Care provides a mechanism for everyone in NHSScotland and Higher Education Institutions to address the underlying issues identified in this analysis. As a 'baseline' analysis, this report will allow progress to be monitored as the SSPC becomes increasingly effective.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Down syndrome in Glasgow, 1980-96--the growing impact of prenatal diagnosis on younger mothers.","authors":"Z Iliyasu,&nbsp;W H Gilmour,&nbsp;D H Stone","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of improved methods of prenatal diagnosis on the prevalence of Down Syndrome (DS).</p><p><strong>Design: </strong>Registry based epidemiological study.</p><p><strong>Setting: </strong>Glasgow Register of Congenital Anomalies, Greater Glasgow Health Board, Scotland.</p><p><strong>Subjects: </strong>All registered cases of DS diagnosed at or after birth plus terminations following prenatal diagnosis from 1980 to 1996. Denominator data (total births to mothers resident in GGHB) were obtained from the Registrar General for Scotland.</p><p><strong>Results: </strong>A total of 293 cases of DS were registered over the 17 year period. Of these, 198 (68%) were live births, 8 (3%) stillbirths and 84 (29%) induced abortions following prenatal diagnosis. There were 212,724 total births to women in the GGHB area over the same period, giving a period pregnancy prevalence of 1.36 per 1000 total births (95% CI 1.21-1.53). After correcting for spontaneous losses, the adjusted pregnancy prevalence was 1.24 per 1000 total births. The pregnancy prevalence of DS rose over time. One hundred and two (35%) of cases of DS were diagnosed prenatally. The annual proportion of DS cases diagnosed prenatally slowly increased to around 60% towards the end of the period. The termination rate also increased, especially in younger (under35) women. A change in this rate in 1987 coincided with the introduction of the triple test.</p><p><strong>Conclusions: </strong>The epidemiological impact of antenatal screening and subsequent prenatal diagnosis is clear with pregnancy and birth prevalence rates diverging steadily over time since the late 1980s. The rising termination rate in younger women suggests that the benefits of antenatal screening are now extending to the lower risk younger age groups.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"20-6"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22313171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of febrile children in a paediatric emergency department.","authors":"O Osman,&nbsp;D Brown,&nbsp;T Beattie,&nbsp;P Midgley","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To study the determinants and appropriateness of hospitalisation of febrile children in a paediatric emergency department.</p><p><strong>Design: </strong>An observational prospective study.</p><p><strong>Setting and subjects: </strong>Patients presenting to the emergency department of the Edinburgh Royal Hospital for Sick Children over nine consecutive weeks.</p><p><strong>Methods: </strong>Clinical and laboratory data were collected from patients presenting with an infectious illness. A three point scale was used to assess both the degree of severity of illness and the probability of bacteraemic illness. Patients who received the following therapies in hospital were identified: intravenous antibiotics, intravenous fluids, oxygen therapy, upper airway suctioning or nasogastric feeding. The clinical and laboratory characteristics of patients admitted to the hospital were studied.</p><p><strong>Results: </strong>A third of the five thousand and twenty one patients seen presented with an infectious illness. Of these, 42% were febrile, while 22% had a high temperature (> 38.5 degrees C). Forty one per cent were hospitalised and of these only 44% received one or more of the treatments mentioned above. Only the illness-severity--score predicted the requirement for such treatment. This clinical scoring was also a powerful predictor of bacterial infection. The positive predictive value of a high temperature (> 38.5 degrees C) in predicting bacterial infection was 40%. The negative and positive predictive values for neutrophilia (> 10 x 10(9)/1) were 47% and 77% respectively. Forty three per cent of the admitted patients were investigated with blood culture and 2.5% of blood cultures were positive for a pathogenic organism. There were no Hib isolates. The positive and negative predictive values of a high temperature for bacteraemic illness were 5% and 99% respectively.</p><p><strong>Conclusion: </strong>A large proportion of paediatric patients is perhaps unnecessarily hospitalised. Inappropriate hospitalisation may be prevented by the development and implementation of guidelines based on objective criteria. Enhancement of the role of ambulatory paediatrics in the care of febrile children may be more cost-effective than anticipatory hospitalisation.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"33-9"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22313173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-admissions to the State Hospital at Carstairs, 1992-1997.","authors":"J M Duncan,&nbsp;A Short,&nbsp;J S G Lewis,&nbsp;P T Barrett","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To examine the incidence and characteristics of re-admissions to the State Hospital over the six year inclusive period of January 1992 to December 1997. RESONS FOR THE STUDY: RISK ASSESSMENT: A re-admission to a high-security setting may be the result of a failed risk assessment at the time of discharge. An analysis of re-admissions might reveal facts that will improve risk prediction. In this context every re-admission to maximum security should qualify for critical incident appraisal. A re-admission could also indicate prudent risk management where the patient is readmitted prior to the occurrence of any new incident. Our analysis may give an indication how risk prediction and risk management is functioning in the Forensic Psychiatry setting.</p><p><strong>Health economics: </strong>Patient numbers at the State Hospital have exceeded planning predictions. In the early 1990s the prediction was that numbers would level off at around 200 patients. Instead admission rates continued to rise and the State Hospital in-patient population has on occasion reached its maximum. This trend has continued throughout the decade with the daily patient numbers averaging 236, 248, 252 and 249 in the last four years (1997-2000). In this context the role played by re-admissions is an important health economics issue.</p><p><strong>Design: </strong>Data gathered from the medical records department and examination of medical case files, entered into a database, and subsequently analysed using a variety of tools. Descriptive statistics for the total State Hospital patient population between 1992-1994 were taken from a published survey. Other comparative analyses were undertaken using data from previously published studies.</p><p><strong>Setting: </strong>The data originate from the State Hospital, Carstairs, Lanarkshire, which is the only psychiatric hospital in Scotland to offer maximum-security care. Patients are admitted from ordinary psychiatric hospitals as well as from a penal setting. The maximum number of staffed beds is currently 257. These comprise an admission unit, two rehabilitation units including one with flatlet accommodation, a specialist learning difficulties unit, an all female unit and six male wards. The Hospital is staffed by psychiatrists, GPs, psychologists, social workers, psychiatric nurses including nurse specialists, occupational therapists, and other specialist staff employed in the education, occupations and recreation departments.</p><p><strong>Results and conclusions: </strong>Annual re-admission rate, averaged over 1992-1997 is 22.3% of all patient discharges in the hospital. This is broadly in line with other studies quoted in the literature. The re-admission rate co-varied with first admission rate at an almost constant ratio of 0.38 over the six-year period of study. There is no apparent systematic reason for this phenomenon. The most apparent risk factor was a previous admission to the State Hospital ","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"70-82"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide in the Highlands of Scotland.","authors":"C Stark,&nbsp;F Matthewson,&nbsp;N O'Neill,&nbsp;K Oates,&nbsp;A Hay","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The Highlands have one of the highest suicide rates in Scotland. This paper describes suicide and deliberate self-harm in the Highlands in the last 20 years and explores possible reasons for the differences from the Scottish average.</p><p><strong>Design: </strong>Retrospective analysis of routine data from the SMRI/SMR01 scheme and information on deaths from the Registrar General. Suicide and undetermined deaths were combined in the analysis.</p><p><strong>Setting: </strong>Highland and Scotland 1978-98.</p><p><strong>Results: </strong>The high rates in Highland are caused by an excess of male deaths. Highland has had consistently high male suicide rates over the 20 year period compared to Scotland. These differences do not disappear when deaths of non-Highland residents are excluded. By comparison, deliberate self-harm admissions follow a similar pattern to Scotland as a whole. Causes of death differed from Scotland as a whole, with an over-representation of drowning, gases and firearm deaths.</p><p><strong>Conclusion: </strong>Highland suicide rates are elevated compared to Scotland. This is mainly due to an excess of deaths in men up to the age of 74 years, and is not accounted for by deaths of non-residents. Female deaths are not elevated in comparison to the rest of Scotland. Male attempted suicide rates do not differ from Scotland. Lethality of method--drowning, car exhausts and firearms--may contribute to the elevated male death rates.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"60 1","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22313172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}