Health bulletin最新文献

{"title":"First steps in developing a managed clinical network for vascular services in Lanarkshire.","authors":"D Moir,&nbsp;H Campbell,&nbsp;J Wrench,&nbsp;S Miller","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To survey key personnel involved in setting up a Managed Clinical Network (MCN) for vascular services in Lanarkshire to assess their views, knowledge and understanding about networking, with a view to facilitating the implementation of the MCN.</p><p><strong>Design: </strong>A questionnaire was designed covering current networking practice, use of protocols, audit and training. It was piloted with the MCN core group and extended to the wider steering group. Semi-structured interviews were completed with core group members focusing on the structure and management of the network.</p><p><strong>Setting: </strong>Lanarkshire Health Board, Lanarkshire Acute Hospital Trust and Lanarkshire Primary Care Trust.</p><p><strong>Subjects: </strong>The core group and steering group for the development of a Managed Clinical Network for Vascular Surgical Services.</p><p><strong>Results: </strong>Clinicians tend to have more contacts with clinicians and managers with managers. There was close and frequent networking among clinicians of equal status. Respondents shared increased expectations for participation in audit, working to protocols, training and development and improved means of obtaining patients' views and providing information. All respondents recognised the necessity for network leadership although, in this study, it was not possible to define the style of leadership.</p><p><strong>Conclusion: </strong>This study identified a degree of existing, informal networking among members of the core group and steering group and it will be important to build on that foundation as the MCN develops. Further research is required to determine the most appropriate form of leadership for the network, and to identify, more clearly, what is understood by a managed network and what accountability there should be.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 6","pages":"405-11"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22310639","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":"Appropriateness of bed usage for inpatients admitted as emergencies to internal medicine services.","authors":"S H Armstrong,&nbsp;N R Peden,&nbsp;S Nimmo,&nbsp;M Alcorn","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To establish the appropriateness of bed usage for acute care within the medical directorates of two district general hospitals using a validated assessment tool, the Emergency Admission Review (EAR). This tool assesses the appropriateness of day of care against strict criteria and allows classification of care as either acute or non-acute.</p><p><strong>Design: </strong>Prospectively, 200 medical emergency admissions, 100 in each of the hospitals, were selected. Following identification patients were assessed every two days during the first fortnight of admission or until discharge. Those patients staying longer than two weeks were then assessed weekly until conclusion of the audit period or discharge whichever was reached first.</p><p><strong>Setting: </strong>The medical directorates of two District General Hospitals within one acute NHS trust.</p><p><strong>Subjects: </strong>All patients admitted as medical emergencies, who were 14 years or older and had a length of stay of 24 hours or more.</p><p><strong>Results: </strong>A total of 787 acute in-patient bed days were analysed in Hospital A of which 363 (46%) were deemed inappropriate for acute care. In Hospital B 810 bed days were analysed and 44% (363) were deemed inappropriate. In Hospital A the most common reason for bed-days not meeting the acute care criteria was short-term waiting, accounting for 60% (217 days) of the total bed days deemed non-acute. In Hospital B the most common reason for patients receiving non-acute care was that they were having active rehabilitation. This accounted for 29% (105 days) of the total number of non-acute care days. In Hospital B three patients accounted for 28% of the total occupied bed days.</p><p><strong>Conclusions: </strong>The use of the EAR is a systematic and objective approach to the assessment of appropriateness of acute care. It applies strict criteria to determine the reason for a patient's continued hospital stay. From the results it is clear that a significant proportion of medical emergency admissions in both Hospital A and B remain in hospital for care that is deemed non-acute and therefore in theory could be performed in another setting. This information has significant potential in identifying the opportunities for streamlining services within hospitals to reduce short-term delays and also to inform the development of intermediate care services both within and outwith the acute hospital setting.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 6","pages":"388-95"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22310140","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":"Specialist alcohol liaison services in general hospitals improve engagement in alcohol rehabilitation and treatment outcome.","authors":"A Hillman,&nbsp;B McCann,&nbsp;N P Walker","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of providing a specialist addictions trained psychiatric nurse on outcome of alcohol treatment in patients presenting to general medical and surgical wards of a district general hospital. Before introducing the specialist alcohol liaison service, a range of staff including a consultant liaison psychiatrist, junior psychiatrists and community psychiatric nurses trained in liaison psychiatry assessed this patient group.</p><p><strong>Method: </strong>A retrospective review of all alcohol liaison referrals with ICD-10 defined alcohol misuse was performed for one year. Comparison data for the first 100 referrals to the specialist alcohol liaison service were obtained prospectively. Indicators included diagnosis at referral, and engagement in and completion of alcohol rehabilitation.</p><p><strong>Results: </strong>The rates of completion of a four to six week period of alcohol rehabilitation were significantly better after introduction of the Specialist Alcohol Liaison Service. Of those who commenced alcohol rehabilitation, 88% completed, compared to 40% in the traditional assessment service (p < 0.0001).</p><p><strong>Conclusion: </strong>Specialist addictions trained staff in the assessment and management of alcohol dependent patients in medical and surgical wards produce a better immediate outcome than their non-specialist colleagues. This may have implications for service design.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 6","pages":"420-3"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22310642","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":"Audit of orthopaedic bed utilisation.","authors":"A Mohammed,&nbsp;B M Thomas,&nbsp;M G Hullin,&nbsp;S W McCreath","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Blockage of beds on an orthopaedic ward causes multiple problems; it can result in cancellation of patients or elective surgery, longer waiting lists and a crisis with emergency admissions. This often necessitates 'boarding out' of patients, which is not ideal for optimal patient care. Not all patients on an orthopaedic ward need continuing orthopaedic medical or nursing care and it may be more appropriate for these patients to be managed in a rehabilitation environment. From 1/09/98-30/11/98 data were collected on all patients admitted to an adult orthopaedic ward. Information recorded included the reason for admission, age, diagnosis, surgical procedure, family and social circumstances. In addition, the date when discharge was deemed appropriate was recorded as well as the actual date of discharge. We defined the length of overstay as the time spent in an orthopaedic bed after discharge had been deemed appropriate. There were 621 patients admitted for a total of 3159 bed days. There were 253 elective admissions and 368 emergency admissions. A total of 255 bed days were blocked by 46 patients (41 emergency and 5 elective) accounting for eight per cent of the total bed days. Of these 236 (93%) were due to emergency admissions and 19 (7%) were due to elective admissions, most blocked beds were due to patients who required rehabilitation in either a unit for the young disabled or a geriatric rehabilitation ward.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 6","pages":"353-5"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22310135","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":"Managing genital chlamydia trachomatis infection in Scotland: targeted opportunistic testing or a screening programme?","authors":"D J Clutterbuck","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To compare two models of testing for genital chlamydia trachomatis infection: opportunistic testing for genital chlamydia trachomatis at sexual health related consultations, as advocated in the SIGN guideline on Chlamydia trachomatis, or the introduction of a screening programme.</p><p><strong>Design: </strong>Calculation of estimates of numbers of cases found in one Health Board Area using the two different approaches. Review of the literature on chlamydia with reference to the UK National Screening Committee criteria for appraisal of a screening programme.</p><p><strong>Setting: </strong>Lothian Health Board Area.</p><p><strong>Results: </strong>The evidence suggests that a screening programme for chlamydia has population benefits and is cost effective compared to a no-screening approach. However, current understanding of the natural history of chlamydial infection and the effect of treatment is inadequate to fully inform individual women regarding the benefit of testing. Full implementation of the SIGN guideline on Chlamydia trachomatis in Lothian would detect at least 600 new cases of chlamydia whereas a screening programme would detect over 2000 new cases in the first year.</p><p><strong>Conclusion: </strong>Opportunistic testing at sexual health related consultations does not equate with a screening programme. Although a screening programme would detect more cases of chlamydia trachomatis its cost effectiveness compared to opportunistic testing is unproven. Introducing a screening programme has individual psychological and broader social and ethical implications and must not occur by default.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 6","pages":"396-404"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22310141","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 does receiving the care programme approach mean for service users?","authors":"H Alexander,&nbsp;L Brady","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To explore what receiving the Care Programme Approach means for service users.</p><p><strong>Design: </strong>A qualitative study based on peer group discussion, the transcript being subjected to issues analysis to generate key themes.</p><p><strong>Setting: </strong>Ayrshire and Arran, West of Scotland.</p><p><strong>Subjects: </strong>Six people with severe and enduring mental illness who were receiving the Care Programme Approach. The size of the group was restricted to allow service users time to express their views. (A representative response was not being sought.)</p><p><strong>Results: </strong>Four major themes emerged from the service users: the power of user involvement, how receiving CPA can help to avert potential problems, the rights of service users, and the benefits of advocacy. These service users felt that CPA had made a real difference to their lives.</p><p><strong>Conclusion: </strong>As user involvement is an integral part of CPA, it is important that we develop strategies that allow their views to shape, in a genuine way, the services being put in place to meet their needs. In Ayrshire they seem to have learned that their participation mattered.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 6","pages":"412-6"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22310640","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":"Huntington's disease: seldom seen--seldom heard?","authors":"K McGarva","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To ascertain the needs of people with Huntington's Disease (HD). HD is a complex disease which does not fit neatly into either physical or psychiatric service provision.</p><p><strong>Design & methodology: </strong>Structured questionnaire interview of both affected individuals and carers. Participants were recruited through the Fife branch of the Scottish Huntington's Association and interviewed by an independent researcher. Fifteen affected individuals and sixteen carers were interviewed. Levels of stress were measured using validated questionnaires, HAD (Zigmond & Snaith, 1983) and PSS (Cohen et al, 1983).</p><p><strong>Results: </strong>A range of perceived difficulties for both people with Huntington's Disease and carers were highlighted as were gaps in service provision. Services were at best ad hoc and mostly \"reactive\" in nature.</p><p><strong>Conclusions: </strong>HD is a disorder of families and it is not unusual for more than one family member to be affected. There is therefore an increasing burden of care falling upon a small number of individuals who may themselves be at risk of developing the disease. Gaps in service provision need to be addressed proactively to facilitate a quality of life for individuals and carers. In the experience of the Scottish Huntington's Association, the results of this survey reflect the situation throughout Scotland.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 5","pages":"306-8"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314546","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":"Haemodialysis in a rural area: a demanding form of treatment.","authors":"A Brammah,&nbsp;G Young,&nbsp;A Allan,&nbsp;S Robertson,&nbsp;J Norrie,&nbsp;C Isles","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To determine distances travelled and time spent waiting for transport among hospital haemodialysis patients living in a rural area.</p><p><strong>Design: </strong>Cross sectional survey comparing the subregional dialysis unit in south west Scotland with 12 of the other 13 Scottish Adult Renal Units.</p><p><strong>Subjects: </strong>Forty three Dumfries and Galloway patients and 935 other Scottish patients receiving hospital haemodialysis in November 1999.</p><p><strong>Results: </strong>At the time of the survey 8/43 (19%) Dumfries patients travelled in excess of 100 miles per dialysis day (15,000 miles per year) solely for the purpose of dialysis, compared to 20/935 (2%) elsewhere in Scotland (p < 0.001). Twenty seven (63%) Dumfries and 594 (64%) patients in other Scottish Units relied on hospital car, Patient Transport Service bus or ambulance for the journey home after treatment. Dumfries patients who travelled by Patient Transport Service or hospital ambulance had to wait twice as long before they left the renal unit as patients using a dedicated hospital car or private car.</p><p><strong>Conclusion: </strong>Haemodialysis in a rural area has every reason to be considered a demanding form of treatment. Greater promotion of home based treatment would improve the quality of life for many of these patients, while dedicated hospital cars would reduce 'car to needle time' for those who remain on hospital haemodialysis.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 5","pages":"294-9"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314611","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":"Managing heart failure in the community; role of the nurse specialist.","authors":"M Smith,&nbsp;J B Irving","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness of a nurse specialist in managing patients with heart failure in the community.</p><p><strong>Design: </strong>Out patient attendances and re-admissions to hospital for the two years (April 1995-97) before the service started were compared with the two years afterwards (April 1997-99).</p><p><strong>Setting: </strong>Integrated Community and Acute Trust in West Lothian.</p><p><strong>Patient population: </strong>Sixty one patients with severe heart failure (New York Heart Association class IV).</p><p><strong>Results: </strong>Twenty eight patients died within the study period. Of those surviving, total re-admissions (bed days used) were reduced from 605 to 270 days, outpatient clinic attendances fell from 168 to 60. Among those who died the rates corrected for survival period were not changed for re-admission but reduced from a mean of 6.6 to 2.3 attendances per patient.</p><p><strong>Conclusion: </strong>A nurse lead service for patients with heart failure significantly reduces clinic attendances and hospital re-admission.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 5","pages":"340-2"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314551","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":"From the Chief Nursing Officer.","authors":"A Jarvie","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 5","pages":"286-9"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314609","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}