Health bulletin最新文献

{"title":"Hospital at home services for acute exacerbation of chronic obstructive pulmonary disease: a survey of British practice.","authors":"M K Johnson,&nbsp;U Flanigan,&nbsp;J Fuld,&nbsp;A Irwin,&nbsp;C Stewart,&nbsp;R D Stevenson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the prevalence of and attitudes towards hospital at home services for acute exacerbation of chronic obstructive pulmonary disease (COPD) in Great Britain. To identify the models of service in existence, in particular staff numbers and the workload experienced.</p><p><strong>Design: </strong>A postal survey was used to locate existing schemes. Telephone interviews were conducted with each of the hospital at home services identified.</p><p><strong>Subjects & setting: </strong>A questionnaire was sent to one consultant in each of 223 respiratory departments in Great Britain. Thirty six departments were subsequently contacted by telephone.</p><p><strong>Outcome measures: </strong>Awareness and prevalence of hospital at home services. Perceived problems with starting a service. Details of organisation of existing services.</p><p><strong>Results: </strong>We received 186 replies to the postal questionnaire. Of these respiratory departments, 179 (96%) were aware of hospital at home services for acute exacerbation of COPD and, in November 1999, 30 (16%) were running such a service. Difficulty in obtaining funding was the main reason for not setting up a service rather than lack of evidence of benefit or unsuitability of local circumstances. Median staffing level was two nurses (range one to six) looking after a median number of new patients of five per week (range 0.5 to 12). There was wide variation in the organisation of services.</p><p><strong>Conclusions: </strong>Despite lack of objective evidence of effectiveness, there was a high level of awareness of and interest in starting hospital at home services for acute exacerbation of COPD in British respiratory departments when assessed in November 1999.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"163-70"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315006","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":"Discussing wisdom teeth with patients: a critique of information materials.","authors":"M O'Donnell,&nbsp;V Entwistle,&nbsp;C Deery","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the quality of information leaflets about third molar extraction.</p><p><strong>Design: </strong>Quality assessment of information leaflets about third molar extraction. We focused particularly on the extent to which they reflect current research evidence.</p><p><strong>Setting: </strong>All fifteen oral and maxillofacial surgery departments in Scotland were asked to provide copies of existing patient information materials on third molar surgery.</p><p><strong>Results: </strong>Six different leaflets were assessed. Most were apparently intended for people who were about to undergo and/or had just undergone the procedure rather than for people facing decisions about extraction. The leaflets appeared to reflect varying policies about third molar extraction and some of the information provided did not reflect current research evidence.</p><p><strong>Conclusions: </strong>There is currently a lack of good quality information materials available to people who are considering third molar extraction. It is likely that there are also problems with the quality of other patient information leaflets. Health care professionals need to review the quality of patient information leaflets to ensure that the information provided reflects current research evidence.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"171-7"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315007","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":"An investigation of the correspondence between psychological problems diagnosed by GPs and those subsequently targeted for treatment by clinical psychologists.","authors":"N Broomfield,&nbsp;P Fleming,&nbsp;D Foot","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>1. To observe the level of concordance between problems identified by GPs in the referral letter, and primary treatment targets identified by Clinical Psychologists following assessment within an NHS Clinical Psychology Department. 2. To examine whether concordance between GP and Psychologist varies for different psychological problem areas. 3. To examine whether concordance between GP and Psychologist varies with time spent on the waiting list.</p><p><strong>Design: </strong>A retrospective review, and classification, of GP referral letters and Psychologists treatment targets.</p><p><strong>Setting: </strong>A Department of Clinical Psychology based in Scotland. Sixty five GPs based across fifteen GP practices refer to the department.</p><p><strong>Cases: </strong>Four hundred and one patients consecutively referred by GPs to the Department of Clinical Psychology between April 1 1996 and March 31 1998, and subsequently assessed by one of the qualified Clinical Psychologists. Two hundred and seventy three cases were female (68.08%), 128 male (31.92%).</p><p><strong>Results: </strong>Overall agreement between GP referred problem and Psychologist treatment target, coded in terms of EPPIC 'reasons for care' categories, was 'fair', and observed for 59.6% of cases. High agreement for eating disorders, moderate agreement for anxiety and depression, and low agreement for relationship/social problems was observed. Analysis indicated one third of anxiety referrals and one half of depression referrals were treated differently. Agreement levels were high for short waiting times, and lower for long waiting times, although findings for intermediate waiting times were mixed.</p><p><strong>Conclusions: </strong>Moderate agreement levels between GP and Clinical Psychologist in cases initially referred for anxiety and depression replicate previous findings. Low levels of agreement for relationship/social problems were not anticipated. The implications of results for future research and service provision are outlined.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"178-87"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315008","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":"The OMENS trial: opportunistic evaluation of musculo-skeletal physician care among orthopaedic outpatients unlikely to require surgery.","authors":"A P Brown,&nbsp;A D Kennedy,&nbsp;D J Torgerson,&nbsp;J Campbell,&nbsp;J A Webb,&nbsp;A M Grant","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Study objective: </strong>For orthopaedic outpatients judged as unlikely to require surgery, how does the cost-effectiveness of treatment from a musculo-skeletal medicine physician compare with that of a conventional orthopaedic surgeon-led service?</p><p><strong>Design: </strong>Partially randomised, pragmatic trial comparing management from a single musculo-skeletal medicine physician with orthopaedic surgeon-led management, with the timing and nature of treatments at the discretion of individual clinicians. Main outcomes were: change in patient reported health (SF-36 and EuroQol), and marginal health service costs.</p><p><strong>Setting: </strong>Outpatient department of an Edinburgh orthopaedic hospital.</p><p><strong>Subjects: </strong>One thousand three hundred and twenty six people; aged over 18, referred to and later attending the outpatient department with a 'non-surgical' musculo-skeletal condition, who provided baseline information. Eight hundred and twenty nine were randomly allocated to management by either the musculo-skeletal medicine physician (medical group) or a conventional orthopaedic surgeon-led service (surgical group); 497 were assigned to the treatment groups according to their general practitioner's preference.</p><p><strong>Results: </strong>There are aspects of the study design concerning statistical power, potential selection bias and generalisability, which mean that any results must be treated with caution. Although there was no statistically significant difference in health gain between the randomly allocated groups (with similar findings in the non-randomised medical and surgical groups), the patient groups were heterogeneous and the confidence intervals did not rule out clinically important differences. The medical group received more outpatient treatment, 20% vs. 10% (difference 95% CI 5% to 15%) with a higher rate of physiotherapy referral, 45% vs. 30% (15%, 9% to 22%). The surgical group received more inpatient surgical care 6% vs. 17% (-11%, -15% to -7%). Mean healthcare costs in the medical group were 179 Pounds per patient compared with 287 Pounds in the surgical group (-108 Pounds, -25 Pounds to -191 Pounds).</p><p><strong>Conclusions: </strong>Interpretation should take into account the practical difficulties and circumstances of the study. Although no differences in health gain were found between these two management policies for 'non-surgical' orthopaedic outpatients, the trial was less statistically powerful than planned and the confidence intervals included clinically important differences. Differences in treatment emphasis gave estimated costs savings to the Health Service of 108 Pounds per patient treated by the musculo-skeletal medicine service.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"198-210"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315011","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":"An estimate of the costs of cases of rotavirus infection admitted to hospital in Scotland, 1997.","authors":"J M Cowden","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"188-92"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315009","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":"How do multiple sclerosis patients in Lanarkshire rate health professionals and hospitals?","authors":"E M Scrimgeour,&nbsp;J A Barnes","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"155-7"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314517","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":"Understanding factors influencing request for a repeat termination of pregnancy.","authors":"S K Tewari,&nbsp;O Diaz-Morales,&nbsp;D R Urquhart,&nbsp;T A Mahmood","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess factors influencing request for a termination of pregnancy (TOP).</p><p><strong>Design: </strong>A questionnaire based, prospective study of 150 women requesting a TOP. This questionnaire contained a modified version of the Edinburgh Postnatal Depression Scale (EPDS).</p><p><strong>Subjects: </strong>Of the 150 women requesting a TOP, 100 were seeking a TOP for the first time and the remaining 50 had at least one TOP in the past.</p><p><strong>Results: </strong>Forty-five percent of women requesting termination of the first pregnancy were under the age of 20, 62% earned less than 10,000 Pounds per year and 12% did not use any form of contraception. Ninety-eight percent knew about emergency contraception but only 3% used it. The repeat termination group were older (only 24% under the age of 20). Fifty-five percent earned less than 10,000 Pounds per year, 15% did not use any contraception, 92% knew about emergency contraception but only 10% used it. Both groups were highly satisfied with the counselling, explanation about the procedure and future contraception advice. However, about 60% of women in both groups had suffered from mild to moderate depression as a consequence of termination.</p><p><strong>Conclusion: </strong>This study confirms the need for easy availability of emergency contraception and emphasises the importance of education about contraception in general.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"193-7"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22315010","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":"Adults with Incapacity (Scotland) Act 2000: implications for medical practice.","authors":"D Lyons","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Scottish Parliament has passed a major piece of Legislation, The Adults with Incapacity (Scotland) Act 2000. Various Sections of this Act will be implemented on a phased basis between April 2001 and April 2002. This article summarises the major provisions of the Act and describes the duties of doctors and the impact on medical treatment and research where the person is incapable of giving consent.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"146-9"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314554","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":"Counselling for alcohol problems in primary care in Forth Valley--an innovative approach?","authors":"T Martinus,&nbsp;B Anderson,&nbsp;H Carter","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To explore the implications of establishing a voluntary sector provided alcohol counselling service within a Primary Care setting in Forth Valley Health Board area, and to evaluate the potential of such a project.</p><p><strong>Design: </strong>Analysis of routinely held information and postal questionnaire survey.</p><p><strong>Setting: </strong>North and South Local Health Care Co-operatives, Forth Valley Primary Care NHS Trust in conjunction with Central Scotland Council on Alcohol (CSCA).</p><p><strong>Subjects: </strong>Users of counselling service and local general practitioners.</p><p><strong>Results: </strong>General practitioners referred a total of 349 people with 284 attending for counselling. Survey of a sample of 80 service users achieved a 45% response rate. Of those who responded a majority (89%) said that the health centre location was an important factor in their ability to use and therefore benefit from the service. Accessibility, quality and confidentiality of the counselling service were important factors determining ability to attend and benefit from counselling. The survey of local general practitioners achieved a 69% response. The majority (96%) of general practitioners reported the service to be either extremely valuable or very helpful. General Practitioners listed 3 major benefits as confidentiality, accessibility and cost effectiveness. A significant minority of general practitioners (24%) reported that they were unaware that the service existed. Compared with other routine CSCA counselling services people's reported alcohol consumption was some 18% higher in those referred to the primary care based counselling service. At review, four weeks later, the average reported alcohol consumption had decreased considerably. People using the counselling service reported that the service helped them reduce their alcohol consumption, improve their general health and their personal relationships.</p><p><strong>Conclusion: </strong>This project has demonstrated that a voluntary sector agency can work closely and successfully with primary care services in establishing counselling services for those with alcohol problems. Early evaluation would point towards success in terms of reducing reported levels of drinking and improved health. Local general practitioners indicated their support for continued development of this type of service provision.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 3","pages":"158-62"},"PeriodicalIF":0.0,"publicationDate":"2001-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22314518","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":"Using all the evidence: towards a truly intelligent National Health Service.","authors":"S Kendrick","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In order to become a truly intelligent organisation, the health service needs to make much greater use of the wealth of evidence about effectiveness which its day-to-day activities can potentially provide. Evidence comes in many forms. Each context of health care has its own best configuration of forms of evidence (e.g. process and outcome) and ways of feeding evidence back to staff to help improve effectiveness. A strategy for creating a truly intelligent NHS will involve better routine data systems and more widespread skills in analysing and interpreting data to generate evidence. The single most important key to generating better evidence is getting staff committed to structured recording of clinical data as a valued part of the process of delivering care.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"59 2","pages":"71-6"},"PeriodicalIF":0.0,"publicationDate":"2001-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22312913","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}