Health bulletin最新文献

{"title":"The boom that never was: results of a 10 year audit of paediatric growth hormone prescribing in Scotland.","authors":"W F Paterson,&nbsp;M D Donaldson,&nbsp;S A Greene,&nbsp;C J Kelnar,&nbsp;P J Smail","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate trends in paediatric growth hormone (GH) prescribing in Scotland.</p><p><strong>Design: </strong>Annual audit of paediatric GH patients, analysed by geographical distribution, diagnosis, age and duration of treatment, dosage, sex ratio and prescribing body.</p><p><strong>Subjects and setting: </strong>Paediatric patients receiving GH who attended the four tertiary referral centres in Scotland: Glasgow, Edinburgh, Dundee and Aberdeen, from 1990-1999.</p><p><strong>Results: </strong>The annual total number of paediatric GH recipients ranged from 296-393. The maximum was recorded in 1994, with a progressive decline thereafter. The latest total (296, 1999) represents a 19% decrease since 1990. There is a marked disparity between these figures and projections published by the Scottish Office Clinical Research and Audit Group (CRAG) in 1990 of 500 patients in 1995 and 600 by 2000. CRAG postulated that GH would prove efficacious in a wider range of conditions, that the number of survivors of childhood cancer would increase and that GH therapy would continue following clinical trials. While there has been a relative increase in oncology survivors during the 10-year period, the overall decline in numbers is largely attributable to familial short stature patients in whom there has been a five fold decrease, following completion of clinical trials of GH. The number of children classified \"idiopathic growth hormone deficient\" has also decreased, as the overlap between this condition and normal variant short stature is increasingly recognised.</p><p><strong>Conclusion: </strong>This expensive drug is being used relatively conservatively in Scotland, in the light of research experience. While a small degree of ad hoc usage is inevitable, we strongly support participation in national trials wherever possible. The adoption of an open approach with the Scottish Office regarding GH usage has proved beneficial in alleviating fear of escalating costs and preventing prescribing problems in a country in which 98% of GH is prescribed by general practitioners.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"457-66"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443202","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":"Guardianship in the elderly and the Community Care Act: more of the same?","authors":"J M Barber,&nbsp;J T Crean","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Guardianship has been used in increasing numbers of elderly mentally disordered Scots in the past decade. During this time, the Community Care Act (CCA) encouraging the provision of care for individuals in their home has been enacted. This study aimed to see if the increased use of guardianship could be due to the use of orders to maintain at-risk elderly people in their homes.</p><p><strong>Design: </strong>A retrospective survey of all new guardianship orders in people aged 65 or over, comparing those in the two years before the CCA with those in the two years after. Cases were identified using the Mental Welfare Commission (MWC) database. MWC records for the individuals placed on guardianship were examined for data on demographics, social circumstances and perceived risks, together with duration and outcome of orders. Hospital case records were examined for diagnostic information.</p><p><strong>Subjects: </strong>All individuals aged 65 or over placed on guardianship under the Mental Health (Scotland) Act 1984 between 1st April 1991 and 31st March 1995.</p><p><strong>Results: </strong>85 new guardianship orders were identified, 22 before and 63 after CCA. Most were female (82% before and 85% after) and suffered from organic mental disorders (82% before and 84% after). The modal duration of orders for both groups was six months with a trend towards longer orders being noted in the after CCA group. The majority of orders resulted in the placement of the individual in nursing or residential home care (82% before and after CCA).</p><p><strong>Conclusion: </strong>The increased use of guardianship in elderly mentally disordered individuals is not explained by the use of orders to maintain them at home. It is likelier that the process of social work assessment required by the CCA highlights more cases where guardianship could be used.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"471-7"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443204","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":"Scottish Asthma Management Initiative.","authors":"G Hoskins,&nbsp;R G Neville,&nbsp;C McCowan,&nbsp;B Smith,&nbsp;R A Clark,&nbsp;I W Ricketts","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the development process of a system that links audit, research and patient care and to detail the lessons learned from establishing a Scotland wide asthma management initiative.</p><p><strong>Design, setting and subjects: </strong>Health Boards and practices throughout Scotland were invited to participate in an initiative which links review of care, guideline implementation, chronic disease management (CDM) approval and post-graduate education for doctors (PGEA) and nurses (PREP). Participating practices were given the materials to review 30 patients randomly selected from their asthma register. Health service resource use and drugs prescribed over a retrospective 12 month period were recorded for each patient using paper or electronic materials. All patients were invited for clinical assessment.</p><p><strong>Results: </strong>A two-tier management system proved effective. Twelve of the 15 Scottish health authorities agreed to recognise the audit for automatic CDM approval although the negotiation process was prolonged; 566 practices from all parts of Scotland have expressed an interest in the initiative. Provision of distance learning material linked to PGEA accreditation is free to general practitioners (GP's) and is a useful incentive for participation. To date 42 GPs have completed the distance learning element.</p><p><strong>Conclusion: </strong>The Scottish Asthma Management Initiative has provided the opportunity for all sectors of the health service in Scotland to work together to explore innovative ways to improve the management and care of chronic disease. Participation in an initiative linked to guidelines, education and CDM approval is an excellent way to facilitate health professionals to improve care.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"478-88"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443205","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":"Neighbourhood cohesion and health in socially contrasting neighbourhoods: implications for the social exclusion and public health agendas.","authors":"S Macintyre,&nbsp;A Ellaway","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To report on perceived neighbourhood cohesion and describe its social distribution.</p><p><strong>Design: </strong>Analysis of data from third wave of data collection from Localities component of West of Scotland Twenty-07 Study, collected in 1997 by postal survey.</p><p><strong>Setting: </strong>Socially contrasting neighbourhoods in Glasgow City in the West of Scotland.</p><p><strong>Subjects: </strong>Five hundred and ninety seven people (262 males, 336 females), participants in a longitudinal study.</p><p><strong>Results: </strong>Respondents who are older, live in owner-occupied houses in more affluent areas and who are not working outside the home report significantly more positive assessments of perceived neighbourhood cohesion. Sex, social class and family circumstances did not predict perceived neighbourhood cohesion. There were significant associations between neighbourhood cohesion and self assessed health in the last year; mental health using the GHQ12 measure; total number of symptoms reported in the last month; and reported number of 'malaise' or 'physical' symptoms after taking socio-demographic factors into account.</p><p><strong>Conclusion: </strong>Lack of social cohesion may be more common in deprived areas in Scotland and may produce poorer mental health. Living in an area with low levels of social cohesion may be part of the pathway between life circumstances and death.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"450-6"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443201","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 review of otolaryngology equipment provision in a peripheral clinic setting.","authors":"A J Cain,&nbsp;M R Laing","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the adequacy of otolaryngology equipment provision in peripheral outpatient clinics.</p><p><strong>Design: </strong>Prospective questionnaire study.</p><p><strong>Setting: </strong>Five peripheral otolaryngology clinics in the Highlands of Scotland. (Thurso, Golspie, Dingwall, Fort William and Skye).</p><p><strong>Subjects: </strong>All patients attending the above clinics over a six-month period.</p><p><strong>Results: </strong>The questionnaire return rate was 70%. 30% of patients may have had improved care had the equipment provision been adequate. Nine percent of patients required to be reviewed elsewhere due to inadequate equipment. The annual cost of these reviews exceeds 15,000 Pounds.</p><p><strong>Conclusion: </strong>The provision of adequate clinic equipment would have medium to long term economic advantages and also has relevance in relation to clinical governance and potential medico-legal concerns. The results of this review are timely as a recent BAO-HNS document has confirmed the equipment provision we describe above as being at the minimal acceptable level.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"467-70"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443203","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":"Impact of a nurse led multidisciplinary team on an acute medical admissions unit.","authors":"S Cameron,&nbsp;F McKenzie,&nbsp;L Warnock,&nbsp;D Farquhar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of a nurse-led multi-disciplinary team on management of elderly patients with functional problems admitted to an acute medical admission unit.</p><p><strong>Design: </strong>Data collection from the first 16 months of the team's operation.</p><p><strong>Setting: </strong>A district general hospital, Scotland.</p><p><strong>Subjects: </strong>All elderly patients with functional problems who were considered fit for immediate multi-disciplinary assessment.</p><p><strong>Results: </strong>Over 1000 patients were assessed during the first 16 months. Twenty four per cent of these frail individuals were discharged directly home, of whom, almost half had some form of ongoing support. The remaining 76% were transferred for ongoing care to other wards in the Medical Directorate. Of this group, 49% moved to general medicine, 43% to geriatric assessment and 8% to the Stroke Unit. The team were perceived to improve the appropriateness of these transfers by enabling staff to review both the medical and functional needs of elderly patients when deciding on the best setting for ongoing care.</p><p><strong>Conclusions: </strong>Immediate multi-disciplinary assessment of elderly patients admitted to a medical admissions unit enables the early supported discharge of a proportion of elderly and enhances the ability of the hospital to place appropriately those patients requiring a longer stay.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"512-4"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443210","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":"Recent announcement by the Food Standards Agency concerning its target to reduce food poisoning by 20% by 2006.","authors":"B Purcell","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"518"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443125","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":"Respiratory morbidity in primary care. A population based study, using practices from the Scottish Continuous Morbidity Recording Research Database.","authors":"C R Simpson,&nbsp;P J Helms,&nbsp;M W Taylor,&nbsp;A D Baxter-Jones","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the patterns and period prevalences of respiratory disease with special reference to asthma (including wheezing) in view of its increasing reported prevalence.</p><p><strong>Design: </strong>Observational study based on prospectively entered data.</p><p><strong>Setting/subjects: </strong>Fifty five Continuous Morbidity Recording (CMR) practices with 290,000 patients located throughout Scotland.</p><p><strong>Results: </strong>Respiratory problems accounted for a large proportion (17%) of total general practice workload. Upper respiratory tract infections were the commonest presentation in pre-school children, followed by asthma but with an ever increasing proportion of consultations for bronchitis and lower respiratory tract infections with advancing adult age. There was no significant correlation between deprivation and the incidence of asthma.</p><p><strong>Conclusions: </strong>Observed rates and patterns of disease for CMR practices, were similar to previously reported studies. The large number of presentations by patients in early childhood with minor respiratory illnesses and in particular upper respiratory tract infections are likely to reflect a heightened level of parental anxiety where interpretation of clinical signs and separation of simple and significant illness can be difficult. CMR has also been shown to be of use in helping to investigate links between deprivation and disease incidence or severity. Potential uses for CMR include the study of whole population morbidity and utilisation of primary care services.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"489-96"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443206","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 regional approach to the 'problem' of secondary prevention of coronary heart disease in Tayside.","authors":"H T Dougall,&nbsp;F Sullivan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"509-11"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443209","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":"Uptake of influenza vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland.","authors":"G Barlow,&nbsp;J Kirk,&nbsp;D Nathwani","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To ascertain the uptake of influenza vaccination, the main prompts to vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland.</p><p><strong>Design: </strong>Prospective questionnaire survey.</p><p><strong>Setting: </strong>A small rural district general hospital.</p><p><strong>Subjects: </strong>General medical inpatients and outpatients.</p><p><strong>Results: </strong>The overall uptake of vaccination was 44.8% (n = 250). The main prompts to vaccination were general practitioners (48.2%), the media (11.6%), practice and district nurses (8.9%), friends and relatives (8.9%) and posters at health centres and chemists (7.1%). The main reason for non-vaccination was a lack of awareness of high-risk status (50.7%).</p><p><strong>Conclusion: </strong>The uptake of influenza vaccination in the Angus region of Scotland is unsatisfactorily low. This is mostly due to a lack of knowledge regarding high-risk status, although other reasons, including concerns about the side effects of vaccination, are also important.</p>","PeriodicalId":75896,"journal":{"name":"Health bulletin","volume":"58 6","pages":"505-8"},"PeriodicalIF":0.0,"publicationDate":"2000-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22443208","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}