Health trends最新文献

A postal questionnaire was used to examine possible differences in clinical experience of pre-registration house officers (PHROs) in eight former English regions, and, within the Thames regions, between teaching hospitals, and non-teaching hospitals in Inner London, Outer London and outside London. The main measurements were the numbers of patients clerked in an average week as emergency, routine or day admissions or as outpatients; the number of patients under the respondents' care at time of reply; the experience of specific clinical conditions gained; the overall adequacy of clinical experience; and the suitability of posts for preparing respondents to work as casualty officers, senior house officers, or general practitioners. The results indicate that less clinical experience was acquired by PRHOs training in the Thames regions. They had fewer admissions per week, fewer patients, and exposure to fewer surgical conditions. Within the Thames regions, there was a gradient of improving educational quality (in all areas of this study) from the teaching hospitals, through the non-teaching hospitals in inner and in outer London, and then to the hospitals outside London. No differences were found between Thames region posts outside London and non-Thames regions.

Clinicians and epidemiologists have become increasingly interested in access to patient records for clinical audit and medical research. This article describes the historical background of the Office of Population Censuses and Surveys (OPCS), and the ways in which its records can be used to support such research. It also discusses how confidentiality is safeguarded, whilst at the same time access for those with approved studies has been improved.

All general practices in Nottinghamshire were sent a questionnaire to examine the organisation and structure of their annual health checks for elderly people. The results indicated that 99% of responding practices offered checks, yet nearly one quarter estimated that under 50% of their elderly population actually had a check. Many practices had no system for following up old people who did not respond to an invitation for a check. Practices with smaller numbers of elderly people were more likely to estimate high response rates to invitations for a check and more likely to follow-up those who did not respond. The findings are discussed in relation to the reasons why many elderly people do not receive their annual health check.

Our objective was to establish an audit mechanism to determine the cost and effectiveness of leg ulcer care across two Health Authorities. Following identification of all patients with active ulcers over a two-month period, leg ulcer treatment, costs and outcome were prospectively audited over three months. We found that leg ulcer care is currently expensive and appears to be largely ineffective, especially when compared to the community clinic approach.

A survey of the general hospital services for attempted suicide patients in one Region indicated that most hospitals fell short of many of the standards contained in the Department of Health 1984 guidelines and the recently established Royal College of Psychiatrists guidelines, particularly with regard to active planning and monitoring of the service, involvement of non-medical clinical staff, availability of the service and the training of staff.

Head teachers of all primary and secondary schools in County Durham were surveyed during 1994 to investigate school policy and management of children with asthma. Results indicate a need and opportunity to improve asthma care for children at school through healthy alliances between the health and education authorities.

The demand for, and provision of, primary dental care was investigated in a teaching hospital setting in 1989 and 1993 - a period which saw the introduction of the new dental contract and the publication of the Poswillo report on general anaesthesia and sedation. Five hundred patients who attended the primary care department for the first time at the University of Wales Dental Hospital were interviewed in May/June 1989, and a further 520 patients were interviewed in May/June 1993. Self-referrals increased from 260 patients (52%) in 1989 to 352 patients (68%) in 1993. The proportion of patients who did not have a general dental practitioner (GDP) increased from 32% (160) in 1989 to 39% (202) in 1993. More patients registered with a dentist self-referred in 1993 compared to those in 1989, reportedly because of inability to obtain an appointment with their own GDP (88), rather than because of cost (17). Over the four-year period there was an increase in demand for treatment of early stage (pulpitic) dental infection from 32% to 40%, and a decrease in relation to end-stage infection (dentoalveolar abscess) from 11% to 6%. This 'safety net' role of dental hospitals needs to be taken into account when contracting for services.

This study aimed to describe the use and costs of community services for HIV-infected people by disease stage, sex and transmission category (homosexual, heterosexual, injecting drug use) by use of a prospective cohort study in which people were followed up for six months. There were two major components; gathering quantitative information on service utilisation from people with HIV infection using two interviewer-administered questionnaires and six self-completed monthly diaries; and estimating the costs of the services provided. People were recruited from two London clinics: the Jefferiss Wing Genito-urinary Medicine (GUM) clinic at St. Mary's Hospital, Paddington, and the Patrick Clements GUM clinic at the Central Middlesex Hospital, Harlesden. Costing data was obtained from providers of community services throughout Greater London. The main outcome measures were contacts per person-year, and costs per person-year, for all community services stratified by service sector. The people studied each made, on average, 139 community service contacts per year at a cost of 2,806 pounds; there was little difference in average utilisation between the three transmission categories. There were differences in both the utilisation of services and costs within the formal and informal sectors for subjects from different disease stages. Although the average number of contacts per person-year were similar for women and men, the total cost of community services was higher for women than for men, reflecting the differences in types of services used. The results indicated a high proportion of total care costs for people with HIV and AIDS is incurred through community-based social care.(ABSTRACT TRUNCATED AT 250 WORDS)

Tonsillectomy is a commonly performed operation; like many others there is increasing pressure for it to be performed as a day-case procedure, with no follow-up for the majority of patients. This paper presents the results of a prospective study of the incidence of post-tonsillectomy morbidity, the recognition of these symptoms by patients, and their management by general practitioners. The results indicate: a lack of awareness by patients of symptoms they might expect post-operatively, despite written and verbal information given; an over-prescription of antibiotics by general practitioners for normal post-operative symptoms such as throat pain, temporary voice changes and referred otalgia; and a failure by patients to recognise the importance of the potentially life-threatening complication of secondary haemorrhage from the tonsillar bed.