Health trends最新文献

The Diabetes Control and Complications Trial (DCCT) provided much information towards settling the long-running controversy about the effectiveness of improving control of diabetes on the risk of its major complications. With the appearance or the advance of clinically significant retinopathy as its major outcome variable, DCCT randomised 1,441 insulin-dependent diabetic patients to conventional or intensified control groups. In both primary prevention and secondary intervention arms of the trial, intensified control reduced retinopathy risk by half or more, and also reduced nephropathy and neuropathy risks--however, risk of severe hypoglycaemic episodes was increased about three-fold. By contrast, there were no differences in quality of life, neurocognitive or emotional assessments between the two groups. The application of trial findings to 'real life' care is considered.

The aetiology, presentation and management of fractured mandibles were investigated in a major accident and emergency department in 1983 and 1993. Demographic features of patients in both years were similar: most injuries were in males (89%), most were a result of an assault ( > 75%), and 50% of the patients presented for treatment between the hours of 10pm and 5am. There were striking reductions in the numbers of patients who waited more than 24-hours for an operation (60% in 1983; 34% in 1993), and out-of-hours operating (60% in 1983; 41% in 1993). There was an increase in the number of patients for whom consultants were the principal operator (13% in 1983; 32% in 1993). Changes in the methods of treatment included a decrease in the use of postoperative intermaxillary fixation (98% in 1983; 56% in 1993) and an increase in internal fixation using bone plates (2% in 1983; 53% in 1993). Total inpatient stay was the same in both study years (mean = 3 days), and there was no difference in duration of stay between treatment modalities (internal versus intermaxillary fixation).

Regulation of medicines in the United Kingdom has changed considerably since the establishment of the Medicines Control Agency in 1989, and other changes will take place throughout the European Community (EC) over the next few years. 1995 will see the introduction of a centralised procedure, applicable to a small number of innovative drugs, and a decentralised procedure, based on mutual recognition of licences granted by existing control authorities in other EC countries.

This paper records the result of research and development in interrogating a general practitioner prescription pricing database to provide customised analysis for every practice. The system 'COMPASS' (Computerised On-line Monthly Prescribing Analysed for Science and Stewardship) is described, and identifies instances where each practice might improve cost-effectiveness and scientific rationality in prescribing. One hundred and two such instances are interrogated. This initial COMPASS report is then supplemented by screening the database to show a practice's: 1. range of drugs used--an excessive range should be discouraged. 2. use of drugs often used imprecisely--eg, antibiotics. 3. predicted prescribing cost--based on practice demography. 4. use of drugs with very limited GP value--eg, peripheral vasodilators. Northern Irish fundholding general practitioners are finding COMPASS valuable in planning improvement in cost-effectiveness and quality.

The accuracy of the coding of gastrointestinal endoscopic procedures at Llandough Hospital was audited over 12 months. Although the endoscopy unit kept its own records, none of the staff were initially aware of the coding system used for endoscopic procedures for subsequent hospital activity analysis. Conventional typed discharge summaries were usually inadequate for coding purposes, and there was considerable variation in the proportion of procedures coded. Changes made to improve the accuracy and completeness of coding for endoscopic procedures were seen to be effective in a follow-up study.

This study looked at recent changes in Wales in four health-related behaviours: smoking, alcohol consumption, diet and physical activity. Data are drawn from three large-scale surveys conducted across Wales in 1985, 1988 and 1990. The results show a reduction in smoking prevalence between 1985 and 1990 among men and women, and a growing trend towards healthier eating, with reduced frequent consumption of salt and foods high in saturated fats. Encouraging progress towards healthier living has been made, but the results also indicate the extent of the remaining challenge: greater progress is particularly needed to encourage participation in exercise, and to reduce the numbers of people who drink alcohol in excess of recommended sensible limits.

Data from operating theatre and X-ray department ledgers, and other sources, for two periods (1983-87 and 1988-91) were compared retrospectively to determine the trend in leg amputation in the defined population of a District Health Authority, following an increase in arterial reconstruction and percutaneous transluminal angioplasty for peripheral arterial disease. There was an eleven-fold increase in arterial reconstructions, and a thirteen-fold increase in angioplasty, in 1988-1991 compared with 1983-1987. A significant reduction occurred in the age- and sex-adjusted mean annual rate for major leg amputation, from 47.5 (95% confidence intervals 41.5-53.6) in 1983-87 to 32 (95% confidence intervals 26.5-37.6) in 1988-91 (Wilcoxon rank sum test, p < 0.05). There was no increase in the ratio of above-knee to below-knee amputations. The introduction of peripheral arterial reconstruction and percutaneous transluminal angioplasty was associated with a reduction in major amputations for peripheral arterial disease of 3.8 per 100,000 population per year.

A large questionnaire survey of general practices in England to determine the most recent policies, perceptions, and procedures for influenza immunisation, and the extent to which individual practice characteristics were related to levels of vaccine distribution, was conducted during January and February 1992. The results indicate that the proportion of practices with influenza immunisation policies has increased considerably since the mid 1980s. However, some notable shortcomings remain and practice characteristics appear to have little influence on vaccine delivery, suggesting that other factors may also be important.

Previous research has found the prevalence of child psychiatric disorder in the general population to be between 7% and 25%, and higher among attenders at some general practitioners' surgeries. This survey examines the perception of need among general practitioners and parents of general practice attenders, and compares this with the prevalence of disorder found using the Rutter A Questionnaire for Parents. The results support claims that the services for children with psychiatric disorders are inadequate. However, many children with disorders are presented to other professionals by their parents. Ways to extend the service synergistically to meet some of the unmet need are discussed. The need for further research to be undertaken, which would effectively target such scarce resources, is identified.