JRSM short reports最新文献

Objectives: To assess sickle cell disease (SCD) patient and carer perspectives on the primary care services related to SCD that they receive from their general practitioner (GP).

Design: A focus group discussion was used to elicit the views of patients about the quality of care they receive from their primary health-care providers and what they thought was the role of primary care in SCD management. The focus group discussion was video recorded. The recording was then examined by the project team and recurring themes were identified. A comparison was made with notes made by two scribes also present at the discussion.

Setting: Sickle Cell Society in Brent, UK.

Participants: Ten participants with SCD or caring for someone with SCD from Northwest London, UK.

Main outcome measures: Patients' perceptions about the primary care services they received, and a list of key themes and suggestions.

Results: Patients and carers often bypassed GPs for acute problems but felt that GPs had an important role to play around repeat prescriptions and general health care. These service users believed SCD is often ignored and deemed unimportant by GPs.

Conclusion: Participants wanted the health service to support primary health-care providers to improve their knowledge and understanding of SCD. Key themes and suggestions from this focus group have been used to help develop an educational intervention for general practice services that will be used to improve SCD management in primary care.

Objectives: Chronic diseases are fast becoming the largest health burden in India. Despite this, their management in India has not been well studied. We aimed to systematically review the nature and efficacy of current management strategies for chronic obstructive pulmonary disease (COPD) in India.

Methods: We used database searches (MEDLINE, EMBASE, IndMED, CENTRAL and CINAHL), journal hand-searches, scanning of reference lists and contact with experts to identify studies for systematic review. We did not review management strategies aimed at chronic diseases more generally, nor management of acute exacerbations. Due to the heterogeneity of reviewed studies, meta-analysis was not appropriate. Thus, narrative methods were used.

Setting: India.

Participants: All adult populations resident in India.

Main outcome measures: 1. Trialled interventions and outcomes 2. Extent and efficacy of current management strategies 3. Above outcomes by subgroup.

Results: We found information regarding current management - particularly regarding the implementation of national guidelines and primary prevention - to be minimal. This led to difficulty in interpreting studies of management strategies, which were varied and generally of positive effect. Data regarding current management outcomes were very few.

Conclusions: The current understanding of management strategies for COPD in India is limited due to a lack of published data. Determination of the extent of current use of management guidelines, availability and use of treatment, and current primary prevention strategies would be useful. This would also provide evidence on which to interpret existing and future studies of management outcomes and novel interventions.

Objectives: To determine how patients with sickle cell disease (SCD) perceive the quality of care that they receive from their primary healthcare providers.

Design: A questionnaire-based pilot study was used to elicit the views of patients about the quality of care they have been receiving from their primary healthcare providers and what they thought was the role of primary care in SCD management.

Setting: Sickle Cell Society and Sickle Cell and Thalassaemia Centre, in the London Borough of Brent.

Participants: One hundred questionnaires were distributed to potential participants with SCD between November 2010 and July 2011 of which 40 participants responded.

Main outcome measures: Analysis of 40 patient questionnaires collected over a nine-month period.

Results: Most patients are generally not satisfied with the quality of care that they are receiving from their primary healthcare providers for SCD. Most do not make use of general practitioner (GP) services for management of their SCD. Collecting prescriptions was the reason most cited for visiting the GP.

Conclusion: GPs could help improve the day-to-day management of patients with SCD. This could be facilitated by local quality improvement schemes in areas with high disease prevalence. The results of the survey have been used to help develop a GP education intervention and a local enhanced service to support primary healthcare clinicians with SCD's ongoing management.

Acute dissection of the thoracic aorta (AAD) is a potentially catastrophic disease, with significant morbidity and mortality, which remain unchanged over the last decade. Survival rate has been shown to be directly related to prompt diagnosis and precise management; however diagnosis of the disease remains time-consuming, not readily available, and lacking in sensitivity and specificity. The current approach when diagnosing AAD relies heavily on various imaging techniques, including chest radiograph, echocardiography, computed tomography and magnetic resonance imaging scans. Nevertheless, the door remains open for the incorporation of biochemical tests to aid in detecting AAD. This article will review the imaging modalities currently employed in the management of AAD, as well as a discussion of the potential role of several biomarkers in AAD. To date, imaging is the diagnostic tool for AAD however, technical and logistical limitations limit the use of imaging in various circumstances. Current available biomarkers such as D-dimer and C-reactive protein are under-utilized in many cases, mainly due to their non-specificity in diagnosing AAD. Over the last decade, many biomarkers have been proposed for use in AAD, with several showing promising results - including: smooth muscle myosin heavy chain, calponin, soluble elastin fragments and transforming growth factor β. Extensive research is being undertaken to define the roles of these novel biomarkers in the management of AAD.

Objective: To determine the proportion of hospital deaths associated with preventable problems in care and how they can be reduced.

Design: A two phase before and after evaluation of a hospital mortality reduction programme.

Setting: A district general hospital in Warwickshire, England.

Participants: In Phase 1, 400 patients who died in 2009 at South Warwickshire NHS Foundation Trust had their case notes reviewed. In Phase 2, Trust wide measures were introduced across the whole Trust population to bring about quality improvements.

Main outcome measures: To reduce the crude mortality and in effect the risk adjusted mortality index (RAMI) by 45 in the three years following the start of the programme, from 145 in 2009 to 100 or less in 2012.

Results: In total, 34 (8.5%) patients experienced a problem in their care that contributed to death. The principal problems were lack of senior medical input (24%), poor clinical monitoring or management (24%), diagnostic errors (15%) and infections (15%). In total, 41% (14) of these were judged to have been preventable (3.5% of all deaths). Following the quality improvement programme, crude mortality fell from 1.95% (2009) to 1.56% (2012) while RAMI dropped from 145 (2009) to 87 (2012).

Conclusion: A quality improvement strategy based on good local evidence is effective in improving the quality of care sufficiently to reduce mortality.