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Biomedical subjects

A F Bisset

Publications and source records attributed to A F Bisset.

16 recordsLinked to original sources
PubMed1998

The case for clinical audit of emergency readmissions after appendicectomy.

The aim of this study was to examine how the Scottish Office Clinical Outcome Indicator for emergency readmissions within 28 days of appendicectomy could be made more useful. Scottish Morbidity Record One (SMRI) data on all NHS discharges with a primary operative procedure of appendicectomy, and a linked file of all emergency readmissions within 28 days of discharge in 1993/94 were used in this study. It was found that 8783 appendicectomies were performed in 1993 and 1994, with 403 (4.6%) emergency readmissions within 28 days. A significantly higher proportion of emergency readmissions occurred where a 'normal' appendix was removed, and in interval, prophylactic and incidental appendicectomies. Age and length of initial hospital stay did not affect readmission rates. Hospitals performing more appendicectomies tended to have more readmissions [Spearman's rank correlation coefficient 0.639 (95% CI 0.430-0.782]. None of the five hospitals carrying out less than 17 appendicectomies in 2 years had an emergency readmission. Patients from more deprived areas were significantly more likely to be readmitted. The current performance indicator is useful in identifying patients readmitted to any hospital in Scotland, but needs to be supplemental with more clinical information. The numbers of appendicectomy patients would make this a feasible national clinical audit project, and the lessons learnt should be useful in promoting better practice for considerable numbers of patients of all ages.

Adolescent↗
PubMed1997

Appendicectomy in Scotland: a 20-year epidemiological comparison.

BACKGROUND: The objective of the research was to study the pattern of appendicectomies in Scotland over the last 20 years. METHOD: Routine National Health Service data on patients discharged after appendicectomy in Scotland during 1973-1993 were analysed. RESULTS: For all ages, the appendicectomy rate has fallen steadily from 1.97 per 1000 (10,325 operations) in 1973 to 0.96 per 1000 (4906 operations) in 1993. The proportion of emergency operations increased from 76 to 80 per cent. The median age at operation rose from 18 to 22 years. The proportion of male patients remained higher for emergency operations, whereas the proportion of females, and age at operation, were both higher for non-emergency appendicectomies. In the period 1992-1995, appendicectomy rates were higher for patients with postcodes in areas of greater deprivation, particularly for children aged 0-14 years. Variation in childhood appendicectomy rates across Scotland has declined: apart from Ayrshire and Arran, which had a lower than expected rate, no Health Board had a rate significantly different from the rate in the rest of Scotland in 1993. The case fatality rate fell from 7.0 per 1000 to 1.6 per 1000 (with all the latter deaths in elderly patients). CONCLUSION: Over the last 20 years, appendicectomy rates have declined in Scotland and there is now greater uniformity of childhood appendicectomy rates across Scotland.

Adolescent↗
PubMed1997

Stroke services in general practice--are they satisfactory?

BACKGROUND: The contribution of general practice and primary care teams to stroke care has received surprisingly little attention despite research evidence on the importance of coordinated care. AIM: To determine general practitioners' (GPs') and their patients' satisfaction with hospital and community services for stroke patients in Grampian Region, Scotland. METHOD: A questionnaire survey of 138 stroke patients and their GPs was carried out six weeks after each patient was discharged home between June 1995 and January 1996. Outcomes measured were GP and patient satisfaction with services, Barthel Index, Hospital Anxiety and Depression scores, London Handicap Score, and Homsat and Hospsat scores (satisfaction with stroke services). RESULTS: Response rates of 95% (131) for GPs and 91% (125) for patients were obtained. GPs and patients were generally satisfied with services. Stroke patients were more likely to have had contact with their GP than with any other service. Adverse comments from GPs focused on problems with hospital discharge letters. At six weeks, patients received an average of 2.5 community services and 1.5 hospital services, but there was wide variation across disability groups. CONCLUSIONS: Levels of satisfaction were high, but the wide range and variation in services used by patients emphasized the complexity of the primary care of stroke patients; the need for coordination, review and effective links with hospital; and the key role of the GP.

Aged↗
PubMed1996

Patients with dementia: the view from general practice in Grampian.

A postal survey of all General Practitioners (GPs) in Grampian was carried out in August 1993 to determine GPs' experience and views on patients in their practice with dementia. This was part of a needs assessment on dementia in Grampian. The survey found that GPs were concerned about services for their patients with dementia, and believed there were gaps in service provision. GPs believed it was possible to care for most dementia sufferers within the community provided key services were available. However, the information held at primary healthcare level on numbers of dementia sufferers was limited.

Attitude of Health Personnel↗
PubMed1994

Grommets, tonsillectomies, and deprivation in Scotland.

OBJECTIVE: To see whether there is a relation between grommet insertion operation and tonsillectomy rates, otolaryngology services, and deprivation scores in Scotland. DESIGN: Analysis of routine 1990 NHS data on grommet insertions and tonsillectomies in Scottish children aged 0-15 years compared with data on general practitioner and otolaryngology services and Carstairs deprivation scores. SETTING: All 15 Scottish health boards. SUBJECTS: All children aged 0-15 (1,021,933). RESULTS: Tonsillectomy was more common than grommet insertion operations in Scotland (6182:4850). Health boards with high grommet insertion rates were more likely to have low tonsillectomy rates (Spearman's rank correlation -0.59; 95% confidence interval -0.87 to -0.03). Grommet insertion rates varied fourfold (from 2.4/1000 to 9.2/1000) and tonsillectomy rates twofold (from 3.6/1000 to 8.0/1000) across Scottish health boards. Variation between health boards had changed over the 15 years 1975-90. Variation in grommet insertion rates did not reflect variation in the supply of otolaryngology consultants (Spearman's rank correlation -0.25). There was a non-significant tendency for high general practitioner referral rates to be associated with high grommet insertion rates, low tonsillectomy rates, and less deprived areas (Spearman's rank correlation coefficients 0.50, -0.53, and -0.43). Deprivation (measured by Carstairs scoring for each health board) was associated with higher tonsillectomy rates (Spearman's rank correlation 0.41; 95% confidence interval -0.22 to 0.80) and significantly lower grommet insertion rates (-0.73; -0.92 to -0.28). CONCLUSION: Social factors as well as differences in disease prevalence and medical practice need to be considered when studying variation in childhood grommet insertion and tonsillectomy rates.

Adolescent↗
PubMed1993

Sex and grommet operations.

Sex differences in patients having grommet operations in Scotland were analysed to provide further evidence on whether girls should be managed differently from boys. In children treated at less than one year, 64% were boys, but this proportion declined with age and, after the age of 13 years, became less than 50%. The median age at treatment and the repeat operation rate were similar for both sexes. Different management according to the sex of the patient does therefore not appear to be justified.

Adolescent↗
PubMed1992

Primary and preschool immunisation in Grampian: progress and the 1990 contract.

OBJECTIVE: To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN: Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING: All 95 general practices in Grampian region (313 general practitioners). PATIENTS: All children in the primary immunisation and preschool booster age groups. This formed two groups of children for each of the four calendar quarters of 1990 and first three quarters of 1991 analysed as (a) those aged 2 years on the first day of the relevant quarter and (b) those aged 5 years on the first day of the relevant quarter, with an average population of 6600 and 6400 respectively. MAIN OUTCOME MEASURE: Percentage immunised by practice. RESULTS: For primary immunisation the number of practices achieving immunisation rates of at least 95% increased from 29 (31%) to 76 (81%), and practices achieving 90% rates rose from 69 (73%) to 87 (93%). For preschool boosters, the number of practices achieving at least 95% immunisation rates increased from 22 (23%) to 61 (64%). By the end of September 1991, 76 (80%) practices were achieving at least 90% levels compared with 36 (39%) at the beginning of 1990. Since the beginning of 1989 the proportion of immunisations not given by general practitioners declined from 14% to 2%. CONCLUSIONS: Primary and preschool immunisation rates for preschool children in Grampian showed a sustained improvement during 1990 and consolidation in 1991. Although overall trends were unchanged, 18 months after the introduction of the 1990 contract only one practice failed to meet lower target levels of 70% for both primary and preschool immunisation. By September 1991 more than three out of four practices had reached levels of at least 95% for primary immunisation.

Child, Preschool↗
PubMed1992

Child sexual abuse in general practice in north east Scotland.

All Grampian and North Tayside General Practitioners (GPs) were surveyed by a postal questionnaire to find out how often they had seen victims of child sexual abuse in the last two years; how they managed these patients; and whether any measures were needed to improve interagency working, especially at Case Conferences. A total of 73% of GPs replied, and 73% of these had seen at least one victim of child sexual abuse in the last two years. From this survey GPs saw approximately 2.5 victims per 1,000 per year for girls aged under 16 years. GPs' experience, views and practice varied considerably, even in one geographical area, and 72% of them felt they needed more information on child sexual abuse.

Age Factors↗
PubMed1990

Use of computerised records to ensure optimum measles vaccination.

Measles immunisations in Grampian were studied using the computerised Grampian Immunisation Record System. Records of children who were shown to have been immunised under 12 months of age were re-checked. This served as an audit of Grampian Health Board's centralised computer system and General Practice records, and as an educational exercise for the health professionals involved.

Forms and Records Control↗