Nosocomial influenza infection.
Explore the source record for details and available documents.
Cross Infection↗
Biomedical subjects
C Woodman
Publications and source records attributed to C Woodman.
Pharmacists' evaluation of key communication skills in practice.
This paper reports the results of a major research initiative into the identification of key communication skills in community pharmacist-patient consultations. It is now widely accepted that the quality of practitioner-patient communication is fundamental to effective health care. However, an analysis of the literature pertaining to the communication issues facing health professionals in general and pharmacists in particular emphasised the need for more empirical research, to chart what pharmacists themselves deemed to be the nature and range of skills which contribute to effective communication performance in community pharmacy practice. The main aim of this research investigation was, therefore, to identify what constituted effective communicative performance by community pharmacists. This paper provides full details of the repertoire of skills and sub-skills identified as being the core communicative elements of practice. The results of this research will have relevance for health professionals and behavioural scientists, and will also contribute to the assurance of quality within the field of community pharmacy practice.
Adult↗
Low immunisation uptake: is the process the problem?
OBJECTIVE: To examine mothers' satisfaction with the process of immunisation and its possible contribution to suboptimal immunisation uptake. DESIGN: In depth interviews with mothers. SETTING: Two Community Care Areas, Dublin city, Ireland. PARTICIPANTS: In depth interviews of 23 mothers of children 1-2 years old, recruited purposively from a birth cohort born in 1994. MAIN RESULTS: Mothers preferred general practice to Health Centre immunisation (11:5) for predominantly emotional compared with practical reasons (4:1). Health Centre immunisation was seen, at times, as unacceptably rough and inhuman. Many mothers experienced severe emotional distress at the prospect of inflicting the pain of immunisation on their babies. The non-empathic stance of some immunising doctors was unacceptable to mothers. They valued attempts by health professionals to acknowledge the pain of immunisation and to engage with their baby. Adverse experiences contributed to deferral of future visits and to defaulting behaviour. CONCLUSIONS: Low empathy mass immunisation in clinic type settings may be unacceptable to mothers in the 1990s, and may in part explain suboptimal uptake in health care systems that use such clinics.
Adult↗
Apparent low immunisation uptake in Dublin: under-performance or under-recording?
Through careful follow-up of a cohort, born March to August 1994, we have recorded the highest ever primary immunisation uptake figures for the Dublin area, with completed uptake for Diphtheria, Tetanus and Oral Polio of 92.1%, Haemophilus influenzae type b of 88.7%, Pertussis of 85.7% and Measles/Mumps/Rubella of 78.1%. Eastern Health Board uptake estimates for the same period are 8.1-21.4% lower. We believe the rigour of our data gathering explains this discrepancy. Evidence is reviewed in support of the hypothesis that Eastern Health Board databases underestimate true immunisation uptake.
Child, Preschool↗
Vaccine, yes; injection, no: maternal responses to the introduction of Haemophilus influenzae type b (Hib) vaccine.
We used in-depth interviews with 23 mothers of babies aged 1-2 years to explore their response to the addition of Haemophilus influenzae type b (Hib) vaccine to the primary schedule. Acceptability of the vaccine was principally attributable to maternal perceptions as to the severity of meningitis, with a tendency to overestimate the efficacy of the vaccine. Advice from health professionals and the behaviour of peers contributed to its acceptance. Barriers to the uptake of the vaccine included suspicion regarding the newness of the vaccine, a fear of vaccine overload in such young babies, and the distress of two separate injections. There may be a limit to the number of antigens, and particularly the number of injections, acceptable to mothers.
Attitude↗
Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study.
OBJECTIVE: To compare the cost effectiveness of two possible modifications to the current UK screening programme: shortening the screening interval from three to two years and extending the age of invitation to a final screen from 64 to 69. DESIGN: Computer simulation model which first simulates life histories for women in the absence of a screening programme for breast cancer and then assesses how these life histories would be changed by introducing different screening policies. The model was informed by screening and cost data from the NHS breast screening programme. SETTING: North West region of England. MAIN OUTCOME MEASURES: Numbers of deaths prevented, life years gained, and costs. RESULTS: Compared with the current breast screening programme both modifications would increase the number of deaths prevented and the number of life years saved. The current screening policy costs 2522 pounds per life year gained; extending the age range of the programme would cost 2612 pounds and shortening the interval 2709 pounds per life year gained. The marginal cost per life year gained of extending the age range of the screening programme is 2990 pounds and of shortening the screening interval is 3545 pounds. CONCLUSIONS: If the budget for the NHS breast screening programme were to allow for two more invitations per woman, substantial mortality reductions would follow from extending the age range screened or reducing the screening interval. The difference between the two policies is so small that either could be chosen.
Age Factors↗
Management of Helicobacter pylori infection. Eradication treatment should be limited to patients with proved peptic ulceration.
Explore the source record for details and available documents.
Aged↗
Psychosocial factors and birth outcome: African American women in case management.
The relationship between psychosocial risk factors and birth outcomes among African American pregnant women is explored. The study focuses on social/environmental stressors and proposes a workable model for delivery of services based on case management principles. Unstable income, perinatal medical problems, alcohol use, smoking, access to prenatal care, internal barriers to care, compliance problems, negative experiences with providers, depression, unresolved grief, and fetal substance exposure were significantly associated with low birthweight. Unstable income, compliance problems, internal barriers to care, and poor access to care were significantly associated with preterm delivery. Specific interventions aimed at providing social support, facilitating access to care, health education, and encouragement to verbalize feelings about problems were significantly associated with the number of problems that the client was able to solve. The data indicated the importance of psychosocial, environmental and medical risk factors in the prediction of low birthweight and preterm delivery in a high-risk population.
Adolescent↗
Follow up policy after treatment for Hodgkin's disease: too many clinic visits and routine tests? A review of hospital records.
OBJECTIVE: To examine the effectiveness of routine clinic review in detecting relapse after treatment for Hodgkin's disease. DESIGN: Review of hospital records. SETTING: Regional centre for cancer treatment and research. SUBJECTS: 210 patients with Hodgkin's disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. MAIN OUTCOME MEASURES: The number of clinic visits made by patients over the period of observation, the number of relapses occurring during that time, and the route by which relapse was detected. RESULTS: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thirty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arranged. In only four cases (11%; 95% confidence interval 4% to 25%) was relapse detected as a result of routine physical examination on investigation of a patient who did not have symptoms. CONCLUSIONS: Relapse of Hodgkin's disease after treatment is usually detected as a result of the investigation of symptoms rather than by routine screening of asymptomatic patients. It is therefore proposed that the frequency of routine follow up visits should be reduced and greater emphasis placed on patient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop.
Ambulatory Care↗
What changes in the organisation of cancer services will improve the outcome for women with ovarian cancer?
OBJECTIVE: To examine the influence of operator specialty, volume of work and referral to an oncologist on the survival of women with ovarian cancer. DESIGN: Population-based retrospective cohort study, using hospital records and Cancer Registry data. SETTING: The North Western Region, UK. POPULATION: Six hundred and ninety-one women undergoing laparotomy for histologically confirmed ovarian malignancy during 1991 to 1992. METHODS: Univariate and multivariate survival analyses. MAIN OUTCOME MEASURES: Univariate survival estimates. Relative risks, derived from Cox's proportional hazards model, describing the effect on survival of surgeons vs gynaecologists as baseline, high volume vs low volume operators and referral vs nonreferral to an oncologist. RESULTS: After adjusting for woman and disease-related prognostic factors, operation by a surgeon was shown to have an adverse impact on survival (RR = 1.58, 95% CI 1.19 to 2.10). Regardless of how a high volume operator was defined (in terms of the number of laparotomies performed), no survival advantage over low volume operators could be demonstrated. Women referred to an oncologist had significantly better survival than women not referred (RR = 0.54, 95% CI 0.43 to 0.68). CONCLUSIONS: All women undergoing surgery for ovarian cancer should have access to a gynaecological opinion and postoperatively should be referred for a nonsurgical oncological opinion.
Adolescent↗
Nursing case management and its role in perinatal risk reduction: development, implementation, and evaluation of a culturally competent model for African American women.
The authors outline the need for comprehensive perinatal services management for African American pregnant women, based on social/environmental stressors, and propose a workable model for delivery of services based on case management principles. The implications of case management as an intervention to ameliorate these stressors are discussed. Data from 5 years of comprehensive case management are included to support the effectiveness of case management as an intervention among high-risk women. Steps utilized to develop, implement, and evaluate case management are also discussed.
Adolescent↗
Adequacy of cervical cytology sampling with the Cervex brush and the Aylesbury spatula: a population based randomised controlled trial.
OBJECTIVE: To compare the adequacy of cervical cytology sampling with two sampling instruments commonly used in primary care-namely, the Aylesbury spatula and the Cervex brush. DESIGN: Pair matched, population based randomised controlled trial. SETTING: 86 general practices and family planning clinics in Greater Manchester. SUBJECTS: 15 882 cervical smears taken from women aged 20-64 years as part of the national cervical screening programme. INTERVENTIONS: Participating centres were allocated to sample with either the Cervex brush or the Aylesbury spatula. MAIN OUTCOME MEASURE: Inadequate smear rate. RESULTS: 5.4% and 5.5% (433/8086 and 426/7796) of smears taken with the Cervex brush and the Aylesbury spatula respectively were reported as inadequate (odds ratio 0.95; 95% confidence interval 0.74 to 1.22). CONCLUSION: The Cervex brush offers no advantage over the Aylesbury spatula in reducing inadequate smear rates in the primary care setting.
Adult↗
Towards quality control in cancer chemotherapy.
A survey of all hospital pharmacies in the former North Western Regional Health Authority has revealed that hospital personnel continue to prepare cytotoxic drugs in suboptimal conditions, despite the widespread introduction of pharmacy cytotoxic reconstitution services. Other concerns include the lack of formal training for medical staff in the administration of these agents and the frequent absence of written procedures for dealing with extravasation and chemotherapy errors.
Antineoplastic Agents↗
Cervical smears--an opportunity for disinvestment?
BACKGROUND: The National Cervical Screening Programme was introduced to increase population coverage while reducing the overscreening of women at low risk. AIM: To describe the frequency with which cervical smears are unnecessarily repeated within the prescribed screening interval. METHOD: All cervical smears taken in a primary care setting in Manchester from women aged 20-64, during 1988-92, were identified. A smear was considered unscheduled if it was taken within 30 months of a preceding smear and if there was no clinical indication or laboratory recommendation for an early repeat smear. RESULTS: A total of 100 134 smears were identified from 85 594 women attending 130 general practices and 40 NHS community clinics; 12 633 women subsequently had 14 702 unscheduled smears; 50% of the unscheduled smears were taken by 18% of the general practices and 8% of the NHS community clinics. CONCLUSION: If they are replicated elsewhere, these findings suggest a substantial disinvestment opportunity.
Adult↗
Relationship of generalized anxiety symptoms to urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid.
Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 45 patients with generalized anxiety disorder. Multiple regression analysis demonstrated that the severity of several anxiety symptoms was predicted by levels of 5-HIAA and VMA. These data are consistent with the proposal that serotonin and norepinephrine may be involved in the pathophysiology of anxiety.
Adult↗
Is the clinical oncology information network (COIN) the answer?
Explore the source record for details and available documents.
Databases, Factual↗
Assessing the effectiveness of cervical screening.
The mathematic models used to assess the benefits and cost-effectiveness of cervical screening reveal little consistency in the definition of disease status, the basic assumptions made, or the data used in the model. Conclusions derived from the models often are model and data dependent. Several authors have used simplified models and unrealistic assumptions, such as the failure to differentiate between different grades of dysplasia, or 100% sensitivity for the screening test. The Markov process assumes that the rate of transfer between states is independent of the duration of time spent in one state, and this assumption may be unsound. The difficulty with all models is in interpreting the appropriateness of the parameter values. Some are well documented, for example, stage-specific survival rates for treated patients or attendance for screening. Many, however, cannot be given a fixed value. The large number of factors that appear implicated in the incidence of and mortality from cervical cancer can lead to many feasible sets of parameter values that generate output that approaches the observed data.
Case-Control Studies↗
The association of urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid in patients with generalized anxiety.
There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiology of anxiety disorders. Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 46 patients with generalized anxiety disorder. There was a significant association between urinary levels of 5-HIAA and VMA: r = 0.79; p = 0.0001. Possible implications of this finding are discussed.
Anxiety Disorders↗