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Biomedical subjects

D R Coid

Publications and source records attributed to D R Coid.

At least 19 recordsLinked to original sources
PubMed2006

Mortality in general practice: problems concerning deaths in institutions.

Following the provision of all general practitioners in Grampian with data on their practice death rates, the experience of death rates at institutions in the region was examined. Nursing homes are more likely to be situated in less deprived areas and their age-specific death rates are generally higher than those experienced by residents from non-institutional settings. For residents in non-institutional settings in Grampian, higher death rates generally parallel increasing deprivation. This expected trend is reversed when describing the mortality experience of nursing home residents. One reason for this is the movement of elderly people to the locations of nursing homes in less deprived areas. Methodological issues are discussed and proposals are made to improve the analysis of mortality in this article.

Aged↗
PubMed2004

Monitoring mortality in general practice in Grampian, Scotland.

Information on the distribution of mortality and morbidity in general practice is scarce, and not easily accessible either by health authorities or individual general practices. Although the assessment of population mortality is a standard public health measure, colleagues in public health, information sciences and general practice rarely undertake such activity related to general practice populations. Mortality information can be used for various purposes. Examples are providing background data for clinical audits or alerting practitioners to quality issues in the healthcare industry or even suggesting environmental hazards. We measured the experience of mortality in all generally practices in Grampian in the years 1991 to 1999. All practices were notified of their actual and expected mortality over this period of time and asked for comment. Only three general practices had excess mortality experience in both the periods 1991 to 1995 and 1996 to 1999. Only a minority of practices commented on the results. It appears that a high presence of nursing homes in a practice might skew the results; this phenomenon will be central to further inquiry. Future methodology for recording death in general practice should take account of this, as well as providing an account of the qualitative aspects of patients' need for a dignified satisfactory death.

Adolescent↗
PubMed2003

Partnerships with health and private voluntary organizations: what are the issues for health authorities and boards?

BACKGROUND: The number of voluntary organizations active in health care is considerable. There have been recent calls for a new closer working relationship between voluntary bodies and the National Health Service. The relationship between the two healthcare sectors needs to be efficient and harmonious in the interests of patient care; however, little is known about the nature and problems in the current relationship. The present study was undertaken to examine aspects of this relationship from the point of view of health board personnel. OBJECTIVE: To identify the practices and views of Scottish health board staff concerning the funding, role and responsibility of voluntary organizations in the health sector. METHODS: A qualitative study based on in-depth interviews with health board officials in all 15 Scottish health boards. RESULTS: Policies for financial and other relationships with the voluntary sector were often not explicit. The levels and method of funding voluntary health organizations varied across boards, as did the tenure of awards (from 1 to 3 years). Demand for funding far exceeded monies available. Some health boards ensured accountability through audited accounts, annual reports and site visits; however, others thought this inappropriate for small organizations. Health boards recognized the problems of the precariousness of funding and the administrative burden of the monitoring process and the ritual of applying for funding. CONCLUSION: The uncertainties of long-term funding may impede the contribution of voluntary organizations. There is a tension between the requirements of clinical governance and the ability of small voluntary organizations to provide the necessary documentation. One proposed solution, to reduce the number of organizations, might not appeal to the voluntary sector. Future initiatives could address the problem of tailoring funding and accounting to the resources of voluntary organizations.

Governing Board↗
PubMed2001

What do we know about the voluntary healthcare sector in Scotland?

OBJECTIVE: To document sources of information available to the National Health Service in Scotland (NHSiS) which relate to the health voluntary sector. DESIGN: Interrogation of the databases of the Charities Register in Scotland (CRIS) and Health Education Board for Scotland (HEBS) for information on health voluntary organisations and a retrospective review of information held on health voluntary organisations recently funded by health boards. SETTING: National Health Service in Scotland and the Scottish Council for Voluntary Organisations RESULTS: Nine hundred and fifty six health voluntary organisations in Scotland were registered with the CRIS database. Five hundred and forty five (57%) of these had annual incomes of less than 100,000 Pounds and two thirds of them (630) operated at a local level. Information on 3,106 health and support organisations was present on the HEBS database. In 1997-98 Scottish Health Boards grant funded 278 voluntary organisations. Eighty seven (31%) of these had information held on the CRIS database and another 87 (31%) with the HEBS database. Funding was much more likely to be given to organisations dealing with adult physical health and alcohol problems. Organisations dealing with specific diseases were less likely to be funded. Of the 87 funded organisations registered with CRIS, health boards typically contributed less than 10% of annual funding. CONCLUSIONS: Health planning decisions are made difficult by a deficiency of useful information on the existence, activities and financial positions of voluntary organisations. Construction of accurate and comprehensive national databases to inform these decisions would be expensive. However, the development of appropriate local databases by health boards and the voluntary sector would facilitate the development of a constructive partnership.

Databases, Factual↗
PubMed2000

Grant funding of health voluntary organizations by Scottish health boards.

The objective of this study was to identify grant funding of voluntary organizations by Scottish health boards in the financial year 1997-1998. Scottish health board financial commitments to voluntary organizations were surveyed. Fifteen health board Directors of Finance participated in the study. The outcome measures were relative and absolute commitments of grant expenditure to the voluntary sector by health boards in Scotland. Total expenditure of Scotland's 15 health boards ranged from zero to 764,910 pounds sterling. One health board did not support any voluntary organizations while the greatest number supported by an individual health board was 43. Of health boards that made grants to voluntary bodies the range of expenditure per head of resident population was 0.09 pounds sterling-3.00p pounds sterling. The average grant expenditure to voluntary organizations ranged from 1,839 pounds sterling to 30,308 pounds sterling. The most substantial funding fell to voluntary bodies within the fields of mental health, alcohol and community elderly care. However, there was substantial variation between health boards in whether these bodies were funded, and to what extent funding was given. In conclusions, health boards have conflicting practices in funding voluntary organizations. Although there may be some variation in the needs of voluntary bodies across health boards, this is unlikely to explain the scale of the variation. Further work is required to explain this phenomenon and to propose policies for the support of the voluntary sector by the National Health Service that are acceptable to both funders and providers of services.

Aged↗
PubMed1999

The Dundee Stroke Register: experience of the first ten years.

The objective to establish a register of all patients admitted to Dundee hospitals with acute stroke has been achieved. To do this a computerised database system has been established and a prospective survey has been conducted of clinical data of patients at time of admission, with follow-up at one and three years. All patients with a WHO diagnosis of acute stroke (excluding patients with subarachnoid haemorrhage), from January 1988 have been recorded. By the end of 1998, 3222 patients had been registered. The Dundee Stroke register database is the largest in Scotland and one of the largest in the world. The establishment of the register and database has required substantial investment of resources and the collaboration of the NHS, universities and the private sector. The operation of the register has heightened interest in stroke. It also provides present and future opportunities for clinical research and audit studies and the monitoring of outcomes.

Adult↗
PubMed1994

Assessment of the structures and functions of Fife core dementia teams.

A research partnership was formed between Fife Regional Council's Social Work Department, Fife Health Board and the Dementia Services Development Centre and Social Work Research Centre of Stirling University, to investigate the multi-disciplinary dementia teams which operate in Fife. The primary method of data collection was a series of group interviews with the six dementia teams: the teams were autonomous coalitions of professionals from various agencies and organizations who met together voluntarily. The informal nature of the teams has permitted them to operate without a defined set of purposes or objectives, enabling the participants to work together with a degree of pragmatism according to professional values and agency policies. There was wide agreement within the teams that the coordination of multi-agency services to clients was much improved and inter-personal relations between different professionals had become much better developed since the operation of teams.

Aged↗
PubMed1993

Introduction of hip ultrasonography to the neonatal services of a Fife District General Hospital.

Ultrasonography of the hip is a new technique which is said to assist in the diagnosis of neonatal hip disorders. The authors were unaware of any reports of formal evaluation of the introduction of this new technology into a District General Hospital. This study outlines several aspects of patient care before and after the introduction of neonatal hip ultrasonography to a Fife hospital as an adjunct to a neonatal orthopaedic clinic. After introduction of ultrasound the proportion of patients where the consultant was 'very confident' in the diagnosis increased by 29% (95% confidence intervals 9% to 49%); the proportion of children requiring three or more x-rays in the year following referral fell by 46% (95% confidence intervals 27% to 65%) and the proportion of children requiring five or more follow up attendances in the year following referral fell by 56% (95% confidence intervals 38% to 74%). Introduction of this technology has benefited patients by reducing their need to attend clinics and reducing their overall exposure to ionising radiation. There is a continuing need for ultrasonography to be provided in Fife neonatal orthopaedic outpatient clinics.

Data Collection↗
PubMed1990

Managing the Fife ENT (ear, nose and throat) waiting list: the 1989 review of problems.

In-patient activity of Fife Ear, Nose and Throat (ENT) wards and of Fife ENT consultants are higher than the Scottish averages. Out-patient activity appears to operate at a lower level and hundreds of patients remain on the Fife waiting list for operations. An analysis of 731 patients on the ENT waiting list in 1989 showed that 15% had been waiting for over three years. Over 350 hours of theatre time and over 3,200 in-patient bed days would be required to clear this waiting list. Adopting a guillotine tonsillectomy operative procedure without anaesthesia would make a major contribution to a rapid reduction of the waiting list. Although this is reported to be quick, relatively painless and remarkably free from haemorrhagic complications, it appears not to be acceptable in our medical culture at the moment. A life table analysis suggests that Fife is failing to operate on patients at a rate compatible with the needs of the community: current trends of operating suggest that over one half of patients will be on the waiting list for operations three years after being placed on it. The Secretary of State's 1989-90 waiting list initiative, the appointment of an extra ENT consultant and the allocation of additional operating theatre time may help to resolve these difficulties.

Bed Occupancy↗
PubMed1990

Evaluation of a Fife 'Novopen' clinic held within a diabetes patient education centre.

In common with other hospitals throughout the United Kingdom, a diabetic patient education centre has been established at the Victoria Hospital, Kirkcaldy. Many activities now take place within the centre including a 'Novopen' Clinic at which insulin requiring diabetic patients are converted to a multiple injection method of delivering soluble human insulin. An evaluation of the Novopen Clinic, including the first 60 patients attending, has demonstrated a statistically significant fall in random blood sugar estimations (mean fall 2.0 m.moles 1(-1), 95 per cent confidence intervals 1.5 m.moles 1(-1) to 2.5 m.moles) since conversion at the Novopen Clinic. Changes in mean daily insulin intake (mean increase of 1.6 units per day) and glycosylated haemoglobin (mean fall of 0.88 per cent) were not significant. One hundred per cent of patients surveyed described the Novopen Clinic as 'helpful' or very 'helpful'. Staff see the clinic offering significant opportunities for patient education. The estimated cost of the clinic per new patient was 147 pounds.

Diabetes Mellitus↗
PubMed1990

General practitioner minor surgery facilitated by a Fife District General Hospital. Evaluation of a pilot project.

Large waiting lists for elective surgical operations in Fife stimulated a pilot project to encourage general practitioners (GPs), to undertake more minor surgery operations. A three part evaluation of the work was designed which looked at medical and patient satisfaction aspects of the project; views of the Local Medical Committee (General Practice) and Division of Surgery were sought. All parts of the evaluation appeared satisfactory and health service managers have been provided with sufficient information to make decisions on the implementation of further minor surgical schemes in Fife.

Consumer Behavior↗
PubMed1989

An investigation of apparent leukaemia clusters in Fife by validation of cancer register data and a case-control study.

Validation of the Fife haematological cancer register data from 1968 to 1981 for patients aged 0 to 24 submitted to the Black Advisory Group demonstrated 'catastrophic' or 'major' errors in 23 (19%) of the 124 records. A case-control study of 43 children with acute lymphoblastic leukaemia aged 0 to 14 at diagnosis in Fife between 1970 and 1985 showed that the Mantel-Haenszel odds ratio (ORMH) was significantly higher for children resident at birth in the post code district KY8 (ORMH = 3.86, 95% confidence interval 1.31-11.36) or who had ever lived in post code districts KY8 (ORMH = 4.00, 95% CI 1.51-10.58) or KY11 (ORMH = 2.35, 95% CI 1.08-5.12). We conclude that routine cancer registration data require extensive validation before they can be used for epidemiological purposes; case-control studies can overcome some of the methodological problems involved in investigating apparent leukaemia clusters; and further environmental investigations are needed in two post code districts of Fife.

Adolescent↗
PubMed1989

Measurement for management: report of a pilot project to quantify ambulance misuse for managers of a Fife hospital.

Ambulance services appear to be under increasing pressure to provide a full range of services to the Community. It is important, therefore, that the service is appropriately utilised by patients. Health Service Managers, however, have little readily available information which identifies 'appropriate' utilisation. A simple technique is suggested to measure 'appropriateness' of utilisation of ambulances and a pilot survey of ambulance use by patients attending Dunfermline and West Fife Hospital Out-Patient clinics is described. In each case of ambulance use a panel of health professionals evaluated the 'appropriateness' of the patient having utilised this service. In the clinics surveyed, 91% of the sample of 328 patients did not use an ambulance to travel to clinics; in only two cases was use of the ambulance considered to be 'probably inappropriate'. Misuse of the ambulance service was minimal during this study. Health Service Managers have been provided with some evidence to refute suggestions of substantial, inappropriate use of the ambulance service.

Age Factors↗