The roles and responsibilities of primary care trusts in emergency planning: a report of a major incident in Sunderland, UK.
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Cooperative Behavior↗
Biomedical subjects
D Tregoning
Publications and source records attributed to D Tregoning.
An interim report of health needs assessment of asylum seekers in Sunderland and North Tyneside.
A health needs assessment questionnaire was developed and administered to 397 asylum seekers, 291 males and 106 females, in Sunderland and North Tyneside in the North East of England. The data from the questionnaires were analysed using SPSS Version 10. Individuals retained a copy of their own questionnaire to be used as a hand held record. There was much heterogeneity of country of origin, culture, religion and previous employment and language backgrounds within the sample. A range of health needs was identified which has implications for healthcare provision. Vaccination rates were low as was screening for tuberculosis and cervical cancer. Many asylum seekers identified symptoms related to mental health and requested help in this area. Access to dental treatment was an area of high priority for many respondents.
Adolescent↗
Issues arising from two related cases of childhood tuberculous meningitis.
Two cases of childhood meningitis occurred in the same school within two weeks. The cases were cousins. The first case died and the aetiology was confirmed as tuberculous following a gene probe of a culture from the meningeal tissues at postmortem. The second case, with similar life threatening clinical features compatible with tuberculous meningitis, recovered. Seventy-seven contacts of the two cases among the immediate and extended families were screened. The adult sources of the infection were found to be two aunts of the second case, who were nurses working in the same nursing home. A further 73 contacts of the adult cases were identified. A total of eight close contacts to the aunts were given chemoprophylaxis and three were treated for tuberculosis. Contact tracing was also undertaken in the nursing home but no further cases were identified. These two cases highlight the difficulties in making a rapid diagnosis in tuberculous meningitis, the difficulties in handling media and public concern with limited information, and deciding on the appropriate level of contact tracing in special circumstances.
Child, Preschool↗
Commissioning regional specialist services-HIV and AIDS. Experiences of a consortium arrangement in the North East of England.
The introduction of effective double combination therapy for HIV disease in 1996 and triple therapy in 1997 had cost implications for both purchasers and providers of regional specialist services. There is evidence that more patients presented for treatment. A consortium purchasing approach was undertaken in the North East of England to manage the introduction of combination therapy, to ensure that therapy was available for those who could benefit and to minimise the financial risk for individual health districts. The strengths and weaknesses of such an approach are discussed as well as the potential application to commissioning other specialist services.
Anti-HIV Agents↗
An audit on access to coronary artery surgery within a health district using New Zealand priority criteria as a benchmark.
A professional advisory group in New Zealand, consisting of cardiologists, cardiac surgeons and general practitioners have recommended priority criteria for access to Coronary-Artery Bypass Graft (CABG). They used published outcome studies in developing the criteria, and numerical scores were assigned to both biological and social dimensions of ischaemic heart disease. The New Zealand criteria were used to investigate access to services for patients in the UK in Sunderland, Tyne and Wear. Case notes of 229 Sunderland residents who underwent coronary angiography in the 1995 96 financial year were reviewed. The clinical threshold for access to CABG was much higher in Sunderland than in New Zealand. After controlling for the severity of disease, there was no evidence of inequity of access based on age, gender, smoking status or the deprivation indices of the patients' ward of residence. The correlation between the New Zealand Priority Criteria scores and the waiting time for coronary angiography, CABG and Percutaneous Transluminal Coronary Angioplasty (PTCA) was present, but weak (r = -0.22, -0.1 and -0.54 respectively). The New Zealand consensus criteria proved a useful benchmark both to assess access for patients with ischaemic heart disease to coronary artery surgery in a local Health District and to prioritise patients on the waiting list for coronary artery surgery. They allowed a realistic assessment of access according to age, gender, smoking status and deprivation by taking disease severity into account.
Benchmarking↗
Home Office addicts index no longer exists.
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Government↗
Cyclic adenosine 3', 5' monophosphate: a possible indicator of premalignant changes in the large bowel.
Cyclic adenosine 3', 5' monophosphate (cyclic-AMP) has been estimated in mucosal biopsy samples removed from the descending colon and rectum at endoscopy to investigate the possibility of using this substance for monitoring pre-malignant changes in the large bowel. Four groups of patients have been studied: those with normal large bowel and rectal mucosa; those with non-malignant inflammatory bowel disease; those with an adenomatous polyp in the descending colon or sigmoid colon; and those with a rectal adenocarcinoma. No difference was found in the cyclic-AMP content of 'normal' rectal mucosa, 'normal' colonic mucosa, 'diseased' colonic mucosa, carcinomas, and uninvolved mucosa adjacent to the polyps. Less cyclic-AMP was found in the polyps than in adjacent uninvolved mucosa. Conversely, more cyclic-AMP was found in the carcinomas than in adjacent uninvolved mucosa. It is concluded that although cyclic-AMP may be a very useful parameter for delineating the extent of the disease in individual patients, it is not a suitable biochemical marker for the screening of neoplastic changes in the large bowel in the population as a whole.
Colonic Neoplasms↗
Colonoscopy in surgical practice.
Colonoscopy is a rewarding new technique with a potential for early and more accurate diagnosis. One hundred and seventy colonoscopies carried out over the past three years showed or confirmed colonic cancer in 14 patients, and solitary or multiple colonic polyps were found in 28 cases, of which 18 were excised endoscopically. A large villous adenoma was diagnosed in one patient, and the absence of a suspected sinister lesion was shown by direct examination and biopsy in 110 cases. There were 17 examination failures, including two perforations of the bowel. Colonoscopy complements rather than supplants barium enema examination and will make diagnostic laparotomy for colonic lesions unnecessary. The use of the diathermy snare allows endoscopic removal of colonic polyps and should greatly reduce the need for formal surgery in these cases. The financial saving to the Health Service will greatly outweigh the expense of the procedure, but it should be undertaken only in well organised centres as a specialist service for selected patients. In skilled hands it is safe, but potential hazards exist for the inexperienced endoscopist.
Colon↗