Biomedical subjects
F Namdaran
Publications and source records attributed to F Namdaran.
A review of influenza immunisation in Lothian.
OBJECTIVES: To assess the influence of the Chief Medical Officer's annual guidelines on influenza immunisation and to estimate vaccine uptake particularly of those resident in long-stay residential facilities and of other recommended at-risk groups. DESIGN: Postal questionnaires. SETTING: Lothian, Scotland (population 750,000). SUBJECTS: All consultants caring for patients in long stay National Health Service facilities; a random sample of all general practitioners (GP's) in Lothian; managers/charge nurses of all local authority, private and voluntary long stay facilities in Lothian and continuing care facilities in the National Health Service including adults and children. MAIN OUTCOME MEASURES: Number (%) of general practitioners offering influenza vaccine to at-risk groups as defined in the Chief Medical Officer's guidelines; number (%) of hospital consultants caring for long-stay patients in hospital in Lothian who offer influenza vaccine to the same at-risk groups; percentage of long-stay residents/patients who received influenza vaccine in 1992-3. RESULTS: Seventy nine (75%) GPs said they offered influenza vaccine to all at-risk groups; 15 (14%) GPs said they did not care for patients in long-stay facilities but offered vaccine to the other at-risk groups; 12 (11%) GPs who did have long-stay residents on their list, offered vaccine to some of them only and to all other at-risk groups; 14 (56%) hospital consultants did not offer influenza vaccine to long-stay patients; 10 (40%) immunised only those at risk from chronic medical conditions if their quality of life was good; 1 (4%) consultant offered vaccine to all long-stay patients. In the winter of 1992-3, the mean proportion of residents immunised in private nursing homes was 65%, in residential homes 68.5%, and in long-stay National Health Service wards 4.5%. GPs commented that annual publicity was confusing for the public, vaccine was not available at the right time and there was uncertainty on the efficacy of the vaccine. Hospital consultants were reluctant to immunise patients with a poor quality of life or who were demented and unable to give consent. CONCLUSIONS: A large majority of GPs followed official advice and offered influenza vaccine to long-stay patients and other at risk groups. Hospital consultants offered influenza vaccine only to a small proportion of their long-stay patients, primarily those with a good quality of life.
A review of influenza immunisation in Lothian.
OBJECTIVES: To assess the influence of the Chief Medical Officer's annual guidelines on influenza immunisation and to estimate vaccine uptake particularly of those resident in long-stay residential facilities and of other recommended at-risk groups. DESIGN: Postal questionnaires. SETTING: Lothian, Scotland (population 750,000). SUBJECTS: All consultants caring for patients in long stay National Health Service facilities; a random sample of all general practitioners (GP's) in Lothian; managers/charge nurses of all local authority, private and voluntary long stay facilities in Lothian and continuing care facilities in the National Health Service including adults and children. MAIN OUTCOME MEASURES: Number (%) of general practitioners offering influenza vaccine to at-risk groups as defined in the Chief Medical Officer's guidelines; number (%) of hospital consultants caring for long-stay patients in hospital in Lothian who offer influenza vaccine to the same at-risk groups; percentage of long-stay residents/patients who received influenza vaccine in 1992-3. RESULTS: Seventy nine (75%) GPs said they offered influenza vaccine to all at-risk groups; 15 (14%) GPs said they did not care for patients in long-stay facilities but offered vaccine to the other at-risk groups; 12 (11%) GPs who did have long-stay residents on their list, offered vaccine to some of them only and to all other at-risk groups; 14 (56%) hospital consultants did not offer influenza vaccine to long-stay patients; 10 (40%) immunised only those at risk from chronic medical conditions if their quality of life was good; 1 (4%) consultant offered vaccine to all long-stay patients. In the winter of 1992-3, the mean proportion of residents immunised in private nursing homes was 65%, in residential homes 68.5%, and in long-stay National Health Service wards 4.5%. GPs commented that annual publicity was confusing for the public, vaccine was not available at the right time and there was uncertainty on the efficacy of the vaccine. Hospital consultants were reluctant to immunise patients with a poor quality of life or who were demented and unable to give consent. CONCLUSIONS: A large majority of GPs followed official advice and offered influenza vaccine to long-stay patients and other at risk groups. Hospital consultants offered influenza vaccine only to a small proportion of their long-stay patients, primarily those with a good quality of life.
Trends in elderly patients (65 and over) waiting for long stay care in Edinburgh general hospitals 1988-1994.
Five surveys carried out in Edinburgh nonpsychiatric general hospitals between 1988 and 1994 have shown a progressive drop in the number of elderly patients (65 and over) waiting for long stay care. The overall point prevalence rate has fallen from 21.2% in 1988 to 9.2% in 1994. All three specialty categories (Geriatric Assessment, Geriatric Orthopaedic and General Medical) which have high prevalences have shown falls with the largest fall occurring in General Medical beds from 13.4% in 1988 to 3.8% in 1994. A substantial percentage (61.6%) of patients surveyed in 1994 were waiting to go into Private Nursing Homes which is in stark contrast to 8.5% in 1988, whereas the reverse has happened with those waiting for NHS Geriatric Long Stay care falling from 75% to 12.8%. It appears that the Community Care legislation has accelerated the shift toward Private Nursing Home care but has not, as feared, increased the number of old people waiting for long stay care in Edinburgh hospitals. The number of elderly patients awaiting long stay care in acute general medical beds in Edinburgh has now reached acceptable levels. If the same trend is occurring elsewhere in Scotland, we believe that attention should now turn to monitoring inappropriate early discharge of elderly patients.
Bed blocking in Edinburgh hospitals.
A point prevalence survey of in-patients in all acute hospitals within the city of Edinburgh in 1988 identified 224 elderly patients (65 and over) waiting for long stay care. This represents a 'bed blocking' rate of 19% across all specialties. The highest rate was found in Orthopaedic second line beds (approximately 33%) followed by Geriatric Assessment beds (approximately 30%); Acute General Medical Beds had approximately 13% of their beds blocked. Some 75% of the 224 patients were waiting for Geriatric long stay beds, 5% for Psychogeriatric, and a substantial proportion waiting for continuing care outwit the NHS (nearly 9% for Private Nursing Homes and 11% for residential accommodation). A repeat of this survey in 1990 revealed a small overall drop in bed blocking rate (18%) with moderate changes within the specialty groupings. However a substantial increase (from 20% to 32%) had occurred in those awaiting non-NHS accommodation, and a drop in those waiting for Geriatric Care (75% to 62%).
Continuing care of elderly patients with mental and physical incapacity in a joint geriatric/psychogeriatric ward.
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A study of reported injury accidents among novice motorcycle riders in a Scottish region.
A study is reported of the effect of sex, age, cubic capacity, and training on the rate of reported injury accidents in a cohort of 304 first time learner motorcycle riders resident in the Lothian and Borders of Scotland in 1983. Motorcycle in this paper includes all types of registerable two wheeled motor vehicle. Injury accidents as reported by the police were observed in this cohort over an average period of one year. The overall reported injury accident rate within the cohort was 8.2 per hundred riders. This rate does not seem to be markedly different to the Scottish rate for all riders. It was found that the cubic capacity of the motorcycle was the single most important risk factor of the four studied. The risk was disproportionately high in the 200+ cc category. Lower reported injury accident rates were observed for females and trained riders but these differences did not reach statistical significance mainly due to the low numbers of these two categories within the cohort. Contrary to popular assumption, younger riders within this cohort did not have higher injury accidents. A large proportion of the riders who had been involved in injury accidents within the cohort and who had registered 50 cc motorcycles were found to be riding higher capacity (mainly 200+ cc) motorcycles at the time of accident. There was a very low uptake of motorcycle training (7.3%) by the cohort. Approximately 15% of the cohort was female, a higher percentage than those reported by other studies.
Pneumatosis cystoides intestinalis in Iran.
Nineteen cases of pneumatosis cystoides intestinalis all affecting adults and all involving the small intestine have been collected in two centres of Iran (Shiraz and Tehran) over a 20 year period, the pathological findings being divided into three groups: pure submucosal, combined submucosal and subserosal, and pure subserosal cysts. Experimental PCI was produced in cadavers using high pressure oxygen insuflation of the lungs, thus lending support to the theory that it has a mechanical origin. Other theories of aetiology include tumour, nutritional deficiencies, gas-forming organisms, alveolar rupture, and acid-base disturbance. In most of the cases presented high intraluminal pressure produced by obstruction appeared to force intraluminal gas through a breach in the mucosa into either the lymphatics or perivascular tissue to produce PCI. It is concluded that the aetiology in the vast majority of adult cases is mechanical in nature and that bacteria seem to play very little part, unlike their role in the PCI of infants.
Pull-through ureterosigmoidostomy: a new operation in the treatment of vesicovaginal and rectovaginal fistulas.
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Thoracobilia: a surgical complication of hepatic echinococcosis and amebiasis.
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Serum transaminase levels after closed mitral valvotomy.
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