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Biomedical subjects

R Chesson

Publications and source records attributed to R Chesson.

At least 19 recordsLinked to original sources
PubMed2001

Nice lessons to be learned.

OBJECTIVES: This study examined users' perceptions of the role and value of the Scottish Health Purchasing Information Centre (SHPIC) from 1995 to 1998. METHODS: Questionnaires and interviews were used to gather data from Scottish GP fundholders and health board managers at two stages. RESULTS: Initially, purchasers sought help in identifying the most relevant information. By 1997, while some appreciated the clinical and cost-effectiveness information produced, others were critical of lack of timely production and apparent lack of cooperation between agencies. CONCLUSIONS: New U.K. agencies can learn from SHPIC's problems, specifically in producing clear, coordinated, timely, independent, and well-marketed information with implementation strategies. POLICY IMPLICATIONS: It is important to evaluate the impact of agencies to produce and disseminate evidence-based information, even if this has to be done pragmatically rather than as an outcomes-based assessment. Evidence from evaluations can inform direction and strategy for existing and new agencies.

Attitude of Health Personnel↗
PubMed2001

Health care management: models for evidence-based practice.

Presents models suggesting how research evidence can best be operationalised within health care commissioning. Models were derived from data gathered from surveys of Scottish health board managers and GP fundholders regarding the use of information in commissioning from 1995 to 1997. Feedback on the models was obtained subsequently from practitioners in 1998. Two models, one for health board managers and the other for GPs, are presented. These include critical success factors in achieving evidence-based commissioning and factors that are likely to predispose and precipitate evidence-based practice. Given a culture demanding transparency, accountability and continuing improvement, the models provide tools for reflection, evaluation and planning. In addition, they identify a pragmatic role for managers in evidence-based commissioning and provide a framework for audit.

Contract Services↗
PubMed2000

Health services can be cool: partnership with adolescents in primary care.

Young people's health is giving rise to increasing concern. However, despite recent government emphasis on patient involvement and partnership, little discussion has occurred concerning how this may be achieved with younger age groups in primary care. Here we outline issues relating to adolescents' health and characteristics of current provision. These are considered in the context of innovative services that have incorporated adolescents' views. Finally, we discuss the challenge of establishing a partnership with adolescents and propose strategies for achieving this.

Adolescent↗
PubMed2000

Staff views on orthopaedic patients' accommodation.

Alternative accommodation to traditional wards may be suitable for some orthopaedic patients. Doctors and nurses in this study had different views about patient accommodation. Little reference to patient choice was made by either doctors or nurses. Further research is needed on different staff groups regarding factors influencing discharge decision-making.

Attitude of Health Personnel↗
PubMed1999

More than a sympathetic ear? A report on the first year of a writer in residence in a unit for young, physically disabled people.

OBJECTIVE: To describe a writer in residence scheme and report the views of patients and staff. DESIGN: Qualitative study including interviews with patients, a questionnaire survey of staff, and dialogue with the writer. SETTING: A unit for young people with physical disability. SUBJECTS: A convenience sample of patients admitted to the unit and members of the multidisciplinary rehabilitation team. INTERVENTION: A writer in residence working 15 hours per week in the unit. RESULTS: A small number of patients worked regularly with the writer and this led to the publication of a play, short stories and poems. Patients described wide ranging benefits including improvements in mood state. Staff regarded the writer in residence scheme as enhancing their treatment and care and thought it helpful in addressing their own psychological needs. The writer saw herself as a catalyst 'for the creativity of others'. CONCLUSION: Such schemes have an important role to play in rehabilitation settings.

Adult↗
PubMed1998

Stress urinary incontinence due to prescription medications: alpha-blockers and angiotensin converting enzyme inhibitors.

BACKGROUND: Several antihypertensive medications affect lower urinary tract function and may cause urinary incontinence. CASE: A 59-year-old woman on doxazosin mesylate for control of her hypertension presented with stress urinary incontinence. Because this drug is known to cause loss of urethral tone leading to stress incontinence in some patients, she was switched to enalapril maleate, an angiotensin converting enzyme inhibitor. Her incontinence improved on the new medication, but she developed a persistent dry cough that continued to cause episodic stress incontinence. Because a persistent cough is a known side effect of angiotensin converting enzyme inhibitors, her medication was changed to a calcium channel blocker, amlodipine besylate. Her cough resolved, and her stress incontinence was no longer a clinical problem. CONCLUSION: Gynecologists should be aware of the unexpected side effects of medications on the lower urinary tract.

Adrenergic alpha-Antagonists↗
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↗
PubMed1993

Self reported disability in six electoral districts in Grampian.

Following the Office of Population Censuses and Surveys (1988) Survey on disability, a survey was carried out in Grampian in 1989, initiated by the Social Work Department of Grampian Regional Council. From 5,042 mail questionnaires a response rate of 83.6% was obtained. Twelve and 88% of those with health disorders were considered as having impairments and disabilities respectively, when the categories of the World Health Organisation's International Classification of Impairments, Disabilities and Handicaps (1980) were applied. Thirty-two per cent of survey households considered that they had at least one person with a disability. Of the 1,289 households with disability 23% and 3% had two, and three or more people with a disability. Six disorders accounted for 86.9% of all disability, and asthma accounted for nearly half of all reported disability among Grampian's population under 16 years of age. The nature and extent of disability was found to vary considerably within Grampian.

Adolescent↗
PubMedDate not supplied

Motor/learning difficulties and the family.

The work reported here, which has as its central concern family dynamics and relationships, is part of a wider study of 31 children with motor/learning difficulties. All the children were attending an Occupational Therapy Department and had been assessed as having motor/learning difficulties. Descriptions of family background, structure and composition are provided and findings on conjugal, parent/child, sibling and extended family relationships presented. Characteristic patterns of family interaction are identified and factors affecting family cohesion discussed.

Achievement↗
PubMedDate not supplied

The identification and treatment of motor/learning difficulties: parents' perceptions and the role of the therapist.

The diagnostic experience of 31 children, assessed as having motor/learning difficulties, attending an occupational therapy department within a children's hospital, was investigated. The study demonstrates the difficulty of specific identification of perceptuomotor problems. Close examination of the children's individual diagnostic pathways revealed a high number of health-care professional contacts and the fact that frequently there were lengthy gaps between parental (and sometimes professional) suspicions and final confirmation. The children's diagnostic experiences prior to starting treatment were varied and involved, and no one single route was predominant. The rationale for occupational-therapy assessment and treatment of this disorder is described, and parental perceptions of its effect are discussed. The findings suggest that an important part of therapeutic intervention may be increasing children's self-confidence and reducing intra and extra family tensions. Fewer behavioural problems were reported once treatment had commenced. It was concluded that an important part of the therapist's role was to provide information and support for parents and to liaise with school teachers, in addition to treating the children themselves.

Child↗