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Steve George

Publications and source records attributed to Steve George.

14 recordsLinked to original sources
PubMed2006

Are we getting what we pay for?

The British NHS delivers health care free at the point of access to whomever needs it. It is often claimed to be the envy of the world. But does it deliver health? Or could the resource put into the health service be better spent elsewhere? In this article, we discuss the determinants of health in the United Kingdom in the past, the rise of public health and the impact medical technology has had on health. We discuss resource distribution in health care, and apply the principles of health economics to the wider context of the delivery of health, rather than health care. With a background of rising demand for health care and rationing of resources in the UK, combined with inequalities in life expectancy related to position in society, we conclude that wealth redistribution, environmental regulation, improved nutrition and better education must come first in the priorities for achieving a healthy population.

Financing, Government↗
PubMed2006

The introduction of integrated out-of-hours arrangements in England: a discrete choice experiment of public preferences for alternative models of care.

OBJECTIVE: To establish which generic attributes of general practice out-of-hours health services are important to the public. METHODS: A discrete choice experiment postal survey conducted in three English general practitioner (GP) co-operatives. A total of 871 individuals aged 20-70 years registered with a GP. Outcomes were preferences for, and trade-offs between: time to making initial contact, time waiting for advice/treatment, informed of expected waiting time, type of contact, professional providing advice, chance contact relieves anxiety, and utility estimates for valuing current models of care. RESULTS: Response rate was 37%. Respondents valued out-of-hours contact for services for reducing anxiety but this was not the only attribute of importance. They had preferences for the way in which services were organized and valued information about expected waiting time, supporting findings from elsewhere. Participants were most willing to make trade-offs between waiting time and professional person. Of the predicted utility for three models of care utility was higher for fully integrated call management. CONCLUSIONS: Greater utility might be achieved if existing services are re-configured more in line with the government's fully integrated call management model. Because the attributes were described in generic terms, the findings can be applied more generally to the plethora of models that exist (and many that might exist in the future). The approach used is important for achieving greater public involvement in how health services develop. Few experiments have elicited public preferences for health services in the UK to date. This study showed valid preferences were expressed but there were problems obtaining representative views from the public.

Adult↗
PubMed2006

A systematic review of evidence about extended roles for allied health professionals.

OBJECTIVE: Extending the role of allied health professionals has been promoted as a key component of developing a flexible health workforce. This review aimed to synthesize the evidence about the impact of these roles. METHODS: A systematic review of extended scope of practice in five groups: paramedics, physiotherapists, occupational therapists, radiographers, and speech and language therapists. The nature and effect of these roles on patients, health professionals and health services were examined. An inclusive approach to searching was used to maximize potential sources of interest including multiple databases, 'grey' literature and subject area experts. An expanded Cochrane Collaboration method was used in view of the anticipated lack of randomized controlled trials and heterogeneity of designs. Papers were only excluded after the search stage for lack of relevance. RESULTS: A total of 355 papers was identified as meeting relevance criteria and 21 studies progressed to full review and data extraction. The primary reason for exclusion from data extraction was that the study included neither qualitative nor quantitative data or because methodological flaws compromised data quality. It was not possible to evaluate any pooled effects as patient health outcomes were rarely considered. CONCLUSIONS: A range of extended practice roles for allied health professionals have been promoted and are being undertaken, but their health outcomes have rarely been evaluated. There is also little evidence as to how best to introduce such roles, or how best to educate, support and mentor these practitioners.

Allied Health Personnel↗
PubMed2005

Effect of introduction of integrated out of hours care in England: observational study.

OBJECTIVES: To quantify service integration achieved in the national exemplar programme for single call access to out of hours care through NHS Direct, and its effect on the wider health system. DESIGN: Observational before and after study of demand, activity, and trends in the use of other health services. PARTICIPANTS: 34 general practice cooperatives with NHS Direct partners (exemplars): four were case exemplars; 10 control cooperatives. SETTING: England. MAIN OUTCOME MEASURES: Extent of integration; changes in demand, activity, and trends in emergency ambulance transports; attendances at emergency departments, minor injuries units, and NHS walk-in centres; and emergency admissions to hospital in the first year. RESULTS: Of 31 distinct exemplars, 21 (68%) integrated all out of hours call management. Nine (29%) achieved single call access for all patients. In the only case exemplar where direct comparison was possible, a higher proportion of telephone calls were handled by cooperative nurses before integration than by NHS Direct afterwards (2622/6687 (39%) v 2092/7086 (30%): P < 0.0001). Other case exemplars did not achieve 30%. A small but significant downturn in overall demand for care seen in two case exemplars was also seen in the control cooperatives. The number of emergency ambulance transports increased in three of the four case exemplars after integration, reaching statistical significance in two (5%, -0.02% to 10%, P = 0.06; 6%, 1% to 12%, P = 0.02; 7%, 3% to 12%, P = 0.001). This was always accompanied by a significant reduction in the number of calls to the integrated service. CONCLUSION: Most exemplars achieved integration of call management but not single call access for patients. Most patients made at least two telephone calls to contact NHS Direct, and then waited for a nurse to call back. Evidence for transfer of demand from case exemplars to 999 ambulance services may be amenable to change, but NHS Direct may not have sufficient capacity to support national implementation of the programme.

After-Hours Care↗
PubMed2004

Has the cocaine epidemic arrived in the UK?

National surveys of the UK drug situation in 2000 found that cocaine was the most frequently seized Class A drug, with 25-40 tonnes of cocaine being smuggled into the UK each year. In the light of these findings, an audit of the analytical monitoring for cocaine abuse has been performed covering the period from 1996 to 2002. It was found that there has been a consistent upward trend in the percentage of requests found to be positive for cocaine over this 7-year study period, rising from 9.7% in 1996 to 22% in 2002. This data would suggest that the use of cocaine has increased dramatically over the past few years, indicating that the arrival of the "cocaine epidemic" has now started to become a reality in the UK.

Adolescent↗
PubMed2004

Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study.

The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993-2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population.

Cautery↗
PubMed2004

The Subjective Index of Physical and Social Outcome: its usefulness in a younger stroke population.

Studies on stroke subjects that aim to improve their well-being or community support have not been shown to be effective when measures of disability and handicap have been employed. This paper illustrates the usefulness of the Subjective Index of Physical and Social Outcome (SIPSO) with young adults following a stroke. The study comprised a cross-sectional survey of people (57% male; 39% female; median age 55.7) with a stroke (1-10 years ago), aged 18-65, recruited via NHS stroke registers and young stroke groups (response rate 53%). The SIPSO was incorporated into a postal needs-assessment questionnaire. Median SIPSO score: 24.5 (IQR 17-32). The SIPSO internal reliability: ICC 0.91 (95% CI, 0.90-0.92), item to total SIPSO correlations ranged from 0.52-0.83. The SIPSO construct validity was good: those with poorer employment, mobility and sex-life outcomes had lower SIPSO scores than those with better outcomes; there was no association between age and SIPSO scores, SIPSO scores were not significantly different for men and women. Test-retest reliability was good. The SIPSO had excellent reliability and validity properties in his population. Further work on its responsiveness needs to be carried out. The measurement of personal experience of integration can be a vital basis for effective clinical care.

Adult↗
PubMed2004

Position of immunological techniques in screening in clinical toxicology.

There is a continuing increase in the use of immunological techniques in the field of clinical toxicology. This is primarily due to the rapidity by which analytical results are now required, and can be obtained, following the testing of individuals for drug use. There has recently been an increase in the repertoire of assays now available to testing laboratories (e.g., buprenorphine and heroin metabolite assays), with the techniques themselves becoming increasingly more specific for the drugs and/or metabolites being monitored (e.g., methadone metabolite assays). The near patient testing (NPT), or point-of-care testing (POCT), devices are now several generations forward from their inception, with some tests now approaching the sensitivity and specificity of automated laboratory-based methods. This review has been collated from the literature to illustrate some of the possible reasons for the move towards the increasing use of immunological techniques, and to highlight some of the advantages and disadvantages associated with such drug screening methods. In particular, it has been shown that it is important to determine, monitor and review the knowledge and training of the individual using the technique. In addition, quality control and quality assessment are paramount to ensure the validity of any drug testing being performed. It has also been shown that it is vital to maintain and develop the relationships between the staff performing the testing, the laboratory (if the testing is performed using NPT devices), and the clinicians utilising the results obtained from drug testing. Without these links, interpretive errors could arise which could adversely affect the diagnosis and management of patients.

Drug Evaluation, Preclinical↗
PubMed2002

Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial.

OBJECTIVE: To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers. DESIGN: Randomised controlled equivalence/non-inferiority trial. SETTING: Four NHS hospitals in three trusts. Three of the four were teaching hospitals. PARTICIPANTS: All patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999. INTERVENTION: Assessment by one of three appropriately trained nurses or by one of several preregistration house officers. MAIN OUTCOME MEASURES: History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome). RESULTS: 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%). CONCLUSIONS: There is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment.

Clinical Competence↗
PubMed2002

NHS Direct audited.

Explore the source record for details and available documents.

Consumer Behavior↗
PubMed2002

How many patients with haematological malignancy need the facilities offered by a district general hospital?

BACKGROUND: The objective of the study was to study the utilization of specialist clinical services for haematological malignancy in a defined patient population. Patients with haematological malignancy are mostly aged over 65 years. Demographic projections for the United Kingdom suggest that the incidence of haematological malignancy will increase by 20 per cent in the next 20 years, mostly as a result of demographic change. METHODS: A prevalence survey was carried out of out-patients with haematological malignancy resident in the New Forest area and their utilization of haematology clinical services at two sites. RESULTS: One hundred and ten patients (60 male, 50 female) were identified over three months: 87 (79 per cent) were aged over 65 years. Follow-up and therapy were carried out at a community hospital at Lymington, 19 miles from Southampton, in 83 patients (79 per cent, 45 male, 38 female, median age 74.9 years), and at one of two large hospitals in Southampton in 27 patients (21 per cent, 15 male, 12 female, median age 73.8 years). Attendance for more complex treatment at Southampton was necessary for 10 patients (9 per cent) in the Lymington group. Most interventions in both groups (356/379; 94 per cent) were basic, and were available and undertaken at either study site. Only 23/379 (6 per cent) of interventions required by the patient sample were more complex. CONCLUSIONS: Most haematological malignancies are chronic disorders with a simple clinical management plan, requiring periodic clinical monitoring. A consultant-led haematology clinic supported by access to multipurpose day treatment facilities in the community hospital allowed 75 per cent of patients to receive their care at a more geographically convenient location, important for conditions in which 79 per cent of patients are aged over 65 years, and in which this proportion will increase. Only a minority of cases require care in specialist hospital haematology units; the majority can be managed using community-based haematological follow-up care. Future studies are needed to assess cost-effectiveness and the impact on primary care of increasing the use of community-based treatment facilities.

Aged↗
PubMedDate not supplied

Application of the CEDIA 6-MAM assay to routine drugs-of-abuse screening.

A total of 1010 urine specimens obtained from General Practitioners, drug dependency units, and hospitals throughout the West Midlands were screened using the Microgenics CEDIA 6-monoacetylmorphine (6-MAM) assay as a means of establishing its effectiveness as a screening technique to monitor heroin abuse. A total of 282 specimens screened positive for 6-MAM using the CEDIA 6-MAM assay. However, the presence of 6-MAM could not be confirmed by gas chromatography-mass spectrometry in 21 (7%) of the CEDIA-positive specimens. Morphine was identified in all of these specimens at free concentrations ranging between 410 microg/L to 2010 microg/L. The data presented from this preliminary investigation suggests that either there are substances present within the urine specimens, as yet undetermined, which are interfering with the assay or that there may be a greater degree of cross reactivity to other opiates than previously published. 6-MAM assays may be potentially useful rapid screening techniques for high-throughput drugs-of-abuse screening laboratories performing employment and pre-employment screening. However, all positive results will still need to be confirmed by a more sensitive and specific technique.

Codeine↗