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At least 19 recordsLinked to original sources
PubMed2000

The NHS--is Scotland different? A case study of the management of health care in the hospital service in the west of Scotland 1947-1987.

Management of the health service in Scotland and England, has since its creation, shown both divergence and congruence. In the initial decades in Scotland the executive hospital boards (which contained strong medical professional membership) and central government had a clearer relationship than in England. The health service-civil service machinery in Scotland was without doubt more to the forefront with higher status in the Scottish 'polity' than was the case in England. The 1970s reforms also indicated difference: despite the pro managerialist tones of the Farquarson Lang report in Scotland, a managerial emphasis was more apparent in the English reforms. By the 1980s, the government's clear intention that their 'radical' agenda should apply in Scotland and England was implemented in many instances: aspects of the new managerialism were applied as vigorously in the case examined than anywhere in England; the attempt to draw clinicians into resource management (as advocated in the Griffiths report) appeared to have advanced further in Scotland until well into the 1990s. Yet in other aspects, Scotland diverged from parts of England in the implementation of the 1980's agenda most notably in the growth of private practice though the case indicated significant Scottish developments here too. The article concludes by speculating on some Scottish differences in the coming years.

England↗
PubMed1997

Changing roles of nurses in Scotland. A survey of developing clinical roles within NHS trusts in Scotland.

OBJECTIVES: A position paper to enhance understanding of:- the range of role developments within nursing in Scotland; the educational and managerial preparation planned and undertaken for the introduction of new nursing roles; the implications of new roles with regard to working practices, career development and organisational issues; the perceived benefits and drawbacks of new roles; the nature of role evaluations; plans for future development. DESIGN: A survey of eighteen executive Nurse Directors across Scotland who were interviewed about new clinical roles for registered nursing staff currently being developed within their NHS Trust. A postal survey was also conducted including the remaining NHS Trusts in Scotland. A sampling framework was constructed based on: geographical location (at least one NHS Trust from each of the twelve Mainland Health Board areas was sampled); type of NHS Trust (sample was undertaken to include a representation of major teachinghospitals, district general hospitals and community and mental health services). SETTING: NHS Trusts in Scotland. August-October 1995. SUBJECTS: Executive Nurse Directors and in some settings Nurse Managers and nurses undertaking new roles in NHS Trusts in Scotland. RESULTS: New roles identified for nurses fitted into two main categories:- additional skills which were new to existing roles; developing posts which incorporated many new skills. There were four types of developing posts:- Medical Support Nurses; Clinical Nurse Specialists; Advanced Practitioners; Practice Development Facilitators. CONCLUSIONS: New roles for nurses were considered to be beneficial for patients, nurses and the organisation. Protocol usage and educational input into the new roles was variable. Formal evaluation was not well established at the time of the survey.

Clinical Competence↗
PubMed1995

Screening experience and baseline characteristics in the West of Scotland Coronary Prevention Study. The WOSCOPS Study Group. West of Scotland Coronary Prevention Study.

The West of Scotland Coronary Prevention Study (WOSCOPS) is a randomized, double-blind, placebo-controlled trial of pravastatin in a primary prevention context. The primary end point of the trial is definite coronary artery disease (CAD) death and/or nonfatal acute myocardial infarction. This study describes the baseline characteristics of the trial recruits and of the subjects who were screened during the recruitment process; 6,595 men, aged 45 to 64 years, with raised cholesterol levels, were randomized in equal numbers to placebo or pravastatin after initial screening of approximately 81,000 subjects in the West of Scotland. With the exception of cholesterol levels and history of CAD, the recruits had a similar risk factor profile and demographic distribution to the group of screenees from which they were selected. Compared with previous primary prevention studies of cholesterol-lowering drugs, the WOSCOPS recruits are, on average, 7 to 9 years older than subjects in other trials and have average total cholesterol levels 0.5 mmol/L (19.4 mg/dl) lower than those in the Helsinki Heart Study and the Lipid Research Clinics-Coronary Primary Prevention Trial. The study has achieved its initial goal of accumulating > 30,000 patient-years of randomized follow-up. Recruits had their final trial visits in the first half of 1995 and the main results will be available in the fourth quarter of 1995.

Age Factors↗
PubMed1972

Differences in opportunities for the disabled in England and Scotland: a survey of paraplegics in Scotland.

The facilities available to disabled people living in Scotland were studied by visiting and interviewing a group of 50 paraplegics living in Glasgow and the surrounding counties. The degree of unemployment in the group (74%) was far greater than has been reported in other surveys, and no quadriplegic was in remunerative employment. Though the general unemployment level in the area is high services to help the disabled gain employment were only partially utilized.Liaison between social workers was not always successful. Some paraplegics were visited at home by both a medical social worker and a local authority social worker, while others were not supported by either. There was no apparent attempt by local authorities to identify the disabled, as is required in England under Section 1 of the Chronically Sick and Disabled Persons Act, 1970. Several paraplegics lacked facilities which are covered by Section 2 of the Act. The exclusion of Scotland from Sections 1 and 2 of the Chronically Sick and Disabled Persons Act may widen the differences between the two countries as the Scottish legislation is less specific.

Adolescent↗
PubMed1993

Scotland's health--a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland.

The recent White Paper, 'Scotland's Health: A Challenge To Us All', emphasises the importance of lifestyle factors, such as smoking, diet and exercise, in Scotland's poor health record. Targets are to be set for improvements in diet, and individuals will be encouraged to improve their eating habits. In this paper we suggest that attention should be given to the price and availability of healthy foods, particularly in socio-economically deprived areas. To illustrate the possible importance of this, we present findings from a small exploratory study of two socially contrasting and non-contiguous localities in Glasgow which indicates that price disincentives to eating healthy may be greater in poorer than in more affluent areas.

Diet↗
PubMed1997

Baseline risk factors and their association with outcome in the West of Scotland Coronary Prevention Study. The West of Scotland Coronary Prevention Study Group.

The West of Scotland Coronary Prevention Study recently demonstrated the benefits of pravastatin therapy in the prevention of coronary heart disease events in middle-aged hypercholesterolemic men without prior myocardial infarction. We present an analysis of the influence of baseline risk factors on coronary events and total mortality in the trial, and their interaction with therapy, using the Cox proportional hazards model. The multivariate predictors of fatal or nonfatal coronary events were treatment allocation (pravastatin or placebo), current smoking, diabetes mellitus, nitrate consumption, minor electrocardiographic abnormalities, angina pectoris, family history of premature coronary death, widowhood, blood pressure, and total cholesterol/high density lipoprotein cholesterol ratio. Independent of other risk factors, pravastatin reduced the risk of definite coronary heart disease death or nonfatal myocardial infarction by 32% (95% confidence interval 17 to 44, p = 0.0001), definite or suspected coronary heart disease death by 35% (3 to 56, p = 0.035), cardiovascular death by 33% (4 to 53, p = 0.027), coronary revascularization procedures by 38% (11 to 56, p = 0.009), and all-cause mortality by 24% (2 to 41, p = 0.037). The 5-year risk of fatal or nonfatal myocardial infarction, calculated using the predictors identified in the Cox analysis, ranged from <4.4% in the lowest quartile of risk to >9.6% in the highest quartile. The proportional benefit achieved by pravastatin was independent of other risk factors; hence, the absolute benefit of therapy was greatest in subjects with the highest baseline risk. Such subjects can be identified easily in the population and deserve high priority for treatment.

Anticholesteremic Agents↗
PubMed1994

Prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland. West of Scotland Laparoscopic Cholecystectomy Audit Group.

Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear. A prospective audit of the introduction of laparoscopic cholecystectomy in the west of Scotland over a two year period was carried out to attempt to assess this new procedure. A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy submitted prospective data from September 1990-1992. A total of 2285 cholecystectomies were audited (a completed data collection rate of 99%). Laparoscopic cholecystectomy was attempted in 1683 (74%) patients and completed in 1448 patients (median conversion rate to the open procedure 17%). The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes (range 30-330) and overall hospital stay three days (1-33). There were nine deaths (0.5%) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure. In the laparoscopic cholecystectomy group there were 99 complications (5.9%), 53 (3%) of these were major requiring further invasive intervention. Forty patients (2.4%) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries. There were 11 (0.7%) bile duct injuries in the laparoscopic cholecystectomy series, five were noted during the initial procedure and six were recognised later resulting from jaundice or bile leaks. Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies. In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease. Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy, the bile duct injury rate is higher.

Adolescent↗
PubMed2002

A population-based study of intensive multi-agent chemotherapy with or without autotransplant for the highest risk Hodgkin's disease patients identified by the Scotland and Newcastle Lymphoma Group (SNLG) prognostic index. A Scotland and Newcastle Lymphoma Group study (SNLG HD III).

The aim of the study was to identify all patients with poor risk Hodgkin's disease (HD) using a numerical prognostic index in a defined population and to recruit them into a trial of intensive chemotherapy prednisolone, vinblastine, doxorubicin, chlorambucil, etoposide, bleomycin, vincristine, procarbazine (PVACE-BOP)x3+autotransplant (Arm A) versus PVACE-BOPx5 (Arm B) in first remission. In 10 years, the Scotland and Newcastle Lymphoma Group (SNLG) registered 930 patients with HD of whom 178 (19%) were identified as 'poor risk' by the SNLG index and were aged 16-59 years. 126/178 (71%) entered the study. Of the 120 confirmed poor risk HD cases, all completed PVACE-BOPx3 with a 93% Complete Response/unconfirmed Complete Response (CR/CRu) rate. Only 65/107 in CR accepted the randomisation. With a median follow-up of 6 years, both arms of the trial have a similar time to treatment failure (TTF) (Arm A 79%+/-11 versus 85%+/-7 Arm B, P=0.35). Advanced stage 'good risk' patients not included in the trial receiving standard therapy with CLVPP or ABVD had a 75% 5-year survival. The study demonstrates that PVACE-BOP therapy in the poorest risk group (58% had an IPI>/=3) produces excellent CR rates (93%) and overall survival with minimal toxicity, and that the substitution of autotransplant in first CR does not improve outcome. The use of the objective SNLG index accurately helped in the selection of the poorest risk group in this population study. The placing of a randomised control trial within the context of a population-based study of HD enhances the validity of the outcome.

Adolescent↗