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Biomedical subjects

R Crouch

Publications and source records attributed to R Crouch.

At least 19 recordsLinked to original sources
PubMed1999

Provision of telephone advice from accident and emergency departments: a national survey.

This study sought to gain a national picture of the provision of telephone advice using a postal survey of senior nurses from accident and emergency (A&E) and minor injury units (MIUs). In all, 268/313 (85%) of hospitals/units responded. The average number of calls reported as received per day was 15.5 (median 12; quartiles 6, 20) for weekdays and 21.0 (median 17; quartiles 10, 29) for weekends. Most (89%) viewed the provision of telephone advice as an important component of their work, but few units offered staff training for this role or had implemented protocols or guidelines. Only 5.4% units included the number of calls received in their department in their workload figures, but 91.9% felt that they should be. Extrapolation of the data from this study to all 313 A&E and MIUs in the UK suggests that just under two million calls for telephone advice are currently made to units each year. Recognition and formalization of this aspect of work is likely to be of increasing importance given the constraints on services and the need to manage demand effectively. Future integration of A&E telephone advice calls with NHS Direct should be considered as a means of managing demand and avoiding duplication of service provision.

Counseling↗
PubMed1998

Pulmonary rehabilitation of the patient with nonobstructive lung disease.

Disability from chronic lung disease is usually associated with COPD and pulmonary rehabilitation programs are designed to address this population. There are a number of chronic nonobstructive lung diseases, however, that can produce disability and that also may benefit from pulmonary rehabilitation. This article discusses how to classify nonobstructive lung disease patients and examines their evaluation, rehabilitation, and outcomes.

Humans↗
PubMed1997

Telephone assessment and advice: a training programme.

Nurses have become increasingly involved in providing telephone assessment and advice, and telephone triage is emerging as an important part of the everyday role that nurses can play in A&E, general practice and other community settings. This article describes a project to prepare staff to fulfil this role.

Counseling↗
PubMed1997

Primary care in the A & E department: meeting the challenge--a workshop series for A & E nurses.

Accident and emergency (A & E) departments lie at the interface between primary and secondary care. Patients who attend the accident and emergency department with primary care needs have traditionally been seen as 'inappropriate' and labelled in pejorative terms. Over the past few years, however, new models of care have emerged through research and practice development for meeting the needs of this group of patients in A & E. For effective service development there is a need to challenge and change the traditional A & E culture. This paper describes an educational approach towards changing clinical practice, by disseminating research and practice development initiatives through a workshop series. It aimed to disseminate research in a relevant manner to practitioners and to develop the primary care orientation of a number of A & E departments in England and Scotland. The workshop series sought to influence clinical practice by sharing the experience of researchers and practitioners in a supportive learning environment. The use of this approach offered a means of bridging the gap between research and practice development. The paper outlines the rationale for the workshop series, its structure, aims and objectives, and the reported progress in relation to change management and service provision identified by the participants. The workshop series proved to be an effective means of disseminating experience of research, practice development and change management.

Education↗
PubMed1997

Patients telephoning A&E for advice: a comparison of expectations and outcomes.

OBJECTIVE: To investigate the expectations of patients when they phone the accident and emergency (A&E) department, how this relates to the advice they receive, the action they subsequently take, and their satisfaction with the service. SETTING: The study was undertaken at an inner city hospital in south east London. METHODS: 597 calls to the department were documented during the study period, and callers for whom a phone number had been recorded were followed up by structured interviews carried out by a trained interviewer within 72 h of the call. Up to three attempts were made to contact each patient. The interviews were conducted at various times of the day to avoid excluding people with different work or social patterns. RESULTS: The interviewer was able to contact 203 patients within 72 h of their call to the A&E department. Of these 197 (97%) agreed to participate. Almost two thirds stated that when they phoned A&E they anticipated receiving self care advice; 11% expected to be advised to see or contact their general practitioner. Only a quarter of callers stated that they had expected to be told to attend A&E. There was disagreement between the advice that nurses documented as having been given, the advice the caller recalled receiving, and the action the patient subsequently took. Even so, 107 (55%) callers were very satisfied and 62 (32%) were satisfied, while 11 (6%) were dissatisfied with the telephone consultation; 15 (8%) were unsure. In all, 170 (87%) thought the advice they received was helpful. CONCLUSIONS: Understanding the reasons why patients phone A&E departments and their expectations should contribute to developing more responsive and effective services.

Counseling↗
PubMed1997

Organ donation in the accident and emergency department: a study of relatives' views.

OBJECTIVE: To determine whether recently bereaved people would object to being asked about organ donation immediately after the death of their relative. METHODS: A telephone interview of 78 recently bereaved relatives of people who had died in an inner city accident and emergency (A&E) department; 68 (87%) agreed to participate in the study and were sent a questionnaire. Outcome measures were views on being asked about organ donation in the A&E department immediately after the death of a relative and knowledge of the possibility for organ donation in A&E after a sudden death. RESULTS: 37 questionnaires were returned: 27 (72.9%) of those who responded would not have minded being asked, five would have minded, and five did not know or did not fill in the questionnaire; 29 were aware that organs could be donated following a death in A&E. Only six people had discussed organ donation before the bereavement. Only two of the people who died and seven of their relatives carried a donor card. Sixteen had heard about the NHS donor register. CONCLUSIONS: Most those responding would not have minded being asked about organ donation following a sudden death. More education is needed in two main areas: (1) to raise public awareness about the shortage of donor organs; (2) to improve the medical and nursing confidence in discussing these difficult issues sensitively but more openly and frequently.

Adult↗
PubMed1997

Satisfaction with telephone advice from an accident and emergency department: identifying areas for service improvement.

OBJECTIVES: Members of the public often telephone general practice, accident and emergency departments, and other health services for advice. However, satisfaction related to telephone consultation has received relatively little attention. This study aimed to describe the views of callers to an accident and emergency department who expressed any element of dissatisfaction about their telephone consultation. This was part of a larger study intended to help identify areas for service improvement. METHODS: A telephone consultation record form was used to document details of advice calls made to the accident and emergency department over a three month period. Callers who provided a telephone number were followed up within 72 hours. The interviews were tape recorded, transcribed, and explored using content analysis for emerging themes related to dissatisfaction. RESULTS: 203 callers were contacted within 72 hours of their call, of which 197 (97%) agreed to participate. 11 (5.6%) expressed global dissatisfaction, and a further 34 (17%) callers expressed at least one element of dissatisfaction at some point during the interview. Sources of dissatisfaction fell into four broad categories, each of which included more specific aspects of dissatisfaction: 36 (80%) callers were dissatisfied with advice issues, 31 (69%) with process aspects, such as the interpersonal skills of the staff member who took the call, 23 (51%) due to lack of acknowledgement of physical or emotional needs, and 11 (24%) due to access problems. CONCLUSIONS: This study supports the findings of other work and identifies three issues for particular consideration in improving the practice of telephone consultation: (a) training of health professionals at both undergraduate and specialist levels should cover telephone communication skills, (b) specific attention needs to be given to ensuring that the information and advice given over the phone is reliable and consistent, and (c) organisational change is required, including the introduction of departmental policies for telephone advice which should become the subject of regular audit.

Adolescent↗
PubMed1996

Paediatric calls to an inner city accident and emergency department: service demand and advice given.

Patients routinely call both Accident and Emergency (A & E) departments and General Practice for advice. Many of these calls concern children. In the UK, telephone calls for advise made to A & E departments are usually dealt with by nursing staff in an informal manner. This paper focuses on telephone calls concerning children received in a busy inner city department. Data were collected using a Telephone Consultation Record proforma (TCR) developed to document all calls to the A & E department. There were a total of 597 calls to the A & E department documented during the study period of which 218 (37%) concerned paediatric patients. The majority of calls were concerning children under the age of 5. One-third of callers were given self-care advice. This paper reports on the volume of calls, the nature of patients' problems and the outcome in terms of the advice given to the caller. The implications of the findings are discussed. Given the current demand for telephone advice, A & E departments should examine the nature and demand for telephone advice and explore methods of providing training and support to staff carrying out this role.

Adolescent↗
PubMed1996

An analysis of telephone calls to an inner-city accident and emergency department.

The general public in the UK often telephone accident and emergency (A&E) departments for medical advice. Such calls are usually dealt with by nursing staff in an informal manner (often with no written record of the call being made). The specific questions addressed in this study are who was calling for advice, when did they call, what were their presenting complaints, and what was the outcome of the call? In addition, the study provided an opportunity to test the implementation of a new system of record-keeping for telephone consultation. A telephone consultation record (TCR) was developed and used to record details of each call made to the A&E department for medical/health advice. An analysis of 597 consecutive documented calls is presented in this paper. The majority of calls were dealt with by 'E' grade nursing staff (42.7%); only four calls (0.7%) were recorded by medical staff. Two hundred and six (43.5%) calls related to patients aged up to 15 years. In 57% of the cases the call was made by a third party. In all, 149 different presenting complaints were recorded on the TCRs. The three most common presenting complaints were dental problems (7.4%), fever (4.3%), and concerns about drug reactions (23%). Seventy-three per cent of callers were advised that a visit to the A&E department was not immediately necessary. The study identifies several important issues for development of a more formal and effective system of telephone advice. The majority of calls made to the A&E department appeared to be of a primary care nature but the extent to which nurses are trained to assess and advise on these problems needs to be questioned. A reluctance to document the calls to A&E was identified, one reason being a concern about accountability. Training and support are clearly required.

Adolescent↗
PubMed1995

Providing health-care advice by telephone.

Telephone advice systems can deliver a high-quality, responsive service. There is potential for development of the practice nurse role as telephone adviser in primary care. This study identifies a need for training nurses in the role of telephone adviser.

Attitude of Health Personnel↗
PubMed1995

Asthma rehabilitation program.

Comprehensive management of asthma includes proper use of medication adjustments in patient lifestyle, exercise conditioning, and patient education to maximize self-management capabilities. Pulmonary rehabilitation programs have used these strategies successfully to improve the functional status and reduce the health care costs of patients with chronic obstructive pulmonary disease. Adapting these programs to the asthmatic population is an important and cost-effective goal.

Adult↗
PubMed1994

Identifying feelings engendered during triage assessment in the accident and emergency department: the use of visual analogue scales.

Feelings engendered during 585 triage nursing assessments made by a total of 10 nurses were studied. Marked differences in nurses' feelings were demonstrated towards patients attending the accident and emergency (A&E) department with 'primary care' needs compared with those assessed as having 'A&E' needs. In particular, nurses demonstrated more negative feelings, in the form of less sympathy, more irritation and less motivation to help, towards patients with 'primary care' needs. Nurses' feelings were adversely affected by delays in patient presentation following the occurrence of illness or injury. Nurses perceived patients' attendance as illegitimate when it had deviated from expected norms of health-care-seeking behaviour. These findings were elicited using visual analogue scales completed immediately following the triage assessment of the patients. This work is part of a larger study into developing the primary care role of accident and emergency nurses. The culture of the A&E department is discussed, and the need to challenge and change this culture to ensure it becomes more responsive to individual patients' needs is advocated. This paper calls for development of triage training and education and further investigation into the effects of nurses' attitudes on patient assessment.

Adolescent↗
PubMed1993

Effect of over-expression of bacterial ribonuclease H on the utility of antisense MYC oligodeoxynucleotides in the monocytic leukemia cell line U937.

RNase H has been clearly implicated in vitro in mediating some antisense effects. In vivo evidence is limited to experiments performed in Xenopus oocytes in which antisense oligonucleotides are microinjected. In other mammalian cell systems scant data have been obtained to support or deny a role for RNase H as an antisense mediator in vivo. These experiments were designed to test the hypothesis that RNase H mediates the MYC antisense-induced reduction in MYC protein observed in the human monocytic leukemia cell line U937. A bacterial RNase H-containing episomal replicon was constructed and stable transfectants were obtained which expressed E coli RNase H in their cytoplasm at a 10-fold higher level than endogenous RNase H. These cells failed to demonstrate heightened sensitivity to MYC antisense (phosphorothioate, end capped and phosphodiester) compared with untransfected or E coli RNase H antisense transfected cells. PCR analysis of each transfectant treated and untreated with MYC antisense failed to demonstrate the appearance of truncated MYC mRNA. These results do not support a role for RNase H in the mediation of MYC antisense-induced MYC protein reduction and growth inhibition in U937 cells.

Base Sequence↗
PubMed1992

'Inappropriate attender' in A&E.

With the current emphasis on reducing patient waiting times, accident and emergency nurses may be tempted to close the doors on what they consider to be 'inappropriate attenders'. The author warns that public perceptions of A&E are often at odds with the nurses view, and that all patients should have access to accident and emergency services. This article takes a critical look at triage since its inception as a means of assessing wounded soldiers during the first world war. He explores patient assessment in accident and emergency departments and nurses' attitudes towards the 'inappropriate attender', highlighting the need for caution when dealing with enquiries from the general public.

Attitude of Health Personnel↗
PubMed1992

The effect of therapeutic drugs used in inflammatory bowel disease on the incidence and growth of colonic cancer in the dimethylhydrazine rat model.

An increased incidence of colonic cancer is associated with chronic inflammatory bowel disease. Sulphasalazine, metronidazole and more recently, modified forms of 5-aminosalicylic acid are used for maintenance therapy of inflammatory bowel disease. In a series of experiments, we used the 1,2-dimethylhydrazine animal model of colonic cancer in conjunction with these drugs, to study the effect on the development of colon cancer. Inbred male Wistar rats were divided into groups receiving orally: metronidazole 18 mg Kg-1 dy-1; sulphasalazine 60 mg Kg-1 dy-1; 5-aminosalicylic acid 30 and 60 mg Kg-1 dy-1 and olsalazine 60 mg Kg-1 dy-1 administered daily. Half of each group also received weekly injections of DMH 40 mg Kg-1. Metronidazole, sulphasalazine and 30 mg Kg-1 dy-1 5-aminosalicylic acid were co-carcinogenic, increasing either the number of cancers or tumour size. In contrast 60 mg Kg-1 dy-1 5-aminosalicylic acid inhibited tumour size and olsalazine had no effect. These results may have a bearing on long term maintenance therapy in inflammatory bowel disease.

Adenocarcinoma↗