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Biomedical subjects

S Lawton

Publications and source records attributed to S Lawton.

At least 19 recordsLinked to original sources
PubMed2000

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 2: audit of service process.

An audit of atopic eczema management, conducted on behalf of the British Association of Dermatologists, examined service structure (phase 1), process (phase 2) and outcome (phase 3). In phase 2, an on-site case-note audit was conducted in 19 hospital dermatology departments randomly selected from the original sample of 187 centres across the U.K. In total, 630 sets of notes were examined for completeness of: (i) information given to general practitioners (GPs) in clinic letters and (ii) facts relevant to the management of atopic eczema recorded in the patients' notes. In general, the information given to GPs in the clinic letters was good, with the recording of diagnosis, treatment and follow-up approaching the 100% working standard. Factual information such as site and severity of eczema (83% and 74%), and presence or absence of asthma (53%) were better recorded than quality of life issues such as sleep loss secondary to itching (21%) and effect on school, work or social life (6%). On average, only 51% of all audit measures were recorded across all centres, with slight variation between centres (41-61%). The centre with the best recording had a purpose-designed data sheet for doctors to complete when seeing new patients with atopic eczema. Such data sheets may help improve case-note recording. Similar data sheets for patients to complete may be more time-efficient.

Adolescent↗
PubMed2000

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 3: audit of service outcome.

Service outcome was examined by a preconsultation (part 1) and a 6-week postconsultation (part 2) patient questionnaire in 29 hospital dermatology departments randomly selected from an original sample of 187 centres across the U.K. The outcome measures were: quality of life as measured by the Dermatology Life Quality Index (DLQI) and Children's DLQI (CDLQI), improvement in sleep loss, improvement in worse aspect of skin disease and return to work or school. Three hundred and fifty-two questionnaires (115 adults, 237 children) were completed for part 1, and 235 (67%) replied to part 2. The mean DLQI at initial consultation was 12.5, dropping to 9.7 at 6 weeks (P = 0.001). The mean CDLQI at initial consultation was 10.5, dropping to 8.7 at 6 weeks (P < 0.001). Forty-nine per cent of adults and 44% of children had a > 25% relative improvement in score, which did not meet the 60% working standard. Forty-four per cent of adults and 47% of children had an improvement in sleep loss at 6 weeks, falling short of the 70% working standard. Sixty-one per cent of adults and 59% of children had an improvement in the worst aspect of their skin condition at 6 weeks, falling short of the 80% working standard. Of the 20 adults and eight children off work/school during part 1, 70% of adults and 87.5% of children had returned to work/school by 6 weeks. This met the 80% working standard for children but not for adults. On a national scale, only one of the eight working standards for service outcome was met, although most of the working standards were met by at least one of the 11 National Health Service administrative areas. This study presents the first national data on the outcomes of a representative sample of atopic eczema patients seen in secondary care. Small sample sizes, instruments which may be insensitive to change, as well as local factors such as case-mix, baseline severity and staff to patient ratios need to be taken into account when interpreting these results. Nevertheless, the results of this baseline audit suggest that the outcome of patients with atopic eczema following secondary care consultation may not be as good as some doctors believe. This suggests that an improvement in practice, a re-evaluation of the working standards, or both, is needed and should be examined in future audit cycles.

Adolescent↗
PubMed1999

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 1: audit of service structure.

This first comprehensive study of atopic eczema management describes an audit of service structure (phase 1), process (phase 2) and outcome (phase 3) in the U.K. This paper describes the phase 1 results. Service structure was audited by a single-page questionnaire containing 10 questions on outpatient facilities. This was sent to the lead dermatologist at 187 dermatology centres throughout the U.K., and a final response rate of 98% was achieved. Although the percentage of centres reporting the presence of recommended facilities did not reach the 100% working standard for any one specific criterion, about half of the recommended items, such as provision of height and weight measuring facilities, access to a dietician, patch testing and photochemotherapy, was reported in over 90% of centres. Areas of service structure which were infrequently reported to be in place were issuing of new appointment letters asking patients to bring their treatment details to clinic (52% of centres) and access to nurses with dermatology experience on paediatric wards (57% of centres). Some audit measures, e.g. access to counselling services, showed wide regional variation (range 33-94% of centres), and these variations could not be explained simply in terms of provision of specialists. Some of the elements of service structure, such as access to nurses with dermatology experience on paediatric wards, may be difficult to change in the short term because of funding and staffing constraints, but others, such as provision of growth charts, are easy to change at little cost. This preliminary audit serves as a framework for future audits of atopic eczema management.

Dermatitis, Atopic↗
PubMed1998

Are staffers headed in the right direction?

Using total quality management principles within a shared governance framework, this case study discusses how to design and implement a plan to achieve independent nursing practice when an employee has unique needs. This experience demonstrates the importance of looking at root causes, separating ability and compliance issues, using all available resources creatively, and planning for success.

Clinical Competence↗
PubMed1997

Supportive learning in distance education.

This paper argues that tutorial support should enhance the learning experience of students who enrol on a distance education programme. A rationale for such support is given as well as a definition of support for distance learners. The complex role of the tutor in distance learning is described which suggests the need for tutor preparation, particularly for tutors adapting to this mode of course delivery. The paper reports on two existing models used within distance education which have focused on the outcome of study. The paper introduces an alternative model of supportive learning which focuses on the development of the educational experience throughout the length of a distance-learning course.

Education, Nursing↗
PubMed1997

Managing atopic eczema: the needs of children.

Atopic eczema is a common inflammatory condition of the skin. The disability and psychosocial impact of atopic eczema can be considerable. Existing dermatology clinics usually do not provide the time and the educational facilities essential for children with atopic eczema and their families.

Ambulatory Care Facilities↗
PubMed1997

Managing atopic eczema: running a specialist clinic.

Specialist management of children with atopic eczema is directed towards education, treatment and reassurance of the child and family. A specialist clinic can tailor care to the individual needs of those attending. Specialist clinics should be constantly evaluated and developed to cope with the changing demands and needs of patients with atopic eczema.

Child↗
PubMed1996

Managed care and the infectious diseases specialist.

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Ambulatory Care↗
PubMed1995

Designing a nursing model for dermatology.

Nursing models provide a useful framework for care but should be adapted to specific patient groups. Models need to be adaptable to changing perceptions of patient needs and to patient-centred care.

Dermatology↗
PubMed1995

The reorganisation of a dermatology department.

In one dermatology unit, work patterns were restructured to improve continuity of care. The creation of nursing teams working in both the ward and outpatients' department has meant the effective use of nursing resources and multi-skilling of nursing staff.

Continuity of Patient Care↗
PubMed1995

Community liaison in dermatology.

Links between hospitals and the community result in greater continuity and therefore quality of care. Consistent assessments and treatment are beneficial to both patients and staff. Liaison posts break down the arbitrary barriers between care settings.

Continuity of Patient Care↗
PubMed1995

Supporting patients with healed leg ulcers.

There are high financial costs associated with recurrence of venous leg ulcers. Costs can be reduced and quality of life improved by a structured programme of education. Continued contact and support for patients following healing is beneficial for both patients and staff.

Aftercare↗
PubMed1995

Nurses' perceptions of dermatology.

There has been a reduction in the provision of specialist nursing care for dermatology patients. Low-status specialties are at greatest risk of erosion of their services. Lack of understanding results in a specialty being perceived as of low status.

Attitude of Health Personnel↗
PubMed1982

A comparison of Vitrathene moulded with Tweeklon ready-made wrist work splints in juvenile chronic arthritis.

A comparatiave study of purpose-made Vitrathene with a ready-made Tweeklon splint has been undertaken in 20 children with juvenile chronic arthritis who had such severe wrist and carpal involvement that a work splint was considered desirable. In half the dominant hand was splinted with Vitrathene and the other half Tweeklon. Assessments included the presence of soft-tissue swelling, extensor tenosynovitis and pain, together with the position and range of movement of the wrist, grip strength and functional tests. Tests included: maintenance of functional position, grip strength, dexterity, wear-resistance, and weight. Although the Vitrathene splint appeared better in the study, it was made by an experienced occupational therapist. The Tweeklon was applied by a physiotherapist reading the instructions which accompanied it; this took about a quarter of the time required to make the Vitrathene splints.

Adolescent↗