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PubMed1996

Medical audit activity in primary and secondary care in the west of Scotland.

OBJECTIVES: To look at the level of activity and motivation towards audit in primary and secondary care in the West of Scotland. DESIGN: An anonymised postal questionnaire survey. SETTING: Area covered by six Health Boards in West of Scotland. SUBJECTS: 150 GPs and 150 hospital-based clinicians randomly selected from two departmental databases. RESULTS: There appears to be a rule of diminishing returns in operation where half of those involved in audit have completed a project and half again have repeated a project. The current level of activity is significantly higher in secondary than primary care (chi 2 p = 0.05). There is significantly more audit activity in teaching than non-teaching hospitals (chi 2 p = 0.01) and significantly more GPs from larger practices have been involved in audit than those from smaller practices (chi 2 p = 0.05). All of those involved in audit have set standards. Levels of motivation towards audit were significantly higher amongst hospital-based clinicians than general practitioners (chi 2 p = 0.001). CONCLUSIONS: There has been a widespread involvement in audit in both primary and secondary care in the West of Scotland, but activity and enthusiasm or motivation are lower amongst general practitioners.

Attitude of Health Personnel↗
PubMed1996

Medical and dental staffing in the National Health Service in Scotland in 1994.

The Scottish Office Home and Health Department (SOHHD) has, since 1980, published a regular series of articles on medical staffing in Scotland. The articles have taken the form of a series of tables provided by the Information and Statistics Division (ISD) of the Common Services Agency from the annual 'Medman' Census of Medical and Dental Staff in Scotland. Although the information given this year is similar to previous years, the format of some of the tables has been changed, and in particular primary care medical and dental manpower information is now included. Comparable medical and dental manpower statistics are regularly published for England and Wales. The background to the present manpower planning strategies have been summarized. In the publications 'Achieving a Balance: Plan for Action', the 'Shaw' Report, 'Hospital Medical Staffing in Scotland' and the Report of the Working Party on the UK Specialist Medical Training (the 'Calman' Report). In essence the strategy has sought to improve and reshape the pyramidal staffing structure of NHS hospitals by matching the number of doctors in the training grades more closely with career opportunities, and by expanding the consultant grade. As the reforms in Specialist Medical Training are introduced, the length of training is likely to be shorter, but more structured. Additionally the 'New Deal' to reduce junior doctors' hours of work is also having a significant impact not only on the hours worked by training grade doctors, but also on local patterns of staffing. There are, too, increased opportunities for flexible and part-time working. SOHHD and the Department of Health have both published recent reports on flexible and part-time working for doctors.

Adult↗
PubMed1997

British agencies for adoption and fostering in Scotland--Scottish Medical Advisers' survey.

Children in local authority care (The survey was conducted before the term 'in care' was replaced by 'looked after' on The Children (Scotland) Act coming into force in October 1996) come from backgrounds of high incidence of mental illness, substance abuse and learning difficulties and have often suffered from neglect and/or abuse. They have a high incidence of medical problems affecting both physical and mental health. The Committee of the Scottish Section of the Medical Group of British Agencies for Adoption and Fostering (BAAF) were concerned about the provision and co-ordination of medical services for children in local authority care. The aim of the survey was to identify the current and evolving practice among medical advisers across Scotland. Questionnaires were returned from 40 Medical Advisers representing each of the local authorities in Scotland. The responses highlighted a variation in the implementation of practice in clinical services provided to children in care and by whom. It confirmed that difficulties in follow-up did exist and revealed widespread confusion surrounding co-ordination of medical services, absence of procedures and ignorance of legal requirements. The study confirms that involved medical practitioners need to have a pro-active role in co-operating closely with social work colleagues to provide a well co-ordinated service of medical supervision providing a comprehensive assessment of health care needs as part of the overall child care plan.

Adolescent↗
PubMed1996

The care of pregnant women with epilepsy--a survey of obstetricians in Scotland.

There is concern regarding the teratogenic risks of antiepileptic drugs (AEDs) and the effect of seizures during pregnancy. Pre-pregnancy assessment and collaboration with the patient's neurologist may improve outcome. This study examined by postal questionnaire how senior obstetricians in Scotland cared for their patients with epilepsy in March 1994. One hundred and nine of 127 (86%) practising obstetricians representative of those working in both teaching and district general hospitals in Scotland responded. Only 16% of district general hospital obstetricians had an accessible epilepsy clinic/service and 19% a neurologist. Only 21% of all respondents considered that pregnancy counselling was being provided by a neurologist/epilepsy specialist, and only 43% were usually able to organize combined specialist care with an interested physician/neurologist. Most (79%) were happy with the concept of collaborative care. Many were uncertain as to the importance of recording epilepsy severity, genetic aspects, making changes to AEDs, monitoring drug levels, the use of vitamin K and breast feeding. Sixty-four per cent did not change their management of labour. Twenty per cent were dissatisfied with the present care of their patients with epilepsy. Over 90% considered guidelines to be important. This survey demonstrates the need for existing epilepsy services to be more accessible to all obstetricians in Scotland, particularly for those working in district general hospitals.

Abnormalities, Drug-Induced↗
PubMed2005

Ciprofloxacin resistance in non-typhoidal Salmonella serotypes in Scotland, 1993-2003.

OBJECTIVES: To determine the levels of resistance to ciprofloxacin among non-typhoidal salmonellae in Scotland. METHODS: Etest strips were used to determine the ciprofloxacin MICs for nalidixic acid-resistant salmonellae isolated from humans during 1993-2003. RESULTS: The percentage of nalidixic acid-resistant salmonellae isolated from human infection in Scotland has increased from 1.4% in 1993, to 8.8% in 1998 and 21.3% in 2003. Of 493 strains of nalidixic acid-resistant Salmonella tested, a single isolate of Salmonella Typhimurium RDNC was resistant to ciprofloxacin at the NCCLS breakpoint of 4 mg/L. Eleven isolates were resistant at the Scottish Salmonella Reference Laboratory breakpoint of 0.5 mg/L, while 466 isolates (94.5%) had reduced susceptibility with MICs of > or =0.125 mg/L and <0.5 mg/L. CONCLUSIONS: These results show that very few non-typhoidal isolates of Salmonella in Scotland that are resistant to nalidixic acid are also resistant to ciprofloxacin at the NCCLS recommended breakpoint of 4 mg/L. The majority of isolates examined, however, do show reduced susceptibility at 0.125 mg/L. This confirms the necessity for continuing antimicrobial surveillance of resistance to this important antibiotic.

Ciprofloxacin↗
PubMedDate not supplied

Robertsonian variation in Mus musculus from Central Europe Spain, and Scotland.

Robertsonian translocations were found among mice captured on one of the Orkney islands in North Scotland, around Barcelona in Spain, and in Southern Germany around the cities of Tübingen and Ravensburg. Mice from Denmark, Poland, Astrachan in the Soviet Union Israel, and Egypt were found to be free of Robertsonian translocations. The Robertsonian variations in mice from Scotland and Spain are probably of independent origin and mostly likely also unrelated to the Alpine-Apennine system. On the other hand, the variation in mice from Southern Germany may be a part of the Alpine system. Hybrid zones were found near Barcelona and near Ravensburg. In the latter almost all the mice were heterozygous for at least one Robertsonian translocation, and often for several translocations. Three out of 14 typed mice were heterozygous for four metacentric chromosomes. The analysis revealed the existence of nine Robertsonian translocations not previously described: Rb(3.14)7Tu, Rb(4.10)8Tu, Rb(6.13)9Tu, and Rb(9.12)10Tu in Scotland; Rb(4.14)11Tu, Rb(6.10)13Tu, Rb(9.11)14Tu, and Rb(12.13)15Tu in Spain, and Rb(2.5)2Tu in Southern Germany.

Animals↗
PubMed2006

Joint inspection of services for people with learning disabilities in Scotland: compliance or commitment?

PURPOSE: The article describes the development of a practical model of joint, integrated inspection of managed care services for people with learning disabilities in Scotland. The model will give a reliable measure of the impact services are making to people's lives and the quality of service that individuals are actually receiving. CONTEXT OF CASE: At present health, social services and education services for people with learning disabilities in Scotland are inspected separately, by up to nine different agencies. The first joint, integrated inspections of all services for people with learning disabilities in Scotland will take place in 2006. This is the first inspection of its kind in the UK, and the first to involve carers and people with learning disabilities on the inspection team. DATA SOURCES: Quality Outcome Indicators were developed in 21 different areas, or domains. Evidence based best practice, and evaluative data from previous inspections were the primary sources of data. CASE DESCRIPTION: This paper reviews the background and rationale for the integrated, joint inspection process. Strengths and constraints of this approach to inspection are discussed, including the crucial importance of commitment from services and from inspectors, rather than mere compliance with demands. Some guidance on how to fully involve staff, carers and services users in the inspection process is given. CONCLUSIONS AND DISCUSSION: The model will produce data to inform decision-making for managers in integrated services and give services users clear information about how well local needs are being met, what areas need development, and what capacity the organisations have to improve. The model of inspection may be of interest to practitioners in a national and international context. The model will be evaluated, following the first joint inspection.

Journal Article↗
PubMed2005

Results of a national asthma campaign survey of primary care in Scotland.

OBJECTIVE: To identify within primary care in Scotland how far procedures for asthma review and patient education match guideline recommendations. DESIGN AND SETTING: Telephone survey of a one in four stratified random sample of all 1058 general practices in Scotland. PARTICIPANTS: Practice nurses, general practitioners. MAIN OUTCOME MEASURES: Number of practices matching guideline recommendations for asthma review, targeting of care, use of structured asthma records, provision of management plans, education, and regular audit. RESULTS: Of 276 general practices contacted 91% (251) completed the questionnaire; 93% (228) ran an asthma review service; 74% (166) employed a specially trained asthma nurse; 39% (106) had a policy for providing action plans; 63% (155) had carried out an asthma audit in the previous 3 years; 76% (218) used a structured tool in consultations, 46% with use of computer technology, 34% used only a manual stamp. Sixty-six per cent (173) had searched for patients overusing beta2 agonists; 32% (79) had searched for patients on medication treatment step 3 and above. Single- or two-partner practices were less likely to follow guideline recommendations but neither rurality nor deprivation was related to guideline compliance. CONCLUSIONS: Three-quarters of Scottish general practices have trained asthma nurses and offer patients asthma review, but only a minority have proactive care procedures for targeting patients or a policy for providing patients with action plans. Practice systems are underused for identifying 'at-risk' patients. There is a need for proactive procedures and provision of self-management materials to patients. Access to trained asthma nurses needs to be improved.

Asthma↗
PubMed2002

The anatomy of a clinical trial. The West of Scotland Coronary Prevention Study.

OBJECTIVE: Treatment of hyperlipidemia to reduce the risk of ischemic heart disease was, prior to the statin era, disappointingly limited in its ability to yield the benefits expected from the strong relationship known to exist between serum cholesterol and coronary death. Three primary prevention trials, using clofibrate, cholestyramine and gemfibrozil, had achieved modest reductions in fatal and nonfatal coronary events but none was able to extend life overall or even to reduce cardiovascular mortality; and combined analyses of the three raised disquiet over potential links between cholesterol reduction, cancer and aggressive or violent behaviour. The time was therefore ripe to determine whether statins could help prevent that first and all important myocardial infarction. METHODS: The West of Scotland Coronary Prevention Study recruited 6,595 45- to 64-year-old men with no history of prior myocardial infarction and with low-density lipoprotein cholesterol in the range 4-6 mmol/l (155-232 mg/dl). Subjects who had undergone coronary revascularisation or had been hospitalised for angina pectoris in the previous 12 months were excluded, as were those with significant electrocardiographic abnormalities. Participants were randomised to receive pravastatin 40 mg/day or matching placebo and were followed for an average of 4.9 years. RESULTS: Treatment with pravastatin reduced the combined risk of fatal and nonfatal myocardial infarction by 31%. Cardiovascular death overall fell by 32% and the need for coronary revascularisation procedures was reduced by 37%. All of these endpoint benefits were statistically significant. Because there was no increase in non-cardiovascular mortality, the reduction in death from any cause also proved to be statistically significant (p = 0.051 by log rank test and p = 0.037 after adjustment for baseline risk factors). CONCLUSIONS: The West of Scotland Coronary Prevention Study is the first to show that cholesterol reduction with pravastatin helps avoid the first myocardial infarction, reduces coronary mortality and extends life. Ongoing exploration of the study database continues to unearth additional surprisingly beneficial effects of the treatment and permits authoritative decision-making on the effective use of lipid-lowering drugs.

Aged↗
PubMed1990

Changing patterns of incidence and mortality from acute pancreatitis in Scotland, 1961-1985.

Data on all discharges from hospitals in Scotland have been recorded since 1961 as the Scottish Hospital In-Patient Statistics and examination of these data has permitted analysis of the incidence and mortality trends from acute pancreatitis. The number of discharges recorded has increased 11-fold in males from 69 patients/year in 1961 to 750 patients/year in 1985, and fourfold in females from 112 patients/year to 484 patients/year respectively. This increase has occurred particularly amongst young and middle-aged males (20-59 years) and in elderly females (over 60 years), the most marked increases occurring in the health boards of the 'central belt' area of Scotland. Mortality rate did not show a corresponding change, increasing only two-fold in males from 15 patients/year to 30 patients/year and in females from 29 patients/year to 37 patients/year. As a consequence the case mortality rate has fallen from 17.8 per cent over the period 1961-65 to 5.6 per cent over the period 1981-85. An apparent increase in the incidence of acute pancreatitis may be inferred from these data, much of which is thought to be due to improved accuracy in diagnosis.

Acute Disease↗
PubMed2005

Identification, assessment and intervention--Implications of an audit on dyslexia policy and practice in Scotland.

This article reports on research commissioned by the Scottish Executive Education Department (SEED). It aimed to establish the range and extent of policy and provision in the area of specific learning difficulties (SpLD) and dyslexia throughout Scotland. The research was conducted between January and June 2004 by a team from the University of Edinburgh. The information was gathered from a questionnaire sent to all education authorities (100% response rate was achieved). Additional information was also obtained from supplementary interviews and additional materials provided by education authorities. The results indicated that nine education authorities in Scotland (out of 32) have explicit policies on dyslexia and eight authorities have policies on SpLD. It was noted however that most authorities catered for dyslexia and SpLD within a more generic policy framework covering aspects of Special Educational Needs or within documentation on 'effective learning'. In relation to identification thirty-six specific tests, or procedures, were mentioned. Classroom observation, as a procedure was rated high by most authorities. Eleven authorities operated a formal staged process combining identification and intervention. Generally, authorities supported a broader understanding of the role of identification and assessment and the use of standardized tests was only part of a wider assessment process. It was however noted that good practice in identification and intervention was not necessarily dependent on the existence of a dedicated policy on SpLD/dyslexia. Over fifty different intervention strategies/programmes were noted in the responses. Twenty-four authorities indicated that they had developed examples of good practice. The results have implications for teachers and parents as well as those involved in staff development. Pointers are provided for effective practice and the results reflect some of the issues on the current debate on dyslexia particularly relating to early identification.

Aptitude Tests↗
PubMed2004

Comparison of clinical reasoning skills in occupational therapy students in the USA and Scotland.

Problem-based learning (PBL) in occupational therapy (OT) education has become increasingly important. However, the efficacy in identifying clinical reasoning skills has not been well researched. The purpose of this study was to evaluate the utilization of clinical reasoning by students in the USA and Scotland. Thirty OT students were videotaped during a PBL case. Responses were transcribed and compiled into 122 statements. The two primary investigators independently coded each of the responses into one of five categories: Procedural, Interactive, Conditional reasoning, N/A, or Other. Intraclass correlation coefficients reflected strong reliability between the two raters (ICC = 0.914). Results of this study indicated that the predominant form of clinical reasoning was procedural in nature (61%) followed by conditional reasoning (27%) and interactive reasoning (12%). Students in Scotland tended to use interactive reasoning more than the students in the USA. Further research is needed to explore educational models to foster clinical reasoning skills in occupational therapy students.

Adult↗
PubMed2002

Sea louse control in Scotland, past and present.

Methods for farming the Atlantic salmon (Salmo salar L) in Scotland were developed at the Unilever Research Laboratory facility at Lochailort on the west coast of Scotland in the late 1960s. By the spring of 1972 a fledgling commercial company had been set up and Marine Harvest, as it was known, received its first year class of smolts at Lochailort. Sea lice (Lepeophtheirus salmonis Krøyer) from passing wild fish infected the smolts but did not cause any significant damage until the summer of 1976 when intervention was required. The Scottish industry has since grown to become a vital source of employment for fragile rural economies and produced about 130,000 tonnes of salmon in 2000. This paper gives an overview of how fish welfare has been maintained by the development of treatments and management strategies aimed at minimising the impact of sea lice.

Animals↗
PubMed2000

Irish descent, religion and food consumption in the west of Scotland.

Mortality and morbidity of people of Irish descent in Britain is high, including from cardiovascular causes potentially linked with diet. The west of Scotland has long had a pattern of Irish migration, where migrants were poorer than the host population, and their different religious background gave rise to prolonged discrimination. This paper uses data collected in 1987/88 from the west of Scotland Twenty-07 study to test whether dietary differences due to poverty or to other factors have persisted among the descendents of these migrants. Being born of Catholic parents was the index of Irish descent used, these respondents consumed less of a factor represented by fruit, yoghurt and vegetables, and more of one represented by snacks and processed foods than the rest of the sample. The picture for those reporting current Catholic affiliation in adulthood was similar. Differences are largely associated with social class and mediated not by low income but by educational disadvantage. The findings suggest the continuation of a diet affected by limited opportunities for social mobility, and thus by obstacles to sustained educational advancement, among the descendants of Irish migrants even after several generations.

Adolescent↗
PubMed1995

Registration of lung cancer in Scotland: an assessment of data accuracy based on review of medical records.

Lung cancer represents a major public health problem in Scotland. Cancer registration data permit the approximate incidence of this disease to be measured directly and the projected incidence to be modelled. Thus, in addition to epidemiologic studies and survival analyses, cancer registration data may be used for planning and monitoring relevant health services. Since the value of the data depends on their quality, we undertook a large-scale study of the accuracy of cancer registration data in Scotland. The medical records of a random sample of cancer registrations attributed to the year 1990 were sought. The sample contained 340 registrations of lung cancer, 309 (91 percent) of which had relevant medical records available for scrutiny. Registration details were reabstracted from available records and compared with data in the registry. Results revealed 19 discrepancies in identifying items of data (surname, forename, gender, and date of birth) involving 16 (5.2 percent) patients. Most were trivial and would not disturb record linkage. Discrepancy rates were found to be: 7.8 percent in postcode of residence at the time of diagnosis, 10 percent in 'anniversary date' (excluding differences of six weeks or less), 12.5 percent in histologic verification status; 4.2 percent in ICD-9 site code (the first three digits), and 15.5 percent in four digit ICD-O morphology code (excluding 'inferred' morphology codes). This relatively high level of accuracy gives weight to routinely published incidence figures and supports the use of these data for exploratory epidemiologic studies, assessment of health care needs, and calculation of survival.

Age Factors↗
PubMed1993

The descriptive epidemiology of pharyngeal cancer in Scotland.

There have been recent reports of substantial increases occurring in the incidence of and/or mortality from tongue and mouth cancers in several countries. In this paper using data from Scotland (1960-89) we report on time trends in pharyngeal cancer. Similar increases in rates are evident for cancers of the oropharynx and hypopharynx while there has been little change in the occurrence of nasopharyngeal cancer (which has distinct aetiological factors). It therefore seems that reported changes in the incidence of and mortality from oral cancer may be real, and in Scotland, this is most probably due to changes in alcohol consumption.

Adult↗
PubMed2006

A population-based study of pancreatic trauma in Scotland.

INTRODUCTION: The aim of this population-based study was to assess the incidence, mechanisms, management and outcome of patients who sustained pancreatic trauma in Scotland over the period 1992-2002. METHODS: The Scottish Trauma Audit Group database was searched for details of any patient with pancreatic trauma. RESULTS: About 111 of 52,676 patients (0.21%) were identified as having sustained pancreatic trauma. The male-to-female ratio was 3:1, with a median age of 32 years. Blunt trauma accounted for 66% of injuries. Road traffic accidents were the most common mechanism of injury (44%), followed by assaults (35%). Thirty-four patients (31%) were haemodynamically unstable on arrival at hospital. Pancreatic trauma was associated with injuries to the chest (56%), head (30%) and extremities (30%); 73% of patients had other intra-abdominal injuries. Of those who left the emergency department alive, at least 77% required a laparotomy. The mortality rate (46%) was directly proportional to the number of injuries sustained (P < 0.05) and was higher in patients with increasing age (P < 0.05), haemodynamic instability (P < 0.05) and blunt trauma (P < 0.05). CONCLUSIONS: Pancreatic trauma is rare in Scotland but is associated with significant mortality. Outcome was worse in patients with advanced age, haemodynamic instability, blunt trauma and multiple injuries.

Adolescent↗
PubMed2005

Clonal analysis of invasive pneumococcal isolates in Scotland and coverage of serotypes by the licensed conjugate polysaccharide pneumococcal vaccine: possible implications for UK vaccine policy.

A 7-valent pneumococcal conjugate vaccine (PCV7) has gained licensure and has proven successful in the USA for preventing pneumococcal disease and reducing the incidence of antibiotic-resistant pneumococcal strains. The ability, therefore, to accurately monitor the likely effect of the introduction of PCV7 vaccine on invasive pneumococcal disease in the UK is essential. Serotyping and multilocus sequence typing was performed on invasive isolates of Streptococcus pneumoniae (n=645) from Scotland during 2003. The information gained from this was used to evaluate serotype coverage by the vaccine and the relationship between serotypes. In the present study, invasive pneumococcal disease in Scotland was caused by 33 different serotypes, consisting of 150 sequence types. Overall, 48.4% of the isolates were of serotypes included in the PCV7. Pneumococci were most frequently associated with sequence types 9, 124, and 162. PCV7 would provide protection in 71.8% of infants under 5 years of age against the serotypes in the vaccine. There was limited evidence of the potential for capsule switch among currently circulating invasive pneumococci. The successful implementation of a suitable vaccination programme should lead to a reduction in invasive pneumococcal disease in the UK as well as a reduction in antibiotic resistance of pneumococcal strains.

Child, Preschool↗