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PubMed2005

An audit of clinical resources available for the care of head and neck cancer patients in England.

AIMS: Thirty-four cancer networks are now responsible for the delivery of head and neck cancer services in England. A survey of all cancer networks was carried out to define the services available for the diagnosis, treatment and support of patients with head and neck cancer. MATERIALS AND METHODS: Fifty-two cancer units were identified in England from the Cancer Services Collaborative 'Improvement Partnership', and approached through a variety of methods. One questionnaire was circulated to all 34 network leads to establish the services and resources in each network. A second questionnaire was circulated to all known head and neck teams in the UK. RESULTS: Multidisciplinary team (MDT) working was evident in all centres, although frequently the MDT was not fully staffed, especially in areas of national staff shortages, such as in pathology, radiology, dietetics and speech therapy. Rapid referral pathways were present for initial assessment of patients, but clinically significant delays were identified in complex investigations, access to intensive care beds and oncological care, especially radiotherapy. CONCLUSION: Major changes in service configuration are likely to be required if the current national targets of time to diagnosis and treatment are to be met.

England↗
PubMed2006

Endometrial ablation in England--coming of age? An examination of hospital episode statistics 1989/1990 to 2004/2005.

OBJECTIVE: To observe numbers and trends in endometrial ablation performed for heavy menstrual bleeding (HMB) in England. DESIGN: Examination of National Health Service (NHS) Hospital Episode Statistics. Number of hysterectomies and endometrial ablation procedures performed each year from 1989/1990 to 2004/2005. RESULTS: Hysteroscopic endometrial ablation peaked in 1992/1993 before falling significantly to a low in 1997/1998. Since then the total number of procedures has increased by 250% and of the 9701 endometrial ablations performed in 2004/2005 over half (5457) are now second-generation techniques. CONCLUSIONS: Endometrial ablation is now more common than hysterectomy for heavy menstrual bleeding and second-generation methods are now more commonly performed than hysteroscopic endometrial ablation. There is every indication that endometrial ablation will continue to increase in practice in England.

Catheter Ablation↗
PubMed2004

Attitudes of mental health professionals and lay-people towards involuntary admission and treatment in England and Germany--a questionnaire analysis.

OBJECTIVES: To identify attitudes about involuntary admission and treatment in mental health professionals and lay-people and to compare results between England and Germany. METHOD: Three scenarios of potentially detainable patients were presented to identify attitudes. A questionnaire asked about attitudes towards involuntary admission as well as treatment. A questionnaire analysis was then performed. RESULTS: There were similar attitudes towards involuntary admission and treatment between lay-people and mental health professionals with the exception of professionals not actively involved in the detention process. The different legal frameworks between Germany and England did not influence attitudes much. Support for involuntary admission and treatment broadly increased with age. CONCLUSIONS: Psychiatrists and other mental health workers are in tune with society with regards to attitudes towards involuntary admission. People involved with mentally ill patients but not in the detention process have negative attitudes towards involuntary admission.

Adult↗
PubMed2026

The costs of genomic newborn screening in England: A micro-costing analysis from the Generation Study.

PURPOSE: This study estimates the total cost per newborn of delivering genomic newborn screening (gNBS) within the Genomics England-led Generation Study. METHODS: A time-driven activity-based costing approach was used to estimate gNBS costs from recruitment to confirmatory testing. Resource use data were obtained through document review, semi-structured interviews with study staff, and direct observation across six English National Health Service Trusts. Inputs were categorized as labor, consumables, or equipment, with unit costs sourced from published pay scales, catalogs, or literature. Equipment costs were annualized at a discount rate of 3.5%. All costs were estimated in 2025 Great British Pounds (£) from the healthcare providers perspective, including overheads and data storage. A one-way deterministic sensitivity analysis was conducted, varying key cost parameters (±20%) and testing alternative delivery scenarios. RESULTS: gNBS costs £1208 per newborn, with sequencing comprising 58% of the total costs, mainly consumables. The cost was reduced by 20% to £963 when excluding research-specific recruitment and consent activities to reflect the delivery of gNBS as part of routine clinical care. CONCLUSION: This study provides an estimate of gNBS costs, highlighting sequencing as the main cost driver. Combined with evidence on outcomes and health care utilization, these findings will inform future cost-effectiveness analyses, supporting policy decisions regarding national implementation in England.

Neonatal Screening↗
PubMed2005

What are 'third way' governments learning? Health care consumers and quality in England and Germany.

This paper examines how consumer information is related to attempts to improve quality of healthcare in England and Germany, both being non-market systems. The paper traces the changes in policy between the first and second electoral terms of the respective 'third way' governments. Both systems are attempting to give consumers more information. But the question is how that information can be used. A degree of convergence can be observed concerning the amount of choice permitted to consumers. In the case of England, the amount of choice consumers have is gradually increasing, while in Germany, attempts are being made to restrict the wide choice of providers in order to cap expenditure.

Choice Behavior↗
PubMed2006

Assessment of factors contributing to changes in the incidence of antimicrobial drug resistance in Salmonella enterica serotypes Enteritidis and Typhimurium from humans in England and Wales in 2000, 2002 and 2004.

An investigation into changes in the occurrence of antimicrobial resistance in Salmonella enterica serotypes Enteritidis and Typhimurium from human infection in England and Wales in 2000, 2002 and 2004 has shown that the incidence of strains of S. Enteritidis with resistance to nalidixic acid coupled with decreased susceptibility to ciprofloxacin has more than doubled between 2000 and 2004, whereas the overall levels of resistance in S. Typhimurium have fallen by ca. 25%. In relation to published data on veterinary sales of antimicrobials in the UK, the findings demonstrate that changes in the incidence of resistance do not correlate with changes in veterinary usage. For S. Enteritidis, important factors in the increased incidence of resistance were foreign travel and the consumption of imported foods contaminated with drug-resistant strains. For S. Typhimurium, the most important factor has been an overall decline in the occurrence of multiple drug-resistant S. Typhimurium definitive phage type 104. These studies have demonstrated that changes in the incidence of resistance in predominant salmonellas in humans in England and Wales from 2000 to 2004 are multifactorial. The findings also demonstrate that, in order to combat drug resistance in zoonotic salmonellas causing infections in humans, controls on the use of antibiotics in food animals analogous to those in operation in the UK should be implemented in countries that regularly import food into the UK.

Ampicillin↗
PubMed2004

Mortality from hypertrophic cardiomyopathy in England and Wales: clinical and screening implications.

OBJECTIVES: Hypertrophic cardiomyopathy is considered a relatively common cause of death in the young. Screening for the disorder has been advocated, but its potential value cannot be assessed because the number of deaths in asymptomatic cases in the general population has not been investigated. We determined the annual number of deaths (and death rates) from hypertrophic cardiomyopathy in England and Wales according to age, sex and the presence or absence of symptoms so that an affected individual's risk of dying from the disorder and the implications of screening could be assessed. METHODS: Ascertainment of all deaths from hypertrophic cardiomyopathy over a 3-year period (1996-1998), using death certification data from the Office of National Statistics. Deaths in people without symptoms were identified from coroner's reports and correspondence with pathologists who conducted the necropsies. RESULTS: There were 184 deaths per year from hypertrophic cardiomyopathy in England and Wales (about 15% of all deaths from cardiomyopathy) of which one third (65) were in people without symptoms. Most (110) of the 184 deaths each year were in people over age 55. Under age 55 there were only 37 deaths each year in asymptomatic people, out of an estimated 60,000 people with the disorder in the population. Of the 37 deaths, 14 (20%) occurred in relation to physical activity and 2 after competitive sport. CONCLUSIONS: In young people without symptoms hypertrophic cardiomyopathy is fairly common (1 in 500) but it rarely causes death; the case-fatality rate is about 6 per 10,000 per year. Current risk estimates from the study of patients in tertiary referral centers or general hospital clinics (420 and 110 deaths per 10,000 per year, respectively) are not applicable to asymptomatic people in the general population; such people, if incidentally identified can be reassured of their low risk of death. Screening would not be worthwhile unless a satisfactory test becomes available that can detect those few cases likely to die.

Autopsy↗
PubMed2005

Treating the vulnerable in England and Wales: the impact of law reform and changing policy.

This article considers the role of treatment in the provision of mental health care in England and Wales. The current legislative position with regard to the making of treatment choices following compulsory commitment will be examined. Consideration will also be given to the position of the informal hospitalised patient, as in the case of R v. Bournewood Community and Mental Health NHS Trust, ex parte L and finally, the role of the common law in establishing (in)capacity in relation to the non-consensual provision of treatment for physical conditions. Attention will then be given to the reform process, which is currently ongoing in England and Wales, and its likely impact on treatment provision. The Mental Capacity Act 2005 received Royal Assent on the 7th April 2005, while the draft Mental Health Bill 2004 underwent detailed examination by the Joint Scrutiny Committee, a report of which was published on the 23rd March 2005. On the 13th July 2005 the British Government outlined its response following the publication of the Scrutiny Committee's recommendations and despite it accepting many of the recommendations put forward, some significant areas of concern remain making the draft Mental Health Bill 2004 "a long way from acceptable legislation".

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Economic issues in access to medications: schizophrenia treatment in England.

Mental health problems and the services to address them are currently receiving more attention in the UK than ever. Mental health care in England--indeed, across the UK--is experiencing a much needed transformation. It is therefore highly pertinent to examine the patterns of psychotropic medication use, given their intended links to recovery, rehabilitation, and reintegration, as well as to explore the economic and other factors that appear to influence those patterns. These are the aims of this paper. Our attention will be primarily focused on England. What this analysis shows is that given a higher profile by government, including additional funding (although not really benefiting differentially compared to other parts of the health service) and the first national service framework, it is possible to see changes in service patterns, access and (to a degree) outcomes. These changes are occurring at a time when new classes of psychotropic medication are being introduced in a range of therapeutic areas, contributing to the relatively rapid growth of take-up but also raising questions about appropriateness, effectiveness, cost-effectiveness and equity.

Drug Costs↗
PubMed2006

An ecological study of factors associated with rates of self-inflicted death in prisons in England and Wales.

This study describes ecological associations between self-inflicted death rates and prison-level environmental indicators over the period 2000-2002 in England and Wales. The objective was to assist in the development of interventions for reducing the incidence of self-inflicted deaths in prisons in England and Wales, by identifying risk factors, including overcrowding, positive drug tests, the number of assaults, purposeful activity, offending behaviour programmes, and cost per prisoner. Poisson regression was used to estimate associations between self-inflicted death rates and these potential risk factors, controlling for different categories of prison. The annual rate of self-inflicted death during 2000-2002 was 1.14 per 1000 (95% CI 0.98 to 1.34), with no evidence for a difference in the two years. Highest rates were in the Male Local and Women's prisons at 1.86 (95% CI 1.42 to 2.26) and 2.27 (95% CI 1.35 to 3.84) per 1000 respectively. In a multivariate analysis, overcrowding, assault rate and purposeful activity were significant. In an analysis controlling also for prison category, only purposeful activity remained independently significant, as a protective factor (RR 0.57, 95% CI 0.35 to 0.92, p=0.02) with weaker evidence for a positive association with positive drug tests (RR 1.41, 95% CI 0.96 to 2.05, p=0.08). Despite concerns about the quality of routinely collected data and the interpretation of ecological associations, this study suggests that a higher level of purposeful activity is independently associated with lower rates of self-inflicted death, whatever the prison category. This adds support to other studies conducted at the level of the individual prisoner.

Activities of Daily Living↗
PubMed2005

Perceptions and practice of concordance in nurses' prescribing consultations: findings from a national questionnaire survey and case studies of practice in England.

BACKGROUND: The number of nurses able to independently prescribe medicines in England is increasing. Patient adherence to prescribed medicines remains a significant problem [Department of Health, 2000. Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS. Stationary Office, London]. Concordance-a partnership approach to medicine consultations-is advocated as an effective solution [Medicines Partnership, 2003. Project Evaluation Toolkit. Medicines Partnership, London]. OBJECTIVES: To investigate whether nurses were practising the principles of concordance within their prescribing interactions. DESIGN: Phase (i) postal questionnaire survey. Phase (ii): case studies of practice. SETTINGS: Phase (i) primary and secondary care trusts throughout England in which nurse prescribers were practicing. Phase (ii) six general practice settings; one community midwifery service; one specialist community palliative care service; one secondary care ophthalmology unit; one NHS walk-in centre. PARTICIPANTS: Phase (i) a random sample of 246 nurses registered as independent nurse prescribers with the Nursing and Midwifery Council in 2002/2003. Phase (ii) purposively selected sample of 14 nurse prescribers who participated in Phase (i) of the study; a total of 208 purposively selected patients completed self-administered questionnaires. METHODS: Phase (i) postal questionnaires. Phase (ii) structured non-participant observation of 118 nurse prescribing consultations; 115 post-consultation patient questionnaires; 93-patient postal questionnaires. RESULTS: 99% of the nurses in the national survey stated they were practising the principles of concordance. The majority of patients surveyed also reported experiencing concordance in practice. Observation of practice revealed that although some principles of concordance were regularly integrated into nurses' practice, other principles were less often in evidence. Some evidence from both observation of practice and patient questionnaires suggested that a professionally determined 'compliance' agenda may still be partially operating in practice. CONCLUSIONS: Most nurses believe they are practicing concordance in their prescribing consultations. The majority of patients also reported that they had experienced some of the principles of concordance in practice. Observation of practice highlighted that the shift from a professionally determined compliance agenda to the integration of concordance into nurses' prescribing consultations had not yet taken place.

Attitude of Health Personnel↗
PubMed2003

The newborn hearing screening programme in England.

Following a systematic review of the role of neonatal hearing screening in the identification of hearing impaired and deaf children in 1997, the Department of Health in England commissioned a national programme of newborn hearing screening in 2001 and has linked a systematic evaluation to the first 23 sites in the implementation of that policy. It is anticipated that all areas of England will participate in the programme by 2004/2005. It is expected that other regions of the UK will also aim for implementation by this date. In addition to successful advocacy by the two major consumer organisations, there were three key elements linked to the decision to implement newborn hearing screening which were primarily evidence based and also driven by two significant service developments. The evidence base showed that newborn hearing screen was considerably more effective and efficient than the infant distraction test used in many areas and that there was a high probability that early intervention increased the potential for better language and communication. The concern over raised anxiety for those parents whose babies need differential assessment as a result of the screen is reduced by the low number of referrals and increased efficiency of assessment when national protocols are used for screening and assessment. The introduction of family friendly hearing services (FFHS) provides a context in which the health, education, voluntary and social services can work together to provide an equitable and seamless service throughout the year for hearing impaired and deaf children and their families. Currently, 22 areas with 110,000 births per annum, have been selected for implementation, some of whom use a pilot community-based model for screening. A major barrier to rapid progress has been a lack of evidence concerning elements of the screening process, e.g. equipment, IT systems, training at all levels. It is anticipated that a further 20-40 areas with an additional 150,000 birth per annum will be brought into the programme by end of 2002/2003. The aims, protocols, training programme and evaluation of the NHS Newborn Hearing Screening Programme are presented with a view to highlighting the research needed to improve specification of large scale screening programmes.

England↗
PubMed2006

Price of beer and violence-related injury in England and Wales.

OBJECTIVES: Relationships between violence-related injury and potential risk factors in England and Wales were investigated over a five-year period, 1st May 1995 to 30th April 2000. METHODS: Records from all 10 economic regions of England and Wales relating to price of alcohol, youth real income, wealth, ethnic density, dates of major sporting events and seasonality were studied with reference to violent injury data derived from 58 Emergency Departments (EDs) over the same period. Panel estimation and multi-level modelling was used to evaluate associations between variables. RESULTS: Overall, 353,443 violence-related A&E attendances were identified over the five-year period. High regional violence-related injury rates correlated with low real price of alcohol as measured by price of beer. Rates of violence were higher during summer months and on days of major sporting events. CONCLUSIONS: Risk of injury in violence was closely linked to alcohol price. Beer price rises should therefore reduce violent injury. Injury reduction efforts should be intensified during the summer and on days of major sports events.

Alcohol Drinking↗
PubMed2005

An analysis of the Research Fellowship Scheme of the Royal College of Surgeons of England.

BACKGROUND: The Research Fellowship Scheme of the Royal College of Surgeons of England commenced in 1993 with the aim of exposing selected surgical trainees to research techniques and methodology, with the hope of having an impact on surgical research and increasing the cadre of young surgeons who might decide to pursue an academic career in surgery. Over 11 million pounds sterling (approximately US 20 million dollars) has been invested in 264 fellowships. The College wished to evaluate the impact of the Scheme on the careers of research fellows, surgical research, and patient care. As the 10th anniversary of the Scheme approached. STUDY DESIGN: Two-hundred and sixty research fellows whose current addresses were available were sent a questionnaire. Two-hundred and thirty-eight (91.5%) responded. RESULTS: Three-quarters of the research fellows conducted laboratory-based research, with most of the remainder conducting patient-based clinical research. One-third of the fellows who have reached consultant status have an academic component to their post. The total number of publications based on fellowship projects was 531, with a median impact factor of 3.5. Almost all fellows had been awarded a higher degree or were working toward this. Half of the fellows received subsequent funding for research, mostly awarded by national or international funding bodies. CONCLUSIONS: The Research Fellowship Scheme of the Royal College of Surgeons of England has successfully supported many trainee surgeons in the initial phase of their research career. It has helped surgical research by increasing the pool of surgeons willing to embark on an academic career. Indirectly, patient care has benefited by promoting an evidence-based culture among young surgeons. Such schemes are relevant to surgical training programs elsewhere if more young surgeons are to be attracted into academic surgery.

Biomedical Research↗
PubMed2006

The current burden of pneumococcal disease in England and Wales.

OBJECTIVE: To evaluate the potential impact of various pneumococcal conjugate vaccination strategies, it is critical to ascertain the pre-vaccination epidemiology and to have a detailed evaluation of the current burden of pneumococcal disease. METHOD: A variety of national data sources and GP sentinel surveillance systems were used to estimate the incidence, number of hospital admissions, deaths, and GP consultations due to pneumococcal disease in England and Wales. Clinical outcomes included pneumococcal meningitis, bacteraemia, pneumonia and otitis media. A statistical model was used to attribute GP consultation recorded as pneumonia and acute otitis media to specific aetiological causes when these were not recorded. RESULTS: The burden of pneumococcal disease is considerable, with incidence rates of both invasive and non-invasive disease peaking in children (<5 years) and in the elderly (75+ years). Around 5800 hospitalisations specifically mentioning Streptococcus pneumoniae are estimated to occur annually in England and Wales, almost 40,000 for lobar pneumonia and over 15,000 for otitis media. There may be an additional 70,000 GP consultations for pneumococcal related community acquire pneumonia and over 630,000 for otitis media. A significant proportion of hospitalisations and GP consultations for pneumococcal disease occur among high-risk groups, with over 80% of hospital admissions reporting more than one diagnosis.

Adolescent↗
PubMed2006

Assessing the burden of influenza and other respiratory infections in England and Wales.

OBJECTIVES: To estimate the burden of influenza in England and Wales, in terms of general practice consultations, hospital admissions and deaths. METHODS: Multivariable regression was used to estimate the influenza attributable fraction of general practice consultations recorded in the general practice research database, of hospital admissions from hospital episode statistics and of deaths recorded by the Office of National Statistics. RESULTS: An estimated 779,000 (95%CI+/-258,000)-1,164,000 (95%CI+/-425,000) general practice consultations, 19,000 (95%CI+/-5000)-31,200 (95%CI+/-11,000) hospital admissions and 18,500 (95%CI 2500)-24,800 (95%CI+/-2500) deaths annually are attributable to influenza infections. In primary care, the bulk of the burden falls on those under the age of 45, whereas the elderly are more likely to be hospitalised and to die. CONCLUSIONS: Although there are significant uncertainties, and considerable year on year variations, it is clear that the burden of influenza is considerable. Although much of this burden falls on the elderly, significant numbers of general practice consultations, hospitalisations and even some deaths occur annually in children in England and Wales.

Adolescent↗
PubMed2005

Minimum prevalence of spinocerebellar ataxia 17 in the north east of England.

OBJECTIVE: To determine the minimum prevalence of spinocerebellar ataxia type 17 (SCA17) in the north east of England. PATIENTS AND METHODS: A defined region containing 2,516,500 individuals with 192 families with undiagnosed ataxia, 90 patients with a Huntington's disease-like phenotype and 292 controls. The number of (CAG/CAA)(n) repeats in the SCA17/TBP gene was determined by fluorescent PCR and sequenced in affected individuals. RESULTS: The mean repeat size for 584 control alleles was 34 (S.D.=3.58), ranging from 25 to 40. Two index cases had larger alleles with repeat lengths greater than the control range. Affected family members presented in adult life with ataxia followed by extrapyramidal features and cognitive impairment. In one family 44 repeats were associated with a younger age of onset than has been previously described. CONCLUSIONS: The minimum prevalence of SCA17 in the north east of England was 0.16/100,000 (upper 95% confidence interval 0.31/100,000).

Adolescent↗
PubMed2006

Evaluating nurse prescribers' education and continuing professional development for independent prescribing practice: findings from a national survey in England.

BACKGROUND: The number of nurses able to independently prescribe medicines in England has risen steadily in recent years. AIM: To evaluate the adequacy of nurses' educational preparation for independent prescribing and to describe nurses' experiences of their continuing professional development as prescribers in practice. DESIGN AND METHOD: Postal questionnaire survey. PARTICIPANTS: Random sample of 246 nurses registered as nurse independent prescribers with the Nursing and Midwifery Council. RESULTS: The majority of nurses considered that the initial taught course element of their education programme met their needs, either to some extent (61% 151/246), or completely (22% 54/246). Most nurses (77% 190/246) received the specified 12 days support from their supervising medical practitioner and most were satisfied and positive about this experience. Nearly all of the nurses (>95%) reported that they were able to maintain a range of specified prescribing competencies in practice. Two thirds (62% 152/246) of the sample reported that they were receiving support/supervision for prescribing. Ninety five per cent (233/246) of the sample also reported that they engaged in self-directed informal continuing professional development, but only half of the sample had experience of formally provided professional development opportunities. Approximately half (52% 127/246) of the sample identified needs for continuing professional development. CONCLUSION: This first national survey of the education and professional development experiences of nurse independent prescribers in England provides evidence which highlights areas in which national policy is working well, and also points up issues which may need addressing as the roll out of nurse prescribing continues. The study also highlights characteristics and issues that health care policy makers and nurse educationalists internationally may wish to consider in developing and refining their own nurse prescriber education programmes.

Attitude of Health Personnel↗