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PubMed2001

Meningococcal disease due to serogroup Y in Scotland, 1992-1999.

Meningococcal disease is an important cause of morbidity and mortality. A retrospective analysis was performed of all cases of invasive group-Y disease that were laboratory-confirmed in Scotland between 1992 and 1999. A total of 1881 meningococcal isolates were characterised, 78 of which were serogroup Y. The incidence of non-invasive group-Y disease remained level between 1992 and 1999. Only 12 isolates were from invasive disease, comprising five strain types. Invasive group-Y disease was associated mostly with the young or old. Serogroup-Y meningococcal disease was uncommon and a rare cause of invasive disease in Scotland between 1992 and 1999; however, it is essential that microbiologists are aware of its potential for increasing in incidence due to the recent introduction of the MenC vaccine, and its increased incidence in the USA.

Adult↗
PubMed2001

Venous thromboembolism prophylaxis used by consultant general surgeons in Scotland.

BACKGROUND: Venous thromboembolism (VTE) is a common source of morbidity and mortality in general surgical patients. Guidelines have been produced to help guide doctors through the complex issue of VTE prophylaxis. This study intended to examine the use of VTE prophylaxis amongst general surgeons in Scotland, with reference to nationally produced guidelines. METHOD: A postal questionnaire was sent to all consultant general surgeons in Scotland. They were asked to give their opinion on the best means of VTE prophylaxis in six different clinical scenarios. The responses were evaluated with reference to the guidelines from the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: A 69% response rate was achieved. There was a wide variance in the suggested prophylaxis in each of the scenarios. With reference to SIGN guidelines, 35% of responses represented undertreatment, 16% overtreatment and 49% appropriate treatment. CONCLUSION: Despite the publication of VTE guidelines, there is still a wide variety of opinions amongst consultant general surgeons with regards to VTE prophylaxis. Many of the responses were not consistent with such guidelines and represent suboptimal prophylaxis for patients.

Attitude of Health Personnel↗
PubMed2002

Supporting families: how are nursing students being prepared for this developing role across Scotland.

Increasing emphasis on primary care has led to a reappraisal of the scope and importance of nursing work with families. The purpose of this study was to explore the knowledge base of lecturers in Scotland that underpinned instruction of student nurses in working with families at diploma and undergraduate level. A postal survey was conducted throughout the 11 educational institutions providing pre-registration nursing programmes. Data were collected from a purposive sample and quantitatively analysed using descriptive statistics. Qualitative data were subjected to content analysis. The response rate was 54.7% (n=95). Findings showed a consensus about the importance of nursing work with families. Family nursing was seen to be relevant across all branches of nursing and academic programmes. There was no statistically significant difference between the levels of academic qualification and perceived knowledge base of lecturers with reference to family nursing theory. The need for a conceptual framework for family nursing was suggested. Knowledge of family nursing literature was limited and necessity for professional development in the teaching of family nursing was acknowledged. The implications of the inquiry point to the need for the integration of family nursing into nursing curricula in Scotland.

Attitude↗
PubMed2002

Nursing shortages and evidence-based interventions: a case study from Scotland.

In this report, key aspects of change in the labour market for nurses in Scotland are examined, and an integrated policy framework intended to improve nurse recruitment, retention and utilization is outlined. The purpose of this article is to provide an overview of the dynamics of the nursing labour market in Scotland and to draw some more general messages from the evidence base on the effectiveness of interventions to improve recruitment and retention of nursing staff. The paper has three main elements: it provides a backdrop of key trends in the Scottish nursing labour market; it summarizes issues related to planning and nursing shortages, including an assessment of the utility of current indicators of recruitment and retention difficulties; and it reviews the main potential interventions to address nurse recruitment and retention difficulties, drawing from key research/evidence from UK and other English language sources. Five main interventions are examined: integrating the planning of the healthcare workforce; improving recruitment; incentives to improve retention; improving staff deployment; and improving utilization/skill mix.

Education, Nursing↗
PubMed2001

Poor but healthy? The youngest generation of Irish catholics in west Scotland.

OBJECTIVE: Catholic adults in the West of Scotland, who are mainly of Irish origin, have been shown to suffer excess morbidity and mortality compared to the general population. A major contributing factor to this inequality is socio-economic disadvantage. This paper investigates the health and socio-economic position of Catholics in the youngest generation. DESIGN: Secondary analysis of baseline data from the West of Scotland 11-16 STUDY: Teenage Health, which is a longitudinal school-based survey. SETTING: One hundred and thirty five primary schools in Glasgow and surrounding districts. SUBJECTS: Two thousand five hundred and eighty six final-year pupils (average age eleven years and three months), born in 1983/1984. RESULTS: Comparing Catholics and non-Catholics on a range of indicators of general health, recent acute symptoms, chronic conditions, mental health and physical measures, we found no evidence of any systematic health inequality. A few indicators did show statistically significant differences at the five percent level, but these were not in any consistent direction. In terms of household socio-economic position, though, we found strong evidence of disadvantage for Catholics. Catholic children were more likely to have parents of manual social class, without any formal qualifications, who were less likely to own their home or a car, more likely to express difficulty 'making ends meet', and more likely to live in a deprived area. CONCLUSIONS: We discuss the prospects for diminishing socio-economic inequality over time between Catholics and non-Catholics in this cohort, which will depend on Catholic social mobility. We consider the likelihood of enduring health equality for Catholics, which will depend on the effects of different influences on health over the life course.

Catholicism↗
PubMed1999

Thrombolysis in peripheral general practices in Scotland: another rule of halves.

OBJECTIVE: To facilitate the adoption of thrombolysis by general practitioners in peripheral practices in Scotland. DESIGN: Survey of practice policies on the management of acute myocardial infarction before and after practice visits by a consultant physician acting as a facilitator; survey of hospital consultants' attitudes to thrombolysis by general practitioners. SETTING: One hundred and eighty-two practices, with an enlisted total of 550,000 patients, located at least 30 minutes from a district general hospital; 23 such hospitals serving these peripheral practices. MAIN OUTCOME MEASURES: Possession of electrocardiograph and defibrillator; adoption of a policy of giving thrombolytic therapy. RESULTS: The majority of practices possessed an electrocardiograph (87%) and a defibrillator (76%). At the time of the visits, 67 practices (37%) already had a policy of giving thrombolytic therapy. When contacted one year later 91 practices (50%) had such a policy. In the interval between visits and follow-up, few had received any encouragement from any source to use this treatment. Hospital consultants' attitudes to thrombolysis by general practitioners were generally negative, and support from local and national health authorities has been inadequate. CONCLUSIONS: Provision of timely thrombolytic therapy for the one tenth of the Scottish population living at least 30 minutes from a district general hospital is a major public health problem for which there is a ready solution: pre-hospital thrombolysis administered by general practitioners has been shown to be feasible, fast, safe, efficacious and cost-effective. To translate this evidence into practice requires a concerted effort from all the professionals involved, and must be directed and supported by local and national management of the National Health Service in Scotland.

Drug Utilization↗
PubMed1999

The epidemiology of lung cancer in Scotland: a review of trends in incidence, survival and mortality and prospects for prevention.

OBJECTIVE: The aims of the study were to review long-term trends in lung cancer incidence, survival and mortality and, in light of these, to consider prospects for prevention. DESIGN: Descriptive epidemiological study. SETTING: Scotland. SUBJECTS: Incident cases of lung cancer, diagnosed 1959-1993, and registered with the Scottish Cancer Registry, and recorded deaths from lung cancer during 1919 to 1993. RESULTS: Scottish men and women continue to experience rates of lung cancer which are amongst the highest in the world. In men, incidence rose from 1959 to a peak in the late 1970s and is now decreasing steadily. In women, although starting from a lower baseline, incidence has risen steadily since 1959 (at an annual rate of increase of 5.0 per cent) and shows no evidence of a sustained decline. It is estimated that, between 1986 and 2000, the annual number of registrations in those aged under 85 years could fall by 20 per cent in men and rise by 8 per cent in women. Incidence in the most deprived areas of Scotland is twice that in the least deprived areas. Survival prospects have changed little over the last 25 years. In both sexes, trends in mortality mirror trends in incidence. CONCLUSION: Although lung cancer incidence in men is falling, it is likely that we have not yet reached the peak of the lung cancer epidemic amongst women. As up to 90 per cent of these tumours are attributable to tobacco, measures to control this drug should be the main focus of prevention activities. Emphasis should be placed on efforts to cut smoking prevalence among women and the most deprived groups of society and to reduce the uptake of smoking amongst the young. The fact that some other countries report more favourable survival figures suggests that there may be scope for improvements in diagnosis and therapy. The formulation of guidelines for best current practice in the management of lung cancer should aid progress in this respect.

Adult↗
PubMed1999

GP non-principals in north-east Scotland--a valuable pool of medical labour or second-class citizens? Results of a questionnaire survey.

OBJECTIVES: (1) To identify all general practitioner [GP] non-principals in the Grampian Health Board area (north-east Scotland), (2) To seek their views via a questionnaire survey, (3) to offer them the opportunity to meet individually with an Associate Adviser [GP Tutor]. DESIGN: All GP practices were contacted, requesting the names of non-principals. A questionnaire was sent, where possible, to all non-principals so identified. SETTING: The Grampian Health Board area in north-east Scotland. SUBJECTS: One hundred and nine names were obtained, 90 questionnaires were mailed and a final response rate of 67 per cent was achieved. RESULTS: Eighty-seven per cent of respondents were female (median age--35 years); 92 per cent were vocationally trained; 89 per cent had at least one postgraduate qualification; 32 per cent had been a principal; 68 per cent agreed to meet with an Associate Adviser. There was considerable confusion regarding entitlement to funding for continuing medical education [CME]. Advantages of working as a non-principal included the flexibility of working part-time and limited involvement in practice administration and out-of-hours work. However, many disliked their inferior conditions of employment, their inability to follow up patients and the negative attitudes displayed by some principals. Feelings of professional isolation, lack of involvement in practice decision-making and employment insecurity were also cited as disadvantages. Short-term career plans included maintaining the status quo (45 per cent); increasing work commitment (26 per cent) or becoming a principal (11 per cent), while in the longer term, 67 per cent of those intending to remain in general practice wished to do so on a part-time basis. The main factors determining career plans were family commitments and/or availability of suitable posts. CONCLUSIONS: Demand for part-time principal posts will undoubtedly increase. Regional databases of non-principals must be established and all GPs must have equal access to CME particularly in the light of the General Medical Council's [GMC] pronouncements on revalidation of all doctors.

Adult↗
PubMed1999

Injuries in the adolescent population in Scotland: patterns and types of injuries sustained.

OBJECTIVE: To provide information on the incidence, sex distribution, type, site and severity of injuries requiring medical attention reported in a nationally representative sample of Scottish teenagers studied longitudinally. DESIGN: Health visitors administered structured interviews with parents (usually mothers). Quantitative data were analysed using SPSS-PC, and qualitative and textual data were coded using the Abbreviated Injury Score (AIS). SETTING: Scotland. SUBJECTS: Responses were received in respect of 958 (68%) of the estimated 1,416 teenagers enrolled in the British Cohort Study (BCS 70), and resident in Scotland in 1986/7. RESULTS: 43% of subjects were reported as having experienced one or more unintentional injury events requiring medical attention between the ages of 10 and 16/17. Boys experienced significantly more injuries than girls. Neither social class nor region appeared to be a significant risk factor for reported injury. CONCLUSION: Patterns of accidents in Scottish adolescents are reported. Further areas for study are suggested.

Adolescent↗
PubMed2001

Independent nursing practice: a national survey of attitudes of practice employed nurses in Scotland.

BACKGROUND: During the last decade, the number of practice nurses has increased dramatically and their role has evolved according to demand rather than through planning and design. Consequently, many nursing roles have become extended and nurses now perform many of the tasks previously performed by doctors. With increasing emphasis on primary care, their new role has become widely accepted and continues to develop. There is now a real question as to whether, with suitable training, it is timely to consider a formal extension to independent practice for at least some practice nurses. OBJECTIVE: The aim was to describe the characteristics of practice nurses and to explore their attitudes to independent practice. For the purpose of this study, independent practice was taken to mean specialised autonomous practice. DESIGN: This was a descriptive, cross-sectional study undertaken by postal questionnaire. A two stage sampling process was used. SETTING: Firstly a 1/2 sample of all general practices in Scotland (n = 625) was asked for the names of all practice employed nurses. Secondly, one practice nurse from each practice was sent a postal questionnaire. RESULTS: Five hundred and thirty eight general practices responded. Eighty six practices had no practice employed nurse. Four hundred and thirty three practices (96%; 433/452) were willing to allow their practice nurses to be approached to take part in the study. Four hundred practice nurses returned questionnaires (92%; 400/433). Fifteen were excluded because the nurses were not fully practice employed. Three hundred and eighty five were suitable for inclusion in the study (85%; 385/452). Most practice nurses were over 35 years of age and had been in post for more than three years. Almost half had at least one other nursing qualification in addition to registration. Eighty six percent thought that there should be independent practice for some nurses within the profession and 65% would, themselves, be happy to practise independently. CONCLUSION: Most practice nurses throughout Scotland think that there should be independent practice for some nurses.

Attitude of Health Personnel↗
PubMed2000

Uptake of influenza vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland.

OBJECTIVE: To ascertain the uptake of influenza vaccination, the main prompts to vaccination and the reasons for non-vaccination in the high-risk patients of Angus, Scotland. DESIGN: Prospective questionnaire survey. SETTING: A small rural district general hospital. SUBJECTS: General medical inpatients and outpatients. RESULTS: The overall uptake of vaccination was 44.8% (n = 250). The main prompts to vaccination were general practitioners (48.2%), the media (11.6%), practice and district nurses (8.9%), friends and relatives (8.9%) and posters at health centres and chemists (7.1%). The main reason for non-vaccination was a lack of awareness of high-risk status (50.7%). CONCLUSION: The uptake of influenza vaccination in the Angus region of Scotland is unsatisfactorily low. This is mostly due to a lack of knowledge regarding high-risk status, although other reasons, including concerns about the side effects of vaccination, are also important.

Female↗
PubMed2000

National Services--the role of the National Services Division of the Common Services Agency in commissioning specialist services on behalf of the NHS in Scotland.

The National Services Division of the Common Services Agency provides a central function commissioning designated national services on behalf of the NHS in Scotland. Services are nationally designated and commissioned only where it would not be possible or sensible to do so on a more local basis because of the rarity of the condition, the need to concentrate expertise and/or to avoid duplication of expensive equipment. The Division also has important central functions in ensuring the effective delivery of national screening programmes and in facilitating the development of national managed clinical networks. The work programme of the Division is overseen by advisory bodies whose membership reflects the key stakeholders in the Scottish NHS. In discharging its role, the Division's aim is to work with clinicians and managers to ensure the delivery of high quality specialist clinical care and screening services in an equitable fashion to patients throughout Scotland.

Contract Services↗
PubMed2000

Professional composition of community learning disability teams in Scotland: implications for service provision.

A survey of all trusts in Scotland who provided specialist services to people with learning disabilities was made with a response rate of 100%. An examination was made of the professional composition of the community learning disability teams and the population covered. A disparity was found across Scottish trusts in the professions represented in the community learning disability teams with some professions having no input. Nursing and Clinical Psychology were found to be the two professional groups with largest representation across Scotland and along with Speech and Language Therapy had representation in all of the Teams. A review of some of the factors which have impacted on the role and professional composition of these services is made and the implications discussed.

Community Health Services↗
PubMed2000

Organisation of services for acute stroke in Scotland--report of the Scottish stroke services audit.

An audit was undertaken of hospital service provision for acute strokes in Scotland, using as a template key recommendations in the four SIGN guidelines on management of stroke. A questionnaire and structured interview was undertaken of key personnel in the 43 Trusts and three directly managed units providing in-patient stroke care in Scotland, and the 15 Health Boards commissioning stroke care. All Trusts and Health Boards participated and a complete set of information for each was recorded on a data-base and analysed. This report gives an overview for 14 key components of an integrated stroke service with results presented in four bands according to Trust type determined by the number of strokes admitted. No Trust provided all key components and for a few components a lack of provision was widespread, e.g. fast-track assessment clinics for TIA and minor stroke, access to CT scanning within 48 hours. Variation occurred between Trusts of similar size, between Trusts of different sizes. Overall the Health Boards were at a preliminary stage in the development of stroke specific service specifications. The results of the audit are a view of stroke services around April 1998, and should enable commissioners and providers to consider how to progress implementation of the clinical guidelines on stroke care.

Acute Disease↗
PubMed2000

Breastfeeding in Scotland--statistical sources.

INTRODUCTION: The health benefits of breastfeeding for babies and mothers are increasingly recognised. In Scotland, a national breastfeeding target has been set and national policies commend the promotion and support of breastfeeding. In order to set realistic local breastfeeding targets, and to evaluate success in increasing the initiation and duration of breastfeeding, Health Boards need accurate local data on breastfeeding rates. OBJECTIVE: To examine existing Scottish sources of routinely collected data on infant feeding intention and practice, and to make recommendations for the future collection, dissemination and quality of such data. METHODS: Information on Scottish infant feeding data was collected from published sources and from personnel responsible for infant feeding data within larger infant and child health data sets. Data for Glasgow were analysed for completeness. RESULTS: Four major sources of routinely collected data exist, one of which provides national figures only. The other three collect local data on feeding intention and practice at a variety of stages from pregnancy to baby's age 8/9 months. Whilst some data are available locally, there is no routine dissemination of data at all stages throughout Scotland. The quality and completeness of data require further investigation. CONCLUSIONS: Attention should be given to developing the use of existing routinely collected sources of data to provide regular, reliable information on local breastfeeding rates to assist the monitoring and implementation of local breastfeeding strategies. A small group of health professionals, health information staff and researchers should be convened by ISD to pursue this task.

Breast Feeding↗
PubMed2003

Analysis of multidrug-resistant Mycobacterium bovis from three clinical samples from Scotland.

OBJECTIVE: To determine whether multidrug-resistant (MDR) strains of Mycobacterium bovis isolated from patients in Scotland were genotypically related. DESIGN: Genotypes of MDR strains were determined using three molecular fingerprinting techniques: pulsed-field gel electrophoresis (PFGE), spoligotyping and restriction fragment length polymorphism (RFLP). PFGE profiles were also obtained for all medical and veterinary isolates occurring in Scotland in 1997-1998. RESULTS: MDR strains showed individual Dra I PFGE profiles. Case III/98 had a profile represented in both veterinary and medical populations, Case I/94 had a profile observed in medical but not veterinary isolates, and Case II/98 had a profile unique to this study. Afl II PFGE discriminated the resistant strains. Spoligotyping grouped Cases I/94 and II/98 (ST-134). Case III/98 had a spoligotype ST-140, which is commonly observed in veterinary isolates. Similarly, DRr-RFLP analysis grouped cases I/94 and II/98, whereas Case III/98 had a common veterinary profile. DRX(PGRS) RFLP gave three unique profiles. CONCLUSION: Three resistant strains were discriminated by PFGE and DRX(PGRS) RFLP, indicating that the three strains are not related in an epidemiologically relevant time scale. However, Cases I/94 and II/98 were more closely linked by spoligotyping and DRr-RFLP data. PFGE and DRr-RFLP linked Case III/98 profiles to the most common veterinary isolate.

Animals↗
PubMedDate not supplied

Evaluating the funding and capacity of research in Scotland.

This paper will discuss the results of a scoping exercise carried out as part of a strategy to inform subsequent models of infrastructure funding. The exercise showed that Scotland has less research capacity in nursing and midwifery than the UK as a whole. Following the publication of a nursing and midwifery research strategy for Scotland, initiatives are being put in place to fund an increase in research capacity and capability in the nursing and midwifery professions.

Humans↗
PubMed2004

Integrating clinical information in NHS Scotland: the role of Scottish Care Information Store.

A key plank in NHS Scotland's information management and technology (IM&T) eHealth Strategy is the web-based system known as Scottish Care Information (SCI) Store, which gives primary and secondary care clinicians access to core clinical information. There is one SCI Store in each of the 15 NHS Board areas. At present all GP practices in 11 of these areas have access to SCI Stores for test results. Work is underway to augment the Stores with clinical letters and GP summary data. Strategically, SCI Store is seen as the ubiquitous element in our eHealth Strategy which will allow information to be shared across Scotland in a secure and reliable way.

Computer Communication Networks↗