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PubMed1992

Dental personnel planning and the single market: problems ahead?

Recently Whitehouse expressed concern about the possible implications of the legislation regarding the freedom of movement of labour within the European Community upon dental policy. Particular reference was made to the possibility of a major inflow of dental personnel to the United Kingdom. This paper looks at the evidence on which such worries appear to be based and examines the possibilities that this could have for planning dental personnel requirements in the UK. Dental personnel are defined in this paper as dental practitioners.

Dentists↗
PubMed1994

The future provision of specialist oral surgery and orthodontic services.

Many dentists express concern about the referral of patients within the NHS for specialist orthodontic and, to a lesser extent, oral surgery care. Most of these concerns relate to a lack of availability of such services. This article discusses possible reasons for these problems. It also explores some of the ways in which future changes in the organisation of the NHS may influence the availability of such specialist services. Strategies which could he used by FHSAs to address and overcome these problems are suggested.

Dental Health Services↗
PubMed1996

A survey of general anaesthesia, sedation and resuscitation in general dental practice.

The Poswillo Report, published in 1990, made recommendations regarding general anaesthesia (GA), sedation and resuscitation in dentistry. The aims of the present study were to examine the level of provision of GA and sedation by general dental practitioners (GDPs) a few years after the publication of the report, and to estimate the degree of compliance of GDPs with a number of its principal recommendations. In May 1994, a questionnaire was sent to 268 GDPs in two Scottish Health Boards, and a response rate of 80% was achieved. Thirteen per cent of respondents had treated GA cases during 1993-94 while 18% indicated that they had stopped providing a GA service since the immediate pre-Poswillo years. However, 91% had referred some patients elsewhere for treatment under GA. There was very little evidence of a replacement of GA by sedative techniques. The percentages of respondents using inhalation or intravenous sedation during the previous year were 9% and 27%, respectively. Almost all of the respondents reported that they had been trained in cardiopulmonary resuscitation and 60% stated that resuscitation exercises were practised at least once a year. While over 80% of the practitioners indicated that their dental surgeries stocked the emergency drugs recommended in the Poswillo Report, 12% expressed concern regarding the length and content of the drug list.

Anesthesia, Dental↗
PubMed2004

Dual-energy X-ray absorptiometry measurements of fat and lean masses in subjects with eating disorders.

OBJECTIVE: The main objective was to use a dual-energy X-ray absorptiometer (DXA) to examine the total-body and regional fat and lean composition of soft tissue in subjects with and without eating disorders initially and after weight change. It was necessary also to study the effects of differences of calibration of different models of DXA scanner. DESIGN: A total of 175 women with eating disorders, including anorexia nervosa (AN) and bulimia nervosa, and 43 age-matched controls were measured for soft-tissue composition with a pencil-beam Hologic QDR 1000W scanner and results converted to be equivalent to those from a fan-beam Hologic QDR 4500A, using previously determined crosscalibration factors. Some measurements were repeated at 6 and 12 months. RESULTS: The baseline body composition of the patients covered a continuous range of fat proportions. Implausibly low fat proportions in some of the AN subjects were corrected by conversion to 4500 equivalents. The relationship between total lean mass and fat mass could be fitted equally well by a linear or linear/log regression. The relationship between leg and trunk fat was best fitted by a polynomial regression. There were weight changes in either direction in some of the subjects. The fat proportion in the total changed mass was a mean of 55%, higher in the legs and lower in the trunk, but not different between weight gainers and losers or clinical groups. The proportion was dependent on the initial fat proportion. CONCLUSIONS: Relatively small differences in fat/lean calibration of DXA scanners may lead to anomalous results in very anorexic subjects and corrections are necessary in comparing results from different instruments. Concerns expressed about preferential trunk fat accumulation during weight recovery are not well founded. Previous claims of a relationship between fat proportion in regained weight and the amount of the weight gain are not justified.

Absorptiometry, Photon↗
PubMed1993

Anterior tooth position and motivation for early treatment.

During 1989-90, 473 parents of children being screened at an orthodontic graduate clinic completed a self-report form about the child's dental/facial appearance, reasons for seeking care and referral paths. Almost all (85%) of the 313 parents of children under the age of 16 years expressed concern about the appearance of the child's teeth, and 44% reported the child had been teased about this. Only 14% of the parents reported that it was the child who had first noticed the need for treatment. The rank order of reasons for seeking treatment were appearance of teeth (85%), advice of dentist (73%), and appearance of face (46%). Using logistic regression, overjet and malalignment were observed to be significant predictors of the parent-report of the child being teased (odds ratios, OR, 5.5 and 2.4, respectively). Overjet predicted citing facial appearance as the reason for seeking treatment (OR 2.9), while age predicted patient-referral (OR 2.2) and overjet predicted parental referral (OR 3.0). Increased overjet is an important focus for early treatment and might accordingly be expected to influence the value of early intervention.

Adolescent↗
PubMed2003

Outcomes of early language delay: II. Etiology of transient and persistent language difficulties.

Genes are known to play an important role in causing specific language impairment, but it is unclear how far a similar etiology is implicated in transient language delay in early childhood. Two-year-old children with vocabulary scores below the 10th centile were selected from a cohort of over 2,800 same-sex twin pairs whose language was assessed by parental report at 2, 3, and 4 years of age. These children with early language delay (ELD) were divided into cases of transient and persistent language difficulties on the basis of outcome at 3 and 4 years. A DeFries-Fulker analysis (J. C. DeFries & D. W. Fulker, 1985) was used to compute group heritability (h2g) of 2-year vocabulary delay separately for those with transient and persistent difficulties. When 3-year and 4-year language attainments were used to categorize outcomes, h2g was similar and modest (.25 or less) for both transient and persistent difficulties. However, when persistent difficulties were defined according to whether parents expressed concern about language at 3 years or according to whether a professional had been consulted about language difficulties at 4 years, heritability was significantly higher. For 289 children with no professional involvement at 4 years, heritability of 2-year vocabulary delay was close to zero, whereas for 134 children with professional involvement, a significant h2g of .41 (SE = .127) was found. Early language delay appears largely environmental in origin for 2-year-olds whose parents do not go on to seek professional help.

Child, Preschool↗
PubMed2001

Preliminary results of a pilot study investigating the potential of salivary cortisol measurements to detect occult adrenal suppression secondary to steroid nose drops.

Adrenocortical suppression is a well-known risk of systemic steroids, but is thought less likely to occur with topical intranasal corticosteroids. However, the UK Committee on the Safety of Medicines (UKCSM) has expressed concern about the possibility of this complication. We assessed the prevalence of adrenal suppression in patients with rhinitis using intranasal beclomethasone and betamethasone; and the potential value of salivary cortisol as a tool for detecting this complication. Sixty-six patients (38 men: 28 women; mean age 49.6[SD 16.0] years) were prospectively screened for adrenal insufficiency using clinical assessment and salivary cortisol measurements. Abnormalities at this initial screening were confirmed with a Short Synacthen Test (SST). No patient was clinically Cushingoid. All 22 beclomethasone users had normal salivary cortisols. Eleven (25%) of 44 patients using betamethasone had subnormal salivary cortisol levels (mean morning cortisol 2.8[SD 0.9]nmol/l) suggesting adrenal suppression, which was confirmed by an impaired SST in each case. The positive predictive value of salivary cortisol measurements was 100%. Only patients with abnormal salivary cortisols had a SST, so no comment can be made about sensitivity/specificity. Topical betamethasone may produce occult adrenal insufficiency and assessment of adrenal function is recommended in these patients. Measurement of salivary cortisol is a useful, non-invasive and economical test for monitoring patients using intranasal corticosteroids.

Administration, Intranasal↗
PubMed1998

Alcohol education in licensed premises using brief intervention strategies.

AIMS: The aim of this feasibility study is to present a description of a new approach based on alcohol brief intervention strategies to intervene with at-risk drinkers in licensed premises. DESIGN: The data presented are from a convenience sample of tavern patrons. SETTING: The intervention called Operation Drinksafe was conducted on 75 occasions in 67 licensed premises in an Australian rural area. PARTICIPANTS: There were 2761 voluntary participants who were provided with a personal risk assessment of their alcohol use. MEASUREMENTS: The main measurements were the Alcohol Use Disorders Identification Test (AUDIT) combined with a blood alcohol concentration (BAC) reading. FINDINGS: The median AUDIT score was 11.0, with 53% scoring in the hazardous range and 25% in the harmful range. For binge drinking, almost two-thirds (62%) of males drank six or more drinks once a week or more compared to 29% of females. Median BAC was 0.03 mg/100 ml with 11% of males above 0.10. Regression analysis revealed that significant predictors of alcohol-related injury were being aged less than 30 years, forgetting the previous night, having had another person express concern about your drinking, and binge drinking weekly or more. CONCLUSIONS: The program had high acceptance among licensees and their patrons. Patrons who are ready to change their at-risk drinking behaviour may benefit from this type of minimal intervention when presented in an interesting way in their drinking environments.

Adult↗
PubMed2002

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility.

AIMS: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect psychoactive substance use and related problems in primary care patients. This report describes the new instrument as well as a study of its reliability and feasibility. SETTING: The study was conducted at participating sites in Australia, Brazil, Ireland, India, Israel, the Palestinian Territories, Puerto Rico, the United Kingdom and Zimbabwe. Sixty per cent of the sample was recruited from alcohol and drug abuse treatment facilities; the remainder was drawn from general medical settings and psychiatric facilities. METHODS: The study was concerned primarily with test item reliability, using a simple test-retest procedure to determine whether subjects would respond consistently to the same items when presented in an interview format on two different occasions. Qualitative and quantitative data were also collected to evaluate the feasibility of the screening items and rating format. PARTICIPANTS: A total of 236 volunteer participants completed test and retest interviews at nine collaborating sites. Slightly over half of the sample (53.6%) was male. The mean age of the sample was 34 years and they had completed, on average, 10 years of education. RESULTS: The average test-retest reliability coefficients (kappas) ranged from a high of 0.90 (consistency of reporting 'ever' use of substance) to a low of 0.58 (regretted what was done under influence of substance). The average kappas for substance classes ranged from 0.61 for sedatives to 0.78 for opioids. In general, the reliabilities were in the range of good to excellent, with the following items demonstrating the highest kappas across all drug classes: use in the last 3 months, preoccupied with drug use, concern expressed by others, troubled by problems related to drug use, intravenous drug use. Qualitative data collected at the end of the retest interview suggested that the questions were not difficult to answer and were consistent with patients' expectations for a health interview. The data were used to guide the selection of a smaller set of items that can serve as the basis for more extensive validation research. CONCLUSION: The ASSIST items are reliable and feasible to use as part of an international screening test. Further evaluation of the screening test should be conducted.

Adult↗
PubMed2001

Working patterns of trainee anaesthetists in the UK: results of a national postal survey.

The 'New Deal' restrictions on junior doctors' hours have major implications for the staffing of anaesthetic departments and the provision of adequate training. The results of a national postal survey demonstrate a decline in traditional on-call arrangements, especially in hard-pressed work sectors such as intensive care. A substantial number of anaesthetic departments have still completely to satisfy the hours restrictions in many work sectors. Many departments experience recruitment difficulties and express concern about both service and training issues.

Accreditation↗
PubMed2000

Topical corticosteroid phobia in patients with atopic eczema.

Topical corticosteroids are widely prescribed by dermatologists caring for patients with atopic eczema. Patients' fears about using topical corticosteroids may have important implications for compliance with treatment. We carried out a questionnaire-based study of 200 dermatology outpatients with atopic eczema (age range 4 months-67.8 years) to assess the prevalence and source of topical corticosteroid phobia. We also questioned patients on their knowledge of the potencies of different topical corticosteroids. Overall, 72.5% of people worried about using topical corticosteroids on their own or their child's skin. Twenty-four per cent of people admitted to having been non-compliant with topical corticosteroid treatment because of these worries. The most frequent cause for concern was the perceived risk of skin thinning (34.5%). In addition, 9.5% of patients worried about systemic absorption leading to effects on growth and development. The most commonly used topical corticosteroid was hydrocortisone, yet 31% of patients who used this preparation classified it as either strong, very strong or did not know the potency. Only 62.5% of the 48 patients who had used both Dermovate (Glaxo) and hydrocortisone in the past were able to correctly grade Dermovate as being more potent than hydrocortisone. The most common source of patient information regarding topical corticosteroid safety was the general practitioner. Although skin thinning and systemic effects can develop very occasionally in people using topical corticosteroids, the concern expressed by people using them seems out of proportion in relation to the evidence of harm. This study highlights the need for provision of better information and education to patients and possibly general practitioners regarding the safety, potency and appropriate use of topical corticosteroids.

Administration, Topical↗
PubMed1998

An activity week for children with cancer: who wants to go and why?

Many children now live with cancer rather than die from it, and such children need both to continue their social, emotional and cognitive development and to make long-term psychological adjustments. This paper presents the findings of a research project set up to explore issues pertinent to the current provision of an activity week experience for a group of British paediatric cancer patients. The aims of the study included finding out which factors discriminate between families who apply for a place to attend the week for their child and families who do not, and to develop a knowledge of what factors are considered by parents and children. The findings suggest that the week appeals to children who are confident, active and able to separate from parents and whose parents are keen to encourage independence and new experiences. Children diagnosed and treated at a younger age and further away from treatment were more likely to express concerns about being homesick and safety and to not apply for the week. Issues of protection, independence and disability are discussed with reference to the importance of parental attitude on children's psychological accommodation to disease and treatment and to the experiences of adult survivors of childhood cancer.

Adaptation, Psychological↗
PubMed2001

Weight gain following treatment of hyperthyroidism.

OBJECTIVE: Patients frequently express concern that treating hyperthyroidism will lead to excessive weight gain. This study aimed to determine the extent of, and risk factors for, weight gain in an unselected group of hyperthyroid patients. DESIGN AND SUBJECTS: We investigated 162 consecutive hyperthyroid patients followed for at least 6 months. Height, weight, clinical features, biochemistry and management were recorded at each clinic visit. RESULTS: Documented weight gain was 5.42 +/- 0.46 kg (mean +/- SE) and increase in BMI was 8.49 +/- 0.71%, over a mean 24.2 +/- 1.6 months. Pre-existing obesity, Graves' disease causing hyperthyroidism, weight loss before presentation and length of follow-up each independently predicted weight gain. Patients treated with thionamides or radioiodine gained a similar amount of weight (thionamides, n = 87, 5.16 +/- 0.63 kg vs. radioiodine, n = 62, 4.75 +/- 0.57 kg, P = 0.645), but patients who underwent thyroidectomy (n = 13) gained more weight (10.27 +/- 2.56 kg vs. others, P = 0.007). Development of hypothyroidism (even transiently) was associated with weight gain (never hypothyroid, n = 102, 4.57 +/- 0.52 kg, transiently hypothyroid, n = 29, 5.37 +/- 0.85 kg, on T4, n = 31, 8.06 +/- 1.42 kg, P = 0.014). This difference remained after correcting for length of follow-up. In the whole cohort, weight increased by 3.95 +/- 0.40 kg at 1 year (n = 144) to 9.91 +/- 1.62 kg after 4 years (n = 27) (P = 0.008), representing a mean weight gain of 3.66 +/- 0.44 kg/year. CONCLUSION: We have demonstrated marked weight gain after treatment of hyperthyroidism. Pre-existing obesity, a diagnosis of Graves' disease and prior weight loss independently predicted weight gain and weight continued to rise with time. Patients who became hypothyroid, despite T4 replacement, gained most weight.

Adolescent↗
PubMed2000

The domiciliary care market in Scotland: quasi-markets revisited.

By offering people the choice of care at home, the policy of encouraging local authorities to purchase domiciliary care services from voluntary and private providers was intended to achieve a key part of the community care agenda. A study to establish the extent to which there was a mixed economy in the purchase and provision of domiciliary care in Scotland in 1996 revealed reluctance by local authority managers to divest the provision of domiciliary care to voluntary and private agencies. In a telephone survey of purchasers, some social work respondents noted a preference for voluntary over private providers and expressed concern as to whether either could take over the bulk of domiciliary care provision. These attitudes were reflected in the pattern of market development observed. Five hundred and ninety providers were identified, but a postal survey of a random sample of one in two providers (response rate 66%) found that the independent sector's share of the market, measured as the proportion of weekly care hours provided, was small compared with the position in England and Wales at that time (15 : 36%). It is concluded that understanding of the development of the quasi-market in domiciliary care in the UK must now take account of slower development in Scotland. Explanation for the difference may lie in the level of state regulation, for in Scotland there was no compulsion on local authorities to purchase from the independent sector. Paradoxically, the quasi-market in England developed through strong state regulation, whereas in Scotland the strength of policy networks may account for the persistence of a more traditional welfare state model. The paper questions whether the incentives for change were sufficient in Scotland under the quasi-market. If local partnerships do not deliver these results the government may have to take a more active role to modernise domiciliary care services.

Journal Article↗
PubMed2003

Vital pulpotomy in the primary dentition: attitudes and practices of Specialists in Paediatric Dentistry practising in the United Kingdom.

OBJECTIVES: This study was designed to examine the attitudes and practices of Specialists in Paediatric Dentistry practising in the United Kingdom in relation to vital pulpotomy in the primary dentition. DESIGN: Data were collected by postal questionnaire. SAMPLE AND METHODS: All dentists whose names were entered on the General Dental Council's Specialist List in Paediatric Dentistry, and who were resident and practising in the United Kingdom, were asked to complete a questionnaire consisting of nine questions. RESULTS: Questionnaires were returned by 184 (86.8%) of the eligible Specialists in Paediatric Dentistry. These yielded a sample group of 179 Specialists practising the primary vital pulpotomy technique. The most commonly used medicament was formocresol, with a 1 : 5 dilution being used by 66.5% of the sample. More than half (54.2%) of the Specialists practising the technique expressed concern regarding their preferred medicament. Without exception, their concerns related to the potential adverse effects of formocresol and formaldehyde. Seventy-five respondents (41.9% of the sample) were considering changing their technique. One hundred and thirty-seven Specialists stated that they routinely took preoperative radiographs, while postoperative radiographs were routinely taken by 107 Specialists (76.5% and 59.8% of the sample, respectively). Rubber dam isolation was used by 62.6% of the sample. CONCLUSIONS: The majority of Specialists are adhering to the UK national clinical guideline for pulp treatment of the primary dentition. However, significant numbers are considering changing their chosen technique. There is a lack of consensus on the use of pre- and postoperative radiographs; specific guidance with respect to their use is required.

Attitude of Health Personnel↗
PubMed1993

Identifying alternative linkages among philosophy, theory and method in nursing science.

The major concerns expressed in the literature regarding the development and expansion of nursing science stem from questions related to 'what sorts of science' and 'which scientific methods' are appropriate for nursing. While there is a sector of nursing's scientific community that advocates a unified approach to philosophy and method, a growing sentiment for the position of philosophical and methodological pluralism is apparent. This paper addresses the nature of scientific pluralism by presenting a framework for alternative linkages possible among the philosophy, theory and method appropriate for nursing science. The nature of nursing knowledge that is produced within the discipline will thus depend on various forms of alternative linkages adopted by nursing scientists in addressing nursing's scientific questions. In turn, such pluralism presents problems of choice to nurses in practice with respect to knowledge utilization.

Bias↗
PubMed1993

Relatives' support groups in a special hospital: an evaluation study.

A support group for the relatives and friends of patients at a special hospital in Merseyside, England, has been in operation for over 1 year. A detailed evaluation of that group has been completed based on the minutes of each meeting and on a structured questionnaire sent out to each relative/friend involved. The evaluation provides an illuminating account of the particular needs of this group, highlighting many of the concerns expressed by the Committee of Inquiry during the recent Public Inquiry at Ashworth Hospital. The results of the evaluation are discussed in relation to work already completed on network support and mental health, as well as the recent work involving the relatives of patients in the community. It provides a direction for future work and research within the special hospitals.

Attitude to Health↗
PubMed1995

Science, technology, caring and the professions: are they compatible?

There is concern expressed about the decreased level of caring in the professions today. Many factors have been proposed to explain this, but the present authors believe it is due to an overemphasis on science and technology. It is in caring that we connect with one another, are fulfilled and experience growth; a lack of caring diminishes both professional and client. The professional-client relationship is essential to the meaning of professional: therefore, a professional must care. Shifting our focus to a paradigm which includes both science and technology and caring allows us to see life's experiences and our interconnectedness in a new way. It is then that the truth will emerge that the essence of caring and profession are one.

Humans↗