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At least 811 records · Page 45Linked to original sources
PubMed2000

A survey of paediatric dental anaesthesia in Scotland.

A postal survey of NHS hospital-based anaesthetists providing out-patient anaesthesia for dental procedures in children under 10 years of age was conducted in February 1999. Information was sought about quality of care and common practice in Scotland. The experience of the anaesthetists involved in such work was substantial, but the monitoring used did not meet current standards, with only 16% of respondents indicating use of a full range of standard devices. Separate recovery facilities were available to 99%, and all had access to a defibrillator, but the qualifications of dedicated assistant and recovery staff were lacking in 14 and 30%, respectively. Intravenous access was not obtained routinely after inhalational induction of anaesthesia by up to 71% (49%, never; 22%, sometimes). Systemic analgesia or local anaesthesia was used by 88%. Discharge times ranged from 10 min to 6 h.

Ambulatory Surgical Procedures↗
PubMed2000

Continuing medical education by anaesthetists in scotland: activities, motivation and barriers.

A postal questionnaire survey was carried out to determine the activities, motivation and barriers to continuing medical education amongst career grade anaesthetists in Scotland. Four hundred and ten consultants and 49 non-consultant career grade anaesthetists were surveyed with a response rate of 84.5%. All respondents had taken part in some educational activities in the past two years. Over 80% had attended 10 or more departmental meetings and over 90% had attended meetings of a Regional society or National meetings. Less than 50% had attended for clinical experience with a colleague and only 20% had done so in another centre. There were trends of changing educational activity with increasing age. The most common motivation was to keep up to date for current clinical duties with keeping up to date for teaching second, but younger consultants were more likely to undertake continuing medical education activities in case their clinical duties changed. Perceived barriers to continuing medical education were similar for internal and external activities but funding was less of a limitation for those working in district general hospitals. There is scope for encouraging activities such as clinical experience with a colleague and a need to explore in greater detail the perception of barriers to continuing medical education and their influence on participation.

Adult↗
PubMed1999

The value of in-patient dermatology: a survey of in-patients in Scotland and Northern England.

Dermatology in-patient units are frequently threatened with reduction or closure, yet there are few objective data regarding the nature and use of in-patient management with which to assess their value. We have surveyed 300 patients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social profile, and the outcome of admission. All departments provided phototherapy and out-patient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted principally because of disease severity but many, including half of those with psoriasis, had concurrent medical problems such as alcohol abuse, psychiatric disorder or arthropathy. Many patients with psoriasis and leg ulcers were from socially deprived areas, as defined by low Carstairs index scores, and a similar proportion received income support. Eighteen per cent of patients, mainly those with acute disorders, would have needed admission irrespective of dermatology bed availability. Out-patient management was considered the next best alternative for only 28% of patients, and many patients would have been expected to treat themselves. By contrast, 84% of patients admitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particularly good in psoriasis, eczema and infection groups. We have demonstrated that in-patient management is highly effective in providing remission in chronic skin disease, and our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.

Dermatology↗
PubMed1999

Haemochromatosis mutations in North-East Scotland.

The HFE gene and its mutations C282Y and H63D cause hereditary haemochromatosis (HH). Among 54 affected individuals from North-East Scotland, 91% were homozygous for C282Y and 5.5% were compound heterozygotes for C282Y and H63D. The general population allele frequencies were high (8% and 15.7% for C282Y and H63D respectively). Although it is likely that HH is under diagnosed, these figures suggest that disease expression is variable, and many of those with the genetic predisposition HH will never develop the clinical consequences of iron overload. This has implications for diagnosis and predictive testing.

Female↗
PubMed2003

Does sticky blood predict a sticky end? Associations of blood viscosity, haematocrit and fibrinogen with mortality in the West of Scotland.

There is increasing evidence that blood viscosity and its major determinants (haematocrit, plasma viscosity and fibrinogen) are associated with an increased risk of incident cardiovascular events; however, their associations with mortality are not established. We therefore studied the associations of these variables with cardiovascular events and total mortality in 1238 men and women aged 25-64 years, followed for 13 years in the first North Glasgow MONICA (MONItoring CArdiovascular disease) survey and West of Scotland centres in the Scottish Heart Health Study. After adjustment for age and sex, increasing whole blood viscosity, plasma viscosity, haematocrit and fibrinogen (analysed by both von Clauss and heat precipitation assays) were significantly associated with mortality. Only the association for fibrinogen (von Clauss assay) remained significant after adjustment for major cardiovascular risk factors. We conclude that clottable fibrinogen may be independently associated with mortality. However, the significance of this association, and the extent to which viscosity is associated with mortality, remain to be established in larger studies and meta-analyses.

Adult↗
PubMed2001

School peer relationships of 'minority' children in Scotland.

This paper examines selected issues arising from two studies in mainstream education of two minority groupings of children in Scotland-those with serious medical conditions and refugee children-completed in 1997 and 1999, respectively. It draws on first-person accounts of children, parents and teachers and focuses on school-based peer relationships, including friendships. Many of the described peer experiences were unhappy or mixed, only a minority were positive. The paper relates the research and its findings to current social and educational policy contexts and to theories on peer relationships, friendship and rejection. It challenges the problematizing of groups or individuals with minority experiences and school staff's acceptance of inevitable difficulty in these children's peer relationships. It hypothesizes that ways of developing all children's peer relationships need to be addressed in schools if the well-being of children who may be socially vulnerable is to be improved.

Adolescent↗
PubMed1999

Women's breast cancer and epidemiology: Scotland and Iceland, contrasts and comparisons.

Epidemiology is a scientific discipline concerned with the distribution and determinants of health and diseases, morbidity, injuries, disability and mortality in populations. This article reviews the literature on women's breast cancer from an epidemiological point of view. Special attention is given to epidemiology and cancer in terms of sources of information, geographical variations, incidence and mortality, risk factors and prevention. Iceland and Scotland were chosen to compare and contrast the epidemiology of breast cancer. These countries were chosen because of the author's general knowledge and acquaintance with both countries and because of her experience in working with breast cancer patients.

Adult↗
PubMed1997

Evaluation of a nurse-led continence service in the south-west of Glasgow, Scotland.

This paper reports the results of a pilot study of a nurse-led continence promotion service in both the community and a local nursing home. Telephone and written referrals were made to the service from 28 primary care teams in Glasgow, Scotland. In the nursing home all patients were assessed and an appropriate management plan implemented. A full assessment was carried out in all community patients, including an appraisal of contributory factors, urinalysis and diaries of food and drink intake. A management plan suited to the patient was then implemented. Patients' levels of incontinence in both arms of the study were assessed objectively using the Lagro-Janssen method. The cost incurred in both arms of the study were measured. There was a 69% improvement in the level of incontinence in the community group compared with 30% in the residents wing and 13% in the hospital wing. The savings in the nursing home amounted to Pounds 4152 in the residents' wing and Pounds 1959 in the hospital wing. In summary, a nurse dedicated to urinary incontinence in the community allows improved management, a greater level of awareness and results in resource savings, whilst increasing patient accessibility to a service.

Aged↗
PubMed1997

The practice-based context of educational innovation: nurse and midwife preparation in Scotland.

The use of an illuminative approach to the national evaluation of the first 18 months of Project 2000 nurse and pre-registration midwifery education in Scotland has facilitated the generation of data about the contexts in which the new programmes function. The aim of this paper is to present some of the data generated from programme participants about the conditions students experience in practice-based learning experiences. The reported issues are direct or indirect effects of policy initiatives and service reforms. The current climate of change in health care provision has fostered a limited number of developments which are consistent with the aspirations of the new programmes and which offer highly valued learning experiences to students. More often however the reforms have served to frustrate the intent of the programmes to offer students experiences which are patient-centred, holistic-care and health oriented.

Community Health Nursing↗
PubMed2002

Preparing for change in the secondary prevention of coronary heart disease: a qualitative evaluation of cardiac rehabilitation within a region of Scotland.

BACKGROUND: Secondary prevention of Coronary Heart Disease (CHD) is often poorly managed and its benefits attained in only a minority of those with CHD. Guidelines developed in the United Kingdom and North America suggest that in future cardiac rehabilitation programmes should provide services through individualized programmes that cater for a wide range of conditions associated with CHD. This will involve substantial and costly changes to current programmes that are mostly standardized and for postmyocardial infarction patients. Based on change theory, this study examined the dynamics, strengths and weaknesses of an existing programme in a Scottish region which was due to undergo the changes suggested by guidelines. AIM: To examine the perceived provision of secondary prevention services for CHD from the perspectives of health professionals within one region in the West of Scotland. METHODS: A purposive sample of 14 health professionals (eight primary and six secondary care health professionals) was selected to cover a range of professional roles including both specialists and generalists. Separate focus group discussions (2) were held with primary care and secondary care professionals. FINDINGS: Whilst the health professionals were enthusiastic about CHD prevention and their involvement, they perceived barriers to the success of the existing service as being complex and multifactorial, including patient, social and service-related factors. Although both groups identified motivation as the most influential personal factor, secondary care staff tended to focus on the importance of patient factors in influencing motivation to change, whereas the primary care staff referred more to the cumulative effects of social and cultural factors. Professionals highlighted weaknesses in the transition between hospital and community-based services with regard to the information flow between primary and secondary care. CONCLUSIONS: Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation programme development and intersectoral working, such as communications and role perceptions in multi-professional working and the need to adapt services to local socio-economic conditions.

Communication↗
PubMed1998

Incidence of mesophilic Aeromonas within a public drinking water supply in north-east Scotland.

The motile mesophilic Aeromonas are ubiquitous to a wide variety of aquatic environments including drinking water distribution systems. Concern over the presence of mesophilic Aeromonas in public drinking water supplies has been expressed in recent years as it has been regarded as a pathogenic organism of importance in gastroenteritis. A major drinking water distribution system in north-east Scotland was monitored over a 12 month period to determine the prevalence of mesophilic Aeromonas. These data were examined in relation to chlorine concentration, pH, temperature, rainfall and the standard bacteriological indicators of water quality. Aeromonas were isolated to varying degrees from 21 of the 31 reservoirs investigated. The maximum recovery observed during the study was 605 cfu in 300 ml. The probability of isolation generally decreased with increasing levels of chlorination, although this oxidant was found to be ineffective in many reservoirs. Certain reservoirs with poor chlorination profiles yielded very few isolates, whereas some highly chlorinated sites liberated Aeromonas frequently and in relatively high numbers. A seasonal pattern in the incidence of Aeromonas emerged with infrequent isolation during the winter period increasing to a peak during the summer, with most isolates recovered when water temperature was > 12 degrees C. An association was demonstrated between the pattern of Aeromonas isolations and that of rainfall. No relationship was apparent between incidence of Aeromonas and total heterotrophic plate counts.

Aeromonas↗
PubMed1998

A survey of the management of leg ulcers in primary care settings in Scotland.

A postal survey was undertaken to describe the management of leg ulcers in a sample of primary care settings in Scotland. The management of leg ulcers caused a considerable workload for all three groups of professionals, although general practitioners (GPs) reported seeing fewer patients. Initial assessment of leg ulcers was often carried out by nurses in collaboration with GPs; however, 48% of district nurses reported assessing patients alone. Choice of treatment depended on clinical criteria and frequency of visits to change dressings. Compression bandages were used routinely by 64% of nurses. Practice protocols were unusual, with only 12% of nurses reporting their use. The management of leg ulcers was not always optimum, and the findings indicate that evidence-based guidelines should be more widely adopted for the management of leg ulcers in general practice.

Community Health Nursing↗
PubMed2001

Clients' reflections on relationships with nurses: comparisons from Canada and Scotland.

It has been suggested that the crucial elements in nursing situations are the nurse, the client, and what goes on between them. This paper examines what goes on between clients and nurses during interpersonal relationships, from the perspective of the clients. Data are presented from studies conducted in Canada and Scotland. It is shown that what clients want, or do not want, during relationships with their nurses, is similar on both sides of the Atlantic. The findings reported in this paper are relevant to transcultural nursing, ethical care, the growth in consumerism, and client advocacy. The findings suggest also that there is a need for nursing research to focus on clinical outcomes in order to establish whether clients' perceptions of helping relationships have any relevance to favourable health outcomes, and the evidence base for clinical nursing.

Canada↗
PubMed2001

Extending the general practice training year: experience of one model in Scotland.

OBJECTIVES: These were: to describe the implementation of a scheme to extend the general practice registrar component of vocational training to 18 months in Scotland; to determine the effect of the additional attachment on registrars' confidence and skill deficits, and compare changes in these parameters with a control group of registrars who did not extend their training, and to determine whether trainers required a different training style for experienced registrars. SUBJECTS: 35 registrars extending their training, their trainers, and 39 controls who did not extend their training. SETTING: Scottish training practices. METHODS: Pre-attachment and post-attachment questionnaires for registrars, triangulated by semistructured telephone interviews, and post-attachment questionnaires for trainers. RESULTS: Extended attachments were popular with registrars and with trainers, who felt they should be a normal part of training. Registrars with extended training declared themselves to have increased in confidence and addressed skill deficits better than controls. Projects completed were assessed as being of high quality. Trainers found 10% of registrars to have a remediable, important deficit in their skills. CONCLUSION: Extended attachments appear to improve registrar confidence and to address knowledge deficits. However, only a minority of registrars had important remediable knowledge deficits and while such attachments may be desirable they may not be essential for most registrars. Overall the outcome appears to have been positive, and supports those who have argued for a change in the proportion of time spent in general practice training, but the scheme is expensive and it is difficult to set a value on what has been gained. Future schemes should have clear training objectives and be tailored towards these.

Chi-Square Distribution↗
PubMed2004

Multiple hybrid origins, genetic diversity and population genetic structure of two endemic Sorbus taxa on the Isle of Arran, Scotland.

Understanding the processes that have given rise to polyploid hybrid taxa is central to our understanding of plant evolution. In this study, we use an array of genetic markers in a population analysis to elucidate the hybrid origins of the Arran whitebeams Sorbus arranensis and S. pseudofennica, two woody plant taxa endemic to the Isle of Arran, Scotland. It has been proposed that S. arranensis was derived by hybridization between S. aucuparia and S. rupicola, and that subsequent hybridization between S. arranensis and S. aucuparia gave rise to S. pseudofennica. Analyses of species-specific isozyme, nuclear intron and chloroplast DNA markers confirm the proposed origin of S. arranensis, and indicate that S. aucuparia was the female parent in the hybridization. Analysis of microsatellite markers suggests that there have been at least three origins of S. arranensis on Arran. Microsatellite markers also support the proposed hypothesis for the origin of S. pseudofennica, and indicate at least five hybrid origins of this taxon. In total, three multilocus genotypes of S. arranensis and eight of S. pseudofennica were detected on Arran and multilocus genotypic diversity levels Hg were 0.09 and 0.63, respectively. Genetic differentiation (thetaST) values based on multilocus genotypes are substantial (0.344 and 0.470 for S. arranensis and S. pseudofennica, respectively) implying limited seed flow among populations. These results indicate that the endemic Sorbus taxa on Arran are the products of multiple and ongoing evolutionary events. This information must be incorporated into management policies for their future conservation.

Conservation of Natural Resources↗
PubMed1997

Data linkage methods used in maternally-linked birth and infant death surveillance data sets from the United States (Georgia, Missouri, Utah and Washington State), Israel, Norway, Scotland and Western Australia.

In this paper we describe the methods used to link birth and infant mortality and morbidity surveillance data sets into sibships using deterministic or multistage probabilistic linkage methods. We describe nine linked data sets: four in the United States (Georgia, Missouri, Utah and Washington State), and four elsewhere (Scotland, Norway, Israel and Western Australia). Norway and Israel use deterministic methods to link births and deaths into sibships. The deterministic linkage is usually dependent on the availability of national identification numbers. In both countries they assign these numbers at birth. Deterministic linkage is usually highly successful, and the major problem is the validation of linkages. In the United States, Western Australia and UK linkage is multistage and probabilistic. This approach is usually dependent on the calculation linkage weights from sociodemographic variables. The success rates of probabilistic methods are above 80%. Maternally-linked perinatal data open new vistas for epidemiological research. Recurrence of poor perinatal outcomes is more appropriately studied using longitudinally-linked data sets. In addition, the emergence of risk factors and the recurrence of risk factors can be studied.

Epidemiologic Methods↗
PubMed2003

Is midwife workload associated with quality of process of care (continuous electronic fetal monitoring [CEFM]) and neonatal outcome indicators? A prospective study in consultant-led labour wards in Scotland.

Evidence for staffing recommendations in labour wards is scant. This study aimed to test association between midwife workload with adjusted process of continuous electronic fetal monitoring (CEFM) and neonatal outcome indicators. This was a prospective workload study in 23 consultant-led labour wards in Scotland. There were 3489 livebirths during September 2000, and 1561 consecutively delivered women with CEFM case review during the mid-two weeks. Process measures were: adjusted rates of CEFM, appropriate CEFM, and time to medical response for a serious fetal heart trace abnormality. Neonatal outcome indicators were: Apgar score < 7 at 5 minutes, admission to neonatal unit (NNU) > 48 hours, and neonatal resuscitation. Complete information was available for 99% (2553/2576) of workload time points, 99% (1559) of CEFM process, and 3083 eligible neonates. There were no associations between occupancy or staffing ratios and adjusted CEFM process, Apgar < 7 at 5 minutes (0.98 [0.83, 1.15]) or admission to NNU for > 48 hours (0.97 [0.95, 1.00]). However, there was association between increasing staffing ratios and lower odds of adjusted neonatal resuscitation (excluding bag and mask only) (0.97 [0.94, 0.99]). The direction of effect of increasing workload suggests detriment to outcome indicators, although the size of effect may be small.

Apgar Score↗
PubMed1999

Breast cancer in Scotland: changes in treatment and work-load. Scottish Breast Cancer Focus Group and the Scottish Cancer Therapy Network.

Throughout Scotland, the patterns of care of patients with breast cancer were examined for the years 1987 and 1993. Substantial changes in oncological work-load were shown in the intervening period. The number of patients referred to an oncologist (clinical or medical) increased by 52% (from 1076 to 1634), the number of patients receiving postoperative radiotherapy to the breast or chest wall increased by 72% (from 724 to 1248) and the number of patients receiving adjuvant chemotherapy increased by 215% (from 123 to 388). The number of consultant oncologists increased by only 16% (from 32 to 37). If patients are to be treated to the standards expected, then increases in work-load must be matched by appropriate increases in staff.

Breast Neoplasms↗