Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENGLAND”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 865 records · Page 48Linked to original sources
PubMed2006

Leading causes of certification for blindness and partial sight in England & Wales.

BACKGROUND: Prevention of visual impairment is an international priority agreed at the World Health Assembly of 2002--yet many countries lack contemporary data about incidence and causes from which priorities for prevention, treatment and management can be identified. METHODS: Registration as blind or partially-sighted in England and Wales is voluntary and is initiated by certification by a consultant ophthalmologist. From all certificates completed during the year April 1999 to March 2000, the main cause of visual loss was ascertained where possible and here we present information on the leading causes observed and comment on changes in the three leading causes since the last analysis conducted for 1990-1991 data. RESULTS: 13,788 people were certified as blind, 19107 were certified as partially sighted. The majority of certifications were in the older age groups. The most commonly recorded main cause of certifications for both blindness (57.2 %) and partial sight (56 %) was degeneration of the macula and posterior pole which largely comprises age-related macular degeneration. Glaucoma and diabetic retinopathy were the next most commonly recorded main causes. Overall, the age specific incidence of all three leading causes has increased since 1990-1991--with changes in diabetic retinopathy being the most marked--particularly in the over 65's where figures have more than doubled. CONCLUSION: The numbers of individuals per 100,000 population being certified blind or partially sighted due to the three leading causes--AMD, diabetic retinopathy and glaucoma have increased since 1990. This may to some extent be explained by improved ascertainment. The process of registration for severe visual impairment in England and Wales is currently undergoing review. Efforts must be made to ensure that routine collection of data on causes of severe visual impairment is continued, particularly in this age of improved technology, to allow such trends to be monitored and changes in policy to be informed.

Adolescent↗
PubMed2006

The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database.

INTRODUCTION: To evaluate the impact of recent evidence-based treatments for severe sepsis in routine clinical care requires an understanding of the underlying epidemiology, particularly with regard to trends over time. We interrogated a high quality clinical database to examine trends in the incidence and mortality of severe sepsis over a nine-year period. METHODS: Admissions with severe sepsis occurring at any time within 24 hours of admission to critical care were identified to an established methodology using raw physiological data from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, containing data from 343,860 admissions to 172 adult, general critical care units in England, Wales and Northern Ireland between December 1995 and January 2005. Generalised linear models were used to assess changes in the incidence, case mix, outcomes and activity of these admissions. RESULTS: In total, 92,672 admissions (27.0%) were identified as having severe sepsis in the first 24 hours following admission. The percentage of admissions with severe sepsis during the first 24 hours rose from 23.5% in 1996 to 28.7% in 2004. This represents an increase from an estimated 18,500 to 31,000 admissions to all 240 adult, general critical care units in England, Wales and Northern Ireland. Hospital mortality for admissions with severe sepsis decreased from 48.3% in 1996 to 44.7% in 2004, but the total number of deaths increased from an estimated 9,000 to 14,000. The treated incidence of severe sepsis per 100,000 population rose from 46 in 1996 to 66 in 2003, with the associated number of hospital deaths per 100,000 population rising from 23 to 30. CONCLUSION: The population incidence of critical care admission with severe sepsis during the first 24 hours and associated hospital deaths are increasing. These baseline data provide essential information to those wishing to evaluate the introduction of the Surviving Sepsis Campaign care bundles in UK hospitals.

Databases, Factual↗
PubMed2001

Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Royal College of Physicians Intercollegiate Stroke Working Party.

STUDY OBJECTIVE: To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke. DESIGN: Retrospective audit of case notes and service organization. SETTING: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland. PATIENTS: The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit. RESULTS: There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay. CONCLUSIONS: There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.

Aged↗
PubMed2001

A survey of services provided by community neurorehabilitation teams in South East England.

OBJECTIVE: To survey the role, function and staffing of community rehabilitation teams in London and the South East NHS Region of England who work with neurologically disabled people, with emphasis on services provided for traumatic brain injury. DESIGN: Telephone survey using a structured interview with team leaders. SETTING: London and South East NHS Regions of England (population 15.6 million). SUBJECTS: Community rehabilitation teams. MAIN OUTCOME MEASURES: A structured interview about service provision. RESULTS: Thirty-five teams were found in 25 Health Authorities serving 14 million people. In a further five Health Authorities, another five teams did not participate. There were fewer than 1.5 community team professionals for 4,000-5,000 neurologically disabled. Teams had seen less than 3% of disabled traumatic brain injuries. Most focused on physical disability. Only two teams specialized in consequences of cognitive impairment or personality change. Stroke and multiple sclerosis were the most common referrals. Sixty per cent of teams had no clinical psychologist. The composition of teams is described, as is caseload, clinical role, outcome measures used, professional links, work practice and staffing issues. CONCLUSIONS: Community physical disability teams seem insufficiently resourced to provide a comprehensive service for the neurologically disabled. There are not enough teams generally, and too few specialize in psychosocial problems. All teams should include a clinical psychologist, should have specialist resources for cases from ethnic minorities and formal policies for staff security. There needs to be clarity over the range of services provided and to whom, and this linked to prevalence of disability and team resourcing.

Brain Injuries↗
PubMed1975

A further investigation of differences in the suicide rates of England and Wales and of Scotland.

National samples of case records of suicidal-type deaths from England and Wales and from Scotland were reassessed by officials in the other country. It emerged that similar criteria for suicide existed in both countries, and that there was no age-related tendency to misclassify cases. The lower official suicide rate amongst the old in Scotland was therefore considered not to result from ascertainment differences. It was also concluded that Scottish records were not so briefly documented as to prevent the conclusive ascertainment of cause by England and Wales coroners. Cases which were designated 'undetermined' in Scotland tended to be classified 'accidental' by coroners. Reasons for the lower incidence of suicide in Scotland are discussed.

Adolescent↗
PubMed1990

Suicide in England and Wales and in Scotland. An examination of divergent trends.

The suicide rates in England and Wales and Scotland converged during the late 1960s, and from 1970 were higher in Scotland. The convergence occurred because of differences in the falls in rates of those aged over 45 years and not because of differences in frequency and decline of coal gas suicide. Male suicide increased more rapidly in Scotland during the 1970s. In England and Wales overall female suicide rates fell during 1958-76 whereas in Scotland there was no clear trend. Suicide by car exhaust increased similarly in both countries, but that by hanging and drug poisoning increased more rapidly in Scotland.

Adolescent↗
PubMed1996

Suicides by burning in England and Wales.

BACKGROUND: The aim was to examine suicides by burning (SBB) occurring in England and Wales. METHOD: The method was a retrospective case note examination of death certificates, coroners inquest notes and GP notes for all SBBs registered in 1991 by OPCS in England and Wales, and an examination of SBB statistics from 1979-1992. RESULTS: In 24% of cases the incident involved others either as intended or actual victims or as witnesses, and three distinct groups (Asian-born women, schizophrenics, and homicide-suicides) were over-represented. The majority were not in contact with current psychiatric services, and 43% had never had contact with psychiatric services. There was no trend in SBB compared to other suicides in 1979-1992. CONCLUSIONS: While SBB may be associated with Asian-born women, homicide-suicide and schizophrenia, the majority of cases did not have these characteristics, and the overall psychiatric contact rate was similar to suicide by unspecified means.

Adult↗
PubMed2001

Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses.

BACKGROUND: Increased rates of schizophrenia continue to be reported among the African-Caribbean population in England. AIMS: To evaluate the competing biological, psychological and social explanations that have been proposed. METHOD: Literature review. RESULTS: The African-Caribbean population in England is at increased risk of both schizophrenia and mania; the higher rates remain when operational diagnostic criteria are used. The excess of the two psychotic disorders are probably linked: African-Caribbean patients with schizophrenia show more affective symptoms, and a more relapsing course with greater social disruption but fewer chronic negative symptoms, than White patients. No simple hypothesis explains these findings. CONCLUSIONS: More complex hypotheses are needed. One such links cultural variation in symptom reporting, the use of phenomenological constructs by psychiatrists and social disadvantage.

Attitude to Health↗
PubMed2001

Suicide in children and adolescents in England and Wales 1970-1998.

BACKGROUND: Suicide rates for England and Wales have been decreasing recently, but rates for young adult males remain high. AIMS: To review changes in suicide rates for children and adolescents in England and Wales between 1970 and 1998. METHOD: Rates for suicide, 'accidental' death by causes similar to suicide and 'undetermined' death for 10-14- and 15-19-year-olds are calculated between 1970 and 1998 using suicide data and estimated mid-year populations obtained from the Office for National Statistics. RESULTS: There has been a substantial increase in suicide rate between the 1970s and the 1990s for males aged 15-19 years. This remains true even when 'undetermined' and 'accidental' death rates for causes similar to suicide are examined. The increase was associated with an increase in self-poisoning with vehicle exhaust gas in the 1980s and an increase in hanging which has continued into the 1990s. Although there was a slight decrease in the official suicide rate for females aged 15-19 years, 'undetermined' deaths increased. There is no indication of a major change in suicide rate in 10-14-year-olds. CONCLUSIONS: The substantial increase in suicide rate in 15-19-year-old males may indicate increased psychosocial stress, particularly affecting this group.

Accidents↗
PubMed2003

Distribution and characteristics of in-patient child and adolescent mental health services in England and Wales.

BACKGROUND: Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK. AIMS: To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales. METHOD: Following identification of units, data were collected by a postal general survey with telephone follow-up. RESULTS: Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions. CONCLUSIONS: A national approach is needed to the planning and commissioning of this specialist service.

Adolescent↗
PubMed2006

Ethnic differences among patients in high-security psychiatric hospitals in England.

BACKGROUND: Black (Black Caribbean and Black African) patients are over-represented in admissions to general adult and medium-security psychiatric services in England. AIMS: To describe the sociodemographic, clinical and offence characteristics of patients in high-security psychiatric hospitals (HSPHs) in England, and to compare admission rates and unmet needs by ethnic group. METHOD: A total of 1255 in-patients were interviewed, and their legal status, socio-demographic characteristics and individual treatment needs were assessed. RESULTS: Black patients in HSPHs are over-represented by 8.2 times (range 3.2-24.4,95% CI 7.1-9.3), are more often male (P=0.037), and are more often diagnosed with a mental illness and less often diagnosed with a personality disorder or learning disability (P<0.001) than White patients. Unmet needs were significantly less common among White than among Black patients (mean values of 2.22 v. 2.62, difference=0.40,95% CI 0.06-0.73). CONCLUSIONS: Compared with the proportion of Black patients in the general population in their region of origin, a much higher proportion of Black patients were admitted to HSPHs, and fewer of their needs were met.

Adult↗
PubMed2006

Crisis resolution/home treatment teams and psychiatric admission rates in England.

BACKGROUND: Introduction of crisis resolution/home treatment teams has been associated with a reduction in hospital admissions in trials. Between 2001 and 2004 there was a rapid expansion in the numbers of these teams in England. AIMS: To examine whether national implementation of these teams was associated with comparable reductions in admissions. METHOD: Observational study using routine data covering working age adult patients in 229 of the 303 local health areas in England from 1998/9 to 2003/4. RESULTS: Admissions fell generally throughout the period, particularly for younger working age adults. Introduction of crisis resolution teams was associated with greater reductions for older working age women (35-64 years); teams always on call were associated with additional reductions for older men and younger women. By the end of the study admissions had fallen by 10% more in the 34 areas with crisis resolution teams in place since 2001, and by 23% more in the 12 of these on call around the clock than in the 130 areas without such teams by 2003/4. Reductions in bed use were smaller. Introduction of assertive outreach teams was not associated with overall reductions in admissions. CONCLUSIONS: Introduction of crisis resolution teams has been associated with reductions in admissions.

Adolescent↗
PubMed2005

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

OBJECTIVE: To undertake a postal survey of cancer networks to define the services available for the diagnosis, treatment and support of patients with head and neck cancer in England. FINDINGS: Thirty-four cancer networks are now responsible for the delivery of head and neck cancer services in England and 52 cancer units responded to our questionnaire. Multidisciplinary team working was evident in all centres. However such team working was not always fully staffed, especially in areas of national staff shortages such as pathology, radiology, dietetics and speech therapy. Rapid referral pathways were present for initial assessment of patients but clinically significant delays were identified in the provision of complex investigations, in access to intensive care beds and for oncological care--especially radiotherapy. CONCLUSIONS: 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.

Cancer Care Facilities↗
PubMed2000

National assessment of PID diagnosis, treatment and management in general practice: England and Wales.

A questionnaire based audit was used to evaluate the diagnosis and management of suspected pelvic inflammatory disease (PID) cases by general practitioners (GPs) in England and Wales. Responses were compared against a clinical management 'gold standard' devised by an independent group of GPs and specialists. Two hundred and ninety-seven (38%) of the 781 questionnaires were returned. Only 21 (7%) had all 'gold standard' sections correct. Diagnostic quality was significantly higher when the clinician was female compared with male (odds ratio [OR]=2.34; 95% confidence limits [CL]=1.19-4.63) and diagnostic quality increased with increasing socioeconomic deprivation. This is the first evaluation of the diagnosis and management of PID by GPs in England and Wales. The unusually poor response rate to a Medical Research Council General Practice Research Framework (MRC GPRF) study may reflect low disease awareness and sub-optimal management. This represents a fundamental obstacle to effective intervention and surveillance. Effective intervention will only be possible if diagnostic practice and management are improved substantially.

England↗
PubMed2001

Would you get your Gonorrhoea treated in the north of England?

The management outcome of gonorrhoea in the northern region of England was assessed and compared with the recently published national guidelines. An audit questionnaire was completed by all genitourinary medicine (GUM) clinics in the region. Information with regard to demographic data, microscopy, culture results, test of cure, antibiotic use and sensitivity and contact tracing were recorded. A total of 420 cases of gonorrhoea were diagnosed in 1998. The ratio of males to females with gonorrhoea was 2.1:1. Half were heterosexual males and one-third females. Direct microscopy was positive in 85% of heterosexual males but in less than one-third of females. Ciprofloxacin was the most commonly used antibiotic. One-third of the isolates were resistant or partially resistant to penicillin. Health advisors saw 85% of patients and 41-68% of 'potential' contacts were seen. The management of gonorrhoea in the northern region of England complies with the national guideline recommendations.

Adolescent↗
PubMed2002

Sexual health provision and the Sexual Health and HIV Strategy for England: a questionnaire survey of general practitioners' views.

An anonymous postal survey was used to assess the views of general practitioners (GPs) on the expected contents of the Department of Health National Sexual Health and HIV Strategy for England prior to release. One hundred and seventeen GPs in four London Primary Care Groups took part (response rate=50%). The majority felt they currently have about the right amount of involvement in patient care (HIV 70%: GUM 66%); 88% of GPs felt they offer general sexual health care (Level one), and most wished to continue with this (85%). However, a sizeable minority of GPs wanted to be involved in the development of care guidelines (HIV 17%; GUM 22%), and 10% considered that they might wish to offer more specialist services (Level two). To achieve a Strategy goal to integrate sexual healthcare services in England, it is likely that there will need to be local consultation and support for GPs.

England↗
PubMed1998

Financing HIV service provision in England: estimated impact of the cost of antiretroviral combination therapy.

The objective of this study was to provide population-based estimates on the cost of HIV service provision in England and the use of dual or triple antiretroviral combination therapy. Contemporary cost estimates of treating HIV-infected individuals by clinical stage of HIV infection (indexed to 1995/96 prices) were linked to the number of diagnosed HIV-infected individuals using statutory medical services in England during 1996. Two cost measures were used: the first one was based on average hospital prices derived from a number of English HIV units. These results were compared with those estimated using standard unit costs obtained through specific costing studies performed at a national HIV referral centre. Overall annual expenditure on HIV service provision was estimated for different treatment scenarios as was expenditure by clinical stage of HIV infection. Using hospital prices, in 1996 the total annual cost estimate for HIV service provision amounted to pound sterling 131 m (range pound sterling 83 m to pound sterling 233 m), or pound sterling 150 m (95% CI pound sterling 126 m to pound sterling 173 m) using standard costs, if all patients with HIV disease were treated with AZT monotherapy. For all eligible patients to be treated with dual therapy, cost estimates amounted to pound sterling 161 m (range pound sterling 126 m to pound sterling 173 m) per year using hospital prices or pound sterling 180 m (95% CI pound sterling 156 m to pound sterling 203 m) when using standard cost estimates, while for triple therapy annual estimated expenditure amounted to pound sterling 204 m per year (range pound sterling 157 m to pound sterling 306 m) when using hospital prices or pound sterling 223 m (95% CI pound sterling 199 m to pound sterling 246 m) using standard costs. Increasingly costs will be more evenly distributed across the 3 stages of HIV infection, with a greater proportion of costs generated by HIV-infected individuals before the onset of AIDS. Using non-standardized hospital prices may systematically underestimate the real cost of service provision. Monitoring prospectively the use, cost and outcome of HIV service provision in a standardized format will provide information on the actual cost impact over the next 2-3 years of combination therapy compared with the scenario-based estimates produced in this paper.

Anti-HIV Agents↗
PubMed1999

Usefulness of information from the unlinked anonymous prevalence monitoring programme for HIV in England and Wales: survey of planners of HIV/AIDS services.

The aim of this study was to evaluate whether information from the Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales is useful to planners of HIV/AIDS services. The study involved 2 stages: examination of 1997 AIDS Control Act Reports for England and Wales, and a telephone questionnaire survey of local planners of HIV/AIDS services. Forty-eight out of 55 health authorities (87.3%) found information from the programme to be useful in general; 37/55 (67.3%) found the information useful for targeting of health promotion; 35/55 (63.6%) found the information useful for assessing the effectiveness of preventive measures aimed at reducing the spread of HIV; and 28/55 (50.9%) found the information useful for planning of medical or social services. If information from the programme was no longer available, 36/55 (65.5%) said it would make some difference to local planning, although 12/55 (21.8%) said it would make no difference. Local planners were generally supportive of the programme, and complaints were mostly directed at funding and timeliness of the reports.

Acquired Immunodeficiency Syndrome↗