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PubMed1998

Impaired Control Scale: cross-validation and relationships with treatment outcome.

AIMS: (1) To cross-validate Australian findings on the Impaired Control Scale (ICS) in an English sample of problem drinkers. (2) To examine a possible improvement to the scoring of the ICS. (3) To explore the relationship of the ICS to treatment outcome. DESIGN: In a repeated measures design, questionnaires and interviews were administered by trained staff during treatment and again at 6 months follow-up. SETTING: Two alcohol and drug treatment services in Newcastle and Liverpool (UK). PARTICIPANTS: Two hundred and twenty-nine problem drinkers attending as in- or outpatients, with abstinence or moderation treatment goals. MEASUREMENTS: ICS scores; typical weekly alcohol consumption (units); degree of alcohol-related problems; severity of alcohol dependence; and classification of outcome using consumption levels and current alcohol-related problems, with collateral confirmation of self-reports. FINDINGS: The satisfactory reliability and validity of the ICS was confirmed in an English sample of problem drinkers in treatment. An improved "substitution method" of scoring was developed to give a single measure of impaired control for all subjects irrespective of degree of attempted control. ICS scores were significantly correlated with treatment outcome and, among a subgroup of subjects who had aimed at abstinence but failed, predicted outcome status after the effects of degree of dependence had been extracted. CONCLUSIONS: Impaired control over alcohol consumption can be measured in a reliable and valid fashion by the ICS. The ICS has potential uses in research on impaired control and as a clinical assessment tool.

Adult↗
PubMed2000

Ibuprofen versus other non-steroidal anti-inflammatory drugs: use in general practice and patient perception.

OBJECTIVE: To investigate whether ibuprofen was as well-regarded by patients as other non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN: Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING: General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS: Unselected patients receiving NSAIDs prescribed for all indications for use. MAIN OUTCOME MEASURES: Effectiveness of ibuprofen and other NSAIDs, possible drug related adverse events, patients' overall satisfaction with ibuprofen and other NSAIDs, factors associated with choice of ibuprofen, drug costs of ibuprofen and other NSAIDs. RESULTS: The main NSAIDs used were ibuprofen, diclofenac and naproxen. Ibuprofen use ranged from 1.0% of prescriptions in one practice to 69.1% in another. Although ibuprofen was generally prescribed in low doses, it was perceived by patients as being as effective as the other NSAIDs used, even after allowing for severity of the pre-treatment condition. Overall, 50.5% of patients rated their NSAID the best treatment they had received for their condition with no differences between individual drugs. CONCLUSIONS: Ibuprofen is as highly regarded as other NSAIDs when used in similar circumstances. Switching patients to ibuprofen may be a realistic way of reducing financial and medical costs associated with NSAIDs.

Adolescent↗
PubMed2000

Pharmacoepidemiology of non-steroidal anti-inflammatory drug use in Nottingham general practices.

AIM: To investigate the pharmacoepidemiology of NSAID usage in Nottingham general practices. DESIGN: Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING: General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS: Unselected patients receiving NSAIDs prescribed for all indications. MAIN OUTCOME MEASURES: Indication for treatment, differences in prescribing to different age groups, compliance and overall scheme drug exposure, drug effectiveness and tolerability, possible drug-related adverse events, patients' overall satisfaction with treatment and estimated costs of care. RESULTS: NSAIDs were used for a wide range of conditions and only a small number of patients had rheumatoid arthritis. The main drugs used were ibuprofen, diclofenac and naproxen. Patients making short-term use of NSAIDs had low compliance if they experienced adverse drug effects, whilst conversely in long-term users, those with high compliance reported more adverse drug effects. Calculated compliance did not vary with age although older patients (over 65 years) claimed in their questionnaires to be more compliant than younger patients. Half the patients reported good or complete symptom relief. Half of those questions (and two thirds of those with good or complete symptom relief) rated their NSAID as the best treatment they had received for their current condition. The frequency of gastrointestinal adverse events was higher in the young and the old, which correlated with the use of anti-ulcer drugs, and increased with the total number of medications used. CONCLUSIONS: NSAIDs are used for a wide-range of conditions. They give symptom relief to, and are perceived as effective by, most patients taking them.

Adolescent↗
PubMed2003

Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD Study.

BACKGROUND AND AIMS: Gastro-oesophageal reflux disease (GERD) can be associated with a variety of extra-oesophageal disorders (EED) such as chronic cough, asthma, laryngeal disorder or chest pain. The aim of the study was to estimate and compare the prevalence of EED in a population with symptomatic GERD presenting as either erosive reflux disease (ERD) or non-erosive reflux disease (NERD). METHODS: Baseline data were collected from a prospective, multicentre, open cohort study (ProGERD) in which patients will be followed for 5 years after initial treatment with esomeprazole. Within the framework of this trial, all patients underwent gastroscopy and filled out a questionnaire designed to assess EED. The influence of potential prognostic factors on the prevalence of EED was analysed by multivariate (stepwise logistic regression) analysis. RESULTS: 6215 patients (3303 male, 2912 female; mean age 54 years) presenting with heartburn were included. EED was detected in 32.8% of all patients. The proportion was significantly higher (P = 0.0002) in ERD patients (34.9%) than in NERD patients (30.5%). As judged from the multivariate analysis, female gender, age, oesophagitis of LA grade C/D, duration of GERD disease greater than 1 years and smoking were significantly associated with EED. ERD patients with oesophagitis of LA grade A or B did not have a significantly higher risk of EED than patients with NERD. CONCLUSIONS: Patients with GERD have a high probability of experiencing EED, which may be associated with a number of prognostic factors such as duration and severity of GERD. Extra-oesophageal disorders are slightly, but statistically, more prevalent in ERD than in NERD patients.

Asthma↗
PubMed2000

An independent assessment of a supraregional pain management programme and comparison of patients' and general practitioners' perceptions of the effects.

This study was designed to evaluate the therapeutic response, as perceived by patients and their general practitioners, to a supraregional residential pain management programme (INPUT). Twenty patients who completed the INPUT programme and their general practitioners, were sent locally designed questionnaires. Eighteen patients and 16 general practitioners responded. Patients were assessed for the effects of the programme on a wide variety of treatment targets reflecting quality of life. General practitioners were questioned about changes in dependence upon healthcare services. The mean time from attending INPUT to assessment was 11.4 (5.7) months. Thirteen patients indicated a moderate or maximal improvement in quality of life. General practitioners reported a reduced use of healthcare services and improvement in quality of life. The majority of our patients attending INPUT gained benefits that improved their quality of life. Healthcare services appeared to benefit from the patients' greater independence in managing their symptoms.

Adult↗
PubMed2001

Psychotropic prescribing practices of paediatricians in the UK.

OBJECTIVE: This study examines the prescribing practices and attitudes to psychotropic medication by paediatricians in the UK. DESIGN: Questionnaires were sent to 100 randomly chosen paediatricians in the UK to assess their prescribing practices of psychotropic medication in children. RESULTS: Paediatricians see and treat many children with a wide variety of psychotropic medications on a regular basis. However, few of them feel competent, and most requested regular psychopharmacology seminars. CONCLUSIONS: In the US, primary care physicians and paediatricians are recognized as primarily responsible for the continuing increase in psychotropic prescriptions in children. This study shows that, in the UK, paediatricians also contribute to such prescribing and need to be taken into account when estimating the prevalence and appropriateness of such medication use in children.

Adult↗
PubMed2002

Is puberty getting earlier? The views of doctors and teachers.

AIMS: To determine the views of teachers, general practitioners (GPs) and paediatricians about whether there has been a recent change in the timing of the onset of puberty in children in the UK and in the timing of menarche in girls. DESIGN: Questionnaires were sent to a stratified random sample of each professional group. RESULTS: In relation to girls, almost 80% of teachers believe that the onset of puberty is occurring earlier and 73% feel that the menarche is occurring earlier. Those who had been working for longer than 10 years were more likely to say that the age of onset of puberty had decreased. GPs feel that both puberty and menarche are starting earlier, whereas paediatricians were evenly divided between those who thought puberty was starting earlier and those who thought that the timing had not changed. In boys, professionals generally believe that the timing of the onset of puberty has not altered significantly. CONCLUSION: Further study is required to determine whether puberty is really occurring earlier in girls.

Age of Onset↗
PubMed1997

Impaired reproductive function in women treated for growth hormone deficiency during childhood.

OBJECTIVE: There are limited data which suggest that disturbance of reproductive function may occur in GH-deficient women. We have evaluated the consequences of growth hormone (GH) deficiency on reproductive function in women treated for GH deficiency during childhood. DESIGN: Questionnaires were sent to 73 GH-deficient women who had been treated for GH deficiency during childhood. The response rate was 82%. These 60 women were then visited to obtain further information concerning their reproductive status. During these visits, blood samples were obtained from 39 women, to evaluate their hormonal status, and 29 of them had a standard insulin tolerance test (ITT), as part of an adult GH substitution trial. Paediatric and gynaecological records were evaluated in all 60 women. SUBJECTS: Sixty GH-deficient women treated in childhood for this deficiency were included in the study. The median age at follow up was 27 years (range 20-43). GH treatment had been discontinued for 9 years (range 2-26). MEASUREMENTS: In the questionnaire and during the visit, attention was paid to GH treatment, pubertal development, menstrual cycle disturbances and fertility. In the 39 blood samples IGF-1, IGFBP-3, TSH, T4 and T3 were measured. GH responses were measured by a standard ITT. RESULTS: Thirty-four women showed no spontaneous pubertal development. Of the 26 women who did, menarche occurred in 39% at the age of 16 years or older. At the time of the study, menstrual cycles in these 26 women were as follows: 12 had regular menstrual cycles, three had developed secondary amenorrhoea after discontinuation of GH treatment, five had irregular menstrual cycles and six had oligomenorrhoea. The 34 women with disturbed pubertal development and the three with secondary amenorrhoea were infertile because of hypogonadotrophism. Only 13 out of 60 women desired pregnancy or had been pregnant. Three with regular menstrual cycles had primary infertility. Ten had ovulation induced or IVF. Six of these became pregnant after 1-7 cycles. Three were still under treatment, the duration of their treatment varying from 3 to 7 years. One woman discontinued treatment. At the time of the study, nine women had actually conceived. Five out of ten completed pregnancies resulted in Caesarian sections because of cephalo-pelvic disproportion or arrest of labour. During the ITT three of 29 women showed GH responses exceeding 5 micrograms/l (10 mU/l), ruling out complete GH deficiency. Higher GH peaks (NS), IGF-1 (P , 0.01) and IGFBP-3 (P < 0.01) levels were found in women with regular menstrual cycles, compared to women using sex-steroid substitution and amenorrhoeic women. CONCLUSIONS: From this study, it can be concluded that disturbances in reproductive function can be expected in women treated for GH deficiency during childhood, so it is advisable to inform these women of this possibility and to maintain follow-up after discontinuation of GH treatment. Whether the somatotrophic axis exerts a direct effect on ovarian function or whether more severe GH deficiency is more frequently accompanied by disturbances in gonadotrophin secretion still has to be elucidated.

Adult↗
PubMed2000

Bone-anchored hearing aid: quality of life assess by glasgow benefit inventory

INTRODUCTION: The bone-anchored hearing aid (BAHA) uses the system of osseointegration described by Branemark. It is a well-established mode of treatment and many studies show the audiological benefit, but none have assessed the benefit to the quality of life of patients who underwent this surgical intervention. This study uses the validated Glasgow Benefit Inventory (GBI) to quantify the changes in quality of life. The GBI is a specific patient-orientated questionnaire designed to look at the changes in health status secondary to an ORL intervention.1 The GBI gives an overll scorek, but also subscores of general, social and physical benefits. METHOD: Sixty consecutive BAHA patients were enrolled in the study. The male: female ratio was 1 : 26, with a mean age of 45 years. The most common indication was hearing loss secondary to mastoid disease/surgery followed by congenital atresia and chronically discharging ear. The mean bone conduction of the better ear was 19 dB and the mean conductive loss across the speech frequencies was 58 dB. Only patients who were fitted with the classic model were included in the study. RESULTS: The response rate was > 70%, which is high and adds weight to the results. The general benefit score was + 40 which is comparable to middle ear surgery, but just below benefit from chochlear implantation. The social benefit was + 27 with only + 10 for the physical score. This pattern mirrors that reported for other ear interventions. CONCLUSION: This paper is the first to demonstrate that there is significant quality of life benefit from BAHA surgical intervention as measured by the GBI.

Journal Article↗
PubMed1995

Diploma-prepared nurses' use of technological equipment in clinical practice.

Increasingly, nurses throughout the western world are receiving their educational preparation for initial registration in a tertiary environment at either the diploma or bachelor degree level. The length of time spent in the clinical setting has been reduced considerably, with the elimination of the apprenticeship system and the role of the student nurse as paid staff member. Concurrently, the amount of technological equipment used in the health care sector is both increasing rapidly and now found in general wards, not just the traditional 'high tech' environments. It is important to evaluate how well the tertiary experience prepares students in terms of their ability to handle common technological equipment such as infusion control devices or suction pumps. In the study reported here 245 diploma-prepared registered nurses completed a questionnaire designed to assess how nurses from tertiary institutions perceived their ability to handle technical equipment in the workplace. The majority of the respondents had been working for 7 to 12 months. No significant relationship was found between the frequency of use of specific items of clinical equipment and whether that item caused the nurse concern in practice. There was also no significant relationship between the frequency of use of an item and whether participants believed that competence should be acquired in relation to that item prior to tertiary graduation. Although moderate levels of comfort in the use of technical equipment were reported upon entry to the workplace, subjects rapidly acquired high levels of comfort in relation to equipment handling. The implications for hospital administrators and tertiary teaching programmes are discussed.

Adult↗
PubMed1995

Survey of carer satisfaction with the quality of care delivered to in-patients suffering from dementia.

Quality assurance in British National Health Service provision stresses the importance of taking account of the consumer's viewpoint. Elderly patients with dementia are not always able to contribute usefully to satisfaction surveys. Therefore, their careers' views were sought in order to assess the quality of services offered to this client group. Forty-one careers of patients discharged from the eight wards for the elderly mentally ill in Leicestershire, England, were randomly selected. Individual focused interviews were conducted in careers' own homes. Both quantitative and qualitative data were obtained by use of a questionnaire designed to tap the patients'/careers' experiences from pre-admission, through hospital stay to post-discharge. Interviews were asked to describe their favorable/unfavorable impressions of, and reactions to, all aspects of hospital care. These interviews were tape-recorded. Analysis of the data included quantitative measurements of scale ratings. Grounded theory was used to analyse qualitative data. A wealth of information was uncovered using this research technique. Much that was positive about the service was elicited. However, careers highlighted areas where they felt the quality of care could be improved within all the foci discussed. Twenty-two recommendations for quality improvements in service provision were made in the report as a result of this survey.

Aged↗
PubMed1997

Computer literacy in nursing: developing the information technology syllabus in nursing education.

This study has two main purposes: first, to identify and describe the computer skills required in nursing; and second, to find out what should be taught about information technology in nursing education. A three-round Delphi survey was carried out with a panel of experts representing nursing practice, nursing education, nurse students and consumers. The panel showed a consensus of opinion on 71% of the items included in the questionnaire designed for the study. The experts agreed that nurses must know how to use the computer for word-processing purposes, for accessing and using the hospital information system, and for e-mailing. Nurses must also be aware of system security and show a positive attitude towards computers. It is concluded that hospital information systems and nursing informatics should be integrated into laboratory and hospital training.

Attitude to Computers↗
PubMed1999

Coping strategies used by hospitalized stroke patients: implications for continuity and management of care.

This paper describes findings from an English study into the perceptions of multi-professional practice given by stroke patients, their informal carers and hospital staff. Unstructured interviews were conducted with nine stroke patients and eight informal carers. Case studies were developed from the interview data which formed the basis of a questionnaire designed to ascertain the aims of care for the case studies and the location of professional responsibility for meeting these aims. This was returned by 31 respondents from a range of professional backgrounds. The findings indicate that patients and carers sought out relationships with staff and other patients in order to gain information to help them understand their uncertain futures. Professional staff were reluctant to pass specific information on to patients as it might be misleading in each individual case. The uncertainty surrounding individual recovery means that supportive relationships initiated by patients and carers may need to be recognized and nurtured.

Adaptation, Psychological↗
PubMed2001

Mental health nurses' perceptions of nurse prescribing.

AIMS: This study aimed to ascertain mental health nurses' perceptions of the advantages and disadvantages of nurse prescribing and to identify the educational needs of mental health nurse prescribers. DESIGN: A questionnaire was designed and administered to a convenience sample in the UK of 73 mental health nurses in clinical practice, 14 working in in-patient settings and 59 in the community. Questions included both closed and open-ended items. Descriptive statistics were used for numerical data, and category analysis of the open-ended questions was undertaken by two of the researchers independently and then conjointly. FINDINGS: The majority of respondents felt that mental health nurse prescribing would significantly improve clients' access to medication, improve compliance, prevent relapse and prove cost effective. However, many were anxious that they did not have sufficient knowledge and skills to assume responsibility for prescribing. CONCLUSIONS: Although there would be benefits to clients and patients, further training, rigorous supervision and the co-operation of doctors will be required if mental health nurse prescribing is to yield the anticipated benefits.

Attitude of Health Personnel↗
PubMed2004

Barriers to evidence-based practice in primary care.

BACKGROUND: Evidence-based practice is one of the most important underlying principles in modern health care. In the United Kingdom, successive governments have highlighted the fact that a quality health service is built upon the use of best evidence. Health professionals are becoming more accountable within clinical governance structures for the care they provide. The need to use robust research findings effectively is a critical component of their role. However, studies show that a number of barriers prevent the effective use of best available evidence. AIM: This study aimed to identify barriers to evidence-based practice in primary care. METHOD: A specially designed questionnaire was used to gather respondents' perceptions of the barriers to evidence-based practice. Data were collected in 2000/2001. FINDINGS: Findings show that general practitioners (GPs) ranked barriers differently to community nurses. GPs believed that the most significant barriers to using evidence in practice were: the limited relevance of research to practice, keeping up with all the current changes in primary care, and the ability to search for evidence-based information. In contrast, the most significant barriers to the identified by community nurses were poor computer facilities, poor patient compliance and difficulties in influencing changes within primary care. This suggests that these two groups may require different strategies for barrier removal. CONCLUSIONS: Identifying barriers is just the first step to addressing issues surrounding the use of evidence-based practice. Extra resources will be needed if these barriers are to be tackled. However, if the resultant change improves the health and wellbeing of people and communities, then the extra costs would be offset by more efficient use of services.

Attitude of Health Personnel↗
PubMed1998

Responses to treatment for sex offenders with intellectual disability: a comparison of men with 1- and 2-year probation sentences.

The present study compares the responses to treatment of sex offenders with intellectual disability receiving 1- and 2-year probationary sentences. There were seven subjects in each group. There were no differences between subjects with regard to age, IQ or previous offences. All subjects received group treatment which addressed issues of: denial, minimization and responsibility for the offence; harm done to the victim; behaviour consistent with offending; and victim awareness and confidentiality. The subjects were assessed on a standard questionnaire designed to assess attitudes consistent with sex offending. All subjects were convicted of either indecent exposure or offences against children. There was a significant difference between the groups at the end of the probation period with subjects sentenced to 2 years' probation showing greater improvement. Subjects receiving 1 years' probation retained a number of attitudes consistent with denial and minimization of their offence. Furthermore, follow-up data underlined the poorer response to treatment for the 1-year probation group in terms of re-offending rates and assessment of attitudes consistent with sex offending. The authors recommend that a court order for a 1-year period of probation with treatment is of little value when dealing with sex offenders with intellectual disability. Rather, a period of at least 2 years' probation with a treatment recommendation is suggested.

Adult↗
PubMed1997

Do-not-resuscitate orders--should the patient be informed?

OBJECTIVES: To analyse the ethical implications of informing patients about their do-not-resuscitate status (DNR). DESIGN: Questionnaire. SETTING: Nationwide, 6 months after the publication of guidelines on DNR in 1994. SUBJECTS: A 10% random sample of the members of the Swedish Cardiac Society. 104 physicians and 196 nurses. MAIN OUTCOME MEASURES: To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed? RESULTS: Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient. but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises. CONCLUSIONS: Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in-hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?

Attitude of Health Personnel↗
PubMed2000

Ethical aspects of clinical trials: the attitudes of participants in two non-cancer trials.

OBJECTIVES: To investigate attitudes to clinical trials in non-cancer trial participants. DESIGN: Questionnaires at entry, during, and after participation in a clinical study. SETTING: Participants in: (i) ROC: a clinical study comparing systemic interferon-alpha-2A treatment vs. prednisolone enemas in ulcerative colitis; and (ii) MRCRUC: a clinical study investigating low-field magnetic resonance imaging as a new modality for the evaluation of patients with inflammatory bowel disease. SUBJECTS: Thirty-two patients in ROC and 47 patients in MRCRUC. OUTCOME MEASURES: Attitudes towards different aspects of clinical research. RESULTS: The majority found scientific testing of clinical methods necessary, having positive attitudes towards both participation by themselves and others. The creation of a personal moral problem by denying participation was rejected by a large majority, and still both personal and altruistic motives for participation were highly rated. An important motive for accepting inclusion was the expectation of being 'a special patient' during the trial. The presence of research ethics committees controlling clinical research had a significant positive impact on decisions to participate, and drawing lots and blinding were found problematic by only a minority. Patients valued their satisfaction with participation in the trials highly, and would almost all accept a request to participate in future trials. The most important reason for this was a feeling of receiving better care and information than expected outside a trial setting, primarily determined by the patients seeing only one physician during the trials. A pronounced wish to obtain follow-up information was expressed. CONCLUSION: Attitudes towards medical research are positive with both altruistic and nonaltruistic motives for participation. Expectations of being treated as 'a special patient' in the trial were important in accepting to participate. Seeing the same physician at control visits was an important factor for satisfaction with participation.

Adult↗