12,364 research outputs found
Evaluation of NHS Direct ââreferralââ to community pharmacists
OBJECTIVES: To evaluate a pilot scheme of referrals from a nurse-led telephone helpline (NHS
Direct) to community pharmacists.
METHODS: A multi-method approach, including analysis of routine data from NHS Direct, postal
surveys of NHS Direct callers, analysis of anonymised transcripts of calls, a postal survey of callers
referred to pharmacists, and face-to-face interviews with NHS Direct nurses.
SETTING: Essex, Barking and Havering.
KEY FINDINGS: During the first three months of the pilot scheme, 6% (1,995/31,674) of NHS Direct
calls triaged by nurses were logged as referred to pharmacists. This built on an existing foundation of
informal referral to pharmacists of 4%. There was no measurable change in callersâ views of the
helpfulness of advice, enablement, or caller satisfaction associated with the scheme. Conditions sent
to pharmacists included skin rash, cough, sore throat, stomach pain, and vomiting and/or diarrhoea.
86% (54/63) of callers referred to pharmacists during the scheme felt the referral was very or quite
appropriate and 75% (48/64) attempted to contact a pharmacist. In general, those who did so found
the experience a positive one: 65% (31/48) spoke to the pharmacist, and 80% (28/35) of people
expressing an opinion were satisfied with the advice offered, but the lack of privacy in the pharmacy
was of some concern. Although routine data indicated high usage of the scheme, nurse referral of
callers to pharmacists declined over time. Their initial enthusiasm diminished due to concerns about
the appropriateness of guidelines, their lack of understanding of the rationale behind some referrals,
and the lack of feedback about the appropriateness of their referrals.
CONCLUSIONS: The evaluation of the pilot scheme has generated a range of recommendations for
the wider national roll-out of the scheme, including revision of the guidelines and review of NHS
Direct nurse training for referral to pharmacy. NHS Direct and pharmacists should consider how to
strengthen the system of pharmacist feedback to NHS Direct
Exploring the effect of changes to service provision on the use of unscheduled care in England: population surveys
Background
Unscheduled care is defined here as when someone seeks treatment or advice for a health problem without arranging to do so more than a day in advance. Recent health policy initiatives in England have focused on introducing new services such as NHS Direct and walk in centres into the unscheduled care system. This study used population surveys to explore the effect of these new services on the use of traditional providers of unscheduled care, and to improve understanding of help seeking behaviour within the system of unscheduled care.
Methods
Cross-sectional population postal surveys were undertaken annually over the five year period 1998 to 2002 in two geographical areas in England. Each year questionnaires were sent to 5000 members of the general population in each area.
Results
The response rate was 69% (33,602/48,883). Over the five year period 16% (5223/33602) 95%CI (15.9 to 16.1) of respondents had an unscheduled episode in the previous four weeks and this remained stable over time (p = 0.170). There was an increased use of telephone help lines over the five years, reflecting the change in service provision (p = 0.008). However, there was no change in use of traditional services over this time period. Respondents were most likely to seek help from general practitioners (GPs), family and friends, and pharmacists, used by 9.0%, 7.2% and 6.3% respectively of the 5815 respondents in 2002. Most episodes involved contact with a single service only: 7.0% (2363/33,602) of the population had one contact and 2% (662/33602) had three or more contacts per episode. GPs were the most frequent point of first contact with services.
Conclusion
Introducing new services to the provision of unscheduled care did not affect the use of traditional services. A large majority of the population continued to turn to their GP for unscheduled health care
Impact of NHS Direct on demand for immediate care: observational study
OBJECTIVES: To quantify the impact of NHS Direct on
the use of accident and emergency, ambulance, and
general practitioner cooperative services.
DESIGN: Observational study of trends in use of NHS
Direct and other immediate care services over 24
months spanning introduction of NHS Direct.
Setting Three areas in England in first wave of
introduction of NHS Direct, and six nearby general
practitioner cooperatives as controls.
SUBJECTS: All contacts with these immediate care
services.
MAIN OUTCOME MEASURES: Changes in trends in use
after introduction of NHS Direct.
Results NHS Direct received about 68 500 calls from
a population of 1.3 million in its first year of
operation, of which 72% were out of hours and 22%
about a child aged under 5 years. Changes in trends
in use of accident and emergency departments and
ambulance services after introduction of NHS Direct
were small and nonÂsignificant. Changes in trends in
use of general practitioner cooperatives were also
small but significant, from an increase of 2.0% a
month before introduction of NHS Direct to - 0.8%
afterwards (relative change - 2.9% (95% confidence
interval - 4.2% to - 1.5%)). This reduction in trend
was significant both for calls handled by telephone
advice alone and for those resulting in direct contact
with a doctor. In contrast, the six control cooperatives
showed no evidence of change in trend; an increase of
0.8% a month before NHS Direct and 0.9% after
(relative change 0.1% ( - 0.9% to 1.1%)).
CONCLUSION: In its first year NHS Direct did not reduce
the pressure on NHS immediate care services,
although it may have restrained increasing demand
on one important partâgeneral practitioners' out of
hours services
Derivation of the time dependent Gross-Pitaevskii equation without positivity condition on the interaction
Using a new method it is possible to derive mean field equations from the
microscopic body Schr\"odinger evolution of interacting particles without
using BBGKY hierarchies.
In this paper we wish to analyze scalings which lead to the Gross-Pitaevskii
equation which is usually derived assuming positivity of the interaction. The
new method for dealing with mean field limits presented in [6] allows us to
relax this condition. The price we have to pay for this relaxation is however
that we have to restrict the scaling behavior to and that we have
to assume fast convergence of the reduced one particle marginal density matrix
of the initial wave function to a pure state
NHS Direct: consistency of triage outcomes
OBJECTIVES: To examine the consistency of triage outcomes by nurses using four types of computerised
decision support software in NHS Direct.
METHODS: 119 scenarios were constructed based on calls to ambulance services that had been
assigned the lowest priority category by the emergency medical dispatch systems in use. These
scenarios were presented to nurses working in four NHS Direct call centres using different computerised
decision support software, including the NHS Clinical Assessment System.
RESULTS: The overall level of agreement between the nurses using the four systems was âfairâ rather than
âmoderateâ or âgoodâ (k=0.375, 95% CI: 0.34 to 0.41). For example, the proportion of calls triaged
to accident and emergency departments varied from 22% (26 of 119) to 44% (53 of 119). Between
21% (25 of 119) and 31% (37 of 119) of these low priority ambulance calls were triaged back to the
999 ambulance service. No system had both high sensitivity and specificity for referral to accident and
emergency services.
CONCLUSIONS: There were large differences in outcome between nurses using different software systems
to triage the same calls. If the variation is primarily attributable to the software then standardising on a
single system will obviously eliminate this. As the calls were originally made to ambulance services and
given the lowest priority, this study also suggests that if, in the future, ambulance services pass such
calls to NHS Direct then at least a fifth of these may be passed back unless greater sensitivity in the
selection of calls can be achieved
Probing quasiparticle excitations in a hybrid single electron transistor
We investigate the behavior of quasiparticles in a hybrid electron turnstile
with the aim of improving its performance as a metrological current source. The
device is used to directly probe the density of quasiparticles and monitor
their relaxation into normal metal traps. We compare different trap geometries
and reach quasiparticle densities below 3um^-3 for pumping frequencies of 20
MHz. Our data show that quasiparticles are excited both by the device operation
itself and by the electromagnetic environment of the sample. Our observations
can be modelled on a quantitative level with a sequential tunneling model and a
simple diffusion equation
On the Scale of the Nonlinear Effect in a Crack Problem
When crack problems are analyzed on the basis of nonlinear
theories, such as finite elasticity or deformation theory of
plasticity, it is inevitable that nonlinear effects will
predominate near a crack-tip, even if the loads are small. The
most favorable circumstance in this regard occurs when the
loads are so small that the zone of significant nonlinearity lies
within the region of validity of the near-tip approximation to
the global solution of the associated linearized crack problem.
This situation - called small-scale yielding for crack problems
in plasticity - permits simplifications in analysis which are
often decisive; see, e.g., Knowles (1977) and Rice (1968).
Insofar as we know, there are no analytical estimates
available of the level of load below which nonlinear effects are
guaranteed to be small-scale in the above sense. Indeed, even a
precise version of the question seems to be lacking. In the present
note we formulate and answer such a question for an
especially cooperative crack problem; that corresponding to
finite anti-plane shear of an infinite medium containing a
crack of finite length for an elastic material of Neo-Hookean
type. The associated boundary value problem is a linear one
for Laplace's equation and thus can be solved globally. Nevertheless,
there is a significant nonlinear effect of Kelvin type in
the stress field. We give a condition under which this nonlinear
response occurs on a small scale near the crack tips
Active heat exchange system development for latent heat thermal energy storage
Active heat exchange concepts for use with thermal energy storage systems in the temperature range of 250 C to 350 C, using the heat of fusion of molten salts for storing thermal energy are described. Salt mixtures that freeze and melt in appropriate ranges are identified and are evaluated for physico-chemical, economic, corrosive and safety characteristics. Eight active heat exchange concepts for heat transfer during solidification are conceived and conceptually designed for use with selected storage media. The concepts are analyzed for their scalability, maintenance, safety, technological development and costs. A model for estimating and scaling storage system costs is developed and is used for economic evaluation of salt mixtures and heat exchange concepts for a large scale application. The importance of comparing salts and heat exchange concepts on a total system cost basis, rather than the component cost basis alone, is pointed out. The heat exchange concepts were sized and compared for 6.5 MPa/281 C steam conditions and a 1000 MW(t) heat rate for six hours. A cost sensitivity analysis for other design conditions is also carried out
Statistical analysis of activation and reaction energies with quasi-variational coupled-cluster theory
The performance of quasi-variational coupled-cluster (QV) theory applied to the calculation of activation and reaction energies has been investigated. A statistical analysis of results obtained for six different sets of reactions has been carried out, and the results have been compared to those from standard single-reference methods. In general, the QV methods lead to increased activation energies and larger absolute reaction energies compared to those obtained with traditional coupled-cluster theory
Acceptability of NHS 111 the telephone service for urgent health care: cross sectional postal survey of users' views
Background. In 2010, a new telephone service, NHS 111, was piloted to improve access to urgent
care in England. AÂ unique feature is the use of non-clinical call takers who triage calls with computerized
decision support and have access to clinical advisors when necessary.
Aim. To explore usersâ acceptability of NHS 111.
Design. Cross-sectional postal survey.
Setting. Four pilot sites in England.
Method. A postal survey of recent users of NHS 111.
Results. The response rate was 41% (1769/4265), with 49% offering written comments (872/1769).
Sixty-ive percent indicated the advice given had been very helpful and 28% quite helpful. The
majority of respondents (86%) indicated that they fully complied with advice. Seventy-three percent
was very satisied and 19% quite satisied with the service overall. Users were less satisied
with the relevance of questions asked, and the accuracy and appropriateness of advice given,
than with other aspects of the service. Users who were autorouted to NHS 111 from services such
as GP out-of-hours services were less satisied than direct callers.
Conclusion. In pilot services in the irst year of operation, NHS 111 appeared to be acceptable to the
majority of users. Acceptability could be improved by reassessing the necessity of triage questions used
and auditing the accuracy and appropriateness of advice given. User acceptability should be viewed in
the context of indings from the wider evaluation, which identiied that the NHS 111 pilot services did not
improve access to urgent care and indeed increased the use of emergency ambulance services
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