The role of ENT surgeons in snoring assessment : some prospective preliminary evidence

Objectives: To determine (i) the prevalence of unsuspected upper aerodigestive tract disease in snorers, (ii) the diagnostic yield of routine flexible endoscopy and (iii) the relationship between symptoms of upper aerodigestive tract disease and examination findings in snorers. Design: Prospective analytical cohort study. Setting: Snoring clinic in Secondary Care Otolaryngologycentre. Participants: Ninety-three patients referred with disruptive snoring.Main outcome measures: A structured history ofupper aerodigestive tract symptoms was obtained byclinic interview. All patients underwent detailed ENTexamination. Univariate analysis was undertaken on data collected. Results: The prevalence of oropharyngeal and laryngealpathology in the cohort was 3%. No unsuspected upper aerodigestive tract pathology was found on routineflexible endoscopy. A history of Hard Nasal Symptoms was an accurate predictor of underlying nasal pathology. Conclusion: The authors propose that the detailed examination of snorers by ENT specialists is unnecessary in the absence of Hard Nasal Symptoms, hoarseness orpain. We propose that a system of triage based on patient history could help identify the minority of snorers who require specialist assessment

The pain of low status: the relationship between subjective socio-economic status and analgesic prescriptions in a Scottish community sample

There is a strong positive relationship between objective measures of socioeconomic status (OSS) and general health. However, there is an increasing interest in the relationship between health and subjective socioeconomic status (SSS), which describes one’s perceived rank in relation to the rest of society, based on factors such as income, occupation, and education. While the relationship between SSS and general health is well2established, the relationship between SSS and pain has received little attention. Gathering both self2report questionnaire data and General Practitioner medical data from a large representative community sample in Scotland between 2012 and 2013 ( N = 1824), we investigated the relationship between SSS and prescriptions for analgesic drugs. We found that higher levels of SSS significantly predicted lower odds of participants having been prescribed at least one analgesic drug in the previous six months. We obtained this result even after controlling for OSS2related variables (education, occupational status, and geographical location) and demographic variables (age and gender). This suggests that, just like the relationship between SSS and general health, SSS has important effects on pain that go beyond the influence of OSS

Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit

Background-—Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation. Methods and Results-—Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees,using the Huber–White–sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98–0.99), having a partner (OR 1.31, 95% CI 1.17–1.48), not being employed (OR 0.86, 95% CI 0.77–0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77–0.92), greater anxiety (OR 1.02, 95% CI 1.003–1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42–0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09–2.47). Conclusions-—CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence-based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized

Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework

Objective: Evidence suggests that only a minority of service users experiencing psychosis have access to Cognitive Behavioural Therapy for psychosis (CBTp). Normalisation Process Theory (NPT) is a theoretical framework which focuses on processes by which interventions are implemented and normalised in clinical practice. This study explored the views and experiences of mental health professionals regarding the implementation of CBTp. Barriers and facilitators to implementation were explored using the NPT framework. Design: A qualitative methodology was adopted involving semi-structured focus groups and individual interviews. Methods: A total of 14 members of staff working in the community and crisis mental health teams were recruited. Thematic analysis was used to generate initial themes. The Framework approach was utilised to map initial themes to the NPT framework. Results: Inductive coding generated five overarching themes consisting of 15 individual subthemes which captured the perceived barriers to engagement; contextual barriers to implementation; optimisation of implementation; positive attitudes towards implementation; and expectations of implementing CBTp. All but two subthemes mapped on to the NPT framework. The deductive analysis suggested that difficulties in making sense of CBTp among professionals were reflected as service level barriers which impeded wider implementation. Conclusion: The results of this study suggested a mixture of barriers and facilitators to CBTp implementation. Interpreting our findings within an NPT framework indicates the importance of strong clinical leadership to address difficulties in sense-making and service investment in CBTp

Individuals with filaggrin-related eczema and asthma have increased long-term medication and hospital admission costs

Background Eczema and asthma are chronic diseases with onset usually before the age of 5 years. More than 50% of individuals with eczema will develop asthma and/or other allergic diseases. Several loss‐of‐function mutations in filaggrin (FLG) have been identified in patients with eczema. However, the association of FLG with healthcare use is unknown. Objectives To determine whether FLG mutations are associated with increased prescribing for eczema and asthma and whether increased prescribing is associated with increased healthcare costs. Methods A secondary analysis of BREATHE, a cross‐sectional study of gene–environment associations with asthma severity, was undertaken. BREATHE data was collected for 1100 participants with asthma, in Tayside and Fife, Scotland during the period 2003–2005. Through collaboration with the Health Informatics Centre in Dundee, BREATHE was linked to accident and emergency, community prescribing and Scottish morbidity records. The data linkage allowed longitudinal exploration of associations between genetic variation and prescribing. Results An association was found between FLG mutations and increased prescribing for mild and moderate eczema, asthma‐reliever medicine and asthma exacerbations. A strong association was found between FLG mutations and prescribing of emollients [incidence rate ratio (IRR) 2·19, 95% confidence interval (CI) 1·36–3·52], treatment for severe eczema (IRR 2·18, 95% CI 1·22–3·91) and a combination of a long‐acting β2‐agonist and corticosteroids (IRR 3·29, 95% CI 1·68–6·43). Conclusions The presence of FLG mutations in this cohort is associated with increased prescribing for eczema and asthma. Randomized controlled trials are required to determine if these individuals could benefit from management strategies to reduce morbidity and treatment costs

Primary Care Staff's Views and Experiences Related to Routinely Advising Patients about Physical Activity. A Questionnaire Survey

Background: United Kingdom public health policy has recently re-emphasised the role of primary health care professionals in tackling increasing levels of physical inactivity within the general population. However, little is known about the impact that this has had in practice. This study explores Scottish primary care staff's knowledge, attitudes and experiences associated with advising patients about physical activity during routine consultations. Methods: A cross-sectional questionnaire survey of general practitioners (or family physicians), practice nurses and health visitors based in four health regions was conducted during 2004. The main outcome measures included: i) health professionals' knowledge of the current physical activity recommendations; (ii) practice related to routine physical activity advising; and (iii) associated attitudes. Results: Questionnaires were returned by 757 primary care staff (response rate 54%). Confidence and enthusiasm for giving advice was generally high, but knowledge of current physical activity recommendations was low. In general, respondents indicated that they routinely discuss and advise patients about physical activity regardless of the presenting condition. Health visitors and practice nurses were more likely than general practitioners to offer routine advice. Lack of time and resources were more likely to be reported as barriers to routine advising by general practitioners than other professional groups. However, health visitors and practice nurses were also more likely than general practitioners to believe that patients would follow their physical activity advice giving. Conclusion: If primary health care staff are to be fully motivated and effective in encouraging and supporting the general population to become more physically active, policymakers and health professionals need to engage in efforts to: (1) improve knowledge of current physical activity recommendations and population trends amongst frontline primary care staff; and (2) consider the development of tools to support individual assessment and advice giving to suit individual circumstances. Despite the fact that this study found that system barriers to routine advising were less of a problem than other previous research has indicated, this issue still remains a challenge

Management of hemiplegic shoulder pain: A UK-wide online survey of physiotherapy and occupational therapy practice

Purpose: The purpose of this study was to explore, via an online survey, how therapists assess, diagnose and manage hemiplegic shoulder pain (HSP) in the United Kingdom. The objectives were to explore (1) how therapists assessed HSP, (2) what the aims of therapy were, (3) what interventions therapists used, (4) what outcome measures therapists used, (5) what training of HSP therapists had, and (6) what barriers therapists experienced in the management of HSP. Methods: An online survey was distributed to physiotherapists (PTs) and occupational therapists (OTs) working in stroke rehabilitation via professional bodies' interest groups. Results: Sixty-seven responses were received: 40 (60%) were PTs and 27 (40%) were OTs. Therapists routinely screened for HSP (n = 59, 89%). When HSP was assessed, 33 (50%) spent 10 min on assessment. Patient-reported pain was used for assessment of HSP by 66 (99%) of respondents. Frequent interventions included positioning (n = 62, 94%), posture re-education (n = 57, 86%), and range of motion exercises (n = 55, 83%). Range of movement was used as an outcome measure by 31 (47%). Sixty (91%) respondents reported receiving training in HSP management. Time constraints (n = 41, 62%) and lack of diagnosis of HSP (n = 33, 54%) were identified as barriers to providing appropriate care to people with HSP. Conclusion: Study findings showed varied practice in the assessment and treatment for HSP and indicate that time constraints are a considerable barrier to the management of these patients. Further research is required to establish best practice which may help improve outcomes and care for people with poststroke shoulder pain