1,529 research outputs found
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
Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit
Background-âCardiac 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-âData 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 HuberâWhiteâsandwich 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 â„8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98â0.99), having a partner (OR 1.31, 95% CI 1.17â1.48), not being employed (OR 0.86, 95% CI 0.77â0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77â0.92), greater anxiety (OR 1.02, 95% CI 1.003â1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42â0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09â2.47). Conclusions-âCR 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
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 oneâs 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
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 lossâofâfunction 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 crossâsectional study of geneâenvironment associations with asthma severity, was undertaken. BREATHE data was collected for 1100 participants with asthma, in Tayside and Fife, Scotland during the period 2003â2005. 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, asthmaâreliever 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) 1·36â3·52], treatment for severe eczema (IRR 2·18, 95% CI 1·22â3·91) and a combination of a longâacting ÎČ2âagonist and corticosteroids (IRR 3·29, 95% CI 1·68â6·43).
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
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
Epidemiology of venous leg ulcers in primary health care: Incidence and prevalence in a health centre-A time series study (2010-2014)
The aims of the study were to describe and analyse the temporal trend of the prevalence
and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to
determine healing times and temporal trends in the study period, and to evaluate
related aspects such as the use of the Ankle-Brachial Pressure Index (ABPI) in a
primary care health centre. This was a retrospective study based on a time series
(years 2010-2014) of the prevalence and incidence of VLUs in people aged over
40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic
health records selecting patients, per year (2010-2014), with VLUs based on the
ICD-10 diagnoses. For prevalence, we took into account any patient with an active
VLU in the year of study. For incidence, we took into account patients with a new
VLU in the year of study. A descriptive analysis was carried out based on each of
the collected variables. The variables were examined according to the years of
study (time series) by one-factor analysis of variance (ANOVA) or Kruskal?Wallis
non-parametric test, as appropriate. A survival analysis by Kaplan?Meier curves
and log-rank test was also performed. A total of 139 patients met the VLU criteria.
Among them, only 79.2% were classified as having a VLU and had a correct ICD
diagnosis. The prevalence and incidence increased over the years, doubling in
patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/
year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the
prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/
year. During the study period, a total of 84.2% of the VLUs healed (117/139
VLU). Regarding average annual time to healing, the trend indicates that lesions
took less time to heal (Kruskal?Wallis test, P = 0.004), ranging between
453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was
found to be increasingly performed prior to the appearance of the lesion. The epidemiological
profile of people affected by VLUs continues to be, mainly, that of
women of an advanced age, over 70 years. The frequency of VLU occurrence rose
continually over the years, but healing took less time, and use of ABPI improved.
Assigning a reference nurse in the wounds unit and the organisational structure
around this problem may have an influence on improving care and the approach to
these types of lesions
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