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Selected AbstractsPreservation of sight in diabetes: developing a national risk reduction programmeDIABETIC MEDICINE, Issue 9 2000L. Garvican SUMMARY Background Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. Photographic schemes The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. Conclusion A systematic national programme based on digital photography is proposed. [source] Evaluating the impact of integrated health and social care teams on older people living in the communityHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2003Louise Brown CQSW BSc(Hons) MSc Abstract Although it is perceived wisdom that joint working must be beneficial, there is, even at this stage, little evidence to support that notion. The present study is an evaluation of two integrated co-located health and social care teams which were established in a rural county to meet the needs of older people and their carers. This study does identify that patients from the ,integrated teams' may self-refer more and are assessed more quickly. This might indicate that the ,one-stop shop' approach is having an impact on the process of service delivery. The findings also suggest that, in the integrated teams, the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information amongst different professional groups. However, the degree of ,integration' seen within these co-located health and social care teams does not appear to be sufficiently well developed to have had an impact upon the clinical outcomes for the patients/service users. It appears unlikely from the available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to service users, then more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that such changes will produce better outcomes. At present, this evidence does not exist, although the present study does suggest that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until the social services and National Health Service trusts develop more efficient and compatible information systems, it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources. [source] Interdisciplinary team interactions: a qualitative study of perceptions of team function in simulated anaesthesia crisesMEDICAL EDUCATION, Issue 4 2008Jennifer M Weller Objectives, We placed anaesthesia teams into a stressful environment in order to explore interactions between members of different professional groups and to investigate their perspectives on the impact of these interactions on team performance. Methods, Ten anaesthetists, 5 nurses and 5 trained anaesthetic assistants each participated in 2 full-immersion simulations of critical events using a high-fidelity computerised patient simulator. Their perceptions of team interactions were explored through questionnaires and semi-structured interviews. Written questionnaire data and interview transcriptions were entered into N6 qualitative software. Data were analysed by 2 investigators for emerging themes and coded to produce reports on each theme. Results, We found evidence of limited understanding of the roles and capabilities of team members across professional boundaries, different perceptions of appropriate roles and responsibilities for different members of the team, limited sharing of information between team members and limited team input into decision making. There was a perceived impact on task distribution and the optimal utilisation of resources within the team. Conclusions, Effective management of medical emergencies depends on optimal team function. We have identified important factors affecting interactions between different health professionals in the anaesthesia team, and their perceived influences on team function. This provides evidence on which to build appropriate and specific strategies for interdisciplinary team training in operating theatre staff. [source] Department of Health Research Overviews , Past, Present and Future: An evaluation of the dissemination of the Blue Book, Child Protection: Messages from ResearchCHILD & FAMILY SOCIAL WORK, Issue 3 2000Weyts Since 1985 the Department of Health has been providing child care research overviews as a means of bringing together the findings of its funded research programmes. With each successive publication a pattern of design and dissemination has emerged. This is illustrated by Child Protection: Messages from Research ( Department of Health 1995), an overview of 20 studies of child protection. It included an introductory essay, summaries of each project and a set of ,True for Us' exercises. Publication was followed by national seminars and widespread distribution of free copies. Given the substantial investment, it seems timely to assess the impact of the dissemination process in terms of reaching and affecting practice. The survey sought to assess awareness, use and opinions of the report from social services, education and health professionals. It consisted of questionnaires administered by post and telephone calls to a representative sample of 600 professionals working in child protection, 292 of whom replied. The results demonstrate that the book is very well known among most professionals working in child welfare, particularly in social services, and is perceived to have affected the practice of over half of the respondents. The study supports the structure adopted for the report but suggests further benefits in employing a variety of dissemination strategies for different professional groups. Finally, the paper discusses the relationship between overviews and evidence-based services. [source] | ||||||||||