Elizabeth M. Russell

A population based survey of women's experience of the menopause

Objective To describe the prevalence of, and degree of distress caused by, 15 symptoms commonly attributed to the menopause among a random sample of women aged 45 to 54, selected from the total population of a geographically defined area.

Systematic review of the quality of surgical mortality monitoring

Mortality is the most tightly defined and used adverse event for audit and performance monitoring in surgery. However, to identify cause and therefore scope for improvement, accurate and timely data are required. The aim of this study was to perform a systematic review of the quality of measurement, reporting and monitoring of mortality as an outcome after surgery.

Problems in using Health Survey questionnaires in older patients with physical disabilities: Can proxies be used to complete the SF-36?

Background: The SF-36 Health Survey questionnaire has been proposed as a generic measure of health outcome. However, poor rates of return and high levels of missing data have been found in elderly subjects and, even with face-to-face interview, reliability and validity may still be disappointing, particularly in cognitively impaired patients. These patients may be the very patients whose quality of life is most affected by their illness and their exclusion will lead to biased evaluation of health status. A possible alternative to total exclusion is the use of a proxy to answer on the patient’s behalf, but few studies of older people have systematically studied patient-proxy agreement. Objective: To compare the agreement between patients, lay and professional proxies when assessing the health status of patients with the SF-36. Methods: The SF-36 was administered by interview to 164 cognitively normal, elderly patients (Mini-mental State Examination 24 or more) referred for physical rehabilitation. The SF-36 was also completed by a patient-designated lay proxy (by post) and a professional proxy. Agreement between proxies and patients was measured by intraclass correlation coefficients (ICCs), and a bias index. Results: Professional proxies were better able to predict the patients’ responses than were the lay proxies. Criterion levels of agreement (ICC 0.4 or over) were attained for four of the eight dimensions of the SF-36 by professional proxies, but for only one dimension by lay proxies. In professional proxies, the magnitude of the bias was absent or slight (<0.2) for six of the eight dimensions of the SF-36 with a small (0.2–0.49) negative bias for the other two. Lay proxies showed a negative bias (i.e. they reported poorer function than did the patients themselves) for seven of the eight dimensions of the SF-36 (small in two and moderate (0.5–0.79) in five). Conclusions: For group comparisons using the SF-36, professional proxies might be considered when patients cannot answer reliably for themselves. However, in the present study, lay proxy performance on a postal questionnaire showed a strong tendency to negative bias. Further research is required to define the limitations and potentials of proxy completion of health status questionnaires.

Delphi method and nominal group technique in family planning and reproductive health research

This is the authors final draft, not as published in The Journal of Family Planning and Reproductive Health Care, 2006, 32(4), pp.249-252

Attitudes and trends of primary care dentists to continuing professional development: a report from the Scottish dental practitioners survey 2000

Objectives To describe the current and intended continuing professional development activity of dentists in general and community practice.Design A cross-sectional survey by postal questionnaire.Methods A semi-structured questionnaire was sent to all general practice and community dentists identified from the dental practices division as being in practice in Scotland. The issues addressed included personal demographics, current working patterns and job satisfaction, training and professional development and finally career and working intentions.Results Of the 1,917 questionnaires sent to general dental practitioners (GDPs), 1,357 were returned useable (70% response rate); 212 of the 283 questionnaires to community dental practitioners (CDPs) were returned giving a 75% response rate. Of the responders, 89% of GDPs (1,188) and 95% of CDPs (178) reported participating in some form of CPD in the preceding year. One sixth of GDPs (211) and one third of CDPs (62) had a further qualification. Short courses such as Section 63 were very popular with over 90% of GDPs, but more than half the respondents did not think that further qualifications would enhance their career prospects. The most commonly identified barriers to further qualifications were heavy clinical commitments (78%), with 73% citing the substantial cost with no additional benefit. Over a third of GDPs under the age of 30 indicated they intended to sit a postgraduate qualification, but this fell to 12% for those aged over 30. The number of dentists identified on a career break was low (18).Conclusion Two years before implementation of the General Dental Councils mandatory revalidation scheme, over 90% of Scottish primary care dentists reported active participation in continuing professional development. Future initiatives must be sufficiently sophisticated to fulfil the educational needs of different age groups, and to focus on part-time and career break dentists as well as full-time practitioners. It is important to establish career pathways in dental primary care. Part-time modular courses such as Masters degrees in primary care based dentistry may be one solution. An increased number of part-time posts for primary care dentists in secondary dental care may increase the skill base and also increase service provision in secondary care establishments. These pathways should create an opportunity to adequately reward those who continue to develop the knowledge and skills necessary for a technically demanding healthcare profession.Key PointsThis paper reports on a wealth of descriptive information gathered from the first national survey in Scotland of primary care dentists declared preferences for appropriate CPD.For those involved in the planning and provision of CPD this will enable more targeted delivery of education provision and more focussed studies on effective educational methods for dentists.The reader has the opportunity to look at trends in preferences based mainly on age and gender, and there are many interesting differences.Career pathways for primary care dentists are uninspiring at present. Suggestions for linking CPD with long term career development are explored.AbstractObjectives To describe the current and intended continuing professional development activity of dentists in general and community practice.Design A cross-sectional survey by postal questionnaire.Methods A semi-structured questionnaire was sent to all general practice and community dentists identified from the dental practices division as being in practice in Scotland. The issues addressed included personal demographics, current working patterns and job satisfaction, training and professional development and finally career and working intentions.Results Of the 1,917 questionnaires sent to general dental practitioners (GDPs), 1,357 were returned useable (70% response rate); 212 of the 283 questionnaires to community dental practitioners (CDPs) were returned giving a 75% response rate. Of the responders, 89% of GDPs (1,188) and 95% of CDPs (178) reported participating in some form of CPD in the preceding year. One sixth of GDPs (211) and one third of CDPs (62) had a further qualification. Short courses such as Section 63 were very popular with over 90% of GDPs, but more than half the respondents did not think that further qualifications would enhance their career prospects. The most commonly identified barriers to further qualifications were heavy clinical commitments (78%), with 73% citing the substantial cost with no additional benefit. Over a third of GDPs under the age of 30 indicated they intended to sit a postgraduate qualification, but this fell to 12% for those aged over 30. The number of dentists identified on a career break was low (18).Conclusion Two years before implementation of the General Dental Councils mandatory revalidation scheme, over 90% of Scottish primary care dentists reported active participation in continuing professional development. Future initiatives must be sufficiently sophisticated to fulfil the educational needs of different age groups, and to focus on part-time and career break dentists as well as full-time practitioners. It is important to establish career pathways in dental primary care. Part-time modular courses such as Masters degrees in primary care based dentistry may be one solution. An increased number of part-time posts for primary care dentists in secondary dental care may increase the skill base and also increase service provision in secondary care establishments. These pathways should create an opportunity to adequately reward those who continue to develop the knowledge and skills necessary for a technically demanding healthcare profession.

Access to specialist cancer care: is it equitable?

The first principle of the Calman–Hine reports recommendations on cancer services was that all patients should have access to a uniformly high quality of care wherever they may live. This study aimed to assess whether the uptake of chemotherapy for colorectal cancer varied by hospital type in Scotland. Hospitals were classified according to cancer specialisation rather than volume of patients. To indicate cancer specialisation, hospitals were classified as ‘cancer centres’, ‘cancer units’ and ‘non-cancer’ hospitals. Colorectal cancer cases were obtained from cancer registrations linked to hospital discharge data for the period January 1992 to December 1996. Multilevel logistic regression was used to model the binary outcome, namely whether or not a patient received chemotherapy within 6 months of first admission to any hospital. The results showed that patients admitted first to a ‘non-cancer’ hospital were less than half as likely to go on to receive chemotherapy as those first admitted to a cancer unit or centre (OR=0.28). This result was not explained by distance between hospital of first admission and nearest cancer centre, nor by increasing age or severity of illness. The study covers the period immediately preceding the introduction of the Calman–Hine report in Scotland and should serve as a baseline for future monitoring of access to specialist care.

The ethics of attribution: The case of health care outcome indicators

The ethical basis of clinical outcomes measurement is a desire to improve care in a way which will increase both clinical effectiveness and value for money-beneficence as well as competence. To date in the U.K., any debate about producing comparative indicators of clinical outcomes has been concerned mainly with the unfairness to individual doctors or clinical teams of judging their performance on this basis. There has been less interest in the prime purpose of such production, which is to increase the accountability and effectiveness of the NHS as a publicly funded service. Rather than working to improve clinical effectiveness and outcomes within clinical services, health authorities which wish to improve outcomes for their populations have been encouraged simply to shift the contract to another provider of care. The key issue on which the ethics of either action rests is the extent to which the attribution of outcome to intervention is valid and reliable and, therefore, that judgements about performance are just and thus ethical. The consequence of unjust judgements may be to increase the inequalities that medical care resource allocation should attempt to reduce.

Learning about rehabilitation

Not many teaching hospitals or practices in Britain can offer a single service specialty of rehabilitation as a forum for undergraduate learning, and it is therefore necessary either to create a simulated programme or to draw together a range of services or specialties solely for teaching purposes. In this paper, a short medical undergraduate course at Aberdeen University Medical School, using the second approach, is described. The focus of the course was on the doctors role, in every patient and specialty, in the active prevention of temporary or permanent dependence and the ultimate aim was to create in medical students a more positive attitude to holistic patient management. A problem-solving framework was used, in which the students were asked to draw up a provisional problem list for patients from nearly all specialties seen in the post-acute phase in Aberdeen hospitals and in the recovering or adapted state at home. In was hoped that in the process of compiling the data-base students would gain some knowledge of the functional consequences of illness and of the profession and services which might be able to help. Students then met clinical staff to discuss their problem lists and the doctors role in preventing or treating functional problems. Subjective assessments of the course by students and staff suggest that, although the students had difficulty at first in seeing the doctors role in relation to functional problems, by the end of the course most had acquired, through discussion of particular patients, awareness of the importance of that role in assessment and patient education. On the basis of this attempt, the course will be continued but with some modifications.

An Introduction to the National Health Service

The National Health Service itself has evolved from an ideal and during the evolution the expectations and attitudes of the originators, the patients, the public at large and indeed the staff of the service have changed.

The Structure of the Service

The National Health Service itself has evolved from an ideal and during the evolution the expectations and attitudes of the originators, the patients, the public at large and indeed the staff of the service have changed.