Prison health and public health responses at a regional prison in Western Australia

Objective: To describe the health of inmates in a Western Australian regional prison and evaluate the coverage of public health interventions. Design: Cross‐sectional audit of all paper‐based and electronic medical notes of inmates at one regional prison in Western Australia. Setting: A mixed medium‐security prison in regional Western Australia. Participants: 185 prisoners, 170 men and 15 women Main Results: The prisoners were mainly young (70% < 35 years of age) and Indigenous (84%). Fifty two percent of prisoners had at least one chronic health condition. There was a significantly higher prevalence of diabetes to that found in the general Indigenous population (15% vs 6% p=0.001), and a significantly lower prevalence hepatitis C (4.5%) compared with both national (29–61%) and State (20%) data. Screening for sexually transmitted infections and blood borne viruses within the first month of incarceration was achieved for 43% of inmates. Vaccination coverage for influenza (36%) and pneumococcal disease (12%) was low. Conclusion: This study makes visible the burden of disease and reach of public health interventions within a largely Indigenous regional prisoner population. Our study demonstrates that the additional risks associated with being Indigenous remain in a regional Australian prison but also shows that interventions can be delivered equitably to Indigenous and non‐Indigenous inmates. Implications: Ongoing monitoring of prisoner health is critical to take advantage of opportunities to improve public health interventions with timely STI and BBV screening and increased vaccinations rates.     

Familial adenomatous polyposis at the Tel Aviv Medical Center: demographic and clinical features

Familial adenomatous polyposis (FAP) is an uncommon, but widespread genetic disorder that develops multiple colonic adenomatous polyps and, if untreated, can lead to large bowel cancer. Little is known about its occurrence and characteristics in the Israeli population. Aims: To evaluate FAP prevalence, phenotypic manifestations and compliance for diagnosis and follow-up in our registry. Methods: Since 1993 approximately one-half of FAP patients in Israel have been seen and followed-up by us before and/or after colectomy. They and their families were encouraged to have mutation analysis, genetic and/or endoscopic screening. Results: 37 pedigrees were identified, including 2 non-Jewish. The Jewish ethnic distribution was similar to that of the general population and the point prevalence rate estimated as 28.4/one million Jewish inhabitants. There were 461 first-degree relatives at-risk for FAP. Genetic screening was completed and successful in 28 pedigrees (87.5%), and 73 FAP patients entered the registry. Marked intra-familial phenotypic variations with minimal disease manifestation were noted in 11 patients belonging to 4 pedigrees. Cancer occurred in 15.1% (11 patients), in 10 before FAP diagnosis or during follow-up elsewhere, but one non-compliant patient developed duodenal cancer. One other patient died from a massive, neglected, intra-abdominal desmoid. Compliance for evaluation and follow-up of pedigree members and individual FAP patients was inadequate in 29% and 27%, respectively. Conclusions: FAP occurs in the Israeli Jewish population at the expected rate, but is inadequately recognized in non-Jews. The inadequate compliance for screening and post-surgical follow-up needs to be addressed by educating the public, health care workers and Health Insurers.     

Patient satisfaction: a valid index of quality of care in a psychiatric service

OBJECTIVE: To assess patients', clinicians' and referrers' satisfaction with care in newly referred psychiatric patients and to compare these with standard quality indicators such as waiting times used by the service. METHOD: A random sample of all new adult psychiatric patients presenting over a 4-month period in 2 successive years to an inner-city psychiatric service was assessed. RESULTS: One hundred and thirteen (68%) of 167 randomly selected patients were seen. Independent evidence of service performance showed that patient satisfaction, but not clinician or referrer satisfaction, was a more accurate indicator of quality of care than standard indicators. CONCLUSION: Simple ratings of patient satisfaction alone may be useful indicators of quality of psychiatric care.     

Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?

The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient's perspective. This paper reports on the findings from a semi-structured telephone interview survey which formed part of a hospital-wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi-structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed.     

ACE inhibitors and heart failure in hospital: any difference between cardiologists and general physicians?

Cardiologists and generalists have been reported to diverge in terms of their self-reported use of angiotensin-converting enzyme (ACE) inhibitors, but information on their actual use of ACE inhibitors has been lacking. In order to assess ACE inhibitor use in patients with heart failure in a teaching hospital and any differences between specialties we studied all patients in the Western Infirmary of Glasgow between 1 April and 1 October 1996 with an echocardiogram showing moderate or severe left ventricular systolic dysfunction (n = 236). We found that most patients were on an ACE inhibitor (66%), 12% had been tried but found to be intolerant, 10% had not been tried because of a contraindication, but 12% had not been tried despite no contraindication. Of those on treatment, 58% were on a dose used in a major survival study (38% of all patients). Most patients were treated by a cardiologist (64%). Of these, more were on an ACE inhibitor (77% vs 53%, p < 0.01), fewer had been tried but found intolerant (11% vs 18%), and fewer had never been tried (11% vs 29%, p < 0.01), irrespective of whether they had a contraindication (5% vs 18%, p < 0.01) or not (6% vs 12%). More were on a dose used in a major survival study (48% vs 31%, p < 0.05). We conclude that, despite improvements over time, ACE inhibitors are still under-used, sometimes without good reason. There are also differences in the use of ACE inhibitors between cardiologists and generalists which may affect outcome, and could affect resource utilisation.     

Production and evaluation of guidelines for the management of inflammatory bowel disease: the Leicester experience

Consensus guidelines for the management of patients with inflammatory bowel disease were produced by gastroenterologists, gastrointestinal surgeons and a cross-section of general practitioners (GPs) from Leicestershire in order to develop a seamless pattern of care with a common approach to diagnosis and treatment. It was hoped that the guidelines would encourage a movement towards care in the community for many patients with stable disease and so speed up new consultation rates. The study then assessed the impact of these guidelines on the referral letters of GPs to hospital consultants, the prediction of disease and adherence to them on re-referring patients after discharge. The guidelines were distributed to all 487 GPs in the Leicester Health Authority area and the gastroenterology teams within the hospitals. The value of the guidelines was assessed by an audit of referral letters, the length of time from referral letter to out-patient appointment, both before and after the launch of the guidelines, adherence to the guidelines on re-referral, and monitoring the outcome of the discharged patients. Whilst the guidelines may have helped GPs to manage stable patients in the community, the content of referral letters and the diagnostic abilities of GPs were not seen to improve since the launch of the guidelines. However, only 5% of stable patients who were discharged from one clinic were re-referred for inflammatory bowel disease.


     

Audit and Re-audit of the CSP Core Standards of Physiotherapy Practice

The third edition of the Core Standards of PhysiotherapyPractice has been piloted in eight sites, representing the whole breadth of the physiotherapy profession. Part of the pilot involved auditing patient records and soliciting patient feedback using a questionnaire, both in two stages. The first audit was carried out before physiotherapists had knowledge of the content of the new standards. The re-audit was carried out after a period of awareness-raising and implementation of any changes arising from the first audit. All audit criteria including the patient feedback were specifically generated from the standards.Significant and important improvements were reported from the patient record audits, especially in the standards relating to recording of patients' expectations, patients' goals, and use of outcome measures.The patient feedback questionnaire showed a consistently high level of achievement but less real change between the two audits. Some issues around consent improved, as did privacy. Performance against some criteria deteriorated, although not significantly, for example patients' perceptions of the effectiveness of treatment. Documentation in patient records has shown important improvements as a result of the new standards. Feedback from patients suggests little change in conformance with those standards and criteria more appropriately measured by patients.Audit is a useful tool for disseminating and implementing national standards when carried out in partnership with physiotherapy managers.     

A modification of the POSSUM surgical audit system for the minimally invasive therapy community

Summary

The POSSUM system has the potential to be the universally accepted basic surgical audit system. Some modifications are suggested to enhance POSSUM'S sensitivity.     

信息系统审计--备份与灾难恢复方案

信息系统有着与生俱来的风险,这种风险以不同的方式冲击着信息系统。就医院行业来讲,HIS已成为医院业务处理的核心,如何控制和规避风险,就需要在建设实施HIS的同时,按照信息系统审计要求,对HIS的安全、风险管理与控制制定方案与审计,目的是保障系统的正常运行。本文也是本院HIS实施过程中制定的审计文档。