methodologically suspect, while the negative studies are accepted uncritically! The book ends wit... more methodologically suspect, while the negative studies are accepted uncritically! The book ends with a chapter by Peter Skrabanek which is, as expected, witty and provocative, but makes no contribution to the scientific arguments. At the beginning the reader is exhorted to "read on and make up your own mind about environmental tobacco smoke". I still have not made up my mind about it. That would be impossible from such a partial book.
To determine whether there was any benefit from a single house call by a health visitor (a public... more To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. A randomized controlled trial with blind assessments at 28 days was conducted. Subjects included residents of Bath, England, with an average age of 83 years, who were discharged consecutively from a geriatric hospital to their homes. Intervention was a single visit by a health visitor 72 hours after discharge, to ensure the patient was settled at home, or normal post-discharge care. Outcome measures taken at 28 days by a research nurse included survival, hospital readmissions, nursing home admissions, cognitive and physical function, services requested and supplied, and drug therapy. There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements. The control subjects did better than the study subjects on many of the outcome measures. A house c...
There is relatively little information available about the response of people of different ages, ... more There is relatively little information available about the response of people of different ages, particularly elderly people, to symptoms of ill health. This background information is essential for altering inappropriate responses, for such responses may cause long delays or even a complete lack of treatment for people who may be responsive to such treatment. This paper indicates that older people may not choose as wide a range of different health care services as younger people. They tend to concentrate their attention on calling the general practitioner or, in the case of foot trouble, the chiropodist, without recourse to other services. In particular, they tend to avoid using the emergency services, even where appropriate, and prefer to refer problems to the general practitioners, rather than the practice or community-based nurses. It will be necessary to help older people to understand the wider roles that nurses in particular are undertaking if primary care is to be seen as the central focus of health services in future. There is need for more health education by general practitioners for elderly people. This is especially important since the role of general practitioners is likely to change as the emphasis on primary care increases.
An objective measurement of anxiety at defined intervals after the onset of acu.te cardiac sympto... more An objective measurement of anxiety at defined intervals after the onset of acu.te cardiac symptoms was made in 203 men admitted to the Coronary Care Unit, Royal Infirmary ofEdinburgh, and in 83 patients in a Teesside coronary survey. Of the Teesside patients, 50 were treated at home, 22 were admitted initially to a coronary care unit, and 11 were admitted directly to a general medical ward. In the Edinburgh patients the level of anxiety was high early in the illness, fell rapidly, and rose again towards the end of their stay in hospital. At 4 months it was that of a normal population. After transferfrom the coronary care unit thegroup was not more anxious than otherpatients in the ward. Reaction to the illness was unrelated to its physical severity. Patients who reacted badly at the beginning were less likely to return to work. The pattern of anxiety in the Teesside patients resembled that of the Edinburgh group, and reaction to illness was largely independent ofphysical aspects. Treatment in hospital, either through a coronary care umnt initially or in a medical ward, did not increase emotional distress. At 3 months patients treated initially in a coronary care unit were less anxious than the others. Throughout the period of study the Teesside patients were more anxious than the Edinburgh patients and outcome was not related to anxiety. Social and environmental differences may account for this. An increasing number of patients with acute attack, and outcome of treatment. At the same time ischaemic heart disease are treated at the beginning an epidemiological survey of the incidence, morof their illness in coronary care units. The physical tality, and outcome in all cases of ischaemic heart benefits of continuous monitoring, early treatment of disease in Teesside County Borough (now part of dangerous arrhythmias, and intensive care by Cleveland County) was being carried out by a highly trained staff have been discussed (Lawrie combined medical team. The opportunity was taken et al., 1967), as have been the possible adverse to measure anxiety in 83 consecutive cases (group psychological effects on the patient of such an en-B) by the same method and at much the same time vironment and of subsequent transfer to open intervals as in the Edinburgh study. Of the Teesside wards (Hackett, Cassem, and Wishnie, 1968; patients, 50 were treated at home by their general Dominian and Dobson, 1969). Rehabilitation may practitioner, 22 were admitted initially to a coronary fail for psychological as well as physical reasons care unit, and the remaining 11 were admitted (Nagle, Gangola, and Picton-Robertson, 1971; directly to a general hospital ward. Cay et al., 1973), so it is important that treatment The purpose of the study was to examine anxiety of the acute attack should not increase emotional after a heart attack in the two very different populadisturbance. tions and to relate this to the varying methods of This paper presents the results of two studies of treatment. anxiety in patients after a heart attack. The first group (group A) comprised 203 men admitted Method consecutively to the Coronary Care Unit of the Royal Infirmary, Edinburgh-a six-roomed purpose-Anxiety was tested by the Cattell 8-Parallel-Form built unit. Anxiety at defined intervals was measured Anxiety Battery (Scheier and Cattell, 1960). Each and related to the physical diagnosis, severity of the of the 8 forms of the battery consists of 7 brief,
POLITICISATION OF HEALTH STATISTICS SIR,—We appreciate your positive response (April 20, p ... more POLITICISATION OF HEALTH STATISTICS SIR,—We appreciate your positive response (April 20, p 138) to our report Unsafe in their Handsl and would like to clarify some points you raised. Since Mr Norman Fowler's leaflet mentioned
A RANDOM sample of over 4,000 residents of Cardiff were questioned about their lifestyle and atti... more A RANDOM sample of over 4,000 residents of Cardiff were questioned about their lifestyle and attitudes to health. Comparisons between the younger and older age groups showed that older people drank less alcohol and smoked fewer cigarettes than younger people, but that they took less exercise and ate fewer foods of the kind associated with a healthy diet. Com-parisons between the Cardiff survey and others reveal similar findings. There is a marked variation in the response of older people to different issues, pos-sibly due to financial pressures. Older people were much closer to younger people in their knowledge of lifestyle issues than in their habits. Measures of the effectiveness of recent prevention strategies suggest that older people, as well as being interested in
These important subjects have been chosen to have free online access. This quarter we are devotin... more These important subjects have been chosen to have free online access. This quarter we are devoting half of the issue to Sports Medicine, thanks to the untiring efforts of our Commissioning Editor for that topic, Professor Nicola Maffulli. In addition, the Bulletin has a section to celebrate its amazing archive, (see end of 'In this Issue'). The British Medical Bulletin (BMB) on its website also has a fascinating section on the Nobel Prizewinners who wrote for the Bulletin and went on to win the accolade and the OUP blog often has input from the Bulletin authors and editors. The first free online access review is Ethics of intensive care unit (ICU) triage during COVID-19 by 'Vinay, Baumann and Biller-Andorno from the University of Zurich, Switzerland'. They say that the coronavirus disease 2019 (COVID-19) pandemic has placed ICU triage at the centre of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria are ethically acceptable. This paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. Points of agreement in the guidelines that are widely supported by ethical arguments are (i) to avoid using a first come, first served, policy or quality-adjusted life-years, and (ii) to rely on medical prognosis, maximizing lives
This is the British Medical Bulletin's third edition for 2016. This set of Reviews is about devel... more This is the British Medical Bulletin's third edition for 2016. This set of Reviews is about developing ideas in medicine for trainee specialists and people who are wishing to get up-to-date in a specialty with which they are not familiar. Reviews, which we believe to be of particular and general interest, will be developed on the Oxford University Press blog. The first review for the present edition is entitled 'The changing face of the English National Health Service; new providers. markets and morality' (pages ??) by Frith from The University of Liverpool, UK. She states that one significant change in the English NHS has been the introduction of market mechanisms. The extent and appropriate role for market mechanisms in the NHS is hotly debated. It appears that we are moving towards a more marketbased NHS, and the possible effects of this will be discussed. Rarely are the policy changes in the NHS evidence-based in any meaningful way, and they are often driven by ideological considerations rather than clear evidence. There needs to be a greater reliance on evidence of what works and a commitment to healthcare as a societal good. There needs to be a discussion of what the NHS should be-a funder and provider, a funder or a partial funder?
Two hundred and three male patients with ischaemic heart disease who had received initial treatme... more Two hundred and three male patients with ischaemic heart disease who had received initial treatment in the Coronary Care Unit, Royal Infirmary of Edinburgh, were interviewed in a medical ward during their convalescence and an estimate of their medical, psychiatric and social ...
methodologically suspect, while the negative studies are accepted uncritically! The book ends wit... more methodologically suspect, while the negative studies are accepted uncritically! The book ends with a chapter by Peter Skrabanek which is, as expected, witty and provocative, but makes no contribution to the scientific arguments. At the beginning the reader is exhorted to "read on and make up your own mind about environmental tobacco smoke". I still have not made up my mind about it. That would be impossible from such a partial book.
To determine whether there was any benefit from a single house call by a health visitor (a public... more To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. A randomized controlled trial with blind assessments at 28 days was conducted. Subjects included residents of Bath, England, with an average age of 83 years, who were discharged consecutively from a geriatric hospital to their homes. Intervention was a single visit by a health visitor 72 hours after discharge, to ensure the patient was settled at home, or normal post-discharge care. Outcome measures taken at 28 days by a research nurse included survival, hospital readmissions, nursing home admissions, cognitive and physical function, services requested and supplied, and drug therapy. There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements. The control subjects did better than the study subjects on many of the outcome measures. A house c...
There is relatively little information available about the response of people of different ages, ... more There is relatively little information available about the response of people of different ages, particularly elderly people, to symptoms of ill health. This background information is essential for altering inappropriate responses, for such responses may cause long delays or even a complete lack of treatment for people who may be responsive to such treatment. This paper indicates that older people may not choose as wide a range of different health care services as younger people. They tend to concentrate their attention on calling the general practitioner or, in the case of foot trouble, the chiropodist, without recourse to other services. In particular, they tend to avoid using the emergency services, even where appropriate, and prefer to refer problems to the general practitioners, rather than the practice or community-based nurses. It will be necessary to help older people to understand the wider roles that nurses in particular are undertaking if primary care is to be seen as the central focus of health services in future. There is need for more health education by general practitioners for elderly people. This is especially important since the role of general practitioners is likely to change as the emphasis on primary care increases.
An objective measurement of anxiety at defined intervals after the onset of acu.te cardiac sympto... more An objective measurement of anxiety at defined intervals after the onset of acu.te cardiac symptoms was made in 203 men admitted to the Coronary Care Unit, Royal Infirmary ofEdinburgh, and in 83 patients in a Teesside coronary survey. Of the Teesside patients, 50 were treated at home, 22 were admitted initially to a coronary care unit, and 11 were admitted directly to a general medical ward. In the Edinburgh patients the level of anxiety was high early in the illness, fell rapidly, and rose again towards the end of their stay in hospital. At 4 months it was that of a normal population. After transferfrom the coronary care unit thegroup was not more anxious than otherpatients in the ward. Reaction to the illness was unrelated to its physical severity. Patients who reacted badly at the beginning were less likely to return to work. The pattern of anxiety in the Teesside patients resembled that of the Edinburgh group, and reaction to illness was largely independent ofphysical aspects. Treatment in hospital, either through a coronary care umnt initially or in a medical ward, did not increase emotional distress. At 3 months patients treated initially in a coronary care unit were less anxious than the others. Throughout the period of study the Teesside patients were more anxious than the Edinburgh patients and outcome was not related to anxiety. Social and environmental differences may account for this. An increasing number of patients with acute attack, and outcome of treatment. At the same time ischaemic heart disease are treated at the beginning an epidemiological survey of the incidence, morof their illness in coronary care units. The physical tality, and outcome in all cases of ischaemic heart benefits of continuous monitoring, early treatment of disease in Teesside County Borough (now part of dangerous arrhythmias, and intensive care by Cleveland County) was being carried out by a highly trained staff have been discussed (Lawrie combined medical team. The opportunity was taken et al., 1967), as have been the possible adverse to measure anxiety in 83 consecutive cases (group psychological effects on the patient of such an en-B) by the same method and at much the same time vironment and of subsequent transfer to open intervals as in the Edinburgh study. Of the Teesside wards (Hackett, Cassem, and Wishnie, 1968; patients, 50 were treated at home by their general Dominian and Dobson, 1969). Rehabilitation may practitioner, 22 were admitted initially to a coronary fail for psychological as well as physical reasons care unit, and the remaining 11 were admitted (Nagle, Gangola, and Picton-Robertson, 1971; directly to a general hospital ward. Cay et al., 1973), so it is important that treatment The purpose of the study was to examine anxiety of the acute attack should not increase emotional after a heart attack in the two very different populadisturbance. tions and to relate this to the varying methods of This paper presents the results of two studies of treatment. anxiety in patients after a heart attack. The first group (group A) comprised 203 men admitted Method consecutively to the Coronary Care Unit of the Royal Infirmary, Edinburgh-a six-roomed purpose-Anxiety was tested by the Cattell 8-Parallel-Form built unit. Anxiety at defined intervals was measured Anxiety Battery (Scheier and Cattell, 1960). Each and related to the physical diagnosis, severity of the of the 8 forms of the battery consists of 7 brief,
POLITICISATION OF HEALTH STATISTICS SIR,—We appreciate your positive response (April 20, p ... more POLITICISATION OF HEALTH STATISTICS SIR,—We appreciate your positive response (April 20, p 138) to our report Unsafe in their Handsl and would like to clarify some points you raised. Since Mr Norman Fowler's leaflet mentioned
A RANDOM sample of over 4,000 residents of Cardiff were questioned about their lifestyle and atti... more A RANDOM sample of over 4,000 residents of Cardiff were questioned about their lifestyle and attitudes to health. Comparisons between the younger and older age groups showed that older people drank less alcohol and smoked fewer cigarettes than younger people, but that they took less exercise and ate fewer foods of the kind associated with a healthy diet. Com-parisons between the Cardiff survey and others reveal similar findings. There is a marked variation in the response of older people to different issues, pos-sibly due to financial pressures. Older people were much closer to younger people in their knowledge of lifestyle issues than in their habits. Measures of the effectiveness of recent prevention strategies suggest that older people, as well as being interested in
These important subjects have been chosen to have free online access. This quarter we are devotin... more These important subjects have been chosen to have free online access. This quarter we are devoting half of the issue to Sports Medicine, thanks to the untiring efforts of our Commissioning Editor for that topic, Professor Nicola Maffulli. In addition, the Bulletin has a section to celebrate its amazing archive, (see end of 'In this Issue'). The British Medical Bulletin (BMB) on its website also has a fascinating section on the Nobel Prizewinners who wrote for the Bulletin and went on to win the accolade and the OUP blog often has input from the Bulletin authors and editors. The first free online access review is Ethics of intensive care unit (ICU) triage during COVID-19 by 'Vinay, Baumann and Biller-Andorno from the University of Zurich, Switzerland'. They say that the coronavirus disease 2019 (COVID-19) pandemic has placed ICU triage at the centre of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria are ethically acceptable. This paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. Points of agreement in the guidelines that are widely supported by ethical arguments are (i) to avoid using a first come, first served, policy or quality-adjusted life-years, and (ii) to rely on medical prognosis, maximizing lives
This is the British Medical Bulletin's third edition for 2016. This set of Reviews is about devel... more This is the British Medical Bulletin's third edition for 2016. This set of Reviews is about developing ideas in medicine for trainee specialists and people who are wishing to get up-to-date in a specialty with which they are not familiar. Reviews, which we believe to be of particular and general interest, will be developed on the Oxford University Press blog. The first review for the present edition is entitled 'The changing face of the English National Health Service; new providers. markets and morality' (pages ??) by Frith from The University of Liverpool, UK. She states that one significant change in the English NHS has been the introduction of market mechanisms. The extent and appropriate role for market mechanisms in the NHS is hotly debated. It appears that we are moving towards a more marketbased NHS, and the possible effects of this will be discussed. Rarely are the policy changes in the NHS evidence-based in any meaningful way, and they are often driven by ideological considerations rather than clear evidence. There needs to be a greater reliance on evidence of what works and a commitment to healthcare as a societal good. There needs to be a discussion of what the NHS should be-a funder and provider, a funder or a partial funder?
Two hundred and three male patients with ischaemic heart disease who had received initial treatme... more Two hundred and three male patients with ischaemic heart disease who had received initial treatment in the Coronary Care Unit, Royal Infirmary of Edinburgh, were interviewed in a medical ward during their convalescence and an estimate of their medical, psychiatric and social ...
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