Health bulletin
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An out-patient and home parenteral antibiotic therapy programme for the treatment of suitable infections was developed over a four year period. This paper describes the impact of one year's experience of its implementation on various measures of outcome. ⋯ Patients were treated over a 12 month period. 51.5 per cent had skin & soft tissue infections and 22.8 per cent bone & joint sepsis. 57 per cent of patients received out-patient and 34 per cent self or carer administered home therapy. Ninety-four per cent of patients were cured or improved following treatment. Only 7.5 per cent of patients required an unscheduled admission to hospital. Twelve per cent of patients had some type of vascular device related adverse event (partly due to a faulty batch of lines) and six per cent of patients had a drug related reaction. The additional daily cost of drugs was minimal (< 12 Pounds/day) and more than 1,461 bed days have been saved across the Directorates. The patient satisfaction level was high.
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An interview survey was conducted to ascertain the views of the first cohort of doctors in Scotland completing Higher Specialist Training under the new Calman arrangements. It was intended that this information would influence plans for the future training of Specialists in Scotland, building on strengths and addressing weaknesses. A team of interviewers saw 140 out of the 168 Senior/Specialist Registrars who were due to receive their Certificate of Completion of Specialist Training (CCST) in the year leading to August 1999. ⋯ Only one third of the sample felt that they had had a continuing mentor or supervisor throughout the training programme. Trainees have reservations about their annual formal RITA assessments with some feeling that they lack objectivity as far as assessment of their own performance is concerned. They were more positive about the impact of Specialty Committees on the quality of training posts.
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Primary care is at the centre of the National Health Service (NHS) in Scotland; however, its R & D capacity is insufficiently developed. R&D is a potentially powerful way of improving the health and well-being of the population, and of securing high quality care for those who need it. In order to achieve this, any Scottish strategy for primary care R&D should aim to develop both a knowledge-based service and a research culture in primary care. ⋯ Comprehensive funding for training and career development will ensure that staff have the skills to participate in both DRDPs and in the School's activities. Thus, inadequate commitment to any one component of the strategy will mean that other components will be less successful. Commitment to all three components will maximise the chances of success.
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To improve the quality of anaesthesia for caesarean section by assessing the type and reason for using a particular anaesthetic; monitoring the incidence of anaesthetic complications or side effects; and measuring patient satisfaction with anaesthesia provided. ⋯ An initial audit involving 79 patients undergoing emergency and elective caesarean section revealed the following: 58.0 per cent of emergency sections and 45.5 per cent of elective sections were given general anaesthesia; "failure to progress" was indicated as the main reason for caesarean section in 27.8 per cent of cases; 25.3 per cent of patients experienced an anaesthetic-related complication or side-effect; and 90.3 per cent of patients were satisfied with their anaesthesia rising to 97.2 per cent after technical adjustment. The main findings were presented to the multi-disciplinary team staffing the unit. It was agreed that the quality of care could be further improved and changes to anaesthetic practice were quickly introduced. A subsequent re-audit of a further 87 patients showed a number of significant improvements: the overall use of general anaesthesia had fallen to 23.8 per cent from 53.0 per cent (P < 0.05); a noticeable reduction in the number of anaesthetic side-effects and complications had occurred, down from 25.3 per cent to 17.2 per cent of all sections; and patient satisfaction rates with anaesthesia provided were maintained.