Journal of public health medicine
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J Public Health Med · Sep 1998
Review Comparative StudyThe effectiveness of hospital at home compared with in-patient hospital care: a systematic review.
Despite the widespread adoption of hospital at home services it is not known if these services represent an effective way to manage patients, compared with in-patient hospital care. ⋯ This review does not support the widespread adoption of hospital at home, nor the discontinuation of existing schemes for elderly medical patients, patients who have had elective surgery, or those with a terminal illness. There is insufficient evidence to determine the effect of hospital at home on patient outcomes, or cost to the health service.
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J Public Health Med · Jun 1998
Randomized Controlled Trial Clinical TrialIs screening for abdominal aortic aneurysm acceptable to the population? Selection and recruitment to hospital-based mass screening for abdominal aortic aneurysm.
The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the criteria from the Council of Europe. ⋯ The attendance rate fell markedly with age, but the recruitment was high even at the age of 73, and travel distance and social class did not markedly influence uptake. A positive morbidity selection to screening for AAA was observed for cardiovascular or pulmonary diseases and potentially mobility-disabling diseases. Furthermore, higher prevalence of AAA was found for initial nonattenders. Thus, screening for AAA seems acceptable to the population, and extra efforts to increase the attendance are beneficial without increased costs per diagnosed AAA. Finally, if mass-screening proves to be cost-ineffective, selective screening of patients with hypertension or ischaemic heart disease might be beneficial.
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J Public Health Med · Mar 1998
Cycle helmet ownership and wearing; results of a survey in South Staffordshire.
Despite increasing evidence indicating that wearing cycle helmets can reduce the severity of head injuries, particularly in children, there is a paucity of local data on cycle helmet ownership and wearing rates. These data together with an understanding of the factors which influence these rates are important in developing appropriate health promotion programmes. ⋯ Cycle helmet ownership and wearing is still disappointingly low, especially amongst older children. The factors influencing patterns of ownership and wearing are numerous and the interrelationships between them are complex, requiring a co-ordinated approach from a range of agencies. Cycle helmet legislation should be considered by the Government.
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J Public Health Med · Mar 1998
Population screening in the NHS: a systematic pathway from evidence to policy formulation.
In 1994 the Chief Medical Officer of England set out a framework for the evaluation and implementation of national screening programmes in the National Health Services (NHS). The framework highlighted the importance of the link between research evidence and the formulation of national policy. It also stressed the necessity for monitoring, evaluation and quality control as integral components for all new screening programmes. ⋯ The Population Screening Panel, an advisory panel of the NHS Health Technology Assessment programme, has the responsibility for determining priorities in research on proposed or existing population screening programmes. The National Screening Committee has a remit to consider this research evidence and to advise government ministers and the NHS on the appropriateness of the implementation, development and modification of national screening programmes. The example of prostatic cancer screening is presented as an illustration of how the NHS is developing a systematic approach to the implementation of screening policy based upon the strategic commissioning of research evidence.
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J Public Health Med · Mar 1998
Assessment of the reproducibility of clinical coding in routinely collected hospital activity data: a study in two hospitals.
The aim of the study was to assess the reproducibility of clinical coding in two National Health Service hospitals within North West Thames region. ⋯ The full clinical codes in NHS hospital episode statistics (HES) data should be treated with caution. The first three characters of ICD-9 codes for diagnoses and the OPCS-4 codes for procedures were more reliable. For some specific conditions such as asthma and fractured femur, reliability of the first three characters is much higher (for example, 86 per cent and 91 per cent for asthma in the two hospitals), but for the full codes can be worse. Secondary diagnoses or comorbidities may be significantly undercoded. A higher level of agreement in 1992-1993 than in 1991-1992 suggests that coding may be improving.