Search

Background Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics. Method This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites. Results A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3–89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July. Conclusions Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting. [ABSTRACT FROM AUTHOR]

There is mounting evidence that prosody facilitates grouping the speech stream into syntactically-relevant units (e.g., Hawthorne & Gerken, 2014; Soderstrom, Kemler Nelson, & Jusczyk, 2005). We ask whether prosody’s role in syntax acquisition relates to its general acoustic salience or to the learner’s acquired knowledge of correlations between prosody and syntax in her native language. English- and Japanese-acquiring 19-month-olds listened to sentences from an artificial grammar with non-native prosody (Japanese or English, respectively), then were tested on their ability to recognize prosodically-marked constituents when the constituents had moved to a new position in the sentence. Both groups were able to use non-native prosody to parse speech into cohesive, reorderable, syntactic constituent-like units. Comparison with Hawthorne and Gerken (2014), in which English-acquiring infants were tested on sentences with English prosody, suggests that 19-month-olds are equally adept at using native and non-native prosody for at least some types of learning tasks and, therefore, that prosody is useful in early syntactic segmentation because of its acoustic salience. [ABSTRACT FROM AUTHOR]

Assessments have been made of the increasing populations of Osilinus lineatus near its eastern English Channel limit of distribution for the year 2008. The first record of a breeding population of Osilinus east of the Isle of Portland at Western Ledges in Portland Harbour was made during a survey in 2004. The 2008 study provides evidence that the breeding range in East Dorset has since extended to Redcliff Point and Osmington Mills, east of Weymouth Bay. Surveyed sites from Portland Harbour to White Nothe have shown large increases in numbers since 2004. The small size of populations to the east of White Nothe indicates that recruitment to sites further east still depended on small numbers of larvae that drifted around Portland Bill from Lyme Bay without supplementation from the Portland Harbour to Osmington Mills sites. [ABSTRACT FROM AUTHOR]

Objective To describe recent trends in prevalence, outcomes and indicators of care for women with pre-existing type I or type II diabetes. Design Regional population-based survey. Setting All maternity units in the North of England. Population A total of 1258 pregnancies in women with pre-existing diabetes delivered between 1996 and 2004. Methods Data from the Northern Diabetic Pregnancy Survey. Outcome of pregnancy cross-validated with the Northern Congenital Abnormality Survey and the Northern Perinatal Mortality Survey. Main outcome measures Perinatal mortality, congenital anomaly and total adverse perinatal outcome (perinatal mortality and live births with congenital anomaly). Results The prevalence of pregestational diabetes increased from 3.1 per 1000 births in 1996–98 to 4.7 per 1000 in 2002–04 (test for linear trend, P < 0.0001), driven mainly by a sharp increase in type II diabetes. Perinatal mortality declined from 48 per 1000 births in 1996–98 to 23 per 1000 in 2002–04 ( P = 0.064). There was a significant reduction in total adverse perinatal outcome rate ( P = 0.0194) from 142 per 1000 in 1996–98 to 86 per 1000 in 2002–04. There were substantial improvements in indicators of care before and during pregnancy and in glycaemic control throughout pregnancy, but indicators of preconceptual care, such as use of folic acid, remained disappointing. Conclusion We observed improvements in pregnancy care and outcomes for women with diabetes in a region with an established audit and feedback cycle. There remains considerable scope for further improvement, particularly in periconceptual glycaemic control. The rising prevalence of type II diabetes presents a challenge to further improvement. [ABSTRACT FROM AUTHOR]

Background: Following the introduction of a computerised diabetes register in part of the northeast of England, care initially improved but then plateaued. We therefore enhanced the existing diabetes register to address these problems. The aim of the trial was to evaluate the effectiveness and efficiency of an area wide 'extended,' computerised diabetes register incorporating a full structured recall and management system, including individualised patient management prompts to primary care clinicians based on locally-adapted, evidence-based guidelines. Methods: The study design was a pragmatic, cluster randomised controlled trial, with the general practice as the unit of randomisation. Set in 58 general practices in three Primary Care Trusts in the northeast of England, the study outcomes were the clinical process and outcome variables held on the diabetes register, patient-reported outcomes, and service and patient costs. The effect of the intervention was estimated using generalised linear models with an appropriate error structure. To allow for the clustering of patients within practices, population averaged models were estimated using generalized estimating equations. Results: Patients in intervention practices were more likely to have at least one diabetes appointment recorded (OR 2.00, 95% CI 1.02, 3.91), to have a recording of a foot check (OR 1.87, 95% CI 1.09, 3.21), have a recording of receiving dietary advice (OR 2.77, 95% CI 1.22, 6.29), and have a recording of blood pressure (BP) (OR 2.14, 95% CI 1.06, 4.36). There was no difference in mean HbA1c or BP levels, but the mean cholesterol level in patients from intervention practices was significantly lower (-0.15 mmol/l, 95% CI -0.25, -0.06). There were no differences in patient-reported outcomes or in patient-reported use of drugs, or uptake of health services. The average cost per patient was not significantly different between the intervention and control groups. Costs incurred in administering the system at the register and in general practice were in addition to these. Conclusion: This study has shown benefits from an area-wide, computerised diabetes register incorporating a full structured recall and individualised patient management system. However, these benefits were achieved at a cost. In future, these costs may fall as electronic data exchange becomes a reliable reality. [ABSTRACT FROM AUTHOR]

Abstract: This paper is about the care of babies with confirmed or potential neurological problems in neonatal intensive care units. Drawing on recent ethnographic research, the paper considers parents’ experiences of sharing information and decisions with neonatal staff, and approaches that support or restrict parents’ involvement. There are growing medico-legal pressures on practitioners to inform parents and involve them in their babies’ care. Data are drawn from observations in four neonatal units in southern England, and interviews with the parents of 80 babies and with 40 senior staff. The paper compares standards set by recent guidance, with parents’ views about their share in decision-making, their first meetings with their babies, ‘minor’ decision-making, the different neonatal units, being a helpless observer and missed opportunities. Parents’ standards for informed decisions are summarised, with their reported views about two-way decision-making, and their practical need to know. Whereas doctors emphasise distancing aspects of the consent process, parents tend to value ‘drawing together’ aspects. [Copyright &y& Elsevier]

Background: Whilst there is broad agreement on what constitutes high quality health care for people with diabetes, there is little consensus on the most efficient way of delivering it. Structured recall systems can improve the quality of care but the systems evaluated to date have been of limited sophistication and the evaluations have been carried out in small numbers of relatively unrepresentative settings. Hartlepool, Easington and Stockton currently operate a computerised diabetes register which has to date produced improvements in the quality of care but performance has now plateaued leaving substantial scope for further improvement. This study will evaluate the effectiveness and efficiency of an area wide 'extended' system incorporating a full structured recall and management system, actively involving patients and including clinical management prompts to primary care clinicians based on locally-adapted evidence based guidelines. Methods: The study design is a two-armed cluster randomised controlled trial of 61 practices incorporating evaluations of the effectiveness of the system, its economic impact and its impact on patient wellbeing and functioning. [ABSTRACT FROM AUTHOR]

The article investigates methods for predicting food allowances from body length (BL) in tropical and temperate ornamental fish species by researchers from Leicestershire, England. The researchers attempt to establish simple mathematical models that can predict body weight (BW) from BL in fish. By linking predicted BW with a known energy requirement and energy density of the food, it becomes possible to calculate accurate food allowances. This particularly useful because, although BW cannot easily be determined by owners of ornamental fish, an estimate of body length is usually possible.

Investigates the potential benefits of dietary sodium in cats by researchers from Leicestershire, England. Use of dietary sodium on the promotion of water intake and urine volume; Tendency for cats to produces small amount of concentrated urine; Determination of urine volume by water intake.

Reports the service of orthogeriatric rehabilitation in Nottingham, England. Lack of health resources; Comparison on the length of stay of female patients and with fractured femur; Addition of hospital beds on ward.

Background: The rise in the incidence of Crohn's disease (CD) suggests the role of an environmental factor in the development of the disease in susceptible individuals. Perinatal exposure to infection has been proposed as such an environmental factor., Aim: To investigate the influence of birth date on the development of CD in later life., Patients and Method: Four registers of patients with CD, diagnosed from 1972 to 1989, were combined, and data from 1624 patients were examined. The birth dates of CD patients were compared with national birth figures for three decades (1941-50, 1951-60, and 1961-70) to avoid temporal changes in birth trends, and year of birth was compared with epidemic measles years between 1951 and 1967. Risk ratios with 95% confidence intervals (CI) and chi(2) tests were performed., Results: There were marginal differences between the birth dates of the CD patients and those predicted from the general population. Further analysis of both season of birth and year halves revealed a very weak association with the first half of the year (relative risk 1.14 (95% CI 1.01-1.30)). There was no association between developing CD and birth during measles epidemics between 1951 and 1967., Conclusions: In utero or perinatal exposure to seasonal environmental factors are unlikely potential aetiological agents in the later development of CD.