Clinical Standards Advisory Group Report Research Articles

An essential overview of orofacial clefting.

An appreciation of the embryologic development of the face is essential to understanding the anatomic variation observed in this phenotypically broad condition. Embryologically, the nose, lip and palate are separated into the primary and secondary palate, which are divided anatomically by the incisive foramen. The epidemiology of orofacial clefting is reviewed together with the contemporaneous cleft classification systems that enable comparisons to be made between international centres for audit and research purposes. A detailed examination of the clinical anatomy of the lip and palate informs the surgical priorities for the primary reconstruction of both form and function. The pathophysiology of the submucous cleft palate is also explored. The seismic impact of the 1998 Clinical Standards Advisory Group report on the organisation of UK cleft care provision is outlined. The importance of the Cleft Registry and Audit Network database in auditing UK cleft outcomes is highlighted. The potential for the Cleft Collective study to establish the causes of clefting, the optimal treatment protocols, and the impact of cleft on patients is tremendously exciting for all health care professionals involved in the management of this challenging congenital deformity.

An assessment of the contribution of UK specialists in restorative dentistry to cleft lip and palate services

To assess the degree and methods of involvement of United Kingdom-based specialists in restorative dentistry in cleft lip and palate services. Postal questionnaire.Setting The questionnaire was sent to specialists in restorative dentistry, periodontics, prosthodontics and endodontics as held by the General Dental Council (n = 709). The study was conducted in January 2008. Dictated by specialists' entry on the GDC Specialist lists in distinctive branches of dentistry document, published 2006.Main outcome measure Identification of specialists involved in the care of cleft lip and palate patients. The response rate was 54% (382/709). Of those replies 20% (77/382) were involved in the care of cleft lip and palate patients. Of these 77 practitioners only 17% (13/77) were part of a multidisciplinary team (MDT). This study would suggest that there were few restorative specialists with a coordinated involvement in the care of cleft lip and palate patients through a recognised MDT. The majority of specialists that were involved in such care were not doing so as a result of their position as specialists. This is perhaps at odds with best practice as described by the Clinical Standards Advisory Group report of 1998.

Alveolar bone grafting: results of a national outcome study

In 1998, the Clinical Standards Advisory Group (CSAG) report demonstrated a successful radiographic outcome of 58%, for alveolar bone grafting, from 157 cases of unilateral cleft lip and palate (UCLP) in children aged 12 years. No further national studies have assessed the current level of radiographic outcome following the re-organisation of cleft services since the recommendations from the CSAG report. In 2008, radiographic images were requested for alveolar bone grafts performed in calendar year 2006 from each of the now established UK cleft centres. A sample of 206 patients with 235 grafted sites was scored by a panel of trained assessors, following a calibration exercise, using a modified Kindelan index. Inter- and intra-observer variation was assessed. The overall radiographic success rate for the 2006 images assessed was 85%. There was no statistical difference for radiographic success between centres or surgeons or cleft type when defined as either a bilateral or unilateral alveolar defect for a patient. Alveolar bone grafting appears to have improved radiographic outcomes when compared with the CSAG report following the re-organisation of surgical services for children with cleft lip and/or palate.

Implementation of standardized medical photography for cleft lip and palate audit

Much has been published relating to the treatment and surgical outcome of cleft lip and palate disorders. Clinical audit is one of the most important tools for assessing the quality of care provided, with medical photography an invaluable component of this process. The Clinical Standards Advisory Group Report 1998 recommended that cleft lip and palate patients should be audited when 0 (under 1 year of age), and then at the ages of 5, 10, 15 and 20 years. For both audit and research purposes, medical photographs need to be accurate and of a consistently high standard. This paper describes the development of a standardized photographic protocol for cleft patients of audit age, to the benefit of both the multidisciplinary team and the patients.

Back pain--whose responsibility?

Back pain--whose responsibility?

Patients’ perspectives on services for epilepsy: a survey of patient satisfaction, preferences and information provision in 2394 people with epilepsy

The objectives of this study were to provide a comprehensive survey of satisfaction with care, care preferences and information provision for patients with epilepsy, and to formulate recommendations for the development of epilepsy services based on the findings. A questionnaire was distributed to 4620 patients who were currently receiving antiepileptic drugs for epilepsy, regardless of aetiology, duration or severity. Two different samples of patients with epilepsy were questioned: the first an unselected sample drawn from primary care, and the second consisting of consecutive patients drawn from hospital clinics. There were 2394 responses to the questionnaire. Satisfaction with primary and hospital care was high, both overall and for specific aspects. However, two major shortcomings were identified. First, few respondents felt that their care was shared between hospital and GP. Secondly, provision of information about epilepsy was perceived to be poor, particularly by the elderly. Younger patients and patients with severe epilepsy had a higher satisfaction with and preference for hospital care, whereas older age groups were more satisfied with and preferred primary care. Patients’ main reasons for preferring primary care were that it was more personal and the GP was more familiar with them, and secondary care was preferred because the hospital doctor knew more about epilepsy. In conclusion, we have conducted the largest representative UK survey of patients’ perceptions and views of the care available for epilepsy. Although patient satisfaction was high, information provision is poor and the shared care model is not operating effectively. We recommend that an emphasis be placed on methods for improving the interface between primary and secondary care. The setting up of hospital epilepsy centres, as recommended by the recently published Clinical Standards Advisory Group report on epilepsy , would provide a focus for these efforts and for information provision.

Epilepsyin primary care

Interest in epilepsy within the health service has grown recently with the clinical standards advisory group report out and a sentinel audit being carried out into sudden death in epilepsy which will impact on nurses working in primary care and schools

Designing a Back Management Service: the Exeter experience and first year results.

The recent British Clinical Standards Advisory Group report on back pain highlighted the importance of primary care in the active management of acute back pain and, at the same time, recommended the establishment of rehabilitation services for those with subacute and chronic back pain. To describe a new Back Management Service (BMS) in Exeter and to review the first year's results. Analysis of observational data collected from the clinic and therapy database. Clinic outcome assessed by diagnostic and referral patterns as well as by general practitioner questionnaire. The Back Management Programme was assessed by Short Form 36 (SF36), Hospital Anxiety and Depression score (HAD) and Oswestry Disability Index (ODI). In the first year 297 patients were seen in the clinic; clinic triage resulted in confirmation of primary care diagnosis in 235 (79%) of patients, with diagnosis revised in 62 (21 %). One hundred and eighty-nine (63.6%) patients were referred for therapy. Of these, 54 were referred for one-to-one therapy and 135 were referred for multidisciplinary review with 29 patients subsequently recruited into the Back Management Programme for rehabilitation. Two out of three outcome measures were significantly improved at the end of the 36-hour, four-week course. A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.

Designing a Back Management Service: the Exeter experience and first year results

Background: The recent British Clinical Standards Advisory Group report on back pain highlighted the importance of primary care in the active management of acute back pain and, at the same time, recommended the establishment of rehabilitation services for those with subacute and chronic back pain. Objective: To describe a new Back Management Service (BMS) in Exeter and to review the first year's results. Methods: Analysis of observational data collected from the clinic and therapy database. Assessments: Clinic outcome assessed by diagnostic and referral patterns as well as by general practitioner questionnaire. The Back Management Programme was assessed by Short Form 36 (SF36), Hospital Anxiety and Depression score (HAD) and Oswestry Disability Index (ODI). Results: In the first year 297 patients were seen in the clinic; clinic triage resulted in confirmation of primary care diagnosis in 235 (79%) of patients, with diagnosis revised in 62 (21%). One hundred and eighty-nine (63.6%) patients were referred for therapy. Of these, 54 were referred for one-to-one therapy and 135 were referred for multidisciplinary review with 29 patients subsequently recruited into the Back Management Programme for rehabilitation. Two out of three outcome measures were significantly improved at the end of the 36-hour, four-week course. Conclusions: A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.

Iso-machines in the physiotherapy management of low back pain

Low back pain is a very topical subject within the physiotherapy profession, particularly since the publication of the Clinical Standards Advisory Group report in December 1994. The increasing cost and incidence of back pain means that many within the profession are reconsidering the management of this condition. One area of controversy in the debate on the management of back pain is the role of iso-machines. This paper reviews the literature relating to isomachines for trunk strength testing. Trunk strength has been shown to be significantly reduced in chronic low back pain sufferers. A list of isomachines commercially available is given. The reliability, validity and clinical utility of the trunk strength measures from iso-machines are discussed and the role of iso-machines in predicting trunk strength and determining maximum voluntary effort is considered. Iso-machines are valuable as a means of obtaining reliable, objective measures of trunk strength. There are, however, claims which have no scientific basis that they can be used to predict back pain and detect malingering.