Joint Working Party Research Articles

Growth monitoring: testing the new guidelines

OBJECTIVETo assess the impact of recent guidelines from the UK joint working party of child health surveillance recommending that all children be measured at age 5 and again between 7...

Resuscitation of the newborn

Neonatology has evolved rapidly over the past decade, yet we still have limited scientific evidence on which to base the resuscitation of the newborn. Although controversy still exists, national guidelines have recently been published in America 1 and the UK. The UK guidelines were published by a joint working party from the new College of Paediatrics and Child Health, and from the College of Obstetrics and Gynaecology (1997). 2 The guidelines look specifically at management protocols within the delivery suite, and are the new ‘gold standard’. Previously, a working party of the British Paediatric Association (1993) 3 published guidelines outlining what services should be provided for neonatal resuscitation in different clinical situations. Perinatal asphyxia remains a significant cause of neurological disability in childhood, and all personnel involved in the delivery of babies should be skilled in assessment and resuscitation. Studies have reported the need for resuscitation with intubation and ventilation in 2% of all deliveries, with twice this number requiring some stimulation owing to periods of apnoea lasting up to 3 min. 4 There are different approaches in immediate management of preterm babies; this paper concerns those born at term.

Review : Child health — the future of paediatric nursing? A discussion paper

■ A critical examination of some of the recommendations within the report 'Developing roles of nurses in clinical child health' (Report of Joint Working Party, 1996) ■ Practitioners have a responsibility to be proactive in analysing and shaping the developing role of the children's nurse to ensure quality of care for the child and family ■ The developing role of the children's nurse needs to incorporate a model which crosses traditional multidisciplinary boundaries ■ Improved quality in care can only be achieved when research into clinical outcomes within children's nursing are available. This will require sufficient support and resources)

A chart audit reviewing the prescription and administration trends of analgesia and the documentation of pain, after surgery.

The report of the joint working party of the Royal College of Surgeons of England, Pain after Surgery, raised many questions in relation to the way pain is managed after surgery. This report questioned many of the existing practices of pain control and highlighted the need for the development of regular pain assessment. The report raised questions regarding PRN (pro-re nata, as needed) prescribing and reinforced the importance of the role of the nurse. This study reviews the way pain is managed in this hospital with regard to analgesia prescribing and analgesia administration trends as well as the documentation of pain. The study was conducted by retrospective review of randomly selected patient charts. The results of this study conclude that documentation of pain following surgery is poor, and needs improvement. Existing prescription trends, in particular PRN prescribing, may be hindering both good practice and the pre-emptive administration of analgesia.

Pre‐registration education and training for dietitiansReport and recommendations from the British Dietetic Association/CPSM Dietitians Board Joint Working Party, February 1996

The following report was presented to the Dietitian's Board of the Council for Professions Supplementary to Medicine (CPSM) and the Education Committee of the British Dietetic Association (BDA) in March 1996. It outlines the process by which the working group examined pre‐registration education and training for dietitians in the light of their current and future role in the UK, together with the recommendations made for changes in training. These proposals were agreed by the Dietitians Board and British Dietetic Association in March 1997 and a new working group will be convened to develop detailed guidelines for education and training.

The Value of Joint Working Parties

It is argued that policy makers, in government especially, use crude output measures such as the link with performance to argue the case for, or more often against, employee participation. The paper considers the problems associated with the use of such crude output measures but argues that researchers cannot avoid the question of what impact participation has on organizational effectiveness. Data from a universal survey of companies given in-depth assistance by ACAS are used to show that, according to managers directly involved, a particular form of participation, the joint working party, has a strong positive benefit to the organisation. This was true of both union and non-union firms. This has important policy implications.

Visual acuity testing in schools: what needs to be done.

Measurement of visual acuity is performed in schools to identify children with amblyopia and unilateral or bilateral refractive errors. The report of a joint working party recommended that children with visual acuity of 6/12 or worse in either eye should be referred for orthoptic assessment.1 The report specified that visual acuity should be measured in a quiet room by a trained school nurse using a properly illuminated Snellen chart at six metres. The British Standards Institute specifies a uniform external illumination of at least 480 lux.2 We performed a study to investigate whether visual acuity measurements in schools are carried out to these specifications and to compare the visual acuity measured in schools with that done in the orthoptic department. …

Measuring up in the public eye

IN 1992 the Society of Practising Veterinary Surgeons (SPVS) set up a joint working party with the BVA, BSAVA, BEVA and BCVA to examine the relationship between the veterinary profession and the animalowning public. This working party was not established in response to any particular request or incident, but as a genuine wish to discover the situation by the then SPVS president, Des Thompson, and his council. Most arms of the profession were involved to ensure the widest possible range of views and experience. This article summarises the report of the working party.

National provision of acute pain services

In order to determine the degree to which the recommendations of the report of the joint working party on 'Pain after Surgery' by the Royal College of Surgeons of England and the College of Anaesthetists have been implemented, a postal survey was conducted of all hospitals in the United Kingdom where surgery is performed. The number of hospitals with a multidisciplinary acute pain service had significantly increased from 2.8% before September 1990 to 42.7% at the end of 1994. Over the same period there has been an increase in the number of hospitals with a named clinician responsible for acute pain management, from 20 before 1990 to 230 (65.2%) and the number of hospitals with an acute pain nurse has increased from 8 (2.3%) prior to 1990 to 139 (39.3%). Routine assessment of pain and sedation occurs in 82% of hospitals with established acute pain services and in less than 50% of hospitals without an acute pain service. The use of written protocols, the provision of out-of-hours cover and regular training for all staff have increased with time. Research and audit activity related to acute pain management has also improved since 1990.

A Partnership Approach to Information Technology in Initial Teacher Training

ABSTRACT This paper describes the changes to the IT element of the secondary Post Graduate Certificate of Education (PGCE) course at the University of East Anglia, in the light of the government initiatives requiring a shift to a partnership approach to initial teacher training. This shift means that only one third of the 36 week course is now delivered at the University. The paper describes the recommendations of a joint working party representing partnership schools and university staff. The implementation of the group's suggestions involved a fundamental revision of the IT component for both university and school based elements and a re‐definition of the roles of all staff involved. This paper concludes with a discussion of the evaluation of the new scheme, including the results of a student questionnaire, after it had been implemented for one year. This found that our move to deal with IT as a subject specific issue was successful and highlighted the level of IT use in school subject departments as th...

Reducing inappropriate referrals of school‐aged children: a joint working party

ABSTRACT The development of a new school‐based service to children attending mainstream schools in Harrow led to a raised profile for the Speech and Language Therapy Service. This resulted in a large increase in referrals of school‐age children. A significant number of these referrals were found to be inappropriate. The assessment of these children, a time‐consuming process, resulted in reduced efficiency of service to those children needing speech and language therapy involvement; at the same time, education staff were identifying that they remained uncertain as to exactly which children were appropriate candidates for speech and language therapy. A joint Working Party, of education staff and speech and language therapists, was established in order to provide information to enable the teaching staff to identify language difficulties more accurately and to review current routes to referral of school‐age children. The Working Party members comprised three speech and language therapists and six education staff from a range of backgrounds. The group had several aims: (1) To develop a checklist for use by teachers; (2) To develop and agree referral criteria; (3) To enable teaching staff to identify language needs more effectively; (4) To encourage education staff to consider other factors which may influence languge develoment, for example, the home language; (5) Through the above, to reduce inappropriate referrals and to ensure more appropriate timing of referrals, for example, following/alongside home language assessment; (6) To provide speech and language therapists with sufficient information to prioritise referrals and to reduce the time required for initial fact‐finding. At a series of meetings it was found that none of the published checklists met identified needs. The group therefore development their own by (1) collating developmental stages for all language areas and expressing these in a manner accessible to teaching staff and (2) organising developmental stages into a logical and user‐friendly format. A flowchart, outlining possible stages in identifying a child's needs (for example, organising the assessment of hearing acuity), was developed. Finally, the flowchart and checklist were amalgamated to form a more streamlined referral format. Following wider discussions within the Speech and Language Therapy and Education departments, the referral format will be Mailed and its effectiveness evaluted in terms of (1) reduction in inappropriate referrals — through comparison of initial assessment statistics prior to and following the introduction of the format and (2) increasing the awareness of teaching staff of communication needs and their confidence in identifying/referring children through use of a questionnaire and interviews.

A survey of acute pain services in the United Kingdom

The report of a joint working party of the Royal College of Surgeons of England and the College of Anaesthetists to consider pain after surgery called for the development of an acute pain service in every hospital performing surgery.1 Despite this firm recommendation, it is perceived that such services are not as prevalent as might be expected. We undertook a survey of the current status of acute pain management in the United Kingdom. We sent a questionnaire to each of the tutors of the Royal College of Anaesthetists. The questionnaire sought details of the existence, staffing, and funding of any form of acute pain service in each hospital. An outline of the hospital's current methods of pain management after major …

Assessment of Dose Proportionality: Report from the Statisticians in the Pharmaceutical Industry/Pharmacokinetics UK Joint Working Party

There are a number of different approaches to the assessment of dose proportionality, but most of these are directed toward hypothesis testing. The analysis of dose proportionality studies, however, requires estimation rather than significance testing in order that the pharmacokinetic and clinical significance of any nonproportionality can be assessed.The methods of statistical analysis of these studies have been reviewed. An empirical model relating the log of the pharmacokinetic parameter linearly to the log of the dose (the “power model”) provides a readily interpreted measure of the degree of nonproportionality. The potential utility of this model has been demonstrated using a number of observed dataseis from different drugs. If there is doubt over the goodness of fit of the power model then analysis of variance (after log transformation), together with pairwise comparisons between doses, provides a suitable alternative approach.

Guidelines on appropriate indications for upper gastrointestinal endoscopy

Upper gastrointestinal endoscopy is a valuable diagnostic tool, but for an endoscopy service to be effective it is essential that it is not overloaded with inappropriately referred patients. A joint working party in Britain has considered the available literature on indications for endoscopy, assessed standard practice through a questionnaire, and audited randomly selected cases using an independent panel of experts and an American database system. They used these data to produce guidelines on the appropriate and inappropriate indications for referral for endoscopy, although they emphasise that under certain circumstances there may be reasons to deviate from the advice given. The need for endoscopy is most difficult to judge in patients with dyspepsia, and this aspect is discussed in detail. Early endoscopy will often prove more cost effective than delaying until the indications are clearer.

Review of the Problems Involved in Using Enzymes in Blood Group Serology - Provision of Freeze- Dried ICSH/ISBT Protease Enzyme and Anti-D Reference Standards

Proteolytic enzyme preparations and techniques used routinely in blood group serology for the detection of atypical patient antibodies prior to transfusion vary widely and are often poorly standardised. Recent advances have been made in the use of biochemical methods to standardise and stabilise the potency of the enzyme preparations used. A joint working party of the International Council for Standardization in Haematology (ICSH) and the International Society of Blood Transfusion (ISBT) has investigated possibilities for the provision of standards for the protease preparations and techniques. The specification for these standards was that the performance of enzyme reference preparation in the reference technique should be of equivalent sensitivity to the ICSH/ISBT LISS spin indirect antiglobulin test using a titration series of a reference weak anti-D, and be free from false-positive reactions. The working party circulated materials for evaluation in inter-laboratory trials, followed by a laboratory workshop meeting to achieve agreement on the specification for reference materials and methods. Reference freeze-dried papain at 0.6 azoalbumin units and weak anti-D preparations (91/562) have been prepared and validated to meet these specifications. The performance of a test enzyme preparation in the technique for which it is recommended for use should be at least equal to that of the reference papain preparation, by the reference two-stage technique in terms of sensitivity, using a titration series of the reference anti-D, and freedom from false-positive reactions, using six fresh inert sera. The reference papain and weak anti-D can also be used to calibrate the level of proteolytic activity required in other procedures in blood group serology, such as new technology methods for antibody detection, and automated and microplate cell grouping procedures. These preparations and an agreed method for their use are now available from listed centres as ICSH/ISBT and Food and Drug Administration reference materials.

Joint statement on general practitioner vocational training in psychiatry

(1) A Joint Working Party of the Royal College of General Practitioners and the Royal College of Psychiatrists prepared a report on training general practitioners in psychiatry in 1974. This was circulated to all regional advisers and course organisers and was published in 1978. Since that time, there have been advances in the treatment of patients with psychiatric disease and considerable change in the organisation of health care services which have resulted in an increasing proportion of psychiatrically ill people being cared for in the community rather than in the hospital setting. With these changes in mind, both Colleges felt that it would be appropriate to convene another joint working party to review the arrangements for the psychiatric component of vocational training for general practice. This report revises the objectives for training that were agreed in 1974 and makes recommendations for the organisation that will achieve them.

Lothians post disaster counselling service

In mid 1988 after Piper Alpha but before the Lockerbie disaster, the Social Work Department and the Mental Health Unit independently began to discuss plans for a post disaster counselling service. Over the next few months a joint working party was set up which during 1988 and early 1989 evolved the service described below.

The significance of patient weight when comparing X-ray room performance against guideline levels of dose

On the basis of a national survey (Shrimpton et al, 1986) of doses to adult patients from routine X-ray examinations, the National Radiological Protection Board (NRPB) has formulated a set of guideline entrance surface doses for some common radiographic projections. These guideline doses are shown in Table I. They have been recommended by a joint working party of NRPB and the Royal College of Radiologists (RCR) as a useful step in reducing unnecessary medical exposures (RCR & NRPB, 1990). The doses were set at the third quartiles of the exposures found in the national survey, i.e. 75% of radiography rooms achieved a mean dose lower than each guideline.

Child Health Macfarlane A Child Health et al Oxford Medical 58pp £4.50 0-19-261768-0.

A proposal for a national health surveillance programme to be carried out in England and Wales, and possibly Scotland, was recommended by a joint working party with representatives from the HVA, RCN, RCGP, British Paediatric Association and the General Medical Services Committee of the BMA (Hall, D Health for All Children. Oxford UP, 1989).

Serological characterization of monoclonal antibodies to complement components of C 3 and C 4

Six monoclonal antibodies to complement components were evaluated, five detected components of C 3 and the other reacted with C 4. The specificity and titre of antibodies to the various complement components is easily determined by the use of C 3 and C 4 coated red cells prepared by low ionic methods. These procedures have been reviewed by Voak and al. [5] and Engelfriet and al. [1] as a result of studies by a joint working party of the ISBT/ICSH on the standardization of anti-human globulin reagents. The aim of this paper is to establish a simple procedure for the characterization of antibodies to C 3/C 4 complement components, as shown in Table I.