NHS Grampian Research Articles

Comparing two measures of multimorbidity in hospitalised patients

BackgroundMultimorbidity is recognised as a complex and growing health challenge. Currently there is no “gold standard” multimorbidity measure and few studies have compared measures in hospitalised patients.
 ObjectivesWe aimed to evaluate two published multimorbidity measures in routine hospital episode data in NHS Grampian, Scotland.
 MethodsWe used the Scottish Morbidity Record (SMR) data for the years 2009-2016. We included all adults admitted to hospital in the Grampian region of Scotland (population 588,100) during 2014. Morbidities were identified from inpatient admissions during the five years prior to admission date in 2014 (ICD-10 codes). Two multimorbidity measures were used: Charlson (Quan 2005), and Tonelli et al (2015); and multimorbidity was defined as ≥2 morbidities. Kappa statistics assessed agreement between the two measures in classifying patients as multimorbid. The association between multimorbidity and mortality, readmissions, and length of stay was examined using regression methods with odds ratios (OR) or incidence rate ratios (IRR) calculated as appropriate.
 FindingsIn 41,545 adults (median age 62 years, 52.6% female), multimorbidity prevalence was 15.1% (95% CI 14.8%-15.5%) using Charlson and 27.4% (27.0%-27.8%) using Tonelli - agreement 85.1% (Kappa 0.57). After adjusting for covariates, multimorbidity was associated with an increased risk of longer length of stay, (Charlson IRR 1.10 (1.03, 1.18; p=0.005); Tonelli IRR 1.11 (1.04, 1.18; p<0.001)) and readmission (Charlson OR 2.06 (1.94, 2.19; p<0.001); Tonelli OR 2.12 (2.01, 2.22; p<0.001)). Multimorbidity had a higher risk of mortality when measured using Charlson (Charlson OR 2.71 (2.52, 2.92; p=<0.001); Tonelli OR (1.84 (1.72, 1.98; p<0.001)).
 ConclusionsMultimorbidity measures operationalised in hospital episode data identified those at risk of poor outcomes and will be useful for future multimorbidity research and use in secondary care data systems.

Contact tracing for chronic hepatitis B in primary care? A 'snapshot' audit in Grampian, Northeast Scotland.

Introduction Contact tracing for chronic hepatitis B infection is an important activity for preventing the spread of hepatitis B infection. In the UK, the 'Green Book' recommends that all sexual and household contacts of individuals with chronic hepatitis B should be tested and vaccinated if required. This audit aimed to evaluate contact tracing in primary care. Barriers to effective follow-up of contacts of patients with chronic hepatitis B were explored and recommendations made. Methods and results Mixed method, including a survey of general practitioners and review of hepatitis B surveillance data from 1 June 2015 to 31 December 2015 held by NHS Grampian Health Protection Team. The audit was carried out in August 2016. Contact tracing was mainly by patient referral. Only 20% (4/20) of identified close contacts were tested. No contact eligible for vaccination was vaccinated, and 57% (8/14) of general practitioners who completed the audit questionnaire suggested that general practitioners do not have a role in contact tracing. Barriers identified were: lack of time, lack of resources and contacts being registered with a different practice. Conclusions This audit suggests that contact tracing for chronic hepatitis B in primary care is largely incomplete. Moving contact tracing from general practice to health protection teams in Boards may be a pragmatic way of improving follow-up activities.

Geographical recruitment to cancer clinical trials in NHS Grampian

Geographical recruitment to cancer clinical trials in NHS Grampian

NHS Grampian project: treating uncomplicated lower urinary tract infection in community pharmacy

NHS Grampian project: treating uncomplicated lower urinary tract infection in community pharmacy

NHS Grampian project: treating uncomplicated lower urinary tract infection in community pharmacy

NHS Grampian project: treating uncomplicated lower urinary tract infection in community pharmacy

Geographical recruitment to cancer clinical trials in NHS Grampian

Geographical recruitment to cancer clinical trials in NHS Grampian

Investigating Orthopaedic Surgical Prophylaxis Changes and Post-operative Acute Kidney Injury (AKI) in NHS Grampian – a Test Case for NHS Scotland

ABSTRACT
 ObjectivesTo support reduction of Clostridium difficile infection (CDI), in 2008 the Scottish Antimicrobial Prescribing Group recommended that all NHS boards in Scotland restrict the use of antibiotics associated with a high risk of CDI. In NHS Grampian the policy for antibiotic prophylaxis in orthopaedic surgery was changed in June 2010. Trauma patients undergoing internal fixation or arthroplasty received flucloxacillin or co-amoxiclav before the policy change and flucloxacillin and gentamicin after the policy change. Previous studies have found similar policy changes resulted in an increase in post-operative acute kidney injury (AKI) and this study examined rates of post-operative AKI before and after this policy change in the NHS Grampian region of Scotland. Patients undergoing elective arthroplasty received either flucloxacillin or co-amoxiclav or cefuroxime before the policy change and cefuroxime afterwards.
 ApproachAll NHS Grampian patients who underwent an orthopaedic surgical procedure with prophylaxis during the period 01 June 2008 to 31 May 2012 were selected. Cases were linked to local creatinine data to detect post-operative AKI. Cases were further linked to national coverage data: (i) hospital discharge data to create the Charlson score for comorbidity, (ii) patient-level community prescribing data to identify previous exposure to any medicines which predispose to renal impairment, (iii) patient-level infection data to identify any post-operative CDI and (iv) Scottish Renal Registry data for case exclusion purposes. Segmented regression analyses of interrupted time series were used to evaluate changes in level and trend associated with the intervention and estimate effect sizes.
 Results3,870 trauma cases and 5,475 elective cases were examined. There was a significant increase in AKI rate following the policy change (β=0.28; 95%CI, 0.03 to 0.53; p=0.028) in trauma patients, equating to an increase of 0.28 cases of AKI per 100 procedures per month and a relative intervention effect at 24 months of 150% (95% CI 25% to 250%) There was no significant change in AKI rate among elective patients.
 ConclusionWe found that a change in orthopaedic antibiotic prophylaxis policy in NHS Grampian to flucloxacillin plus gentamcin was associated with an increase in post-operative AKI. This is consistent with observations in other boards and supports the new recommendation away from this policy made by SAPG in 2012. In cohort of trauma patients we found the change in policy was associated with an increase in post-operative AKI rate.

Data linkage of Psychiatric and Maternity data to investigate the pregnancy outcomes of women with Non-affective Psychosis in Scotland

ABSTRACTObjectiveWomen with a diagnosis of non-affective psychosis have a lower fertility rate than the general population. However, perinatal outcomes in mothers with non-affective psychosis are under-researched. What is the general fertility rate (GFR) of women with a lifetime diagnosis of non-affective psychosis in Scotland? Does such a diagnosis affect the outcome of pregnancy?
 ApproachAn ‘exposed’ cohort with non-affective psychosis and at least one pregnancy was established using a combined dataset derived via data linkage in local safe havens of routine psychiatric and maternity data from two Scottish regions:•NHS Grampian (NHSGr): Aberdeen Maternity and Neonatal Databank (AMND); psychiatric casenotes•NHS Greater Glasgow and Clyde (NHSGG&C): SMR02; PsyCIS bespoke psychiatric databaseExposed women were matched to women without a diagnosis of non-affective psychosis, by maternal age (NHSGG&C only), year of first birth, parity and deprivation, sourced from AMND/SMR02 in a 3:1 unexposed:exposed ratio.
 Demographics and pregnancy outcomes of exposed versus unexposed women were analysed to describe effect of psychosis on pregnancy.
 ResultsMany challenges were encountered in terms of having legal agreements in place between institutions and safe havens, constructing cohorts and datasets within each study site and joining the data to analyse the overall cohort. Challenges with the data itself included discrepancies between the variables measured in datasets in different sites and missing information within patient records, particularly in earlier years. Preliminary results for the NHSGG&C region show that the average GFR for exposed women aged 15-44 from 2005 to 2014 was 14.38 compared to the general population rate of 55.26. The number of women ever having a miscarriage was significantly higher in the exposed group (23.4% vs 9.9%; p-value <0.001). However during the study period (1996 to 2014), more unexposed women had miscarriages (0.5% vs 4.7%; p-value = 0.002). There were no significant differences in pregnancy complications for the study period. The mean birthweight of babies was lower (3.23kg vs 3.35kg; p-value = 0.029) and more babies were admitted to neonatal units (17.5% vs 9.8%; p-value = 0.004) in the exposed group. Results for the NHSGr region and the combined dataset will also be reported.
 ConclusionThis work highlights that there remain hurdles to linking data across sites, despite availability of rich datasets within Scotland. Women with non-affective psychosis within NHSGG&C region had a lower fertility rate on average than the general population and some poorer outcomes, such as birthweight and rate of admission to neonatal units.

Is Cancer Diagnosis Following Emergency Admission Due to Patient Delay or Systems Failure: New Insights from a Comprehensive Primary Care Dataset

ABSTRACT
 ObjectivesA significant proportion (13.9-21.8%) of cancers are diagnosed during emergency admissions to hospital. Patients who are diagnosed in this way have poorer outcomes. Cancer type, increasing age, and deprivation have shown to be associated with cancer diagnosis as an emergency. The role of primary care consulting behaviour prior to emergency presentation with a new cancer diagnosis is unclear and therefore the principle aim of the present study was to investigate this.
 ApproachAll GP practices in the North East of Scotland were invited to participate. 2015 patients with a diagnosis of either colorectal, upper GI, prostate, lung, breast and melanoma were randomly selected from participating practices. A dataset was created that contained routinely collected data from primary care records from these patients. This information was consolidated with information from the NHS Grampian Cancer Care pathway database. Those diagnosed by screening were removed, leaving 1803 patients. The main characteristic examined was whether or not the patient had seen a GP with relevant symptoms in the 2 years before the consultation that resulted in their diagnosis or referral. Chi squared analysis and univariate linear regression analysis was performed on each characteristic to examine the association of independent variables with each outcome. Multivariate linear regression was then carried out across the characteristics.
 Results362 (20.1%) of new cancer diagnosis were by emergency. Only 16.2% (n=260) of patients who saw their GP prior to their admission were diagnosed by emergency. 54.5% (n=97) of patients who had not seen their GP prior to diagnosis were emergency diagnoses. 20.7% (n=75) of patients diagnosed by emergency admission had been referred by their GP at the time of diagnosis and were awaiting their appointment with secondary care. Patients who had been seen in primary care before their cancer diagnosis were significantly less likely to have their cancer diagnosed by emergency admission (p<0.0001).
 ConclusionPatients who present to their GP with symptoms of cancer are much less likely to be diagnosed as a result of an emergency admission. It is therefore postulated that GPs are adequately referring patients with cancer for further investigation and diagnosis. However around a fifth of patients overall are still being diagnosed through emergency admission to hospital, and in the majority of cases this is because they are not presenting themselves to primary care. In order to rectify this we suggest that greater awareness about cancer symptoms amongst the public is necessary.

Does access to health services influence the diagnostic pathway and outcome from cancer: analysis of a linked dataset.

ABSTRACT
 ObjectivesTo determine whether cancer diagnostic pathways and survival are affected by access to GP practice, diagnostic centre and cancer treatment centre.
 Cancer treatment in the UK is generally delivered in large cancer centres within major cities. This could have a detrimental effect on outcomes for people from rural areas who develop cancer. Historical UK studies suggest distance from services affects cancer outcomes. In recent years several developments, such as cancer networks and suspected cancer referral pathways, have occurred within the UK NHS, which may have reduced earlier inequalities. It is currently unknown whether a persons’ geographical location within the UK has implications for the timeliness of their receipt of a diagnosis and treatment for cancer.
 ApproachRoutine clinical data from Scottish Morbidity Record (SMR) 01, Scottish Cancer Registry SMR 06, and Geographical Information Systems (GIS) derived measures of road distances and travelling times from key healthcare facilities have been linked to a clinical tracking database, NHS Grampian Cancer Care Pathway to form the Northeast and Aberdeen Scotland Cancer and Residence (NASCAR) database. This linkage provided a retrospective cohort of 13 702 people diagnosed with cancer since 2007.
 Logistic regression analyses have been conducted to determine the effect of distance from services on provider delays and survival at one year following diagnosis.
 ResultsOf the 13 702 patients included in the analysis the mean age was 67.4 ± 13 years and 45% were male. The highest proportion of patients lived within one mile of their GP practice (35.5%), less than five miles from their diagnostic centre (39.6%) and less than five miles from their cancer treatment centre (39.6%).
 Distance to GP practice or distance to diagnostic centre was not a significant predictor of timely treatment (treatment within 62 days of GP referral) or survival at one year following diagnosis.
 Increased distance to cancer treatment centre predicted shorter timely treatment intervals (5-9 miles [OR 1.50; CI 1.18-1.90], 10-29 miles [OR 1.09; CI0.90-1.31], 30-59 miles [OR 1.26; CI 1.05-1.52], > 60 miles [OR 1.72; CI 1.41-2.09]. Increased distance to treatment centre > 60 miles was associated with quicker times between diagnosis and receipt of treatment [OR 1.26; CI 1.12-1.42).
 ConclusionsIncreased distance to cancer treatment centre is associated with shorter treatment intervals. There was no association between likelihood of metastatic disease at diagnosis or survival at one year. Analysis is on-going into travelling times to services and may provide further insight.

Encouraging the use of research skills in frontline clinicians: A one-day symposium in NHS Grampian

Encouraging the use of research skills in frontline clinicians: A one-day symposium in NHS Grampian

Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: a non-linear time-series analysis

Whereas many antibiotics increase risk of Clostridium difficile infection through dysbiosis, epidemic C difficile ribotypes characterised by multidrug resistance might depend on antibiotic selection pressures arising from population use of specific drugs. We examined the effect of a national antibiotic stewardship intervention limiting the use of 4C antibiotics (fluoroquinolones, clindamycin, co-amoxiclav, and cephalosporins) and other infection prevention and control strategies on the clinical and molecular epidemiology of C difficile infections in northeast Scotland. We did a non-linear time-series analysis and quasi-experimental study to explore ecological determinants of clinical burdens from C difficile infections and ribotype distributions in a health board serving 11% of the Scottish population. Study populations were adults (aged ≥16 years) registered with primary carer providers in the community (mean 455 508 inhabitants) or admitted to tertiary level, district general, or geriatric hospitals (mean 33 049 total admissions per month). A mixed persuasive-restrictive 4C antibiotic stewardship intervention was initiated in all populations on May 1, 2009. Other population-specific interventions considered included limiting indications for macrolide prescriptions, introduction of alcohol-based hand sanitiser, a national hand-hygiene campaign, national auditing and inspections of hospital environment cleanliness, and reminders to reduce inappropriate use of proton-pump inhibitors. The total effect of interventions was defined as the difference between observations and projected scenarios without intervention. Primary outcomes were prevalence density of C difficile infection per 1000 occupied bed-days in hospitals or per 100 000 inhabitant-days in the community. Between Jan 1, 1997, and Dec 31, 2012, we identified 4885 cases of hospital-onset C difficile infection among 1 289 929 admissions to study hospitals, and a further 1625 cases of community-onset C difficile infection among 455 508 adults registered in primary care. Use of 4C antibiotics was reduced by 50% in both hospitals (mean reduction 193 defined daily doses per 1000 occupied bed-days, 95% CI 45-328, p=0·008) and the community (1·85 defined daily doses per 1000 inhabitant-days, 95% CI 0·23-3·48, p=0·025) during antibiotic stewardship. Falling 4C use predicted rapid declines in multidrug-resistant ribotypes R001 and R027. Hospital-onset C difficile infection prevalence densities were associated with fluoroquinolone, third-generation cephalosporin, macrolides, and carbapenem use, exceeding hospital population specific total use thresholds. Community-onset C difficile infection prevalence density was predicted by recent hospital C difficile infection rates, introduction of mandatory surveillance in individuals older than 65 years, and primary-case use of fluoroquinolones and clindamycin exceeding total use thresholds. Compared with predictions without intervention, C difficile infection prevalence density fell by 68% (mean reduction 1·01 per 1000 occupied bed-days, 0·27-1·76, p=0·008) in hospitals and 45% (0·083, 0·045-0·121 cases per 100 000 inhabitant-days, p<0·0001) in the community, during antibiotic stewardship. We identified no significant effects from other interventions. Limiting population use of 4C antibiotics reduced selective pressures favouring multidrug-resistant epidemic ribotypes and was associated with substantial declines in total C difficile infections in northeast Scotland. Efforts to control C difficile through antibiotic stewardship should account for ribotype distributions and non-linear effects. NHS Grampian Microbiology Endowment Fund.

GMC closes inquiry into troubled Aberdeen hospital

A lengthy investigation by the UK General Medical Council into the conduct of senior doctors at Aberdeen Royal Infirmary has concluded without any action being taken. The inquiry was prompted by two critical reports issued in late 2014 by Healthcare Improvement Scotland and the Royal College of Surgeons of England into problems at the hospital, the largest in the NHS Grampian area. The reports found serious …

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm

Essentials Ignorance of direct oral anticoagulants' effects on coagulation tests may be a safety issue. An electronic questionnaire was sent to prescribers in NHS Grampian with 143 respondents. We found widespread evidence of inappropriate interpretation of the clinical scenarios given. The study suggests potential for patient harm due to lack of knowledge and education is required. Background Lack of awareness of the nature of the direct oral anticoagulants (DOACs) combined with the poor correlation between routine coagulation test prolongation and the activity of these drugs represents a potential for patient harm. Objectives To establish the level of awareness of the different DOACs, and to assess whether prescribers were able to recognize the state of anticoagulation in a hypothetical patient. Methods and results An electronic questionnaire was sent by email to prescribers in our health board. Among 143 respondents, we found significant differences in awareness of the currently licensed drugs. Of the respondents, 88%, 80% and 50%, respectively, recognized rivaroxaban, dabigatran, and apixaban. When provided with a routine clinical situation, only 13.5%, 17.5% and 16.8%, respectively, recognized that the hypothetical patient was anticoagulated, and only 55-58% recognized that it was unsafe to proceed with an invasive procedure. Conclusion These results indicate a significant risk for patient harm related to lack of knowledge about this new group of frequently used drugs, and indicate that additional education and training on this subject are required.

Human anogenital distance: an update on fetal smoke-exposure and integration of the perinatal literature on sex differences.

STUDY QUESTIONDo sex and maternal smoking effects on human fetal anogenital distance (AGD) persist in a larger study and how do these data integrate with the wider literature on perinatal human AGD, especially with respect to sex differences?SUMMARY ANSWERSecond trimester sex differences in AGD are broadly consistent with neonatal and infant measures of AGD and maternal cigarette smoking is associated with a temporary increase in male AGD in the absence of changes in circulating testosterone.WHAT IS KNOWN ALREADYAGD is a biomarker of fetal androgen exposure, a reduced AGD in males being associated with cryptorchidism, hypospadias and reduced penile length. Normative fetal AGD data remain partial and windows of sensitivity of human fetal AGD to disruption are not known.STUDY DESIGN, SIZE, DURATIONThe effects of fetal sex and maternal cigarette smoking on the second trimester (11–21 weeks of gestation) human fetal AGD were studied, along with measurement of testosterone and testicular transcripts associated with apoptosis and proliferation.PARTICIPANTS/MATERIALS, SETTING METHODSAGD, measured from the centre of the anus to the posterior/caudal root of penis/clitoris (AGDapp) was determined in 56 female and 70 male morphologically normal fetuses. These data were integrated with current literature on perinatal AGD in humans.MAIN RESULTS AND THE ROLE OF CHANCEAt 11–13 weeks of gestation male fetal AGDapp was 61% (P< 0.001) longer than in females, increasing to 70% at 17–21 weeks. This sexual dimorphism was independent of growth characteristics (fetal weight, length, gonad weight). We confirmed that at 14–16 weeks of gestation male fetal AGDapp was increased 28% (P < 0.05) by in utero cigarette smoke exposure. Testosterone levels were not affected by smoking. To develop normative data, our findings have been integrated with available data from in vivo ultrasound scans and neonatal studies. Inter-study variations in male/female AGD differences lead to the conclusion that normalization and standardization approaches should be developed to enable confidence in comparing data from different perinatal AGD studies.LIMITATIONS, REASONS FOR CAUTIONSex differences, and a smoking-dependent increase in male fetal AGD at 14–16 weeks, identified in a preliminary study, were confirmed with a larger number of fetuses. However, human fetal AGD should, be re-assessed once much larger numbers of fetuses have been studied and this should be integrated with more detailed analysis of maternal lifestyle. Direct study of human fetal genital tissues is required for further mechanistic insights.WIDER IMPLICATIONS OF THE FINDINGSFetal exposure to cigarette smoke chemicals is known to lead to reduced fertility in men and women. Integration of our data into the perinatal human AGD literature shows that more work needs to be done to enable reliable inter-study comparisons.STUDY FUNDING/COMPETING INTEREST(S)The study was supported by grants from the Chief Scientist Office (Scottish Executive, CZG/1/109 & CZG/4/742), NHS Grampian Endowments (08/02), the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no 212885 and the Medical Research Council, UK (MR/L010011/1). The authors declare they have no competing interests, be it financial, personal or professional.

Evaluation of intensive support for people with type 1 diabetes

This brief evaluation paper describes a pilot project established by the diabetes service in NHS Grampian. The intervention aimed to support patients to improve self–management of their condition. Intensive one–toone support was offered to a cohort of patients with high average blood glucose levels (HbA1C&gt;75mmol/mol). The support was led by a Health Psychologist and Diabetes Specialist Nurse (DSN) over an eight–week period. Delivery and input, based on a CBT framework, was tailored to suit individual patients’needs. Patients reported an increase in frequency of self–monitoring of blood glucose and improvement in knowledge and confidence in the management of their diabetes. Qualitative feedback highlighted increased self–esteem and strategies to help cope in difficult situations. Problems arose around identifying suitable patients willing to change their behaviour and the complexity of the patients referred. All patients seen had long–standing issues contributing to their poor control. An important outcome of intensive support ses ions was around selfconfidence/self–efficacy. The burden of living with diabetes can be an ongoing challenge. Many people find it difficult to adhere to the lifestyle, behavioural and psychological changes necessary to effectively manage their condition. There is a clear role for psychological interventions within diabetes care.

Increasing skin self-examination after melanoma: an intervention using text and tablet delivery

Event Abstract Back to Event Increasing skin self-examination after melanoma: an intervention using text and tablet delivery Marie Johnston1*, Peter Murchie1, Julia Allan1, Judith Masthoff1, Susan Hall1, Matt Dennis1, Fiona Walter1 and Billy Brant1 1 University of Aberdeen, United Kingdom Background: Following surgery for melanoma, there is a high risk of recurrence and it is recommended that patients perform regular total skin self-examination (TSSE) to complement physician follow-up. However practice is sub-optimal and reported barriers to TSSE include lack of training, waning motivation and the time required. The Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed based on behaviour change theory [Information-Motivation-Behavioural skills model (IMB) and Control Theory]. Aims: This study assessed acceptability and feasibility of ASICA. Methods: The intervention involves text message prompts from the nurse-lead (N), information and TSSE demonstration by tablet, monitoring of TSSE, photographing any skin changes and sending to N via tablet, feedback and follow-up by N. Interviews were conducted with 21 people previously treated for cutaneous melanoma. The intervention was piloted with 20 people treated for melanoma. Results: Interviewees were positive about the use of technology to remind and instruct on TSSE, conducting it in their homes and getting feedback quickly. Pilot participants were strongly positive; 15 adhered well to the intervention, 4 intermittently and one withdrew. Symptoms were reported by seven and two had further surgery, one with a recurrent melanoma. Several practical issues were identified. Participants’ intention and self-efficacy increased. Conclusions: The ASICA intervention was acceptable to most patients and feasible following small technical adjustments. It is now proposed to evaluate the intervention in a randomised controlled trial. Acknowledgements This work was funded by the RCUK Digital Economy award to the dot.rural Digital Economy Hub, University of Aberdeen; award reference: EP/G066051/1. The Experience Laboratory event was supported in part be a separate award from the University of Aberdeen Knowledge Exchange and Transfer Fund; award reference: GP057 UZZ0101. We wish to acknowledge the participation of all people previously treated for melanoma that took part in the interviews and the pilot exercise. We also acknowledge the professional and lay members of our project steering group. We are grateful for the clinical support and expertise lent to the project from Dr Marianne Nicolson, Miss Michaela Davies, Dr Sanjay Rajpara, Dr Frank Muller and Dr Jamie Hogg, all of NHS Grampian. Further we are indebted to Dr Gemma Teale and colleagues who facilitated the Experience Laboratory at Horizon’s in Moray. Keywords: Melanoma, Self-Examination, Behaviour Change, intervention, Digital, Feasibility study Conference: 2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016. Presentation Type: Poster presentation Topic: Academic Citation: Johnston M, Murchie P, Allan J, Masthoff J, Hall S, Dennis M, Walter F and Brant B (2016). Increasing skin self-examination after melanoma: an intervention using text and tablet delivery. Front. Public Health. Conference Abstract: 2nd Behaviour Change Conference: Digital Health and Wellbeing. doi: 10.3389/conf.FPUBH.2016.01.00021 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 04 Dec 2015; Published Online: 09 Jan 2016. * Correspondence: Prof. Marie Johnston, University of Aberdeen, Aberdeen, United Kingdom, m.johnston@abdn.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Marie Johnston Peter Murchie Julia Allan Judith Masthoff Susan Hall Matt Dennis Fiona Walter Billy Brant Google Marie Johnston Peter Murchie Julia Allan Judith Masthoff Susan Hall Matt Dennis Fiona Walter Billy Brant Google Scholar Marie Johnston Peter Murchie Julia Allan Judith Masthoff Susan Hall Matt Dennis Fiona Walter Billy Brant PubMed Marie Johnston Peter Murchie Julia Allan Judith Masthoff Susan Hall Matt Dennis Fiona Walter Billy Brant Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data

BackgroundRepeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.ObjectiveTo examine the risk factors at the time of a first termination that are associated with...

Self-Reported Digital Literacy of the Pharmacy Workforce in North East Scotland.

In their day-to-day practice, pharmacists, graduate (pre-registration) pharmacists, pharmacy technicians, dispensing assistants and medicines counter assistants use widely available office, retail and management information systems alongside dedicated pharmacy management and electronic health (ehealth) applications. The ability of pharmacy staff to use these applications at home and at work, also known as digital literacy or digital competence or e-skills, depends on personal experience and related education and training. The aim of this research was to gain insight into the self-reported digital literacy of the pharmacy workforce in the North East of Scotland. A purposive case sample survey was conducted across NHS Grampian in the NE of Scotland. Data collection was based on five items: sex, age band, role, pharmacy experience plus a final question about self-reported digital literacy. The study was conducted between August 2012 and March 2013 in 17 community and two hospital pharmacies. With few exceptions, pharmacy staff perceived their own digital literacy to be at a basic level. Secondary outcome measures of role, age, gender and work experience were not found to be clear determinants of digital literacy. Pharmacy staff need to be more digitally literate to harness technologies in pharmacy practice more effectively and efficiently.

Erratum

Erratum