North Nottinghamshire Research Articles

Cognitive behavioural therapy improves psychotic symptoms at 18 months in people with schizophrenia

Tarrier N, Lewis S, Haddock G, et al . Cognitive-behavioural therapy in first-episode and early schizophrenia; 18-month follow-up of a randomised controlled trial. Br J Psychiatry 2004;184:231–9. [OpenUrl][1][Abstract/FREE Full Text][2]...

‘Cash-In-Hand Work: Unravelling Informal Employment from the Moral Economy of Favours’

Through the study of cash-in-hand work, an illicit type of monetary transaction often seen to epitomise unbridled profit-motivated market exchange, the aim of this paper is to challenge the dominant narrative that monetary transactions are universally market-like and profit-motivated. Until now, most studies contesting this narrative have focused upon relatively small marginal sites (e.g., car boot sales, local currency schemes) that can be simply explained away as peripheral or even superfluous to an understanding of monetised exchange in the mainstream economy. Unravelling the characteristics and logics of monetary exchange in this larger economic sphere can be viewed as an exemplar of unconstrained profit-motivated market exchange, however, the intention is to provide a more robust challenge to the view that monetary transactions are always profit- motivated than has so far been the case. To do this, the conventional focus of studies of cash-in-hand work on its variable magnitude is transcended and instead, evidence is reported of a study conducted in North Nottinghamshire that investigates the characteristics and logics underpinning such work. This reveals that although there exists cash-in-hand work of both an ‘organised’ and ‘autonomous’ variety that is conducted under profit-motivated market-like exchange relations (what I here call ‘informal employment’), there is also cash-in-hand work imbued with not-for-profit rationales and non-market economic relations that represents a ‘moral economy of paid favours’ and is more akin to unpaid mutual aid. This paper thus concludes that if not-for-profit monetised transactions can be found even in this sphere, then those contesting the view that monetised exchange is always profit- motivated so as to illuminate alternative futures beyond profit- motivated capitalism should be encouraged to extend their enquiries to more mainstream economic spaces in order to mount a more serious challenge to the hegemony of capitalist relations.

A qualitative study of stroke patients' and carers' perceptions of the stroke family support organizer service.

To investigate stroke patients' and carers' perceptions of the family support organizer (FSO) service in order to highlight its value for potential purchasers and to help shed light on findings from randomized controlled trials. Twenty semi-structured interviews were undertaken with a subsample of stroke patients and their primary informal carers after completion of nine-month outcome assessments as part of a randomized controlled trial. Community stroke services in North Nottinghamshire, UK. Interviewees who received the service reported that the presence of an FSO was valuable in many respects, including helping to claim benefits, as a source of information on stroke, and providing continuity between stroke services. Emotional support was only described by a few. Interviewees who did not receive the service described feelings of isolation and being let down by other stroke services after discharge. They also reported problems accessing information. Help needed to address the practical problems after stroke was commonly reported. For those who did not receive the FSO service, access to support appeared to be found through other channels. The FSO service appeared to be an information service. In order to evaluate community stroke services, a mixture of qualitative and quantitative outcome measures are necessary.

Can the Internet be used to improve sexual health awareness in web-wise young people?

ObjectivesTo assess Internet use amongst young people to determine whether it would be a practical way to provide sex education and information.MethodsYear 10 students (aged 14-15 years) from North Nottinghamshire...

Availability of dental services for patients with blood-borne viruses

Dental practitioners were surveyed, using a self-completed postal questionnaire, to assess their attitudes to managing patients with blood-borne viruses (BBV) and to identify dental services available for such patients in North Nottinghamshire. Questionnaires were completed by 79 (65.3%) of the 121 practitioners from 43 (82.7%) of the 52 study practices. Previous BBV experience was reported by 44 (55.7%), 31 (39.2%), 20 (25.3%) respondents for hepatitis B (HBV), hepatitis C (HCV), HIV, respectively. Over two-thirds would maintain existing patients with subsequently diagnosed BBV on their lists, approximately one-third would accept new BBV patients. Risk factors for BBV of homo/bisexuality and injecting drug use were not asked by 71 (89.9%) and 49 (62.0%) practitioners, respectively. Universal precautions were employed by 67 (84.8%) practitioners regardless of the patient's status and by seven practitioners for known BBV patients. The advice of the General Dental Council, British Dental Association, and the use of universal precautions are discussed.

Quality of Information on Referrals to Colorectal Surgeons: Towards Consensus

SummaryObjectives: To produce a valid, reliable instrument to gauge the extent to which GPs document relevant signs, symptoms and risk factors in referral letters to colorectal surgeons.Design: GPs and colorectal surgeons were invited to participate in a two-part questionnaire survey about the ideal contents of a referral letter. In the second round participants were asked to reconsider the questionnaire in the light of the group's collective replies in the first round. The instrument was tested for predictive validity and inter-rater reliability.Setting: GPs in North Nottinghamshire Health Authority and colorectal surgeons in North Trent.Participants: 125 GPs registered in two districts with North Nottinghamshire Health Authority and nine colorectal surgeons in North Trent were invited to participate.Main outcome measures: Mean scores in the second round of the questionnaire were used to produce an instrument in which marks could be ascribed to each item mentioned on a GP referral letter.Results: There was a 68.6% response rate to the questionnaire survey. The instrument had substantial inter-rater reliability (r= 0.77). Higher scores predicted cases that would be offered urgent appointments by the specialist (OR = 1.06, 95% CI = 1.01 to 1.10). Cases with pathology were not referred with more thorough documentation of pre-referral assessment (score 33 vs. 31, mean difference 2.3, p = 0.06 (t-test), 95% CI = -0.07 to 4.02).Conclusions: In some cases, patients with pathology are entering secondary care with communications from GPs in which the relevant history and examination are not fully documented. Explicit documentation of GP assessment prior to referral may have a significant impact on how cases might be managed in secondary care.

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New developments in genetics-knowledge, attitudes and information needs of practice nurses.

In response to increased referrals to geneticists and the predicted patient demand for genetic counselling, it has been proposed that some genetics services should be provided in primary care. Practice nurses are ideally placed to collect family history information and advise patients accordingly in new patient, family planning, well women/men and chronic disease clinics, but little is known about their knowledge, skills and attitudes towards providing genetic advice. The survey aimed to measure the current situation with regard to: the prevalence of family history recording by practice nurses; confidence in collecting and acting upon family history; and practice nurses' knowledge about familial disorders and genetics. It also investigated what practice nurses think their role should be in relation to the delivery of genetic services; their educational needs; and the most appropriate ways of delivering training/support. A postal questionnaire survey was carried out of all practices nurses (n = 909) in four Health Authorities in England (Oxfordshire, Northamptonshire, Nottingham and North Nottinghamshire) and one Health Board in Scotland (Lothian). Analyses were primarily descriptive. A total of 600 nurses (response rate = 66.0%) returned a completed questionnaire. Ninety-six per cent of practice nurses reported that they routinely collect family history information. Over half of the respondents had been consulted in the previous 3 months by patients with a worry about family history of cancer. Approximately 60% of nurses felt confident about collecting the relevant details regarding a family history of breast cancer but felt less confident in collecting the information regarding familial colorectal cancer. Nurses were also unsure how to proceed, with over a third of nurses referring patients to the GP even if they thought the patient was at population risk or, conversely, not referring those that they thought were at considerably higher risk to the GP. There was a reported need for education about familial disease in general and overall agreement that nurses could play a role in genetics in primary care. This study provides evidence of considerable activity from practice nurses regarding routine collection of family history. There is a need for further education for practice nurses regarding family history information and the new genetics so that this information is managed appropriately.

Poor insight, social avoidance, and better coping predicted prolonged duration of untreated psychosis in schizophrenia

Drake RJ, Haley CJ, Akhtar S, et al. Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry2000 Dec; 177 : 511 –5 [OpenUrl][1][Abstract/FREE Full Text][2] QUESTION:...

Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial

Objective: To test the hypothesis that radiography of the lumbar spine in patients with low back pain is not associated with improved clinical outcomes or satisfaction with care.Design: Randomised unblinded...

Prophylactic antibiotic prescribing — a study in general practice

Objective To study the use of prophylactic antibiotics by general dental practitioners. Design A postal questionnaire of National Health Service (NHS) general dental practitioners in ten English Health Authorities. Subjects General dental practitioners (GDPs) (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Results Responses to the questionnaires were received from 929 (60.1%) practitioners. Over 40% of general dental practitioners would prescribe prophylactic antibiotics for patients with no relevant medical history for minor oral surgery to prevent postoperative infection. Amoxicillin was the predominant choice of antibiotic in this situation. Between 15–67% of GDPs failed to prescribe prophylactic antibiotics for at risk medically compromised patients. GDPs also prescribed for patients with a medical history not known to be at risk from dental procedures. Over 50% of GDPs however, would seek specialist advice about prophylaxis if they were unsure of the indications and over 90% of GDPs indicated they would use the current recommended regime for antibiotic prophylaxis for patients at risk of infective endocarditis. Conclusions The evidence from this study suggests that a significant number of the practitioners surveyed prescribe prophylactic antibiotics inappropriately, both for surgical procedures and for patients at risk from endocarditis. There is also evidence that practitioners prescribe antibiotic prophylaxis for clinical procedures and medical conditions for which there is little evidence. The results suggest that there is a need for the development of guidelines for practitioners on the appropriate prophylactic use of antibiotics.

A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England.

To study the use of prophylactic antibiotics by general dental practitioners. A postal questionnaire of National Health Service (NHS) general dental practitioners in ten English Health Authorities. General dental practitioners (GDPs) (1544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Responses to the questionnaires were received from 929 (60.1%) practitioners. Over 40% of general dental practitioners would prescribe prophylactic antibiotics for patients with no relevant medical history for minor oral surgery to prevent postoperative infection. Amoxicillin was the predominant choice of antibiotic in this situation. Between 15-67% of GDPs failed to prescribe prophylactic antibiotics for at risk medically compromised patients. GDPs also prescribed for patients with a medical history not known to be at risk from dental procedures. Over 50% of GDPs however, would seek specialist advice about prophylaxis if they were unsure of the indications and over 90% of GDPs indicated they would use the current recommended regime for antibiotic prophylaxis for patients at risk of infective endocarditis. The evidence from this study suggests that a significant number of the practitioners surveyed prescribe prophylactic antibiotics inappropriately, both for surgical procedures and for patients at risk from endocarditis. There is also evidence that practitioners prescribe antibiotic prophylaxis for clinical procedures and medical conditions for which there is little evidence. The results suggest that there is a need for the development of guidelines for practitioners on the appropriate prophylactic use of antibiotics.

Do we prescribe therapeutic antibiotics correctly?

Objective To study the therapeutic prescribing of antibiotics by general dental practitioners. Design A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. Subjects General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Results Responses to the questionnaire were received from 929 (60.1%) practitioners. More than 95% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5 %) prescribed antibiotics for acute pulpitis and (3.3 %) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69%) and by 23% after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92%), but would prescribe when under pressure of time (30.3%), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5 %). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. Conclusions The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in National Health Service general dental practice.

A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England.

To study the therapeutic prescribing of antibiotics by general dental practitioners. A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Responses to the questionnaire were received from 929 (60.1%) practitioners. More than 95% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5%) prescribed antibiotics for acute pulpitis and (3.3%) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69%) and by 23% after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92%), but would prescribe when under pressure of time (30.3%), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5%). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in National Health Service general dental practice.

Rehabilitation of a lowland river: Reconciling flood defence with habitat diversity and geomorphological sustainability

Geomorphologically appropriate rehabilitation measures were proposed to enhance the in-stream environment of the lowland River Idle, north Nottinghamshire, UK. However, the River Idle has multi-functional management requirements including those of flood defence so environmental enhancement must be pursued without significantly increasing the flood risk. Hydraulic testing of rehabilitation proposals is complicated because of the stringent assumptions about flow and morphology in ‘traditional’ hydraulic models. While new generation two- and three-dimension hydraulic models may overcome some of these problems, they are extremely data intensive, require advanced modelling capabilities and are, therefore, very expensive to apply. Also, they do not yet predict morphology-flow interactions adequately. As an alternative, several simple hydraulic models were applied to test the rehabilitation proposals, based on a fitness-for-purpose criterion.BENDFLOW was applied to fine tune the optimal siting of measures and to estimate the additional near-bank scour generated by proposed bend re-profiling. HMODEL2 and the FCFA method were used to test the impact on local channel conveyance capacities and HECRAS was applied to simulate the impact of the proposals on regional flood defence. Indicative results from the testing suggested a maximum increase in near-bank scour of 0·15m in re-profiled bends, a loss of approximately 10% in flood conveyance locally due to deflector installation or reed and tree planting, and a 0·12m increase in flood stage within the reach for a 15 year flood. The modelling results were acceptable to the management authority as an indication of an acceptable compromise between flood defence and conservation interests, and construction of the measures followed in 1996. It is clearly that it will require the results of post-project monitoring to indicate whether compromises made to the rehabilitation initiatives in order to satisfy flood defence requirements have unduly reduced their environmental enhancement potential but, for assessing the proposed methods, the models are recommended for use other lowland river environments.

Evidence of Late Devensian and early Flandrian processes and environments in the Idle Valley at Tiln, North Nottinghamshire

SUMMARY This paper elucidates the late Pleistocene and early Flandrian environmental history of the Lower Idle Valley through sedimentological, palaeobiological and radiometric dating studies of fluvial and aeolian deposits. The lower part of the sequence comprises braided river sands and gravels with silty peats infilling a scour hollow in their upper surface. Coleopteran and palynological analyses of the organic sediments indicate deposition in a slow moving or static water body with fringing reeds, sedges and substantial beds of wet moss. Away from the water, the vegetation was open and probably of grassland with few trees. Radiocarbon dating indicates accumulation of organic material started towards the end of the Dimlington Stadial, c. 13,500 cal bp. A cryoturbated, podsolized sandy clay with plant matter was developed on the sands and gravels and is akin to an ‘Arctic Structure Soil’. The sandy clay parent material on which the soil was developed is suggested to have originated in a lacustrine environment, tentatively linked to the Lake Humber complex. The palaeosol is buried, in turn, beneath coversands, the uppermost part of which is reworked. Thermoluminescence (TL) age determinations show that the coversands started to accumulate around 13,700 bp, probably in response to climatic deterioration prior to the Loch Lomond Stadial. Reworking began around 8,500 years ago.

Auditing health promotion activities in primary health care teams: an analysis of activity and suggestions for indicators of service delivery

An audit of health promotion activity by primary health care teams in North Nottinghamshire was conducted in 1996/7 which collected quantitative data on the health promotion activity and qualitative data on examples of good practice. This paper reports the quantitative findings of 179 health promotion events. The analysis revealed information about the style, target group and topic of the health promotion events as well as information about the partnerships with outside agencies, and the level of co-operation between health workers. Measures of service delivery are suggested which can help develop targets for a planned and appropriate delivery of health promotion.

Sand Martin Riparia riparia ‐ male or female?

8,037 examinations were made of brood patches of Sand Martins from 1971 to 1992 in north Nottinghamshire and given one of 12 different descriptions. The 1,997 birds which were examined more than once (5,443 times in total) and identified as 1,061 females and 936 males from the types of patch/es they had carried were then used to test the accuracy with which three distinct types of patch (described in the text) could be used to identify the sex of birds in different periods throughout the breeding season. It was found that females carried at least 98.9% of the Large patches at any time of the breeding season; that males carried at least 96.5% of the Small patches from June to August inclusive but that males carried less than 95% of the Intermediate patches (which formed 29.7% of the patches examined) apart from late in June and in July and males carried only 83.8% of these Intermediate patches in early June and 86.6% in August. It is emphasised that an examination of the cloaca did not form part of this study and was not used to identify the sex of birds in the field.

Design principles and suitability testing for rehabilitation in a flood defence channel: the River Idle, Nottinghamshire, UK

1. The River Idle is a low gradient river flowing through north Nottinghamshire. The river was comprehensively channelized (early 1980s) for flood defence and land drainage. The scheme has produced a trapezoidal channel with a lack of ecological diversity, a poor fishery and low aesthetic value. A rehabilitation design was required to tackle these deficiencies through improvements which did not compromise the other obligations of the managing authority. 2. Rehabilitation proposals were based on a semi-quantitative assessment of the sources and pathways of sediment transport through the system. Geomorphological reconnaissance was used to define conservation value, to prioritize the most suitable reaches for restoration and to identify a reference reach. On this basis, structures were designed to achieve short-term objectives without compromising long-term geomorphological sustainability. 3. After design, the siting and impacts on flow conveyance were tested using appropriate hydraulic models. BENDFLOW was used to refine the positioning of deflectors while the estimated reduction in flow conveyance (HMODEL2 and FCFA) did not exceed 10% of capacity or 0.05 m in water surface elevation (HECRAS) under high flow conditions. 4. As river restoration and rehabilitation schemes become more widely employed in rivers with multi-functional management requirements, so detailed design principles set into their catchment context and hydraulic testing will become increasingly critical to protect designs from the criticism that flood defence and land drainage interests are adversely affected. © 1998 John Wiley & Sons, Ltd.

Community immunization programme in response to an outbreak of invasive Neisseria meningitidis serogroup C infection in the Trent region of England 1995-1996.

Between 8 December 1995 and 16 January 1996 seven laboratory confirmed cases of septicaemia owing to infection with Neisseria meningitidis serogroup C strains and one highly probable case of meningococcal septicaemia occurred in three electoral wards in south Rotherham and the Retford area of north Nottinghamshire. All cases occurred among children aged 1-17 years. One patient died. The public health response to this outbreak was the largest community prophylactic antibiotic and immunization programme against meningococcal infection, to date, in the United Kingdom. The target group for each Health Authority was 8900 for Rotherham Health Authorities and 8000 for North Nottinghamshire Health. Local logistical factors led to differences in the implementation of the programme by each Health Authority. At the completion of each programme, 8320 doses of vaccine had been administered (92.5 per cent coverage) during the Rotherham Health Authorities programme and 7660 (95.7 per cent coverage) during the North Nottinghamshire Health programme. The additional financial cost of the exercise amounted to approximately Pounds 125000 for each Health Authority. This paper describes the evolution of the outbreak, the decision-making process resulting in the immunization programme in each Health Authority, the implementation of each programme, problems identified and lessons learned.