Routine Attendance Research Articles

P111 Perceptions of Chlamydia screening, contraception and HIV testing among 16–24 year old patients visiting a GP surgery

Background A complex intervention based on the Theory of Planned Behaviour significantly increased chlamydia screening in general practice (McNulty et al 2014). It may be more beneficial to extend this intervention to a broader sexual health offer including chlamydia testing, contraception advice and when appropriate, HIV testing (3Cs and HIV). Aim To determine young adults’ opinions of having a broader sexual health offer (3Cs and HIV) at their GP practice. Methods Thirty interviews were conducted with 9 male and 21 female patients, 16–24 years in English GP practices. Participants were interviewed immediately before or after a routine practice attendance of any type. Data was analysed using a thematic framework and using QSR Nvivo 10. Results Participants indicated that method of testing, timing and staff member approach were important aspects to chlamydia screening and contraception discussions. Participants displayed a clear preference for the GP practice over other sexual health service locations. Items most important to participants were convenience, reassurance, and that the sexual health discussion is appropriate and routine. Barriers identified were embarrassment, unease, lack of time, religion and concern of causing offence. Suggested facilitators include raising awareness, reassuring confidentiality, ensuring the discussion is facilitated by trust and professionalism at the end of the consultation. Conclusion The majority of participants are happy to be offered 3Cs and HIV at their GP surgery. Therefore, it is important for GP staff to recognise these preferences and ensure that the full 3Cs and HIV services are made available and offered to appropriate patients.

Chronic Student Absenteeism: The Critical Role of School Nurses.

Routine school attendance is necessary for youth to develop into well-educated, successful adult citizens who will make significant contributions to society. Yet over 5 million students in the United States are chronically absent missing more than 10% of school in a year. The growing problem of chronic absenteeism among youth can be linked to increases in chronic health conditions in childhood such as allergies, asthma, diabetes, and obesity. School nurses are in an ideal position to play a vital role in reducing chronic student absenteeism, enabling youth to achieve their maximum learning potential. However, the role of the school nurse has not historically been recognized as a key factor for assisting youth to be present and regularly engaged in school. This feature article highlights a hospital-funded school nurse program within the state of Michigan that has reduced chronic absenteeism rates by placing school nurses into schools where previously there were none. The program implemented a number of initiatives that were instrumental in increasing the health and safety of students and provides a unique "before and after" glimpse of how school nursing reduces chronic student absenteeism rates and validates the essential role of the nurse within the educational system.

Frequent attendances to National Health Service general practitioner-led urgent care centres in London: an observational study

BackgroundSome patients attend emergency departments more frequently than others and account for a disproportionate number of attendances. However, little is known about repeat attenders at National Health Service urgent care centres. We aimed to describe the volume and characteristics of repeat attenders at such centres. MethodsIn an observational study, we analysed routine attendance data at two urgent care centres in London. We included all adult patients (aged 18 years and older) who attended either centre at least once between Jan 1, 2010, and Dec 31, 2012. We used Poisson regression models to predict the characteristics of frequent attenders. For each patient, the outcome variable was the numbers of repeat visits, and the exposure variable was length of follow-up. The predictors were age, sex, and risk factors recorded at the first visit (socioeconomic status, ethnicity, centre attended, referral to an accident and emergency [A&E] department, referral to a non-A&E service, mental health indication, number of diagnoses, and general practitioner [GP] registration status). We also estimated population attributable fractions for the non-base levels of each risk factor. Findings189 614 attendances were made by 108 677 patients. Although only 3116 (2·9%) attended more than five times, they accounted for a disproportionate number (26 826, 14·1%) of the total attendances. The strongest predictor of frequent attendance was low socioeconomic status (population attributable fraction for men 0·501, 95% CI 0·446–0·550; women 0·353, 0·281–0·418). Frequent attendees were commonly of non-white ethnicity (men 0·057, 0·038–0·076; women 0·030, 0·017–0·044) and unregistered with a GP (men 0·021, 0·015–0·027; women 0·017, 0·013–0·020). Patients referred to non-A&E services at their first visit were less likely to re-attend (men −0·020, −0·024 to −0·015; women −0·011, −0·015 to −0·007). InterpretationAlthough very few patients attended the centres frequently, they contributed disproportionally to the workload of the centres. Patients of low socioeconomic status, non-white ethnicity, and unregistered with a GP were more likely to attend frequently. Interventions to reduce repeat attendances could target these populations via educational programmes or enhanced access to community-based services. The generalisability of these findings is limited because data come from only two urgent care centres in London. FundingThis study was funded by a grant from the Imperial College NHS Trust Healthcare Charity and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London.

TOEIC의 디지털 융복합 블렌디드 학습과 면대면 학습의 비교 연구

Abstract The purpose of this research was to perform a comparison of face-to-face and blended learning of TOEIC to see if there is a difference in their learning effectiveness. The research compared the improvement rate of the students’ academic achievement, their self-evaluation results, and their participation rate and results of the online assignment by using t-test, pearson correlation analysis, and regression analysis. The research results demonstrated that the blended learning is pedagogically more effective than the face-to-face although the difference is not large. It was analyzed that the results were largely thanks to the following facts: In the blended learning, the students could interact with their instructors face-to-face in the off-line class, they got the weekly text message to encourage them to participate in the online class, and their routine online class attendance could cause their more positive participation in the online assignment. Key Words : blended learning, face-to-face learning, TOEIC, digital convergence, online assignment

Parental absence from clinic predicts human immunodeficiency virus treatment failure in adolescents.

It is estimated that more than 2.1 million adolescents (10–19 years of age) live with human immunodeficiency virus (HIV) in low-income and middle-income countries.1 When compared with both adults and younger children, HIV-infected adolescents have higher rates of nonadherence, virologic failure, and death.2,3 As they age, adolescents generally increase their health care–related autonomy. Adolescents may attend a clinic with or without an adult caregiver (parent). The relationship between parental attendance at clinic visits and adolescent chronic disease outcomes is unknown. We hypothesized that routine clinic attendance without a parent would be associated with the risk of HIV treatment failure, particularly in younger adolescents.

Prevention of postnatal mental health problems in women: knowledge exchange in primary care in Victoria, Australia.

What Were We Thinking (WWWT) is a psychoeducation group program for the primary prevention of postnatal mental health problems in women. It addresses two neglected risks for postnatal depression and anxiety: unsettled infant behaviour and adjustments in the partner relationship after the birth of a first baby. WWWT has evidence of efficacy when facilitated by specialist nurses. It is designed to be facilitated by trained nurses as part of standard postnatal primary care. The aim of this study is to assess nurses' understanding of their role in prevention of postnatal mental health problems, the requirements for and feasibility of implementing WWWT, and nurses' current practice and specific training needs. Maternal and Child Health (MCH) coordinators emailed nurses at all Victorian MCH centres an invitation to participate in a study about parent-infant mental health. Semi-structured interviews and group discussions were conducted. Responses were analysed thematically. MCH nurses demonstrated a willingness to implement a structured mental health-promotion intervention into clinical practice. Successful implementation will require changes to enable routine attendance of fathers at group sessions and recommendations to parents about the use of infant behaviour management strategies. This study contributes to comprehensive knowledge exchange about the implementation of a complex intervention in standard primary care. This knowledge is essential for generating practice-based evidence of the WWWT mental health-promotion program's effectiveness. SO WHAT?: The findings will inform a training program for WWWT nurse facilitators and the protocol for a cluster randomised control trial (RCT) to test the effectiveness of WWWT in standard postnatal care.

Long‐term routine dental attendance: influence on tooth loss and oral health‐related quality of life in Swedish older adults

Few studies have investigated the effect of long-term routine dental attendance on oral health between middle-aged and older adults, using a prospective cohort design. This study aimed to assess routine dental attendance (attending dentist in the previous 12 months for dental checkups) from age 50 to 65 years. Moreover, this study examined whether long-term routine dental attendance contributes to oral health-related quality of life, OHRQoL, and major tooth loss independent of social factors and the type of treatment sector utilized. Whether oral health impacts of long-term routine attendance varied with type of treatment sector utilized was also investigated. In 1992, a census of the 1942 cohort in two counties of Sweden participated in a longitudinal questionnaire survey conducted at age 50 and again after 5, 10, and 15 years. Information was collected on a wide range of health- and oral health-related aspects. Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow-ups in 1997, 2002, and 2007. Routine dental attendance decreased from 69.1% at age 50-64.2% at age 65. Adjusted logistic regression analyses revealed that individuals reporting long-term routine attendance (routine attendance in both 1992 and 2007) were 0.3 (95% CI 0.2-0.5) times less likely than their counterparts who were nonroutine attenders to report oral impacts. According to generalized estimating equations (GEE), individuals who reported long-term routine attendance were 0.6 (95% CI 0.4-0.7) times less likely than nonroutine attenders to have major tooth loss across the survey years. The effect of long-term routine attendance on OHRQoL was stronger in public than in private dental healthcare attenders. Routine attendance decreased from age 50-65 years. Long-term routine attendance had positive impact on major tooth loss and OHRQoL supporting the principle of encouraging annual dental attendance for preventive checkups among older people.

Urgent and nonurgent presentations to a psychiatric emergency service in Nigeria: pattern and correlates.

Psychiatric emergencies are acute mental health disturbances that require immediate intervention. However, the emergency department is increasingly being utilised for nonurgent mental health problems, thereby compromising the quality of care available for patients with urgent problems. This study assessed the level and correlates of urgency of mental health problems among patients presenting to an emergency department in Nigeria. The Crisis Triage Rating Scale, Clinical Global Impression Scale and a supplementary questionnaire were administered to 700 attendees at the emergency department of the Federal Neuro-Psychiatric Hospital Yaba, Lagos. Only 29.1% of the presentations constituted an “emergency” 10.9% were “urgent,” while 60% were “nonurgent.” The most common reason for nonurgent presentations was the need for medication refill. On regression analysis, level of urgency of presentations was independently associated with employment status, need for medication refill, substance abuse, suicidality, routine clinic attendance, and use of physical restraint before presentation. The majority of visits to the emergency department are for apparently “nonurgent problems.” However in a resource-poor setting, the emergency department may be the only safety net for the attendees. Our findings point to a need for education of service users and policy shifts in mental health care financing and organisation.

Executive functioning and Alzheimer’s disease: Patient and carer experience

This pilot study used the DEX questionnaires (Burgess et al., 1996), part of the Behavioural Assessment of the Dysexecutive Syndrome battery, to investigate executive functioning difficulties faced by patients diagnosed with Alzheimer’s disease (AD). Sixteen patients and 16 carers rated the difficulties they face. The questionnaires were completed anonymously during routine attendance at a memory clinic. The patient group rated their impairment, on average, as significantly less impaired than the carer group, t(30)=3.4, p<.005. The implications for the care of patients with AD and their carers are discussed and possible future areas of research outlined.

People reducing risk and improving strength through exercise, diet, and drug adherence (PRAISEDD): a case report on long-term single site adoption

African-American and low-income older adults have heightened risk for cardiovascular disease (CVD). Culturally and socially congruent community-based programs can promote risk-reduction behaviors, including physical activity (PA), and can demonstrate durability. The purpose was to increase lifestyle PA and promote self-management of CVD risk factors in a sample of at-risk older adults and to sustain a PA program within low-income housing. Exercise and education sessions were conducted three times/week for 12weeks. A community champion was trained to carry on the classes thereafter, with monthly inoculation visits by a nurse and exercise trainer. Outcome measures included attendance and CVD risk factor control. This ongoing community-based program, incorporating peer leadership, inoculation visits, and self-efficacy enhancement, has been sustained for over 3years with classes one to two times per week and routine attendance of about 12-18 residents. PRAISEDD demonstrates that a community-based PA program can be maintained using within-community leadership, periodic involvement of health care experts, and social support and self-efficacy enhancement.

Factors associated with utilization of HAART amongst hard-to-reach HIV-infected individuals in Atlanta, Georgia.

The study is aimed at identifying clinical, demographic and behavioral factors, including participation in HIV care, associated with the utilization of antiretroviral therapy (ART), among hard-to-reach HIV-positive individuals in Atlanta, GA. The study included 184 HIV-positive participants of the Infectious Disease Program (IDP) of the Grady Health System between February 1999 to March 2001. Individuals were categorized as regular attendees (those who consistently kept their outpatient appointments, n = 65), irregular (those who inconsistently kept their appointments, n = 60) or non-attendees (those who failed routinely to keep their appointments, n = 59). Univariate and multivariate analyses using log-binomial regression modeling were done. HIV-infected individuals who consistently kept their appointments at the IDP received ART at a frequency (86%) that is twice that of those who missed some appointments (42%) and four times that of those who routinely failed to keep appointments (20%). In multivariate analysis, category of clinic attendance (regular, irregular or non-attendee) was the only risk factor independently associated with utilization of ART: Regular attendees (RR = 3.59, 95% CI 2.12 to 6.08) and irregular attendees (RR = 2.26, 95% CI 1.28 to 4.01) compared to non-attendees. The positive association between routine clinic attendance and use of antiretroviral therapy observed in this study should encourage the development of strategies to retain patients in outpatient HIV care.

Nurse‐led cardiovascular risk factor intervention leads to improvements in cardiovascular risk targets and glycaemic control in people with Type 1 diabetes when compared with routine diabetes clinic attendance

To compare the effects of a dedicated cardiovascular risk factor clinic run by a nurse consultant with routine diabetes clinic attendance in achieving glycaemic and cardiovascular risk targets in patients with Type 1 diabetes. Eighty-one patients (45 male, mean age 34.6 years, mean duration of diabetes 15 years) with an HbA(1c) ≥ 8% (64 mmol/mol) and at least one other risk factor for the development of cardiovascular disease were randomized to receive either routine care or intensive nurse-led cardiovascular risk factor intervention. HbA(1c) , non-fasting lipid profile, blood pressure, weight, BMI and insulin dose were recorded at baseline, 6, 12 and 24 months. At baseline there were no differences between the groups. At 12 months, there were significant improvements in the nurse-led cardiovascular risk factor group: HbA(1c) [10.1% (87 mmol/mol) vs. 9.3% (78 mmol/mol), P < 0.001], total cholesterol (5.8 vs. 4.3 mmol/l, P < 0.001), systolic blood pressure (127 vs. 115 mmHg, P < 0.001) and diastolic blood pressure (71 vs. 65 mmHg, P < 0.05). Improvements were maintained in all variables at 24 months except diastolic blood pressure. In the routine group, only total cholesterol improved significantly (5.8 vs. 5.2 mmol/l, P < 0.01) after 12 months and this was maintained at 24 months. A nurse consultant cardiovascular risk factor clinic has a beneficial effect on cardiovascular risk targets in Type 1 diabetes, probably attributable to the increased use of lipid-lowering and anti-hypertensive agents and this was maintained at 24 months. Glycaemic control also improved.

Multidisciplinary cancer care in Australia: A national audit highlights gaps in care and medico‐legal risk for clinicians

Multidisciplinary care (MDC) is accepted as best practice in cancer treatment planning and care. Despite recognition of the importance of a team approach, limited data are available about the extent to which MDC has been implemented in Australia. The aim of the audit was to investigate the implementation of MDC for five main cancer types across Australia in line with best practice. A sample of 155 hospitals was surveyed to investigate the status of MDC for cancer treatment planning in Australia across five cancer types (breast, gynecological, lung, prostate and colorectal). The survey investigated team structure, meetings, patient consent, documentation of team recommendations and communication with the patient. Two-thirds of hospitals surveyed did not have a multidisciplinary team. Of those with such a team; in one-third patients were not informed their case would be discussed by the team, in half patient consent was not sought for all cases discussed by the team, in one-quarter the team's recommended treatment plan was not noted in the patient record. Less than 1% of teams reported routine attendance by the tumour-specific minimum core team. MDC is not being implemented in line with best practice or applied consistently across Australia. This audit has highlighted gaps in care delivery, despite national recommendations about MDC. Areas being neglected can affect the quality of care provided and may put clinicians at medico-legal risk. Recommendations to improve uptake and effectiveness of MDC are provided.

The changing prevalence of diagnosed diabetes and its associated vascular complications in a large region of the UK*

To characterize the prevalence of diabetes in a large health district in 2004 and compare it with a previous estimate made in 1996. The study population comprised the resident population of Cardiff and the Vale of Glamorgan. Routine record linkage was used to identify patients from various sources of hospital and mortality data. Patients with diabetes were identified according to biochemistry test results, coding on routine data or attendance at a diabetes-related clinic. Diabetes-related complications were ascribed according to coding on routine data. It was possible to identify 17 088 people with diabetes alive on 1 January 2005. Of these patients, 9064 (53.0%) were male and 8024 (47.0%) were female. Mean age (+/- sd) was 59.6 +/- 18.9 years for males and 61.2 +/- 20.4 years for females. The crude prevalence of diabetes in 2005 was 3.9% (3.4% adjusted) compared with 2.5% in 1996 (2.3% adjusted). With the exception of females aged > or = 75 years, the prevalence of diabetes increased in all age- and sex-specific subgroups. Within the 2005 cohort, over two-thirds has no recorded complications compared with approximately one half of the 1996 cohort. The prevalence of individual complications decreased, with the exception of renal complications. The prevalence of identified diabetes appears to have increased substantially over a relatively short period of 9 years to 2004. The increase in prevalence was 46%, with an increase in numbers of patients with diabetes of 53%. A number of factors are likely to have contributed to this, including an increase in case ascertainment.

The changing prevalence of diagnosed diabetes and its associated vascular complications in a health district of the United Kingdom

Diabet. Med. 27, 673–678 (2010) Abstract Aims To characterize the prevalence of diabetes in a large health district in 2004 and compare it with a previous estimate made in 1996. Methods The study population comprised the resident population of Cardiff and the Vale of Glamorgan. Routine record linkage was used to identify patients from various sources of hospital and mortality data. Patients with diabetes were identified according to biochemistry test results, coding on routine data or attendance at a diabetes-related clinic. Diabetes-related complications were ascribed according to coding on routine data. Results It was possible to identify 17 088 people with diabetes alive on 1 January 2005. Of these patients, 9064 (53.0%) were male and 8024 (47.0%) were female. Mean age (± sd) was 59.6 ± 18.9 years for males and 61.2 ± 20.4 years for females. The crude prevalence of diabetes in 2005 was 3.9% (3.4% adjusted) compared with 2.5% in 1996 (2.3% adjusted). With the exception of females aged ≥ 75 years, the prevalence of diabetes increased in all age- and sex-specific subgroups. Within the 2005 cohort, over two-thirds has no recorded complications compared with approximately one half of the 1996 cohort. The prevalence of individual complications decreased, with the exception of renal complications. Conclusions The prevalence of identified diabetes appears to have increased substantially over a relatively short period of 9 years to 2004. The increase in prevalence was 46%, with an increase in numbers of patients with diabetes of 53%. A number of factors are likely to have contributed to this, including an increase in case ascertainment.

The experience of cancer-related fatigue in Taiwanese children

The purpose of this study was to describe the experience of cancer-related fatigue in children of different ages in Taiwan. A total of 17 children with different stages of cancer were interviewed. The methods of data collection included interviews, participants' observations, medical chart reviews and the researcher's reflexive journals. Data were progressively analysed by using qualitative data analysis method throughout the process of data collection. The results indicated that children in all age groups used the word 'tiredness' or 'weary' instead of 'fatigue'. Patients in different age groups described the fatigue differently. Younger children (<9 years) reported that fatigue affected their ability to participate in physical activities. Children aged 10-12 years described fatigue as extreme tiredness that affected their daily lives both physically and psychosocially by altering their daily routine and school attendance and performance. Adolescents described fatigue as unrelievable tiredness that differed from normal tiredness and had a great impact on physical and psychosocial aspect, particularly altering their future life plans and self-performance. This study shows that the definition and impact of fatigue differs among children by age group. Defining and understanding the effects of fatigue can help clinicians assess fatigue and implement effective strategies to alleviate it.

Effects of fruits and vegetables on electolytes and blood pressure of hypertensive patients seen in Nigeria

High-fruit and high-vegetable diets are known to have ameliorating effects on many diseases and their complications. The objective of this study was to assess the effects of high fruit and high vegetable diets on the electrolytes and blood pressure of hypertensive patients. This experimental study was conducted at Olabisi Onabanjo University Teaching Hospital (formerly Ogun State University), Ogun state, Nigeria. Twenty five hypertensive volunteers from among hypertensive clinic attendees were recruited into the study. They were taught how to prepare two serves of vegetables and fruit (approximately 500g diced fruit salad) per day and were encouraged to consume the serves on daily basis from week one through to week ten. Baseline and bi-weekly assessment of plasma electrolytes, such as sodium, potassium, chloride and bicarbonate was carried out on the patients. Anthropometric measurements and blood pressure were also assessed biweekly on the patients during their routine clinic attendance. There was a gradual reduction in plasma sodium and chloride concentrations as well as the blood pressure which became significant in week ten. The mean baseline plasma sodium reduced significantly from 139.0 ± 0.9mmo/L to 137.5 ± 0.9mml/L, P < 0.001 after ten weeks of high fruit and high vegetable diets. Plasma chloride also reduced from baseline value of 103.2 ± 2.5mmol/L to 98.8 ± 0.7mmol/L, P < 0.0001. But the plasma potassium improved from 3.64 ± 0.2mmol/L at baseline to 3.9 ± 0.4mmol/L at week ten, P = 0.0357. The mean systolic blood pressure also dropped from the baseline value of 155.3± 7.6mmHg to 141 ± 2.4 mmHg, P < 0.0001. Also reduced was the mean diastolic blood pressure from 89.3 ± 7.6mmHg to 88.0 ± 2.4, at week ten. However, the plasma bicarbonate and BMI did not charge significantly throughout the study period. High-fruit and high-vegetable diets appear to have an ameliorating effect on the blood pressure of hypertensive patients. This may be beneficial and complementary in the management of hypertension. Keywords: Hypertension, Fruits and Vegetables, Electrolytes. AJFAND Vol. 8 (3) 2008: pp. 349-357

Comment on: Outpatient parenteral antibiotic therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years

Sir, It is with interest that we read the recent report by Matthews et al., describing the success in terms of safety and practicality of the self-administration model of outpatient parenteral antibiotic therapy (S-OPAT). We have had similar experiences in our very different Asian setting. Our service at the 1000 bed National University Hospital (NUH) in Singapore was established in late 2004 using an infusion centre model (H-OPAT). The patient demographics and disease spectra have been recently described and are consistent with the experience of Matthews et al., that is, a predominance of middle-aged (median 55 years) male (60%) patients with musculoskeletal infections (40%). Our antibiotic usage differed in several ways. Rather than a predominance of once-daily delivery antibiotics (ceftriaxone and teicoplanin comprised 80% of the antibiotics used), we require a greater diversity of antibiotics, particularly those with pharmacokinetics benefiting from 24 h infusion devices. From 369 antibiotic courses in OPAT in Singapore, 5 drugs are seen to make up 80% of total utilization; vancomycin (100), ceftriaxone (66), cefazolin (45), ertapenem (45) and ceftazidime (39) were the most frequently used, reflecting the diversity of bacteria treated and their sensitivity patterns, including methicillin-resistant Staphylococcus aureus and multidrug-resistant Gram-negative infections. Transport complexities in this large Asian city, evidence of cost–benefit, and individual patient and carer requests for autonomy led us to incorporate S-OPAT into our service during 2006. To date, 53 patients have availed themselves of S-OPAT at NUH. As with the report by Matthews et al., it is now responsible for 25% of the total bed days saved and has contributed significantly to the expansion of service (Figure 1). Our S-OPAT service is however unique in several regards. Contrary to other services described in the literatures, we heavily use elastomeric infusion devices for selfadministration of antibiotics. We believe that this may be more convenient and potentially safer as it involves less handling by the patient or carer. Training of home caregivers occurs in the outpatient setting during the routine infusion centre attendance. This prevents a possible prolongation of inpatient length of stay. When performed by skilled nurses and accompanied by an assessment process, caregiver training was achieved with a median of 2 attendances (range 1–10). Individuals providing the infusor exchanges included spouse (25%), children (25%), self (23%) and parent (15%). We note that Matthews et al. showed no difference in complication rates between the S-OPAT and H-OPAT cohorts. Our outcomes are similar. The rates of drug complications (3.8% versus 2.2% per episodze), line-related complications (0% versus 2.2%), re-admission rates (13.2% versus 13.9%) and complications unrelated to OPAT (11.3% versus 9.8%) were not different between the respective S-OPAT and H-OPAT groups (Fisher’s exact test). In conclusion, our experience supports the findings of Matthews et al. and shows that the S-OPAT model applies equally to the Asian setting. When accompanied by judicious patient selection, comprehensive education, and continuous support of caregivers in the community, self-administration of antibiotics is safe and allows for greater uptake of the service. The increasing proportion of bed days saved attributable to S-OPAT and our successful use of infusion devices highlight the potential expanding role for this form of antibiotic delivery.

Self−management in the care of patients with inflammatory bowel disease

The cost of managing chronic disease within the NHS has come under increasing focus, along with the issue of self−care of chronic disease. Self−management is one way of addressing these two issues. Self−management is a partnership approach to patient care which involves the patients′ ability to identify worsening symptoms and adjust treatment accordingly. This approach involves changes in service provision to become patient centred with the aim of reducing routine hospital attendance. Guided self−management in inflammatory bowel disease involves the provision of action plans, individualized patient information, open−access clinic appointments, telephone helplines and patient centred consultations. The key focus of self−management is that treatment and management pathways are agreed between the healthcare professional and patient.

Mode of detection of recurrent gynecological malignancy: does routine follow-up delay diagnosis and treatment?

To investigate value of routine scheduled follow-up in detecting recurrent gynecological cancer, the National Group of Gynaecology NSSG Leads conducted a national prospective audit of the mode of detection of disease recurrence under the auspices of the Department of Health Cancer Services Collaborative. Two hundred fourteen responses were received from 16 of 34 cancer networks in England in addition to one center from Wales between August 2004 and October 2005. Only 42.5% of disease recurrences was detected at routine follow-up. Only 26.2% was diagnosed during an unscheduled (expedited) clinic appointment, while 19.2% was diagnosed by another professional group and 12.1% by “other” means (routine Ca125 or imaging). Only 77.1% of patients had symptoms at the time of detection of recurrent disease. Sixty-one patients (28.5%) complained of symptoms when they attended for routine scheduled follow-up. This data suggest that if these patients had recognized the significance of these symptoms and requested early clinic review, the diagnosis may have been expedited. Diagnosis of recurrence may be delayed for a significant proportion of women because they await a routine scheduled follow-up clinic attendance to report the development of symptoms. Patient-initiated follow-up may provide a more reactive and flexible model of care that encourages women to present as soon as symptoms are experienced. This model will be assessed in the UK in a large, multicenter, randomized controlled trial, Follow-up in Gynaecological cancer Units: Randomised controlled trial for Endometrium (FIGURE trial).