Thames Region Research Articles

Management of chronic prostatitis in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 2000.

Twenty-two Genitourinary Medicine (GUM) clinics in North Thames participated in a survey of policies and case notes audit of chronic prostatitis managed within the past 2 years, compared with the UK National Guideline. For 32/33 cases notes reviewed (97%) chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/CPPS) were diagnosed. Of these, 14/32 cases (44%) were following non-chlamydial non-gonococcal urethritis (NGU), 1/32 cases (3%) followed Chlamydia trachomatis infection and for 17/32 cases (53%) no predisposing cause was identified. The single case of chronic bacterial prostatitis (CBP) was caused by prostatic infection with Staphylococcus spp. All cases were prescribed antibiotics, initial follow-up appointments coinciding with completion of antibiotics. Fourteen cases (42%) were discharged following GUM clinic management; only 7 of these cases (50%) were asymptomatic, the others having residual problems. Nine cases (27%) were referred to a specialist. Ten cases (30%) defaulted follow-up appointments; 7 of these did not attend their first follow-up appointments.

An audit of the application of care aims across the south west Thames region.

Care aims are a means of defining the purpose of intervention of health care. The Malcomess care aims model uses these labels to guide the planning, delivery and outcome measurement of care. Within speech and language therapy (SLT) this involves the use of one of seven labels which clarify and make explicit the purpose of each episode of care undertaken with a client. This relatively simple application has been shown to change the way SLTs work, clarifying expectations of many who use the service. In the South West Thames Region, a project was put in place for SLTs which included undertaking training, audit and support. The outcome of the audit showed that care aims had been adopted across the region in a sufficiently flexible way to meet local needs and offered therapists the tools to reflect on the types of interventions provided to clients.

Management of Chlamydia trachomatis genital tract infection in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 1999.

Assessment of clinical management of Chlamydia trachomatis genital tract infection was made, with particular regard to the UK National Guideline. Questionnaires for self-completion, mailed to lead clinicians in 31 Genitourinary Medicine (GUM) clinics in the North Thames Region between May and June 1999, focused on policies and practice. Audit of actual management of up to 10 most recent cases (5 male and 5 female) attending each clinic within the past 2 years was also undertaken. Twenty-two units (71% response) completed the survey questionnaire and 23 units (74% response) audited a total of 229 cases (males=108, females=118, sex not stated=3). Findings indicate that GUM clinics are managing these infections largely as recommended in the national guideline. Nucleic acid amplification techniques will supersede established diagnostic tests for GUM clinics in North Thames, increasing costs for the service, but also sensitivity of detection.

Does oral polio vaccine cause intussusception in infants? Evidence from a sequence of three self-controlled cases series studies in the United Kingdom.

The use of live oral poliomyelitis vaccine (OPV) has led to the elimination of poliomyelitis disease in many countries since licensure in 1960. The discovery of an increased risk of an intestinal obstruction known as intussusception following live rotavirus vaccination raised questions about the possibility of a link between live OPV and intussusception. Three self-controlled case-series studies were carried out. The first was exploratory and included 218 intussusception episodes from hospital admissions data linked to vaccination records in the Thames region. The two subsequent studies, which used further hospital admissions data and the General Practice Research Database (GPRD) included 107 and 198 episodes respectively and were used to test hypotheses generated in the first study. In the exploratory study risk periods of up to 6 weeks after each dose were examined. The only period with some evidence of an increased risk was the 14-27-day period after the third dose (relative incidence (RI) = 1.97, p = 0.011). The second hospital admissions study and the GPRD study showed no evidence of an increased relative incidence in any putative risk period and did not confirm the increased risk in the 14-27-day period after dose 3 with a combined RI of 1.03. The sequence of studies does not support the hypothesis that OPV causes intussusception. The increased RI in the first study may be explained as a chance finding due to the number of risk periods examined and highlights the need for caution when looking at many risk periods without an a priori hypothesis.

Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London.

To determine the maternal and fetal risk of adverse outcome during pregnancy in relation to low maternal body mass index in an unselected population. Retrospective analysis. Information for the years between 1988 and 1997 was extracted from a validated maternity database, including all but one of the maternity units in the North West Thames Region; 215,105 completed singleton pregnancies were studied. Comparison of pregnancy outcome was made on the basis of maternal body mass index at booking. There were 176,923 with a normal weight body mass index ( = 20 < 25). There were 38,182 with an underweight body mass index (< 20). Comparisons included antenatal complications (e.g. gestational diabetes, pre-eclampsia); intervention in labour, maternal morbidities (e.g. infection, postpartum haemorrhage, pulmonary thromboembolism); and neonatal outcome (admitted to special care baby unit at 24 hour of age, gestation at delivery, birthweight, stillbirth). Data are presented as percentages of outcomes in the normal and underweight groups with adjusted odds ratios and confidence intervals according to body mass index group. In the underweight group only antenatal anaemia, preterm delivery and birthweight below the 5th centile were more frequent than in women of normal body mass index. The prevalence of certain complications, including development of gestational diabetes mellitus, pre-eclampsia, obstetric intervention and postpartum haemorrhage, were significantly lower in those with low body mass index. Low maternal body mass index is associated with increased prevalence of some pregnancy complications, notably preterm delivery and low birthweight, but overall the outcome is favourable and several adverse outcomes are less common in this group of women.

Maternal request for caesarean section: is it obstetrician driven?

To assess whether maternal request for elective caesarean section was in fact obstetrician driven a postal questionnaire was undertaken in the North Thames Region. One hundred and thirtyfour consultants who undertook NHS obstetrics replied to the questionnaire. Only one (0·8%) offered elective caesarean section to all women, and all suggested trial of scar in selected cases. Eighty-three (61·9%) of respondents felt that maternal request had significantly increased their caesarean section rate. It is concluded that maternal request for caesarean section is not obstetrician led, but patient driven.

Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London

Objective To determine the maternal and fetal risk of adverse outcome during pregnancy in relation to low maternal body mass index in an unselected population. Design Retrospective analysis. Methods Information for the years between 1988 and 1997 was extracted from a validated maternity database, including all but one of the maternity units in the North West Thames Region; 215,105 completed singleton pregnancies were studied. Comparison of pregnancy outcome was made on the basis of maternal body mass index at booking. There were 176,923 with a normal weight body mass index (= 20 < 25). There were 38,182 with an underweight body mass index (< 20). Comparisons included antenatal complications (e.g. gestational diabetes, pre-eclampsia); intervention in labour, maternal morbidities (e.g. infection, postpartum haemorrhage, pulmonary thromboembolism); and neonatal outcome (admitted to special care baby unit at 24 hour of age, gestation at delivery, birthweight, stillbirth). Data are presented as percentages of outcomes in the normal and underweight groups with adjusted odds ratios and confidence intervals according to body mass index group. Results In the underweight group only antenatal anaemia, preterm delivery and birthweight below the 5th centile were more frequent than in women of normal body mass index. The prevalence of certain complications, including development of gestational diabetes mellitus, pre-eclampsia, obstetric intervention and postpartum haemorrhage, were significantly lower in those with low body mass index. Conclusion Low maternal body mass index is associated with increased prevalence of some pregnancy complications, notably preterm delivery and low birthweight, but overall the outcome is favourable and several adverse outcomes are less common in this group of women.

GANDOLF: a system for generating automated nowcasts of convective precipitation

AbstractDuring the past decade hydrologists have become increasingly aware of the problems of fluvial flood prediction during periods of intense convection, particularly in urbanised catchments whose rainfall‐runoff responses tend to be rapid. Existing approaches to deterministic, short‐range rainfall prediction are often deficient in their treatment of convective precipitation because they cannot resolve individual convective clouds or effectively model their evolution. In 1994 the UK Met. Office established a joint R&amp;D programme with the Environment Agency (responsible for flood prediction in England and Wales) to explore the benefits of an Object‐Oriented conceptual Model (OOM) of convection in the nowcasting of fluvial floods. This involved the development of an automated nowcasting system (GANDOLF) designed to run the OOM during episodes of air mass convection. This paper describes the structure and function of the GANDOLF system and compares the performance of the OOM with that of two other precipitation models routinely used by Thames Region of the Agency. Copyright © 2000 Royal Meteorological Society

Parents' perceptions of disclosure of the diagnosis of cerebral palsy

The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents...

Survey of smear taking practice in the former North Thames region

One hundred and seventy-seven doctors and 161 nurses from 230 clinics responded to a questionnaire on smear taking practice. The responses show that 66% of smear takers use the Aylesbury spatula and 30% use the Ayre spatula. A total of 53% use a cytobrush for selected cases. Training of smear takers and preparation of smears was satisfactory. Most (but not all) smear takers routinely record clinical information on the request form. Only 20 cytology laboratories in the North Thames region (70%) provide additional feedback to the smear takers about the quality of their smears apart from the information on the request form. Our study shows that feedback is an area where interaction between the laboratory and smear taker could be encouraged.

Obstetric risks of pregnancy in women less than 18 years old

Objective: To quantify the age-related risks of adverse outcome during pregnancy in women less than 18 years old. Methods: We analyzed data from 341,708 completed singleton pregnancies in the North West Thames region between 1988 and 1997. Pregnancy outcomes were compared by age at delivery in women less than 18 years old ( n = 5246) and 18–34 years old ( n = 336,462); women 35 years old or older ( n = 48,658) were excluded. Data are presented as percentages of women less than 18 and 18–34-year-old women, with adjusted odds ratios (OR) and 99% confidence intervals (CI). Results: Pregnancy in women less than 18 years old was associated with increased risk of preterm labor before 32 weeks’ gestation (OR 1.41, CI 1.02, 1.90), maternal anemia (OR 1.82, CI 1.63, 2.03), chest infection (OR 2.70, CI 1.21, 6.70), and urinary tract infection (OR 1.60, CI 1.11, 2.31), but less obstetric intervention. Operative vaginal delivery (OR 0.46, CI 0.41, 0.56), elective cesarean (OR 0.47, CI 0.35, 0.65), or emergency cesarean (OR 0.45, CI 0.38, 0.53) were all less likely in women aged less than 18 years. Women less than 18 years old were no more likely to have stillbirths (OR 0.75, CI 0.42, 1.34) or small-for-gestational-age infants (OR 0.95, CI 0.82, 1.09) than women aged 18–34 years. Conclusion: Pregnant women less than 18 years old were more likely to deliver preterm than older women. In most other respects they have less maternal and perinatal morbidity and were more likely to have normal vaginal deliveries.

South East Thames Regional Clinical Psychology Training Scheme: in the beginning

South East Thames Regional Clinical Psychology Training Scheme: in the beginning

The risks associated with pregnancy in women aged 35 years or older.

The obstetric risks of adverse outcome during pregnancy in women aged > or =35 years were quantified using a retrospective analysis of data from 385 120 singleton pregnancies in the North West Thames Region, UK, between 1988 and 1997. A comparison of pregnancy outcome was made on the basis of maternal age at delivery: 18-34 years (n = 336 462), 35-40 years (n = 41 327) and women aged > 40 years (n = 7331). Women aged <18 years (n = 5246) were excluded from the study. Data are presented as percentages of 18-34 year old women, 35-40 year old and > 40 year old women, with adjusted odds ratios (OR) according to age group. Pregnant women aged 35-40 years were at increased risk of: gestational diabetes, OR = 2.63 [99% confidence interval (CI) 2.40-2.89]; placenta praevia = 1.93 (1.58-2.35); breech presentation = 1.37 (1.28-1.47); operative vaginal delivery = 1.5 (1.43-1.57); elective Caesarean section = 1.77 (1.68-1.87); emergency Caesarean section = 1.59 (1.52-1.67); postpartum haemorrhage = 1.14 (1.09-1.19); delivery before 32 weeks gestation = 1.41 (1.24-1.61); birthweight below the 5th centile = 1.28 (1.20-1. 36); and stillbirth = 1.41 (1.17-1.70). Women aged >40 years had higher OR for the same risks. Pregnant women aged >/=35 years are at increased risk of complications in pregnancy compared with younger women.

HCV prevalence in pregnant women in the UK.

The objective of the study was to assess the prevalence and epidemiology of hepatitis C virus (HCV) infection in pregnant women in the North Thames region, and in the UK in general. Demographic data were linked to neonatal samples prior to anonymization and testing by anti-HCV EIA, and with RIBA 3 confirmation. Risk factors for maternal infection were explored. Area-specific seroprevalence rates were multiplied into population sizes to estimate HCV prevalence in pregnant women in the UK. A total of 241/126,009 samples were confirmed anti-HCV positive, and a further 40 were indeterminate, representing a seroprevalence of 0.19-0.22%; 51% of maternal HCV infections were in UK-born women (71% of the population), and 22% in women from continental Europe (5% of the population). Among European-born women, HCV prevalence was associated with birth in continental Europe, partner not being notified at birth registration, partner born in a different region to the mother, and inner city residence. Four of the 241 anti-HCV positive samples (1.7%) were also anti-HIV-1 positive. It was estimated that each year an estimated 1150 out of 730,000 pregnancies in the UK would involve a woman infected with HCV (uncertainty range 660-1850), a prevalence of 0.16% (0.09-0.25%). On the basis of reported rates of mother-to-child transmission of HCV, this would represent approximately 70 paediatric HCV infections per year.

Patterns in the incidence of age-related ovarian cancer in South East England 1967-1996.

To study the age-related trends in the incidence rates of ovarian cancer in South East England between 1967 and 1996. A retrospective review of systematically collected data on ovarian cancer in South East England. Data were obtained from the Thames Cancer Registry on the numbers and rates per 100,000 population of ovarian cancer per five-year age group (0-85+) in the 30-year period from 1967 to 1996 from the 26 health authorities in the Thames region. Linear regression was performed to determine the changes in incidence rates of ovarian cancer per age group over time. The change in overall incidence of ovarian cancer in South East England, as well as the change in incidence of ovarian cancer in each five-year age groups (20-85+) in the 30-year study period. There was a strong positive correlation between ovarian cancer rates and year of diagnosis in women aged > or = 70 years, and this was particularly marked in women > 85 years of age. There was a negative correlation between rates and year of diagnosis in women aged 45-59 years. The analysis did not demonstrate a significant correlation between ovarian cancer rates and year of diagnosis in women < 44 years of age or women aged 60-69 years. There have been significant changes in the pattern of ovarian cancer incidence in South East England during the 30-year period studied. The observed changes in ovarian cancer incidence in younger women may, in part, be explained by known reproductive factors. The rise in ovarian cancer rates among the older age group is difficult to explain, but has important implications for the future planning and provision of cancer services.

Regional variation in ampicillin and trimethoprim resistance in Escherichia coli in England from 1990 to 1997, in relation to antibacterial prescribing.

Over 200 hospitals in England report resistance data for bacteraemia and meningitis isolates to the Public Health Laboratory Service. We reviewed ampicillin and trimethoprim resistance rates from 1990 to 1997 for Escherichia coli, which is the species reported most frequently from these bacteraemias. Ampicillin resistance was relatively stable over time, but varied between Health Regions. The proportion of ampicillin-resistant E. coli in the East Anglia region remained </=42% in all years except one and that in the South Western region always remained <50%. At the other extreme, the proportions of ampicillin-resistant isolates in the Northern and Trent regions never fell below 59%. The prevalence of resistance to trimethoprim rose over time in most regions; again, however, the prevalence of resistant isolates was lowest in the East Anglia and South Western regions, whereas the highest resistance rates were reported from Mersey, NW Thames, NE Thames and North Western regions. These observations were related to data for community prescribing, which accounts for most ampicillin and trimethoprim use. Prescribing data for ampicillin and trimethoprim from 1987 to 1997 were obtained from the IMS-HEALTH Medical Data Index, and data for all antibacterial drugs between 1995 and 1997 from the Prescription Pricing Authority. Correlations between resistance rates and prescribing of specific antibiotics were weak, although there was some trend for regions with high total prescribing to have higher rates of ampicillin resistance. The South Western region was conspicuous both for low rates of resistance and low prescribing. Several factors may determine the lack of wider and more obvious relationships between resistance and prescribing. In particular, regions may be inappropriately large areas to test the relationship, isolates from bacteraemias may not be representative of those experiencing selection pressure in the community and the resistance data may have been distorted by nosocomial strains, although this seems unlikely with E. coli.

Failed tracheal intubation in obstetrics: a 6-year review in a UK region.

In the South Thames (West) region of the United Kingdom, during a 6-year period from 1993 to 1998, there was a significant increase in the Caesarean section rate accompanied by a significant decrease in the use of general anaesthesia for operative delivery. During this time, there were 36 failed tracheal intubations occurring in 8970 obstetric general anaesthetics (incidence 1/249). There was no significant difference in the incidence of failed tracheal intubation in each of the six years. In 24 of the 26 cases for which the patients' notes could be examined, there was either no recording of preoperative assessment, a failure to follow an accepted protocol for failed tracheal intubation, or no follow-up.

Management of HIV and pregnancy in England's North Thames Region 1999: a survey of practice in 21 hospitals

Management of HIV and pregnancy in England's North Thames Region 1999: a survey of practice in 21 hospitals

The mandatory collection of data on ethnic group of inpatients: experience of NHS trusts in England in the first reporting years

This paper reports the findings of a questionnaire survey of the experience of NHS trusts' mandatory collection and the use of ethnic group data of hospital inpatients in the South Thames Region, and the analysis of the ethnicity field in the Hospital Episode Statistics (HES) database for England. High levels of invalid ethnicity coding in hospital episode statistics, 44.0% (regional range 31–76%) in 1996/97 and 62.9% (range 43–90%) in 1995/96, render the data unusable. Over a third of NHS trusts felt there were other ethnic group categories for which data should have been collected, especially a subdivision of the white group. Only one in five trusts found the collection of ethnic group data useful and almost nine-tenths of trusts had made no use of the data, all but one trust stating that collection had not influenced the way services were provided. High levels of incompleteness of ethnic coding and data of questionable quality make it impossible to interpret the relative access of the ethnic minority population to hospital services and such collection is, arguably, at variance with Caldicott guidelines on patient-identifiable information. A high political priority must be accorded to the operationalisation of mandatory collection in order to meet new government objectives on fair access to services. Public Health (2000) 114, 254–259

The mandatory collection of data on ethnic group of inpatients experience of NHS trusts in England in the first reporting years

This paper reports the findings of a questionnaire survey of the experience of NHS trusts' mandatory collection and the use of ethnic group data of hospital inpatients in the South Thames Region, and the analysis of the ethnicity field in the Hospital Episode Statistics (HES) database for England. High levels of invalid ethnicity coding in hospital episode statistics, 44.0% (regional range 31–76%) in 1996/97 and 62.9% (range 43–90%) in 1995/96, render the data unusable. Over a third of NHS trusts felt there were other ethnic group categories for which data should have been collected, especially a subdivision of the white group. Only one in five trusts found the collection of ethnic group data useful and almost nine-tenths of trusts had made no use of the data, all but one trust stating that collection had not influenced the way services were provided. High levels of incompleteness of ethnic coding and data of questionable quality make it impossible to interpret the relative access of the ethnic minority population to hospital services and such collection is, arguably, at variance with Caldicott guidelines on patient-identifiable information. A high political priority must be accorded to the operationalisation of mandatory collection in order to meet new government objectives on fair access to services. Public Health (2000) 114, 254–259