Trent Regional Health Authority Research Articles

Postnatal women's experiences of management of depressive symptoms: a qualitative study

Postnatal depression is a public health problem requiring intervention. To provide effective care, information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept, or decline, psychological intervention postnatally. To provide the first integrated in-depth exploration of postnatal women's experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PoNDER trial. General practice: primary care within the former Trent regional health authority, England. Thirty women with 6-week Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 18 and probable depression completed semi-structured interviews. All women had taken part in the Post-Natal Depression Economic Evaluation and Randomised controlled (PoNDER) trial where intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles. When accepted, psychological sessions were experienced as positive, effective, and 'ideal care'. Women approved of using the EPDS but did not understand the health visitor's role in supporting women. Seeking help and accepting sessions depended on women's perspectives of their health visitor as an individual. Women's experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive. Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters. There is a case for specific enhancement of interpersonal skills in health visiting, or alternatively offering a choice of health visitors to women.

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Admission rates for peptic ulcer in the Trent Region, UK, 1972–2000: Changing pattern, a changing disease?

Background and aim. Peptic ulcer disease is believed to be less common and less severe as a result of modern medical treatment. We therefore examined changes in the admission rates for patients with duodenal ulcer and gastric ulcer, both emergency (for haemorrhage, perforation or severe pain) and for elective surgery, before and since the introduction of the new advances in therapy. These admission indices reflect disease prevalence and severity. Patients and methods. We identified admission rates during 1972–2000 within the Trent Regional Health Authority, UK (population 4.7 million), from computerised patient information using diagnostic search codes ICD8–10 and expressed as rates per million resident population. Drug expenditure details were obtained from the Department of Health. Results. Emergency admission rates as a whole changed little, a decline in the young being offset by an increase in the elderly. Haemorrhage was the most common reason (approximately 115 per million for duodenal ulcer and 87 for gastric ulcer) throughout [compared with perforation (80 and 21) and pain (90 and 68)]. In contrast, elective surgery has almost disappeared; this reduction began before the introduction of modern treatment. Conclusion. Emergency admission rates for duodenal and gastric ulcer for complications or severe pain have fluctuated over the last three decades but with little overall change. In contrast, elective surgery has declined dramatically, as a result of advances in treatment but also from changes in the natural history.

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

First admissions to a regional secure unit over a 16-year period: changes in demographic and service characteristics

Arnold Lodge Regional Secure Unit has provided medium secure psychiatric care for the Trent Regional Health Authority since July 1983. We examined a series of 504 first admissions to Arnold Lodge in order to explore trends in demographic and service utilization characteristics over 16 years. We found an increase in the admission of more serious offenders; a reduction in the length of stay; a decline in the proportion of psychopathically disordered patients; and a sixfold increase in the ratio of men to women.

First admissions to a regional secure unit over a 16-year period: changes in demographic and service characteristics

Arnold Lodge Regional Secure Unit has provided medium secure psychiatric care for the Trent Regional Health Authority since July 1983. We examined a series of 504 first admissions to Arnold Lodge in order to explore trends in demographic and service utilization characteristics over 16 years. We found an increase in the admission of more serious offenders; a reduction in the length of stay; a decline in the proportion of psychopathically disordered patients; and a sixfold increase in the ratio of men to women.

The views of nurses to the conduct of a randomised controlled trial of problem drinkers in an accident and emergency department

The Trent Regional Health Authority funded a study in 1995 to train nurses in an accident and emergency (AandE) department to screen all adult attendees for alcohol problems with a view to identifying a sample of problem drinkers to participate in a randomised controlled trial (RCT). In the RCT identified drinkers were to be assigned either to health education plus brief counselling intervention or, as controls, to health education alone. Despite 16 654 attendances at AandE during the recruitment phase of the study only 20% of attendees were screened of whom a further 19% were identified as problem drinkers by the CAGE screening questionnaire. Less than half of the problem drinkers were, however, provided with feedback by the nurses, leaving a small group of 264 eligible for entry to the RCT. The great majority of this subgroup refused an initial appointment at the specialist clinic and so the trial was abandoned. A number of in-depth interviews were undertaken with the nurses in an attempt to understand ways in which the overall conduct of the study might have been improved. This paper outlines in some detail some of the reasons for the lack of success with the study which include; general environmental factors that undoubtedly led to stress and poor morale amongst the nursing team, the differences in perception between managers and clinical nurses concerning the value of research and the inadequacy of the initial training programme. The paper concludes that there are problems in the NHS which do not provide a helpful backcloth to the successful conduct of health services research.

Are outcome data regarding the survivors of neonatal care available from routine sources?

AIMTo determine whether existing information and surveillance systems can be used to provide follow up data on groups of infants at increased risk of disability—for example, the survivors of neonatal...

Ten-year follow-up of ARIMA forecasts of attendances at accident and emergency departments in the Trent region.

Forecasting models for first, return and total attendances at accident and emergency (A&E) departments and yearly forecasts were developed ten years ago for all the health districts in the Trent region in England. The one-yearly forecasts had been checked against the 1986 actual figures and found accurate for first attendances but less accurate for return attendances. The forecasts for 1993 and 1994 were much further from the actual figures than the 1986 forecasts, with an increasing bias towards overestimation, particularly for reattendances. Whether a first attender is reviewed at a further visit may depend on local medical policy, which itself may vary with personnel changes. The one-off original ARIMA forecasts for new attendances for 1994 were no better than the district projections made in 1984, but they were better than the Trent Regional Health Authority guidelines. The ten-year strategic plan for Trent Regional Health Authority overestimated the increase in the number of first attendances at A&E departments in the Trent region. The forecasting methodology on which it was based could be improved by incorporating the ARIMA method into planning at the health district level. New forecasts or updated ones need to be calculated yearly.

Methodological issues in surveys of physical activity: the case of the Trent Health Lifestyle Survey

This paper examines methodological issues in physical activity measure ment by examining the findings of the 1994 Trent Health Lifestyle Survey which reported physical activity participation levels in adult men and women in the Trent region of England. In the survey, individuals were sampled from FHSA registers across ten districts of Trent Regional Health Authority ( N=18,787), and results indicated that high proportions of males (44 per cent) and females (46 per cent) had not undertaken any occasions of moderate or vigorous physical activity of at least 20 minutes duration in the previous four weeks. When asked about accumulated time spent on physical activity, 65 per cent of males and 64 per cent of females reported participating in 30 minutes or more 'energetic' activity on most days. In order to examine methodological issues, results of the survey are compared with those from national physical activity prevalence surveys. This comparison illustrates that even small methodological differences between surveys can substantially influence results, and caution is required in making such comparisons.

Midwifery education: Part 4 The Trent region

In April 1990, Trent Regional Health Authority reorganized nursing and midwifery education into four large colleges. In the north of the region the Sheffield and North Trent College took over five midwifery schools in South Yorkshire and North Derbyshire; in Mid Trent the college encompassed all of Lincolnshire (two midwifery schools), Nottingham and Central Nottinghamshire Schools of Midwifery; to the south, Leicester School of Midwifery became the Charles Frears College of Nursing and Midwifery; and in the west, Derby College comprised just one midwifery school.

Sterilization of instruments in general practice: what does it entail?

There is increasing interest amongst general practitioners in carrying out minor surgical procedures but it is unclear what resources are available for this. We decided to assess the level of knowledge of sterilization and the use of benchtop sterilizers in general practice by circulating a postal questionnaire to the 883 general practices in the Trent Regional Health Authority. The response rate was 49%. Minor surgical procedures were performed in 86% of practices but less than half of respondents understood what was meant by sterilization. 28% considered that the floor of the surgery should be disinfected or sterilised and 13% believed that immersion in 2% glutaraldehyde for 10 min constituted sterilization. 93% had a benchtop steriliser, only a quarter kept a log book, and approximately a third had it serviced at intervals of one year or longer. Less than 50% understood the correct position in which a bowl or kidney dish should be placed and 41% had used or had access to a local sterile services department. The concept of sterilization is not clearly understood and the use of benchtop sterilisers in Trent is suboptimal. On-going education of staff in primary care is required and consideration should be given to a system of accreditation.

Community Based Physiotherapy in the Trent Region: A Survey

A survey was carried out to investigate community based physiotherapists employed by Trent Regional Health Authority. Questionnaires were distributed to 150 community based physiotherapists employed by Trent RHA, of which 97 (65%) were returned. Information was obtained on personal details, geographical location and distribution, transport, referral mechanisms, treatment, patient details, equipment, educational background, assistant availability and interdisciplinary communication. The majority of therapists had been recruited during the past five years, and had been qualified for 11–15 years. The most common venue for treatment was the patient's own home, resulting in an average of 16% of the working day spent in transit. Most referrals came from GPs, but therapists were often dissatisfied with the information given in the referral documentation. Conditions referred for community based physiotherapy included strokes and other neurological problems, mobility cases, the elderly, soft tissue injuries, rheumatological conditions, trauma and orthopaedics, and back and neck problems. A majority (68.4%) of respondents stated that they were not involved in any formal health education/health promotion activities. There was general satisfaction with access to equipment, with in-service training, and with the links with other community based professionals. Areas for further investigation include case-load analysis, referral documentation, administrative support, use of assistants, provision of paediatric physiotherapy, and the potential for health education/health promotion strategies. A survey was carried out to investigate community based physiotherapists employed by Trent Regional Health Authority. Questionnaires were distributed to 150 community based physiotherapists employed by Trent RHA, of which 97 (65%) were returned. Information was obtained on personal details, geographical location and distribution, transport, referral mechanisms, treatment, patient details, equipment, educational background, assistant availability and interdisciplinary communication. The majority of therapists had been recruited during the past five years, and had been qualified for 11–15 years. The most common venue for treatment was the patient's own home, resulting in an average of 16% of the working day spent in transit. Most referrals came from GPs, but therapists were often dissatisfied with the information given in the referral documentation. Conditions referred for community based physiotherapy included strokes and other neurological problems, mobility cases, the elderly, soft tissue injuries, rheumatological conditions, trauma and orthopaedics, and back and neck problems. A majority (68.4%) of respondents stated that they were not involved in any formal health education/health promotion activities. There was general satisfaction with access to equipment, with in-service training, and with the links with other community based professionals. Areas for further investigation include case-load analysis, referral documentation, administrative support, use of assistants, provision of paediatric physiotherapy, and the potential for health education/health promotion strategies.

Neonatal intensive care cots: estimating the population based requirement in Trent, UK.

To estimate the population based requirement for neonatal intensive care (NIC) cots by investigating NIC utilisation in a large population based study. This was a two year, non-randomised, prospective cohort study of neonates receiving NIC in hospitals in the Trent Regional Health Authority (RHA). The main study considered the 2979 neonates born to Trent RHA residents who had begun high dependency care in Trent RHA or neighbouring health authorities between 1 April 1990 and 31 March 1992 and met any of the following criteria: (i) birth weight < 1500 g; (ii) gestation < 32 weeks; (iii) need for active respiratory support other than initial resuscitation; (iv) need for in utero or neonatal transfer to receive high dependency care; (v) severe asphyxial brain insult after delivery : and (vi) death. The analysis here is restricted to the 1730 neonates who received total parenteral nutrition or assisted ventilation, or both; that is, those who received NIC level 1 (ICL1) on at least one day. MEASUREMENT AND ANALYSIS: The treatment history of each neonate was converted into a time-line detailing the dates of beginning and stopping NIC, the dates of any transfers between units, and any gaps in NIC treatment. The duration of ICL1 was observed directly and that of intensive care level 2 (ICL20 was imputed from a model based upon round trip transfers. These were also recorded on the timeline. The time-lines were first used to derived the observed distribution of the utilisation of NIC cots in Trent RHA during the study. An extensive series of Monte Carlo simulations was then carried out in order; (i) to estimate cot requirements in smaller populations; (ii) to determine whether Trent RHA utilised its NIC cots in a manner that was clinically appropriate at the population based level; (iii) to perform a series of sensitivity analyses; and (iv) to compare results with an equivalent study carried out in the Northern RHA. Trent RHA is reasonably representative of the greater population of England and Wales in terms of both the distribution of birth weight and of birth weight-specific neonatal mortality. Trent RHA did not seen to be underprovided for NIC cots or to be overusing these cots inappropriately. It therefore seems reasonable, if the assumptions of the analysis are borne carefully in mind, to treat these utilisation data as a rough guide to true population based need. NIC cot requirements depend critically upon the size of the served population - small populations are subject to greater random variability and require relatively more cots to ensure cot availability on an equivalent proportion of days. A neonatal unit should not therefore serve a population generating fewer than 5000 and 25 000 births per annum, the estimated population based provision which would ensure free cots on 29 out of 30 days falls gradually from 1.20 to 0.88 NIC cots per 1000 births per annum. A cooperative network of NICUs offers the opportunity to provide fewer cots per head of population while maintaining good access for most neonates referred to the service.