The influence of the new general ophthalmic services (GOS) contract in optometrist referrals for glaucoma in Scotland

Purpose: To assess the quality of referrals from community optometrists in the northeast of Scotland to the hospital glaucoma service before and after the implementation of the new General Ophthalmic Services (GOS) contract in Scotland. Methods: Retrospective study encompassing two 6-month periods, one before the implementation of the new GOS (Scotland) contract in April 2006 (from June to November 2005), and the other after (from June to November 2006). The community optometrist referral forms and hospital glaucoma service notes were reviewed. Comparisons were performed using the t-test and ?- test. Results: In all, 183 referrals were made during the first 6-month period from June to November 2005, and 120 referrals were made during the second 6-month period from June to November 2006. After the introduction of the new GOS contract, there was a statistically significant increase in true-positive referrals (from 18.0 to 31.7%; P=0.006), decrease in false-positive referrals (from 36.6 to 31.7%; P=0.006), and increase in the number of referrals with information on applanation tonometry (from 11.8 to 50.0%; P=0.000), dilated fundal examination (from 2.2 to 24.2%; P=0.000), and repeat visual fields (from 14.8 to 28.3%; P=0.004) when compared to the first 6-month period. However, only 41.7% of referrals fulfilled the new GOS contract requirements, with information on applanation tonometry the most commonly missing. Conclusions: After the implementation of the new GOS (Scotland) contract in April 2006, there has been an improvement in the quality of the glaucoma referrals from the community optometrists in the northeast of Scotland, with a corresponding reduction in false-positive referrals. Despite the relatively positive effect so far, there is still scope for further improvement. © 2009 Macmillan Publishers Limited All rights reserved.

The effects of new topical treatments on management of glaucoma in Scotland:An examination of ophthalmological health care

Background: The management of glaucoma has been changed in the past decade by the introduction of new drugs. The impact of these changes on clinical care of patients was examined by examining operation and prescribing rates for glaucoma in four geographical areas of Scotland for the years 1994 to 1999. Methods: A retrospective analysis of national health statistics: primary care prescribing data, hospital derived operation rates, consultant numbers, optometrist numbers, and eye test data, expressed by estimated population at risk of glaucoma. The outcome measures were prescribing volume and cost for glaucoma medications, and operation rates, corrected for population estimated to be at risk of glaucoma (PEG), for trabeculectomy, for Scotland as a whole, and for four geographical "regions" (north east, south east, central, and south west Scotland). Results: Prescribed items per 1000 population estimated to have glaucoma (PEG) increased by 24.9% between 1994 and 1999. This was above the general increase in prescribing in Scotland (17.8%). This increase varied in the four health regions evaluated (14.3% to 31.9%). Prescribing of topical ß blockers increased little (6.4%), but there was a large increase in the use of new products (topical prostaglandins, carbonic anhydrase inhibitors, and a agonists), at the expense of miotics (47.7% fall), and older sympathomimetics. This change in prescribing pattern was accompanied by a 61.5% increase in cost (range 42.2% to 73.4% in the four regions). New drugs accounted for more than half of total glaucoma expenditure in 1999. Operation rates (corrected for PEG) fell by 45.9% (range 43.1 to 58.6%) between 1994 and 1999. Other indicators suggested increased activity in ophthalmic areas (for example, cataract operations, eye tests, numbers of optometrists and ophthalmic surgeons all increased). Within north east Scotland operation rates decreased and prescribing increased less than in other regions, both from lowest regional baseline in 1994. Conclusions: The introduction of new drug classes has had dramatic effects on the prescribing of glaucoma treatments. There has been a decline in older treatments and an increase in new agents, which has been associated with a large reduction in operation rates for glaucoma in Scotland over 6 years. Comparison of prescribing and operation data indicates regional differences in healthcare delivery for glaucoma.

A review of glaucoma treatment in Scotland 1994-2004

Objective: This study evaluated the changing trends in glaucoma management in Scotland between 1994 and 2004. Methods: A retrospective analysis of national health statistics in Scotland from 1994 to 2004. The Scottish morbidity record was used to collect information on all episodes of trabeculectomy. Data on number of prescriptions were gathered for individual drugs and also for groups of active ingredient. The population likely to have glaucoma (PLG) was calculated from estimates of prevalence in individuals aged 40 years and older, based on published epidemiological studies. The outcome measures were trabeculectomy rates, corrected for population likely to be at risk of glaucoma (PLG), and prescribing volume and cost for glaucoma medications. Results: Trabeculectomy rates have fallen by 67% from 46 per 1000 PLG in 1994 to 15.4 per 1000 PLG in 2004. Over the same time period, the population likely to be at risk of glaucoma (PLG) increased by 16.6%. The cost of prescribing has increased by 122% over 11 years compared with an increase in number of items per 1000 PLG by 27.5%. In 1994, ß-blockers accounted for 65.2% of prescribed drugs but by 2004 this had dropped to 33%. Since their introduction, the prescribing of prostaglandin analogues has increased rapidly and in 2004, they accounted for 39.4% of prescribed drugs. Conclusion: The increasing useof prostaglandin analogues has led to an increase in prescribing rates and a rapid increase in cost. At the same time, prescribing of ß-blockers has declined and trabeculectomy rates have fallen.

Special Section: Archaeology in Scotland.

(15 papers edited).

Peer tutoring in reading in Scotland:Thinking big

A large-scale randomised-controlled trial of reading tutoring in 80 schools in Scotland used the Paired Reading (PR) technique. On long-term evaluation, cross-age PR was significantly better than regular teaching, but same-age was not. On short-term evaluation, PR pupils did significantly better than control pupils in both years, and cross-age and same-age were similarly effective. Low socio-economic pupils, lower reading ability pupils, girls and reading with maths tutoring groups did significantly better. Implementation was good in parts, but some important aspects of technique were rare. Reading gains were significantly greater for those with mistakes about every 2 minutes and those who stopped reading to talk every 5 to 7 minutes. Significant gains in self-esteem were seen in same-age and cross-age groups, and for tutees and tutors, but not for controls. The relationship of achievement gain to quality of technique and socio-emotional gains is discussed, with implications for practice. Copyright © 2011 UKLA.

''We are an island”: Geographical Imagery in Accounts of Citizenship, Civil Society, and National Identity in Scotland and in England

In this article we question recent psychological approaches that equate the constructs of citizenship and social identity and which overlook the capacity for units of governance to be represented in terms of place rather than in terms of people. Analysis of interviews conducted in England and Scotland explores how respondents invoked images of Britain as “an island” to avoid social identity constructions of nationality, citizenship, or civil society. Respondents in Scotland used island imagery to distinguish their political commitment to British citizenship from questions relating to their subjective identity. Respondents in England used island imagery to distinguish the United Kingdom as a distinctive political entity whilst avoiding allusions to a common or distinctive identity or character on the part of the citizenry. People who had moved from England to Scotland used island imagery to manage the delicate task of negotiating rights to social inclusion in Scottish civil society whilst displaying recognition of the indigenous population’s claims to distinctive national culture and identity.

Three new distal tephras in sediments spanning the Last Glacial-Interglacial Transition in Scotland

Three new microtephras are reported from a number of lake sites from the Inner Hebrides and Scottish mainland. One occurs stratigrapically in the middle of Greenland Interstadial 1 (GI-1) and has been named the Penifiler Tephra. It is rhyolitic and possesses a geochemical signature that is very similar to that of the Borrobol Tephra, which also occurs in three of the sequences reported here, but which lies close to the lower boundary of GI-1. The second occurs stratigraphically in the early Holocene below the Saksunarvatn Ash and is named the Ashik Tephra. This tephra is geochemically bimodal, with a rhyolitic component comparable to the An Druim Tephra that occurs later in the Holocene, and a basaltic component which is similar to the Saksunarvatn Ash. A third tephra occurs stratigraphically above the Saksunarvatn Ash and is provisionally named the Breakish Tephra. The consistent inter-site correlation demonstrated for these new tephras at several sites enhances the regional tephrostratigraphic framework, and increases the potential for correlating palaeoenvironmental events during GI-1 and the early Holocene. However, the occurrence of multiple tephras with similar geochemistry in close stratigraphic and temporal proximity has implications for the rigour with which tephrostratigraphic investigations must be performed.

Social Risk of Public Spending Cuts in Scotland: Local Authority Experiences

This paper relates to work supported by the Joseph Rowntree Foundation which examines the way Scottish Local Authorities have approached budget cuts (Asenova, et. al., 2013). Starting with a discussion of notions of social risk, we discuss the heightened challenges faced by local authorities. We note that the literature on public sector innovation predict such pressures would cause local authorities to engage in short term decision making and adopt a static coping approach to risk mitigation which is likely to stifle innovation and obstruct the creation of more coherent and resilient localities. Although we find this to have happened in some areas, we discuss two cases where these challenges have promoted innovative and inclusive approaches to service re-design and delivery.