Identifying additional patients with diabetic nephropathy using the UK primary care initiative

AIMS:
The aim of this study was to use general practice data to estimate the prevalence of diabetic nephropathy within the registered diabetes patients and examine variation in practice prevalence and management performance since introduction of this initiative.
METHODS:
Reported quality indicators from the Northern Ireland General Practice Quality and Outcomes Framework were analysed for diabetes and diabetic nephropathy prevalence and management in the period 2004-2008. Variation in prevalence at practice level was assessed using multiple linear regression adjusting for age, practice size, deprivation and glycaemic control.
RESULTS:
In 2006-2007, 57,454 (4.1%) adult diabetic patients were registered in the denominator population of 1.4 million compared with 51,923 (3.8%) in 2004-2005 (mean practice range 0.5-7.7%). Diabetic nephropathy prevalence was 15.1 and 11.5%, respectively (8688 and 5955 patients). Documented diabetic nephropathy prevalence showed marked variation across practices (range 0-100%) and was significantly negatively correlated with diabetes list size, albumin creatinine ratio testing rates and renin-angiotensin-aldosterone system blockade use and positively correlated with exception reporting rates. Specifically, for every increase in 100 diabetic patients to a register, documented diabetic nephropathy prevalence reduced by 40% (P=0.003). On the positive side, median albumin-creatinine ratio testing rates doubled to 82% compared with figures in the pre-Framework era.
CONCLUSIONS:
Implementation of the Northern Ireland General Practice Quality and Outcomes Framework has positively benefitted testing for diabetic nephropathy and increased numbers of detected patients in a short space of time. Large variation in diabetic nephropathy prevalence remains and is associated with diabetes registry size, screening and treatment practices, suggesting that understanding this variation may help detect and better manage diabetic nephropathy.

Geography's medieval history: A neglected enterprise?

This paper examines the marginal place of ‘medieval geography’ in contemporary geographical scholarship. Over the past two decades, geographers' studies of the subject’s historiography have tended to focus mainly on ‘modern’ and ‘early-modern’ rather than medieval geographies. This contrasts with the early 20th century when ‘medieval geography’ was seen by geographers to be part of the discipline’s long history. Set within the context of current discussion on writing geography’s histories, the paper examines how geographers, and latterly historians, have sought to characterize and represent medieval geographies. This reveals that the subject of geography in the Middle Ages shared in the same fluidities and ambivalences that characterize geography today. The paper thus helps to challenge orthodox views of geography’s history, and argues that the connections and continuities that have shaped geography for over two millennia cautions us against taking a compartmentalized approach to historiographies of geography.

Measuring workforce segregation: religious composition of private-sector employees at individual sites in Northern Ireland

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The journey of a ‘green’ micro-enterprise – The Green Planet

This teaching case explores the longitudinal evolution of a small environmental micro-enterprise, The Green Planet retail store. Exploring two decades of business history it analyses the development of this business as sustainability issues and greener consumer goods mainstreamed in society. The case presents one of the first explorations of the individual trade-offs that owners make between economic, environmental and social criteria, alongside an exploration of the role that the personal values of the owner played in the evolution of this business. Also presented is a sample of other environmental enterprises profiled alongside The Green Planet in the early 1990s. This additional dataset provides a rich resource for readers, and a number of indicative discussion themes are identified. Readers interested in topics such as marketing, business strategy, innovation, entrepreneurship, corporate social responsibility and environmental management will find this case a valuable addition to their teaching resources.

Analysis of pharmacists attitudes toward a distance learning initiative on health screening

A questionnaire was developed to investigate pharmacists' attitudes to distance learning (DL) as a vehicle for continuing education (CE). It was included in each of a two part DL course on Health Screening. Part One was mailed to all community pharmacists in England (16,400) and returns were received from 1487. The questionnaire in Part Two was returned by 436 pharmacists. Attitude statements were scored using a five-point Likert scale. The mean response to all attitude statements was positive. Participants were significantly more satisfied than non-participants with DL in general and the DL course studied (P less than or equal to 0.05). Over 80 percent of respondents completing the course found DL to be enjoyable and more suitable than other CE methods. More females and less males than expected (based on registration statistics) requested (P less than or equal to 0.001) and completed the course (P less than or equal to 0.001). Pharmacists of all ages participated, although those recently qualified showed greater interest.