The quality of primary care in a country with universal health care coverage.

BACKGROUND: Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.OBJECTIVE: To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.DESIGN AND PARTICIPANTS: Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university primary care settings.MAIN MEASURES: We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.KEY RESULTS: Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including > 75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients < 65 years (70.1% vs 68.0% in those a parts per thousand yen65 years, p = 0.047).CONCLUSIONS: Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.

A biodegradable drug delivery system for the treatment of postoperative inflammation

Cataract surgery is often performed in patients suffering from associated pathologies. Our goal is to develop a biodegradable drug delivery system (DDS) combined with the artificial intraocular lens (IOL). DDS were manufactured using poly(D,L-lactide-co-glycolide), or PLGA, and were loaded with triamcinolone acetonide (TA). The loading capacity was approximately 1050 microg of TA per DDS. The higher the molecular weight of PLGA (34,000, 48,000 and 80,000Da), the slower was the release of TA in vitro. Cataract surgery was performed on the right eye of rabbits. IOL was inserted with (i) no DDS, (ii) unloaded DDS PLGA48000, (iii) one loaded DDS PLGA48000, (iv) two loaded DDS. The number of inflammatory cells and the protein concentration were measured in the aqueous humor (AH). Unloaded DDS showed good ocular biocompatibility. One DDS PLGA48000 loaded with TA significantly reduced postoperative ocular inflammation. Two loaded DDS PLGA48000 was even more effective in inhibiting such inflammation. On long-term observation (days 63 and 84), reduction of inflammation could be obtained by insertion of one DDS PLGA48000 and a second DDS PLGA80000. Therefore, our "all in one" system is very promising since it could replace oral treatment and reduce the number of intraocular injections

Guidance on Drug and Substance Misuse in Mental Health Care Settings (PDF 954 KB)

Guidance on Drug and Substance Misuse in Mental Health Care Settings

Evaluation of the Irish Pilot Programme for the Education of Health Care Assistants

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The prevention of transmission of blood-borne diseases in the health-care setting

  The risk of transmission of blood-borne pathogens in the health-care setting has become a matter of increasing concern in Ireland in recent years. Health-care workers undertaking exposure-prone procedures are at risk of contracting blood-borne diseases from the patients they are treating and there is also a small risk that patients who are undergoing such procedures may become infected by the health-care workers who are treating them. An Advisory Group on the Transmission of Infectious Diseases in the Health-Care Setting was established in 1995 to advise the Minister for Health on the prevention of the transmission of such diseases. The Advisory Group published its report in 1997. It was realised at that time that this matter would need to be kept under review and a Standing Advisory Committee was established. Guidelines on this subject were published by the Advisory Committee in June1999. In the current document, these guidelines have been substantially revised in the light of recent information and technical developments and are now considered to be a Code of Practice in the area of prevention of the transmission of blood-borne pathogens in the health-care setting.    

Optimization of the piggyBac Transposon Using mRNA and Insulators: Toward a More Reliable Gene Delivery System.

Integrating and expressing stably a transgene into the cellular genome remain major challenges for gene-based therapies and for bioproduction purposes. While transposon vectors mediate efficient transgene integration, expression may be limited by epigenetic silencing, and persistent transposase expression may mediate multiple transposition cycles. Here, we evaluated the delivery of the piggyBac transposase messenger RNA combined with genetically insulated transposons to isolate the transgene from neighboring regulatory elements and stabilize expression. A comparison of piggyBac transposase expression from messenger RNA and DNA vectors was carried out in terms of expression levels, transposition efficiency, transgene expression and genotoxic effects, in order to calibrate and secure the transposition-based delivery system. Messenger RNA reduced the persistence of the transposase to a narrow window, thus decreasing side effects such as superfluous genomic DNA cleavage. Both the CTF/NF1 and the D4Z4 insulators were found to mediate more efficient expression from a few transposition events. We conclude that the use of engineered piggyBac transposase mRNA and insulated transposons offer promising ways of improving the quality of the integration process and sustaining the expression of transposon vectors.

Health In Ireland: Key Trends 2011

The purpose of Health in Ireland, Key Trends 2011, as with previous editions, is to provide summary data on the main areas of health and health care over the past decade. It also aims to highlight selected trends and topics of growing concern and to include new data where it becomes available. A further objective is to assess ourselves and our progress in the broader EU context. With these goals in mind, the booklet is divided into six chapters ranging from population, life expectancy and health status through to health care delivery, staffing and costs. Click here to download PDF 2.26MB

Health In Ireland: Key Trends 2013

Health in Ireland, Key Trends 2013 provides summary statistics on health and health care over the past ten years. It also highlights selected trends and topics of growing concern and includes new data which has become available during the course of the year. An important objective is to assess ourselves and our progress in the broader EU context. The booklet is divided into six chapters ranging across population, life expectancy and health status through to health care delivery, staffing and costs. Overall, the picture which emerges is of continuing progress, but at a reduced rate, set in a context of very ignificant financial constraints. Rapid ageing of the population in conjunction with lifestyle-related health threats present major challenges now and for the future in sustaining and further improving health and health services in Ireland Click here to download PDF 3.2MB

Introduction to Basic Health Care Statistics

A video summary by Catherine Comiskey

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Full report

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice. Executive summary

This report arises from a project commissioned by the Department of Health's Equality and Human Rights Group to produce an evidence-based review with a national perspective that addresses (i) ethnic differentials in health and healthcare and (ii) evidence of effective NHS and other action, including seective examples of good practice to illustrate each area. Rather than aiming for comprehensive coverage, the Department suggested a document that focuses on selective topics and population health priorities drawn from the NHS plan, existing and developing National Service Frameworks, and other policy documents and which, collectively, are encompassed in the NHS's 10-point Race Equality Action Plan. The authors were not asked to review the evidence on other key areas (such ashypertension, stroke, disability, etc.), ethnic disparities in the wider determinants of health, and on some specific groups such as Gypsy Travellers and refugees and asylum seekers. Some of these topics are covered in other reviews.

Providing meaningful care: using the experiences of young suicidal men to inform mental health care services

A short report using the experiences of young suicidal men to inform mental health care services.�