Sperrin Lakeland Trust - Comprehensive Assessment of Acute Services at Sperrin Lakeland Trust

Sperrin Lakeland Trust - Comprehensive Assessment of Acute Services at Sperrin Lakeland Trust

Recovery of Health Services Charges (NI) Order 2004 - Regulatory Impact Assessment (PDF 254 KB)

Recovery of Health Services Charges (NI) Order 2004 - Regulatory Impact Assessment

Bone mineral density (BMD), micro-architecture estimation (TBS) and vertebral fracture assessment (VFA) extracted from a single DXA device in combination with clinical risk factors improve significantly the identification of women at high risk of fracture

Introduction: Osteoporosis (OP) is a systemic skeletal disease characterized by a low bone mineral density (BMD) and a micro-architectural (MA) deterioration. Clinical risk factors (CRF) are often used as a MA approximation. MA is yet evaluable in daily practice by the Trabecular Bone Score (TBS) measure. TBS is a novel grey-level texture measurement reflecting bone micro-architecture based on the use of experimental variograms of 2D projection images. TBS is very simple to obtain, by reanalyzing a lumbar DXA-scan. TBS has proven to have diagnosis and prognosis value, partially independent of CRF and BMD. The aim of the OsteoLaus cohort is to combine in daily practice the CRF and the information given by DXA (BMD, TBS and vertebral fracture assessment (VFA)) to better identify women at high fracture risk. Method: The OsteoLaus cohort (1400 women 50 to 80 years living in Lausanne, Switzerland) started in 2010. This study is derived from the cohort COLAUS who started in Lausanne in 2003. The main goals of COLAUS is to obtain information on the epidemiology and genetic determinants of cardiovascular risk in 6700 men and women. CRF for OP, bone ultrasound of the heel, lumbar spine and hip BMD, VFA by DXA and MA evaluation by TBS are recorded in OsteoLaus. Preliminary results are reported. Results: We included 631 women: mean age 67.4±6.7 y, BMI 26.1±4.6, mean lumbar spine BMD 0.943±0.168 (T-score -1.4 SD), TBS 1.271±0.103. As expected, correlation between BMD and site matched TBS is low (r2=0.16). Prevalence of VFx grade 2/3, major OP Fx and all OP Fx is 8.4%, 17.0% and 26.0% respectively. Age- and BMI-adjusted ORs (per SD decrease) are 1.8 (1.2- 2.5), 1.6 (1.2-2.1), 1.3 (1.1-1.6) for BMD for the different categories of fractures and 2.0 (1.4-3.0), 1.9 (1.4-2.5), 1.4 (1.1-1.7) for TBS respectively. Only 32 to 37% of women with OP Fx have a BMD < -2.5 SD or a TBS < 1.200. If we combine a BMD < -2.5 SD or a TBS < 1.200, 54 to 60% of women with an osteoporotic Fx are identified. Conclusion: As in the already published studies, these preliminary results confirm the partial independence between BMD and TBS. More importantly, a combination of TBS subsequent to BMD increases significantly the identification of women with prevalent OP Fx which would have been miss-classified by BMD alone. For the first time we are able to have complementary information about fracture (VFA), density (BMD), micro- and macro architecture (TBS & HAS) from a simple, low ionizing radiation and cheap device: DXA. Such complementary information is very useful for the patient in the daily practice and moreover will likely have an impact on cost effectiveness analysis.

Equality Impact Assessment Guidance Framework (PDF 177 KB)

This document sets out a guidance framework for undertaking an EQIA, and has been approved by the Equality Steering Group and the Regional Equality Liaison Panel. The framework is designed to assist practitioners or managers having to undertake an EQIA for the first time. The framework will: - Introduce policy makers to an effective EQIA approach, setting out a recognised need for specific requirements and guidance on how to fulfil equality requirements; - Steer policy makers to where to seek help, including key documents and additional information sources. åÊ

Nursing Needs Assessment Tool - Users Guide 2002 (PDF 32 KB)

This assessment tool is designed to assess the registered nursing needs of a person needing long-term care. The tool is designed to encapsulate a systematic approach to assessment whilst at the same time embracing professional decision-making that takes place in the relationship between a nurse and another person. For this reason, the tool takes the assessment through a staged approach, moving from a general ‘narrative’ based assessment of ‘domains’ of care need, to a focused assessment of risk and complexity. åÊ

A palliative care needs assessment for children

The development of a children’s hospice is not seen as a priority by the respondents in this study, some of whom raised concerns regarding accessibility and cost. There is a degree of ambiguity however, regarding the role of ‘hospice’ in paediatric palliative care with some respondents associating it only with end-of-life care. There is a substantial need for ongoing education, training and development of healthcare professionals caring for children with life-limiting conditions. Palliative care services currently provided to children in Ireland with life-limiting conditions are seen to be inequitable, differing significantly according to diagnosis (malignant versus nonmalignant) and according to geographic location. This poses challenges, particularly for parents of children with non-malignant diseases. Both families and professionals often deem the physical environment for adolescents in hospitals unsuitable. The difficulties encountered in the transition from children’s services to adult services have been identified as an issue for adolescents. The provision of bereavement support varies between services. Professionals have identified the need for a broader range of bereavement services.

Proceedings of the National Conference on the assessment of Older People's Health and Social Care Needs and Preferences

The Conference took place on May 30th, 2002 in the Royal Marine Hotel, Dun Laoigaire. It attracted over 250 delegates from across the statutory, voluntary and private sectors and the interest that was expressed in the Conference was indicative of the growing recognition of the importance of establishing a more co-ordinated way of conducting health and social care assessments for older people. The Conference provided the opportunity to both discuss the necessity for a standardised approach to conducting assessments and to explore the merits of establishing a national framework for the multi-disciplinary assessment of older people’s health and social care needs and preferences.   Download document here

Assessment of total energy expenditure in free-living patients with cystic fibrosis.

The increase in resting energy expenditure (REE) reported in patients with cystic fibrosis (CF) does not necessarily imply an increase in total energy expenditure (TEE). In this study REE was assessed with open-circuit indirect calorimetry, and free-living 24-hour TEE with the heart rate method. Thirteen patients with CF, aged 8 to 24 years, with adequate nutritional status and moderately decreased pulmonary function, were studied. They were compared with 13 healthy control subjects matched for gender, age, height, and nutritional status. Resting energy expenditure was higher in patients with CF (1512 +/- 88 kcal/day) than in control subjects (1339 +/- 76 kcal/day; p less than 0.01), whereas free-living 24-hour TEE (2345 +/- 127 kcal/day and 2358 +/- 256 kcal/day, respectively) and net mechanical work efficiency of walking on a treadmill (20.4 +/- 0.7% and 19.8 +/- 0.6%, respectively) were similar. Respiratory quotient was higher in patients with CF than in control subjects at rest (0.834 +/- 0.009 vs 0.797 +/- 0.008; p less than 0.05), and tended to remain so during physical exercise, indicating a higher contribution of carbohydrate oxidation to energy expenditure. We conclude that in free living conditions, patients with CF can compensate for their increase in REE by a reduction in spontaneous physical activities or other yet undefined mechanisms.

Assessment of Therapeutic Response of Plasmodium vivax and Plasmodium falciparum to Chloroquine in a Malaria Transmission Free Area in Colombia

In order to determine the frequency of therapeutic failures to chloroquine (CQ) in patients with malaria due to either Plasmodium falciparum or P. vivax, and to explore the usefulness of a malaria-free city as a sentinel site to monitor the emergence of drug resistance, 53 patients (44 infected with P. vivax and 9 with P. falciparum) were evaluated at the Laboratory of Parasitology, Universidad del Valle in Cali, Colombia. Patients received 25 mg/kg of CQ divided in three doses over 48 h; they were followed during 28 days according to WHO/PAHO protocols. While therapeutic failures to CQ in the P. vivax group were not detected, the proportion of therapeutic failures in the P. falciparum group was high (78%) and consistent with the reports from endemic areas in Colombia. The diverse origin of cases presenting therapeutic failure confirmed that P. falciparum resistant to CQ is widespread in Colombia, and further supports the change in the national antimalarial drug scheme. Monitoring of drug resistance in malaria free areas would be useful to identify sites requiring efficacy evaluation, and in some situations could be the most appropriate alternative to collect information from endemic areas where therapeutic efficacy studies are not feasible.