Mr Boki Savelyich

Patients with fractures of facial bones often have a poorer quality of life after a fracture, as well as some form of psychological morbidity.

The aim of this paper is to assess the quality of life of patients with surgically treated fractures of facial bones.

Thirty patients with fractures of the facial bones and jaw were included in this prospective clinical study, treated at the Department of Maxillofacial Surgery in Nis and the Department of Otorhinolaryngology and Maxillofacial Surgery in Podgorica, of both sexes, aged 18 to 65. The standardized questionnaire of the quality of life in relation to health, (UW QoL v.4), was used.

Women, as compared to men, had higher level of anxiety. Patients were mostly male (> 90%), while patients younger than 50 years old had a higher level of anxiety than the older ones. During the one month monitoring period, 60% of the operated patients had a good quality of life. Mood swings and feelings of depression were present in approximately half of the patients. A third of them stated those factors as the most annoying ones, which was cited as the most common cause of the poor quality of life in other studies, too.

Facial fractures have a major impact on the quality of life of patients soon after the injury in terms of altered appearance, inability to perform activities and recreation and mood swings, as well as presence of pain. It is important to understand the impact of maxillofacial trauma for each patient individually, physically and mentally.

Purpose: Coronary risks attributed to psychological factors emphasise importance of the personality type. We examined personality of some coronary patients by using a well established Cloninger's model of personality. This is a hierarchically organised system, composed of four temperament and three character dimensions, including a number of their sub-dimensions.

Method: There were 340 participants, allocated to either clinical or healthy control group. The clinical group consisted of 170 participants with a coronary disease, of those 85 were in the post-acute myocardial infraction (MI) sub-group and 85 in sub-group that underwent coronary bypass surgery (CBS). The healthy control group consisted of 170 participants, all free from cardiovascular or any other chronic illness. The age range of the participants was between 37 and 77 years (average 56,11 years). There were 264 males and 76 females. Both study groups were balanced as to sex and age, including the age at onset of the disease. All participants were fully informed and consented for the study. The Cloninger's Temperament and Character Inventory (TCI) was used to determine personality profile of the participants, and data analysed by the SPSS software using descriptive statistics and the t-test.

Results: Statistically significant difference between the clinical and control group on the TCI main dimensions was found only for the Reward Dependency (t[338]=2.04,p

Conclusions: Patients with MI and CBS tend to have a dependent type of personality (i.e. "externally driven"), with an intensive response to reward, perpetually seeking approval, may appear insecure and easily hurt. A reduction in reward or recognition could lead to atypical forms of depression or reactive dysphoria. In addition, CBS patients exhibited behaviour contrary to their genuine, biological behaviour as a mean of defence from a possible harmful dependency. Our findings are relevant for optimising clinical management of these patients, particularly in terms of communication, prevention and rehabilitation planning.

Background.
This paper describes the results of a feasibility study for a randomised controlled trial (RCT).

Methods.
Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT.

Results.
Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment.

Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination.

Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308).

Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study.

Conclusion.
This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial.

Objective: The authors sought to identify ways in which the use of general practice computer systems could be improved to enhance safety in primary care.

Design: Qualitative study using semistructured interviews.

Participants: Thirty one participants, representing a broad range of relevant disciplines and interest groups. Participants included clinicians, computer system and drug database suppliers, academics with interests in health informatics and members of governmental, professional and patient representative bodies.

Setting: UK.

Results: Participants identified deficiencies in current systems that pose serious threats to patient safety. To bring about improvements, providers need to supply clinicians with safe, accurate and accessible information for decision support; be aware of the importance of human ergonomics in the design of hazard alerts; consider the value of audit trails and develop mechanisms to allow for the accurate transfer of information between clinical computer systems. These improvements in computer systems will be most likely to occur if mandated through regulations. Individual practices are in need of improved education and training which focuses, in particular, on providing support with recording data accurately and using call, recall and reminders effectively.

Conclusion: There are significant opportunities for improving the safety of general practice computer systems. Priorities include improving the knowledge base for clinical decision support, paying greater attention to human ergonomics in system design, improved staff training and the introduction of new regulations mandating system suppliers to satisfy essential safety requirements.

Aim: To investigate general practitioners’ (GPs’) stated knowledge, use and training needs related to the patient safety features of computerised clinical systems in England.

Design: Questionnaire survey.

Subjects and setting: GPs from six English primary care trusts.

Outcome measures: GPs’ views on the importance of specified patient safety features on their computer system; their knowledge of the presence of specified safety features; previous training and perceived future training needs.

Results: Three hundred and eighty one GPs (64.0%) completed and returned the questionnaire. Although patient safety features were considered to be an important part of their computer system by the vast majority of GPs, many were unsure as to whether the system they were currently using possessed some of the specified features. Some respondents erroneously believed that their computers would warn them about potential contraindications or if an abnormal dose frequency had been prescribed. Only a minority had received formal training on the use of their system’s patient safety features.

Conclusions: Patient safety was an issue high on the agenda of this GP sample. The importance of raising GPs’ awareness of both the potential use and deficiencies of the patient safety features on their systems and ensuring that appropriate training is available should not be underestimated.

Background: This study was carried out as part of a European Union funded project (PharmDIS-e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index.

Objectives: To determine (i) accuracy of the PharmDIS-e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program.

Methods: We needed 45 patients to have 95% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin.

Results: Forty-five patients were recruited. There was a correlation of 0·65 between measured and predicted digoxin concentrations (P

Conclusion: PharmDIS-e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.

Background. Primary Care Groups and Trusts (PCG/Ts) are responsible for improving the health of local populations, but there is little evidence of their strategic involvement in accident prevention.

Objective. To determine the effect of providing information on local accidental injuries to PCG/Ts on the development of accident prevention strategies.

Methods. The study is a randomized controlled trial in PCG/Ts in the former Trent Region. Intervention PCG/Ts were sent profiles containing PCG/T specific information on hospital admissions for accidental injury and their costs and on accident prevention interventions. Health promotion leads were surveyed at baseline and three and fifteen months. The primary outcome was whether the PCG/T had a written accident prevention strategy. Secondary outcome measures included other accident prevention activities, prioritization of accident prevention, and knowledge and attitudes towards accident prevention.

Results. At three months 38% of PCG/Ts in the intervention arm had a written accident prevention strategy, compared with 42% in the control arm [difference −4%, 95% confidence interval (CI) −31% to 25%]. At fifteen months these values were 55% in the intervention arm and 50% in the control arm (difference 5%, CI −24% to 33%). There were no statistically significant differences between the groups for any outcome measures.

Conclusions. Providing profiles containing information on accidental injuries to PCG/Ts did not significantly increase the development of accident prevention strategies, however this study only had sufficient power to detect substantial changes. Larger national studies would be required to detect moderate effects of tailored packages in changing PCG/T behaviour.

Our objective was to identify and establish consensus on the most important safety features of GP computer systems, with a particular emphasis on medicines management. We used a two-round electronic Delphi survey, completed by a 21-member multidisciplinary expert panel, all from the UK. The main outcome measure was percentage agreement of the panel members on the importance of the presence of a number of different safety features (presented as clinical statements) on GP computer systems. We found 90% or greater agreement on the importance of 32 (58%) statements. These statements, indicating issues considered to be of considerable importance (rated as important or very important), related to: computerised alerts; the need to avoid spurious alerts; making it difficult to override critical alerts; having audit trails of such overrides; support for safe repeat prescribing; effective computer-user interface; importance of call and recall management; and the need to be able to run safety reports. The high level of agreement among the expert panel members indicates clear themes and priorities that need to be addressed in any further improvement of safety features in primary care computing systems.

The aim of this questionnaire survey was to find the information needs of British Asian cancer patients. An additional objective was to find the extent of family involvement when the patient was given the cancer diagnosis and the patients' views about information disclosure. We interviewed 82 Asian patients and 220 random white control patients. More white British patients gave positive answers to the statement ‘I want as much information as possible’ than Asian patients (93.1 vs 77.5%, P⩽0.001). However, 92.6% of Asian patients wanted to know if they had cancer. Many more Asians (66.2 vs 5.1%, P

Unintentional injury is the leading cause of death in children aged 1 to 15, and two thirds of fatal injuries in schoolchildren result from road traffic crashes.1 More than 75% of children fatally or seriously injured in road traffic crashes are pedestrians or cyclists.

Socioeconomic gradients exist in children admitted with pedestrian and pedal cycle injuries,2 but little is known about trends in these gradients over time. We examined trends in admission rates and socioeconomic gradients for traffic injuries in children between 1992 and 1997.

Our objective was to assess accidental injury prevention activity within Primary Care Groups/Trusts (PCG/Ts), and current knowledge and attitudes towards accidental injuries and their prevention amongst PCG/T board members. We used a cross-sectional postal questionnaire survey design. Participants were board members of 51 PCG/Ts in Trent. The main outcome measures were prioritization of accidental injury prevention and factors influencing prioritization, perceptions of the accidental injury rates in the population served by the PCG/T, accidental injury prevention activity undertaken by the PCG/T, attitudes towards accidental injury prevention and towards the PCG/Ts involvement in accidental injury prevention, knowledge of accidental injury mortality, and beliefs in the effectiveness of interventions. Many (66%) PCG/T board members see accident prevention as the least important of the priority areas in the Government’s health strategy for England. Half the PCG/Ts (49%) had formally discussed accidents at a PCG/T meeting, 34% had taken action and 29% had written an accident prevention strategy. The median number of agencies PCG/Ts were working with on accident prevention was 2. GPs held less positive attitudes about accident prevention than other board members (Z = −10.01, P

General practice computer systems already have a number of important safety features. However, there are problems in that general practitioners (GPs) have come to rely on hazard alerts when they are not foolproof. Furthermore, GPs do not know how to make best use of safety features on their systems. There are a number of solutions that could help to improve the safety features of general practice computer systems and also help to improve the abilities of healthcare professionals to use these safety features.

Objective: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years.

Design: Cross sectional survey of routinely collected hospital admission data for injury 1992-7.

Setting: 862 electoral wards in Trent Region.

Subjects: 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14.

Main outcome measures: Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards' Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward.

Results: Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was ≥3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)).

Conclusion: There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources.