Accelerated Up-Dosing of Subcutaneous Immunotherapy with a Registered Allergoid Birch Pollen Preparation.

Background: Early pollen flight and new allergens prolonging the pollen season means that the time for up-dosing of allergen-specific subcutaneous immunotherapy (SCIT) outside the pollen season becomes shorter. Hence, for patients who wish or need to be up-dosed faster, an accelerated induction regimen would provide a useful treatment option.

Methods: An accelerated up-dosing regimen (0.

Methods used in clinical development of novel anti-asthma therapies.

In recent years, it has become increasingly important to get as much as possible information on clinical efficacy already in the early phases of drug development. For proof of concept (POC) studies testing novel anti-inflammatory drugs in asthma, there are several validated exacerbation models, inducing various aspects of the airway inflammation and airway responsiveness. The choice of the appropriate asthma model depends on the drug's targets within the inflammatory process.

Complex fractures, do we operate on enough to gain and maintain experience?

Complex fractures are generally assumed by our profession to require adequate training and continuing practice to treat optimally. The quantity of complex fractures treated in individual hospitals and by or under the care of individual orthopaedic consultants may have implications regarding the quality of care for particular patients and also for the training of specialist registrars.A complex fracture was defined as a comminuted peri- or intra-articular fracture or segmental shaft fracture: fractures acknowledged at specialist fracture courses and by special trauma surgeons to require particular training and experience to treat optimally.

An assessment of the POSSUM system in orthopaedic surgery.

We describe the development and validation of a scoring system for auditing orthopaedic surgery. It is a minor modification of the POSSUM scoring system widely used in general surgery. The orthopaedic POSSUM system which we have developed gives predictions for mortality and morbidity which correlate well with the observed rates in a sample of 2326 orthopaedic operations over a period of 12 months.

Musculoskeletal recovery 5 years after severe injury: long term problems are common.

Five years after severe injury (ISS>15), usually involving several body regions, 158 patients were assessed regarding their musculo-skeletal recovery. An earlier paper in this journal about this study 'Injury 29 (1998) 55' showed that when considering the main body regions causing long term disability, 45% were due to bony injuries to the extremities, pelvis and shoulder girdle. We analysed these body areas regarding the degrees of disability and pain and also for problems with activities of daily living, work, sport and mobility.

Age and proximity to death as predictors of GP care costs: results from a study of nursing home patients.

This paper reports the results of a study of GP costs associated with a group of nursing home patients who died at various stages during a 12-month period. The relationship between costs per month of care, patient age and proximity to death, where sex and diagnosis are controlled for are reported. A comparison of care costs for patients in their last year of life and those who survived the course of the study is also made.

Variations in GP nursing home patient workload: results of a multivariate analysis.

The number of old people living in UK nursing homes has increased substantially over the past 15 y. There is evidence that such patients generate larger workloads for primary carers than do those of similar age and sex living in their own homes. Clearly, any extra workload involved in providing primary care services to nursing home patients, needs to be reflected in the resources afforded general practitioners (GPs) who are tasked with its provision.

The impact of nursing home patients on general practitioners' workload.

Background: Although the number of people in nursing homes has risen substantially in recent years, the shift of responsibility into general practice has rarely been accompanied by extra resources. These patients may be associated with a higher general practitioner (GP) workload than others of similar age and sex.

Aim: To assess the GP workload associated with nursing home residents and its associated costs.

Head injury in the severely injured: long-term follow-up in 157 patients.

Ninety-two patients with head injury in the context of multiple injury were followed up 5 years after injury. Severe disability in this group of patients was nearly always due to brain/spinal cord injury, rather than musculoskeletal injury. A substantial number of patients with mild or moderate head injuries had significant persisting disability 5 years after injury.

Explaining variations in prescribing costs: results from a comparison of nursing home patients with matched pairs living in the community.

Objectives: To examine and explain variations in prescribing costs associated with nursing home patients and patients matched by age and sex living in the community.

Design: A 12-month case control study.

Subjects: All nursing home residents over 65-years-old registered with nine general practices and patients matched with them for age and sex living in the community.

The impact of nursing home patients on prescribing costs in general practice.

Objectives: To compare the costs of prescribing for older people in nursing homes with older people living at home and to compare patterns of prescribing between these two groups.

Design: Retrospective case-control study.

Setting: Nine general practices in Nottinghamshire.

Anxiety and depression disorders 5 years after severe injuries: a prospective follow-up study.

Individuals with severe injuries were investigated 5 years after the traumatic events, and predictors of anxiety and depression disorders were identified. Trauma victims were selected who had an Injury Severity Score of > or = 16 and were brought to all hospitals in the Mersey region and North Wales over 1 year. The 212 patients aged > or = 15 years who left the hospital alive and lived within an accessible distance of the study hospital in Warrington were contacted 5 years later and 158 (74.

What problems do patients present with outside normal general practice surgery hours? A prospective study of the use of general practice and accident and emergency services.

Background: This study was designed to address some current issues concerning the use of general practice and accident and emergency (A & E) services outside normal surgery hours.

Method: Six general practices in Nottingham (with a combined population of 46,698 patients) were recruited to take part in the study. Over a six month period, data were collected on patient contacts with general practice services and the local A & E department outside normal surgery hours.

Disability after severe injury: five year follow up of a large cohort.

The early outcome for severely injured patients has improved in the last 20 years, but the level of continuing long term disability in such patients is not known. A large cohort of severely injured patients (ISS > 15) were interviewed and examined approximately 5 years following their injury. We present the preliminary results which show that only 30 per cent had made a full recovery, and that an alarming 47 per cent remain with moderate, severe or very severe disabilities.

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey.

Objectives: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department.

Design: Six month longitudinal study.

Setting: Six general practices and the sole accident and emergency department in Nottingham.

Problems found in the over-75s by the annual health check.

Background: Research into the health of elderly people has found problems unknown to their general practitioners. It was anticipated that annual checks, as required by the 1990 general practitioner contract, would help to detect these problems, yet the value of these checks has been questioned.

Aim: To investigate the problems found by general practice contractual annual checks of the over-75s and the consequent actions taken; to identify patient, demographic or practice characteristics associated with the discovery of problems.

The epidemiology of pelvic fractures in the Mersey Region.

The Mersey Region Trauma Survey was performed over 12 months in 1989 and 1990 to study the epidemiology of trauma in a population of 3,200,000. All deaths from injuries, and all survivors with an injury severity score of 15 or over were included, giving a total of 1088 cases. This paper, primarily epidemiological, considers those victims with a pelvic fracture (153 patients), and especially those who reached hospital alive (111 patients).

Preventable deaths among major trauma patients in Mersey Region, North Wales and the Isle of Man.

Preventable and unexpected deaths following injury were identified from among 1088 victims of major injuries arising in a defined population and area during a 12-month period. In hospital, 44 (16 per cent) deaths from blunt injury, one death from penetrating injury and one death from drowning were preventable. In patients sustaining blunt injuries, 22 per cent of non-head-injury deaths and 13 per cent of head-injury deaths were preventable.

Maxillofacial and associated injuries in severely traumatized patients: implications of a regional survey.

The aim of this paper was to study the incidence and causes of facial injuries occurring in conjunction with major trauma, and to examine the role of the maxillofacial surgeon in the management of severely injured patients. A prospective study was undertaken of 1088 patients seen in 16 hospitals over a 1-year period. A total of 161 (15%) patients sustained facial injuries.

Severe motorcycle injury in Mersey region and North Wales.

Ninety-three patients were involved in serious motorcycle accidents (death or Injury Severity Score more than 15) during a 1-year period among a total of 554 victims of serious road traffic accidents studied at 16 district general and teaching hospitals. There were 91 males and two females. The average age was 29 years (range 15-81 years).

The epidemiology of major injuries in Mersey Region and North Wales.

A prospective epidemiological study was undertaken to determine the workload and patient characteristics for a putative trauma centre in a large defined area. One thousand and eighty-eight patients were included: 430 brought in dead, 309 hospital deaths and 349 survivors. Types of injury were: blunt 76 per cent, penetrating 3.

Evaluation of the short-term impact of counseling in general practice.

This paper describes the findings of a randomised controlled trial of the short-term impact of counseling in the general practice setting. Compared with patients who received usual advice from their general practitioner for acute problems such as relationship difficulties, anxiety and depression, those who received counseling from qualified counselors working within the primary health care context showed greater improvement in psychological health as measured by the General Health Questionnaire. Significantly fewer of those counselled were prescribed anti-depressant drugs by the general practitioners in the study, or were referred to psychiatrists or clinical psychologists for care.

Regional review of blunt trauma in children.

Seventy-five severely injured children (Injury Severity Score greater than 15 or death) were identified during a 1-year prospective audit of all severe trauma in a single region. Fourteen children were admitted primarily to the regional children's hospital, comprising 0.2 per cent of that accident and emergency department workload.

Regional audit of pedestrian accident care.

In all, 160 serious pedestrian accidents (ISS > 15 or death), were recorded during a 12-month prospective study of all trauma in a population of 3.2 million. Of these, 35 died at scene, 125 arrived at hospital alive and 68 (54 per cent) subsequently died.

Pedestrian accidents on Merseyside: the case for criminalization of jaywalking.

During a 12-month review within Merseyside, 85 serious pedestrian accidents (ISS > 15 or death), were identified. Analysis of police accident statistics showed that 17 per cent of these cases had not been recorded. Children and the elderly made up 64 per cent of those injured.