Economic assessment of the impact of telecare on the use of social care resources using a zero-inflated, hierarchical linear statistical model.

Introduction: There is an ever-increasing demand for social care in the UK, with expenditure predicted to double to £56 billion by 2038/39. Many councils are under budget restrictions putting pressure on the number of services provided and their quality. Telecare complements social care and involves the implementation of technology to keep individuals more independent.

Choosing and using methodological search filters: searchers' views.

Background: Search filters or hedges are search strategies developed to assist information specialists and librarians to retrieve different types of evidence from bibliographic databases. The objectives of this project were to learn about searchers' filter use, how searchers choose search filters and what information they would like to receive to inform their choices.

Methods: Interviews with information specialists working in, or for, the National Institute for Health and Care Excellence (NICE) were conducted.

Understanding care closer to home for ill children and young people.

Aim: To gather evidence to support the implementation of standard six of the National Service Framework for Children, Young People and Maternity Services (Department of Health and Department for Education and Skills 2004), which states that care should be provided as close to home as possible.

Methods: A mixed methods study comprising of a systematic review, a national survey of provision of care closer to home (CCTH), four in-depth, qualitative case studies and a cost analysis.

Findings: The systematic review suggests that CCTH is no less clinically effective than hospital care.

Glucocorticoid replacement therapy and fibrinolysis in patients with hypopituitarism.

Background: Hypopituitarism is associated with increased cardiovascular mortality, and it has been suggested that unphysiological glucocorticoid replacement regimens might contribute to this risk. Traditional glucocorticoid replacement regimens have often led to excessive serum cortisol levels. The hypercortisolaemia of Cushing's syndrome is associated with an increased risk of thromboembolism.

Interpretation of the short Synacthen test in the presence of low cortisol-binding globulin: two case reports.

Context: Ten percent of serum total cortisol (TC) is unbound; the remainder is bound to cortisol-binding globulin (CBG) and, to a lesser extent, albumin. CBG concentrations can drop significantly, particularly in critical illness, resulting in a low TC although the free, active, cortisol may be normal or increased. In the context of a low CBG, the diagnosis of pituitary-adrenal insufficiency with measurements of TC is difficult.

Hepatitis C nightmare. Interview by Charlotte Alderman.

Sustaining a needlestick injury resulted in nurse Dianne Wright contracting hepatitis C infection in 2003. Despite 24 weeks of gruelling treatment, she continued to work. A blood test taken at six weeks after the injury confirmed hepatitis C.

Failure to normalize parathyroid hormone during treatment of vitamin D deficiency in Asian patients.

Objective: Vitamin D deficiency and osteomalacia remain commonplace within the Asian community in Bradford. The treatment of vitamin D deficiency and osteomalacia is cheap and effective, but there are few data on long-term outcomes. Studies have suggested that a minority of patients fail to normalize parathyroid hormone (PTH) levels during therapy with vitamin D.

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

Objectives: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE).

Design: Interrupted time series analysis, review of case notes, survey, and interviews.

Setting: Acute and primary care trusts in England and Wales.