Assessment of patients' attitudes towards weight loss in an Irish general practice setting.

BACKGROUND: Ireland is on course to become the most obese country in Europe by 2025. A recently published action plan for obesity in Ireland identifies primary care as one of the best places to tackle this issue. AIM: This study aims to assess patients' attitudes towards weight loss management in general practice in Ireland. DESIGN AND SETTING: A descriptive study was conducted at one urban single-handed and one rural group practice in the south west of Ireland. METHOD: The study is a quantitative cross-sectional survey. RESULTS: The response rate was 18.72% in the rural and 22.8% in the urban practice. Thirty-three percent of patients underestimated their BMI. Sixty-four percent of overweight and 39% of obese patients said their general practitioner (GP) had never discussed their weight with them. Eighty-five percent of overweight and 68% of obese patients were never told their weight might be affecting their health. Only 19% of obese patients had been referred to a weight loss service. Eighty-seven percent of respondents felt their GP would be a good person to advise them. The main reasons patients felt that their weight was not addressed include patients themselves only wanting to discuss the issue they came with and they also felt that time pressure was stopping GPs. CONCLUSION: Overweight or obese patients are more likely to underestimate their BMI. GPs are not discussing weight management with patients who would benefit the most. There is a poor referral rate to weight loss services. Patients are happy to discuss their weight with their GP but are aware that time management is an issue in their consultations.

Keeping children safe at home: protocol for a case-control study of modifiable risk factors for scalds.

BACKGROUND: Scalds are one of the most common forms of thermal injury in young children worldwide. Childhood scald injuries, which mostly occur in the home, result in substantial health service use and considerable morbidity and mortality. There is little research on effective interventions to prevent scald injuries in young children. OBJECTIVES: To determine the relationship between a range of modifiable risk factors for medically attended scalds in children under the age of 5 years. DESIGN: A multicentre case-control study in UK hospitals and minor injury units with parallel home observation to validate parental reported exposures. Cases will be 0-4 years old with a medically attended scald injury which occurred in their home or garden, matched on gender and age with community controls. An additional control group will comprise unmatched hospital controls drawn from children aged 0-4 years attending the same hospitals and minor injury units for other types of injury. Conditional logistic regression will be used for the analysis of cases and matched controls, and unconditional logistic regression for the analysis of cases and unmatched controls to estimate ORs and 95% CI, adjusted and unadjusted for confounding variables. MAIN EXPOSURE MEASURES: Use of safety equipment and safety practices for scald prevention and scald hazards. DISCUSSION: This large case-control study will investigate modifiable risk factors for scalds injuries, adjust for potential confounders and validate measures of exposure. Its findings will enhance the evidence base for prevention of scalds injuries in young children.

Role of quality assessment in improving red blood cell transfusion practice.

A prospective analysis of perioperative red blood cell transfusion practice in 110 patients undergoing elective primary total hip arthroplasty was conducted as a part of a quality assessment programme at the National Orthopaedic Hospital. In addition to demographic and clinical data, blood loss and perioperative transfusions were also recorded. Blood was collected for evaluation of haematocrit levels at predetermined intervals (preoperative and 6 h, 1, 2, 3, 7 days, postoperatively). Blood transfused with the patient's haematocrit of more than 30 per cent was considered inappropriate. In addition, a discharge haematocrit exceeding 36 per cent was chosen to identify overtransfusion. Eighty-four per cent were transfused a total of 191 units of homologous blood. Only 4 units were transfused between 3 patients, intraoperatively. All intraoperative transfusions were appropriate. Using the preset criteria (i.e. blood transfused with haematocrit of more than 30 per cent), 36 per cent of total units transfused were inappropriate. Using the criterion of discharge haematocrit of more than 36 per cent, 24 per cent of the patients were overtransfused. As compared to a previous retrospective analysis of blood transfusion in the same patient population which showed that inappropriate transfusion occurred in 45 per cent of the patients, the results from this study suggest a trend towards a more conservative transfusion practice. The improvement in transfusion practice may be due to the ongoing quality assurance programme and the use of transfusion guidelines.

Intravenous antibiotics at home.

Intravenous antibiotics can be administered safely and effectively and at substantially less cost in a home environment. Patients who are candidates for this treatment must be in stable condition clinically, possess a ready venous access, and show the mental and physical capabilities required to administer intravenous medication. Antibiotics must be delivered promptly and retain their sterility and activity until infusion. Close monitoring of the patient during therapy is essential. Orthopedic infections, mainly osteomyelitis, septic arthritis, and bursitis, have thus far been our most frequently treated infections, with Staphylococcus aureus, aerobic gram-negative bacilli, and S epidermidis the most commonly encountered pathogens. Penicillins, cephalosporins and aminoglycosides have been given most often. Cure rates have exceeded 85%, and many patients resume usual activities during treatment. Complications are unusual, cost savings are substantial, and patient satisfaction is maximal.