Assessing and improving out-of-hours palliative care in a deprived community: a rapid appraisal study.

Recent changes to out-of-hours primary care in the UK have generated concerns about care for palliative care patients. The aim of this study was to identify key challenges and improvements to out-of-hours palliative care in a mixed urban and rural deprived area. We integrated data from three sources: interviews with patients and professionals, direct observations of services, and routine statistics. Key issues in the provision of care were the importance of good communication and having information available, the unwieldy process of accessing medical care out of hours, professionals bypassing routine out-of-hours care for palliative care patients, and out-of-hours care being provided by practitioners unaware of local services. We recommend provision to out-of-hours services of an enhanced 'special note' for palliative care patients, to be completed early in the course of the illness and updated regularly. The provision for certain complex patients to bypass NHS24 should be considered if routine care is not satisfactory.

Practice based health needs assessment: use of four methods in a small neighbourhood.

OBJECTIVE: To explore the use of four methods to define health needs in a community, with a view to formulating guidelines for practice based assessment of health needs. DESIGN: Collection of data on health needs for a specific neighbourhood with four complementary methods: rapid participatory appraisal, postal survey, analysis of routinely available small area statistics, and collation of practice held information. SETTING: Council estate of 670 homes in Edinburgh. MAIN OUTCOME MEASURES: Description and comparison of health needs found by the different methods. RESULTS: Each method yielded particular insights into both health and health care needs. CONCLUSIONS: An extended primary care team with public health support can assess health and health care needs in a neighbourhood by means of a mixture of quantitative and qualitative methods. Different methods may be more suitable to assess different health needs or to explore potential service provision in the community or in primary or secondary care. A composite method may be most informative.

Listening to local voices: adapting rapid appraisal to assess health and social needs in general practice.

OBJECTIVES: To explore the use of rapid appraisal in defining the health and social needs of a community and to formulate joint action plans between the residents and service providers. DESIGN: Collection of data by an extended primary care team from three sources: existing documents about the neighbourhood, interviews with a range of informants, and direct observations to build a profile of the community. SETTING: Council estate of 670 homes in Edinburgh. MAIN OUTCOME MEASURES: Perceived problems of the community and suggestions for change. RESULTS: The interviews and focus groups identified six priorities for change, many of which were not health related. These changes have been or are being implemented. CONCLUSIONS: An expanded primary care team can use rapid appraisal as a first step in identifying and meeting local health needs. It facilitates a multidisciplinary approach and complements quantitative methods of assessing need.

Family planning in rural Africa: can it work?

High fertility is the major demographic problem presently affecting rural Kenya. Chogoria Hospital has attempted to provide a community based family planning service to address this issue. This paper describes the intervention used and analyses the current contraceptive practice in the area. It is concluded that community based distribution of family planning commodities may be associated with a marked decrease in fertility rate and family size within a relatively short period. Family planning initiatives in Africa may be remarkably cost-effective interventions in the development of a nation and be associated with well spaced and healthy children.

Assessment of broadband ultrasound attenuation in the os calcis in vitro.

1. We have examined the relationship between the attenuation of broadband ultrasound in the os calcis in vitro and its bone mineral density measured by quantitative computed tomography and by physical density. 2. Broadband ultrasound attenuation was found to correlate closely with physical density (r = 0.85, P less than 0.0001), but the correlation was less than that observed between quantitative computed tomography and physical density (r = 0.92, P less than 0.0001). Measurements of broadband ultrasound attenuation and quantitative computed tomography were significantly correlated (r = 0.80, P less than 0.0001). 3. Partial correlation analysis showed a significant relationship between broadband ultrasound attenuation and bone density, but when the effect of physical density was taken into account no significant correlation was found between broadband ultrasound attenuation and quantitative computed tomography (r = 0.08, not significant). 4. Broadband ultrasound attenuation in three prospective amputees showed a high degree of concordance between measurements in vivo and in vitro, with no interference by surrounding soft tissues. 5. The correlation between physical density and broadband ultrasound attenuation was independent of quantitative computed tomography, suggesting that the technique measures aspects of density which differ from its mineral density. Broadband ultrasound attenuation holds promise as a reproducible, rapid, radiation-free assessment of skeletal status.