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This study aims to describe the pattern of home mechanical ventilation (HMV) usage in Australia and New Zealand.34 centres providing HMV in the region were identified and asked to complete a questionnaire regarding centre demographics, patient diagnoses, HMV equipment and settings, staffing levels and methods employed to implement and follow-up therapy.28 (82%) centres responded, providing data on 2,725 patients. The minimum prevalence of HMV usage was 9

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Background: Insomnia is a common sleep complaint, with 10% of adults in the general population experiencing insomnia disorder, defined as lasting longer than three months in DSM-5. Up to 50% of patients attending family practice experience insomnia, however despite this, symptoms of insomnia are not often screened for, or discussed within this setting. We aimed to examine barriers to the assessment and diagnosis of insomnia in family practice from both the clinician and patient perspective. Methods: The present article identified research that has examined barriers to assessing insomnia from the clinician's and the client's perspectives following MEDLINE and Google Scholar searches, and then classified these barriers using the theoretical domains framework. Results: The most common barriers from the clinician's perspective were related to Knowledge, Skills, and the Environmental Context. From the patient perspective, barriers identified included their Beliefs about the consequences of Insomnia, Social Influences, and Behavioural Regulation of Symptoms. Conclusions: Utilising this theoretical framework, we discuss options for bridging the gap between the identification and subsequent management of insomnia within the family practice setting. To assist clinicians and those in community health care to overcome the Knowledge and Skills barriers identified, this article provides existing relevant clinical criteria that can be utilised to make a valid diagnosis of insomnia.

Objective To assess the policy proposed by the American Diabetes Association of universal screening in general practice of all patients aged over 45 years for diabetes. Design Cross sectional population study. Setting Local general practice in the United Kingdom. Participants All patients aged over 45 not known to have diabetes. Main outcome measures Prevalence of diabetes in the screened population, cardiovascular risk profile of patients diagnosed as having diabetes after screening. Results Of 2481 patients aged over 45 and not known to have diabetes, 876 attended for screening. There were no significant demographic differences between the screened and unscreened patients. Prevalence of diabetes in patients with age as a sole risk factor was 0.2% (95% confidence interval 0% to 1.4%). Prevalence of diabetes in patients with age and one or more other risk factors (hypertension, obesity, or a family history of diabetes) was 2.8% (1.6% to 4.7%). Four hours a week for a year would be needed to screen all people over 45 in the practice's population; about half this time would be needed to screen patients with risk factors other than age. More than 80% of patients newly diagnosed as having diabetes had a 10 year risk of coronary heart disease > 15%, 73% (45% to 92%) were hypertensive, and 73% (45% to 92%) had a cholesterol concentration > 5 mmol/l. Conclusions Screening for diabetes in general practice by measuring fasting blood glucose is feasible but has a very low yield in patients whose sole risk factor for diabetes is age over 45. Screening in a low risk population would best be targeted at patients with multiple risk factors.

(1) air (placebo), (2) oxygen and (3) NIV. The primary outcome measures were CF specific QoL, daytime sleepiness and exertional dyspnoea. Secondary outcome measures were awake and asleep gas exchange, sleep architecture, lung function and peak exercise capacity. Results: Compared with air, NIV improved the chest symptom score in the CF QoL Questionnaire (mean difference 10; 95% CI 5 to 16; p = 0.002) and the transitional dyspnoea index score (mean difference 3.1; 95% CI 1.2-5.0; p = 0.01). It reduced maximum nocturnal pressure of transcutaneous CO 2 (PtcCO 2 mean difference 217 mm Hg; 95% CI 27 to 228 mm Hg; p = 0.005) and increased exercise performance on the Modified Shuttle Test (mean difference 83 m; 95% CI 21 to 144 m; p = 0.02).

Ethics committees now require that individuals give informed consent to much health services research, in the same way as for clinical research. This is misguided. Existing ethical guidelines do not help us decide how to seek consent in these cases, and have allowed managerial experimentation to remain largely unchecked. Inappropriate requirements for individual consent can institutionalise health inequalities and reduce access to services for vulnerable groups. This undermines the fundamental purpose of the National Health Service (NHS), and ignores our rights and duties as its members, explored here. Alternative forms of community consent should be actively pursued.A fter a half century of rapid technological development, much organisational change in the National Health Service (NHS) is now driven by the results of medical research. Clinical medical research has traditionally been concerned with the question of whether specific therapies are effective, and usually postpones the question of how best to organise their delivery in, say, rural, or urban populations. Health services research (HSR), on the other hand, looks at the needs and outcomes of populations in relation to health care delivery, considered both as a resource issue and an organisational problem. For example, a study of the effects of screening and treating a population for the sexually transmitted infection chlamydia 1 is HSR rather than clinical research. While overlapping with epidemiology, HSR is also concerned with the evaluation of new organisational structures or care pathways, which have not generally been the concern of clinical research. An example of this would be the evaluation of antenatal care by midwife teams, rather than "standard care". 2 3 Health service research then, covers research into organisational structures or care pathways that may influence outcomes at a population level-this may include the evaluation of screening programmes, new staffing structures, resiting of services or collaborative services, to give a few examples. It does not include the use of experimental medical treatments.The evaluation of health services through HSR requires information about the population as a whole. For example, to discover that death rates from cancer vary geographically will require access to information about patients diagnosed and their deaths, and often review of patients' NHS records. In the wake of the incorporation of the Human Rights Act into UK law, and the new Data Protection Act, there has been a rise in public concern to protect the privacy of individuals in health care law. This presents problems for the guardians and users of databases such as the cancer registries. The cancer registries have in the past collected basic personal information about individuals diagnosed, in order to enable health services and researchers to compare survival trends, as well as to detect new risks and enable their investigation. Thus death rates can be compared, 4 5 and new risks investigated-either through statistical means or through appro...