Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was undertaken to provide a snapshot as to how the English National Health Service (NHS) is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally. An online survey was sent to 234 NHS hospital trusts, with a response rate of 35%. Respondents who completed the online survey, on behalf of their representative organisations, were senior clinical governance leaders. The findings demonstrate that the majority of organisations, that responded, were actively measuring culture. Significantly, a wide variety of tools were in use, with variable levels of satisfaction and success. The majority of tools had a focus on patient safety, not on understanding the determining factors which impact upon healthcare OC. This paper reports the tools currently used by the respondents. It highlights that there are deficits in these tools that need to be addressed, so that organisations can interpret their own culture in a standardised, evidence-based way.
Converging evidence points to the significant involvement of the immune system in autism spectrum disorders (ASD). Positron emission tomography (PET) can quantify translocator protein 18 kDa (TSPO), a marker with increased expression mainly in microglia and, to some extent astroglia during neuropsychiatric diseases with inflammation. This preliminary analysis explored, for the first time, whether TSPO binding was altered in male and female participants with ASD in vivo using full kinetic quantification. Thirteen individuals with ASD (IQ > 70 [n = 12], IQ = 62 [n = 1]), 5 F, 25 ± 5 years) were scanned with [ 18 F]FEPPA PET. Data from 13 typically developing control participants with matching age and TSPO rs6971 polymorphism (9 F, age 24 ± 5 years) were chosen from previous studies for comparison. The two tissue compartment model (2TCM) was used to determine the total volume of distribution ([ 18 F]FEPPA V T ) in four previously identified regions of interest (ROI): prefrontal, temporal, cerebellar, and anterior cingulate cortices. We observe no significant difference in [ 18 F]FEPPA V T relative to controls (F (1,26) = 1.74, p = 0.20). However, 2 ASD participants with higher V T had concurrent major depressive episodes (MDE), which has been consistently reported during MDE. After excluding those 2 ASD participants, in a post-hoc analysis, our results show lower [ 18 F]FEPPA V T in ASD participants compared to controls (F (1,24) = 6.62, p = 0.02). This preliminary analysis provides evidence suggesting an atypical neuroimmune state in ASD.
This paper presents a simple methodology for combining bone densitometry data from different sites in the UK, having instruments from the same manufacturer (LUNAR Radiation). Additive normalization factors were used on all data prior to inclusion in a reference database which ultimately included data on 1372 Caucasian women, aged 20-70 years, of whom 749 were post-menopausal. Reference data for spine (L2-L4) and femoral neck bone mineral density are given in tabular form as 3 year moving averages for: (1) all women; (2) perimenopausal women grouped by menopausal status; and (3) post-menopausal women with respect to years since menopause. These data may be used to construct Z-score. T-score or percentile reporting ranges and may be adopted as the core for a UK reference range.
Medical treatment of symptomatic osteoporosis is unsatisfactory. Treatment of patients with low bone density but without history of fracture includes hormone replacement therapy (HRT) which offers the prospect of reduced fracture risk. Dual energy X-ray absorptiometry (DXA) offers a safe and accurate technique available for the measurement of bone mineral density at a district general hospital level. All open access service providing densitometry measurements for general practitioners and hospital consultants was instigated at South Cleveland Hospital in February 1991. A major purpose of the service was to provide density measurements in order to 'inform' the discussion between the patient and doctor with regard to the use of anti-resorptive and other medical agents. We report our experience of operating such a service. The report analyses the main reasons for referrals. Nine hundred and thirty female subjects and 63 male subjects were scanned. The main reason for female referral were early menopause, consideration for HRT, personal history of fracture and family history of fracture--these account for 54.7% of all referrals. In men, there was a high incidence of fracture, back pain and the use of steroids given as reasons for referral. Sixty-seven per cent of patients were referred by general practitioners. Eighteen per cent of female lumbar spinal BMD values were between 1 and 2 S.D. below the Leeds normative mean and 9.0% below 2 S.D. Figures for the femoral neck were 22.0 and 9.0%.(ABSTRACT TRUNCATED AT 250 WORDS)
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