ObjectivesTo conduct a systematic review of strategies to optimize immunisation uptake within preschool children in developed countries.DesignSystematic review.SettingDeveloped countriesParticipantsPreschool children who were due, or overdue, one or more of their routine primary immunisations.Main outcome measuresIncrease in the proportion of the target population up to date with standard recommended universal vaccinations.ResultsForty-six studies were included for analysis, published between 1980 and 2009. Twenty-six studies were randomized controlled trials, 11 were before and after trials, and nine were controlled intervention trials. Parental reminders showed a statistically significant increase in immunisation rates in 34% of included intervention arms. These effects were reported with both generic and specific reminders and with all methods of reminders and recall. Strategies aimed at immunisation providers were also shown to improve immunisation rates with a median change in immunisation rates of 7% when reminders were used, 8% when educational programmes were used and 19% when feedback programmes were used.ConclusionGeneral practitioners are uniquely positioned to influence parental decisions on childhood immunisation. A variety of strategies studied in primary care settings have been shown to improve immunisation rates, including parental and healthcare provider reminders.
Our survey suggests that a large proportion of the UK general public do not wish for life-sustaining treatments if they were to become demented and the majority agreed with various forms of euthanasia.
Early detection of developmental problems improves outcomes for parents and children. Parents want to be involved in assessment and need high‐quality, accurate, and reliable data on child development to help monitor progress and inform decisions on referral. The aim of this paper is to review which websites are readily accessible to parents on child development and to assess their quality. An internet search (on Google and Yahoo) was conducted using the search terms ‘child development’, ‘parenting’, and ‘developmental milestones’. Criteria were agreed for evaluating web‐based resources, adapted from and based on previously reported methods. Data were collected on site content, diagrams and layout, readability (Flesch Reading Ease Scale), design, navigability, overall design, and interactive features. Forty‐four relevant websites were identified for further analysis: six government, three university, 15 health‐care professional, four American Academy of Pediatrics, 10 by journalists, and six undisclosed. The best websites are presented, with justification for their choice. Overall, information available for parents about child development is accurate but much of it is incomplete, unclear, or difficult to access. There is a need to develop an easily accessible, clear, and authoritative resource for parents with illustrations. Focus groups are being held to inform this research further.
ObjectivesTo ascertain clinicians' knowledge of their patients when requesting radiological investigations, as required legally by UK government legislation ‘Ionising Radiation (Medical Exposure) Regulations 2000’ (IRMER 2000), following the implementation of European Working Time Directive.DesignCross sectional survey.ParticipantsAll doctors requesting radiological requests every Monday, following the weekend on-call, over an 8-week period. There were no exclusion criteria.Main outcome measuresBaseline data analysis, including grade and specialty of requesting doctor, types of modality requested, knowledge of their patient, addressograph signature confirming identity and appropriateness of investigation.Results164 requests were received, the majority (61%) were made by Foundation Programme 1 (FP1) doctors and general medical specialties accounted for the highest proportion of requests (45%). Ultrasound scanning was the most frequently requested investigation (47%), closely followed by computed tomography (CT) scans (42%). Almost a third (30%) of requests were made by doctors who had not seen the patient to be investigated, predominantly by FP1 doctors (p=0.003) and more frequently by general medical specialties (p=0.001). Signatures were absent on 20% of the addressographs and overall, 10% of requests were deemed inappropriate.ConclusionsIn almost a third of radiological requests, doctors have not seen patients to be investigated, most likely as a result of shift working patterns. This does not fulfil the IRMER 2000 criteria and potentially exposes patients to unnecessary and inappropriate radiation.
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