Results of the Belgian Sentinel Network of general practitioners on the involvement of therapists in stroke rehabilitation

This study examines which therapists are involved in the rehabilitation of stroke survivors in Belgium at different points in time. A nationwide registration of stroke patients was provided by 199 and 189 family physicians working in sentinel practices for the years 2009 and 2010 respectively. 326 patients who were diagnosed with stroke were included. Patients with paralysis/paresis received significant more physiotherapy after one month (63%) compared to non-paralysed patients (38%) (P=0.005). Residing in a nursing home was associated with higher proportions of patients receiving physiotherapy, both after one (P=0.003) and six (P=0.002) months. 31% of patients with aphasia were treated by a speech and language therapist after one month, which decreased after six months to 20%. After six months, the patients in a nursing home received significant more often speech and language therapy (P=0.004), compared to patients living at home. The proportion of patients receiving stroke rehabilitation services provided by physiotherapists, speech/language therapists and occupational therapists is rather low, especially 6 months after the critical event.

Sentinel Practices in Dentistry: A Preliminary Evaluation

The objectives of this study were to compare the socioeconomic make-up and the dental caries and dental treatment patterns of a general dental practice (GDP) population of five-year-old children with those of the total resident population of five-year-old children in a specific locality, and, secondly, to examine the process of gathering information on oral healthcare needs in primary dental care. The study was set in Halton, North Cheshire. Data were collected retrospectively from the patient records of four GDP ‘sentinel’ practices using a common data abstraction form. The socioeconomic profiles of the GDP population and the 1995/6 NHS child dental health survey population were compared using the Super Profiles geodemographic classification by plotting frequency distributions. The dmft of each population was compared by calculating 95% confidence intervals. The GDP population showed a slight over-representation in the more affluent groupings of the Super Profiles Lifestyle categories and a more dramatic under-representation in two of the more deprived groupings. The confidence intervals for dt and dmft of the GDP data did not include the mean figures produced by the NHS survey, indicating a significant difference at the P<0.05 level. These differences may be accounted for by the differences in the socioeconomic make-up of the two populations. Local practice policies on patient selection may also have a consequential effect on population disease estimates derived from primary dental care. Data on population disease experience from primary dental care could only be produced by hand-sorting through patient records, which was time-consuming and inefficient. Standardised electronic systems will need to be developed to make GDP data-collection a viable proposition. Information from primary dental care has the potential to make a major contribution to locality oral health needs assessment and it should be seen as being complementary to information gathered from epidemiological surveys.

Impact of influenza and respiratory syncytial virus on mortality in England and Wales from January 1975 to December 1990

SummaryThe effects of influenza A and B and RSV on mortality in England and Wales were assessed by regression analysis for the period 1975–90. Morbidity data from sentinel practices were used to calculate 4-weekly rates of aggregated upper respiratory tract infections (URTI); PHLS laboratory reports were used as indices of infection, and 4-weekly death rates from all causes, excluding childbirths, were used to study relationships with mortality. Deaths correlated strongly with influenza A and B reports, temperature, and interactions between aggregated URTI and temperature, and RSV outbreaks and temperature. Estimates of ‘seasonal’ 4-weekly mortality associated with URTI were made by substituting into primary regression models the mean of annual trough consultation rates for aggregated URTI and baseline values for RSV and influenza. Peak 4-weekly mortality associated with URTIs was estimated at c. 24000 and c. 28000 during combined influenza and RSV epidemics of 1975–6 and 1989–90 respectively. Secondary regression analysis was carried out with the estimated ‘seasonal’ 4-weekly deaths associated with URTI as dependant variable and laboratory data as regressors. Estimated excess mortality associated with influenza was considerable even during years without major epidemics. Overall during the 15 winters the estimated mortality associated with RSV was 60–80 % more than that associated with influenza. The modelling permits only a crude estimate of RSV associated mortality. None the less it suggests that RSV is an important cause of winter mortality.

Eurosentinel: Development of an International Sentinel Network of General Practitioners

The Eurosentinel project was a European concerted action. It started in June 1988 and ended in June 1991. Its purpose was to coordinate activities in the field of sentinel practices with GPs and the ultimate goal was to establish a real European network of sentinel practices. This paper deals with the purposes of the project, the studies carried out in the frame of the project, and an evaluation of three years Eurosentinel.