No / OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England. RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills. CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.

No / Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. Design: Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. METHODS: Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. RESULTS: We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. DISCUSSION: The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.

O profissional de saúde ao visualizar a gravidez na adolescência como um problema de saúde a ser corrigido, torna invisível o paciente como sujeito de direitos e necessidades de cuidado. Há percepções de que as práticas no campo da Medicina estão descoladas da realidade e não atendem, ao que parece, às demandas dos usuários como sujeitos de direitos das ações em saúde. Os conhecimentos adquiridos, construídos e compartilhados foram incorporados à realidade da prática médica, porém a grande questão é saber e entender em que medida e de que forma acontece esse processo e como se relaciona com os demais envolvidos, ou seja, qual a percepção e o que prevalece ou torna-se invisível o sujeito paciente na abordagem médica às questões complexas da saúde dos indivíduos. Os objetivos desse trabalho foram desvelar as invisibilidades do sujeito paciente na questão da gravidez na adolescência sob os olhares do profissional da saúde e, consequentemente, caracterizar especificidades dos olhares do profissional da saúde na prática da assistência aos adolescentes com experiência de gravidez que os tornam invisíveis ao profissional. Para esse fim, foi adotado como procedimento metodológico a investigação cientifica da pesquisa descritiva de abordagem qualitativa, por meio da análise de conteúdo des entrevistas semi estruturadas, de aspecto geral sobre assuntos relacionados ao tema central gravidez na adolescência e a assistência médica, com perguntas comuns e consensuais que envolviam significados, ensino, a prática cotidiana e saúde pública com profissionais de saúde médicos, que trabalham com adolescentes grávidas, nos serviços da rede de saúde pública em município da Grande São Paulo, com vinculação acadêmica a Instituição de Ensino Superior. Desvelaram-se que as invisibilidades do sujeito paciente na questão da gravidez na adolescência são resultados da produção médica no cuidado ao paciente, nos valores e representações da lógica médica. Caracterizaram-se como especificidades dos olhares do profissional de saúde que invisibiliza o sujeito adolescente na prática assistencial a produção da ciência médica fundamentada na percepção de mundo para esses profissionais que conflitam com as percepções de mundo do adolescente na experiência da gravidez. A ciência médica voltada ao modelo biomédico e organicista, baseada numa tradição positivista, torna a arte médica um lugar de pouca reflexão estrutural e privilegia-se o saber instituído em detrimento de novas possibilidades do cuidado médico, onde as questões que envolvem dimensões humanas têm difícil inserção. O outro eixo está fundamentado nas percepções de modelo social de estrutura familiar tradicional e no poder em manter a ordem que a sociedade atribui ao médico. / The health professional to show teenage pregnancy as a health problem to be corrected, makes invisible the patient as a subject of rights and care needs. There are perceptions that the practices in the medical field are detached from reality and does not meet, it seems, the demands of the users as subjects of rights of health actions. The knowledge acquired, built and shared were incorporated to the reality of medical practice, but the big question is to know and understand to what extent and in what way does this process and how it relates to others involved, therefore, what the perception and what prevails or becomes invisible subject patient in medical approach to the complex issues of the health of individuals. Among the most common health guidelines, some are eligible to potentially reach a greater degree of complexity to the care and become provocative assistance gaps, which in this study called the invisibility of the subject, and one of the staves, we work with teenage pregnancy, and the invisibility of this teenager in this important moment of your life that need care and support of the health professional. The objectives of this study were to reveal the invisibilities of fellow patient on the issue of teen pregnancy in the looks of the healthcare professional and, consequently, characterize specificities of the looks of the health professionals in the practice of assistance to adolescents with pregnancy experience that makes them invisible to the professional. For this purpose, was adopted as methodological procedure scientific research of qualitative research, through the analysis of semi structured interviews, General aspect on subjects related to the central theme teen pregnancy and medical assistance, with common questions and consensual involving meanings, teaching, daily practice and public health with medical health professionals, who work with pregnant adolescents services public health network in municipality of greater São Paulo, academic affiliation with the Medical Education Institution. Was unveiled that the invisibility of the subject patient issue of teenage pregnancy are the result of medical production in patient care, values and representations of medical logic. Were characterized as specific looks of the health professional that the adolescent subject rather invisible in healthcare practice the production of medical science based on the perception of the world for these professionals that conflict with the perceptions of the world of the adolescent experience of pregnancy. The focused on biomedical and medical science organicist model, based on a positivist tradition, makes the medical art a place of reflection and little structural knowledge is privileged at the expense of established new possibilities of medical care, where issues involving human dimensions are difficult insertion. The other axis is based on the perceptions of the social model of traditional family structure and power \"in maintaining order\" that society attaches to the doctor.

O profissional de saúde ao visualizar a gravidez na adolescência como um problema de saúde a ser corrigido, torna invisível o paciente como sujeito de direitos e necessidades de cuidado. Há percepções de que as práticas no campo da Medicina estão descoladas da realidade e não atendem, ao que parece, às demandas dos usuários como sujeitos de direitos das ações em saúde. Os conhecimentos adquiridos, construídos e compartilhados foram incorporados à realidade da prática médica, porém a grande questão é saber e entender em que medida e de que forma acontece esse processo e como se relaciona com os demais envolvidos, ou seja, qual a percepção e o que prevalece ou torna-se invisível o sujeito paciente na abordagem médica às questões complexas da saúde dos indivíduos. Os objetivos desse trabalho foram desvelar as invisibilidades do sujeito paciente na questão da gravidez na adolescência sob os olhares do profissional da saúde e, consequentemente, caracterizar especificidades dos olhares do profissional da saúde na prática da assistência aos adolescentes com experiência de gravidez que os tornam invisíveis ao profissional. Para esse fim, foi adotado como procedimento metodológico a investigação cientifica da pesquisa descritiva de abordagem qualitativa, por meio da análise de conteúdo des entrevistas semi estruturadas, de aspecto geral sobre assuntos relacionados ao tema central gravidez na adolescência e a assistência médica, com perguntas comuns e consensuais que envolviam significados, ensino, a prática cotidiana e saúde pública com profissionais de saúde médicos, que trabalham com adolescentes grávidas, nos serviços da rede de saúde pública em município da Grande São Paulo, com vinculação acadêmica a Instituição de Ensino Superior. Desvelaram-se que as invisibilidades do sujeito paciente na questão da gravidez na adolescência são resultados da produção médica no cuidado ao paciente, nos valores e representações da lógica médica. Caracterizaram-se como especificidades dos olhares do profissional de saúde que invisibiliza o sujeito adolescente na prática assistencial a produção da ciência médica fundamentada na percepção de mundo para esses profissionais que conflitam com as percepções de mundo do adolescente na experiência da gravidez. A ciência médica voltada ao modelo biomédico e organicista, baseada numa tradição positivista, torna a arte médica um lugar de pouca reflexão estrutural e privilegia-se o saber instituído em detrimento de novas possibilidades do cuidado médico, onde as questões que envolvem dimensões humanas têm difícil inserção. O outro eixo está fundamentado nas percepções de modelo social de estrutura familiar tradicional e no poder em manter a ordem que a sociedade atribui ao médico. / The health professional to show teenage pregnancy as a health problem to be corrected, makes invisible the patient as a subject of rights and care needs. There are perceptions that the practices in the medical field are detached from reality and does not meet, it seems, the demands of the users as subjects of rights of health actions. The knowledge acquired, built and shared were incorporated to the reality of medical practice, but the big question is to know and understand to what extent and in what way does this process and how it relates to others involved, therefore, what the perception and what prevails or becomes invisible subject patient in medical approach to the complex issues of the health of individuals. Among the most common health guidelines, some are eligible to potentially reach a greater degree of complexity to the care and become provocative assistance gaps, which in this study called the invisibility of the subject, and one of the staves, we work with teenage pregnancy, and the invisibility of this teenager in this important moment of your life that need care and support of the health professional. The objectives of this study were to reveal the invisibilities of fellow patient on the issue of teen pregnancy in the looks of the healthcare professional and, consequently, characterize specificities of the looks of the health professionals in the practice of assistance to adolescents with pregnancy experience that makes them invisible to the professional. For this purpose, was adopted as methodological procedure scientific research of qualitative research, through the analysis of semi structured interviews, General aspect on subjects related to the central theme teen pregnancy and medical assistance, with common questions and consensual involving meanings, teaching, daily practice and public health with medical health professionals, who work with pregnant adolescents services public health network in municipality of greater São Paulo, academic affiliation with the Medical Education Institution. Was unveiled that the invisibility of the subject patient issue of teenage pregnancy are the result of medical production in patient care, values and representations of medical logic. Were characterized as specific looks of the health professional that the adolescent subject rather invisible in healthcare practice the production of medical science based on the perception of the world for these professionals that conflict with the perceptions of the world of the adolescent experience of pregnancy. The focused on biomedical and medical science organicist model, based on a positivist tradition, makes the medical art a place of reflection and little structural knowledge is privileged at the expense of established new possibilities of medical care, where issues involving human dimensions are difficult insertion. The other axis is based on the perceptions of the social model of traditional family structure and power \"in maintaining order\" that society attaches to the doctor.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 5 uppsatser.

The Importance and Protection of the Conscience of Physician in the Physician-Patient Relationship In democratic countries all over the world, the protection of the conscience of health workers represents a very relevant problem. Especially the controversial but legal procedures, such as abortion or, in some countries, euthanasia, are often refused by health workers on the basis of their conscience. The society faces a difficult dilemma of balancing the interests of physicians, patients, and health care systems. The thesis approaches the problem primarily from the perspective of Catholic moral theology in the frame of a predominantly secular environment of the contemporary Euro-American civilisation. There are analysed the concept of conscience, the basic principles of moral reasoning, virtue ethics and its importance for modern medicine and, finally, the concept of conscientious objection as a model example of the protection of health worker's conscience. The above mentioned particular topics serve as a basis for the evaluation of the importance of the conscience of health worker and the proposal of possible solutions to the related dilemmas.

儒醫是宋以後經過醫學文本訓練的，男性醫者的，文化認同/角色/定位。道醫、巫醫和女性醫者等其他醫者漸成為邊緣他者。儒醫宣稱比其他醫療實踐者更加深諳醫學經典、更加理性。儒醫攀附儒自居，模仿理學門戶互相攻訐，有學派之分。元代婺州朱震亨，「丹溪學派」的創始者，是明代儒醫的典範。本文將以朱震亨和「丹溪學派」為個案，一方面探討儒醫如何建構醫學身體、疾病觀念及其實踐，另一方面探討「丹溪學派」的思想和社會史。 / 第一、二、三章分別從三個角度探討元明儒醫的身體觀。首先，在強烈的「南人」認同之下，元代江浙的士人強調「南/北」身體的差異，「北醫」的療法不適合「南人」的身體，朱震亨被塑造為「南醫」的典範。其次，自劉完素以後，「火」不是日常生活中的火熱之氣，也不是推算運氣的術語，成為元明醫家對身體疾病的想像。據此，朱震亨提出「陽有餘而陰不足」的身體觀，是明代「丹溪學派」遵守的教條。第三，鬼神病因漸漸從儒醫的身體觀中淡出。道教醫學中的「傳尸勞瘵」，混雜了鬼邪和血氣病因，宋元儒醫卻劃分血氣「虛勞」和鬼邪「勞瘵」的界線。朱震亨將「勞瘵」解釋為「陰不足」病。追隨丹溪之後，虞摶病人見鬼實際上是「心神不寧」，清醫吳瑭認為「祝由科」是巫術，儒醫無法容忍鬼邪病因和儀式療法。 / 第四、五章討論儒醫多樣化的實踐。在臨床實踐中如何治療「陰不足」病，「丹溪學派」並不一致，王綸提倡的「補陰丸」在明代江浙醫者的實踐中廣受歡迎，但來自學派內部嚴厲的批評聲同時存在。明代醫家認為唐宋方書治「勞瘵」的天靈蓋「殘忍」，但紫河車卻是明代常用的治療「勞瘵」藥物。儒醫反對儀式療法，但某些驅除鬼邪的針灸療法，改頭換面依然留存在醫學實踐中，比如「秦承祖灸鬼法」。 / 第六、七章指出，從朱震亨到「丹溪學派」，是元代婺州地方士人建設宗族組織、講習理學、建構地方認同背景之下的社會史，也是蘇州城市醫者專業化、組織化的結果。元明政權更迭之後，「丹溪」弟子進入太醫院，依靠政治權威提升「丹溪」的醫學地位。1450年代以後「丹溪」成為商業書坊的暢銷本，注重師承關係的學派逐漸消解，「丹溪」成為大眾通俗的醫學入門文本作者。清代，考據醫學「丹溪」為通俗庸醫，「丹溪」不再是醫者撰寫醫書、醫療實踐的必引權威。 / This thesis aims to explain how Confucian physicians (儒醫) constructed the medical thoughts and practice. A Confucian physician is supposed to be a well-educated gentleman (儒) and a master of the medical classics. From the 12th century on, Confucian physicians gradually became a new identity of the orthodox doctors, while the Taoists, shamans, midwives and surgical practitioners all became the “others. At the same time, among the Confucian Physicians, different schools appeared. The Danxi School (丹溪學派) was a group of disciples following Zhu Zhenheng (朱震亨1282-1358) from the 14th to 15th centuries in Jiangnan (江南) . Zhu was a gentleman from Wuzhou, who was treated as an ideal model of “Confucian physicians through the whole Ming dynasty. / The first three chapters focus on the medical thoughts of Confucian phycians. Chapter One studies on the body of the “Southerners (南人). People living in the territory of Southern Song identified themselves as the “Southerners. This identity was strengthened by the unequal racial policy under the Mongol reign. It motivated the Jiangnan literati to appeal for a medical knowledge body specifically for the “Southerners, which would focus on treating the ailments caused by the “southern environment and dietary habits. Chapter Two explores the concept of “fire. In the Song dynasty, “fire is an element of the prevalent cosmological theory of “the five circulatory phases and the six seasonal influences (五運六氣) . However, in Liu Wansu (劉完素1132-1208) ’s innovative interpretation, the concept of “fire was internalized into the body structure. Zhu Zhenheng inherited this concept of bodily “fire and developed the theory of “yang is always in excess, yin is always deficient (陽有餘而陰不足) , which was later strictly followed by the Danxi School. Chapter Three investigates the disease of “laozhai (勞瘵) . According to the Taoist interpretation, the disease of “laozhai was due to the ancestor’s sin. However, Confucian physicians developed a new meaning in the context of Danxi’s “yin is deficient body. Demons were gradually excluded from the etiology of the Danxi School. / Chapter Four and Five study on the practice of Confucian physicians. The Danxi School didn’t have consensus on how to treat the “yin is deficient disease. Therefore, the therapy of “nourishing yin (滋陰) was quite differential in individual practices. However, it is certain that Confucian physicians tended to use herbs to treat patients who declared themselves suffering from demons. Religious rituals of expelling demons were excluded from their clinical practice. However, Confucian physicians didn’t refuse to use some unusual herbal remedies such as the placenta, or moxibustion that might function as Taoist rituals of expelling demons. / Chapter Six and Seven analyze the rise and fall of the Danxi School. The reason why Zhu became a powerful medical master lies not only in his medical thoughts or skills but in his social activities. He was very active in the lineage organization and local administration. In the local society, Zhu gained the power and fame as an authoritative Confucian gentleman, though he had never received any governmental position. After the death of Zhu, his disciples achieved successful careers as professional doctors in Suzhou (蘇州) . Later when the Ming Empire was established in Nanjing, most of Danxi’s disciples went into the Imperial Medical Service (太醫院) . After the 1450s, Zhu Zhenheng became a best-selling author and a symbol of the popular medicine. The popularity of his works eventually destroyed the structure of the master-disciple relationship in the Danxi School. The Danxi School gradually disappeared. In the end, because the mid-Qing physicians preferred ancient masters such as Zhang Zhongjing (張仲景 fl. 168-196) to the modern, vulgar Danxi, the Danxi School and their medical master faded away from the mainstream medicine. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 張學謙. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 197-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Zhang Xueqian. / 導論 --- p.1 / Chapter 一、 --- 儒醫：宋元明清醫者的身份認同 --- p.2 / Chapter 二、 --- 儒醫的理性與實踐 --- p.6 / Chapter 三、 --- 丹溪學派：醫學思想的社會史 --- p.11 / Chapter 四、 --- 研究說明 --- p.16 / Chapter 第一章 --- 元代醫學的「南/北」身體觀 --- p.18 / Chapter 一、 --- 南宋和元：「南人」認同的多層含義 --- p.18 / Chapter 二、 --- 「南/北」身體觀論述 --- p.24 / Chapter 三、 --- 製造「南醫」/「北醫」 --- p.32 / Chapter 四、 --- 結論 --- p.38 / Chapter 第二章 --- 丹溪學派的口號：「陽有餘而陰不足」的身體觀 --- p.40 / Chapter 一、 --- 五運六氣與宋人的身體觀 --- p.40 / Chapter 二、 --- 內丹對醫學身體觀的影響 --- p.46 / Chapter 三、 --- 朱震亨的相火論 --- p.50 / Chapter 四、 --- 結論 --- p.59 / Chapter 第三章 --- 宋明儒醫的「理性化」：以「勞瘵」為中心 --- p.60 / Chapter 一、 --- 《道藏》文本中「勞瘵」的界定 --- p.62 / Chapter 二、 --- 儒醫文本中「勞瘵」的界定 --- p.68 / Chapter 三、 --- 儒醫「勞瘵」與明代社會身體 --- p.73 / Chapter 四、 --- 明代儒醫對「祝由」的困惑 --- p.77 / Chapter 五、 --- 結論 --- p.85 / Chapter 第四章 --- 「陰虛」病與療法 --- p.87 / Chapter 一、 --- 丹溪「陰虛」病及療法 --- p.87 / Chapter 二、 --- 補陰丸與人參之爭 --- p.93 / Chapter 三、 --- 薛己、趙獻可：從補陰血到補陰精 --- p.99 / Chapter 四、 --- 結論 --- p.103 / Chapter 第五章 --- 儒醫的實踐 --- p.105 / Chapter 一、 --- 道醫「追蟲」儀式 --- p.105 / Chapter 二、 --- 儒醫勞瘵療法 --- p.108 / Chapter 三、 --- 天靈蓋與紫河車在明代醫學中的不同遭遇 --- p.113 / Chapter 四、 --- 從「秦承祖灸鬼法」到「灸鬼哭穴」 --- p.121 / Chapter 五、 --- 結論 --- p.125 / Chapter 第六章 --- 從朱震亨到「丹溪學派」的社會史 --- p.126 / Chapter 一、 --- 朱震亨的出身與赤岸朱氏宗族的建構 --- p.129 / Chapter 二、 --- 「儒醫」朱震亨與地方社會 --- p.136 / Chapter （一） --- 朱震亨之行醫 --- p.137 / Chapter （二） --- 朱震亨之醫療產業 --- p.140 / Chapter （三） --- 朱震亨在地方社會的角色 --- p.142 / Chapter 三、 --- 元代婺州的「丹溪」門徒 --- p.147 / Chapter （一） --- 地方醫療資源與組織 --- p.147 / Chapter （二） --- 婺州地方士族的網絡 --- p.151 / Chapter 四、 --- 元末蘇州的「丹溪」門徒 --- p.155 / Chapter 五、 --- 明代太醫院的「丹溪」門徒（1368-1450） --- p.162 / Chapter 六、 --- 結論： --- p.166 / Chapter 第七章 --- 「丹溪」的大眾化與清代醫學的轉折 --- p.167 / Chapter 一、 --- 「丹溪」文本的製造與流傳 --- p.168 / Chapter （一） --- 「丹溪」文本的製造 --- p.168 / Chapter （二） --- 「丹溪」文本的印刷與晚明私人的商業書坊 --- p.178 / Chapter 二、 --- 「丹溪」權威的下降 --- p.183 / Chapter （一） --- 明清醫者對「南/北」身體觀、療法的不同意見 --- p.184 / Chapter （二） --- 「陰不足」到「命門火衰」 --- p.186 / Chapter （三） --- 考據醫學之批評「丹溪」 --- p.188 / Chapter 三、 --- 結論 --- p.192 / 結論 --- p.193 / 參考書目 --- p.197 / Chapter 一、 --- 一手文獻 --- p.197 / Chapter (一) --- 醫書 --- p.197 / Chapter (二) --- 正史 --- p.200 / Chapter (三) --- 文集 --- p.201 / Chapter (四) --- 地方志和家譜 --- p.203 / Chapter (五) --- 筆記和其他： --- p.204 / Chapter 二、 --- 工具書： --- p.206 / Chapter 三、 --- 近人研究： --- p.207 / Chapter (一) --- 中文專書 --- p.207 / Chapter (二) --- 英文專書 --- p.209 / Chapter (三) --- 中文論文 --- p.212 / Chapter (四) --- 英文論文 --- p.214

1 ABSTRACT The issue of births outside a medical facility is currently a controversial topic between specialists as well as in the public sector. While the specialists concur in refusing home births, the society is divided. There are voices that refuse home births but there are also plenty of people who support the right of mothers to give birth outside of a medical facility. Very sensitive topic is the legal and ethical aspects of the protection of unborn children and the issue of a safely conducted delivery. In the last decades, the life value of an unborn child has been seen as an ethical problem. The right to life is one of the fundamental human rights, which is enshrined in the constitutional system of the Czech Republic and also in the international human rights conventions. Because there are different opinions regarding this issue, it is necessary to establish a view that is widely accepted so that legal standards can be approved provided that the opinions of minorities are being respected. The main objective of this presented dissertation was to ascertain why are people losing confidence in a doctor's role during delivery and what is the reason for some of the mothers being unsatisfied with current institutional system of obstetrics. On the basis of these factual findings, which emerged during the...

The purpose of this thesis is to find out how a hundred and its public healthcare system managed the 1918 flu pandemic, with Näs hundred as a case study. Relevant information is found using archived copies of the provincial physician's sent letters, editions of the local newspaper, and death-and-funeral books. Such information includes mortality statistics, which measures were taken, which role the private sector had, and if there was any change within the public healthcare system. The study finds that the Spanish flu stood out from other illnesses and the general state of health. At its culmination in October, hundreds were sick and private workplaces were short of staff. The mortality rate seems to have been around 0.49% of the population, which is a reasonable rate in comparison to other case studies. When the epidemic was at its height, the authorities closed schools and prohibited events that attracted larger masses of people. This was announced through the local newspaper, alongside urges for the people to avoid crowding. Within the public healthcare system, there were no extensive changes, except an increase in workdays, a higher salary and a decrease in the number of nurses. There was a discussion on who should be allowed to be cared for in the epidemic hospital, as this hospital, according to routine, did not care for people with influenza or people from outside the central locality. There is no evidence on how this turned out, but some information seems to suggest that the hospital, or at least the epidemic nurse, did get to care for people with influenza. Nonetheless, it is clear that the public healthcare system could not manage the epidemic, and that the majority of people had to be treated in their homes by a relative or an ambulating nurse. When it comes to actions taken by the private sector, charity funding for the victims is the sole provable action. In contrast to other case studies, there is no evidence of private healthcare or charity organizations that would have cooperated with the public healthcare system. This charity, as well as those measures taken by the authorities, can be seen as consequences of a so-called institutional weakening, which itself would be a consequence of the epidemic outbreak. The outbreak showed that the public healthcare system could not handle an epidemic of this size, which in turn made established routines obsolete, showed that there were holes in the system and legitimized interventions made by the authorities. As a consequence, the aforementioned measures were taken to inhibit the spread of the epidemic and to care for the sick. / Syftet med denna uppsats är att undersöka hur ett härad och dess sjukvårdsorganisation klarade av 1918 års influensapandemi, med Näs härad som fallstudie. Relevant information hittades genom att granska provinsialläkarens konceptböcker, nummer av Säffle-Tidningen och död- och begravningsböcker från tiden. Sådan information inkluderar hur sjukan utmärkte sig som bidragande faktor till det allmänna hälsoläget, vilka åtgärder som vidtogs som reaktion av epidemin och ifall någon förändring i sjukvårdens organisation skedde till följd av spanska sjukan. Uppsatsen kommer fram till att spanska sjukan stod ut från övriga sjukdomar och det allmänna hälsoläget. Vid kulmen i oktober var hundratals insjuknade och arbetsplatser hade brist på personal. Dödstalet låg på runt 0,49% av befolkningen, vilket är ett rimligt tal i jämförelse med tidigare forskning. När epidemin var som mest utbredd stängde myndigheterna skolor, biografer och liknande tillställningar som drog till sig större folkmassor. Detta utannonserades i Säffle-Tidningen, samtidigt som de uppmanade folk att hålla distans till sjuka och undvika trängsel. Inom sjukvården kom inga större förändringar, utan främst utökade arbetstider, höjd lön och en minskning i antal sköterskor. En diskussion fanns dock kring vilka som skulle få vårdas i epidemisjukhuset, som enligt rutin inte tog emot folk sjuka av influensa eller folk utanför den centrala köpingen. Det går inte att belägga hur detta kom att se ut, men en del tyder på att epidemisjukhuset, eller åtminstone epidemisjuksköterskan, trotts allt kom att vårda folk sjuka i influensa. Oavsett är det klart att sjukvården inte hade beredskap nog att hantera sjukan, och att majoriteten av de sjuka fick vårdas i hemmet av anhörig eller kringvandrande sjuksköterska. Av vad man kan belägga med det givna källmaterialet är en välgörenhetsfond åt de utsatta det närmsta man kommer vad gäller reaktioner från privat sektor. Till skillnad från fallstudier i tidigare forskning finns inget bevis på att privat vård eller välgörenhetsorganisationer kom att samarbeta med sjukvården. Oavsett kan detta, samt de åtgärder och förändringar som vidtogs av myndigheterna, ses som ha kommit till följd av en institutionell försvagning, som i sig var en följd av det epidemiska utbrottet. Epidemin påvisade nämligen att sjukvården och samhället inte kunde hantera en så stor mängd sjuka, vilket gjorde att rutiner blev obsoleta, att hål i systemet uppenbarades, och interventioner kunde legitimeras av myndigheterna. Som följd vidtogs ovannämnda åtgärder för att försöka hämma epidemins spridning och vårda de sjuka.

No / Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance. To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs. DESIGN OF STUDY: Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices). SETTING: Six general practices in the West Midlands, England. PATIENTS: Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP. MEASUREMENTS: Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors. RESULTS: Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration >/= 7 mmol/L and antihypertensive prescribing only with blood pressure >/= 160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures >/= 140/90 mm Hg and with 10-year cardiovascular risk. LIMITATIONS: Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program. CONCLUSIONS: GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines.