BackgroundIncreasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses.MethodsPatient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland.ResultsFemale patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses.ConclusionsWithin this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.

OBJECTIVES:The HPV (human papillomavirus) vaccine has been one of the most successful vaccines in the past decade, securing rapid inclusion onto national immunization programmes (NIP). By contrast, the HZ (herpes zoster) vaccine, another recent launch, has failed to gain widespread coverage. The aim of this research is to compare these cases based on cost effectiveness in order to understand underlying criteria for successful vaccine uptake. METHODS: We conducted a literature review using databases (Cochrane library, Medline and Google scholar) for the time period 1995 Ϫ2010. Key search words included HPV, HZ, vaccination, economic evaluation and cost effectiveness. Extracted studies were selected based on pre-determined inclusion and exclusion criteria. RESULTS: Despite low incidence rates for cervical cancer in some countries, the HPV vaccine was considered to be cost effective with ratios ranging from $14,149 to $29,580/QALY. It provides long term protection in a young population. Although the HZ vaccine displayed a similar CE range, $16,229 to $28,325/QALY, this was heavily dependent on age (optimal years being 60-70). Consequently, the HZ vaccine is indicated for the elderly. It is also considered to provide waning immunity after initial vaccination. From a public health point of view, the HZ vaccine was not as well received as the HPV vaccine. CONCLUSIONS: In addition to vaccine efficacy, long term immunity and safety, there are additional factors which influence vaccine uptake. For example there are substantial public good aspects of vaccination with long term societal returns reflected in maximal population coverage. In particular, awareness and support from the medical profession, particularly general practitioners, also assist in the perception of societal value that a vaccine can provide. These factors are all very important considerations beyond economic evaluation, and therefore have great influence over inclusion onto NIPs.OBJECTIVES: Immunization Information Systems (IIS) were developed to improve quality and efficiencies in health management. Policies that govern IIS systems are complex, and may interact with other immunization record policies. This study updates and expands on a 9-year-old survey. METHODS: IIS relevant statutes and regulations in 50 states, 5 cities and Washington D.C. (Nϭ56) were identified through legal databases and reviewed for content. Coding categories were derived considering previous studies, including IIS authorization, covered entities, privacy and information sharing, reporting, enforcement and similar provisions within the A122

This edited collection provides a unique insight into sexual health in Scotland. It sets out the challenges facing Scotland in terms of poor sexual health and inequalities, within devolved government arrangements and a different healthcare system from the rest of the UK. It suggests that these factors have facilitated the development of an integrated model of sexual health planning and delivery with resonance beyond Scotland. Chapter authors include clinical specialists, managers and policy-makers, academics and senior government officials from Scotland and other parts of the UK, all of whom have an active role in commissioning, delivering or commenting upon sexual health services or sexual health. Both editors have significant experience in developing, delivering and managing innovative sexual and reproductive health services and have held national and international leadership and advisory roles concerning health policy and service management. They were instrumental in developing and delivering Sandyford, NHS Greater Glasgow and Clyde’s sexual health service – the largest in the UK and viewed as the UK leader in progressive service development