Journal of the Royal Society of Medicine
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One-third of accident and emergency (A & E) patients who deliberately take an overdose are not admitted to hospital, and this proportion is increasing. We conducted an audit of 300 case records of such patients from two different district health authorities in London. We found that only 4% of patients were assessed in the manner recommended by the Department of Health and 10% had no psychosocial assessment whatsoever. We recommend specific training, an assessment form, regular audit, and communication with the general practitioner.
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The aim of this study was to compare and contrast the views of general practitioners (GPs), hospital doctors and medical students to alternative medicine. A questionnaire was sent to a random sample of 100 GPs and 100 hospital doctors in the South West Thames Regional Health Authority (SWTRHA). A convenience sample of 237 pre-clinical medical students at St George's Hospital Medical School was also given a questionnaire. ⋯ Twelve per cent of hospital doctors and 20% of GPs were practising alternative medicine. The majority of the respondents felt that alternative medicine should be available on the National Health Service (NHS) and that medical students should receive some tuition about alternative therapies. A considerable proportion of those doctors referring patients to alternative practitioners were ignorant of their official qualifications.
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The purpose of this article is to examine the success and motivation of a small but remarkable group of severely handicapped individuals.
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Assessments of need carried out so far have concentrated on single diseases or interventions rather than care groups or on people who have multiple pathologies. We therefore began a needs assessment for older people in a central London health authority. The health district--then called Parkside--covered 25 square miles in north London and had a resident population of 432,600 people, of which 7% were aged 75 years and over and 2% were aged 85 years and over. ⋯ Using data from the OPCS survey we were able to estimate there were 7328 people aged 75 years and over who were in the OPCS top five severity rating, which would mean that they probably required services. For mental health we estimated there would be approximately 6000 older people suffering from clinically significant depression, 6000 older people suffering from anxiety, and between 2740 and 4441 suffering moderate to severe dementia. A next step is to match an assessment of the prevalence of disease and disability, with an estimate of that being served locally.
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Poor initial assessment contributes to morbidity and mortality in acute severe asthma. We have audited this aspect of management in an A & E department over a single 6-month senior house officer employment cycle. The use of a cheap and simple stamp highlighting important clinical features of asthma was associated with a significant improvement in early assessment.