1Background: Transition of patients care between settings presents an increased opportunity

BackgroundThe UK government currently recommends that all patients receive medicines reconciliation (MR) from a member of the pharmacy team within 24 hours of admission and subsequent discharge. The cost-effectiveness of this intervention is unknown. A pilot study to inform the design of a future randomised controlled trial to determine effectiveness and cost-effectiveness of a pharmacist-delivered service was undertaken.MethodPatients were recruited 7 days a week from 5 adult medical wards in 1 hospital over a 9 month period and randomised using an automated system to intervention (MR within 24 hours of admission and at discharge) or usual care which may include MR (control). Recruitment and retention rates were determined. Length of stay (LOS), quality of life (EQ-5D-3L), unintentional discrepancies (UDs) and emergency readmission (ER) within 3 months were tested as outcome measures. The feasibility of identifying and measuring intervention-associated resources was determined.Result200 patients were randomised to either intervention or control. Groups were comparable at baseline. 95 (99%) patients in the intervention received MR within 24 hours, while 62 (60.8%) control patients received MR at some point during admission. The intervention resolved 250 of the 255 UDs identified at admission. Only 2 UDs were identified in the intervention group at discharge compared with 268 in the control. The median LOS was 94 hours in the intervention arm and 118 hours in the control, with ER rates of 17.9% and 26.7%, respectively. Assuming 5% loss to follow-up 1120 patients (560 in each arm) are required to detect a 6% reduction in 3-month ER rates.ConclusionsThe results suggest that changes in outcome measures resulting from MR within 24 hours were in the appropriate direction and readmission within 3 months is the most appropriate primary outcome measure. A future study to determine cost-effectiveness of the intervention is feasible and warranted.Trial registration numberISRCTN23949491.

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged ‘well’, of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21–63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged "well", of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21-63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

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-Investigations were undertaken on veterans of the Gulf conflict of 1990/91 at the Gulf Veterans' Medical Assessment Programme (GVMAP), to determine whether routine investigations should be carried out on these veterans. Blood investigations were analysed of a 10% random sample of veterans and also of two veteran groups -one group was well (asymptomatic) and the other unwell (post-traumatic stress disorder). Neurological investigations were carried out as well as 1,000 ultrasound studies and 3,000 ECGs. Almost all blood tests proved normal. The only significant differences found between the two groups were for the alanine/ aspartate transaminase and gamma glutamyl transaminase values, where there were more abnormal findings in the unwell group. Abnormal, but expected, neurological investigations were found in those referred for these tests. Ultrasound abnormalities were related to known established clinical diagnoses, apart from three cases. ECG abnormalities were only present in those with known clinical diagnoses. It was concluded that reducing the number of investigations would not only be cost effective but should help to lessen veterans' anxieties. KEY WORDS: Gulf War veterans 1990/91, implications, results, routine investigations, way forwardA short time after their return from the Gulf War of 1990/1, some veterans began to complain of symptoms of ill health, which became popularly known as 'Gulf War Syndrome' . There have been unsubstantiated claims in the media and by some veterans' activist groups that Gulf War service is linked to increased rates of mortality, birth defects, pregnancy problems and other more specific illnesses. Elsewhere claims of specific illnesses or unique syndromes have been made 1,2 and carefully reviewed, 3,4 finding little, if any, evidence of these links. In the UK, in response to these symptoms, the Ministry of Defence established in October 1993 the Gulf Veterans' Medical Assessment Programme (GVMAP), which was much heralded by the media. Similarly, in the USA, the Department for Veterans' Affairs Gulf Registry Health Examination Program (VA Registry) also started assessing veterans who had left the armed services in 1992. In 1994, the Department of Defense set up the Gulf veterans Comprehensive Clinical Evaluation Program (CCEP).The GVMAP was never intended as a screening programme but, since it is the only programme available to Gulf veterans, it acted as a surrogate screening programme. Investigations were undertaken to help the medical assessments when it was thought that there may have been a condition specifically related to the Gulf War. Initial research, [5][6][7][8] and that carried out later, 9,10 benefiting from the results of almost a decade of research and assessment, found no evidence to support the concept of 'Gulf War Syndrome' or any unique Gulf War related illness. Similar conclusions have been reached at CCEP. 11 The diagnosis of 'symptoms, signs and ill defined conditions' (SSIDC) has now virtually disappeared in recent literature compared with ea...

To determine whether the health of Porton Down volunteers (PDV) has suffered as a result of their participation in medical trials, during which they were exposed to single low dose concentrations of chemical warfare agents. Methods ResultsThe diagnoses were not unusual for UK nationals with a mean age of 62 years. The majority of volunteers went to Porton Down in the 1950s and then had a mean age of 19. The mean time between volunteers attending Porton Down and coming to MAP was 42 years. We found no correlation between chemical exposures and later development of established diagnoses, a latent period of 30 years. ConclusionOn a clinical basis, no evidence was found to support the hypothesis that participation in Porton Down trials produced any long-term adverse health effects or unusual patterns of disease compared to those of the general population of the same age.

The study sought to ascertain whether referring veterans of the 1990-1991 Persian Gulf conflict with chronic post-traumatic stress disorder (PTSD) to specialized centers with a knowledge of military culture and the impact of conflict resulted in successful psychotherapeutic outcomes at 1-year follow-up times. A total of 120 referrals to specialist centers were made by general physicians. Of these, 19 were non-PTSD referrals, and 80 patients were confirmed by a psychiatrist as having PTSD. A degree of success in psychotherapeutic interventions for PTSD at 1 year, determined from general practitioner follow-up correspondence, was obtained for 95% of referrals. There were no distinguishing features between successful and unsuccessful outcomes. This study shows that early attention, i.e., diagnosis and treatment by psychiatrists knowledgeable regarding the service environment, can be beneficial for this group.