No abstract

To show that the treatment of buckle fractures of the distal radius in children in a soft bandage is an effective and safe method of treatment, a randomized prospective trial was undertaken. Patients entered the trial after diagnosis in the accident and emergency department. Allocation to either plaster cast or bandage was random. Bandage patients were seen each week. Plaster cast patients were seen at 4 weeks. Measurements were taken at all visits. Patient questionnaires were completed at the end of treatment. Thirty-nine patients completed the study. Eighteen were allocated to bandage, 21 to plaster cast. Those in bandage showed an excellent range of movement by the first week. Results were highly positive for treatment in bandage, with no reported adverse effects and a highly desirable result for the patient. The authors would suggest a change in treatment policy for such fractures.

No abstract

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.

Routinely-collected statistics show considerable variation between local authorities in Great Britain, in the proportions of supported residents placed in nursing and residential care. This raises the question of whether this is due to variations in demand (the type of resident approaching authorities), supply (the level and type of provision available for local authorities to purchase), or policy (in terms of eligibility criteria or interpretations of need at field level). Data were used from a national longitudinal survey of individuals admitted to publicly-funded residential and nursing home care. Information was collected from  local authorities on a cohort of , local authority supported residents who had been admitted to residential and nursing home care. The paper examines the pattern of admissions, the characteristics of people admitted and the relationship between these characteristics and admissions to residential or nursing home care. Characteristics of the individual explained the placement of over  per cent of admissions. Supply factors were statistically significant but did not improve the explanatory power of the model. Survival among those admitted to a type of care that was not predicted by the model, suggested that some unmeasured aspects of prognosis may account for some of the residual variation in placements. Overall, the results indicate a reasonably high level of consistency between authorities in nursing home placement decisions. This suggests that either there is considerable variation in the types of individual approaching local authorities or, more likely, that some authorities are more successful in maintaining people for longer at home than others. In addition to maintaining people at home to a higher level of dependency, prevention of admission to residential care is likely to be associated with : interventions that address carer support, safety issues among people who are deaf, and motivation.KEY WORDS -old age, residential care, nursing home care, predictors of placement..

The allocation of central government funds is a critical element in the equitable provision of local authority commissioned and provided services. A variety of approaches to allocating funding for social services for older people have been used over the years, most recently based on needs-based formulae. In 2004, the Department of Health for England commissioned research to help inform the improvement and updating of the formula. The results of individual-level analyses were compared with the results obtained from analyses of small area (ward-level) data on service users. Both analyses were affected by problems of data availability, particularly the individual-level analysis, and the Department of Health and the (then) Office of the Deputy Prime Minister decided that the formula calculations should be based on the results of the small area analysis. However, despite the differences in approach, both methods produced very similar results. The correlation between the predicted relative needs weights for local authorities from the two models was 0.982. The paper discusses the strengths and weaknesses of each approach and developments that could allow a normative approach that would incorporate future policy objectives into formulae that, to date, have inevitably been based on historical data and service patterns.

We describe a case of persistent postoperative bleeding following total hip arthroplasty in which, initially, no obvious cause was identified. The patient was taking ginkgo biloba extract, an unlicensed herbal medicine taken to improve mental alertness. Ginkgo biloba is an anticoagulant that inhibits platelet-activating factor and is contraindicated with aspirin. Four weeks' postoperatively, the ginkgo was stopped, and the bleeding stopped 6 weeks later.

Empirical estimates of trends in health expectancy throughout the nations of the developed world provide conflicting evidence on the debate whether increasing life expectancy is accompanied by a compression or expansion of morbidity and disability. Complicating this issue is the fact that various methods are available for calculating health expectancy, each requiring a unique and often difficult to obtain source of data. It is suggested here that to reliably communicate the policy relevance of the measure of health expectancy it is necessary for countries such as the United Kingdom to make a long-term commitment to developing longitudinal databases that permit the most reliable estimates of trends in the health status of the population.