Objectives-to determine the incidence of verbal abuse and physical violence in accident and emergency (A&E) departments and to discover the extent of provision of security measures and instructions for staff on how to deal with these problems. Design-A postal questionnaire. Setting-A&E departments in the UK and the Republic of Ireland. Subjects-Two hundred and seventy three consultants named in charge of 310 departments. Subjects and methods A questionnaire was sent to 310 A&E departments throughout the UK and Republic of Ireland, representing a total of 273 consultants in A&E medicine. After six weeks, a second questionnaire was sent to those departments that had failed to reply initially.Respondents were asked to indicate the annual number of new attendances, the department type (inner city/urban/country), and the number and type of standard security methods in current use. They were asked to try to assess their staffs' perceptions as to how safe or vulnerable they felt at work.All respondents were asked to enumerate, as accurately as possible, the number of episodes of verbal and physical abuse in the previous year from their records, to indicate the frequency of verbal and physical abuse, that is daily, weekly, etc, to identify the nature of physical injuries sustained, to indicate the types of staff most commonly in receipt of abuse, and which members of the public were most likely to behave in an abusive manner.They were asked to describe departmental policy for recording and dealing with incidents and to indicate if any legal or civil action had been undertaken by trusts to support staff and prosecute offenders. They were also asked to indicate why they thought abuse occurred and to give an opinion as to possible measures that could be taken to try to alleviate these problems if, indeed, problems of this nature were found to be widespread. They were also asked to indicate the effect that abuse had on staff morale. ResultsOf the 310 departments mailed replies were received from 233 (75%) departments, involving 219 (80%) consultants. Department types were given as follows: 53 country (23%), 50 inner city (17%), 117 urban (50%), two inner city/urban, and eight (3%) urban/country. Three departments did not categorise themselves.

Objective: To see whether three hours of combined doctor and nurse triage would lead to earlier medical assessment and treatment and whether this benefit would carry on for the rest of the day when normal triage had resumed. Method: Eight days were randomly selected; four for team triage and four for the normal nurse led triage. Team triage was coordinated by a middle grade or consultant from 9 am to 12 noon. Times to triage, to see a doctor, radiology, admission, and discharge were recorded. No additional medical or nursing staff were used and staffing levels were similar each day. All patients including blue light emergencies and minor injuries were included. Results: Median times were significantly reduced (p,0.05) during the intervention to triage (2 min v 7 min, p = 0. 029), to see a doctor (2 min v 32 min, p = 0.029), and to radiology (11.5 min v 44.5 min, p = 0.029). Waiting times at midday were longer for patients in the non-intervention group. More patients were seen and discharged within 20 minutes in the intervention group (18 of 95 (19%) v 2 of 69 (3%) p = 0.0043). No significant knock on effect was demonstrable for the remaining 21 hours after the intervention ceased. Conclusion: Three hours of combined doctor and nurse triage significantly reduces the time to medical assessment, radiology, and to discharge during the intervention period. Waiting times at midday were shorter in the triage group. There was no significant knock on effect the rest of the day.

SUMMARY Between 1960 and 1974 the incidence of coeliac disease in children under 12 years in County Galway remained fairly constant, but since 1975 it has fallen by 62% and the lowered incidence seems well established. The number of those who were breast fed and the age at which first gluten feeding took place during the 22 years both increased significantly and from the mid-70s total protein content and osmolarity of proprietary cow's milk formulas were reduced. All three factors may be relevant. A negative correlation with the incidence of gastroenteritis was found.

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