Current Government recommendations in England suggest a national approach to risk management but, in an increasingly litigious society, how do professional carers balance risk management with the promotion of a person-centred approach in dementia care? Wandering behaviour can be both beneficial and harmful to a person with dementia and generate considerable emotional distress in their carers. This study combined a systematic review and qualitative research methods to explore the perspectives of different stakeholders in the management of wandering in dementia. A major theme for carers was the conflict between the prevention of harm and the facilitation of a person's right to autonomy. Such tensions also impacted on carers' abilities to provide person-centred care. This dilemma was highlighted through the use of assistive technologies such as electronic tracking devices. Interestingly, people with dementia felt that the use of such technology placed them at greater risk, i.e. as a target to theft, than the process of wandering itself. They spoke of their need for independence and their concern over carer surveillance and the identity of 'big brother.' There is a need to develop practical tools for managing risk within dementia care which allow all perspectives to be captured and risk management to be negotiated.

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In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials.

Although heralded as a major breakthrough in the treatment of Alzheimer’s disease the experience and impact of using cholinesterase inhibitors (CHEIs) from the perspective of people with Alzheimer’s disease has not been widely reported. This qualitative study reports the lived experience of CHEI users and the perceived impact of the treatment. The views and experiences of 12 older people referred for memory problems or receiving treatment and 11 associated family carers were obtained using a combination of semi-structured interviews and focus groups. A key theme that emerged from the qualitative analysis was the belief that any new treatment ‘is worth a try’. For some participants the benefits of using CHEIs were ‘difficult to say’. Others reported seeing ‘a difference’, ‘getting no worse’ or no improvement in their symptoms. The study highlights the importance of listening to the voices of people with dementia and their family carers in the management of pharmaceutical treatments and the need to involve (potential) treatment users in defining quality-of-life outcomes in cost-effectiveness studies.

Aim To obtain a consensus of expert views on how best to implement screening and brief intervention (SBI) for excessive drinkers in a routine and enduring fashion in primary health care throughout England. Method A Delphi survey of expert opinion in the UK. Participants Seventy-nine experts in SBI, of whom 53 (67%) remained in round 3 of the survey. The expert panel included primary health-care professionals, alcohol-service workers and researchers/ academics. Measurements In round 3, 53 panel members (67% of an initial sample of 79) made ratings on a fivepoint Likert scale of 157 items developed from responses to open ended questions in round 1 and fed back with group median ratings derived from round 2. Consensus was defined as an interquartile range of ƒ1 and attention was mainly directed to items with consensus around median responses of strong agreement or disagreement. Findings A number of clear conclusions emerged from the survey, including the recommendation of routine screening confined to new patient registrations, general health checks and special types of consultation. The employment of a specialist alcohol worker as a member of the primary health-care team was strongly supported, but a model of interprofessional cooperation in the delivery of SBI could also be derived from findings. Other conclusions included the importance for the widespread implementation of SBI of a national alcohol strategy.

INTRODUCTION Bacterial sexually transmitted infections (STIs) contribute to a significant burden of ill-health despite being easy to diagnose and treat. STI management guidelines provide clinicians with evidence-based guidance on best-practice case management. AIM To determine the extent of adherence to STI management guidelines for partner notification, follow up and testing for reinfection following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. METHODS Retrospective review of electronic patient records for individuals diagnosed with chlamydia or gonorrhoea in eight primary care clinics in Wellington, New Zealand. At each clinic, 40 clinical records were reviewed (320 in total). Outcome measures were: overall numbers (%) of cases with documented evidence of reason for testing, sexual history, treatment, advice, partner notification and follow up. Partner notification outcomes were: n (%) with evidence of partner notification discussion and n (%) with partners advised, tested and treated. Proportions retested between 6 weeks and 6 months and n (%) positive on retesting were also determined. RESULTS Presenting features and treatment were generally well documented. Recent sexual history including number of partners was documented for half of cases reviewed (159/320). Partner notification discussion was documented for 74% (237/320) of cases, but only 24.4% (78/320) had documentation on numbers of partners notified and 17% (54/320) on numbers of partners treated. Testing for reinfection between 6 weeks and 6 months occurred for 24.7% (79/320), of whom 19% (15/79) re-tested positive. CONCLUSIONS This research suggests there are gaps in important aspects of patient care following bacterial STI diagnosis - a factor that may be perpetuating our high rates of infection. A more systematic approach will be needed to ensure people diagnosed with an STI receive the full cycle of care in line with best practice guidelines.

BackgroundEvidence-based guidelines for the management of Chlamydia trachomatis and Neisseria gonorrhoeae recommend testing for reinfection 3–6 months following treatment, but retesting rates are typically low.MethodsParticipants included six primary care clinics taking part in a pilot study of strategies designed to improve partner notification, follow-up and testing for reinfection. Rates of retesting between 6 weeks and 6 months of a positive chlamydia or gonorrhoea diagnosis were compared across two time periods: (1) a historical control period (no systematic approach to retesting) and (2) during an intervention period involving clinician education, patient advice about reinfection risk reduction and retesting, and short messaging service/text reminders sent 2–3 months post-treatment inviting return for retesting. Retesting was calculated for demographic subgroups (reported with 95% CI).ResultsOverall 25.4% (61 of 240, 95% CI 20.0 to 31.4) were retested during the control period and 47.9% (116 of 242, 95% CI 43.2 to 55.1) during the intervention period. Retesting rates increased across most demographic groups, with at least twofold increases observed for men, those aged 20–29 years old, and Māori and Pasifika ethnic groups. No significant difference was observed in repeat positivity rates for the two time periods, 18% (11 of 61) retested positive during the control and 16.4% (19 of 116) during the intervention period (p>0.05).ConclusionsClinician and patient information about retesting and a more systematic approach to follow-up resulted in significant increases in proportions tested for reinfection within 6 months. These simple strategies could readily be implemented into primary healthcare settings to address low rates of retesting for bacterial sexually transmitted infections.Trial registration numberACTRN12616000837426.

Between 2001 and 2006 UK guidance recommended that people with mild to moderate Alzheimer's disease were eligible for treatment with donepezil, rivastigmine and galanatamine on the National Health Service (NHS). However, there was considerable variation in uptake of and access to treatment. This qualitative study aimed to understand which factors influence decisions to initiate, continue and discontinue treatment with the drugs. The views and experiences of 12 older people referred for memory problems or receiving treatment, 11 family carers and 16 health and social care professionals were obtained using a combination of semi-structured interviews and focus groups. Four factors outside UK guidance and prescribing