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One hundred medical and surgical patients admitted to an accident and emergency ward were screened for psychiatric disorder. A psychiatric diagnosis was made in 37 patients, 32 of whom were correctly identified by the GHQ. Psychiatric morbidity was associated with being single, lower social class, unemployment, homelessness and living in Bloomsbury Health District or north-east London. It was also associated with not being registered with a GP. The 14 overdose patients were no more likely to receive a psychiatric diagnosis than other patients, yet constituted most of the psychiatric referrals. Few patients were asked by medical staff about emotional worries or problems. A desire to be asked such questions and a past psychiatric history were associated with a psychiatric diagnosis. Routine screening of psychiatric morbidity in both medical and surgical patients and appropriate psychiatric referral of identified patients is recommended. A system of facilitating GP registration is necessary, as much of the morbidity identified could be contained within primary care.

Forty housemen were sent a letter informing them of changes to the coroner's rules and emphasizing the importance of recording alcohol abuse. All relevant death certificates signed by the housemen over the next 3 months were selected for case note review to check details of the alcohol history taken and the consequent accuracy of the death certificate. A questionnaire was also sent to the housemen covering reasons for not recording alcohol abuse and knowledge of the coroner's rules. Comparison of the results with those from an earlier group of housemen who received no informatory letter suggest that minimal educational intervention can effect housemens' attitudes and practice.

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This paper discusses the Holon Framework, which aims to control and improve the software development process. It is an interdisciplinary approach that is derived from software engineering and the systems movement. We outline key characteristics of software process control and improvement. Criticisms of the orthodox algorithmic cost models are identified to justify the use of alternative mathematical techniques such as system dynamics. We argue that mathematical techniques used in planning can be linked with hard systems thinking. Therefore, the essence of hard systems thinking is highlighted, and a serious weakness identified, to explain the development of soft methodologies and soft systems thinking. A significant limitation of soft systems methodology is highlighted to substantiate the need to combine it with the goal/question/metrics methodology. We justify the case study approach given the nature of the investigation. An overview of the Holon Framework is provided. The soft part of the framework, which is linked to improvement, is employed to identify relevant problems and generates a baseline metrics programme. The research design of the case study is used to evaluate our findings. Finally, we outline future work in employing the hard part of the framework, which is linked to control; this will complete the full cycle of the approach. Copyright © 2003 John Wiley & Sons, Ltd.

Study objective-The aim was to assess the relationship between social deprivation, as measured by the Jarman underprivileged area score (UPA score), and psychiatric admission rates and length of stay within an inner London borough.Design-The study was a retrospective survey of psychiatric admission rates for electoral wards in the London borough of Islington in relation to Jarman UPA scores and subscores.Setting-Islington Health Authority psychiatric admission wards at the Whittington and Friern HospitalsPatients-All admissions during the year of 1985 were studied (n = 778).Main results-No correlation was found between the total Jarman UPA score and either admission rates or length of stay. There was, however, a correlation between the Jarman UPA subscore for ethnic minorities and admission rates (r=0-409, p < 005), and between the Jarman UPA subscore for lone parents and length of stay (r = 0390, p < 0 05).Conclusions-The Jarman UPA score at electoral ward level is not related to psychiatric morbidity, and should not therefore be used for planning local service