Clinical records are the most basic of clinical tools. Aggregated, they form a permanent account of individual considerations and the reasons for decisions. Essential for effective communication and good clinical care, they are often accorded low priority, are poorly maintained and not readily available. Independent inquiries, health ombudsmen's reports and the courts have repeatedly criticised the quality of records and the resulting failings of care. Most advice from professional bodies, indemnity organisations and the General Medical Council is extremely brief and confined to individual entries in the record. Patient safety and the demands of clinical governance make change essential. This article draws together standards and concludes with some good practice points for a fit-for-purpose, structured, multidisciplinary record to support good care and protect the interests of patients and clinicians. These principles should be equally applicable to electronic records.
Summary and conclusionsWomen attending a family planning clinic were studied to determine the relation between cervical erosion and clinical and social characteristics. The appearance of the cervix was recorded without knowledge of the women's symptoms.The prevalence of erosion increased with parity but, when the effects of other factors were controlled, decreased in women aged 35 and over. Erosion was significantly more common in women taking the "pill" and less common in women using barrier methods of contraception than in others. There was considerable variation between doctors in the reporting of erosion. No association was found between erosion and postcoital bleeding, dyspareunia, backache, or dysuria. There was a significant but modest association between erosion and vaginal discharge and a suggestion that erosion may sometimes be associated with nocturia and frequency of micturition. Vaginal flora was similar in women with and without erosion.Cervical erosion should not be regarded as pathological in asymptomatic women, nor should it be assumed necessarily to be the cause of symptoms in women with genitourinary complaints.
Of 49 schizophrenicpatientsfollowed up 12 monthsafter their first admissionto hospital, onlyabout 45% had experiencedno relapseand had no schizophrenicsymptoms;a poorer outcome was moreoften found in Feighnerpositivethan Feighnernegativeschizophrenic patients. The patients' overall level of unemployment had more than doubled to 51 %. In patients whose acute episodesrespondedto treatment, pimozidetaken once weekly as maintenance therapy was as effective as intramuscularflupenthixol decanoate, but tardive dyskinesiaappeared in two patients receivingweekly pimozide;the repeat psy chometric assessmentat 12 months found modest improvements, i.e. no evidence of intellectual decline, in Matrices, Block Design, and Digit Copying tests. Forty per cent of relativesstillshowed significantpsychological distress,which correlatedwith patients' schizophrenicsymptoms, and the relatives' socialfunctioningremainedpoorerthan that of a normal community sample.
SynopsisA modified version of the Manic State Rating Scale comprising 28 items with a glossary has been tested on 16 manic patients. The scale has satisfactory inter-rater reliability and appears to be valid.
The NT POCT Program has been operationally effective and well received by staff working as i-STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long-term viability.
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