The community diagnostic ultrasound service offers reduced waiting times compared to the NHS Trust service, and is of comparable quality. This benefit, together with high patient and GP satisfaction levels, may justify the possible reduced cost-effectiveness of the service compared to the NHS Trust service.
Public health teams within UK local authorities are well placed to ensure veterans have more knowledge about and access to public services. Interventions to address stigma and veterans' reluctance to seek help were needed. To this end, interventions for local veterans, their loved ones and staff in public services, designed in co-creation with these groups, is discussed.
Practice and empirical data indicate concerns regarding the delivery of primary palliative care, particularly the provision of a multidisciplinary approach. A collaborative study was undertaken between an academic unit and primary care practice to evaluate current care provision and explore methods of developing services. A two-phase study was carried out over a period of 18 months using an action research approach, in order to facilitate concurrent service evaluation, change in practice, and the involvement of professionals in research and practice development. The first phase highlighted the need to enhance primary palliative care services; a number of practice changes were identified and implemented during the second phase and evaluated using quantitative and qualitative methods. Data demonstrated the enhancement of services, benefits to patient care and professional working and the viability of an innovative model of palliative care delivery - that of a surgery-based clinic for palliative care patients and carers. A framework for the provision of multidisciplinary palliative care in the community was developed.
Suboptimal ward care of critically ill patients Suboptimal care should have been defined Editor-McQuillan et al show that most patients receive suboptimal management of oxygen therapy, airway, breathing, circulation, and monitoring before admission to intensive care. 1 In an area of medicine renowned for objective measurement it is surprising that this study should rely on the subjective opinions of two assessors about what constituted suboptimal care. Understandably, their opinions often disagreed. The authors accept that there are difficulties in relying on assessors' opinions, but we must not underestimate these limitations. The assessors knew the outcomes of the patients, which must have biased their opinions, particularly since suboptimal care is not defined. How suboptimal care was defined is crucial to the paper's message, and more information about the data evaluated by the assessors would have been preferable to the lengthy discussion, much of which was not directly related to the data. Unfortunately, many of the data are self fulfilling. It is unsurprising that the suboptimally managed group scored badly on oxygen therapy and airway, breathing, and circulation and that 67% of this group were late admissions to intensive care since these were presumably the factors used to determine suboptimal management. Nevertheless, a key message is that most of the well managed patients were admitted to intensive care units within the first day of admission, with presumably some going straight from accident and emergency. These acutely ill patients are perhaps more easily identifiable as going to need intensive care. Conversely, those patients who arrived at hospital less ill and who deteriorated while on general wards were those who received suboptimal care. There was a longer time between admission to hospital and admission to intensive care in these patients. We are not told if any of the admissions to intensive care were delayed because of lack of beds. Although there is no excuse for suboptimal care, sometimes admission to intensive care is requested because a ward with overstretched nursing staff and no high dependency beds recognises that it is unable to provide optimal care for an acutely ill patient.
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