The self-administered questionnaire is unacceptable for older hospital inpatients. Use of an interviewer improves response, but factors which influence health status, such as physical and cognitive dysfunction, have a significant effect on response rates. Therefore the utility of the SF-36 in its present form as a routine health status measure for use in older hospital inpatients is questioned.
An obese 33 year old woman presented to the accident and emergency (A&E) department following a fall down a flight of stairs. She complained of excruciating left elbow pain. There was an obvious deformity and an x ray confirmed a posterior dislocation of the elbow with a displaced fracture of the radial head (fig 1, left panel).The patient was referred to orthopaedics and booked for theatre. The casualty officer had attributed the patient's symptoms to the elbow injury and as a result did not remove her clothing. When the patient was seen on the way to theatre by the registrar her shirt was removed. This showed asymmetry between the two shoulder regions. Although the patient did not have any significant shoulder pain, an x ray was requested. This confirmed an anterior dislocation of the left shoulder (fig 1, right panel). Both were then reduced under general anaesthesia.
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