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This paper demonstrates that it is possible to incorporate criteria other than cost-effectiveness in the prioritization of public health investment using an MCDA approach. There are numerous approaches available that adopt the MCDA framework. Further research is required to determine the most appropriate approach in different settings.

One hundred and twenty-four patients over the age of 75 years were assessed for the cause of their macrocytosis (MCV > 95 fl). A definitive diagnosis was reached in 75/124 (60%) by non-invasive techniques. The remainder underwent a bone marrow biopsy yielding a definitive diagnosis in a further six patients who had an identifiable myelodysplastic syndrome (MDS). A high proportion of the remainder had morphological abnormalities which fitted with no recognized pathological entity. It is suggested that these may represent MDS in evolution.

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This paper discusses an assessment procedure for the formal identification of patients requiring long-stay geriatric care. It was introduced immediately prior to the reorganization of geriatric in-patient care at St Pancras Hospital which saw the abolition of mixed wards of acute, rehabilitation, and long-stay patients and their replacement by six specialized wards, three of which are long-stay wards accommodating 51 patients. The formal assessment and referral for long-stay care is itself one outcome of deliberations made by a multidisciplinary panel formed a few months before the hospital reorganization to examine the kind of care and environment that might best enable the long-stay elderly to enjoy, within the limits of their disabilities, as dignified and worthwhile lives as possible. The paper begins by outlining the reasons why an assessment procedure came to be seen as a necessary and important element in the new system of continuing care of geriatric patients. This is followed by a brief consideration of how the procedure operates. An example of the assessment form is included.