The aim of this study was to investigate why nonurgent patients present to the Emergency Department (ED) despite availability of alternative services; also to assess impact of the UK Choose Well Campaign. A convenience sample of nonurgent ED attenders was surveyed in North Wales, UK. More than half of patients sought advice from friends, family, carer or GP before attending ED. Of the one-third of patients who had not tried an alternative service before presenting to ED, reasons given included patients thinking that they might need a radiograph (46%), believing that GP would be unable to help (29%) or stating that GP was not available (19%). Twenty per cent of patients reported they would have changed their decision about attending ED if they had known more about alternatives. Only 12% were aware of Choose Well. Analysis suggests that though Choose Well effectively provides information on alternatives, it does not translate into more appropriate attendance.

appropriate to be touched for reassurance. A greater proportion of females than males thought the back was an appropriate place to be touched. The remaining patients did not feel it was appropriate to be touched anywhere other than the arm or hand by the GP for reassurance, again proportionately more females than males. WHAT DOES THIS MEAN? It seems that a large majority of our patients would be comforted by the use of touch by their GP. The demographics of the population recruited are those of a relatively socioeconomically deprived and ageing population, with relatively little ethnic diversity. If this study were to be repeated elsewhere, the results might well be different. The study may also have some element of selection bias which results from the distribution technique of the questionnaires. There is no in-depth statistical analysis of the results but nonetheless they have interest and meaning, and it is hoped that this study may stimulate further modes of clinical research and discussion. My preliminary findings of the use of touch in comforting patients in general practice suggest that touch is indeed a modality that patients feel can be an integral part of the consultation. Information of this kind may help GPs to recognise the potential value of using touch in the consultation, to remove taboos around the subject, and to contribute to the strengthening of doctor-patient relationships.

No abstract

Around the 90-year anniversary of the Battle of the Somme, it is important to remember the international effort that went into responding to the new diseases, which appeared during the First World War, such as trench nephritis. This condition arose among soldiers in spring 1915, characterized by breathlessness, swelling of the face or legs, headache, sore throat, and the presence of albumin and renal casts in urine. It was speedily investigated by the military-medical authorities. There was debate over whether it was new condition or streptococcal nephritis, and the experts agreed that it was a new condition. The major etiologies proposed were infection, exposure, and diet (including poisons). Research pointed to the origin of the disease as being infective rather than toxic, but no definite cause was discovered. A number of labels were given to the disease, including war nephritis. However, trench nephritis was the one used most widely. Trench nephritis was a serious problem for the Allies, leading to 35 000 casualties in the British and 2000 in the American forces. There were also hundreds of deaths. The condition was treated in line with pre-war regimens designed for acute nephritis. No significant preventative methods were implemented for trench nephritis, as there was no consensus regarding causation. The medical response to trench nephritis was largely ineffective, with medical commentators recognizing that there had been a lack of medical progress.