Current quality of life (QOL) assessments, whilst being suitable for patients undergoing active treatment, are often too cumbersome for patients who are in the terminal phase of their illness, and may themselves produce distress. In an attempt to measure QOL in these patients a simple assessment was piloted (PEPS--patient evaluated problem score) in which patients were asked to identify and grade major problems as they perceived them and also to grade problems previously identified by the medical and nursing staff. A global QOL score and a self-administered WHO score completed the assessment. Of 70 patients admitted to the unit over a seven-month period, 44 completed questionnaires, 38 in full. Subsequently, uptake has been far greater (due to establishment of the method as part of routine care) with 73% of all patients admitted to our unit completing PEPS. Overall, a mean of 5.6 problems per patient were identified, of which 14% were psychosocial. Of those patients who completed questionnaires, 58% identified problems not picked up by the nursing and medical staff; 52% of these were psychosocial problems. Of 28 patients who died having previously completed questionnaires 22 had done so in the previous three weeks including eight in the previous seven days. PEPS has proved very useful in the management of patients, enabling the identification of previously unrecognized or underrated problems, particularly of a psychosocial nature, and also as a means of evaluating progress. It is readily acceptable to patients, even those close to death.
Describes the results of a postal questionnaire survey of all 1,383 hospital consultants in the North Western Region of the UK in 1994; updating a similar survey conducted in 1987. In both surveys, consultants were asked to describe their current management role, management training received and any perceived future training needs. A series of open questions in the 1994 survey explored barriers and incentives to the take-up of management training. The results show that in 1994 more doctors were taking on greater management responsibility and from an earlier age. Consequently, the proportion of consultants expressing a need for management training had risen from 62 per cent in 1987 to 73 per cent in 1994. The most useful courses were local budgeting and business planning. However, many consultants described problems in accessing training. Concludes by highlighting policy implications arising from the surveys which will need to be addressed if consultants are to fulfil their management potential.
More work needs to be done to improve the design of smoking cessation programmes, to make them more culturally appropriate for pregnant women who appear to be socially disadvantaged, have poor housing and lack a stable relationship.
This paper illustrates the effect of a large influx of holidaymakers on a medical unit in Cornwall. Increasing numbers of visitors are coming to Cornwall and, unless adequate resources are allocated for their efficient medical care, the medical facilities available to the residents will suffer greatly.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.