Objective To measure the effect of giving out free smoke alarms on rates of fires and rates of fire related injury in a deprived multiethnic urban population. Design Cluster randomised controlled trial. Setting Forty electoral wards in two boroughs of inner London, United Kingdom. Participants Primarily households including elderly people or children and households that are in housing rented from the borough council. Intervention 20 050 smoke alarms, fittings, and educational brochures distributed free and installed on request. Main outcome measures Rates of fires and related injuries during two years after the distribution; alarm ownership, installation, and function. Results Giving out free smoke alarms did not reduce injuries related to fire (rate ratio 1.3; 95% confidence interval 0.9 to 1.9), admissions to hospital and deaths (1.3; 0.7 to 2.3), or fires attended by the fire brigade (1.1; 0.96 to 1.3). Similar proportions of intervention and control households had installed alarms (36/119 (30%) v 35/109 (32%); odds ratio 0.9; 95% confidence interval 0.5 to 1.7) and working alarms (19/118 (16%) v 18/108 (17%); 0.9; 0.4 to 1.8). Conclusions Giving out free smoke alarms in a deprived, multiethnic, urban community did not reduce injuries related to fire, mostly because few alarms had been installed or were maintained.
Objectives-To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. Setting-The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. Methods-Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. Results-Community and paid workers distributed 20 050 smoke alarms, potentially suYcient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were £145 087. Conclusions-It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's eVects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost eVectiveness, are being evaluated as a randomised controlled trial. (Injury Prevention 1999;5:177-182)
Zontinuity of patient care after discharge from hospital relies on effective &charge communication between the hospital doctors and the patient's general mactitioner. The aim of this study was to investigate the effectiveness of discharge :ommunication, in terms of its content and timing. The study involved analysing all &charge correspondence received by two city-based group practice medical :entres over a period of one month. Three hundred and one pieces of discharge :orrespondence were scrutinised. These comprised 164 initial discharge rummaries and 137 follow-up discharge letters. In general, information was more thoroughly and more accurately recorded in the follow-up letters than in the iischarge summaries; however, there were significant delays in the receipt of the letters by the GPs. Results showed that there are many aspects of the correspondence between secondary and primary care which need improving. These include: improvement in the design of discharge correspondence forms; improvement in completing the forms; and improvement to the administrative systems for dispatching discharge correspondence. Although not specifically looked at in this study, we also believe that it would be useful for a mechanism to be set up for hospital pharmacists to establish links with their community colleagues in advance of a patient's discharge in order that the patient's pharmaceutical needs may be readily met in the community.RECENT government publications about National Health Service reforms indicate that the profession of pharmacy will have to become more involved in the provision of pharmaceutical services to patients moving between the new care environments. At present, continuity of patient care after discharge from hospital relies on effective discharge communication between the hospital doctors and the patient's general practitioner (GP).2 Such correspondence normally involves a discharge summary, which frequently incorporates details of prescribed medication, and, at a later date, a discharge letter which is in the form of a report. The purpose of discharge correspondence is to provide continuity of care. The correspondence should include personal details of the patient, their treatment and after-care regimens. Initial correspondence should reach the GP soon after patient discharge, allowing a care regime to be implemented with the minimum of delay.A previous study3 sought to define the ideal content and design of hospital discharge reports. The aim of this study was to investigate the effectiveness of such reports, in terms of their content and timing, in achieving a smooth, seamless approach to patient care.
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