Do patients receive adequate pain control after discharge from the ED?

Studies on the effectiveness of pain management have uniformly concluded that health care providers underestimate or undertreat pain. In the emergency department (ED) in which this study was conducted, physicians receive formal didactic and bedside teaching on pain recognition and management in order to heighten the awareness of patient's need for pain control. The purpose of this study was to determine if this outpatient pain management of patients with acute, painful conditions is better than that reported in the medical literature. In this prospective study, 110 adult patients who had an acute, painful diagnosis were telephoned 48 hours after discharge from the ED and asked if they felt their pain at home was well controlled. Patient satisfaction with pain control was higher (91%) than that reported in the medical literature. Also, pain medication was provided more frequently by this study's ED (95%). Education on pain awareness and treatment is a way to improve pain management.     

Drug Education: Supporting Parents to Support Children

Such research evidence as exists on effective drug strategies in prevention and education draws attention to the importance of involving parents along with other community agencies and school governors. Much depends nevertheless on the way in which 'involvement' is interpreted and the assumptions that are made about parents' knowledge of drugs and drug education as well as their attitudes to drug issues. As the age of initial experimentation and contact with drugs continues to fall, the importance of enskilling parents to support drug education programmes for 5 year olds and upwards continues to rise. This paper reports the first wide ranging survey of parents' knowledge of drugs and drug issues across an entire English county embracing younger as well as older children. The need for more coordinated, informed and systematic guidance to parents is established.     

Some practical perspectives for educating gifted children

This article identifies common characteristics of educationally related programs that form a common basis for understanding and working with gifted programs. Special approaches and programs for educational enrichment as well as specific activities that have been successful are discussed.     

A combined course of primary health care practice and family medicine at the University of Gezira

The community-based course presented is a longitudinal course running through four semesters in the Faculty of Medicine, University of Gezira, Sudan. Students combine their regular work in primary health care centres with attachments to a number of families in Wad Medani town. They continue to visit these families regularly throughout their entire medical course with the aim of studying them and helping them with some of their medical and psychosocial problems.     

Articulation of Asthma and Its Care Among Low-Income Emergency Care Recipients

Low-income minority patients from East St. Louis, Illinois, a depressed midwestern urban city, who had visited acute care settings with asthma symptoms, participated in a focus group. Questions were constructed around the Health Belief Model to characterize participants' experiences in receiving asthma care, their confidence in long-term asthma self-management, barriers they perceived to managing their asthma, and recommendations they would make for improving asthma care in their community. Analysis of comments suggests an appreciable understanding of asthma triggers, limited coping behaviors for asthma symptoms, very limited practice of active asthma management, perception of the health care system as frequently insensitive to their needs or their knowledge of their own care, exchange of well-articulated information regarding how to deal with the system, and an apparent lack of awareness of any potential contribution of patient education or support system.     

Drug related hospital admissions

Summary As part of a high-intensity monitoring study of drug events as the cause of admission to departments of internal medicine, the effect of an educational intervention programme was studied. Two departments were included, one specialising in geriatrics and one that received patients by non-selected referral. The series consisted of 607 consecutive admissions studied before and 703 after the intervention. The drug events considered were adverse drug reactions and dose-related therapeutic failures, mainly due to non-compliance.A modest, statistically non-significant decrease in drug related hospital admissions (DRH) was seen, from 14% before to 13% after the intervention period. However, DRHs classified as definitely avoidable showed the significant decrease of 83%.There was no apparent relationship between the topics selected for the intervention programme and changes in the pattern of DRHs. No relationship between alterations in sales data and hospital admissions caused by a given drug could be demonstrated. A blinded external evaluation of case abstracts did not disclose any significant shift in the investigators' assessments.The intervention may have had an non-specific effect on avoidable DRHs.     

The short-term stability of student ratings of instruction in medical school

The purpose of this study was to assess the degree of consistency in student ratings of teacher effectiveness during the first year of medical school. Student ratings of teaching effectiveness represent a commonly used source of information that enters into the academic decision-making process. In medical school, student evaluations often represent a major source of information that is used in promotion and tenure decisions. It is essential that the precision of such ratings be ascertained so that decision-makers will know how much confidence to place in this source of information on teaching effectiveness. In this study, each member of a first-year medical school class was randomly assigned a two-digit identification number at the beginning of the spring semester, 1986. As the semester progressed students were asked to evaluate each full-time teacher in three major courses. Multiple instructors were utilized in each course (n = 10). Each teacher was evaluated immediately after lectures during the first (T1) and second (T2) halves of the course. Students evaluated the teacher a third time (T3) as part of the end-of-semester overall course evaluation. The teachers were evaluated on a short eight-item Likert-type scale that identified several key indicators of effective teaching. Students attached their anonymous identification numbers to individual ratings so that their responses could be matched in the analysis. The results indicate that medical students are only moderately consistent in the extent to which they evaluate teachers. This inconsistency varied by course and by instructors within courses.(ABSTRACT TRUNCATED AT 250 WORDS)     

上海市少年儿童住院医疗保险费用分析

本文研究了上海市少年儿童住院医疗保险的费用水平、特点和影响因素。研究结果表明:手术与否、患者年龄、就诊地点、家长医疗保健制度和医院等级的差异造成次均费用的差异;次均费用构成比较合理,药品费比例低于全市水平。病种费用居前三位的是白血病、肺炎和先天性心脏病;特殊病种占总医疗服务人次的4.90％,而医疗费用占总费用的32.57％。     

Occupational therapy in rural India

India is called the land of villages. In 1951, 82.7% of the Indian population lived in rural areas. Sanskritisation and urbanisation have changed the pattern. It is expected that by the year 2020 this percentage would come down to 55%. These villagers are relocating in urban slums. Thus from the rehabilitation point of view both problems pose challenges. An Indian village community is a political, economic and cultural unit. At the urban slum area at Malwani and in small villages near Juchandra, community rehabilitation programmes were found to be most pragmatic. Community education and preventive occupational therapy are found to be essential steps in rural rehabilitation. Therapists have to work on ‘disability, attitude and beliefs’ and change the behaviour to deal with the grass root (basic) causes. It is felt that for longer sustainment, community-based rehabilitation should originate within the community. Heath professionals must recognise the capabilities of individuals within the support structure of the family and community, while helping individuals to improve the quality of their lives.     

Teaching of medical ethics

Teaching medical ethics in Manchester within the introductory course of obstetrics and gynaecology is a joint activity with the Centre for Social Ethics and Policy. This interdisciplinary teaching has evolved through lecture sessions with small-group discussions dealing with topics of interest in human reproduction. The small-group discussion have been replaced by an open debate conducted by the students. Their own involvement and participation and an exposure to the disciplines of the humanities has broadened their approach to different ways of problem-solving of these real issues.