Home Care of the Frail Elderly in the United Kingdom:

The paper reports the essential featurcs and evaluation of a scheme to improve the cffcctiveness of home care for the frail elderly. Decisions about resource allocation were devolved to front line social work staff, giving them greater autonomy within clear expenditure parameters. More imaginative responses were noted in the management of a number of difficult problems and the results of the evaluation were generally positive. It appeared that the scheme was most cost-effective for the extremely mentally and physically frail living with others and also for the less frail, socially isolated, depressed elderly person.     

Training Clinical Psychology Students in Aging

Many conference reports have urged various strategies to increase the numbers of mental health service providers to the aged. The effectiveness of two strategies-specialized training and the infusion of gerontological content into regular professional curricula-were addressed in a program evaluation. Two groups of clinical psychology doctoral trainees were assessed on knowledge, attitudes, and akills. One group was in a special clinical-aging track; the other had different primary interests but-by virtue of being in the same graduate program-encountered gerontological content. The results support the suggestion that exposure to aging indirectly can contribute to increased knowledge and sophistication.     

Introducing the editorial board

One of the most important contributions made to any medical journal is that of its board of editorial consultants. In the February issue we began to lntroduce the members of our Editorial Board. Each month we will publish brief profiles of a few more of these distinguished physicians so that ali of you may become a little more familiar with th ose whose dedicated labor does so much to make this journal possible.     

A PPROPRIATENESS OF I NTRAVENOUS C ANNULATION BY P ARAMEDICS : A L ONDON S TUDY

Introduction. The number of patients undergoing intravenous (IV) cannulation by paramedics has increased dramatically over recent years in the UK. Treatment protocols for cannulation in the field are loosely defined. Variation in practice may lead to patients' receiving differential treatment according to customary practice, rather than according to their clinical conditions. Objectives. To explore variations in practice and assess level of appropriatenesss of IV cannulation by London Ambulance Service (LAS) paramedics; to revise treatment protocols and work toward clinical guidelines, if indicated by study findings. Methods. Skill usage data were analyzed for all LAS paramedics for 1995–96. All patients who were IV-cannulated and transported to three hospitals by LAS during March 1996 were identified. A panel of accident and emergency (A&E) and prehospital specialists judged each case for appropriateness. Results. Variation during the year was wide, with a range of 1 to 221 (mean 47) patients cannulated per paramedic, although the majority showed some consistency in frequency of skill usage. A sample of 183 cases was reviewed. The majority judged 149 (81.4%) to be appropriate, although there was considerable disagreement between reviewers (κ = 0.43, p < 0.001). Data suggested that those paramedics who cannulate more frequently cannulated less appropriately during the study period (lowest 30%: 73.9% appropriate; highest 30%: 45.8% appropriate, p = 0.05). Conclusion. Despite wide variation between paramedics, the panel judged overall appropriateness of cannulation to be high. The audit advisory group judged that new clinical guidelines might not achieve an improvement in practice and were not supported by study findings. It was recommended that variations be addressed through individual practice review.     

Maintaining Independence Through Home Modifications

Many different types of activities can be modified or eliminated in order to maintain older adults independently in their homes, but one activity essential to independence, the use of the telephone by older adults, has not been researched.

The purpose of this study is to investigate whether older adults have made changes to their homes in order to make the telephone more accessible and if so, what changes have they made. Reasons for not making modifications are also examined.

The sample included 34 older adults, age 65 and older living alone in the community as homeowners and renters. A questionnaire was administered in the homes of participants for whom information was recorded about telephone location.

The subjects reported making few modifications to their telephone. Most subjects have three to four telephones. The most common technology related to the telephone used by subjects was an answering machine. The study has implications for physical and occupational therapists working with older homeowners who need to modify their homes in order to continue to live independently.     

The 6th Annual Meeting of the UK Cord Blood and Adult Stem Cell Group

The meeting was established in 1999 by the UK cord blood immunobiology group. Over the last 6 years the annual meeting has attracted multidiscipline participants interested in the immunobiology of cord blood and the immunology of maternal fetal engraftment from universities, hospitals and cord blood banks throughout the UK and Europe. The 6th annual meeting was held in the Life Bioscience Centre ‘Centre for Life’ in association with the University of Newcastle upon Tyne. The purpose of this meeting was to bring together the most up-to-date scientific results, both the clinical applications and immunobiology of cord blood stem cells. The meeting, although relatively small-scale, was clearly focused on specific topics and was highly interactive between scientists and clinicians. The meeting was introduced and chaired by Professor Anne Dickinson, University of Newcastle upon Tyne, UK.     

Pacing in adults with congenital heart disease

Adults with congenital heart disease constitute one of the fastest growing populations in cardiology. Pacing is an integral part of their therapy and may reduce their morbidity and mortality significantly. The current generation of pacemakers is more sophisticated and complex, and they are being utilized for indications other than conduction abnormalities, such as termination of tachycardia and improvement of heart failure. The complex anatomy and history of multiple previous surgeries in adults with congenital heart disease, however, pose many limitations and technical challenges related to the placement of a pacemaker. Unique and innovative approaches to endocardial lead placement and improved epicardial leads is making pacemaker implantation more feasible in these patients.