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It is routine practice for insulin to be administered by hospital staff to diabetic inpatients who would normally self-inject at home. The accuracy of this practice has not been clearly evaluated. Our audit aimed to evaluate the accuracy of insulin administration times, patient preference and the possibility of self-administration by hospitalised patients.Information on patient preferences, and the timing of meals and insulin administration, was collected for insulin-treated diabetic inpatients whose insulin was administered by hospital staff (Group 1), and for another group whose insulin was self-administered (Group 2).In Group 1 (175 meals, 25 patients), only 19% of insulin administration times were deemed accurate. In this Group, 15/21 patients wanted to self-inject in hospital. In Group 2 (10 patients, 73 meals), the timing of 57/73 (78%) insulin self-administrations was accurate, and the remaining errors were often not through patient fault.The timing of insulin administration to hospitalised patients needs to be improved. An option may be to allow selected patients to self-administer their insulin. Copyright

One hundred consecutive patients who were treated in an Accident and Emergency Department for 'cardiac arrest' were studied prospectively. Of these 30% had arrested within the community, 21% in transit and 49% in hospital. The immediate outcome was that 40 left the A&E Department alive; of these, 13 left hospital alive. The 'survivors' included 3 cases of documented asystole. Patients who were over the age of 65, who arrested out of hospital and at night, were found to have a poor prognosis. The time between arrest and arrival of the ambulance was found to affect outcome. Patients with ventricular fibrillation had the best prognosis and those with electromechanical dissociation the worst.

Letters to the Editor 71 Anaesthesia for reduction of anterior dislocations of the shoulder Sir, Further to Mr A. Banerjee's letter to your journal regarding the requirement of anaesthesia for reduction of anterior dislocations of the shoulder, while agreeing with him that anaesthesia is not necessary for the majority of patients, I would like to point out that in the original description by Theodore Kocher published in 1881 there is no mention of traction during the manoeuvre. In fact, Kocher describes flexion at the elbow with the arm parallel to the chest, lateral rotation of the humerus, flexion at the shoulder, adduction and lastly internal rotation. He claimed that anterior sub-coracoid dislocation of the shoulder can be reduced without either assistants or anaesthesia, provided that neither the glenoid rim nor the greater tuberosity were fractured and that capsular damage was not so extensive that the bone surfaces were not held apposed. In our department we have used Kochers method without anaesthesia or analgesia for 42 consecutive anterior subcoracoid dislocations of the shoulder since August 1990 with a success rate of 40 out of 42. The two failures were due to undiagnosed greater tuberosity fracture, and subsequently required general anaesthesia.