Objective-To assess doctors' and nurses' views on the presence of relatives in the resuscitation room during cardiac arrest or major trauma. Design-Questionnaires were sent to accident and emergency (A&E) nurses In a 10 year study by Hanson and Strawser4 in which relatives were given the option of witnessing resuscitation attempts, family members reported that in those cases where the patient died, the presence of relatives brought a sense of reality to their loss, helping to avoid a prolonged period of denial. We were impressed by the research and were keen to put into practice the policy of offering relatives or loved ones the opportunity of being present in the resuscitation room. Before bringing about a change in practice we decided to assess doctors' and nurses' views so that potential problems could be addressed. MethodsQuestionnaires were sent to A&E nurses and doctors of all specialties in all grades of seniority at Queen Mary's University Hospital, Roehampton, in November 1995 (we did not include nurses outside A&E, as changes in our policy would not affect them but would affect doctors in all specialties). One hundred and three questionnaires were sent on a named basis. Recipients were asked to state whether they would or would not favour the presence of relatives in the resuscitation room if the relative had expressed a desire to be there. They were also invited to give comments to support their view. The information gained was analysed. The questionnaire is shown in appendix 1. ResultsEighty one questionnaires were returned, a response rate of 78.6%. A pattern emerged showing that A&E nurses were likely to be in favour of the presence of relatives, while doctors were more likely to be in favour with increasing seniority (P << 0.001). STATUS OF RESPONDENTSHouse officers formed the smallest proportion (10%) of respondents, as they are only attached to medical and surgical firms. A&E nurses formed 12% of respondents, registrars 16%, senior house officers 33%, and consultants 29% (fig 1).
We compared the accuracy of teleconsultations for minor injuries with face-to-face consultations. Two hundred patients were studied. Colour change, swelling, decreased movement, tenderness, instability, radiological examination, severity of illness, treatment and diagnosis were recorded for both telemedicine and face-to-face consultations. Colour change showed an accuracy of 97%, presence of swelling or deformity of 98%, diminution of joint movement of 95%, presence of tenderness of 97%, weight bearing and gait of 99%, and radiological diagnosis of 98%. The severity of illness or injury was overestimated in one case and underestimated in five cases. Treatment was over-prescribed in one case and under-prescribed in three cases. The final diagnosis was correct in all but the two cases in which mistakes were made in the teleradiology. Overall, there was good accuracy using teleconsultations.
SUMMARYTrainee doctors must acquire skills in resuscitation, but opportunities for learning on real patients are limited. One option is to practise these skills in newly deceased patients. We sought opinions from 400 multiethnic guests at an open-access dinner dance for members of a local community. The questionnaire could elicit the responses strongly agree, agree, unsure, disagree or strongly disagree.332 (83%) guests responded. For non-invasive techniques, 32% of responders supported practice without consent, 74% with consent. Support diminished with increasing invasiveness of procedure. 91 % of the sample were uncomfortable about the procedures, the commonest reason being 'respect for the body' (264/302). 86% of responders felt that practice should last for no more than 5 minutes. The most popular solutions were for people to carry a personal card giving consent (89%) and establishment of a central register of individuals consenting to be practised upon after death (79%).
The technical performance of a telemedical system when used for remote trauma management was compared with face-to-face consultation. Two rooms, 20 yards apart, were linked telemedically in the same Accident & Emergency Department. Two hundred patients, with 'minor' and 'moderate' injuries, underwent the two types of consultation. The Accident & Emergency consultant marked physical parameters using a five-point pre-determined Likert scale. The following parameters were thought to be of excellent quality when compared to face-to-face consultation: overhead fluorescent lighting for the background illumination, video lighting for a close-up view, sound quality after volume adjustment, echo-cancellation after adjustment and lip synchronization. However, the following parameters scored poorly: sound before volume adjustment, echo-cancellation before adjustment, fine and coarse movements. It can be concluded that the quality of lighting and image quality are good in telemedicine. Sound and movement still present some problems. This technology is likely to be used more frequently for remote trauma management.
but couldbeadaptedtousethe Internet 2. Four terminals were installedin 1998 in public areas in hospitals and general practice centres. The terminals carriedhealthy-lifestyle messages and were designedto be colourful, noisy and fun. They could also carry local and topical information. Although session times were generally very short, acceptability and retention of information appeared to be better than using other media. Further research is needed to confirmthese initial findings and to adapt the messages to public access locations.
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