The objective of this study was to assess the quality of communications between hospitals and general practitioners (GPs). The proportion of medical records in which the patient's general practitioner (GP) was identified, the accuracy of medications recorded in the discharge summary, the proportion of GPs who received discharge summaries, and the timeliness of receipt of discharge summaries were all evaluated. Discussions were held with all stakeholders, the literature was reviewed and GPs were surveyed to identify potential measures of quality. These were then trialled to assess their utility and practicability. Timeliness, issues that required follow-up and treatment provided in hospital were of greatest importance to general practitioners. The GP's name was recorded in 88% of audited records. Few inaccuracies were detected in the medications recorded in the discharge summaries, and GPs received 77% of discharge summaries. Methods similar to those used in this study might be broadly applied to improve the quality of discharge communication throughout Australia.
No abstract
Summary. Doctors often lack the knowledge and skills to identify and assess those who drink to excess and are unsure of what their preventive and educational role should be. As part of a prospective study of early identification and intervention with general hospital patients who drink to excess, we were interested to discover whether brief education about alcohol‐related problems and training in the use of a quick and efficient alcohol screening questionnaire would improve doctors' alcohol history‐taking and thus their identification of those at risk. The case notes of every fifth admission to orthopaedic and medical wards at the York District Hospital were studied before and after doctor education. Recorded information on both alcohol and tobacco increased over the period reviewed, reflecting perhaps doctors' growing awareness of the health‐threatening aspects of these drugs. While there was no major change in doctors' alcohol history‐taking, with two thirds of case notes making no mention, or only vague mention, of alcohol, there was a significant post‐education increase in the number of patients for whom detailed drinking histories were recorded, but no significant changes in tobacco histories. Small but significant improvements such as these are important in view of the size of the medical problems arising from the use of alcohol.
Traumatic pelvic injuries are an important group of acquired pathologies given their frequent association with significant vascular compromise. Potentially fatal as a consequence of rapid hemorrhage, achievement of early hemostasis is a priority; endovascular management of traumatic pelvic arterial injuries is an important potential option for treatment. Precipitated by any number of mechanisms of trauma, pelvic vascular injury necessitates timely patient assessment. Variable patterns of arterial injury may result from blunt, penetrating or iatrogenic trauma. Selection of the most appropriate imaging modality is a priority, ensuring streamlined access to treatment. In the case of CT, this is complemented by acquisition of the most appropriate phase of imaging; review of both arterial and delayed phase imaging improves the accuracy of detection of low-flow hemorrhage. In cases where surgical intervention is not deemed appropriate, endovascular treatment provides an alternative means for cessation of hemorrhage associated with pelvic injuries. This may be achieved in a selective or nonselective manner depending on the patient's clinical status and time constraints. Consequently, a detailed understanding of vascular anatomy is essential, including an appreciation of the normal variant anatomy between males and females. Additional consideration must be given to variant anatomy which may co-exist in both sexes. This review article aims to provide a synopsis of endovascular management of pelvic vascular injury. Through case examples, available treatment options will be discussed, including thrombin injection and transcatheter arterial embolization. Furthermore, potential adverse complications of pelvic arterial embolization will be highlighted. Finally, in view of the potential severity of these injuries, a brief overview of initial management of the hemodynamically unstable patient is provided.
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