Objective-To compare pre-hospital parental administration of pain relief for children with that of the accident and emergency (A&E) department staff and to ascertain the reason why pre-hospital analgesia is not being given. Designlmethods-An anonymous prospective questionnaire was given to parents/guardians of children < 17 years. The children were all self referred with head injuries or limb problems including burns. The first part asked for details of pain relief before attendance in the A&E department. The second part of the questionnaire contained a section for the examining doctor and triage nurse to fill in. The duration ofthe survey was 28 days. MethodsThe questionnaire (fig 1) was devised after discussion with staff from the hospital and the local university (Magee). Further modifications were made over a 48 hour period, to the satisfaction of both medical and nursing staff. The questionnaire was then piloted for a full week (without further modification) to encourage staff participation. The questionnaire was administered over a 28 day period in spring 1998. One questionnaire was distributed per child.The questionnaire was in two parts. The first was filled in by a parents or guardians of the child attending the A&E department. All children were <17 years old. Children entered in the study were self referred with head injuries and limb problems including lacerations and burns. Children attending by ambulance or directly from school or with abdominal, chest, or dermatology conditions were excluded from the study.The first part of the survey ascertained the age of the child, the occupation of the parents/ guardians, the delay in presentation, and if there were painkillers suitable for children at home. When pain relief was given before A&E department attendance, the type and the dose of analgesic were documented. The reason for analgesia not being given was recorded. The second part of the questionnaire was completed by A&E department staff. This included the type, dose, and timing of administration of analgesia. The problem, whether a limb injury, burn, laceration, or head injury and the result of radiography (if required) was recorded. The diagnosis and whether the child required a general anaesthetic were documented. The authors checked each proforma every day against the A&E department ledger and completed any unfinished second part of the proformas. SETTINGThe A&E department serves an urban/rural catchment of more than 250 000. In the year, the busiest periods with children are summer and autumn; 40% of the 43 500 new patient attendances are children. The

Objective-To assess whether the quality of x ray films transmitted via a low cost (low resolution) telemedicine link was satisfactory for clinical diagnosis. Methods-A retrospective study of a set of consecutive accident and emergency (A&E) radiographs. An A&E registrar viewed these directly on a standard x ray viewing box and via a telemedicine link. Results-There were 81 abnormalities out of 234 x ray films. Three abnormalities were missed both on the x ray viewing box and telemedicine link, one of which was significant. There were five additional abnormalities missed on the telemedicine link but detected on the x ray viewing box, ofwhich two were significant. One normal x ray film was interpreted as abnormal on the telemedicine link. There were no false positives on direct viewing. Conclusion-Transference of plain radiographs using a low cost/low resolution telemedicine link by A&E doctors is adequate for clinical interpretation.

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.

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