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patients attended the department in two separate one month periods at equal intervals pre-and post-guidelines publication. The majority of patients with a SIGN indication for admission were admitted (93% pre-and 92% post-guidelines). For skull x ray (SXR) requests, in the pre-guidelines group, 92% of admitted patients with a SIGN indication for x ray had a SXR: this figure dropped to 79% post-guidelines. 36% of patients with a SIGN indication for CT actually had a scan pre-guidelines: this figure increased to 64% post-guidelines. 57% of patients pre-guidelines and 44% of patients post-guidelines were discharged from A&E in accordance with the SIGN recommendations. Of patients admitted for neurological observations, this increased from 50% pre-to 88% post-guidelines. Of patients who were discharged ''inappropriately'', only one re-presented and was subsequently admitted but required no neurosurgical intervention. Despite publication of the SIGN guidelines and positive reinforcement in A&E and at ward level, practice has not changed significantly. Where our practice did not adhere to SIGN recommendations, there was no untoward sequelae. For published national guidelines to be effective, a formal audit structure with regular feedback is necessary to ensure a continued change in clinical practices.

This article discusses the use of confrontational theater and critical ethno-drama as a potential route toward examining and illuminating the construction of performance catharsis. Staged catharsis is discussed as a means of sharing and mapping the collectivized understandings produced by audiences and participants. Theoretically, such a process may result in a better comprehension of a collectivized emotional position as the underpinning of a new understanding of collective action.

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