The economic recession has left many undocumented migrants from the European Union accession states stranded and unemployed in the UK, without recourse to public funds. The TB team at Homerton University Hospital found a significant number of eastern Europeans squatting in derelict buildings in the London borough of Hackney. Because of the high rate of tuberculosis (TB) in Hackney, the team developed an outreach clinic to screen people for TB. During this screening initiative, which took place between August 2008 and March 2009, team members compiled a database of 98 eastern European citizens, and screened 62 for TB. Team members became aware during this time that, while eastern Europeans had significant health problems ranging from alcohol dependency to trench foot and scabies, very few of them had access to any form of health care except the local accident and emergency department. The team extended the screening programme to other homeless people. It has developed strong, collaborative links with a range of agencies to sustain its work with Hackney's vulnerable populations.

Our study was helpful in identifying the types of education that physicians wanted as well as the duration of the programming prior to the development of teaching interventions.

Background: Specialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians. Methods: A family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians' awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1-10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders. Results: A total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84-92%)]. The average rating was 8.1 (on a scale of 1-10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48-60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1-10) for the usefulness of PCN Clinical Pathways.

Objectives-To determine (a) whether doctors involved in the process of emergency surgical admission could agree about which patients should be admitted, (b) whether there were consistent differences between doctors in different speciality groups, and (c) whether these opinions were greatly influenced by nonclinical factors. Design-Independent assessment of summarised case histories by three "expert" clinicians (two consultant surgeons and one general practitioner (GP)), by a group of 10 GPs, and by a group of 10 in the organisation and funding ofacute surgical services, changes in public attitudes, and changes in medical attitudes.The last of these is clearly pivotal, since doctors have the responsibility of defining whether acute hospital admissions are necessary or not. We do not know whether there is general agreement within the profession about what constitutes a "necessary" admission, but such a consensus is clearly necessary to allow rational analysis of the problems posed by increasing numbers of such admissions. Surgical emergency admissions have received less attention than medical emergencies, but the rise in numbers appears to affect all specialty groups. We therefore set out to determine the attitudes of the doctors directly involved in admitting surgical patients to hospital. The training and clinical role of different types of doctors may lead to differences of opinion about the appropriate management of patients presenting with acute "surgical" conditions. We therefore asked whether doctors involved in the process of emergency surgical admission could agree about which patients should be admitted, whether there were consistent differences between doctors in different speciality groups, and whether these opinions were greatly influenced by non-clinical factors. To answer these questions we asked doctors involved in the emergency admission process to evaluate case summaries of a series of real emergency admissions to the Fazakerley surgical unit.

Mortality rates remain high in patients with pelvic injuries despite improvements in trauma care in recent years. Pelvic injuries are associated with patients with a high Injury Severity Score (ISS); it can therefore be difficult to distinguish whether the pelvic injury was a primary causative factor of mortality. ‘Open book’ fractures carry a mortality rate as high as 50% and clinicians should therefore have a low threshold for suspecting a pelvic injury. Paramedics should follow the latest guidance found in the UK Ambulance Service Clinical Practice Guidelines ( Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2016 ; 2017 ). Additionally, log rolling and/or ‘springing’ the pelvis of a patient with a pelvic injury will cause pain, disrupt clots and distort a potential fracture. Furthermore, pelvic binders/splints can reduce the area into which a patient can haemorrhage, if they are placed correctly. Lastly, triage of these patients can be difficult and major trauma centres should be considered for definitive care.