St Helen's Rehabilitation Hospital

Fifty female patients admitted to the orthopaedic unit at the Royal East Sussex Hospital with a fracture of the proximal femur were followed prospectively. Forty-six of these patients had concurrent medical problems. Six patients required resettlement after recovery from their fracture, and of the twenty-six returning home, eighteen required support from social services. The function of the geriatric/orthopaedic unit is reviewed and it is suggested that the combined unit is of value to all elderly patients with a proximal fracture of the femur.

BACKGROUND: The death of a patient is a significant event that occurs often enough in general practice for it to have the potential to tell us much about the care we provide. There are few large series in the literature and we still know little about the collaborative use of this outcome measure. AIM: To determine the pattern of deaths and potentially preventable factors in our practices. METHOD: We completed a standard data collection form after each death in four general practices over a 40-month period. The results were discussed at quarterly meetings. RESULTS: A total of 1263 deaths occurred among our registered patients during the period of the audit. Preventable factors contributing to deaths were considered to be attributable to: patients (40%): mainly cigarette smoking, poor compliance, and alcohol problems; general practice teams (5%): mainly delayed referral, diagnosis and treatment, and failure to prescribe aspirin to patients with vascular disease; hospitals (6%): mainly delayed diagnosis and perceived treatment problems; the environment (3%): mainly falls, principally resulting in fractured neck of femur. CONCLUSION: A simple audit of deaths along the lines that we describe gives important information about the care provided by general practice teams and those in hospital practice. It has both educational value and is a source of ideas for service improvement and further study, particularly when carried out over several years.

Movement Therapy in Hemiplegia: A Neurophysiological Approach Get access Movement Therapy in Hemiplegia: A Neurophysiological Approach, by Signa Brunnstromm. New York: Harper & Row, 19 192 pp. R. E. Lrvine, MD R. E. Lrvine, MD St. Helen's Hospital HastingsSussex, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar The Gerontologist, Volume 12, Issue 2_Part_1, Summer 1972, Pages 205–208, https://doi.org/10.1093/geront/12.2_Part_1.205a Published: 01 July 1972

Educational psychology has recently experienced something of a revival in the provision of psychological therapy. This revival has aligned with general developments in evidence‐based psychology. A product of this has been more frequent delivery of empirically supported therapies in practice settings, for example, anxiety reduction programmes in school classes. This has enriched educational psychology practice and increased its opportunity to participate in therapy services through engagement with multi‐professional teams, coordination of training providers, training of trainers or indeed direct delivery. However, there are concerns that over‐commitment to simple intervention protocols has undermined educational psychologists’ wider role as highly skilled therapist/generalists. This article summarises the terms of debate in which empirically supported research practices have developed. Following an overview of the most common therapies, a series of questions challenging current research practices are posed. This paper finally reconsiders the impact that patterns of research and provision have had on educational psychology in practice.

The efficacy and biochemical effects of two low-dose thiazide plus potassium-sparing diuretic preparations were compared in the treatment of elderly patients with stable, mild to moderate congestive heart failure. Sixty patients (mean age 80 years) were randomly allocated to treatment with 1 tablet daily of either 25 mg hydrochlorothiazide/2.5 mg amiloride or 25 mg hydrochlorothiazide/50 mg triamterene. The dose was increased to 2 tablets daily if necessary, after 2 weeks, for a further 6 weeks. Patients' response to treatment was assessed at 2, 4 and 8 weeks using a simple clinical scoring system for signs and symptoms of their condition, and routine biochemical analysis was carried out at baseline and the end of treatment. One patient was withdrawn from the study due to a rash which was probably related to hydrochlorothiazide/amiloride treatment. A further 11 patients were excluded from the analysis because of intercurrent illness or inadequate records. Analysis of the results from 48 patients showed that both treatments resulted in an improvement in clinical score and weight reduction, with more than three-quarters of the patients responding to treatment. No serious biochemical disturbances occurred; in particular, no new cases of hyponatraemia (serum sodium less than 130 mmol/l) developed. Both preparations, therefore, were effective and tolerated forms of treatment for mild to moderate congestive heart failure in the elderly and there were no significant differences between them.

This book offers insight and lessons learned from two pilot studies which used interactive digital narrative (IDN) as educational interventions to effect positive change regarding social issues, looking into interdisciplinary approaches to research and education methods, combining arts and science methodologies and science communication.

A randomized trial of the Copper 7 200 (Cu 7 200) and the Multiload Copper 250 (ML Cu 250) intrauterine devices (IUD) was carried out for 13 months. On life table analysis at 12 months, net cumulative closure rates for use-related terminations (net rates) for the Cu 7 200 were higher than for the ML Cu 250 for accidental pregnancy (NS), expulsions (P less than 0.02) and medical removals for pain and/or bleeding (P less than 0.01). The continuation rate was lower for the Cu 7 200 (P less than 0.001). In a larger comparative study, at 12 months there was a highly significant difference (P less than 0.001) in favour of the ML Cu 250 in accidental pregnancy, expulsions and removals for pain and/or bleeding and continuation of use. Since the ultimate purpose of the use of an IUD is pregnancy protection with a minimum of side effects, the continued use of the Cu 7 200 is not recommended.

The results of screening 1140 acutely-ill elderly patients with the Amersham Amerlex FT4 assay are presented. Nonthyroidal illness was the commonest cause of abnormal results and we stress the importance of performing confirmatory tests in this group of patients.

This pilot study explored an embedded librarian (EL) intervention to enhance occupational therapy student information literacy skills development. The EL provided computer laboratory and in-class instruction, online presence in the classroom website, and extensive office hours to assist students in the identification of information needed, determination of how and where to find scholarly information needed, and assessment and utilization of information retrieved to meet assignment requirements. Participants were 46 third-year (junior) occupational therapy students. Three tools were used to assess skills pre and post intervention: the Student Assessment of Information Literacy Skills, the Student Perception of Literacy Skills-Q (SPIL-Q), and database tracking of frequency, kind (in-person versus email), and topic (citation formatting, database search term development, etc.) of student visits. These were analyzed via percentage of change and compared with course grade via Pearson r correlation tests. Results: Students showed limited improvement on the quantitative SAILS test (2%), but 31% (n=14) perceived increase in overall information literacy skills on the SPIL-Q, particularly in finding information needed for assignments. Correlation analyses revealed a moderate, positive correlation (r = .600, p < .05) between those who made in-person inquiries to the EL related to defining the need for information and overall course grade. Responses to the question of why students accessed/did not access the librarian outside of class were grouped into general themes. Results suggest occupational therapy educators and students might benefit from explicit instruction and in-person modeling of identification of information needed and database search techniques to locate best evidence for practice decisions and to emphasize this as a lifelong requirement of client-centered care.

The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated, with collaboration and engagement throughout any transition. This paper provides an overview of the evidence relating to the delivery of effective, integrated out-of-hospital care, with a discussion of the literature. It also considers how one Clinical Commissioning Group has begun the process of integration with the focus on community nursing services for the provision of better care for patients with an evidence-based approach.

A review has been made of the outcome and efficiency of the obstetric and neonatal service, St Helen's Hospital, Auckland. In the last seven years there has been a 33% fall in perinatal mortality rates to 5.88 per 1000 births in 1987. The average perinatal death rate for Maori infants was low, 4.81 per 1000 compared to 7.43 per 1000 for Europeans over this period. There has been a 38% increase in births to 3597 a year while the total hospital staffing has only risen 9%. Thus the ratio of births to staff has increased by 26.6% to 15.6. The cost per infant delivered in constant dollars has fallen 18.7% in the same period to $2432. The postnatal bed occupancy was 101% in 1987 and the average day stay fell to 5.7 days. An extra 61 full time staff would be needed to reduce the workload to that of 1981 and the staff is now unable to give the family focused holistic care that is needed.

Dr. Edward Richardson, dean of ripon: Christopher Richardson, son of Edward Richardson, mayor of hull Get access J. Richardson J. Richardson 112, St. Helen's Place, E.C. Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s6-VI, Issue 138, 19 August 1882, Page 148, https://doi.org/10.1093/nq/s6-VI.138.148c Published: 18 August 1882

In treating of this important subject the writer will refer to the principal types of Direct-Acting Winding Engines at present in work in the different coal-mining districts of this country.He is indebted to many friends for the data supplied, which he trusts may prove useful by furnishing the means of comparing the various usages and results in the different districts.In Figs. 1 and2, Plates 28 and 29, is shown a Single-Cylinder Vertical Winding Engine, having double-beat gunmetal valves and seats, with parallel motion and tappet valve-motion.A number of winding engines have been constructed of this type, of which one of the earliest has been at work over twenty-six years, having a cylinder 34 in.diameter and 5 ft.stroke, and a pair of flat winding drums D D, 9 ft.diameter.This engine winds coal from a shaft 10 ft.diameter and a depth of 450 yards in 55 seconds, or at the rate of.16 miles per hour j the time of banking is 30 seconds.The ropes used are flat, made of steel, and last about eighteen months.The engine winds four tubs at a time, each weighing 12 cwt., and containing

Eccrine hidrocystoma is a rare benign cyst arising from the sweat glands, whereas actinic keratosis is a premalignant cutaneous lesion. Scheuermann's kyphosis is a structural spinal disorder typically identified during adolescence. The coexistence of these conditions has not previously been reported. A patient in their early 70s presented with a blue, dome-shaped cyst located in the deeper portion of the external auditory canal. Surgical excision was performed, and histopathological examination revealed an eccrine hidrocystoma with equivocal features of actinic keratosis. The patient also had a known diagnosis of Scheuermann's kyphosis. Although the hidrocystoma was completely excised, the premalignant potential of actinic keratosis necessitated close clinical follow-up. This rare case underscores the importance of comprehensive histopathological evaluation and vigilant monitoring of potential premalignant lesions. Awareness of such uncommon associations may aid clinicians in optimizing management strategies and ensuring appropriate long-term follow-up.

Abstract Incontinence is liable to breed a sense of frustration and hopelessness but there are now many aids for incontinent people. Several factors are involved such as bladder instability, neuropathic bladder, environment, psychological, iatrogenic and mechanical factors, and so on. Diagnosis should differentiate between stress incontinence, overflow incontinence and the atonic bladder. Drugs are seldom effective by themselves but play a useful role as adjuvants in the general management of the patient. A number of drugs are useful, such as anticholinergics, oestrogens, and possibly indomethacin. The anticholinergics are most widely used, emepronium and flavoxate being the most effective. Toilet training is most important and many advances have been made in the last few years to produce aids and appliances for the incontinent patient. Among these are male and female urinals, commodes, incontinence pants of several varieties, incontinence pads and absorbent bed sheets. Catheterization may be needed as a last resort.

ZusammenfassungDas Wort Orthopädie bedeutet eigentlich die Korrektur von Skelettdeformitäten im Kindesalter, heutzutage ist es jedoch für uns alltäglich, ältere Patienten mit Erkrankungen des Bewegungsapparates zu behandeln. Bei der Bezeichnung „Geriatrische Orthopädie“ handelt es sich jeodch um ein neues Konzept. Die Idee zu einer geriatrisch-orthopädischen Station ging von meinem Kollegen Prof. Michael Devas aus. Die grundsätzlichen Voraussetzungen dazu fanden ihren Niederschlag in seinem Buch, das er 1977 herausgab (M. B. Devas, 1977). Prof. Devas ist heute Prof. für Orthopädie in Penang, Malaysia. Von 1957 bis 1981 war er jedoch in Hastings tätig.

Summary: A case is reported in which elective Caesarean section was necessitated by extensive vulval and vaginal condylomata acuminata. The problems of treatment in pregnancy, particularly during the latter part of the third trimester, are discussed.