Clinical effectiveness on an acute in-patient psychiatric unit.

The paper outlines a model for addressing clinical effectiveness, and an illustration of how this is practically implemented through team working in a multidisciplinary in-patient environment. This is particularly relevant given the number of recent reports that highlight the need to develop and invest in the in-patient services. The difficulty in implementing evidence-based practice for mental health interventions is also addressed and initiatives being developed to enable a realistic approach in such an environment are described. The paper describes a structure and a process, using examples from audit, research and other initiatives particular to the unit, in providing accessible evidence based interventions for ward based staff, and improved clinical effectiveness generally.

The day hospital debate--a contribution.

OBJECTIVE: To compare the prevalence of difficult behaviours in confused older people attending a National Health Service (NHS) day hospital with those attending non-NHS day care facilities. DESIGN: A behavioural rating scale was completed and referral information collected for people with dementia attending day care services. SETTING: One day hospital and seven day care facilities in one UK health authority. PATIENTS: All 20 attenders at an NHS day hospital and 64 attending day care, the latter identified by the staff as 'confused'. MEASURES: A 15-item behaviour rating scale. RESULTS: The quantitative ratings showed more disturbance (restlessness, friction, sexual disinhibition), poorer memory and decreased mobility in the NHS attenders. These small differences concealed much greater qualitative differences in the methods of operation of the two types of facility, with the focus being on assessment and throughput in the day hospital and social support in the day care services. CONCLUSIONS: In the light of recent debate, this study has demonstrated small but measurable behavioural differences between an NHS day hospital and non-specialist day care. However, a focus on rating of behaviour alone conceals much greater differences in why people are referred, by whom and for what reasons. The day hospital has its own role and is not merely plugging a gap.

Congenital esophageal stenosis. A rare cause of food impaction in the adult.

When esophageal peristalsis is preserved, the presentation of congenital esophageal stenosis may be delayed until adulthood. Serial Maloney dilations are a safe and effective method of treating muscular congenital esophageal stenosis.