The association between drug related deaths and prior contact with hospital-based services.

UNLABELLED: Reducing drug related deaths has been identified as a health priority by the Scottish Executive. AIMS: This study investigates the association between drug related deaths in the Lothian region and prior contact with hospital-based services in the Edinburgh Royal Infirmary. DESIGN/SETTING: Retrospective analysis of 90 drug related deaths in Lothian from 2003-2005. Hospital episodes within five years of death were identified by searching the electronic patient record system within the Edinburgh Royal Infirmary. FINDINGS: Seventy-five of the 90 drug related deaths occurred in the hospital catchment area. Forty five of these 75 deaths (60%) occurred in patients who had used hospital-based services in the previous five years. The median time from hospital contact to deaths was five months and median number of hospital attendances/admissions was three (range 1 - 26). CONCLUSION: Liaison between emergency departments, clinical toxicology services and community based drug addiction services is important to identify drug misusers at high risk. A hospital-based specialist nurse-led liaison service may be able to fulfil this role.

Transforming the National Health Service. The challenge for career management.

Claims that, for the 1990s, images of careers are multidimensional and individualistic. Notes that employees are encouraged to take responsibility for their own self-development, incorporate horizontal as well as vertical moves and forge careers based on "employability", i.e. learning, networking and reputation. Bases its arguments on the findings of a study into senior executives in the NHS, and explores the consequences of organizational restructuring for the careers of clinical, general and functional managers. Suggests that organizational and professional barriers exist to undermine the notion of the multidimensional career. Argues that prescriptive approaches to career self-development need to take account of organizational context and that, to meet the challenges of careers in the 1990s, both the organization and the individual need to become more willing to take risks.

An evaluation of community nursing services for HIV/AIDS patients in Lothian, Scotland.

This paper reports on a postal questionnaire survey of district nurses' work with HIV positive patients. Each nurse was asked to provide information about their contact with HIV positive patients and the level of training they had received in HIV/AIDS care. The nature of nursing activities carried out for these patients was established along with levels of confidence the nurses had in being able to provide a high standard of care. Where the nurses indicated less than full confidence they were asked to indicate what factors predisposed their response. Questionnaires were completed by 101 district nurses. On average, each nurse made 1.25 visits to HIV-infected patients in the two weeks preceding the study. The nursing activities most commonly carried out for these patients were providing advice/counselling, carer support, general nursing care and specialist treatments. The activities least commonly carried out were technical procedures, tests and assessments. Nurses were most confident in providing a high standard in relation to general nursing care and least confident that high standards were being achieved in providing specialist treatments. The most frequently encountered explanations offered by the district nurses for their lack of confidence in achieving a high standard were a lack of specialist training and a lack of experience with HIV-infected patients.

Trends in elderly patients (65 and over) waiting for long stay care in Edinburgh general hospitals 1988-1994.

Five surveys carried out in Edinburgh nonpsychiatric general hospitals between 1988 and 1994 have shown a progressive drop in the number of elderly patients (65 and over) waiting for long stay care. The overall point prevalence rate has fallen from 21.2% in 1988 to 9.2% in 1994. All three specialty categories (Geriatric Assessment, Geriatric Orthopaedic and General Medical) which have high prevalences have shown falls with the largest fall occurring in General Medical beds from 13.4% in 1988 to 3.8% in 1994. A substantial percentage (61.6%) of patients surveyed in 1994 were waiting to go into Private Nursing Homes which is in stark contrast to 8.5% in 1988, whereas the reverse has happened with those waiting for NHS Geriatric Long Stay care falling from 75% to 12.8%. It appears that the Community Care legislation has accelerated the shift toward Private Nursing Home care but has not, as feared, increased the number of old people waiting for long stay care in Edinburgh hospitals. The number of elderly patients awaiting long stay care in acute general medical beds in Edinburgh has now reached acceptable levels. If the same trend is occurring elsewhere in Scotland, we believe that attention should now turn to monitoring inappropriate early discharge of elderly patients.