The Fourteenth Session of the UN Commission on Sustainable Development: The Energy Session

A review of the Fourteenth Session of the UN Commission on Sustainable Development, focusing on international energy issues.

Domestic Violence and the Inter-American Commission on Human Rights: Jessica Lenahan (Gonzales) v United States

On 21 July 2011 the Inter-American Commission on Human Rights issued its much awaited decision in the case of Jessica Lenahan (Gonzales) v United States. In a landmark decision the Commission found the United States of America to be in violation of the American Declaration of the Rights and Duties of Man 1948 due to the failure of the state to protect a victim of domestic violence and her children. This paper analyses the Lenahan decision and its significance for the United States. In particular, the substantial influence of the case law of the European Court of Human Rights on the Commission’s reasoning is examined.

General practitioner records on computer--handle with care

This 1 year prospective study involved nine general practitioners in an urban health centre who routinely record all patient contacts on computer. The study determines by comparison with a manual record how accurately doctors record laboratory investigations on computer and compares the effectiveness of three interventions in improving the completeness of computerized recording of presenting symptoms, problems/diagnoses and laboratory investigations. Recording was analysed for 1 month prior to and for two 1 month periods following each intervention. A control group was used. A total of 7983 patient contacts were analysed. Intervention led to an improvement in the recording of presenting symptoms and problems/diagnoses. Recording of investigations on the computer showed no improvement, remaining at one-third of the total in the treatment room book for both study and control doctors. The effectiveness of the different forms of intervention depended on both the aspect of the consultation considered and the familiarity of individual doctors with the method of data collection. Aspects considered less important required greater intervention to bring about a marked improvement, as did doctors relatively new to the practice. It may not be possible to get all aspects of the consultation recorded with the same degree of accuracy. This has implications for the accuracy of retrospective studies dependent on existing computerized data.

Commission on the Voluntary Sector and Ageing: a policy review

This article comments on the English Commission on the Voluntary Sector & Ageing, a voluntary sector-led initiative aimed at making proposals for voluntary sector leaders and charitable organisations on how to approach the ageing population. By examining the work of the commission, the review contributes to debates on the implications of population ageing for the voluntary sector.

General practitioners perceptions on advance care planning for patients living with dementia

BACKGROUND: Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care.

METHODS: A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented.

RESULTS: One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed.

CONCLUSION: Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.