Effectiveness of screening for risk of medical emergencies in the elderly

Study objective: UK government policy mandates the introduction of 'intermediate care services' to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated one of these initiatives-the Keep Well At Home (KWAH) Project-in a West London Primary Care Trust. Design: KWAH involves a two-phase screening process, including a home visit by a community nurse. We employed cohort methods to determine whether KWAH resulted in fewer emergency attendances and admissions to hospital in the target population, from October 1999 to December 2002. Results: estimated levels of coverage in the two phases of screening were 61 and 32%, respectively. The project had not maintained records of which additional health and social care services had been delivered following screening. The rates of emergency admissions to hospital in the 9 months before screening were similar in practices that did and did not join the project (rate ratio (RR) = 1.05; 95% CI 0.95-1.17), suggesting absence of volunteer bias. Over the first 37 months of the project, there was no significant impact on either attendances at Accident & Emergency departments (RR = 1.02; 95% CI 0.97-1.06) or emergency admissions of elderly patients (RR = 0.98; 95% CI 0.93-1.05). Conclusion: the KWAH Project has been ineffective in reducing emergency admissions among the elderly. Significant questions arise in relation to selection of the screening instruments, practicality of achieving higher coverage of the eligible population, and creation of a new postcode lottery.

A flexible and practical framework for reporting on ecologically sustainable development for wild capture fisheries

The principles of sustainable development (or ecologically sustainable development as it is known in Australia) are now accepted as the foundation for natural resource management worldwide and there are increasing community expectations that they will be implemented explicitly. Previous attempts to assess sustainable development for fisheries have mostly failed because the methods have been too restrictive, often attempting to develop a single set of indicators. In 2000, all the fishery agencies and major stakeholder groups in Australia supported the development of a National ESD Framework. This initiative resulted in a practical system being generated through the results of a series of case studies and stakeholder workshops. The Australian National ESD Framework divides ESD into eight major components within the three main categories of ecological well-being, human well-being and ability to contribute: Four main steps are used to complete an ESD report for a fishery: (1) identify relevant issues, (2) prioritise these using risk assessment, (3) complete appropriately detailed reports on each issue and (4) compile the material into a report. The tools to assist this process are now available and have been used to generate reports for many Australian fisheries. (C) 2004 Elsevier B.V. All rights reserved.

Lessons from the National Mental Health Integration Program

Three projects were funded under the national Mental Health Integration Program (MHIP) in 1999, each of which employed a different model aimed at improving linkages between disparate parts of the mental health system. A national evaluation framework guided local evaluations of these projects, and this paper presents a synthesis of the findings. For providers, the projects improved working relationships, created learning opportunities and increased referral and shared care opportunities. For consumers and carers, the projects resulted in a greater range of options and increased continuity of care. For the wider system, the projects achieved significant structural and cultural change. Cost-wise, there were no increases in expenditure, and even some reductions. Many of the lessons from the projects (and their evaluations) may be generalised to other mental health settings and beyond.

Media influence to suicide: The search for solutions

This review explores the influence to suicide in print and electronic media, and considers both real and fictional deaths. The conclusion appears inescapable that reports about celebrities which are multi-modal, repeated, explicit, front page, glorify the suicide, and describe the method lead to an increase in deaths from suicide, particularly in the region in which reports are published. The paper argues that even if there was multi-national agreement to international guidelines, media will continue to report suicide when it is considered to be a matter of public interest. What appears crucial is a collaborative approach between professionals and the media to promote a negative attitude toward suicide without increasing stigma toward those with mental health problems.