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(2) PATIENTS
PREFER COMMUNICATION WITH
DOCTORS, RATHER
THAN PRESCRIPTIONS
(3) COULD
NURSE-LED CARE HELP TO UNBLOCK
NHS BEDS?
(1) HOW PARENTS
WERE TOLD THAT THEIR
UNBORN CHILD HAD AN EXTRA OR MISSING
SEX
CHROMOSOME ± A MATTER OF CHANCE
(What parents are told after prenatal
diagnosis of a sex
chromosome abnormality: interview
and questionnaire study)
http://bmj.com/cgi/content/full/322/7284/463
Some parents are given misleading information
about the
condition when they are first informed
that their unborn child
has a sex chromosome anomaly, finds a
study in this week's
BMJ. These disturbing findings emphasise
the need for
established protocols for communicating
such results to
parents.
Abramsky and colleagues interviewed 29
health
professionals who had recently informed
parents of a sex
chromosome anomaly in an apparently anatomically
normal,
viable fetus. They found enormous variation
between
different health professionals in what
they knew, thought, and
told parents about specific sex chromosome
anomalies.
Furthermore, some obstetric units have
no established
protocol for communicating results to
parents.
Although there were some examples of excellent
counselling,
there were other examples of grossly inadequate
or frankly
misleading information being given, say
the authors. It is
essential for obstetric units to have
an established protocol
for giving results and for all staff who
communicate results to
parents to have accurate, up to date information
about the
condition identified, they conclude.
Contact:
Lenore Abramsky, Senior Research Officer,
Imperial
College of Science, Technology, and Medicine,
Northwick
Park, Harrow, UK
Email: l.abramsky@ic.ac.uk
(2) PATIENTS PREFER
COMMUNICATION WITH
DOCTORS, RATHER THAN PRESCRIPTIONS
(Preferences of patients for patient
centred approach to
consultation in primary care: observational
study)
http://bmj.com/cgi/content/full/322/7284/468
People waiting to see their doctor would
prefer a "patient
centred approach" to their consultation
± including good
communication, partnership with their
doctor and health
promotion information - rather than an
examination or a
prescription, finds a study in this week's
BMJ.
A total of 824 patients in the waiting
room of three doctors'
surgeries completed a pre- consultation
questionnaire about
what they wanted the doctor to do in the
consultation. Three
areas of patient preferences were identified:
"communication"
including listening and exploring concerns,
"partnership"
including discussion and mutual agreement
about treatment,
and "health promotion" including how to
stay healthy and
reduce the risks of future illness. Fewer
(63%) wanted an
examination and only a quarter wanted
a prescription.
Patients with a very strong preference
for patient
centredness are those who are vulnerable
either
psychosocially or because they are feeling
particularly unwell
or worried, and doctors should be sensitive
to those
patients, conclude the authors.
Contact:
Paul Little, MRC Clinician Scientist, Community
Clinical
Sciences (Primary Medical Care Group),
University of
Southampton, Aldermoor Health Centre,
Southampton, UK
Email: psl3@soton.ac.uk
(3) COULD NURSE-LED
CARE HELP TO UNBLOCK
NHS BEDS?
(Therapeutic nursing or unblocking
beds? A randomised
controlled trial of post-acute intermediate
care unit)
http://bmj.com/cgi/content/full/322/7284/453
Transferring patients to a low technology
unit, where nurses
rather than doctors manage recuperation
after acute illness,
is a safe alternative to conventional
care on a general medical
ward, finds a study in this week's BMJ.
This approach may
also constitute an overall benefit for
the NHS by unblocking
beds in community hospitals.
Steiner and colleagues randomly referred
patients to care on
the nurse-led unit of Southampton University
Hospitals Trust
or to usual post-acute care in the hospital.
Length of stay,
patient function, and discharge to a more
dependent living
arrangement was evaluated after six months.
Length of stay was 14.3 days longer in
the nurse-led unit
than in general medical wards, but the
difference dropped to
4.5 days and was no longer significant
when transfers to
community hospitals were taken into account.
No
differences were found in death, functional
status, or living
arrangements at any time.
Nurse-led units are safe and do not shift
service demands
from hospital to community, say the authors.
Instead, they
seem to unblock beds in community hospitals
- an important
finding, not reported elsewhere in the
literature. If such units
are to become an effective part of the
government's recent
commitment to intermediate care, assessment
of local
responsibilities along the full continuum
of care will be
needed, they conclude.
Contact:
Andrea Steiner, Research Associate Professor,
University of
California, Santa Cruz, USA
Email: steiner@cats.ucsc.edu
Bronagh Walsh, School of Nursing &
Midwifery, University
of Southampton, Southampton UK
Email: B.M.Walsh@soton.ac.uk
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