The management of first seizures in adults in a district general hospital.

This study considered the management of first seizures in adults in Stirling Royal Infirmary over a six month period. Thirty-four patients presented of whom 19 were admitted to medical wards. Alcohol was implicated in 35% of cases. Blood tests were done in many but provided little useful information. CT Scan was performed in 53% and was abnormal in 15% (five patients). EEG was requested for 21% and failed to influence management in any. Six patients (18%) were started on anticonvulsant therapy. It was recorded in only three cases that advice on driving had been given. The literature concerning single seizures is complex, especially with regards to recurrence risk and treatment benefits. We await with interest the publication of the SIGN (Scottish Intercollegiate Guidelines Network) guidelines for seizure investigation and treatment in Scotland.

Standardization of health assessments for patients aged 75 years and over: 3 years' experience in the Forth Valley Health Board area.

BACKGROUND: The new contract for general practitioners (GPs) was introduced in 1990. This required all GPs to offer their patients aged 75 years of over an annual assessment. AIM: The study aimed to determine if 3 years' experience had resulted in standardization of the way in which health assessments for patients aged 75 years and over are carried out. METHOD: The study was carried out in 1993. Questionnaires were sent to the principal partners of all 55 general practices in the Forth Valley Health Board (FVHB) area. The main outcome measures were the fulfilment of contractual requirements and standardization of the health assessment process. RESULTS: Completed questionnaires were returned by 49 practices (89%) Eighty per cent (39 practices) had drawn up their own assessment programme in 1990. Responsibility for assessments was most often (41 practices) shared between different members of the primary care team (84%). Although most practices satisfied contractual requirements, there were wide variations in approach, potentially influencing outcome. CONCLUSION: Despite three years' experience, no standardized approach to the health assessment of patients aged 75 years and over has been developed. Purchasers of health care require information on the needs of their client population, and this should be available in an accessible, standardized form. There is an urgent need for a review of the way in which the 1990 contract has been implemented to standardize health assessments and improve effectiveness in meeting its original aims.

Use of influenza vaccine in long-stay geriatric units.

A postal questionnaire sent to all consultant geriatricians in Great Britain and Northern Ireland determined that less than one consultant in five offered influenza vaccine to patients in continuing-care wards. The main reasons given were that vaccine was inappropriate or unnecessary. This information prompted a prospective study of viral illness during the winter months of 1986-87 in eight continuing-care wards with a population of 196 patients. There were 70 episodes of influenza-like illness (ILI), but only 17 viruses were isolated, the commonest being rhinovirus (seven patients). As most cases of ILI in this population were caused by viruses other than influenza, the reluctance of most geriatricians to give influenza vaccine to continuing-care patients appears justified.