Homeless healthcare: raising the standards.

Over the past 3 years the number of homeless people in the UK has increased by 34%. Most will die young, largely due to treatable conditions. Secondary care can, and must, do more for the silent killer that homelessness is.

Living for the weekend: electronic documentation improves patient handover.

With increasing shift work the importance of effective handover is becoming more widely recognised, resulting in the production of guidelines on written handover documentation. A particular area of poor compliance was handover from the week to weekend teams for medical inpatients, as shown through an audit cycle. Full implementation of any guidelines can be time and financially costly. However, a simple, minimal cost, electronic-based list improved the quantitative measures of written handover, particularly in areas of patient location, resuscitation status and investigations. Qualitative data showed multiple benefits, but also problems with logistics in computer terminals, networks and access. Solutions to such problems are discussed, with the importance of carefully implemented longer-term changes being emphasised.

Putting your HAT on.

One in three deaths of people who are homeless are preventable. The morbidity and mortality of people who are homeless is shocking. With people who are homeless having a higher rate of emergency department attendance and hospital admission compared with the general population, we have a unique opportunity to change their health and their life.This led to the design and implementation of the Homeless Assessment Tool (HAT) at Gloucestershire Hospitals NHS Foundation Trust. The HAT is an opportunistic prompt to assist doctors in providing the best care for patients who are homeless upon (or during) hospital admission.Teaching sessions on the health of people who are homeless and the HAT were given to doctors and nurses. Feedback commended the HAT's comprehensiveness, ease of use, and utility in assessing and managing a patient who is homeless.As such, the HAT is accepted as a standard by the Faculty for Homeless and Inclusion Health, further demonstrating its merits in assessing patients who are homeless.

Movement disorders after stroke.

Many different types of hyperkinetic and hypokinetic movement disorders have been reported after ischaemic and haemorrhagic stroke. We searched the Medline database from 1966 to February 2008, retrieving 2942 articles from which 156 relevant case reports, case series and review articles were identified. The papers were then further reviewed and filtered and secondary references found. Here we review the different types of abnormal movements reported with anatomical correlation, epidemiology, treatment and prognosis. Post stroke movement disorders can present acutely or as a delayed sequel. They can be hyperkinetic (most commonly hemichorea-hemiballism) or hypokinetic (most commonly vascular parkinsonism). Most are caused by lesions in the basal ganglia or thalamus but can occur with strokes at many different locations in the motor circuit. Many are self limiting but treatment may be required for symptom control.

The introduction of a homeless healthcare team in hospital improves staff knowledge and attitudes towards homeless patients.

It is estimated that 12,300 people slept rough in 2018, a 98% increase since 2010. Similar trends can be seen in the number of people living in tents or sleeping on overnight public transport. Such individuals are five times more likely than age-matched, housed people, to attend hospital. This is due to the severe ill-health and poor engagement with primary care, prevalent among this population. Following the introduction of the Homeless Reduction Act 2017, hospitals must now take a more personalised approach to their homeless patients, ensuring that ongoing care is accessible after discharge. Here, we demonstrate that employment of a dedicated homeless housing officer within a district general hospital can radically improve both staff attitudes towards this patient group as well as individual patient outcomes.

Fracture rates in Parkinson's disease compared with age- and gender-matched controls: a retrospective cohort study.

INTRODUCTION: Patients with Parkinson's disease (PD) are not routinely prescribed bone-protecting medication despite the fact that they are known to be at risk of falling. We investigated whether subjects with PD were more at risk of fractures than other patient groups in order to establish whether preventative measures should be targeted on those who have been diagnosed with PD. METHODS: We performed a retrospective cohort study, reviewing the records of PD patients compared with age- and gender matched patients attending medical clinics. Power analysis indicated the need for 194 in each group for a 95% confidence level. Our study comprised 200 PD patients and 200 controls. All limb and vertebral fractures before the date of diagnosis, or control, were recorded. RESULTS: 52% of patients in each group were female. The mean age of the PD patients was 75.6 years (43.7-96.0) and that of controls 75.2 years (43.9-95.9). The mean interval from diagnosis was 5.46 years, providing 1092 person-years of follow-up in both groups. Fractures were significantly more common in the PD group than the control group (PD 15%, controls 7.5%; p = 0.007). The commonest site of fracture was femur in PD patients (11 of 38 fractures) and forearm in the control group (5 of 16 fractures). CONCLUSION: The risk of fracture is significantly increased in PD relative to patients with other medical conditions. Hip fractures are commonly fatal in older people and partly preventable. Prospective studies of intervention to prevent fractures in PD are required.