QUALITY IMPROVEMENT: Supporting a hospital in difficulty: -experience of a '-buddying' agreement to implement a new medical pathway.

Increased NHS regulation has identified many healthcare organisations with operational and/or financial difficulties. Although the causes are often complex, most cases are effectively managed internally with limited input from external agencies. How best to support the few organisations needing additional support has not been established. 'Buddying', in which senior clinical and managerial teams from a well performing organisation work with colleagues from an organisation in difficulty has been proposed as a potential solution. Previous reports suggest that these partnerships are generally valued by the organisation in difficulty but there is a paucity of measured operational benefit. In this article we present our experience of a 'buddying agreement' and its impact on the introduction of a new 'whole system' medical pathway (ie rotas, staffing, process) at an organisation in difficulty. We describe the process, problems, effect on operational performance, staff survey feedback six months post-implementation and the lessons learned. Factors critical to success were good communication; clear responsibilities, common values and strong governance; incorporation into an effective local improvement programme; targeting of specific issues; ability to influence people and foster relationships; adequate 'manpower' and gradual transition to local 'ownership'.

Effects of stimulant medication on cognitive performance of children with ADHD.

The effect that treatment with stimulant medication has on the intellectual performance of children with attention deficit hyperactivity disorder (ADHD) was examined. Thirty-one children diagnosed with ADHD were given a WISC-III before any treatment was implemented. At least 1 year later, children were retested. At this time, 24 of the children were taking stimulant medications. Children receiving medications had significant increases in IQ scores, but no changes were found for those not taking medications. Changes in IQ scores were moderately related to parents' perceived efficacy of the medication and parent-reported compliance with medication but were not strongly related to changes in parent-reported ADHD symptoms.

Intermediate care in a primary care trust.

Improving the quality of care for older people has been a key aim of the NHS for many years and is an important part of the NHS Plan (DoH 2000). The National Service Framework for Older People, published in 2001, made it clear that intermediate care processes are central to the provision of quality care to this sector of the population (DoH 2001). This article describes a service model of intermediate care in one primary care trust, outlining the processes and challenges encountered in establishing this multidisciplinary cross-agency initiative.

Growth deficits and attention-deficit/hyperactivity disorder revisited: impact of gender, development, and treatment.

OBJECTIVE: Although the relationship between putative growth deficits and attention-deficit/hyperactivity disorder (ADHD) has been examined in boys, this issue has not been evaluated in girls. METHODS: Height and weight were examined in 124 female ADHD children and 116 female controls using age and parental height corrections, attending to issues of pubertal stage and treatment. Also, we examined the interaction between ADHD status and gender on growth outcomes using data from 124 ADHD and 109 control males. RESULTS: The ADHD-growth association was not moderated by gender. No deficits in age-adjusted height or age and height-adjusted weight were detected in ADHD girls. Also, we found no association between growth measurements and psychotropic treatment, malnutrition, short stature, pubertal development, family history of ADHD, or psychiatric comorbidity, except for major depression: ADHD girls with major depression were on average 7.6 kg heavier than ADHD girls without depression, adjusting for age and height. CONCLUSIONS: No growth deficits appear to be associated with ADHD or its treatment in females. These findings add to a growing literature supporting the notion that stimulant treatment does not have an adverse impact on ADHD children's growth and development.