Improving pain management for children having dental extractions under general anaesthesia.

Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles. This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.

A review of the HIV-related sexual behaviour of gay men and men who have sex with men.

In the last decade studies have identified a myriad of factors associated with continued risky sex in gay men and men who have sex with men. More recently the phenomenon of 'relapse' has been identified among this population. The results of such studies have been fed into the ongoing development of strategies to prevent HIV transmission. This paper critically examines this research--most of which is quantitative--and argues that the usefulness of the research is limited. Because of methodological problems, the evidence is contradictory and indeed, comparison across studies is almost impossible. An examination of the concept of 'relapse' illustrates the problems of relying on quantitative research which, in the main, removes individuals from their social context. The paper concludes that more qualitative research is required to locate individuals within their social milieu and to better understand them as individuals interacting with others and involved in an ongoing decision-making process about sexual pleasure and risk.

Computer-based hypertension clinic records: a co-operative study.

A computer-based medical record system has been developed to help with research into hypertension and the management of patients with hypertension. Standard medical records are replaced by data collection forms and case notes printed by the computer. A computer-generated document for recording information at follow-up visits contains an up-to-date summary of the important clinical features with warnings of risk factors. A blood-pressure graph and a letter for the general practitioner are produced on request. The system has been used in three clinics for two years and is being tested in general practice. Information on 900 newly-referred patients has been recorded and at present data on 30 to 40 new patients and 160 follow-up visits are added each month.