ED, email, emess!

Email has transformed communication in the National Health Service. Handling a torrent of unfocused communication is a potential burden on the clinician's time and a source of stress at work. A prospective study of the number of emails, links and attachments received during a 14-day period by four doctors of an emergency department has revealed the large number of emails received, with consultants receiving more emails than registrars. The time required to merely read this mass communication is substantial. It is suggested that time needs to be allocated to handle emails and that doctors may benefit from training on how to handle them.

A prospective study of injuries inflicted on children by children.

Intentional injuries inflicted upon children by adults rightly cause great concern and have been studied extensively. In contrast, little is known about the pattern, nature and extent of injuries sustained by children inflicted by other children. A funded prospective study of injured children was undertaken over 18 months. Children's injuries were studied in an epidemiologically complete population comprising the western two-thirds of Cornwall. Information was collected from ten hospitals in standardised fashion using the widely accepted Children's Hospital Injury Reporting and Prevention Programme (CHIRPP). 597 injuries (67% involving boys) were identified as having been inflicted apparently deliberately by other children. 62% of injuries affected children aged under 12 years. 245 injuries (41%) occurred at or around school, 143 (24%) at home. Most injuries involved soft tissues, but there were 116 fractures, which accounted for 22 of the 40 hospital admissions. Interestingly, despite a description of an ''assault'', only 38% of injuries were initially coded as intentional by treating hospital staff. These results reveal the previously largely unrecognised scale of the problem of interpersonal violence between children. It is not surprising that most injuries occurred in or around school, given that this is where children interact with other children. The attitude of healthcare professionals may need to change if this problem is to be properly addressed.

Pulse oximetry in clinical forensic practice.

The potential role of a hand held battery operated digital pulse oximeter was investigated on 270 consecutive patients seen by one forensic medical examiner. An oxygen saturation reading on air was obtained on 236 patients (87%). Of the patients in whom the pulse oximeter could not provide a reading, the principal reason for being unable to record a value was lack of patient cooperation (26 of the 34 patients). Of the 236 oxygen saturations recorded, 234 were 95% or higher. The two patients with lower readings (83% and 93%) required assessment and treatment at hospital: one for an opioid overdose, the other for pneumonia. The modern generation of hand held pulse oximeters can provide very useful information in a challenging environment and should occupy a definite corner of the forensic medical examiner's medical bag.