Walk in centres: lessons from Canada

The current reforms of the United Kingdom's primary healthcare sector intend to improve accessibility to health care. One of the proposals is to introduce "walk-in" primary care centres. The intention is to pilot "a series of nurse led centres which can be used on a `drop in' basis, providing minor treatment, health information and self help advice." The Canadian medical system has many similarities to the British system. Canada's health system is funded through general taxation (and Medicare premiums), and its general practitioners (family physicians) have a gatekeeper role to secondary care in most provinces. Canada has had walk-in centres for over 20 years. However, these centres are a doctor led service. The lessons learnt in Canada about walk-in centres may be relevant to the NHS. In this article I review the available literature about Canadian walk-in centres

On a class of distributions with simple exponential tails

A simple general construction is put forward which covers many unimodal univariate distributions with simple exponentially decaying tails (e.g. asymmetric Laplace, log F and hyperbolic distributions as well as many new models). The proposed family is a special subset of a regular exponential family, and many properties flow therefrom. Two main practical points are made in the context of maximum likelihood fitting of these distributions to data. The first of these is that three, rather than an apparent four, parameters of the distributions suffice. The second is that maximum likelihood estimation of location in the new distributions is precisely equivalent to a standard form of kernel quantile estimation, choice of kernel being equivalent to specific choice of model within the class. This leads to a maximum likelihood method for bandwidth selection in kernel quantile estimation, but its practical performance is shown to be somewhat mixed. Further distribution theoretical aspects are also pursued, particularly distributions related to the main construction as special cases, limiting cases or by simple transformation

"It isn't just consultants that need a BSc": student experiences of an Intercalated BSc

More medical schools are moving towards a compulsory intercalated BSc. These courses have not traditionally been aimed at those students interested in general practice and have tended to have limited clinical relevance. This paper explores the perceptions of students who undertook a BSc in primary health care using qualitative methodology comprising semi-structured interviews with students just before completion of their course. Interviews were undertaken with 24 of the 26 students who started the course over a 4-year period. All the students have finished the course and have graduated with good honours degrees. Students refine existing skills and develop new, relevant skills for medicine. The students discussed the prestige (or lack) of a BSc in this field and how the course has impacted on their career decisions. A Primary Health Care BSc such as this appears to give students an in depth and to some, a positive view of general practice and primary care. The course allowed students to develop a more critical approach to medicine and enabled them to develop skills in addition to those acquired from their undergraduate medicine course. They perceived that these skills will serve them throughout their career in whatever branch of medicine they choose

Beam Dynamics Studies for the HIE-ISOLDE Linac at CERN

The upgrade of the normal conducting (NC) Radioactive Ion Beam EXperiment (REX)-ISOLDE heavy ion accelerator at CERN, under the High Intensity and Energy (HIE)-ISOLDE framework, proposes the use of superconducting (SC) quarter-wave resonators (QWRs) to increase the energy capability of the facility from 3 MeV/u to beyond 10 MeV/u. A beam dynamics study of a lattice design comprising SC QWRs and SC solenoids has confirmed the design's ability to accelerate ions, with a mass-to-charge ratio in the range 2.5 < A/q < 4.5, to the target energy with a minimal emittance increase. We report on the development of this study to include the implementation of realistic fields within the QWRs and solenoids. A preliminary error study is presented in order to constrain tolerances on the manufacturing and alignment of the linac.Comment: 3 pages, 8 figures, 1 table, submitted to the Particle Accelerator Conference (PAC) 2009 in Vancouver. Page formatting changed to US letter siz

An IT approach to cardiovascular care based on primary care

We describe a unique telemedicine approach to cardiovascular care, based in primary care, which combines store and forward with real time video. Patients presenting to the family practitioner (GP) with chest pain or symptoms indicative of cardiac disease are assessed within the health centre by exercise test ECG. The report, together with other clinical information is forwarded as an electronic referral to the cardiologist. Suitable candidates for angiography have an initial teleconsultation by video-conferencing, in which not only may the patient, GP and cardiologist discuss the diagnosis and forthcoming procedures in hospital, but also can undertake management of the patient, such as review of medication and life style. Follow-up consultations may be conducted by further tele-clinics. We also show how re-engineering the process has the potential to eliminate 75 of outpatient appointment