Developing a multidisciplinary pathway for functional neurological disorders in a UK National Health Service: The Exeter model

Functional neurological disorders remain common presentations to both outpatient and inpatient NHS services, but little consensus exists with respect to how such services and clinical pathways for patients should be structured and should function. This article sets out a model for an integrated multidisciplinary approach that takes full account of the number specialties involved, constraint on resources and time involved, and that has functioned well in the NHS despite a pandemic

Attachment in pregnant drug users : he impact of attachment classification on expectations of and relationship to the child

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How to make a politician more likeable and effective: framing political judgments through the numeric values of a rating scale

Two studies examined whether the numeric values used on rating scales would influence judgments about British Prime Minister Tony Blair. Study 1, conducted on the day before the 1997 British general election, involved participants rating Blair on the attributes of caring, friendliness, honesty, and intelligence. For all participants, the verbal endpoints were not at all and extremely. However, the numeric values associated with these endpoints were either -5 and +5 or 0 and 10. The results supported the prediction: Trait ratings of Blair were more favorable in the -5 to +5 condition. Study 2, conducted less than one week after Blair's victory in the election, explored whether trait ratings (as elicited from a numeric values manipulation) would impact a subsequent judgment about Blair's predicted effectiveness as Prime Minister. The results supported the hypothesis: Participants used their earlier responses to derive their second judgment, such that Blair was expected to be more effective when he had previously been rated on a -5 to +5 scale. Implications of the findings on social judgments and political attitudes are discussed

The found down patient

BackgroundUnconscious patients who present after being "found down" represent a unique triage challenge. These patients are selected for either trauma or medical evaluation based on limited information and have been shown in a single-center study to have significant occult injuries and/or missed medical diagnoses. We sought to further characterize this population in a multicenter study and to identify predictors of mistriage.MethodsThe Western Trauma Association Multicenter Trials Committee conducted a retrospective study of patients categorized as found down by emergency department triage diagnosis at seven major trauma centers. Demographic, clinical, and outcome data were collected. Mistriage was defined as patients being admitted to a non-triage-activated service. Logistic regression was used to assess predictors of specified outcomes.ResultsOf 661 patients, 33% were triaged to trauma evaluations, and 67% were triaged to medical evaluations; 56% of all patients had traumatic injuries. Trauma-triaged patients had significantly higher rates of combined injury and a medical diagnosis and underwent more computed tomographic imaging; they had lower rates of intoxication and homelessness. Among the 432 admitted patients, 17% of them were initially mistriaged. Even among properly triaged patients, 23% required cross-consultation from the non-triage-activated service after admission. Age was an independent predictor of mistriage, with a doubling of the rate for groups older than 70 years. Combined medical diagnosis and injury was also predictive of mistriage. Mistriaged patients had a trend toward increased late-identified injuries, but mistriage was not associated with increased length of stay or mortality.ConclusionPatients who are found down experience significant rates of mistriage and triage discordance requiring cross-consultation. Although the majority of found down patients are triaged to nontrauma evaluation, more than half have traumatic injuries. Characteristics associated with increased rates of mistriage, including advanced age, may be used to improve resource use and minimize missed injury in this vulnerable patient population.Level of evidenceEpidemiologic study, level III