Streaming primary urgent care: a prospective approach

Aim: To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice. Design: An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients’ records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results. Subjects and setting Adult health consumers attending ED and urgent care services in North East London. Results The health user survey identified younger rather than older users (mean age of 35.6 years – SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance. Conclusion: A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery

Salomon ben Abraham ibn Ya'ish. Commentaire sur le Canon (Livre I, lacunaire) d'Avicenne. ‫ יעיש, שלמה בן אברהם אבן. ‫ תפסיר מסאיל אלכתאב אלויל מן אלקאנון

F. 1-271, commentaire acéphale sur le premier livre du canon d'Avicenne de Salomon ibn Yaish. Le titre est donné selon le colophon. Les textes d'Avicenne sont introduits par les mots קאל אבו עלי; le commentaire de Yaish est introduit par תפסיר. Le début du texte du canon commence ainsi : והדה אלקוה אלה'' לקוה הי אלחקיקה אלמדרכה Le début du tafsir commence ainsi : גרצה פי הדא אלקול תעריף חאל אלקוה אל תאלתה מן אלקוי אלכמס אלתי ללקוה אלמדרכה Fin du tafsir : מא קצד אלנאצר תפסירה מן אלמסאיל אלתי וקעת פי אלפן אלראבע וכמל בדלך מא קצד תפסירה מן מסאיל אלכתאב אלאול מן אלקנו