Emergency medical care.

A survey carried out over five periods between 1973 and 1975 to study the mode of referral of emergency medical patients to a district general hospital showed that, out of a total of 2511 patients, 51% referred themselves, 40-8% were referred by general practitioners, and only 4-7% by doctors employed by the emergency treatment service. Of the 1720 patients admitted to the medical wards, 50-9% were referred by general practitioners and 37-3% were self-referred while the corresponding figures for the 791 not admitted were 19% and 80-7% respectively. Two-thirds of the self-referred patients came from their own homes, usually by ambulance ordered by a "999" emergency call. The figures were similar in each of the five periods.     

The carrier in government medical care plans.

The nalorphine (pupil) test for narcotic abuse is widely used in California. It is based on the ability of nalorphine to produce mydriasis in subjects who have recently taken morphine-like drugs and to produce miosis in others. The test will usually detect as little as 15 mg of morphine or comparable doses of other narcotics for several hours except in special circumstances. It is even more reliable for detection of chronic use of narcotics. A simple card pupillometer is adequate for measuring changes in pupil size resulting from nalorphine.Analysis for narcotics in urine by thin layer chromatography is also used, either alone or in conjunction with the pupil test, to detect drug abuse. In one study which included many urine speciments from subjects who had negative pupil tests the correlation between the pupil test and urinalysis was good (85 percent). When urinalysis was used to confirm suspicion of drug use resulting from a positive or equivocal pupil test, inter-method agreement dropped to about 50 percent for various reasons. Even so, use of the pupil test for screening and urinalysis for confirmation provides a satisfactory program for detection of narcotic abuse.     

Sexual dysfunction in the elderly. Pathophysiological and medical issues. Treatment of erectile dysfunction

Erectile dysfunction (ED) is a very distressing condition that not only negatively affects the elderly man's sexual ability, but also his overall quality of life and that of his partner. Encouraging men, alone or as a couple, to seek professional help is a major educational challenge which needs to be met by medical, social and political initiatives. The exact pathogenesis of ED remains unknown, but is presumed to be multifactorial; vascular disease is the most frequent cause with endothelial dysfunction being the common denominator. It has been postulated that ED is a sentinel symptom of cardiovascular clinical events and should prompt investigation and intervention for cardiovascular risk factors. Therefore, when a patient presents with ED, a thorough history and physical examination should be performed, as well as appropriate laboratory tests aimed at detecting associated diseases.     

Nurses and nursing in primary medical care in England.

In 1974 we sent questionnaires on attachment and employment of nurses to 9214 general practices in England. There were 7863 replies (85%), of which 551 were excluded from the study. A total of 2654 nurses were directly employed by 24% (1774) of the practices, and 68% (4972) had attached nurses. Practices in health centres were larger and had greater nursing resources than those in other premises. We suggest that practices may employ nurses to compensate for ineffective nursing attachments, and we conclude that general-practice-employed nurses are becoming "professionalised".