Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients

The study was designed to assess the views and knowledge of hospital doctors in general and geriatric medicine on oral health in older people. Eighty two doctors in general and geriatric medicine at two hospitals were shown 12 colour slides of oral mucosal conditions and asked to give a diagnosis for each slide and complete a questionnaire. Completed questionnaires with the answers to the coloured slides were returned completed by 70 doctors. The majority of doctors (84%) felt it was important to examine older patients' mouths, however only 19% (chi(2) p=0.0001) routinely do so. If asked to prescribe nystatin by the nursing staff, 30% said they would do so without examining the mouth itself. Only 9% of doctors knew that wearing dentures was a specific risk factor for oral candidiasis (chi(2) p=0.001). Altogether 56% of doctors did not feel confident in examining the oral cavity and most (77%) did not think they had had sufficient training in this examination. Only two doctors correctly diagnosed all of the slides. An early squamous carcinoma was misdiagnosed by 80% of the doctors (chi(2) p=0.0001). Hospital doctors do not routinely inspect older patients' mouths. Even if shown slides of typical oral mucosal lesions many hospital doctors are unable to diagnose them. Issues on training need to be addressed. From the patients' point of view a public health campaign is required to educate older people on the need for a regular dental review and be aware that doctors may not be able to diagnose serious oral conditions.

The impact of hearing on communication

The study was designed to assess the impact of hearing impairment on communication between older hospital patients and medical staff and to see whether intervention to improve hearing influences perceived communication. Structured interviews were held with 200 mentally alert elderly hospital in-patients before and after the introduction of voice amplifiers and acetate cards depicting a hearing problem. Prior to intervention 22% of patients rated communication with their doctor as poor or unsatisfactory. Following intervention there was a significant improvement (Chi-square p=0.006), with only 6% of patients reporting communication with their doctor as poor or unsatisfactory. Most of the patients who felt communication was unsatisfactory could not hear what was being said. We conclude that simple measures can improve the number of older patients hearing what their doctor says and improve their perception of communication with the hospital doctor.

Cardiopulmonary resuscitation training: where are we now?

The aim of this study was to assess the current situation with regard to cardiopulmonary resuscitation training and organisation 10 years after guidelines were published by the Royal College of Physicians. Questionnaires were sent to 100 UK hospital trusts (88 responses) and 200 general practitioners on Wirral, Merseyside (92 responses). Most trusts gave their staff annual training in CPR, but only 80% trained all staff who came into contact with patients. Not all trusts employed resuscitation training officers, carried out routine audit or had formal CPR policies. The majority of GPs had had no training in CPR for more than five years. Only one practice had a defibrillator, yet 14% had needed to carry out CPR in the past 12 months. Less than half the GPs ever discussed CPR with appropriate patients. The resuscitation service in this country is fragmented, and certain areas--particularly in the training of GPs--need attention.