Outpatients

In 2005-06 some £259 million was spent on outpatient services in Northern Ireland. A perennial cause of inefficiency in the provision of these services has been patients' failure to attend appointments and the cancellation of clinics by Trusts. In September 2006 almost 15,000 consultant-led clinic sessions were cancelled and there were 200,000 cases of patients not attending. A survey found that some 10 per cent of outpatients are "not seen" through cancellation or non-attendance, an opportunity cost of £11.6 million. Health service managers and clinicians need to monitor non-attendance/cancellation rates closely, in order to clarify the factors influencing them, and to allow planning of effective strategies aimed at minimising any loss of time and resources. The report also notes that outpatient services run by healthcare professionals other than consultants are not covered in the weekly statistical management information currently collected: if these are included outpatient activity levels are twice that officially reported. Changes to the way in which patients and general practitioners access outpatient services are being implemented and they should reduce waiting times and have an impact on cancelled clinics and missed appointments.

An introduction for residents and new psychiatrists who work with patients.

This concise manual of outpatient gynecological care is in its Fourth Edition. Chapters cover the full range of gynecological problems as se en in the outpatient clinical setting, and follow a consistent sequent ial organization in each chapter under the headings of history, physic al exam, investigative procedures, and management. New to each chapter is a section on patient education, and several of the chapters contai n tables that can be used for patient handouts. The book is reorganize d and new chapters include the topics of domestic violence, osteoporos is, alternative therapy, and prevention of gynecological cancers.

Dirk Zimmermann illustrates that some therapists significantly differ concerning their average dropout rates. He points out that initial impairment is a strong predictor of early termination. Different dropout criteria as well as various explaining variables on patient and on therapist level were assessed. Premature treatment termination is a common phenomenon in psychotherapy with mean dropout rates of about 20%. Therapist effects account for 3%–4% of the variation in dropout.

Chikungunya fever is a vector borne disease transmitted by mosquitoes that became widely prevalent in most of the coastal States of Indian Union since 2006. It causes numerous health problems to the victims and cognitive problems for medical practitioners and policy makers. Several episodes of the fever have shown long term physical and neurological disability besides short term morbidity. There is no vaccine available to prevent Chikungunya though it is generally considered non-fatal. Hence the disease can be treated at relatively low cost by simple measures to prevent the severity of the disease. However, poor people treated the diseases relatively costly. Though the disease was not new to India, the disease caused panic among the public and resulted in socio political and medical concern when the epidemic outbreak penetrated fast in to rural and urban areas after 2006.The symptoms, side effects and socio-economic impacts were not similar in the affected areas. In the Kanyakumari District of Tamil Nadu, the disease inflicted more among the rural agricultural laborers and tapper workers in rubber plantations, resulted in severe loss of employment and productivity. The present study is an attempt to analyse the economic impact of Chikungunya fever at the household level in Kanyakuramari District. This report presents the results of the study The Economic Impact of Chikungunya Fever on Household level in Tamil Nadu: A study in Kanyakurmari District This project is undertaken with the financial support from Malcolm and Elizabeth Adiseshaiah Trust, Chennai. This financial assistance is gratefully acknowledged. I am indebted to Presidency College for providing the necessary facilities to undertake the project. I fail in my duty if I dont mention the helps extended by the post graduate students of Marthandam Christian College, Kanyakumari. I am indebted to Prof. R.Nagaraj of MIDS for his valuable guidance in undertaking the project. I also gratefully acknowledge the support of Mr.K.Sampath Kumar. B.P.Chandramohan