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Table 1 England Royal United Hospital Bath Birmingham Children's Hospital Birmingham Royal Alexandra Children's Hospital Brighton Bristol Royal Hospital for Children Bristol Frenchay Hospital Bristol Royal Derby Hospital Derby Royal Devon and Exeter Hospital Exeter Leicester Royal Infirmary Leicester Alder Hey Children's Hospital Liverpool Barts & The London London Chelsea & Westminster Hospital London Evelina Hospital London King's College Hospital London Lewisham Hospital London Royal Free Hospital London St George's Hospital London St Mary's Hospital London North Manchester General Hospital Manchester Royal Manchester Children's Hospital Manchester Nottingham Children's Hospital Nottingham Derriford Hospital Plymouth Queen Alexandra Hospital Portsmouth Salford Royal Hospital Salford Sheffield Children's Hospital Sheffield University Hospital Southampton Southampton Sunderland Royal Hospital Sunderland Ireland Cork University Hospital Cork Temple Street Children's University Hospital Dublin Our Lady's Children's Hospital, Crumlin Dublin Tallaght Children's Hospital, Tallaght Dublin Northern Ireland Royal Belfast Hospital for Sick Children Belfast Scotland Aberdeen Royal Infirmary Aberdeen Forth Valley Hospital Dumbarton Royal Hospital for Sick Children Edinburgh Royal Hospital for Sick Children (Yorkhill) Glasgow Crosshouse Hospital Kilmarnock Royal Alexandra Hospital Paisley Wales Children's Hospital for Wales Cardiff Morriston Hospital Swansea Individual membership is open to anyone with this vision including doctors, nurses and allied health professionals.

ObjectiveChildhood burns represent a burden on health services, yet the full extent of the problem is difficult to quantify. We estimated the annual UK incidence from primary care (PC), emergency attendances (EA), hospital admissions (HA) and deaths.MethodsThe population was children (0–15 years), across England, Wales, Scotland and Northern Ireland (NI), with medically attended burns 2013–2015. Routinely collected data sources included PC attendances from Clinical Practice Research Datalink 2013–2015), EAs from Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI, 2014) and National Health Services Wales Informatics Services, HAs from Hospital Episode Statistics, National Services Scotland and Social Services and Public Safety (2014), and mortality from the Office for National Statistics, National Records of Scotland and NI Statistics and Research Agency 2013–2015. The population denominators were based on Office for National Statistics mid-year population estimates.ResultsThe annual PC burns attendance was 16.1/10 000 persons at risk (95% CI 15.6 to 16.6); EAs were 35.1/10 000 persons at risk (95% CI 34.7 to 35.5) in England and 28.9 (95% CI 27.5 to 30.3) in Wales. HAs ranged from 6.0/10 000 person at risk (95% CI 5.9 to 6.2) in England to 3.1 in Wales and Scotland (95% CI 2.7 to 3.8 and 2.7 to 3.5, respectively) and 2.8 (95% CI 2.4 to 3.4) in NI. In England, Wales and Scotland, 75% of HAs were aged <5 years. Mortality was low with 0.1/1 000 000 persons at risk (95% CI 0.06 to 0.2).ConclusionsWith an estimated 19 574 PC attendances, 37 703 EAs (England and Wales only), 6639 HAs and 1–6 childhood deaths annually, there is an urgent need to improve UK childhood burns prevention.

Objectives To establish the safety of an intranasal diamorphine (IND) spray in children. Design An open-label, single-dose pharmacovigilance trial. Setting Emergency departments in eight UK hospitals. Participants Children aged 2–16 years with a fracture or other trauma. Outcome measures Adverse events (AE) specifically related to nasal irritation, respiratory and central nervous system depression. Results 226 patients received 0.1 mg/kg IND. No serious or severe AEs occurred. The incidence of treatment-emergent AEs (TEAEs) was 26.5% (95% CI 20.9% to 32.8%), 93% being mild. 89% were related to treatment, all being known effects of the drug or route of administration except for three events in two patients. 20.4% (95% CI 15.3% to 26.2%) patients reported nasal irritation, all mild except one moderate and one ‘unknown’ severity. No respiratory depression was reported. Three AEs related to reduced Glasgow Coma Score (GCS) occurred, all mild. Conclusions There were no safety concerns raised during the conduct of the study. In addition to expected side effects, IND can cause mild nasal irritation in a proportion of patients. European Union Drug Regulating Authorities Clinical Trial No 2009-014982-16.

The benefits of early thrombolysis in acute myocardial infarction are well known. 1 In March 2000 the National Service Framework for coronary heart disease established a target of 60 minutes between the patient's call for help and the delivery of thrombolysis. 2 Emphasis is placed upon improved ambulance response and more efficient delivery of in hospital or prehospital thrombolysis, but hardly any attention is paid to the \"decision time\": the minutes that elapse between symptom onset and a call for professional help.

Background: The National Service Framework for coronary heart disease established clear standards for the management of patients with acute myocardial infarction in March 2000. This study evaluates an emergency department’s thrombolysis performance in light of these standards. Setting: Inner city teaching hospital emergency department. Methods: The data were prospectively collected using a formal clinical pathway for all patients receiving thrombolysis in the emergency department between February 2000 and January 2001. Cases were reviewed at monthly multidisciplinary audit meetings. Regular feedback complemented routine teaching for both nursing and medical staff. Results: 127 patients were thrombolysed, of whom 92 (72%) were immediately eligible. Some 77% of these had a door to needle time of less than 30 minutes and 38% less than 20 minutes. Twenty per cent of patients had a call to door time of less than 30 minutes. Some 84% of patients managed by the emergency department team had a door to needle time of less than 30 minutes compared with 53% of those patients seen by duty physicians. Conclusions: The thrombolysis target set by the National Service Framework for April 2002 is achievable. The target set for April 2003 remains an ambitious goal. Overall call to needle times are undermined by call to door times. Emergency department teams may be more efficient than duty physicians in processing patients needing thrombolysis.

Background: The National Service Framework for coronary heart disease established clear standards for the management of patients with acute myocardial infarction in March 2000. This study evaluates an emergency department’s thrombolysis performance in light of these standards. Setting: Inner city teaching hospital emergency department. Methods: The data were prospectively collected using a formal clinical pathway for all patients receiving thrombolysis in the emergency department between February 2000 and January 2001. Cases were reviewed at monthly multidisciplinary audit meetings. Regular feedback complemented routine teaching for both nursing and medical staff. Results: 127 patients were thrombolysed, of whom 92 (72%) were immediately eligible. Some 77% of these had a door to needle time of less than 30 minutes and 38% less than 20 minutes. Twenty per cent of patients had a call to door time of less than 30 minutes. Some 84% of patients managed by the emergency department team had a door to needle time of less than 30 minutes compared with 53% of those patients seen by duty physicians. Conclusions: The thrombolysis target set by the National Service Framework for April 2002 is achievable. The target set for April 2003 remains an ambitious goal. Overall call to needle times are undermined by call to door times. Emergency department teams may be more efficient than duty physicians in processing patients needing thrombolysis.

Interpretation of cognitive test performance among individuals from a given population requires an understanding of cognitive norms in that population. Little is known about normative test performance among elderly illiterate non-English-speaking individuals. An age-stratified random sample of men and women, aged 55 years and older, was drawn from a community-based population in the rural area of Ballabgarh in northern India. These Hindi-speaking individuals had little or no education and were largely illiterate. A battery of neuropsychological tests, specially adapted from the CERAD neuropsychological battery, which was adminstered to this sample, is described. Subjects also underwent a protocol diagnostic examination for dementia. Norms for test performance of 374 nondemented subjects on these tests are reported across the sample and also by age, gender, and literacy.