the columns correspondence Are institutional and individual interpersonal racism the same ?

Singh (2007) and Murray & Fearon (2007) surprisingly and erroneously assume that institutional racism and individual interpersonal racism are the same! They dismiss the contribution of institutional racism to systemic problems in the provision of services and service delivery, and argue that


How nasty has NICE been to people with dementia?
A revised NICE Technology Appraisal restricted the use of acetylcholinesterase inhibitors (AchIs) in Alzheimer's to patients suffering moderately severe dementia based on Mini-Mental State Examination (MMSE) of 20 or below (National Institute for Health and Clinical Excellence, 2006).R(Eisai Ltd) v NICE [2007] upheld this guidance, albeit with caveats advising against undue reliance on MMSE scores for those who have learning disability or for whom English is not a first language.In Derby, the new guidance was in place from 1 January 2007 onwards and policed by our pharmacy department where all applications for AchIs must be submitted.
We undertook a mirror image study of my prescribing, comparing data for two 6 month periods before and after implementation (1 Feb 2006to 31 July 2006and 1 Feb 2007to 31 July 2007 respectively).
Eleven patients began AchI therapy in the first period and 22 in the second.In both periods, three of the initiates had dementia with Lewy bodies while the remainder of the patients had Alzheimer's or mixed Alzheimer's vascular dementia.Mean MMSE of the Alzheimer's mixed group was 23.9 (range 14^28) in the first period and 17.7 (range 8^28) in the second (t=2.79,P=0.0098).In the latter group, six patients were judged to have moderately severe impairment despite MMSE above or below the NICE threshold.
These results suggest that the new guidance has significantly restricted the use of AchIs to those with more severe cognitive impairment but there is little evidence that rate of usage has been curbed.In fact, the publicity surrounding the controversial guidance may have fuelled demand for these agents.AND CLINICAL EXCELLENCE (2006).TA111Alzheimer's diseasedonepezil, galantamine, rivastigmine (review) and mementine: guidance.National Institute for Health and Clinical Excellence.R (Eisai Ltd) v National Institute for Health and Clinical Excellence [2007]  Informal discussion with trainees in our trust demonstrated that some of them were not aware of documenting reflective practice in the portfolio, some were concerned about lack of structure for writing in the portfolio and very few complained of lack of time.

NATIONAL INSTITUTE FOR HEALTH
Major changes in the training curriculum will probably make the documentation of educational and clinical supervision increasingly important and in the context of the possible introduction of revalidation by the General Medical Council, reflective practice may become an important section of the trainees' portfolio in future.BOUCH, J. ( 2003 Psychiatrists and the media I agree with the views of Dr Aslam ( 2007) encouraging colleagues to use the media as an educational tool.And I believe we can go one better by starting our own media organisations to output health information in various languages.
I help run Unity FM, a community radio station serving the Muslim population here in Birmingham.We broadcast programmes concerning both physical health and mental health issues.We also obtained some funding from a local primary care trust to run an infant mortality campaign recently.
If others wish to volunteer at the station, maybe as a guest to be interviewed on one of our shows, then please contact me.Patients deemed likely to require admission, either by the on-call junior doctor or the community teams, are first admitted in this unit.Alternatives to inpatient treatments are explored and a comprehensive assessment of needs is conducted within a maximum of 72 hours.This ensures adequate utilisation of inpatient beds and also prioritises community treatment.
Tangible benefits in the past 2 years include a 36% reduction in admissions through accident and emergency units with an overall reduction of in-patient admissions of 42%.The average wait for allocation of beds has halved and use of out-of-area beds has been reduced to zero.The downside has been an increase in average length of stay as an in-patient.This is understandable with a greater proportion of severely unwell patients on the wards now.A recent staff survey shows a high level of satisfaction with the unit and some of the main reasons highlighted are early input from senior medical staff and an alternative to inpatient care.Junior doctors particularly found this unit extremely helpful especially in complementing their out-of-hours work.
The trust also has had substantial financial benefit including closure of a 23 bed acute in-patient ward.
We feel this model of working has been successful in our trust and can possibly benefit others in similar situations.
ASLAN, N. (2007)Using the media as an educational tool.Psychiatric Bulletin, 31, 398.With ever increasing budget restraints and firm emphasis on community treatment, South Essex Partnership NHS Foundation Trust introduced the Assessment Unit in April 2005.It serves a dual purpose of gatekeeping and deciding appropriate care setting for patients.