The incidence of hip fractures is an index of the overall burden of osteoporosis in a society. Hip fractures are a major cause of morbidity, mortality and hospital admissions amongst older people. A study published recently in the Journal of Public Health Medicine by Tai-Yin Wu and colleagues examined trends in hip fracture admissions and mortality in England. They found that between 1998 and 2009, there was little change in age-standardized hip fracture rates (102.0 to 101.8 fractures per 100,000 person-years), but age-standardized in-hospital mortality decreased by 17%, from 127 to 106 deaths per 1,000 hip fracture admissions. Most hip fractures and deaths occurred in women and older people. A socioeconomic gradient was present for mortality, with a 26% difference in mortality in 2008 (94 to 118 deaths per 1,000) between the most affluent and most deprived areas in England. As the number of older people in the population rises, hips fractures will continue to be an important public health issue, emphasising the need for the effective prevention of osteoporosis, and rapid, high-quality treatment of patients once they are admitted to hospital.
Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have
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