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The in-patient setting compared with international and out-patient findings. Only 15% of decisions regarding antidepressant dosage did not satisfactorily meet guideline recommendations Table 2, Fig. 3 ; . Studies from the USA e.g. Dawson et al, 1999 ; have reported that up to 50% al, of antidepressant dosages were not in accordance with recommendations. For out-patient settings, similar rates were reported 44% ; , with worse treatment outcome for patients receiving too low a dosage of antidepressants Simon et al, al, 1995 ; . The high rate of benzodiazepine prescribing at discharge up to 56% ; is a point for discussion. Combination therapy with benzodiazepines is said to decrease dropout rates but at the same time there are concerns about dependence and accident proneness Furukawa et al, 2002 ; . Treatal, ment guidelines advise clearly against benzodiazepines for patients with comorbid drug diazepines addiction. In contrast, almost 20% of this subgroup were still taking benzodiazepines at discharge. The duration of treatment may account for this deviation from guideline recommendations. Possibly benzodiazepine withdrawal had not yet been completed and benzodiazepines may have been continued in subsequent out-patient treatment. The fact that only half of the patients with comorbid drug addiction and benzodiazepine prescription at discharge continued out-patient treatment does not support this assumption. The data reflect a restricted routine use of ECT in Germany. This is not in line with guideline recommendations and research findings that showed ECT to be an effective treatment for patients with severe and psychotic symptoms and those not responding to antidepressant medication American Psychiatric Association, 2000; UK ECT Review Group, 2003 ; . These results are in accordance with Muller et al 1998 ; , who Muller showed that the application of ECT in German hospitals was much more influenced by social factors and psychiatrists' attitudes than by medical factors. According to guideline recommendations Table 2 ; , cognitivebehavioural therapy and interpersonal therapy are the most effective specific treatment strategies for major depressive disorder. While cognitivebehavioural therapy was the most applied therapeutic modality in the present study, interpersonal therapy still seems to be relatively unknown in German psychiatric hospitals and oretic, because drug information.
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Background: Prescribing of antibiotics, often in the empiric setting, frequently falls on training grade or junior doctors, who are often the least experienced in this. Recognition of infection and sepsis represents basic components of good antibiotic prescribing practice. Methodology: We undertook two questionnaire and interview based surveys 1999 and 2003 ; of prescribing training grade doctors in a teaching hospital in North-East Scotland to determine their knowledge level regarding i ; doctor's knowledge of the definitions of systemic inflammatory response syndrome sirs ; , sepsis, severe sepsis and septic shock; ii ; the source of local or other information each doctor used when prescribing an antibiotic; iii ; the criteria each doctor used when choosing the route of administration of antibiotic and to determine if each doctor knew the likely cost differential between an intravenous and oral antibiotic. Interventions: Between the two audits 4 years apart several initiatives have been introduced to improve the education and support related to antibiotic prescribing. These included a pharmacy and ID led 6-monthly teaching programme for all residents and final year medical students in Dundee, introduction of sepsis protocols on all medical and surgical wards and improving access to and awareness of the local antibiotic prescribing formulary. Result: see attached table figure and microzide.

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