Multiple myeloma in South Cumbria 1974-80: problems of health analysis in small communities.

The occurrence of seven cases of multiple myeloma over seven years in a small community 15 miles from a plant reprocessing nuclear fuel caused much local concern. A case control study of 34 confirmed cases in the health district during 1974 to 1980 revealed no excess of known risk factors among the 23 cases for whom informants could be traced. The possible effects of exposure to marine discharges of radioactive material cannot be completely ruled out, but dose estimates make this highly unlikely. Such studies are a necessary response by community physicians to the population they serve but have major practical and theoretical limitations.

The Abrams report--communicable disease control; how do Health Districts measure up to the recommendations?

BACKGROUND: The aims of the study were to examine whether Health Districts in the North Western Region complied with the recommendations in the Abrams report regarding the control of communicable disease [incorporated into the Annex to Circular HSG(93)56], and to identify areas that need further attention. METHODS: The recommendations were extracted and arranged in questionnaire form. Further items were included dealing with the use of Epinet in communicating with the profession. A compliance score was derived from affirmative and qualified affirmative responses. RESULTS: Many recommendations were met by all or most Districts. Compliance was 90 percent or over for 58 percent of the questions where an assessment was appropriate. Of the 16 Districts in consortia, 75 percent did not have a consortium plan. Day-to-day plans were informal in 21 percent of Districts. In 63 percent of Districts the Family Health Services Authority (FHSA) was not involved to the extent that it should be. The Consultant in Communicable Disease Control (CCDC) had insufficient District Health Authority support in 42 percent of Districts and insufficient Local Authority support in 16 percent of Districts. In 58 percent of Districts there was lack of inclusion of matters relating to the control of infectious disease in contractual statements between purchaser and provider. There was a lack of audit in 47 percent of Districts. CONCLUSIONS: One plan or a compatible series of plans are required across each District. Informal day-to-day plans should be formalized. The FHSA should be fully involved in infectious disease control plans. Certain Districts require a Community Infection Control Nurse, accountable to the CCDC and/or administrative support to input and scan surveillance data. Contractual statements between purchaser and provider should include appropriate infection control requirements when this is not already the case. Communicable disease control audit should be a regular part of CCDC duties.

The use of smart cards in the NHS.

The majority of doctors have experienced the frustration of the loss of a patient's medical records. A new development in technology may help alleviate this problem and indeed facilitate patient care. This development is the smart card. This article describes the types of smart cards and their use within the NHS.

The potential role of IT in supporting the work of junior doctors.

OBJECTIVES: To develop an information system using hand-held personal computers to support the work of junior doctors. DESIGN: A user-driven design process was used. Functionality reflected the core work of house officers (HOs) and senior house officers (SHOs); i.e. ward round lists, immediate discharge summaries, patient handover, laboratory and guidelines reference information and a personal record of clinical experience. SETTING: Salford Royal Hospital NHS Trust is a university hospital with a large acute medical case load. SUBJECTS: Several 'generations' of HOs and SHOs working in two of the four medical firms. Predominantly acute medical case load. MAIN OUTCOME MEASURES: Robustness, acceptability and benefits, assessed by observations and questionnaires. RESULTS: The system has proved robust. It is time neutral for the juniors and minimal time is needed for training/adaptation. Most felt the system to have either made their lives easier or to have had no detrimental impact. Ward round lists and printed immediate discharge summaries have been particularly successful. CONCLUSIONS: A hand-held IT system designed for house doctors can provide immediate, low-cost support for their activities.

Effects of influx of holidaymakers on an acute medical unit in Cornwall.

This paper illustrates the effect of a large influx of holidaymakers on a medical unit in Cornwall. Increasing numbers of visitors are coming to Cornwall and, unless adequate resources are allocated for their efficient medical care, the medical facilities available to the residents will suffer greatly.

Influence of physical, psychological and behavioural factors on consultations for back pain.

Over 34,000 questionnaires were used to study occurrence and consultations for back pain in the community. The 12-month period prevalence was 24% and 13% of the sample consulted a doctor. Elderly women were at greatest risk of back pain. The consultation rate increased in both sexes throughout middle age, but declined in men over the age of 55 yr. Back pain was associated with the Goldberg General Health Health Questionnaire score suggesting psychiatric morbidity [odds ratio (OR) = 2.05; confidence interval (CI) 1.89-2.23], obesity (OR = 1.59; CI 1.40-1.79), and cigarette smoking (OR = 1.52; CI 1.36-1.70). Vigorous daily activity was positively associated with back pain in men aged 18-39 yr (OR = 1.37; CI 1.02-1.85), and women aged 18-39 yr (OR = 1.50; CI 1.08-2.09), but was negatively associated with back pain in women aged over 65 yr (OR = 0.35; CI 0.16-0.76). Alcohol consumption was also negatively associated with back pain (OR = 0.72; CI 0.62-0.85). The prevalence of arthritis, constipation and respiratory disorders was increased in those who consulted for back pain corrected for the other variables. Thus back pain was substantially more common in women compared to men over 55 yr. Psychiatric morbidity, cigarette smoking and obesity were associated with back pain at all ages, but the effect of physical exercise appeared to change with age. Further studies are required to explain the sex differences and nature of the associations.

Dissecting the patient stay in the UK.

A method of analysing the factors which contribute to the length of stay in England as an acute medical in-patient has been developed, and applied in both real-time and cross-sectional studies. The major factors delaying discharge were found to be the time taken to respond to treatment and the actions of agencies other than the acute medical unit of the hospital. Areas where improvement could be made have been identified and some changes implemented. The system can be applied to monitor the effect of such changes.

Evidence of udder excretion of Campylobacter jejuni as the cause of milk-borne campylobacter outbreak.

We describe a community outbreak of campylobacter enteritis associated with the consumption of untreated milk, apparently contaminated by two cows with campylobacter mastitis. The outbreak occurred in two phases. Strains of Campylobacter jejuni of the Penner serogroup complex 4, 13, 16, 50 and Preston biotype code 6100 were isolated from patients in both episodes and from the faeces of the cattle, milk filters, bulk milk and retail milk. Milk samples from two of 40 milking cows were found to contain C. jejuni, and the wheys from these two cows had high titres of antibody to C. jejuni detected by ELISA techniques.