Loss of vision before ophthalmic referral in blind and partially sighted diabetics in Bristol.

Data from all patients registered blind from diabetic retinopathy in Avon during a 16 month period were analysed with regard to management before hospital referral. The main findings were: 50% of the patients had no screening for retinopathy and were known to be diabetic; 25% were regularly screened for retinopathy (three quarters by local opticians); 22% were newly diagnosed as diabetic at the time of hospital referral. The degree of visual loss at the time of first hospital attendance was found to be marked (average 4.4 Snellen lines of acuity) but was not significantly different for different sources of referral. Only one eye of one patient had normal acuity at first attendance and 88% had lost two or more lines; 72% of registrations were a result of diabetic maculopathy. Delay from waiting for hospital appointments did not contribute significantly to the outcome in the group of patients studied.

The MD thesis in the training of a consultant physician.

A postal survey was carried out among the 94 consultant physicians of the South Western region (83% response rate) to ascertain their attitudes to the tradition of obtaining an MD by thesis as part of a physician's training. Most felt that the practice was questionable, and only half felt that it made an important contribution. For some, doing an MD had been a painful experience, even a waste of time. Having an MD impressed selection committees, but did not appear to alter the length of training nor the probability of obtaining a consultant post in a teaching hospital. We suggest that the MD is of limited value in judging a junior doctor's suitability to be a consultant physician.

Information needs of patients and visitors in a district general hospital.

A survey of the information needs of patients and visitors to a large District General Hospital was conducted during a one-month period in 1988 to identify sources of information used by patients and their visitors, whether these sources were perceived as adequate and what improvements were suggested. The findings indicate that of 406 respondents, 37% had wanted to know more about a particular condition within the preceding 12 months. The most frequently used sources of information were general practitioners, hospital doctors and nurses, and written material. The most frequent inquires were about disease aetiology and prevention, and the treatment and prognosis of a wide range of medical conditions. Thirty-six per cent of the inquirers had received little or none of the information that they sought. Visitors were more likely than patients to be dissatisfied with presently available sources of information, and patients over 60 years old were more likely to be satisfied than younger groups. Dissatisified persons were most often seeking improved access to doctors and nurses, more explanations from these staff, and more readily available booklets and leaflets. The results are discussed in relation to previous findings with hospital in-patients. They support a stated need in the recent Government White Paper, Working For Patients, for patient information leaflets and for clear and sensitive explanations about what is happening to them in hospital.

Blind and partial sight registration in Avon.

All blind and partially sighted registration forms for the county of Avon for a two-year period were analysed, and the findings are presented. Comparisons with the national figure published by Sorsby over 20 years ago show there has been no marked change in the rates of blind registration per 100,000 population with the exception of those for cataract, which show a large reduction. Diabetic registrations have remained similar, but this may represent an encouraging trend in view of the significant increase in the size of the diabetic population. Glaucoma may show some improvement in the future when time has elapsed for beta blockers and trabeculoplasty to be fully assessed. There has been an increase in the rate of registration from aging macular degeneration.

Deaths in Anguilla 1885-1980

An analysis has been made of the causes of death and ages at death from the registrar of deaths on the island of Anguilla from 1885 to 1980. Prior to 1945, infant mortality was about 100 per thousand live births but subsequently started to fall and is now 30. Similarly, deaths under the age of 5 years as a percentage of total deaths was 30 percent but fell to 10 percent in 1980. Infections are now very rarely registerd as cause of death whereas stroke and cancer have become increasingly frequent.(AU)

Trial of early nifedipine in acute myocardial infarction: the Trent study.

Over 30 months 9292 consecutive patients admitted to nine coronary care units with suspected myocardial infarction were considered for admission to a randomised double blind study comparing the effect on mortality of nifedipine 10 mg four times a day with that of placebo. Among the 4801 patients excluded from the study the overall one month fatality rate was 18.2% and the one month fatality rate in those with definite myocardial infarction 26.8%. A total of 4491 patients fulfilled the entry criteria and were randomly allocated to nifedipine or placebo immediately after assessment in the coronary care unit. Roughly 64% of patients in both treatment groups sustained an acute myocardial infarction. The overall one month fatality rates were 6.3% in the placebo treated group and 6.7% in the nifedipine treated group. Most of the deaths occurred in patients with an in hospital diagnosis of myocardial infarction, and their one month fatality rates were 9.3% for the placebo group and 10.2% for the nifedipine group. These differences were not statistically significant. Subgroup analysis also did not suggest any particular group of patients with suspected acute myocardial infarction who might benefit from early nifedipine treatment in the dose studied.