Preventable factors and death certification in death due to asthma.

A 2 yr District-wide study was carried out to assess whether there were preventable factors in the management of patients dying from asthma, and also to assess the accuracy of death certification of asthma. Eighteen deaths occurred in which asthma was the certified cause of death. In 10, asthma was the actual cause of death. Due to inaccuracies of death certification, death was due to other causes in seven cases. In the remaining case it was not possible to differentiate between asthma and chronic obstructive airways disease. Among the 10 deaths from asthma the condition was considered to be mild in three. In three, death occurred too rapidly for help to have been available. Preventable factors were present in four cases. In three, either the patient, the doctor or both failed to appreciate the severity of the condition and the need for urgent help or hospitalization. The fourth patient had failed to seek any medical care. Many lives might be saved if patients and doctors treated severe breathlessness due to asthma with the same sense of urgency that chest pain suspicious of myocardial infarction is treated. Education is needed to improve both the clinical and post mortem accuracy of death certification. Both this and the management of asthma should be the subject of ongoing local audits.

Medical audit--comparison of outcome among patients treated by different teams of physicians in a single hospital.

Routinely stored hospital activity analysis data was analysed retrospectively to compare the outcome of medical treatment delivered to 11,224 inpatients by different teams of physicians in a single hospital. Interpretation of the data was difficult because of suspected inaccuracies in hospital activity analysis, and because of the effect of the handover of known old patients between the teams of doctors. If these problems can be overcome the method could be used widely to provide a quantitative means of medical audit.

Smoker's face: an underrated clinical sign?

In a prospective survey of patients attending a general medical outpatient clinic roughly half the current cigarette smokers who had smoked for 10 years or more were identified, using defined criteria, by their facial features alone. These facial features, designated "smoker's face," were present in three (8%) of those who had smoked cigarettes for 10 years or more in the past and in none of the non-smokers. The association of smoker's face with current smoking that had continued for 10 years or more was significant (p less than 0.001) and remained after the patient's age, social class, exposure to sunlight, recent change of weight, and estimated lifetime consumption of cigarettes were controlled for. Smoker's face may be a helpful indicator in antismoking campaigns.

A biochemical and clinical comparison of two commercially available creatine kinase iso-enzyme MB assay kits suitable for use in the routine medical laboratory.

Two methods for the measurement of plasma creatine kinase MB (CK-MB) activity were compared for analytical performance, cost, practicality, and diagnostic correlation with clinical and electrocardiographic findings in patients admitted to the coronary care unit of a district general hospital. The methods were column chromatography and immunoinhibition. Both methods were found acceptable, and the method to be adopted would depend on the staff arrangements and resources available in the laboratory.

Oral disopyramide in prophylaxis of arrhythmias following myocardial infarction.

Oral disopyramide given prophylactically following myocardial infarction has been compared with placebo in a double-blind trial using continuous-tape monoriting of the electocardiogram. It caused a significant reduction in the incidence of ventricular arrhythmias and of the various degrees of heart-block. There was a significant reduction of reinfarction during hospital stay in patients who had received disopyramide. Disopyramide appears to be a safe and effective oral therapy in the prevention of potentially serious arrhythmias following myocardial infarction.

The effect of temperature of the culture medium on the outcome of blood culture.

Small numbers of seven species of bacteria commonly causing bacteraemia in man were inoculated into fresh human blood, and then cultured by a standard method used for diagnostic blood culture. Prior warming of the medium did not improve the recovery of the inoculated bacteria and it is suggested that such warming is not required when performing diagnostic blood culture.