Prevention of post splenectomy sepsis: a population based approach.

BACKGROUND: The aim of the study was to prevent the occurrence of serious, overwhelming infection following splenectomy, by a district based initiative. Subjects were residents of Plymouth and Torbay District Health Authority (DHA) who had undergone splenectomy in the past and general practitioners (GPs) within the District. METHODS: District guidelines on the prevention of post splenectomy sepsis were developed and disseminated among local GPs and hospital doctors. Patients who had undergone operative splenectomy were actively traced through GP and hospital information systems so that they could be offered sepsis preventive measures in accordance with the guidelines. Data capture-recapture was used as an ascertainment adjustment method to estimate the district prevalence of alive patients who have had an operative splenectomy. A postal questionnaire of district GPs was undertaken after one year to determine their awareness and use of the guidelines. RESULTS: Eight-eight alive patients who had undergone splenectomy were not previously identified be their GP as being asplenic. They were traced so that they could be offered sepsis preventive measures in line with the local guidelines. The estimated district prevalence of individuals who had had an operative splenectomy after ascertainment adjustment using data capture-recapture is p = 9.75 per 10,000 population [95 per cent confidence interval (CI) (7.87, 11.64) per 10,000]. Out of 367 district GPs, 201 used the local guidelines after one year. CONCLUSIONS: Effective prevention of overwhelming infection following splenectomy requires an active population based approach.

The school-aged siblings of children with disabilities.

A retrospective cohort study was performed of the school-aged siblings of children with severe learning difficulties. Index siblings demonstrated restricted contact with friends, behaviour difficulties, increased anxiety and increased acceptance towards disability compared with comparison siblings. Boys older than the disabled child demonstrated increased acceptance, whereas older girls demonstrated high rates of behaviour difficulty. Younger siblings demonstrated higher levels of anxiety, and those near in age demonstrated restricted contact with friends and behaviour difficulties. Those with no other normally developing siblings had restricted contact with friends. The 'burden of care' experienced by the mother had a significant positive correlation with the adverse effect on siblings.