Cervical smears--an opportunity for disinvestment?

BACKGROUND: The National Cervical Screening Programme was introduced to increase population coverage while reducing the overscreening of women at low risk. AIM: To describe the frequency with which cervical smears are unnecessarily repeated within the prescribed screening interval. METHOD: All cervical smears taken in a primary care setting in Manchester from women aged 20-64, during 1988-92, were identified. A smear was considered unscheduled if it was taken within 30 months of a preceding smear and if there was no clinical indication or laboratory recommendation for an early repeat smear. RESULTS: A total of 100 134 smears were identified from 85 594 women attending 130 general practices and 40 NHS community clinics; 12 633 women subsequently had 14 702 unscheduled smears; 50% of the unscheduled smears were taken by 18% of the general practices and 8% of the NHS community clinics. CONCLUSION: If they are replicated elsewhere, these findings suggest a substantial disinvestment opportunity.

Trauma audit--the use of TRISS.

The TRISS methodology for evaluating trauma care has been applied in two UK hospitals over a 12 month period. Unexpected deaths occurred in both hospitals and were related to delays in transport between hospitals. The delays were instigated by the receiving hospitals and never the despatching hospital. Unexpected survival occurred in one of the hospitals. The common factors were: 1. Patients were taken there directly and did not require further transfer. 2. They were resuscitated by a consultant. 3. They were electively ventilated. 4. CT Scan excluded a neurosurgical emergency. 5. When surgery was required it was carried out early. 6. They were treated for several weeks in an ICU with 24 hour direct consultant involvement. They all developed septic shock and acute respiratory distress but ultimately made a full recovery. This evidence supports the view that direct transfer of patients to Trauma Centres in the UK is likely to reduce unnecessary deaths. The development of such a system and the location of such centres must be based on objective measures of case mix and performance. We recommend the establishment and development of a Major Trauma Outcome Study (MTOS) (UK).

Rate of onset of drunkeness. A preliminary study.

Of eight moderate drinkers drinking until they became intoxicated, four left relatively sober prior to a rapid increase in sensations of intoxication, and four experienced a gradual progression to intoxication.