The role of occupational and environmental exposures in the aetiology of acquired severe aplastic anaemia: a case control investigation.

Aplastic anaemia is a rare but serious disorder with a high morbidity and mortality rate. The causes of aplastic anaemia are, for the most part, unknown. We report on the hypothesis that aplastic anaemia may be caused by occupational and/or environmental exposures to certain chemicals. The UK Aplastic Anaemia Study was an interview-based case-control study covering the whole of Great Britain. Those patients diagnosed between 1 July 1993 and 20 October 1997, aged < or =75 years and born and diagnosed in the UK were eligible for the study. Two hundred eligible cases of aplastic anaemia were compared with 387 age- and sex-matched controls. A number of occupational exposures showed increases in risk. In a multivariate model of these exposures the odds ratios (ORs) for solvents/degreasing agents, pesticides and radiation were >2 and statistically significant. Reported chemical treatment of houses within 5 years of diagnosis had a significantly raised risk for adults [OR = 2.51, 95% confidence interval (CI) 1.02-12.01], particularly for woodworm treatment (OR = 5.1, 95% CI 1.5-17.4). This study identified significant risks associated with self-reported exposure to solvents, radiation and pesticides in the workplace. Self-reported chemical treatment of houses was also associated with an increased risk of developing aplastic anaemia, in keeping with previous literature.

Do general practice computer systems assist in medical audit?

This study was designed to assess the capabilities of current general practice computer software to perform medical audit. A total of 43 general practice clinical software suppliers were asked to complete a questionnaire consisting of general questions concerning their systems' responses to 85 audit questions that a practice might wish to ask in the areas of quality of care and contractual compliance. It was assumed that all systems had full patient data. Fourteen installations representing 14 systems that had been randomly selected from the responders were visited to validate the suppliers' responses. Thirty-two (74%) suppliers responded to the questionnaire and they represented 7696 installations. One supplier marketed two distinct systems giving 33 systems for analysis. The majority (52%) of responding suppliers had between 0 and 50 installations. Many shortfalls in auditing capability were demonstrated, e.g. 24% of systems were unable to audit the clinical content of a patient review, 48% were unable to audit the numbers of acute and repeat prescriptions, 51% were unable to audit emergency admissions, 70% were unable to audit the length of time a drug had been prescribed for and 85% were unable to audit the continuity of patient care. Limitations in the ability to perform even basic medical audits were demonstrated among current general practice computer systems. These have implications for the development of medical audit. Seven (21%) of the systems had no facilities for statistical analysis including percentages and 8 (24%) had no graphical abilities.(ABSTRACT TRUNCATED AT 250 WORDS)