Aspects of audit. 2. Audit in British hospitals.

British hospitals have advantages over other areas of health care for developing and evaluating audit: more uniform and comprehensive medical records, statistical and diagnostic data, fewer patient contacts, more time to examine patients and record information. Although little has been published, a few studies show the extent to which formal audit has been developed in Britain.     

Radiation therapy for seminoma of the testis: results in British Columbia.

Between 1942 and 1978 radiation therapy was given to 362 patients with seminoma of the testis, 40 (11%) of whom had a history of maldescent of either testis. The disease was classified retrospectively according to the extent of the primary tumor, the involvement of the regional lymph nodes and the presence of distant metastases (the TNM system), and the results of treatment were analysed according to the classifications. Among the 275 patients referred for treatment at least 5 years before this analysis the 5-year survival rates were 87% overall, 96% for those with a T1 or T2 (relatively localized) tumour but no evidence of nodal involvement or distant metastases and 62% for the 24 with palpable or distant metastases at the time of clinical presentation. Of the 28 patients in whom the disease recurred 15 were successfully treated. A second primary testicular tumour developed in the contralateral testis of eight patients. The incidence of other cancers was not increased over the expected rate in the general male population of the same age.     

Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

Background

Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC).

Methods

We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews.

Results

Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence.

Conclusions

Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians.     

Survey of safety and health care in British medical laboratories.

A retrospective postal survey of 24 000 medical laboratory workers in England, Wales, and Scotland showed highly variable standards of safety and health care. Pre-employment health screening was offered to two-thirds of employees, the physicians being the least likely to be examined (15%). Scottish laboratories provided better safety control than English and Welsh laboratories, while Public Health Service Laboratories had a better record than National Health Service establishments. Mouth pipetting is still practised in 65% of English and Welsh laboratories, and the use of protective clothing is rarely compulsory. The servicing of safety cabinets is often inadequate. Known and suspected carcinogens are still apparently used in a few laboratories (2-10%). In view of the wide variation in standards among laboratories, urgent consideration should be given to establishing regulations for codes of safe practice rather than relying merely on recommendations as at present.     

Surgical audit: Comparison of the work load and results of two hospitals in the same district.

Surgical audit is being undertaken to monitor and compare (by computer) the type of patient, work load, and results of two similar surgical units. Both units are in the City and Hackney District of London, one at St Bartholomew''s Hospital and the other at Hackney Hospital. During 1978, 736 patients were admitted by the unit at St Bartholomew''s Hospital and 902 by the unit at Hackney. At St Bartholomew''s 70% of admissions were elective compared with 49% at Hackney, where 86% of patients lived within the district compared with only 36% at St Bartholomew''s. The wound was the commonest site for complications, infection affecting 9% of those at Hackney and 6% at St Bartholomew''s, despite identical antibiotic policies. There were six post-operative deaths at St Bartholomew''s and 32 at Hackney. In both hospitals the length of stay was similar, 50% of patients being discharged within one week and 80% within two weeks. As a result of the audit a vigorous venous thrombosis prophylactic regimen has been instituted, and at Hackney the anaesthetic department has been strengthened and a new intensive care unit opened.     

Retransmission of echo-like signals: methods and results of studies on nocturnal moths (Insecta)

Studies of capability to echolocate in nocturnal moths using the method of echo-signal retransmission are described in detail. During retransmission the insect was presented not with the echo from some real object but with electronically generated echo-like signal which appears following the certain delay after insect's own acoustic signal. In that way the artificial echo from non-existent obstacle is produced. In the current study the delay was set to 0.5 ms that corresponds to a distance of about 8 cm from obstacle. At the same time there was no any single movement of any object near the flying insect therefore the activities of sensory systems other than auditory did not cause systematical influence on results obtained. Noctuid moths (Noctuidae, Lepidoptera) are acoustically active insects. They are capable of producing ultrasonic clicks during flight. The most typical response of a moth to the retransmission of echo-like stimuli is an activation of own clicks emission that is often accompanied with rise in click amplitude. Using the activation of emission as a criterion of moth's response to the echo-like stimulation we measured echolocational thresholds in three species: Amphipyra pyramidea (36 dB SPL), Enargia paleacea (31 dB SPL) and Blepharita satura (26 dB SPL). The ability to echolocate was also demonstrated in 20 species of subfamilies Catocalinae, Amphipyrinae, Cuculliinae, Hadeninae, Noctuinae, Heliothinae.     

Rotylenchus ouensensis n.sp. (Nematoda: Hoplolaimidae) from the British Isles

Summary Females and males of a new species of Rotylenchus are described from a coniferous woodland at St. Ouens, Jersey. This species is characterized by having virtually no overlap of the oesophagus over the intestine, 7 to 10 head annules, the anterior body cuticle tessellated and the lateral field irregularly areolated along its entire length, more densely so around the phasmid on the female tail. A key to the species of Rotylenchus is given. ac]19810407     

Study design and methods of the Ansan Geriatric Study (AGE study)

Background  

The overall objective of the Ansan Geriatric Study (AGE study) was to describe the prevalence, incidence, and related risk factors for geriatric diseases in elderly Koreans.     

IndigenousTrichogramma (Hym.: Trichogrammatidae) parasitizing eggs ofRhopobota naevana (Lep.: Tortricidae) on cranberries in British Columbia

Two indigenous species ofTrichogramma were reared from natural populations of the blackheaded fireworm,Rhopobota naevana (Hübner) infesting cranberries in British Columbia, Canada. One was identified asTrichogramma sp. nr.sibericum Sorokina and the other wasTrichogramma minutum Riley. Percentage of parasitized hosts increased during the season in an abandoned field, but decreased in a commercial field where pesticides were used. The potential ofTrichogramma as a biological control agent against the fireworm is discussed.