The impact of a patient education program on directed donations

The effect of an informational program in which the benefits and disadvantages of directed donations are discussed directly with the prospective recipient of the blood and/or that patient's family was examined during a 20-month period. Data collected for 27 regional Connecticut hospitals that accept directed donations were compared with similar data for Hartford Hospital, an 885-bed tertiary-care facility. The number of directed-donor units (68) collected by the American Red Cross Blood Services for Hartford Hospital during the study period was comparable to the number (average, 62.3) provided for smaller (301-450 beds) institutions in the state. The percentage that directed-donor units drawn for Hartford Hospital represented of the total number of homologous units provided (0.23%) was less than that for any of the categories of hospitals, by size, in the state. Supplying the patient and/or the patient's family, in a personalized manner, with information concerning the advantages and disadvantages of directed as well as of volunteer donor blood can result in a marked overall reduction in the number of directed donations and also serves to reassure those concerned about blood transfusion.     

Danazol administration after gonadotrophin-releasing hormone analogue reduces rebound of uterine myomas [published erratum appears in Hum Reprod 1998 Mar;13(3):780]

We report the results of administration of danazol after suspension of gonadotrophin-releasing hormone analogue (GnRHa) therapy for uterine myomas. A total of 21 women with uterine myomas was treated with 100 mg danazol for 6 months after GnRHa therapy. Uterine volume and endocrine status were monitored monthly by ultrasound and assay of plasma gonadotrophins, oestradiol and progesterone. The results show a rebound of uterine volume about 30% less than in controls at the end of danazol therapy. Menstrual cyclicity returned after 65 +/- 3 days in 16 subjects and five patients remained amenorrhoeic. Hormone assays confirmed renewed ovarian function in the women whose menstrual periods returned. Bone mineral content was substantially reduced during GnRHa treatment but improved significantly during danazol therapy even in the women who remained amenorrhoeic. These results show the utility of danazol in prolonging the therapeutic effects of GnRHa. The mechanism by which danazol inhibits rebound of uterine volume may be due to its antiprogesterone effects on uterine myomas.      

Patterns of referral to Red Cross War Memorial Children's Hospital, Cape Town

Patterns of referral to Red Cross War Memorial Children's Hospital were studied to assess the appropriateness of referrals. From 1 July to 31 December 1987 all 9,288 referral letters presented to the hospital were collected and a sample (4,662 letters) analysed. It emerged that the patients were similar to those attending the outpatient department without referral, except that relatively fewer referred patients were black. The private sector, i.e. general practitioners, was the largest referral agency, followed by day hospitals. Most patients were referred to the outpatient department without an appointment. Of the specialist clinics, the surgical clinics (i.e. ophthalmology and ear, nose and throat) had the highest number of referrals. The majority of patients (84.9%) were not admitted. Only in 30.3% of referred cases did the hospital make contact with referral agents. Referral rates were highest from the predominantly coloured areas of the Cape Peninsula. The hospital cannot isolate itself from the community it serves and needs to support and guide referral agents in order to improve the utilisation of the hospital. Training of health professionals in order to increase expertise is a priority. A study of the total patient population would facilitate the understanding of hospital utilisation. Similar studies could be beneficial at other hospitals.     

Pneumothorax and other lung diseases: effect of altered resolution and edge enhancement on diagnosis with digitized radiographs

Prior studies have shown that pneumothorax is one of the more difficult entities to diagnose with digitized radiography. This study was designed to test whether increasing resolution from 1.25 to 2.5 line pairs per millimeter (lp/mm) and image processing (edge enhancement from unsharp masking) would increase accuracy and confidence in the diagnosis of pneumothorax, as well as normal cases and other forms of lung disease. Conventional radiographs were digitized with use of a laser reader and then reformatted as film hard copy. Eleven observers read 35 cases reformatted in three different ways (1.25 lp/mm, 2.5 lp/mm, 1.25 lp/mm unsharp mask). The images with finer resolution (2.5 lp/mm) and unsharp mask images were superior to those with coarser resolution (1.25 lp/mm) for the diagnosis of pneumothorax. There was no difference in diagnostic accuracy for normal patients. For abnormalities other than pneumothorax, the unsharp mask images were significantly worse. Confidence in the diagnosis of pneumothorax and other abnormalities was highest with the finest resolution (2.5 lp/mm).     

Characterization of antibody and selection of alternative drug therapy in hydrochlorothiazide-induced immune hemolytic anemia

The authors report the clinical and laboratory findings of a patient who had severe immune hemolytic anemia due to hydrochlorothiazide (HCTZ). In this case, the HCTZ antibody reacted not only with other thiazide and thiazide-like drugs, but also with a chemically unrelated diuretic, ethacrynic acid. These results indicate that HCTZ antibody activity is not restricted solely to the thiazides and imply that therapy with any of the reactive drugs would be contraindicated for this patient. The serologic screening for drug reactivity may be useful for selecting alternative therapy for patients with drug-induced immune hemolytic anemia.