Parents in the anaesthetic room

One hundred and forty-one parents were asked to complete a questionnaire about their reactions after accompanying their child during induction of anaesthesia. Of 139 respondents, 99% believed that their presence was of benefit to their child, and 95% believed that they helped the anaesthetist. The degree of anxiety experienced by the parent did not significantly affect this view, nor was the degree of anxiety affected by the method of induction chosen by the anaesthetist.     

Three ‘silent’ mastoid abscesses

Acute mastoiditis with abscess formation is uncommon, its incidence being modified by modern antibiotic usage for acute suppurative otitis media (ASOM). It tends to occur in young children who have no previous history of ear disease. The diagnosis is a clinical one, and treatment requires hospital admission and some form of surgical drainage procedure, in order to prevent intracranial complications, eg, meningitis and intracerebral abscess.     

Intravenous digital subtraction arteriography in the evaluation of vascular grafts

Between 1982 and 1986 intravenous digital subtraction arteriography was used to evaluate vascular grafts in 97 patients (54 males, 43 females). Indications included recurrent symptoms, absent or diminished pulses, a drop in Doppler pressure measurements, and clinical uncertainty with respect to graft patency. Problems identified included graft stenosis, stenosis of the anastomosis or its distal vessels, false aneurysm, arteriovenous fistula and emboli. Forty-eight operations were carried out following intravenous digital subtraction arteriography, and radiographic findings were verified surgically. Twice, intravenous digital subtraction arteriography did not show significant graft findings which were discovered at surgery. Thus intravenous digital subtraction arteriography showed a sensitivity of 95.8% and specificity of 100%. Complications following intravenous digital subtraction arteriography were: two patients developed urticaria, and one superficial thrombophlebitis. There were no cases of pulmonary edema or death. In conclusion intravenous digital subtraction arteriography is very useful in the diagnosis of graft-related problems if done on a selective basis looking at graft and anastomosis site only, intravenous digital subtraction arteriography is done on an outpatient basis, has high sensitivity and specificity, good patient acceptance, is safe, fast and is less expensive than conventional arteriography.     

The Total Health Care Audit System: a systematic methodology for clinical practice evaluation and development in NHS provider organizations

Writing in Medical Education in 1982, Fowkes (1982) noted the lack of general agreement within the medical profession on methods of audit, a deficiency previously articulated by Shaw (1980) and later emphasized by McIntyre (1985). More recently, a study by Black & Thompson (1993) of consultant and junior medical staff in four London district general hospitals revealed that 'many doctors did not understand how to undertake audit', and major research by both Hopkins (1993, 1994) and Buttery et al. (1994) described a multiplicity of methodological deficiencies in the general approaches to audit adopted by clinicians since the promulgation of the White Paper definition in 1989. Soundness of methodological approach is fundamental to securing the success of clinical audit within Provider organizations and is thus central to the generation of measurable improvements in the quality of clinical care being delivered to patients. It is therefore disturbing that methodological deficiencies may still be observed in general approaches to audit (Buttery et al. 1994), with no author yet recommending a formal system for critical inquiry into clinical practice. It was the recognition of the unsatisfactory nature of this situation which led us to develop a system aimed at assessing, in a critical fashion, the quality of the totality of care dispensed within NHS provider organizations. The system is presented here for the first time.