Online Medical Database Searching

A wide range of databases and databanks are presently availableto medical researchers. This paper outlines the scope of thedatabases available through a commercial host system and describesthe procedures required for their access and use. A discussionof some of the limitations and likely future developments ispresented in the context of our experience of their use. Requests for reprints should be addressed to: Dr N. Wood, Department of Epidemiology and Community Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK     

Sickness Absence from Work and Influenza Immunization

The worth of influenza immunization for employees in U.K. industryhas been debated for more than a decade. In this study no evidencecould be found of a protective effect for sickness absence patterns.Other evidence is also cited that suggests routine influcnzalimmunization programmes for healthy adults of working age areno longer justilied. *Requests for reprints should be addressed to: Dr Robin Philipp, Department of Epidemiology and Community Medicine, University of Bristol, Bristol BS8 2PR.     

An Evaluation of Undergraduate Occupational Health Teaching

It has been reported that at present, UK medical schools donot have a uniform approach to undergraduate occupational healthteaching. Consequently, a suggested educational framework forthis teaching has been prepared. In this study a problem managementquestionnaire was used to evaluate a course based on this framework.Patterns of student understanding about hazards, risk groups,and staff responsible for occupational health in the hospitalenvironment, were compared before and after the courses. Thisenvironment was chosen for study because after graduation alldoctors work for some time in hospitals and different doctorsmay treat hospital staff for problems acquired at work. Thefindings show that although specific teaching of hospital occupationalhealth is not given, students grasp the introductory conceptsand then modify their approaches to the prevention and clinicalcare of health problems associated with hospital employment.In particular, they become more aware of different risk groupsand the sources of professional advice. Findings from such studiesbefore and after tuition help tutors to identify gaps in knowledgeand can be used with student groups to reinforce their interestin learning. Requests for reprints should be addressed to: Dr Robin Philipp, Department of Epidemiology and Public Health Medicine, Canynge Hall, University of Bristol, Whiteladies Road, Bristol BS8 2PR, UK     

Near‐Fatal ICD Lead Dysfunction with Implications for ICD Testing

A 31‐year‐old male patient with an implantable cardioverter defibrillator (ICD) experienced ventricular fibrillation. After resuscitation, no communication between the device and an ICD programmer was possible. The ICD was explanted, no signs of destruction were visible, and the ICD leads revealed normal values. A new ICD was implanted, interrogation values were stable. However, immediately after defibrillation testing the connection between programmer and ICD was interrupted and could not be established again. The device showed burn marks and a hole in the can. Analysis revealed an isolation defect of the ICD lead, which was not detectable with standard interrogation.     

Technique and Results of Percutaneous Mitral Valvuloplasty with the Multi-Track System

The Multi-Track System is a simplified double-balloon technique for percutaneous mitral valvuloplasty. Here we describe the technique and report the results obtained using it. The Multi-Track catheter has a short distal tip for connection to the guidewire. This leaves the rest of guidewire free to receive other catheters. Various catheters can be introduced over the same guidewire. The balloons are introduced one after the other allowing a smaller size of vascular access and transseptal passage. Furthermore, simultaneous pressure measurements in the left atrium and left ventricle are possible through a simple venous access, allowing avoidance of arterial puncture. We used this technique worldwide between June 1994 and February 2000 for the treatment of 153 patients with mitral stenosis worldwide. In 12 cases, the procedure was done using the exclusive venous approach. The mean mitral valve area increased from 0.75 ± 0.22 to 2 ± 0.33 cm²and the mean left atrial pressure dropped from 27 ± 8 to 11 ± 4 mmHg. Four patients had a significant increase in mitral regurgitation, requiring surgical treatment in two patients. There was no mortality. The Multi-Track system is a valid user-friendly and cost-effective alternative for the treatment of mitral stenosis. It is a rapid and effective procedure associated with low risks.