Site of injection for vaccination.
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Hepatitis B Vaccines↗
Biomedical subjects
A Cockcroft
Publications and source records attributed to A Cockcroft.
Review of management of incidents involving exposure to blood in a London teaching hospital, 1989-91.
OBJECTIVE: To review management of incidents involving exposure to blood reported to an occupational health unit. DESIGN: Analysis of all reported incidents from January 1989 to June 1991. SETTING: London teaching hospital. SUBJECTS: 447 health care workers and students. MAIN OUTCOME MEASURES: Immunisation against hepatitis B virus before exposure, proportion of known source patients tested for hepatitis B surface antigen and HIV antibodies, and reasons for not testing known source patients. RESULTS: 447 incidents were reported: 337 sharps injuries and 110 other exposures. 310 staff reporting incidents (205 (82%) nurses) were already immune to hepatitis B virus, nearly always because of immunisation. 345 source patients were identified, 77 of whom had already been tested for hepatitis B surface antigen (28 positive results) and 58 for HIV antibodies (18 positive results). Of those not previously tested, 145 of 266 were subsequently tested for hepatitis B surface antigen (two positive) and 149 of 287 for HIV antibodies (none positive). The main reasons for not testing source patients were that the incident was not considered a risk, that the patient had gone home, and that the clinical team were unwilling to ask the patient. Specific hepatitis B immunoglobulin was given to 18 staff who were not immune and was avoided in 11 cases by a negative result for the patient. Prophylactic zidovudine was discussed but not given to any staff member. CONCLUSIONS: Management of exposure to blood is improved by widespread immunisation against hepatitis B virus and by knowledge of source patients' hepatitis B virus and HIV status.
Blood↗
Tuberculosis screening in health service employees: who needs chest X-rays?
There is uncertainty in the NHS about which individuals should be offered pre-employment screening by chest X-ray and whether this procedure is of value in the detection of tuberculosis. To provide evidence for practice, pre-employment chest X-ray and tuberculin skin test status were examined retrospectively for employees of a health district. Cases were those with an abnormal chest X-ray; referents were a sample of the remainder with a normal chest X-ray. The majority of the population had positive tuberculin skin tests and there was no difference between cases (58 positive out of 68) and referents (170 positive out of 212). Most of the X-ray abnormalities were trivial; four findings were thought significant, but would have caused no problems if undetected and none of these findings was related to tuberculosis. We conclude that in new employees in Hampstead health district, X-ray abnormalities are rare and not predicted by testing tuberculin skin reactivity; neither procedure is justified routinely as a means of screening for tuberculosis. The situation in districts with a high incidence of tuberculosis needs to be investigated.
Adolescent↗
Emotional distress in doctors: sources, effects and help sought.
All doctors in a London Teaching Hospital were sent a self-administered, anonymous questionnaire, to study past episodes of emotional distress. We inquired about frequency of past and current emotional distress, sources of distress, effects on work and home life, type of help sought and perceived outcome of that help. Of 320 doctors, 210 (66%) responded. One hundred and forty-one (68%) reported previous episodes of moderate or severe emotional distress. Logistic regression revealed that distress was significantly more common in younger doctors and in women. Many respondents reported work problems as causing their distress and work was frequently adversely affected by episodes of distress. Professional help was rarely sought; non-professional help was from family and friends. Current emotional distress was related to a history of past distress, especially among the most junior doctors. We conclude that past emotional distress is reported by most doctors, with work pressures an important contributing factor. Doctors do not appear to use available sources of professional help. Our findings confirm that doctors have difficulty disclosing psychological problems. Specific programmes aimed at prevention and management of distress in doctors need to be initiated and evaluated.
Adult↗
A study of the detailed circumstances of 'sharps' injuries in health care workers.
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Adult↗
Compulsory HIV antibody testing, universal precautions and the perceived risk of HIV: a survey among medical students and consultant staff at a London teaching hospital.
Routine screening of patients and health care staff for HIV has not been endorsed by the medical profession. Instead universal precautions have been recommended as being the most effective way of minimizing the occupational risk of HIV infection. Consultant staff and undergraduate medical students at the Royal Free Hospital and School of Medicine, London, were asked about their attitudes towards compulsory HIV antibody testing, their compliance with universal precautions and their perceived risk of HIV infection. A substantial proportion of staff and students supported compulsory HIV antibody testing for patients, health care workers and certain subgroups of the population. Most of the clinical students and about half the consultants failed to comply with universal precautions. Staff and students saw themselves at greater risk of HIV infection in the hospital than in their personal lives. Clearly, these beliefs and practices must be taken into account when introducing a policy of universal precautions.
AIDS Serodiagnosis↗
The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease.
The main objective of the present study was to test the hypothesis that patients with cardiopulmonary disease can reliably identify different sensory qualities of their experience of breathlessness. A secondary aim was to examine whether there was any relationship between such specific descriptors of the sensation of breathlessness and a patient's clinical diagnosis. A randomly ordered list of 45 descriptors of breathing discomfort related to exertion was administered on two occasions to 208 patients with cardiopulmonary disease; patients identified the descriptors that applied to their own experience. A total of 169 patients were considered reliable in that their responses were repeatable between questionnaires; there was evidence that an individual's reliability could be assessed by asking repeat questions within a questionnaire. With these patients, individual descriptors generated different degrees of yes and no response and were answered with a variable consistency, suggesting that some questions may be more useful than others in discriminating between the quality of patients' sensations. Overall, patients with obstructive disorders (asthma and chronic obstructive airways disease [COAD]) answered yes more often than those with restrictive or cardiac conditions, possibly reflecting differences in severity of disease. A cluster analysis separated the descriptors into 12 groups which appeared to describe different aspects of breathing discomfort. Relative to their response to other clusters, COAD patients were more inclined to identify distress, asthma patients to indicate wheeziness, restrictive patients to report rapid breathing, and the cardiac group to describe a need to sign. A second cluster analysis separated patients into 12 groups based on responses for the descriptor clusters.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Survey of student nurses' smoking habits in a London teaching hospital.
As a preliminary to a 3-year intervention project to reduce smoking levels and prevent smoking commencement among student nurses, a survey of smoking habits among all 368 student nurses at The Royal Free Hospital was conducted in the Autumn of 1988. Absence rates of smokers and those who had never smoked were also studied. The response rate was high (95%) and the survey showed a high percentage (43%) of smokers among the student nurses. There was a higher proportion of smokers among those who did not respond to the first mailing of the questionnaire. The absence rate among smokers was almost twice that of the nonsmokers (P less than 0.005) and the number of days absent was related to the number of cigarettes smoked (P less than 0.05). Sixty-two per cent of nurses who smoked before they started their training (n = 125) said they had increased their smoking since commencing training and 39 (11%) nurses started smoking after starting nurse training. 'Stress', greater opportunity to smoke and peer influence were given as reasons for increased smoking and smoking commencement during nurse training.
Absenteeism↗
Knowledge and attitudes of health care workers about AIDS and HIV infection before and after distribution of an educational booklet.
Hospital workers (509) in a health authority were surveyed, and asked if they were in contact with HIV positive or AIDS patients; about their perception of risk; of their knowledge about and attitudes towards HIV and AIDS problems at work; and their desire for more information about AIDS and HIV. Overall scores for level of knowledge and attitudes were calculated; clinical workers scored better than non-clinical workers. Following the first survey, an information booklet was distributed to all health authority staff and after distribution, 232 staff were surveyed again. In this group (the follow-up group), there was a reduction in perceived risk, an improvement in the level of knowledge and in attitudes, and a reduction in the desire for further information. The group who initially had the least level of knowledge and most unfavourable attitudes (non-clinical workers) were the group who improved most.
Acquired Immunodeficiency Syndrome↗
Antibody response after hepatitis B immunisation in a group of health care workers.
Hepatitis B immunisation has been offered to staff of Hampstead Health Authority since 1982 and is now offered to all staff with clinical contact. Three doses of 20 micrograms of vaccine are given at zero, one, and six months and the antibody response is measured three months later. Results were analysed to seek for associations with the antibody response. At the time of analysis, 2739 people had started vaccination and 1067 had completed the course and had a measurement of antibody response. Vaccine injections were initially into the buttock and later into the arm; measurement of antibody levels was initially by radioimmunoassay (RIA) and later by enzyme immunoassay (EIA). A positive antibody response was defined as a positive/negative ratio of greater than 10 for RIA or a level of greater than 10 mIU/ml for EIA. Associations between antibody response and other variables were tested by chi 2 and a multiple logistic regression analysis was undertaken to examine the effects of variables in combination. The overall antibody response rate was 95%. Men and women did not respond differently but there were significantly more positive responses with the EIA testing method and a tendency for more positive responses with arm injections. The responders were significantly younger than the non-responders and had significantly lower values of body mass index (wt/ht2).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
AIDS/HIV counselling in occupational health.
AIDS/HIV counselling will increasingly become part of the role of occupational health professionals. Issues that arise in the occupational setting include: occupational transmission, knowledge and attitudes, problems with family and friends, AIDS dementia, and uncertainty. Dilemmas can occur in relation to contamination incidents, HIV positive employees, or staff refusing to work because of fears of HIV/AIDS. It it easier to deal with the problems that arise if the issues have been thought through beforehand. Examples are given of problems that have occurred in a setting of occupational health in the British Health Service and their resolution is discussed.
Counseling↗
AIDS/HIV infection and employment: the role of occupational health services.
Occupational health services need to be active in the development of local policies about AIDS/HIV and employment. Employment issues include the possible hazards from HIV infected employees, which are more fears than real risks, and the problems faced by HIV infected employees. Pre-employment HIV screening does not eliminate HIV from the workforce and involves much extra work. The occupational health service can be a source of confidential counselling for HIV infected individuals and will need to advise on work fitness. HIV as a bar to certain jobs is difficult to justify. The problems relating to HIV infection at work are best dealt with by education of staff at all levels.
Acquired Immunodeficiency Syndrome↗
Assessment of breathlessness.
In summary, breathlessness is an important symptom in a number of disease states. The most appropriate techniques for assessment of the symptom depend on the circumstances, ranging from the time-honoured clinical interview by a skilled observer, through questionnaires for epidemiological use, to direct scaling of the sensation by subjects under experimental conditions. The use of direct scaling techniques has enabled researching into mechanisms of breathlessness in recent years, resulting in an increased understanding of the sensation, but no significant therapeutic advances as yet. An area of current research interest is study of the different descriptors for the sensation used by different subjects. This may have great practical importance because it may be that, as with pain, different types of breathlessness will respond to different types of treatment.
Dyspnea↗
Pulmonary rehabilitation.
Rehabilitation of patients with chronic respiratory disease has tended to be neglected in the past, partly because of a generally pessimistic view of their prospects. Simple programmes of exercise training can produce measurable increases in exercise tolerance and sometimes great improvements in quality of life for respiratory patients. The effects of exercise seem to be through improvement in exercise efficiency. A full rehabilitation programme also involves an attempt to deal with patients' psychological problems and to help them regain independence in all aspects of their lives. The opportunity exists to improve the lot of a large group of people, at a relatively modest cost.
Exercise Therapy↗
Respiratory health workers visiting patients with chronic respiratory disability.
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Community Health Nursing↗
Controlled trial of respiratory health worker visiting patients with chronic respiratory disability.
Seventy five patients with chronic respiratory disability were randomised to a group visited by a respiratory health worker (42) or control group (33). The first group was visited monthly by a respiratory nurse, who gave education and support. The effect of the intervention was assessed in terms of quality of life (by questionnaires), the number and duration of admissions to hospital, and the number of deaths. The questionnaires on quality of life showed no changes in either group during the study, but nearly all of the group visited by a respiratory health worker said that they valued the visits and wished them to continue. Their knowledge about their condition also improved compared with that of the controls. The duration of stay in hospital for respiratory reasons in the group visited by a respiratory health worker was longer than that of control patients. This was explained by their being scored as more ill than the controls on admission. Fewer patients died in the group visited by a respiratory health worker than in the control group (p = 0.11). The patients in the group visited by respiratory health workers may have survived longer because they sought help rather than dying at home. If confirmed this could have implications for the cost of their care.
Aged↗
Arterial oxygen saturation and breathlessness in patients with chronic obstructive airways disease.
Nine patients with chronic obstructive airways disease performed a 6 min self-paced walk (breathing air) on a treadmill and then identical (but operator-controlled) treadmill walks breathing either air or supplemental oxygen sufficient to just prevent arterial oxygen desaturation during the exercise. During the exercises, ventilation was recorded and patients recorded their sensation of breathlessness on a visual analogue scale (VAS) every 30 s. Breathing supplemental oxygen produced a small fall in mean exercise ventilation and a large and consistent reduction in mean exercise breathlessness. In seven patients the VAS scores were higher on air than with supplemental oxygen, at similar levels of ventilation. An analysis of covariance, to control for reduction in ventilation, showed a decrease in mean breathlessness when breathing supplemental oxygen, significant at the 8% level. The reduction in breathlessness produced by preventing exercise desaturation cannot be explained by the decrease in ventilation. This suggests that hypoxia may be a stimulus for breathlessness. The mechanism is unknown.
Aged↗
Voluntary isocapnic hyperventilation and breathlessness during exercise in normal subjects.
1. Nine normal subjects performed 6 min, constant-workload, exercise tests on a bicycle ergometer at either a 'high workload' or at a 'low workload'. During the first 'high workload' test their spontaneous breathing pattern was recorded on to magnetic tape. During one subsequent 'high workload' test and one 'low workload' test they voluntarily copied their recorded breathing pattern. During a second 'low workload' test they breathed spontaneously. Isocapnia was maintained by the operator throughout both the copying tests. During the exercise tests ventilation was recorded and subjects indicated the level of their sensation of breathlessness every 30 s. 2. Subjects felt markedly less breathless when a proportion of their ventilation was produced by voluntary effort than when the same total level of ventilation was produced entirely by the stimulus of exercise. Furthermore, voluntary isocapnic hyperventilation during exercise did not increase breathlessness above that normally associated with that level of exercise. 3. These results suggest that it is reflexly driven ventilation, and not simply the level of ventilation itself, which relates to the level of breathlessness during exercise.
Adult↗