The difficulties of investigating motor vehicle traffic accident mortality in a district.

Many difficulties were experienced in obtaining and using data required to test a series of proposed hypotheses to explain the high standardised mortality ratio (SMR) for motor vehicle traffic accidents (MVTAs) in the Bath District. The authors had expected that, given the importance of MVTAs and the amount of effort put into collecting data by established organisations, it should have been possible to access easily the information required to investigate a district which had a high SMR. The variety of data, collected by the many organisations involved in the problem of road traffic accidents, was expected to assist the investigation. However, in practice the result of the difficulties was that the considerable data collected on MVTAs were not readily usable in the district-based investigation described in this paper. Organisational and definitional reasons are identified to explain the observed difficulties. Several possible solutions are proposed. The responsibility for MVTA prevention should be with a single named authority which could be either the County Council or the District Health Authority. Systems should be organised to allow each district to access easily the statistics relating to accidents involving residents of the district, especially those occurring outside the district of residence. Results of coroners' investigations should also be routinely transferred to the coroner of the district of residence so that information on deaths to all residents of a district can be obtained from a single local source. Given the existing systems and limited resources, the authors concluded that further investigation into the high SMR for MVTAs in the Bath Health District was not justified.(ABSTRACT TRUNCATED AT 250 WORDS)

Public attitudes to charging for some National Health Service services.

This report describes the views of members of the public to proposals to charge for a given list of NHS services for which no charges are currently made. The questions were part of a survey conducted in Cardiff in 1986. The majority of respondents would agree with the suggested charges being levied. This agreement spanned all sections of society. Despite the majority in favour, the sample was divided with a third of respondents being strongly for nearly all the charges and a quarter being strongly against all or all but one of the charges. Most respondents to the survey are judging each charge as a separate issue rather than indicating either approval or disapproval for all cases. If charges for services were to be introduced there could be majority agreement but each charge would have to be considered as a separate issue.

Consultants' views of a district's services.

A postal questionnaire survey of consultants in the Bath Health District was conducted to establish a means for individual consultants to express their views about the provision of health services in the district, so that by working together a new relationship between the District Health Authority (DHA) as purchaser and the clinicians as providers of services could commence. A response rate of 84 per cent was achieved. The survey sought views on clinical and management issues to be used in the development of service agreements (contracts) and views on topics identified by general practitioners (GPs) as areas in need of improvement. Detail is given of results relating to out-patient services, issues of communication and the continuing role of community hospitals. Most consultants sanctioned the appropriateness of referrals by GPs to out-patient services but they identified some out-patient referrals as inappropriate. This justifies a further review of the out-patient services to be purchased by the DHA. Consultants were in agreement that there was scope for review of out-patient follow-ups. They agreed with GPs that discharge summaries could be provided within 24 hours of patient discharge to improve communication with GPs and that consultants should be available by pager to be contacted by GPs, but disagreed with GPs about the feasibility of giving patients on waiting lists a firm admission date at the time of going on the waiting lists. The majority of consultants were in favour of continuing support for community hospitals. They identified overall social value of community hospitals and greater clinical value of out-patient services than in-patient services in community hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Targets--are they sensible?

Targets are becoming increasingly important in the new NHS for both purchasers and providers. Targets must be meaningful and carefully considered before it becomes sensible or realistic to attempt to achieve them. Choosing an unworkable target no matter how well-intentioned, will not achieve the desired result. This paper discusses the role of targets, comments on targets that are in use and proposes a set of 'Golden Rules' for the selection of targets.

Follicular carcinoma in a lingual thyroid.

This paper present the clinical story of a forty-year-old lady who presented with referred left-sided otalgia from a follicular carcinoma occurring in a lingual thyroid. This coincided with the presence of a normal quantity of thyroid tissue in the neck. The lingual mass was excised and the diagnosis (hitherto unsuspected) was made histologically. The patient's otalgia disappeared and her further management was conducted in another Unit.

Impending asphyxia induced by anticoagulant therapy.

A case is presented of spontaneous haemorrhage into the floor of the mouth occurring in a patient receiving anticoagulants. Spread of interstitial haematoma to the submucosal tissues of the pharynx and larynx caused respiratory embarrassment necessitating a tracheostomy. The genesis and management of such a problem are discussed, and it can be appreciated that close co-operation between the otolaryngologist, haematologist and anaesthetist is essential.

Extracranial neurilemmomata of the head and neck.

Whilst it is to be appreciated that a neurilemmoma is an uncommon type of tumour, it is a diagnostic possibility which must be considered whe one is faced with the management of a patient with a mass involving any part of the head and neck. It should be stressed that the diagnosis is not usually evident after extensive clinical and special investigations but is usually made retrospectively after histological examination of the excised surgical specimen.