Allergy in Irish adults: a survey of referrals and outcomes at a major centre.

BACKGROUND: There is an increasing demand for specialist public allergy services across Ireland. Little data exist on the patterns of allergic disease in Irish adults. The limited resources available require innovative strategies to ensure quality care delivery. AIMS: This study aimed to review the types of allergy referrals and diagnostic outcomes at a major Irish centre, and to establish an efficient method of communication with non-specialist practitioners. METHODS: Demographic data, referral characteristics and diagnostic outcomes from one hundred consecutive new allergy referrals were identified. Additionally, communications to a pilot email service were reviewed over a 12-month period and user satisfaction assessed. RESULTS: Requests for the investigation of food allergy accounted for 71% of referrals. Despite this, the main diagnostic outcome in this cohort was a non-allergic condition, chronic spontaneous urticaria (56%). immunoglobulin E (IgE)-mediated food allergy was definitively diagnosed in only 9% of patients, with the majority of these presenting with anaphylaxis. The allergy advice email service received 43 requests for assistance over 12 months, mainly for help in the interpretation of an allergy clinical history. Feedback on the email service was universally positive. CONCLUSIONS: The majority of patients in this cohort did not have IgE-mediated allergic disease. Increased awareness of the features that differentiate allergy from non-allergic conditions such as food intolerance or chronic spontaneous urticaria is required. The allergy advice email service should be developed further to play a key role in education and care delivery in partnership primary care.

Regionalization of infection prevention and control services in a publicly funded health care system.

In 1994 health services in the Edmonton region were consolidated into an integrated network called Capital Health. Infection control professionals in the region met to develop a vision for the future of infection control; the tasks were to prepare a proposal for a regional program, develop indicators for outcome measurements, and standardize guidelines and products. Although regionalization of infection control is a complex process, we have had success with a proactive approach led by infection control professionals.

A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention.

This article reviews the literature related to the epidemiology, prevention and management of sharps injuries in health care workers, particularly nurses, and the subsequent risk of harm. The studies are reviewed chronologically, beginning with the efforts to reduce sharps injuries by changing behaviours, followed by the introduction of barriers to protect the caregiver, and finally, the engineering of safer products. Initial efforts to prevent sharps injuries focused on placing rigid, disposal containers at the site where sharps were used and instructing health care workers to refrain form the practice of recapping. When these interventions were shown to alter the type, but not the overall number, of sharps injuries, alternative measures were sought. This search intensified with the increasing evidence of the small, but measurable, risk of the transmission of human immunodeficiency virus from sharps injuries. The current knowledge of the factors related to sharps injuries has been collected primarily through retrospective surveillance. This surveillance has been conducted primarily in hospital settings and has focused on the type of sharp and the purpose for which it was used rather than prospective research. Research is now needed to elucidate the organizational and behavioural factors leading to sharps injury both within the hospital as well as other health care settings. The implications for nursing practice are discussed.

A randomised phase II study of carmustine alone or in combination with tumour necrosis factor in patients with advanced melanoma.

Laboratory data suggest a synergistic interaction between carmustine (BCNU) and tumour necrosis factor (TNF) in melanoma. We therefore studied the activity of 200 mg/m2 BCNU given alone or in combination with 88 micrograms/m2 recombinant human TNF-alpha (rhTNF alpha) as a daily i.v. infusion for 5 days at 48-day intervals to patients with metastatic melanoma. In this randomised phase II trial, the rate of response to BCNU alone was 20% [95% confidence interval (CI), 2%-38%], and this was not improved by the addition of TNF (response rate, 10.5%; 95% CI, 1.3%-33%). Toxicity was higher in the combination arm, and there was no difference in survival.

Acute myeloblastic leukaemia--a model for assessing value for money for new treatment programmes.

OBJECTIVE: To measure the effects of changes in treatment of acute myeloblastic leukaemia that may give better value for money. DESIGN: Retrospective analysis of patients' notes to identify items of management costing money; prospective costing of these items. The Medical Research Council acute myeloblastic leukaemia 9 trial was used to identify the amount and distribution of these costs when either one or two courses of induction treatment were required to obtain complete remission. These findings were then extrapolated to four published international controlled trials using similarly intense treatment and in which the number of courses of treatment required for complete remission was stated, to compare British costs for treatment with idarubicin and daunorubicin, both in combination with cytarabine. SETTING: Leukaemia unit, Royal Marsden Hospital, London. SUBJECTS: Data on 10 patients receiving intensive induction treatment for acute myeloblastic leukaemia were used to identify 160 items of cost in four broad groups: general (including accommodation), diagnostic, supportive treatment, and cytotoxic chemotherapy. One newly treated patient was prospectively assessed over one month, including a time and motion study, to cost these items; then costs for 268 patients from the MRC trial receiving moderate induction chemotherapy including daunorubicin were assessed, and costs for treatment of 522 patients in the four international studies comparing daunorubicin with idarubicin were analysed. MAIN OUTCOME MEASURES: Cost effectiveness was measured as the overall cost to obtain complete remission in untreated patients with acute myeloblastic leukaemia after treatment with idarubicin or daunorubicin. RESULTS: The 160 costed items were measured for their sensitivity in varying the total cost of treatment, this being assessed within Britain in other district general and private hospitals to measure the extremes of cost of these items. Overall, idarubicin, although more expensive, showed a substantial saving (1477 pounds per patient) in total hospital costs, more than offsetting the increased cost (607 pounds) of the new treatment, an overall savings of 870 pounds per patient (5%). CONCLUSION: Approaches modelling cost effectiveness may be an essential part of planning new programmes of treatment in the future. This method can be used to estimate the cost effectiveness of the treatments in different environments and countries where costs may vary widely.