Lumbar punctures in the Acute Medicine Department: indications and evaluation of use.

AIMS: Evaluate the use of lumbar puncture (LP) in the Acute Medical Department of a typical urban district general hospital. Increase the proportion performed on appropriate patients. METHODOLOGY: An observational, single-centre, retrospective examination of patients undergoing LP at Solihull Hospital over four consecutive months. Discussion of findings and LP indications with the Acute Medicine Department. Re-audit over four months. RESULTS: Total LPs performed fell by 65%. The proportion performed on patients presenting with red flags rose by 19% (p=0.0098). The proportion that yielded positive findings rose by 33% (p<0.0001). 72% of patients with red flags had negative LP. CONCLUSIONS: Awareness of indications and observation of practice reduces total LPs performed and increases the proportion performed on appropriate patients.

Occupational health crossing borders part 2: Comparison of 18 occupational health systems across the globe.

BACKGROUND: Occupational health and safety (OHS) is considered one of the most important factors for a sustainable development; however, it is often considered a luxury by decision-makers. This article compares OHS systems of 18 countries at different stages of development. METHODS: In an international summer school, structure of the national OHS system, definition of occupational accidents and diseases, procedures for compensation claims, outcome (expressed as incidence of occupational accidents) and training opportunities were presented. RESULTS: National OHS systems ranged from non-existent to systems implemented almost 200 years ago. Priorities, incidence of occupational accidents and training opportunities varied. Common problems included the lack of OHS service for small enterprises and in rural areas. CONCLUSIONS: International training programs like this summer school might enhance the exchange about OHS opportunities around the globe and contribute to improved workers health.

Occupational health crossing borders - part 1: concept, teaching methods, and user evaluation of the first international summer school in Munich, Germany.

BACKGROUND: Occupational health and safety (OHS) is relevant for occupational health professionals (OHP) throughout the world. However, training opportunities are often limited and exchange between OHP from industrialized and developing countries is sparse. We aimed to contribute to the international exchange of OHP through a 2-week summer school program. METHODS: Twenty-three OHP from 11 countries participated. Teaching methods included interactive lectures, participants' presentations, case-based e-learning, enterprise visits, and hands-on sessions. After completion, participants evaluated the course. RESULTS: OHS systems of 18 different countries were presented using the same set of clinical cases as a starting point. Opportunities and challenges in the different OHS systems were considered. On median, participants rated the course as excellent and totally agreed that it will help them in their daily work. CONCLUSIONS: An international summer school teaching basic aspects of different OHS systems is a useful tool for training and exchange at the global level.

PEF analysis requiring shorter records for occupational asthma diagnosis.

BACKGROUND: The Oasys programme plots serial peak expiratory flow (PEF) measurements and produces scores of the likelihood that the recordings demonstrate occupational asthma. We have previously shown that the area between the mean workday and rest day PEF curves [the area between the curves (ABC) score] has a sensitivity of 69% and specificity of 100% when plotted from waking time using a cut-off score of 15 l/min/h. AIMS: To investigate the minimum data requirements to maintain the sensitivity and specificity of the ABC score. METHODS: A total of 196 sets of measurements from workers with occupational asthma confirmed by methods other than serial PEFs and 206 records from occupational and non-occupational asthmatics who were not at work at the time of PEF monitoring were analysed according to their mean number of readings per day. Measurements from work and rest days were sequentially removed separately and the ABC score calculated at each reduction. The sensitivity and specificity of the ABC score (using a cut-off of 15 l/min/h) was calculated for each duration. RESULTS: Two-hourly measurements (approximately 8 readings per day) with eight workdays and three rest days had 68% sensitivity and 91% specificity for occupational asthma diagnosis. As readings decreased to or=15 workdays were required to provide a specificity above 90%. CONCLUSIONS: To be sensitive and specific in the diagnosis of occupational asthma, the ABC score requires 2-hourly PEF measurements on eight workdays and three rest days. This is a short assessment period that should improve patient compliance.