Survey of Patient Knowledge and Awareness of "Sick Day Rules" in Rheumatology Patients on Long Term Glucocorticoid Therapy.

Aims Rheumatic disease (RMD) patients treated with long-term glucocorticoids (GC) are at risk of developing tertiary adrenal insufficiency. With this survey we aimed to assess the knowledge of RMD patients taking long-term glucocorticoid therapy regarding risk of adrenal insufficiency and understanding of the "steroid sick day rules". Methods RMD patients taking ≥2.5 mg prednisolone daily for ≥3 months were recruited from the Rheumatology outpatient department in Beaumont Hospital, Dublin. Patient knowledge and previous counselling of steroid sick day rules was determined using an 8-point questionnaire carried out face-to-face or via phone call. Results 51 RMD patients on GC therapy were recruited. 3/51 (5.9%) of patients reported that they had been counselled on the Sick Day Rules. 2/51 (3.9%) carried a steroid emergency card or MedicAlert bracelet. Few patients would increase their steroid dose appropriately in response to infection, vomiting or peri-procedure [14/51 (27.5%); 9/51 (17.7%) and 5/51 (7.2%), respectively]. Conclusion We demonstrate a significant deficit of patient knowledge around the precautions for long-term GC use in rheumatic diseases. We suspect that our results may be generalisable to many other RMD units. We are currently reviewing our procedures around healthcare professional and patient education, issuing of information leaflets, emergency cards or MedicAlert bracelets etc. to at risk patients.

Hyperventilation in febrile Nigerian children without pneumonia: an evaluation of the influence of anaemia.

A total of 225 pre-school Nigerians were studied to evaluate the effect of anaemia on the respiratory rate of febrile children, and the influence of this on the reliability of the WHO criteria for the clinical diagnosis of pneumonia in the primary health care setting. Malaria was the commonest cause of febrile illness (63.1 pc). The prevalence of severe anaemia was 28.0 pc. The mean respiratory rate of anaemic children (53.9 +/- 12.8/min) was significantly higher than that of the non-anaemic (48.4 +/- 12.7/min; p = 0.011). Mean body temperature was not significantly different in both groups. Haematocrit was negatively correlated with respiratory rate. The positive correlation observed between temperature and respiratory rate was enhanced by decreasing haematocrit. More of the severely anaemic children (68.6 pc) exceeded the WHO respiratory rate threshold for diagnosis of pneumonia than the moderately anaemic (55.4 pc) or non-anaemic (36.1 pc). The specificity of the WHO criteria for clinical diagnosis of pneumonia decreased with decreasing haematocrit.

General surgery with a special interest in vascular surgery: an audit of relative workload.

In a district general hospital (DGH) almost all vascular surgery is provided by general surgeons with a vascular interest and training. There is a growing view, however, that vascular surgeons should be 'pure' to the exclusion of other surgery. In an attempt to define the relationship between general and vascular work in a DGH we have analysed, prospectively, out-patient, in-patient and theatre workload over a three-month period. Eight-hundred-and-forty-four patients (277 new, 567 follow-up) were seen in the clinics. Nine per cent of new vascular referrals and 33 per cent of new general referrals were booked for admission. There were 356 admissions (50 per cent 'emergencies') representing a wide spectrum of general surgery. Elective and emergency vascular cases stayed in hospital for twice and four times longer, respectively, than general patients. Vascular patients represented 26 per cent of the caseload but accounted for 46 per cent of the bed occupancy. Vascular operations made up only 21 per cent of the total theatre caseload (233 procedures) but consumed 34 per cent of theatre time. The vascular unit in a DGH deals with a substantial number and wide variety of general surgical cases. Vascular surgery, however, consumes disproportionately large amounts of out-patient and theatre time and hospital beds. This has implications both for the planning of vascular services and also for the resource allocation within the hospital.

Positive experiences: prejudice has pay-offs too.

Having HIV disease is not on the whole a positive experience. There have been many negative reactions to HIV and AIDS from the public, media and health professionals. We can all recount horror stories of people who have been disadvantaged by prejudice because they were in what was perceived as a high risk group. So how is it possible to discuss the positive effects of prejudice? The way HIV is managed can be seen to be a direct result of pre-existing prejudice towards the marginalised groups with which it first became identified in Western countries. The lessons we have learned from HIV can be applied in diverse areas of health care to benefit all clients and patients.

Risk factors for Haemobartonella felis infection in cats.

A seroepidemiologic survey for Haemobartonella felis infection in cats of Wake County, NC was undertaken. To help assess risk factors, cat owners completed a 10-item questionnaire. Additionally, blood samples were obtained for determination of H felis presence, FeLV infection, and anemia. Prevalence rates for H felis presence were as follows: all cats, 4.9% (6/123); healthy cats, 3.6% (3/83); and ill cats, 7.5% (3/40). The estimated relative risk for haemobartonellosis was also increased in cats with any of the following: anemia, FeLV-positive status, lack of vaccinations, history of catbite abscesses and/or anemia, age less than or equal to 3 years, or outdoor-roaming status. The sex, breed, number of cats in the household, or presence of fleas were not significant factors, although ill male cats had a greater estimated relative risk for haemobartonellosis.

Seroepidemiologic survey of feline immunodeficiency virus infection in cats of Wake County, North Carolina.

Feline immunodeficiency virus (FIV) antibodies were detected in 9 of 123 (7.3%) cats. More clinically ill cats had titers to FIV than did healthy cats (15% vs 3.6%). Previous or current illnesses in these FIV-positive cats included urinary bladder disease, anemia, cat-bite abscesses, bacterial infections, bleeding disorders, diabetes mellitus, and chronic respiratory tract disease. All FIV-positive cats were males, with mean age of 6.0 years (range, 1 to 11 years). Half (n = 3) of the clinically ill FIV-positive cats were concurrently seropositive for FeLV antigen. Three of the ill cats were euthanatized or died 1 month after initially testing, whereas the remaining 3 ill cats and the 3 healthy FIV-positive cats were healthy 1 year after initial testing. Antibody titer to FIV persisted in 4 of 5 cats, but serotest results were equivocal in 1 cat evaluated 1 year later.