151 OUTPATIENT FOLLOW-UP
EXPIRATORY BACTERIAL FILTER!
SIR,—DR Lumley and her colleagues (July 3, p. 22) give
a
valuable report of the long-term performance of bacterial filters which can be used to prevent contamination of ventilators. Effective filters allow ventilators to be used most economically and safely. One of the tests they used was a measurement of the resistance of the filters. They measured the pressure drop across the filter at constant flow-rates using a simple water manometer. Their results are reported in mm H2O. They use a conversion factor to give the pressure in the approved SI unit-the pascal. Unfortunately, 1 mm H20 9-81 Pa (at sea level), not 1.33 Pa as the paper states and uses. If the importance of papers such as these is not to be hidden, then either the conversion factor should be correct or the conversion not done at all, especially where the calibration standard is a simple device-a ruler. =
Department of Anæsthetics, University of Southampton, Southampton General Hospital, Southampton SO9 4XY ’"," This letter has been shown
JOHN NORMAN Dr
to
Lumley and her
colleagues, whose reply follows.-ED.L. SIR,-We thank Professor Norman for identifying the in
erroi
paper. We apologise for our inability to apply the correct factor when converting from conventional and clinicall) useful units to the recently approved SI units but feel that oul error reflects the difficulty confronting the clinician at the present time. We agree wholeheartedly with Professor Norman, and hop< that our conversion error will serve as an example and stimu late those in a similar position to resist the use of impractica units which have little clinical relevance. JEAN LUMLEY Departments of Anæsthetics and Bacteriology, ANITA HOLDCROFT Medical School and Royal Postgraduate St. Mary’s Hospital Medical School, London H. GAYA our
JOURNAL OF I.D.E.A.S SIR,—Ifind it increasingly difficult to follow many of the papers in your journal. This L.o.A.F.ing on my part is largely due to the i.D.E.A.s of your contributors.* The temptation to save space and time by using abbreviations seems irresistible. That even the commonest may confuse is seen with C.D.H. serving for congenital dislocation of the hip, congenital disease of the heart, and coronary disease of the heart. Perhaps these abbreviations are designed to dissuade the uninitiated from penetrating the mysteries of the newer disciplines. Several readings of Segal and Peters’ article’ failed to enlighten me on what N.A.D.H. stood for and your accompanying editorial did not help by using the letters N.A.D.H, nor was it clear what the N.A.D. actually did stand for. And I did know C.G.D. and N.B.T. While it is clearly too much to expect authors to allow for readers’ ignorance surely you, Sir, should insist on this simple aid to understanding. Institute of Child Health London WC1N 1EH
J.
A. S. DICKSON
*.* We will try to do better. N.A.D.H stands for nicotinamideadenine dinucleotide, reduced-ED.L. *
L.O.A.F.
=
I.D.E.A.
=
1 Segal,
A
Lack of appreciation factor. Incompletely defined essential
abbreviation.
W., Peters, T. J. Lancet, 1976,
1363.
i,
SIR, —Loudon1 has dealt with Paulley’s complaints2 about general practice admirably. Of course there are bad doctors and low standards in general practice. They occur in general practice in about the same proportion as in consultant practice. However, one aspect has so far not been mentioned. Consultants are in an especially privileged position from which they could influence and improve standards in general practice. Safeguards could easily be built into a system of sensible discharge of patients from outpatient follow-up. An audit of the kind described by McColl et al.3 in the surgical team at Guy’s but extended to include general practitioners would be immensely valuable. Most of the failure of general practice is due to poor administration and organisation of practices rather than to frankly ignorant or negligent doctors. An interest in this aspect of their work could be stimulated by local experimental schemes of shared care or early return of patients to general practice initiated by consultants. It is certainly not true that long-term follow-up of conditions such as hypertension and diabetes is necessarily better done in hospital outpatients. In fact, the reverse is usually true. Readings of blood-pressure and blood-sugar obtained in outpatient clinics are often a poor indication of the usual levels. The general practitioner is much more easily accessible than the consultant for the patient with untoward side-effects. Forrester4 is absolutely right that most general practitioners do not at present organise efficient follow-up of long-term patients. With consultant help they could do so. The Surgery, 50, The Glade, Furnace Green, Crawley, Sussex
GILLIAN STRUBE
SANITARY CONDITIONS IN PRISON
SIR,-A patient of mine has just spent 5 weeks on remand in Holloway Prison for women. The treatment she received there was sensible and kind and what might be expected of a well-run prison. However, it appears that in Holloway frequency of micturition and dysuria are recognised by the inmates as being, almost inevitably, among the penalties of their imprisonment. My patient developed these symptoms within a couple of days of going to Holloway. She was given penicillin and, when this had no effect, other antibiotics; she had to be admitted to the prison hospital for 2 days because her pain was so severe.
She tells
me
that cells
are
shared
by
two
people;
each has
bucket, a jug, and a bowl. The bucket is for defalcation and micturition, the bowl for washing, and the jug for water. Once a
day, at 3.30 P.M., the prisoners are allowed to get a jug of water and to empty the bucket and clean it out with scouring powder. If they are on association (allowed to join in communal activities), every second day they can get a fresh supply of water later on in the afternoon, but on the other days they cannot do this. My patient and the other person in her cell had diarrhoea for 2 days. In consequence they were allowed out once more than usual to empty their slops-this being regarded by my patient as an example of special kindness on the part of the prison officer. Prison in Britain is supposed to be corrective rather than punitive. The sort of conditions described to me must be so unpleasant (particularly in hot weather) that they can only amount to ill-treatment. I had in fact noticed previously that
a
1. 2 3. 4.
Loudon, I. S. L. Lancet, 1976, ii, 37. Paulley, J. W. ibid. 1976, i, 1346. McColl, I., Fernow, C., Mackie, C., Rendall, M. ibid. 1976, i, 1341. Forrester, R. M. ibid. 1976, ii, 104.
EXPIRATORY BACTERIAL FILTER!
SIR,—DR Lumley and her colleagues (July 3, p. 22) give
a
valuable report of the long-term performance of bacterial filters which can be used to prevent contamination of ventilators. Effective filters allow ventilators to be used most economically and safely. One of the tests they used was a measurement of the resistance of the filters. They measured the pressure drop across the filter at constant flow-rates using a simple water manometer. Their results are reported in mm H2O. They use a conversion factor to give the pressure in the approved SI unit-the pascal. Unfortunately, 1 mm H20 9-81 Pa (at sea level), not 1.33 Pa as the paper states and uses. If the importance of papers such as these is not to be hidden, then either the conversion factor should be correct or the conversion not done at all, especially where the calibration standard is a simple device-a ruler. =
Department of Anæsthetics, University of Southampton, Southampton General Hospital, Southampton SO9 4XY ’"," This letter has been shown
JOHN NORMAN Dr
to
Lumley and her
colleagues, whose reply follows.-ED.L. SIR,-We thank Professor Norman for identifying the in
erroi
paper. We apologise for our inability to apply the correct factor when converting from conventional and clinicall) useful units to the recently approved SI units but feel that oul error reflects the difficulty confronting the clinician at the present time. We agree wholeheartedly with Professor Norman, and hop< that our conversion error will serve as an example and stimu late those in a similar position to resist the use of impractica units which have little clinical relevance. JEAN LUMLEY Departments of Anæsthetics and Bacteriology, ANITA HOLDCROFT Medical School and Royal Postgraduate St. Mary’s Hospital Medical School, London H. GAYA our
JOURNAL OF I.D.E.A.S SIR,—Ifind it increasingly difficult to follow many of the papers in your journal. This L.o.A.F.ing on my part is largely due to the i.D.E.A.s of your contributors.* The temptation to save space and time by using abbreviations seems irresistible. That even the commonest may confuse is seen with C.D.H. serving for congenital dislocation of the hip, congenital disease of the heart, and coronary disease of the heart. Perhaps these abbreviations are designed to dissuade the uninitiated from penetrating the mysteries of the newer disciplines. Several readings of Segal and Peters’ article’ failed to enlighten me on what N.A.D.H. stood for and your accompanying editorial did not help by using the letters N.A.D.H, nor was it clear what the N.A.D. actually did stand for. And I did know C.G.D. and N.B.T. While it is clearly too much to expect authors to allow for readers’ ignorance surely you, Sir, should insist on this simple aid to understanding. Institute of Child Health London WC1N 1EH
J.
A. S. DICKSON
*.* We will try to do better. N.A.D.H stands for nicotinamideadenine dinucleotide, reduced-ED.L. *
L.O.A.F.
=
I.D.E.A.
=
1 Segal,
A
Lack of appreciation factor. Incompletely defined essential
abbreviation.
W., Peters, T. J. Lancet, 1976,
1363.
i,
SIR, —Loudon1 has dealt with Paulley’s complaints2 about general practice admirably. Of course there are bad doctors and low standards in general practice. They occur in general practice in about the same proportion as in consultant practice. However, one aspect has so far not been mentioned. Consultants are in an especially privileged position from which they could influence and improve standards in general practice. Safeguards could easily be built into a system of sensible discharge of patients from outpatient follow-up. An audit of the kind described by McColl et al.3 in the surgical team at Guy’s but extended to include general practitioners would be immensely valuable. Most of the failure of general practice is due to poor administration and organisation of practices rather than to frankly ignorant or negligent doctors. An interest in this aspect of their work could be stimulated by local experimental schemes of shared care or early return of patients to general practice initiated by consultants. It is certainly not true that long-term follow-up of conditions such as hypertension and diabetes is necessarily better done in hospital outpatients. In fact, the reverse is usually true. Readings of blood-pressure and blood-sugar obtained in outpatient clinics are often a poor indication of the usual levels. The general practitioner is much more easily accessible than the consultant for the patient with untoward side-effects. Forrester4 is absolutely right that most general practitioners do not at present organise efficient follow-up of long-term patients. With consultant help they could do so. The Surgery, 50, The Glade, Furnace Green, Crawley, Sussex
GILLIAN STRUBE
SANITARY CONDITIONS IN PRISON
SIR,-A patient of mine has just spent 5 weeks on remand in Holloway Prison for women. The treatment she received there was sensible and kind and what might be expected of a well-run prison. However, it appears that in Holloway frequency of micturition and dysuria are recognised by the inmates as being, almost inevitably, among the penalties of their imprisonment. My patient developed these symptoms within a couple of days of going to Holloway. She was given penicillin and, when this had no effect, other antibiotics; she had to be admitted to the prison hospital for 2 days because her pain was so severe.
She tells
me
that cells
are
shared
by
two
people;
each has
bucket, a jug, and a bowl. The bucket is for defalcation and micturition, the bowl for washing, and the jug for water. Once a
day, at 3.30 P.M., the prisoners are allowed to get a jug of water and to empty the bucket and clean it out with scouring powder. If they are on association (allowed to join in communal activities), every second day they can get a fresh supply of water later on in the afternoon, but on the other days they cannot do this. My patient and the other person in her cell had diarrhoea for 2 days. In consequence they were allowed out once more than usual to empty their slops-this being regarded by my patient as an example of special kindness on the part of the prison officer. Prison in Britain is supposed to be corrective rather than punitive. The sort of conditions described to me must be so unpleasant (particularly in hot weather) that they can only amount to ill-treatment. I had in fact noticed previously that
a
1. 2 3. 4.
Loudon, I. S. L. Lancet, 1976, ii, 37. Paulley, J. W. ibid. 1976, i, 1346. McColl, I., Fernow, C., Mackie, C., Rendall, M. ibid. 1976, i, 1341. Forrester, R. M. ibid. 1976, ii, 104.
