Department Of Health And Social Security Research Articles

X-ray protection considerations for mammography screening centres.

The inception of the National Breast Screening Programme, following publication of the report Department of Health and Social Security (DHSS), 1986) of a working group under the Chairmanship of Sir Patrick Forrest, led to the construction of a significant number of new mammography rooms including mobile units, with many more being proposed for the next few years. As a result, Radiation Protection Advisers (RPAs) are now being required to give advice on room construction for these units. The Guidance Notes For Health Authorities On Mammographic Equipment Requirements For Breast Cancer Screening published by the DHSS (1987), whilst giving clear guidelines to facilitate standardization on most technical aspects of mammography screening/ assessment centres, do not give any outline of the protection requirements, merely stating in paragraph 3.7.3. that “Radiation protection and operational features must meet the requirements of the local Radiation Protection Adviser.” Such Radiation Protection Advisers will need access to both attenuation data and scatter measurements on which to base their recommendations. This paper presents measurements at mammographic energies of both the attenuation properties of a range of materials that could be used in barrier construction, and phantom scatter measurements. In addition, the application of these results to the situation that will be found in the new screening centre and measurements performed to confirm the conclusions are presented.

Permanent brain damage and pertussis vaccination: is the end of the saga in sight?

The development and widespread uptake of a safe and efficacious aluminium adsorbed diphtheria-tetanus-pertussis vaccine (DTP) in the United States between 1933 and 1944 led to a gradual decline in whooping cough morbidity and instilled confidence in a vaccination programme which has been effectively maintained for over 40 years. T his contrasts with the turbulent history of pertussis vaccination in the United Kingdom where doubts as to the efficacy of available vaccines delayed their active national promotion until 1957, after which various reports resulted in further doubts over efficacy and safety. In 1974, the mass media became involved in the safety issue when the National Hospital for Sick Children case series of neurological events, which had occurred after DTP vaccination was made core material for a television documentary. The Department of Health and Social Security (DHSS) responded by establishing two retrospective studies of case records of post vaccination adverse events and two prospective studies. One of the latter, the National Childhood Encephalopathy Study (NCES) was regarded as the definitive case control study. A claim for damages, Loveday v Renton and The Wellcome Foundation, heard in the High Court of Justice in London, from early October 1987 until late February 1988 dealt with the general issue of whether, on the balance of probabilities, pertussis vaccine could cause permanent brain damage. The cornerstone of the claim that pertussis vaccine can cause permanent brain damage has always been the apparent clustering of onset of neurological disorders within the first 24-48 h after vaccination. One of the main finds of the NCES, however, which was not divulged in any published report but emerged in the course of the hearing, was that permanent brain damage did not occur within 48 h of DTP vaccination in any child in England, Scotland and Wales from mid-1976 to mid-1979 when 2 million doses of vaccine were used. The NCES, in this respect, completely undermined the evidence provided by various published case series. After a 61 day hearing, High Court judgment was given to the effect that the judge was not satisfied on balance of probability that pertussis vaccine can cause permanent brain damage in young children. Were it not for the fact that The Wellcome Foundation intervened in the action and obtained a court order giving access to the NCES cases records, some crucial information collected by the NCES might not have been brought to light.(ABSTRACT TRUNCATED AT 400 WORDS)

An alignment test jig for measuring the effective focal-spot size of mammographic X-ray tubes

Following publication of the Forrest Report (Department of Health and Social Security (DHSS), 1986) and with the implementation of a breast cancer screening programme in the UK, there is considerable interest in the technical aspects of mammographic systems. The equipment requirements for mammographic X-ray screening units have been identified (DHSS, 1987) and guidance on the commissioning and routine testing of mammographic X-ray equipment is also expected (Institute of Physical Sciences in Medicine (IPSM), 1989). These documents relate to all aspects of the mammographic X-ray set including the specification and measurement of the size of the X-ray tube focal spot. It is recommended (DHSS, 1987) that effective focalspot sizes are measured using a pair of slit radiograms in the manner described in BS 6530 (British Standards Institution (BSI), 1985). This standard provides details on the construction of the slit diaphragm and the geometry to be employed when performing focal-spot measurements. In particular, the method requires that the centre of the slit diaphragm and its axis of symmetry are aligned with the reference axis, which is defined as the line through the centre of the radiation source and parallel to the reference direction or that specified direction to which the characteristics such as target angle are referenced. The manufacturer should specify the reference axis when providing data on anode target angle and size of focal spot.

Ethnic density is unrelated to incidence of schizophrenia.

Data deriving from the Mental Health Enquiry were obtained from the Department of Health and Social Security (DHSS) for all 186,000 admissions in England in 1981 to test the 'ethnic density hypothesis'. This hypothesis has been used to explain variations in rates of mental illness between ethnic groups in other countries, and suggests that there is an inverse relationship between the size of ethnic groups and their admission rates. The data analysed in the present paper for the main foreign-born immigrant groups to England not only failed to support the ethnic-density hypothesis, but in some cases, showed a significant positive relationship between group size and admission rates. Some possible reasons for these findings are explored.

Paediatric manpower: towards the 21st century.

The British Paediatric Association (BPA) has carried out a national survey of paediatric medical manpower in the hospital and community child health services. The results of the survey relating to England and Wales are presented and compared with Department of Health and Social Security (DHSS) manpower statistics. On the basis of the survey findings and current trends in the pattern of paediatric care paediatric manpower requirements over the next 10 years are estimated.

Treated blood pressure, rather than pretreatment, predicts survival in hypertensive patients. A report from the DHSS Hypertension Care Computing Project (DHCCP).

A group of hypertensive patients (n = 2855) with an untreated diastolic blood pressure greater than or equal to 90 mmHg were followed in the Department of Health and Social Security (DHSS) Hypertension Care Computing Project (DHCCP) for periods of up to 10 years. During this period 191 of these patients died. Survival was assessed in relation to pretreatment blood pressure levels and blood pressure achieved during treatment. The blood pressure during treatment was a useful predictor of mortality, but the pretreatment pressure was not. After adjusting for age, mortality was particularly related to the height of the systolic and diastolic blood pressure during the second and third years of treatment. In men, age-standardized 5-year mortality was greater than 10% in those with a first year treated systolic pressure greater than 150 mmHg or a diastolic pressure greater than 95 mmHg. In women, age standardized 5-year mortality was greater than 5% with the same levels of treated blood pressure. The longest survival occurred with the lowest bands of treated pressure, i.e. systolic pressure less than 140 and diastolic pressure less than 90 mmHg; the 5-year mortality being less than 7% in men and less than 3% in women. Treated systolic and diastolic pressures were useful in predicting death from ischaemic heart disease (IHD).

Alternative strategies for the UK department of health and social security (DHSS): Some comments

AbstractGiles and Kings (1987) suggest the use of windchill as an alternative indication of coldness for use in the UK Department of Health and Social Security's exceptionally cold weather payments scheme. It is argued here that the use of windchill confers no obvious benefit and would result in added problems.

Microbiological evaluation of a hospital delivered meals service using precooked chilled foods

A delivered meals service supplying centrally produced, precooked, chilled foods to 24 hospitals was introduced in Plymouth Health District between August 1985 and July 1986. Over 18 months, 3393 food items were examined microbiologically, using the criteria recommended by the Department of Health and Social Security (DHSS) (1980). No Salmonella spp., Staphylococcus aureus or Clostridium perfringens were detected. Seventy-five (8·6%) of 876 cooked vegetable items had total viable counts (TVC) greater than 1 × 10 5 cfu g −1 (the recommended limit) after aerobic incubation at 37 °C for 48 h, whereas only 2·6% (66) of 2517 foods other than vegetables had TVC above this limit. Reasons for high counts were investigated and mostly corrected so that, whereas 8·4% of samples had TVC above recommended limits in the first 4 months of the study, only 1·6% exceeded this limit in the last 3 months. The value of microbiological standards for cook-chill food and their use in hygiene control are assessed.

Dynamic monitoring of output on a superficial X-ray set using a solid-state device.

A solid-state output monitor has been constructed and tested on a Philips RT100 superficial X-ray set operating at 55, 70 or 100 kVp. The device is useful to radiographers, technicians, engineers and physicists and can be easily assembled and fitted with a minimum amount of machine downtime. Recommendations concerning control of X-ray doses for superficial therapy are outlined in a Radiotherapy Apparatus Safety Measures Panel (RASMP) document (Department of Health and Social Security (DHSS), 1975). These recommendations do not require the use of a dose-rate monitor but the Code of Practice, Section 4.2.10 (ii) states that, where a monitor is not fitted, the output under standard conditions should be checked frequently, preferably at least once each working day (Her Majesty's Stationery Office (HMSO), 1972). The latter statement is repeated in paragraph 344 of the consultative document of Draft Guidance Notes for the Protection of Persons against Ionizing Radiations Arising from Medical and Dental Use (HMSO, 1983). The Ionizing Radiations Regulations 1985 do not contradict this statement (HMSO, 1985). The need for a dose-rate monitor in a superficial X-ray set is highlighted in a Hospital Physicists' Association (HPA) Radiation Protection Topic Group Newsheet (HPA, 1986) describing a situation in which an incorrect filter had been inserted in the beam. Routine measurement of output can be done by radiographers using locally constructed equipment (as described, for example, by Tranter et al (1978)) but will only indicate output whilst the detector is in position.

A single alternative formula for Department of Health and Social Security S-curves

The formula most commonly used in the United Kingdom for prediction of cash flows during construction of a building is that published by the Department of Health and Social Security (DHSS). The one empirical formula for the S-curve requires a series of parameters to be used for different contract costs. From a reliability theory approach, an alternative mathematical form, which includes the Weibull function, has been proposed as the basis for the S-curves. This paper demonstrates that not only can the Weibull function be used as an excellent altnerative to the DHSS formula but also that the Weibull function overcomes some of the limitations of the original formula. Relationships between the Weibull parameter values for each of the fits to the set of DHSS curves are derived empirically so that one single formula with a total of seven parameters replaces the DHSS formula and its associated tables for different project costs.

Evaluation report: dialysis and ancillary equipment.

As part of the continuing comparative evaluation programme of electromedical equipment sponsored by the UK Health Departments, the evaluation of dialysis and ancillary equipment is being carried out by the Department of Medical Physics and Clinical Engineering, Hallamshire Hospital, Sheffield, and other hospitals within the She field Health Authority, in conjunction with the Medical Equipment Laboratory of the British Standards Institulion.In this issue m publish a summary of two reports, ‘Health Equipment Information’ (‘HEI’) 171 and 174, published by the Department of Health and Social Security (DHSS). The models reported on here are as follows.Haemodialysis equipment:Cobe Century 2000 Rx and Gambro AK-10.Peritoneal dialysis equipment: Gambro PD-10.Ancillary equipment:Gambro FAM-10 Fistula Assessment Monitor; AMP CAPD Mk II Bag Heater Unit; Culligan RSI-C & RS5-C, Gambro WRO 10–01 and Millipore Hemo-RO 63/67 Reverse Osmosis equipment.Ecaluation summaries of similar instruments, evaluated and reported on in earlier reports and summaries, which are still available, are included for information.Readers are advised to consult the full reports before reaching Purchasing decisions. They may be obtained from DHSS Leaflets Unit, PO Box 21. Stanmore, Middlesex HA7 IAY, CK

Community care.

Community care has lost its innocence. Critics and evangelists vie for television space and newspaper headlines. The Chief Medical Officer had to beg for clarification of a term that had developed too many meanings and an “ethos of virtue” (Acheson, 1985). How should it be defined? Can a hospital be part of the community? Does it mean care ‘in’ ‘by’ the community? The Department of Health and Social Security (DHSS) definition seems to be “the provision of alternatives to long-term institutional care for the chronically sick or those suffering from long-term handicaps or disabilities” (Hunt, 1985). Lord Trefgarne (1984) put the policy aim, more simply, as “to move out of hospital those people who do not really need to be there”.

Good king wenceslas: Alternative strategies for the U.K. department of health and social security(DHSS)

AbstractThe U.K. Department of Health and Social Security (DHSS) is required to make, to those eligible, a single payment for additional fuel costs during a period of exceptionally severe weather. Previous methods of assessing exceptionally severe weather, criticized on a number of grounds by Social Security Commissioners, resulted in parliamentary debate and frequent press attention. Work on exceptionally severe weather in winter in Birmingham is presented here for the period since November 1959. Three measures of cold—mean daily temperature, degree days and windchill—are assessed for their usefulness in identifying exceptionally severe weather as a single day occurrence and/or as runs of days, during the winter months from November to March. Recommendations are made that thresholds based on probability of occurrence be used and that windchill is the best of the three measures which could be used in future winters. It is concluded that although climatologists can provide the necessary data, probability levels and parameters, it must be Parliament and the DHSS who must define ‘period’ and ‘exceptionally severe’. In either case the final decision can only be a political one.

Hydrogeochemical studies for Al, F and Fe in waters supplying haemodialysis units in the Trent region, U.K.

Geographical and seasonal variations in the concentrations of Al, F and Fe in tap water supplying home haemodialysis units within the administrative area of the Trent Regional Health Authority, have been examined. Aluminium and fluoride were considered for their implications in bone disorders and iron for its competitive binding with aluminium to transferrin in serum. Four different water treatment systems are currently used and the extractive performance of these have been assessed. In general, the current Department of Health and Social Security's (DHSS) guidelines for aluminium in water used to prepare dialysate are met (30 μg/l), but the proposed European Economic Community's (EEC) levels of 10 μg/l, are not. The removal of fluoride and iron from water by the different treatments was comparable to the removal of aluminium. A comparison between old and new equipment highlights the importance of regular monitoring and maintenance.

Disclosure of medical records in litigation.

In negligence claims against doctors, health authorities, and drug companies medical records provide vital evidence of what went wrong. In such litigation each side must disclose to the other any documents that relate to the matters in issue. Traditionally, this step in the litigation timetable, known as discovery, has come after the issue of the writ and the close of the pleadings (the written particulars setting out the issues in the case). In 1970, however, a new concept was introduced into the law? prewrit discovery. This enables anyone contemplating bringing an action for damages for death or personal injury to apply to the court for an order releasing the relevant records before the action has been started. The idea was to help lawyers and medical experts assess better the chances of success before embarking on litigation. The provision has not been popular with health authorities, which regard it as an opportunity for lawyers to engage in fishing expeditions in the hope of dredging up grounds for launching a claim. The court can order the production of documents to the would be litigant himself or to only his legal adviser, or to both legal adviser and medical expert. Only if he has no legal adviser is discovery limited to a medical expert. But to save time and to avoid the cost of a court application solicitors will ask for the records to be released voluntarily. A Department of Health and Social Security (DHSS) circular, HC(82)16, advises authorities to disclose case notes without a court order after consultation with the doctors concerned unless there is some good reason not to do so. Such a reason might relate to the defence against the particular claim or to the grounds for seeking discovery being obviously insubstantial. Health author? ities sometimes resist the request, particularly if it is vaguely worded and not specific about the alleged negligence or the particular docu? ments sought. Often, authorities will offer to disclose records to only a medical expert and not to the solicitor and his client, even though the court would order disclosure to the solicitor. If the request does go to court the rule is that the patient pays both his own and the health authority's costs even if he wins the release of his notes. But an authority that unreasonably refuses to hand over records, forcing a prospective litigant to seek a court order, may be landed with its own costs and in exceptional cases may even have to pay the plaintiffs costs. This happened last year in Hall v Wandsworth Health Authority, where Mr Justice Tudor Price said that there was no reasonable excuse for failure to disclose to the solicitor before the court hearing. He added that the failure to disclose even after the court order showed that the defendants were not approaching the matter with the urgency such litigation demands.

Admission guidelines for head injuries: variance with clinical practice in accident and emergency units in the UK.

Guidelines for the initial management of head injuries were formulated by neurosurgeons and a multidisciplinary group of clinicians and administrators attending a seminar convened by the UK Department of Health and Social Security (DHSS). Analysis of data collected previously by the Royal College of Radiologists in nine accident and emergency units in the UK shows that admitting practice varied between centres and was very different from that recommended subsequently in the guidelines. Only 49 per cent (range 22 to 71 per cent) of patients who had skull X-rays and possessed symptoms and signs warranting admission were admitted to hospital and 14 per cent (range 1 to 20 per cent) of those without appropriate symptoms and signs were admitted. Rates of admission for patients with a history of unconsciousness, which according to the guidelines is not a criterion for admission, were up to ten-fold higher than for comparable patients with no such history. Implementation of the guidelines could have a substantial effect on clinical practice and could reduce admissions of patients who had skull X-rays by up to 46 per cent.

A gamma camera phantom support stand for safer and faster non-uniformity measurement procedures.

Flood sources are regularly required for calibrating gamma cameras which employ digital non-uniformity correction systems (Department of Health and Social Security (DHSS), 1980) and generally for image quality control. A flood source was made for this purpose, but it soon became clear that the mass (20 kg) and size (61 cm × 61 cm × 6 cm) of the phantom made it hazardous to use. The measurement procedure required the phantom to be manually agitated to assist the uniform distribution of radionuclide (400 MBq 99Tcm) and then placed adjacent to the collimator of the gamma camera. A support stand for the phantom was designed and produced to facilitate a safer and faster procedure. The basic design of the stand can be adapted to accommodate a range of phantom shapes and sizes.

Problems in using medical statistics

I work at the National Perinatal Epidemiology Unit which is a Department of Health and Social Security (DHSS) funded multidisciplinary research unit. We have a strong view that before collecting new data we should use the data which already exist. As a result, both our economist and I make very extensive use of official statistics.

Handling statistical enquiries in the medical library — some practical examples

Every library school student knows that statistics — like conference proceedings and technical reports — belong to that category of material called ‘difficult literature’. It is true that often it is not easy to find out what is available, and that frequently the published statistics do not give the figures in quite the way that your enquirer wants. A starting point for many enquiries will be the Guide to official statistics, compiled by the Central Statistical Office and the coverage of which is much wider than might be expected from the title. However there are other sources of information which may be less obvious, and these include recent journal articles and reviews, annual reports of organisations, textbooks, monographs and computerised bibliographic databases. In addition there are a number of organisations which may be able to provide statistical information or advise on it, such as the Office of Population Censuses and Surveys (OPCS), the Department of Health and Social Security (DHSS), the Office of Health Economics (OHE), and the Royal College of General Practitioners. Bear in mind too that the various tiers of the National Health Service may issue their own statistics, for example the North West Thames Regional Health Authority produce their Annual patient statistics which give figures by district and by individual hospital. Libraries should try and get themselves on the mailing list for these documents!

Organising a counselling service for problems related to the acquired immune deficiency syndrome (AIDS).

Recent Department of Health and Social Security (DHSS) guidelines on screening procedures for antibody to human T cell lymphotropic virus type III (HTLV-III) have stressed the importance of providing adequate counselling for patients before and after testing. The establishment of a national acquired immune deficiency syndrome (AIDS) counselling training unit has enabled large numbers of National Health Service staff to be trained in this work. Suggestions for the establishment of district counselling facilities are made, based on this training, and some preliminary results showing change from high risk sexual behaviour after counselling are presented.