Central London Hospital Research Articles

Antenatal serum screening for genital herpes: a study of knowledge and attitudes of women at a central London hospital.

To evaluate the knowledge and attitudes of women regarding genital herpes and specifically serum screening for prevention of vertical transmission. Antenatal clinic at the Chelsea and Westminster Hospital, London. Randomly selected women at their first antenatal visit. A questionnaire focussing on the women's knowledge of, and their attitudes about, genital herpes was completed. The results were analysed using the Statistical Package for Social Sciences (SPSS). One hundred women were surveyed over six weeks. The majority (80%) were aware that genital herpes was a sexually transmitted disease and 60% were aware that it can be transmitted to the baby in pregnancy. Only 34% thought that genital herpes is always symptomatic and 56% believed that they would know for certain if they had herpes. Sixty percent thought they would know whether their partners had ever been infected. Eighty percent of our sample population were prepared to be screened, and 76% would also encourage their sexual partner to have a blood test. This study shows that the study population had a good knowledge about genital herpes and that there would be acceptance of antenatal testing. Whether serum screening is cost-effective must still be evaluated. The impact of such a screening on a couple's relationship is potentially deleterious and needs to be assessed carefully before a screening programme for genital herpes is actually introduced. The next phase of our study will address this issue.

Thunderstorm associated asthma: a detailed analysis of environmental factors.

To seek associations between meteorological factors, concentrations of air pollutants or pollen, and an asthma epidemic which occurred in London on 24 and 25 June 1994 after a thunderstorm. Retrospective study of patients' accident and emergency department records, with bivariate and multivariate analysis of environmental factors and data collection for the two months surrounding the epidemic. The accident and emergency department of St Mary's Hospital in west central London. 148 patients presenting with asthma between 1 June and 31 July 1994, of whom 40 presented in the 24 hours after the storm. The asthma epidemic was significantly associated with a drop in air temperature six hours previously and a high grass pollen concentration nine hours previously. Non-epidemic asthma was significantly associated with lightning strikes, increase in humidity or sulphur dioxide concentration, a drop in temperature or high rainfall the previous day, and a decrease in maximum air pressure or changes in grass pollen counts over the previous two days. New episodes of asthma during the epidemic on 24 and 25 June 1994 were associated with a fall in air temperature and a rise in grass pollen concentration. Non-epidemic asthma was significantly associated with a greater number of environmental changes. This may indicate that the patients with thunderstorm associated asthma were a separate population, sensitive to different environmental stimuli.

A patient's view: endoscopy

Unpleasant but not painful, said my general practitioner. “They knock you out,” said a general practitioner pal. I was deeply apprehensive of this examination. The endoscopy was done in a central London hospital because it is my university vacation and my doctor in Wales, now a budget holder, arranged for the examination. It is a credit to a national health scheme that the whole operation was carried out with such smooth efficiency. I received a clear leaflet, written in a tone of becalming reassurance, setting out the procedures for the investigation. It pointed out that there were slight variations, and I thought that a nice and intelligent touch. The leaflet, which was beginning to assume the position of a sacred text in my …

Preoperative HIV antibody testing: the views of surgeons and patients.

Fifty surgeons and 72 preoperative patients in 2 central London hospitals were asked their views on preoperative HIV antibody testing, who is at risk of HIV infection and HIV test counseling. A substantial proportion of both surgeons and preoperative patients, 48% and 54% respectively, supported compulsory HIV antibody testing without patient consent. They believed this should occur as a routine practice prior to surgery. However, surgeons and patients differed in the preoperative patients to be considered for such testing. All surgeons advocating compulsory testing believed that it was only necessary for those patients belonging to high risk groups whilst preoperative patients believed that all patients should be HIV tested prior to surgery. Surgeons and patients also differed in their views on who was at risk of HIV infection. Surgeons believed those at risk to be members of identifiable risk groups whilst patients believed everyone was at risk, especially those engaging in high risk behaviours. Finally, when asked which health professionals they thought should be involved in HIV test counselling, both surgeons and patients agreed that hospital doctors, including surgeons themselves, should take on the responsibility of test counselling. The implications of this and routine HIV antibody testing are discussed.

Difference in prevalence of gestational diabetes and perinatal outcome in an innercity multiethnic London population

In order to establish the prevalence of gestational diabetes mellitus (GDM) among ethnic groups residing in the catchment area of one hospital in central London and to assess both the mode of delivery and the baby outcome, we studied retrospectively 703 women selected for screening for GDM during the years 1991 and 1992. While the prevalence of GDM was approximately 2% overall, within the ethnic groups a significant difference was found with Asians and Africans/Afrocaribbeans being four and two times more likely to have GDM, respectively, than Caucasians ( P < 0.001). Both maternal obesity and the diagnosis of GDM influenced the time and the mode of delivery, but perinatal mortality and morbidity did not differ significantly between women with GDM and women with normal glucose tolerance. An association between the GTT glucose area and the gestational age and ethnicity adjusted birth weight was observed in women with normal glucose tolerance test, but was absent in the GDM pregnancies, providing indirect evidence that dietary treatment, with or without insulin treatment, altered the maternal milieu in the latter sufficiently to modify fetal growth.

Nursing unit relieves pressure.

Direct referrals may be the next stage in the development of a successful nursing-led in-patient unit set up to take the pressure off acute services at a busy central London hospital, Department of Health Chief Nursing Officer Yvonne Moores said this week.

Who chooses to have the HIV antibody test in the antenatal clinic?

With the increase in human immunodeficiency virus (HIV) seroprevalence amongst antenatal clinic attenders, and given that current medical opinion considers it desirable that a woman is aware of her serostatus, it has been recommended that the HIV test is offered to all women in the antenatal clinic and that its uptake is monitored. This paper reports on the uptake rate during the 12 months to February 1990 at a central London hospital, which was 17%, and the characteristics of the women who agreed to be tested for HIV. Using information collected by the midwife on an interactive computer during the ‘booking’ interview, it was found that women who were single and not in a stable relationship (p<0.001) and those who described themselves as Mediterranean (p<0.01) were more likely to accept the test. Caucasian women (p<0.05) and married women (p<0.05) were less likely to accept the test. Accepters did not differ from decliners in any other variable examined. Possible reasons for these differences are discussed.

Funding policies for HIV and AIDS: time for change.

Funding for HIV and AIDS in England has been allocated to regions by a formula based on the number of cases of AIDS and HIV infection and on population size. Regions have distributed the resources directly to hospitals and community services. A survey of staff and managers in North East Thames region showed that funding arrangements have led to unsatisfactory development of services for HIV and AIDS. Firstly, because hospitals are funded according to current numbers of patients services are highly developed at the central London hospitals and underdeveloped in outer districts. Secondly, specialised community care teams have been established rather than integrating care for HIV and AIDS into generic primary care. Thirdly, the information on district of residence of infected patients is inaccurate, limiting allocation of funds according to population needs. Fourthly, prevention of infection has been given far less attention than treatment and care despite the lack of effective treatment. In future allocations for HIV and AIDS should be made to purchasers rather than directly to providers.

HIV antibody testing in the antenatal clinic: the views of the consumers

Objective: to investigate the attitudes of parturient women to HIV antibody testing in the antenatal clinic. Design: anonymous self completion questionnaire. Subjects: 318 women attending antenatal clinic for their first booking appointment. Setting: a central London hospital, UK. Results: 58% of the women felt that testing should not be compulsory, 33% that it should. Sixty per cent felt that results of the test should be given as routine but 38% felt that they should only be given if requested. Fifty five per cent felt the HIV test was as important as all the other routine tests and 60% felt that they personally did not need to be tested. Only 44% wanted to speak to a midwife about the test, with 23% saying that they did not want to speak to anyone at all. The main reason given for accepting testing was concern about passing the virus on to the baby, which was also the main concern if the test was found positive. Few women (23%) felt that those identified as positive should be encouraged to terminate their pregnancy. Conclusions: policy decisions around HIV testing should take into account the diversity of the needs and wants of this multicultural and multiracial group of consumers.

A longitudinal study of pelvic inflammatory disease.

To study the microbiology and long term prognosis of pelvic inflammatory disease (PID). A prospective study of women with laparoscopically confirmed PID. Teaching hospital in central London. 23 women with PID. Microbiological investigations at the time of diagnosis and at follow up; subsequent fertility and the occurrence of pelvic pain. PID diagnosed by laparoscopy was regarded as moderate to severe in 15 cases. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum or a combination of these micro-organisms were detected most frequently in the cervix, less often in the endometrium and least in the tubes, C. trachomatis being the micro-organism found most commonly in the tubes. There was serological evidence of acute chlamydial infection in 13 of 20 cases in which paired sera were available and a serological response to M. hominis in 9 of 12 cases in which it was possible to evaluate the results. On the basis of microbiological and serological results, C. trachomatis appeared to be the most important aetiological agent in 10 cases, N. gonorrhoeae in four cases, M. hominis in three cases and U. urealyticum in none; in five cases, two of these micro-organisms appeared to be of equal importance. After 1 to 3 years, 33% of the women were having difficulty conceiving and 56% continued to complain of pelvic pain. It is difficult to be certain of the infectious cause of PID in any given case. However, the evidence that N. gonorrhoeae and C. trachomatis are pathogens is very strong. M. hominis may be responsible for a few cases on its own or together with other micro-organisms.

A 7-year review of maxillofacial trauma in a central London hospital'

A 7-year review of maxillofacial trauma in a central London hospital'

A 7-year review of maxillofacial trauma in a central London hospital'

A 7-year review of maxillofacial trauma in a central London hospital'

A 7-year review of maxillofacial trauma in a central London hospital

Over a 7-year period from January 1, 1983 to December 31, 1989, 439 maxillofacial injuries were referred to the Oral Surgery Department of St Mary's Hospital in London. During this period there was a decrease in the incidence of maxillofacial injuries presenting as a result of road traffic accidents, with a corresponding increase in the number of cases related to assault. The patterns of age and sex distribution, however, reflected the results of previous studies by other maxillofacial units within the UK. Of particular interest is the finding that a large proportion of maxillofacial injuries (43%) included in this survey had no active treatment.

The Risks of Staying in London: A Review of Overseas Visitors Admitted to a London Hospital

A retrospective review of 103 acute admissions of overseas visitors to a central London hospital was performed. Admissions were most commonly due to infection (43 admissions) and to recurrence of preexisting disease (40 admissions). Patients over 60 years were frequently admitted with new diagnoses. Groups at risk of admission were identified and strategies to reduce admissions discussed.

Incidence and risk of transmission of HTLV III infections to staff at a London hospital, 1982–85

In 1982 only two cases of acquired immune deficiency syndrome (AIDS) and one case of persistent generalized lymphadenopathy (PGL) were diagnosed at St Stephen's hospital in central London. By 31 July 1985, the numbers of cases with these conditions had increased to 41 and 185 respectively and a total of approximately 400 patients had been recognized as having HTLV III infection. A large increase in the numbers of cases of AIDS was noted between July 1984 and July 1985. Over 80 patients with HTLV III infection were admitted to hospital and had surgery or other invasive procedures carried out. Approximately 3000 blood samples from HTLV III antibody positive patients were processed by the pathology department--mainly by the microbiology and haematology laboratories. Hospital and laboratory staff observed hepatitis B precautions. In spite of regular contact with patients with HTLV III infection and their samples, serological studies on 150 hospital staff showed no evidence of spread of HTLV III from patients to staff.

CIRRHOSIS IN SOUTH LONDON

Alcoholism was the major ætiological factor in 65% of 78 patients presenting with cirrhosis to a hospital in Central London during 1968-74. It is suggested that in the U.K. the importance of alcoholism in patients with cirrhosis has been underestimated.

SEVERE SYSTEMIC INFECTIONS COMPLICATING "MAINLINE" HEROIN ADDICTION

11 young, unemployed heroin and cocaine addicts were admitted with chest infections to three central London hospitals in a nine-month period. Septicæmia was present in 9 of them. The radiological changes in the lungs were often minor at first. 2 patients died despite intensive therapy. In such patients, blood-cultures should always be done, and pending the completion of tests at least two antistaphylococcal drugs should be given. Such drugs should be continued even when staphylococci have disappeared from the sputum.

An Address [ABRIDGED] ON THE UNITY OF MEDICINE.: Introductory to the Post-Graduation Session at the Central London Hospital for Diseases of the Throat, Nose, and Ear,

An Address [ABRIDGED] ON THE UNITY OF MEDICINE.: Introductory to the Post-Graduation Session at the Central London Hospital for Diseases of the Throat, Nose, and Ear,