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Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

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Bloodstream infection related to a central venous catheter in the intensive care unit is a substantial clinical and economic problem. The aim of the study was to examine the incidence of central line related bloodstream infections and central line associated bloodstream infections in Our Lady of Lourdes Hospital, Drogheda, during a six month period, using an active patient based prospective surveillance method. CLRBSI rate in ICU/HDU was 0.93/1000 central line days. There was no CLABSI identified in the studied time period. However, further interventions are needed, particularly with CVC care bundle. Also, the implementation of 2% chlorhexidin in 70% isopropylalcohol use for skin asepsis, which is recommended by the Irish national guidelines, would be beneficial.

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The aim of this study was to derive quality of life values for the four key breast screening outcomes (true negative, false positive, true positive and false negative), including the quality of life effects of the screening and treatment processes. In doing so, methodological issues in health status measurement were explored, in particular the valuation of temporary health states. The true negative and false positive descriptions were temporary health states, lasting for short term durations (12 months) and the true positive and false negative outcomes were chronic health states lasting for long term durations (rest of life). Descriptions of breast screening outcomes were valued using the time trade-off technique and the visual analogue scale. Paired comparisons between TTO values for states with the same duration found a difference between the true negative and the false positive time trade-off values but no difference for true positive and false negative descriptions. The TTO values for the false positive were low. The study highlights several important methodological issues such as the use of the two stage procedure for valuing temporary health states, the impact of duration on values, the impact of anchor points, and the importance of qualitative analysis of respondents values. Further empirical testing of all these issues is recommended.

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These guidelines have been produced by a working party of the Association of Local Authority Medical Advisors to help doctors arrive at equitable decisions when assessing applications for ill health retirement. The general guidelines are intended to apply to all pension schemes and the specific ones to those such as The Local Government Pension Scheme where there is a requirement for the applicant to have permanent ill health.

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Chronic alcohol exposure appears to suppress cell-mediated immunity which may contribute to the high incidence of infections among alcohol-dependent patients. We measured serum neopterin, as a marker of macrophage function and T-lymphocyte activation, in 26 alcohol-dependent patients. The mean serum neopterin in these patients was significantly lower than the mean serum neopterin in matched controls. In those who abstained, the mean serum neopterin at 3 weeks rose and was no longer significantly different from controls. Our findings suggest that alcohol-dependent patients have suppressed macrophage function which may be reversible within 3 weeks of abstention.

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The time trade-off method was incorporated into a study of valuation of health states following treatment for breast cancer. A major aim of the work was to determine whether different groups give different valuations. The time trade-off technique was simple and quick to administer, acceptable to subjects, and produced different values in different groups. Age and sex of valuers had some influence: the most striking differences were found between women who had experienced breast cancer and those who had not. The time trade-off method has considerable potential in health state valuation. The choice of valuers needs to be further explored.

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OBJECTIVE: To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN: Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS: Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information feedback from clinical or administrative data systems were reviewed. MAIN OUTCOME MEASURES: Evidence for effect of information feedback on change in clinical practice. RESULTS: Information feedback was most likely to influence clinical practice if it was part of strategy to target decision makers who had already agreed to review their practice. A more direct effect was discernable if the information was presented close to the time of decision making. The questions of the optimum layout and quantity of information were not addressed; the 36 papers were insufficient for defining good formats for information to be used for audit or quality assurance. CONCLUSIONS: Given the cost of information processing and the current emphasis on closing the audit loop in the health services, it is important that the use of information in the audit process should be critically evaluated.

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Fire setting can be a serious form of anti-social behaviour. A study of 79 consecutive out-patient attenders at a Child Guidance Clinic found a rate of 15 (18.9%). The number of fires set ranged from 1 to 20 (mean 9.9). Conduct disorder was found in 8 (53.3%) of the fire setters.

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The prolactin (PRL) response to fenfluramine (FEN), a serotonin (5-HT) releasing agent, is used as an index of 5-HT sensitivity in studying disorders associated with central 5-HT abnormality. Plasma oestrogen levels are known to augment PRL responses to a variety of stimuli. In order to examine the effect that ovarian steroids have on this response nine, healthy women were tested twice at three time points in the menstrual cycle: early follicular, mid-cycle and late luteal phase with either d-FEN, a more specific 5-HT agent than the racemic mixture, or placebo. Responses to d-FEN were maximal at mid-cycle, lowest during the early follicular phase, with responses premenstrually being intermediate between the two. Responses to placebo did not vary. Plasma oestradiol levels fluctuated in parallel with neuroendocrine responses to d-FEN. The possible mechanisms are discussed, including an effect that oestradiol may exert at central serotonin sites.

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Forty-one patients with DSM-III alcohol dependence syndrome were studied, as were 30 patients with major depression and 20 healthy controls. Nineteen of the alcohol-dependent patients had depressive symptoms. All subjects underwent a TRH/TSH stimulation test. Fifty percent of the alcohol-dependent patients without depression had a blunted response, while 52% of patients with depression were similarly blunted. The overall rate of blunting in the non-alcoholic major depressives was 26%. Blunting in the alcoholics was not associated with a personal or family history of affective disorder. Furthermore the blunted response in recently detoxified alcoholics was of no prognostic significance.

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Prolactin response to buspirone challenge was examined in eight normal healthy male and six healthy female volunteers. A significant increase in prolactin levels was noted around 90 min following oral administration of buspirone hydrochloride. When subjects were tested on two further occasions it was found that responses in males were consistently reproducible while responses in females varied throughout the menstrual cycle with maximum responses occurring premenstrually. It is postulated that increased sensitivity of the 5HT receptor premenstrually may explain the variability in females.

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