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Asbestos exposure in the workplace (do the fibres count)

Introduction

The aim of our survey was: “To establish a systematic programme to protect the health of workers from asbestos related illness”.

Our client was Dr John Alchin of the Otago Area Health Board and we were supervised by Professor Bill Glass of the Department of Preventive and Social Medicine.

The components of our study were:

  1. Establish which are at risk occupations.
  2. Establish a register of industries and workers in these occupations in Dunedin.
  3. Establish for these workers a surveillance programme:
    • Pre-employment - questionnaire, examination
    • Subsequent regular surveillance
      • chest x-ray
      • lung function tests
  4. Education of these workers on asbestos risk and how to protect themselves.
  5. Checking for compliance with Asbestos Regulations.

During the course of our study we concentrated mainly on the first three points due to time constraints but the other issues would be important to cover in the future.  We also found that a large proportion of our sample were motor mechanics therefore in the following review of asbestos related lung disease we have looked specifically at disease in this subgroup.

Authors of Report

Joseph Hassan, Nimi Jeevarathnam, Sue Read, Richard Roxburgh, Milne Simpson, Murray Smith.

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Following up patients after curative surgery for colorectal cancer

Abstract

Colorectal cancer is the second most common malignant cause of death in our society.  Each year 1800 New Zealanders develop this disease and 950 die of it.  Follow-up services obtained by 153 clients first diagnosed with colorectal cancer of Duke’s classification A, B or C without metastases, who received potentially curative surgery, were included in this study.  All clients had received their initial treatment, between the years 1986-88 inclusive, at Dunedin Public Hospital.  The clients perceived value of the follow-up percent of clients had received inadequate follow-up care during the first three post-operative years.  The criteria for this analysis was based on the minimum ideal follow-up protocols recommended by the surgeons currently practicing at Dunedin Public Hospital.  A review of relevant literature showed widely differing views on the ideal protocol for a worthiness of, follow-up care.  Several recommendations are made in order to improve the quality of follow-up care to clients undergoing potentially curative surgery for colorectal cancer.

Authors of Report

Ward Douglas, Kim Glass, Robyn Blake, Deidre McAlpine, Denise Limby, Tim Bradley, Lisa Horrell.

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Outpatient referral process:  Survey of participant’s satisfaction

Introduction

Outpatient clinics play a large part in providing specialist health care to the general community.  In an effort to study this system of health care, two aims were proposed:  firstly, to examine selected aspects of General Outpatient activities at Dunedin Public Hospital during 1988; and secondly, to ascertain the level of satisfaction with the referral process, by surveying the three parties involved – the patient, General Practitioner and Outpatient doctor. 

Tens of thousands of patients are seen each year in the Outpatients Department but until recent computerization took place, little or no information regarding the overall functioning of the department was available.

One trend that has started to emerge, is the alarmingly high rate of those who do not attend clinics.  Taking this into consideration, along with proposals from our clients, it was decided to concentrate on the following areas:

  1. Patient numbers per clinic per year
  2. Referral sources
  3. Waiting times for appointment and comparison with the incidence of those failing to attend clinics

The General Practitioner acts as the central coordinator in the referral process, deciding who will be referred to the Outpatients Department, and communicating with both the specialist and the patient in this regard.  Previous studies have shown a 25-30 fold difference in referral rates between different General Practitioners.  The reasons for this are not clear, although factors such as experience, expertise in a particular field and geographical location could be expected to contribute to the effect.  With such a large variation in rates of referral, it can be questioned whether or not resources are being used efficiently and optional care being provided.  To see if such variations existed locally we calculated referral rates for General Practitioners in the Dunedin area.

While an analysis of the numbers of patients seen in Outpatients Department provide some measures of the success of the system, if adequate health care is being provided presumably all three people involved in a referral are also satisfied.  Only one previous study examining the satisfaction of, and agreement between all three parties, has been reported.

Using a Likert type scale, (definitely no/probably no/probably yes/definitely yes), for their answers, they analysed results by discerning between definite agreement (definitely no) and some doubt (probably no/probably yes/definitely yes).   Their results showed that only 33% of the time did all three parties agree on the reason for referral.  Furthermore, only 21% of the cases showed agreement that the General Practitioner definitely could have done no more before referral, and 30% showed total agreement that the General Practitioner definitely could have managed without referral.  All three agreed that 49% of the time that the consultant seen was definitely the right person to see the patient.

In order to compare Dunedin Public Hospital with the published results, similar questions were incorporated into the questionnaire to be sent out, as well as separate questions pertinent to other issues in the referral (See Appendix B).  In this way it was hoped to examine both satisfaction, and concordance between the three groups, the latter giving some indication of the level of communication being attained.

Authors of Report

Peter McIlroy, Andrew Miller, John Woodfield.

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The acceptability of day hospital surgery to patients at Dunedin Public Hospital

Abstract

On behalf of Dr T McKendrick of the Otago Area Health Board we undertook to determine patient satisfaction with the current Day Surgery Service at Dunedin Hospital.

We distributed postal questionnaires to the 250 Day Surgery patients and their care-givers.

The response rates were 71% of patients and 58% of care-givers.  Our results showed that 93% of responders perceived that they were “well treated” as Day Surgery patients and 90% would have the same operation as a Day patient in the future.

Dissatisfaction with Day Hospital service was mainly concerned with being sent home too soon, inadequate information, a home environment not conducive to post-operative recovery, and difficulties arranging a care-giver.

Patient comments also highlighted the need for improved administration of the Day Hospital Service.

Authors of Report

Murray Malcolm, Shree Mayadeo, Shona McDowell, Jennifer O’Donnell, Anne Roche, Graham Viney, Jan Widdowson.

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The efficacy of antenatal ultrasound scanning in determining foetal outcome – a retrospective study

Abstract

A retrospective study of 2229 women who had a pregnancy between May 1 1988 – April 30 1989 was carried out, examining outcomes with respect to foetal anomalies, of pregnancies in two populations of women, one group which was scanned antenatally by ultrasound and one group which were not.

There was a highly statistically significant difference between the scanned and the non-scanned group with a larger number of congenital variables by scanning (P=0.005) in the former group.  However there was no statistical difference (P=0.45) between the two groups with respect to congenital anomalies present at birth.  It was not possible to determine the outcome of all the non-scanned pregnancies as the required data was not available in a retrospective study.

All major clinical anomalies in the scanned group were detected by ultrasound, however 50% of the anomalies overall, were not identified at the time of scanning, irrespective of the gestation at which the scan was performed.  The missed anomalies being minor ones which were not clinically significant.  Of all the congenital anomalies suspected by scan, 68% subsequently were found to be normal at birth or after short term follow-up indicated a high rate of pick-up of self-limiting anomalies.  On the basis of these results, we conclude that ultrasound scanning is useful for detecting major anomalies and if performed prior to 20 weeks gestation it allows for greater management options.  The anomalies which were missed and those suspected by subsequently resolved were minor and had limited clinical significance, therefore would add no further advantage by being detected on scanning.  It appears from this study that ultrasound scanning did identify more anomalies in the scanned group, however a significant number of pregnancies subsequently had normal outcomes.  This resulted in there being no difference between the scanned and non-scanned group with respect to foetal outcome.

Authors of Report

Farah Deobhatka, Helen Jones, Claire McNee, Peter Ooi, Andre Peyroux.

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The use of solvents and other chemicals in the light industrial setting

Aims

The aims of this study are as follows:

  1. To undertake a chemical census of all chemicals used within an area of light industry.
  2. To have an idea of what chemicals workers are exposed to most and to what use they are put.
  3. To look in more detail at solvents and solvent exposure including adequacy of labeling, time exposed, modes of exposure, levels of exposure and use of safety equipment.
  4. To determine if there are any adverse health effects to workers exposed to solvents.
  5. To pin point any health hazards perceived by workers due to chemicals.
  6. To look at the wider issue of control of toxic substances in New Zealand.
  7. To search the literature for information pertaining to solvent exposure in New Zealand and overseas.

Authors of Report

Richard H Steele, Antony Taylor, Komudi Siriwardena.

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Vaginal examination by medical students a consumer perspective

Introduction

The Cartwright report has focused attention on gynaecological practices including the teaching of vaginal examinations to medical students.  It suggested changes to exiting methods mainly in the area of consent.  Bearing in mind that communication is another major issue we felt a survey of women’s opinions was the best way to ensure a situation acceptable to all concerned.  Having decided that consent is necessary we aimed to explore who should request it.

From a brief review of the literature it was quickly seen that examinations performed by students have received little attention.  An American survey: “Women’s attitudes towards gynaecological practices” by L. Weiss and R. Meadow (Obstetrics & Gynaecology, 54:1 1979) gave questionnaires to 75 female students and faculty members at a community college.  Of these 85% reported negative feelings toward the pelvic examination ranging from anxiety to dehumanization.  Forty one percent expressed negative feelings toward their physician’s behaviour at 87% recommended changes related to this sphere compared to 29% of procedural changes.  Similar studies have produced similar results.

In our questionnaire we explored the anxiety level engendered by a vaginal examination comparing it to that of other examinations, i.e. an abdominal and a breast examination.  We aimed to discover whether the vaginal examination is set apart from other examinations by the general public or if the medical profession reinforces false barriers.

Teaching vaginal examinations under anaesthesia has long been believed to be more comfortable and acceptable for the student and the patient.  However, as with many beliefs, this has been set on an unquestioned basis.  We aimed to discover its truth.

In centres other than Dunedin healthy volunteers have been used to teach vaginal examinations to students.  This has removed the obligation at patient may feel to say yes to a doctor who is treating her.  Trained volunteers could give beneficial feedback to the student.  We investigated the acceptance of this concept and, as an initial step, whether anyone actually would volunteer.

From the results which follow we intend to express the women’s opinions on vaginal examinations by medical students.

Authors of Report

Martin Bonne, Julia Collett, Emma Henderson, Patrick Kay, Andrew Kelly, Ben Matalavea.

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What does the patient know?  A survey of how much medical patients know about their illness and treatment

Abstract

A survey was undertaken of medical patients in a large public hospital.

One hundred and twenty four patients were entered into the survey, 85 were interviewed.

Interviewing was done by telephone after the patients had been discharged.  The sixth year medical students who did the interviewing subsequently assessed the patient’s knowledge against their medical records.  The assessment was done by the students in pairs.

74% of patients had a good or excellent knowledge of what illness they had. 

45% had a good or excellent knowledge of the reason why they had their illness.

75% of patients had a good or excellent knowledge of that tests and treatments they had done.

53% had a good or excellent knowledge of the reason why they were having tests or treatments.

49% had good or excellent knowledge of what to expect in the future.

Older patients, especially those older than 75 years, were less well informed than younger patients.

Consultants told the patient most in 47% of cases, and when told by the consultant 62% of patients had good or excellent knowledge of what to expect in the future.

78% of patients were satisfied with the information they had received.

Only 1% would rather have been told less.

89% of patients said they had enough time to talk to staff.

Authors of Report

Judith Adams, Teresa Booth, Florina Chan Mow, Marjolein Copland, Lynda Croft.

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