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A postal questionnaire on ‘sterilization and disinfection’ was sent to all 144 nurse members of the British Association of Health Services in Higher Education (BAHSHE). Forty-nine (34%) completed valid questionnaires were returned. Despite the majority of practices performing minor surgical procedures such as cervical cytology (N= 40, 82%), ear syringing (N= 44, 90%) and wound dressing (N= 49, 100%), only 11 (22%) had access to a sterile supply department (SSD), and the definitions of sterilization and disinfection were only identified by 23 (52%) and 14 (32%) of the respondents, respectively. Forty-one (84%) respondents had a benchtop sterilizer (30 had a benchtop sterilizer, 11 a vacuum sterilizer and two had both), although there was considerable confusion on their appropriate use and maintenance. Just over half had written procedures for sterilizer use, no practice changed the sterilizer water on a daily basis as recommended by the Medical Devices Agency (MDA), few kept a sterilizer logbook and even fewer had read the MDA Device Bulletin on benchtop sterilizers. The majority of respondents voiced an interest in attending a workshop on sterilization and disinfection. We conclude that despite the location of the general practices within an academic environment, the concept of infection control is clearly not understood by university health service staff. As the implications of a failure to implement proper infection control procedures are potentially serious, the need for adequate education and training of staff is of critical importance.

General practitioners are now asked to prescribe drugs that, due to possible risks and side effects, had previously been prescribed almost exclusively at hospital.

: In view of the recent trend towards more minor surgery being carried out in general practice we decided to conduct a postal survey to assess the level of knowledge of sterilization and disinfection and the use of benchtop sterilizers in general practice in Northern Ireland. The survey, of all 366 practices in the Province, was carried out in January/March 1998. One hundred and eleven (30%) completed questionnaires were returned. All practices performed at least one of a range of procedures requiring sterilization or disinfection, e.g., minor surgery 95%, cervical smear taking 98%, syringing of ears 98%. Only 76% of practices had a benchtop sterilizer and 39% did not have access to a sterile supply department (SSD); 32% of the latter had no desire to utilize such a service. Only 25% and 34% correctly identified the Medical Devices Agency (MDA) definitions of sterilization and disinfection respectively. The MDA Device Bulletin on benchtop sterilizers had been read by only 26% of respondents. There was an 86% interest in attending a workshop on sterilization and disinfection. The concepts and practice of sterilization and disinfection appear not to be clearly understood. We conclude that resources must be identified to provide appropriate education in this important area for primary care staff.

This paper outlines some early issues from a research project that is part of a North West Regional Health Authority pilot study on clinical supervision. The aims of the study and the research methodology utilized are discussed. The experiences of both a sister from a busy accident and emergency department and a practice nurse in the community are examined consecutively as supervisor and supervisee.

Serum vitamin E, vitamin E/cholesterol and physical activity and fitness were examined in a representative cross section (n= 1600) of the Northern Ireland population as part of the Northern Ireland health and activity survey. Serum vitamin E levels were measured by high-performance liquid chromatography, cholesterol by an enzymatic method, physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2max. The levels of serum vitamin E and vitamin E/cholesterol ratio in the Northern Irish population were similar or higher than in other populations with lower incidences of coronary heart disease. The assessment of activity showed that 75% of the population fell below recommended activity levels likely to confer a cardioprotective effect. A significant relationship (P= 0·01) was found in males between serum vitamin E levels and lifetime participation in physical activity. Otherwise no relationship was found between serum vitamin E or vitamin E/cholesterol ratio and physical activity or fitness in the population.

To investigate the relationship between physical activity, physical fitness, blood pressure, and fibrinogen.

Critical reading is an important skill for those trying to practice evidence-based medicine. There are a number of recognized structures for critical reading, including the READER model. These methods should be subjected to high-quality studies.

This paper outlines some early issues from a research project that is part of a North West Regional Health Authority pilot study on clinical supervision. The aims of the study and the research methodology utilized are discussed. The experiences of both a sister from a busy accident and emergency department and a practice nurse in the community are examined consecutively as supervisor and supervisee.

SUMMARYEpidemiological studies have demonstrated the considerable benefits of habitual vigorous activity, both at work and during leisure time. There are many benefits at all ages and for all levels of fitness, but particular emphasis is being placed on the cardiovascular benefits. Exercise may induce beneficial changes in lipid profile and thus reduce risk of cardiovascular disease. Lifestyle changes cost little, have few side‐effects, and are self‐administered. Increasing habitual physical activity is a form of lifestyle modification that can be tailored to all needs — a non‐therapeutic intervention of proven efficacy and of value to all patients.

In a prospective study over a period of 5 months (July-November, 1982), 506 patients were treated at a District General Hospital for a sports related injury. All the patients were seen initially in the Casualty Department and the majority of attendances (58%) were due to injuries caused by the two principal contact sports--Association and Rugby football. There were 294 patients (58%) aged 21 or less and 45 (9%) were aged 15. The study was intended to provide a summary that would quantify the local problem and assess both the efficacy of the existing system and the need for a specialist sports injury service.

OBJECTIVE: To evaluate the READER model for critical reading by comparing it with a free appraisal, and to explore what factors influence different components of the model. DESIGN: A randomised controlled trial in which two groups of general practitioners assessed three papers from the general practice section of the BMJ. SETTING: Northern Ireland. SUBJECTS: 243 general practitioners. MAIN OUTCOME MEASURES: Scores given using the READER model (Relevance, Education, Applicability, Discrimination, overall Evaluation) and scores given using a free appraisal for scientific quality and an overall total. RESULTS: The hierarchical order for the three papers was different for the two groups, according to the total scores. Participants using the READER method (intervention group) gave a significantly lower total score (P < or = 0.01) and a lower score for the scientific quality (P < or = 0.0001) for all three papers. Overall more than one in five (22%), and more men than women, read more than 5 articles a month (P < or = 0.05). Those who were trainers tended to read more articles (P < or = 0.05), and no trainers admitted to reading none. Overall, 58% (135/234) (68% (76/112) of the intervention group) believed that taking part in the exercise would encourage them to be more critical of published articles in the future (P < or = 0.01). CONCLUSION: Participants using the READER model gave a consistently lower overall score and applied a more appropriate appraisal to the methodology of the studies. The method was both accurate and repeatable. No intrinsic factors influenced the scores, so the model is appropriate for use by all general practitioners regardless of their seniority, location, teaching or training experience, and the number of articles they read regularly.

UTIs are common acute infections in nursing home residents

Two children suffering from systemic juvenile chronic arthritis (JCA)11complicated by acute disseminated intravascular coagulation (DIG) are described. One had a fatal outcome with acute renal failure and cerebral haemorrhage; the other recovered. Early recognition and treatment of the underlying cause — usually an infection — as well as replacement of clotting factors are important in management.