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CONFIDENTIALITY IN SOCIAL WORK
635 MONTH OF BIRTH FOR COMPLEX VENTRICULAR SEPTAL DEFECT: HOSPITAL FOR SICK CHILDREN, JULY 1, 1968, TO JUNE 30, 1973
the N.H.S. accept their responsibilities in this matter and insist the Minister take the necessary steps to enable the N.H.S. to carry out its functions in this respect and the consultants to carry out theirs. In the county I am employed by we were recently told to fill in County Council forms giving full details of all psychiatric patients we saw-including their full names and addresses, their presenting problem, whether they were married or co-habiting or not, &c, How can the &c. hospital social worker carry out her hospital functions properly under such conditions ? SOCIAL WORKER.
"
"
simple " and complex categories-though subject to a personal bias unless carefully defined-seems valid and is intriguing because of two further findings. There were striking and significant differences in sex-ratio (46-6% female in 174 cases of simple v.s.D. v. 60-7% female in 89 complex V.S.D.) and in case-fatality within the first year of life (2-9% for simple v.s.D. v. 22-5% for complex V.S.D.).
The division of
v.s.D.s
into "
Cardiac Records and Evaluation
Section, Division of Cardiology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.
DAVID COOK VERA ROSE.
CONFIDENTIALITY IN SOCIAL WORK SIR,-Mrs Clarke (Jan. 4, p. 35) drew attention to the inroads being made into confidentiality and ethical relationships brought about by the provision of Clause 18 (4) (a), and Clause 12 (2) of the National Health Service Reorganisation Act, 1973. A form which has been issued to hospital social workers in Kent requests full details of all patients seen by social workers attached to hospital clinical teams, including their presenting problems and marital status, and social workers have also been ordered to report all non-accident injuries to the Director of Social Services. This form is indexed and a copy sent to the director. Hospital social workers in Kent have, with the support of their consultants, refused to comply with this request. They are under threat of disciplinary proceedings if they allow the information collected on this form to be passed to people outside the County Council and social services, including, presumably, medical staff who are looking after these patients. It seems that the first loyalty of hospital social workers is not now to the patient and the consultant leading the clinical team but to the Director of Social Services. This information could be used for purposes other than those concerning the patient’s health, as Mrs Clarke indicated. The hospital social workers should be supported in their stand. The matter has been referred to the Council and Ethics and Education Committee of the H.C.S.A., who view with concern the increasing dissemination of confidential
information. Normansfield Hospital,
Kingston Road, Teddington, Middlesex TWll 9JH.
I that every doctor concerned and
SiR,—I strongly support Mrs Clarke’s should like
to
add my
plea
T. LAWLOR. comments.
PREVENTION AND TREATMENT OF VARICELLA DURING STEROID THERAPY SIR,-Following the paper by Takahashi et al.1 and your editorial2 on chickenpox vaccination, I wish to report my experience in prevention and treatment of chickenpox in children undergoing corticosteroid therapy. Since Haggerty’s first paper3 there have been few reports of adverse effects of steroids on varicella.4,5 In the past three years I have treated varicella appearing during steroid therapy in 5 children aged 1-12 years. During the incubation period they received 2-5-3-0 mg. per kg. of prednisone for at least ten days (2 children for asthma,1 for nephrotic syndrome, and 2 for acute bronchiolitis). They all developed a varicella rash with atypical features and distribution: (1) all lesions were in the same stage in any general anatomical area without an erythematous base; (2) some of the lesions became large and umbilicated ; (3) the rash was more profuse on the distal extremities, and there were always lesions on the soles and palms (rare in the normal course of varicella). The treatment adopted was to stop the steroids gradually and to transfuse fresh leucocytes and plasma (20 ml. per kg.) from adult donors recently convalescent from varicella. The effect was dramatic: twenty-four to thirty-six hours after the single transfusion, the atypical varicella lesions dried up, and no new lesions appeared. None of the children developed progressive varicella. No signs of graft-v.-host reaction were observed. Zoster immune globulin has been demonstrated to be an important factor in prevention of varicella 6; and transfer factor was introduced in clinical practice.7 These developments make it possible to prevent and treat varicella in children at risk:
(1) Immediately after contact with varicella, zoster immune globulin or fresh convalescent serum should be given. (2) When the first lesion of varicella is observed, leucocytes should be transfused from a convalescent adult donor. (3) Children with lymphoproliferative disorders on immunosuppressive therapy should receive transfer factor from lymphocytes of varicella-convalescent donors. (4) If this treatment fails, the administration of cytosine arabinose should be considered.
Until the
development
of
a
may prevent the serious
ated with steroid
safe vaccine, this regimen of varicella associ-
complications therapy.
Pædiatrics Department A, Rokach Hospital, Tel-Aviv, Israel. 1.
Takahashi, M., Otsuka, T., Okuno, Y., Yazaki, T., Isomura, S. Lancet, 1974, ii, 1288.
2. ibid. p. 1300. 1974. 3. Haggerty, R. J., Eley, R. C. Pediatrics, 4. Finkel, K. C. ibid. 1961, 28, 436. 5. Christie, A. B. Infectious Diseases: 6. 7.
Z. SPIRER.
1965, 18, 160.
Epidemiology and Clinical Practice; p. 269. London, 1974. Brunell, P. A., Gershon, A. A., Hughes, W. T., Riley, H. D., Jr., Smith, J. Pediatrics, 1972, 50, 718. Lawrence, H. S. Selective Immunotherapy with Transfer Factor in Clinical Immunology (edited by F. H. Bach and R. A. Good); vol. II, p. 115. New York, 1974.
the N.H.S. accept their responsibilities in this matter and insist the Minister take the necessary steps to enable the N.H.S. to carry out its functions in this respect and the consultants to carry out theirs. In the county I am employed by we were recently told to fill in County Council forms giving full details of all psychiatric patients we saw-including their full names and addresses, their presenting problem, whether they were married or co-habiting or not, &c, How can the &c. hospital social worker carry out her hospital functions properly under such conditions ? SOCIAL WORKER.
"
"
simple " and complex categories-though subject to a personal bias unless carefully defined-seems valid and is intriguing because of two further findings. There were striking and significant differences in sex-ratio (46-6% female in 174 cases of simple v.s.D. v. 60-7% female in 89 complex V.S.D.) and in case-fatality within the first year of life (2-9% for simple v.s.D. v. 22-5% for complex V.S.D.).
The division of
v.s.D.s
into "
Cardiac Records and Evaluation
Section, Division of Cardiology, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.
DAVID COOK VERA ROSE.
CONFIDENTIALITY IN SOCIAL WORK SIR,-Mrs Clarke (Jan. 4, p. 35) drew attention to the inroads being made into confidentiality and ethical relationships brought about by the provision of Clause 18 (4) (a), and Clause 12 (2) of the National Health Service Reorganisation Act, 1973. A form which has been issued to hospital social workers in Kent requests full details of all patients seen by social workers attached to hospital clinical teams, including their presenting problems and marital status, and social workers have also been ordered to report all non-accident injuries to the Director of Social Services. This form is indexed and a copy sent to the director. Hospital social workers in Kent have, with the support of their consultants, refused to comply with this request. They are under threat of disciplinary proceedings if they allow the information collected on this form to be passed to people outside the County Council and social services, including, presumably, medical staff who are looking after these patients. It seems that the first loyalty of hospital social workers is not now to the patient and the consultant leading the clinical team but to the Director of Social Services. This information could be used for purposes other than those concerning the patient’s health, as Mrs Clarke indicated. The hospital social workers should be supported in their stand. The matter has been referred to the Council and Ethics and Education Committee of the H.C.S.A., who view with concern the increasing dissemination of confidential
information. Normansfield Hospital,
Kingston Road, Teddington, Middlesex TWll 9JH.
I that every doctor concerned and
SiR,—I strongly support Mrs Clarke’s should like
to
add my
plea
T. LAWLOR. comments.
PREVENTION AND TREATMENT OF VARICELLA DURING STEROID THERAPY SIR,-Following the paper by Takahashi et al.1 and your editorial2 on chickenpox vaccination, I wish to report my experience in prevention and treatment of chickenpox in children undergoing corticosteroid therapy. Since Haggerty’s first paper3 there have been few reports of adverse effects of steroids on varicella.4,5 In the past three years I have treated varicella appearing during steroid therapy in 5 children aged 1-12 years. During the incubation period they received 2-5-3-0 mg. per kg. of prednisone for at least ten days (2 children for asthma,1 for nephrotic syndrome, and 2 for acute bronchiolitis). They all developed a varicella rash with atypical features and distribution: (1) all lesions were in the same stage in any general anatomical area without an erythematous base; (2) some of the lesions became large and umbilicated ; (3) the rash was more profuse on the distal extremities, and there were always lesions on the soles and palms (rare in the normal course of varicella). The treatment adopted was to stop the steroids gradually and to transfuse fresh leucocytes and plasma (20 ml. per kg.) from adult donors recently convalescent from varicella. The effect was dramatic: twenty-four to thirty-six hours after the single transfusion, the atypical varicella lesions dried up, and no new lesions appeared. None of the children developed progressive varicella. No signs of graft-v.-host reaction were observed. Zoster immune globulin has been demonstrated to be an important factor in prevention of varicella 6; and transfer factor was introduced in clinical practice.7 These developments make it possible to prevent and treat varicella in children at risk:
(1) Immediately after contact with varicella, zoster immune globulin or fresh convalescent serum should be given. (2) When the first lesion of varicella is observed, leucocytes should be transfused from a convalescent adult donor. (3) Children with lymphoproliferative disorders on immunosuppressive therapy should receive transfer factor from lymphocytes of varicella-convalescent donors. (4) If this treatment fails, the administration of cytosine arabinose should be considered.
Until the
development
of
a
may prevent the serious
ated with steroid
safe vaccine, this regimen of varicella associ-
complications therapy.
Pædiatrics Department A, Rokach Hospital, Tel-Aviv, Israel. 1.
Takahashi, M., Otsuka, T., Okuno, Y., Yazaki, T., Isomura, S. Lancet, 1974, ii, 1288.
2. ibid. p. 1300. 1974. 3. Haggerty, R. J., Eley, R. C. Pediatrics, 4. Finkel, K. C. ibid. 1961, 28, 436. 5. Christie, A. B. Infectious Diseases: 6. 7.
Z. SPIRER.
1965, 18, 160.
Epidemiology and Clinical Practice; p. 269. London, 1974. Brunell, P. A., Gershon, A. A., Hughes, W. T., Riley, H. D., Jr., Smith, J. Pediatrics, 1972, 50, 718. Lawrence, H. S. Selective Immunotherapy with Transfer Factor in Clinical Immunology (edited by F. H. Bach and R. A. Good); vol. II, p. 115. New York, 1974.