- Email: [email protected]
HIV-infected healthcare workers: results from a straw poll
patients should
NS=not
Table:
statically significant, bpm=beats per minute. QT and ventricular fibrillation
differences were found between patients with ventricular fibrillation and patients without in QT intervals, QT dispersion, or in related variables (table).
*Miguel Fiol, Jaume Marrugat, Jaume Antonio Bayés de Luna
Bergadá, Josep Guindo,
*Coronary Care Unit and Intensive Care Unit, Hospital Son Dureta, Palma de Mallorca 07014, Spain; Departament d’Epidemiologia i Salut Pública, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain; and Departament de Cardiologia, Hospital Sant Pau, Barcelona
1 Higham PD, Furniss SS, Campbell RWF. Increased QT dispersion in patients with ventricular fibrillation following myocardial infarction. Circulation 1991; 84 (suppl II): 61 (abstr). 2 Van de Loo A, Avendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994; 74: 1113-18. 3 4
Glancy JM, Garratt CJ, Woods KL, De Bono DP. QT dispersion and mortality after myocardial infarction. Lancet 1995; 345: 945-48. Leitch J, Basta M, Dobson A. QT dispersion does not predict early ventricular fibrillation after acute myocardial infarction. PACE 1995; 18: 45-48.
HIV-infected healthcare workers: results from a
straw
poll
be contacted, 83% thought this should be done via letters from the hospital; only 10% agreed with GP visits. Of the 618 GPs working in Glasgow, 82% responded to the questionnaire, 13% felt that direct contact should be made with all patients who have been under the care of an HIV-infected healthcare worker. 61% considered that all patients who had been operated on should be contacted, and 22% thought that only those undergoing exposureprone procedures should be contacted. 5% thought that no patients should be contacted directly. Of those who thought that some or all patients should be contacted, 79% felt that contact should ideally be made via letter from the hospital, 3% via a letter from the GP, 1% by a visit with the GP, and 17% by a visit with another healthcare worker. Only 5% of responding GPs agreed with the national guidelines being revised to incorporate the judge’s "face to face" recommendation. Among reasons given by the majority for opposing the revision, were: lack of time, lack of clerical support, lack of counselling skills, and lack of knowledge regarding transmission of HIV infection. A majority felt that notifying patients of possible HIV exposure in hospital was an inappropriate task for GPs; many felt they would be unable to ensure that all patients received comparable information and advice. In summary, most patients were reassured by the letter they received. Most patients and GPs felt that all patients operated on by an infected surgeon should be contacted, and that this should be done by means of a letter from the hospital. Very few patients of GPs felt that it would be appropriate for the information to be relayed face-to-face. The results of this study do not support alteration of existing recommendations so as to accommodate the Manchester
judge’s ruling. *J Pell, L Gruer Glasgow Health Board, Glasgow
surgeon in Glasgow was diagnosed as having HIV infection.’ The information was leaked to the news media, and the case received much publicity. An ad hoc team sent a letter of reassurance to all those patients who had been operated on by the surgeon during the previous 10 years, offering a telephone helpline and individual counselling if desired. This procedural
Greater
departed from national guidelines, which recommend that patients should only be notified if they have undergone "exposure-prone" procedures.2 Furthermore, in January, 1995, a judge in Manchester-in ruling that two health authorities had risked psychiatric injury to patients by notifying them in writing-advocated that any such notification should be made "face to face" by
3
SIR-In December,
1994,
a
response
a
3
patient’s general practitioner.
In view of these events, and 3 months after the
disease
surgeon’s
publicised, we sent questionnaires to all the Glasgow patients who had been sent a letter, and to all general practitioners (GPs) in greater Glasgow. Of 530 patients, 318 responded to a single mailing; 64 first became aware of the incident as a result of their original letter, and the remainder had been informed through media reports. Overall, whether first informed by the news media or not, 91% found the original letter helpful, and 80% were reassured by it. However, of those whose first inkling of was
exposure to risk came from the letter itself, 28% felt more anxious after reading it, whereas only 11 % of those already aware of the incident felt increased anxiety after reading the original letter. 89% of our responders thought that all patients treated by an HIV-infected healthcare worker should be informed of that person’s diagnosis; 9% thought that only those undergoing exposure-prone procedures should be informed, and 2% thought that letters of reassurance were unnecessary. Of 309 who thought that
1
2
G1 1ET, UK
Pell JP, Gruer L, Goldberg D. HIV-infected healthcare worker. December 1994: report and recommendations. Glasgow: Greater Glasgow Health Board, 1995. UK Departments of Health. AIDS-HIV infected healthcare workers: guidance on the management of infected healthcare workers. Department of Health, March 1994. A and B and Others vs Tameside and Glossop, and Salford and Trafford health authorities (High Court, Mr Justice French: unreported, 31 January 1995).
Mortality and haemophilia SIR-A recent study of mortality of people with haemophilia in the UK’ has been cited as convincing evidence that HIV-1 is the cause of AIDS. A countervailing theory is that AIDS results not from HIV but from exposure to combinations of pathogenic factors, including factor VIII concentrate which is used to treat haemophilia A. The Multicenter Haemophilia Cohort Study has enrolled 2041 people with haemophilia since 1982.2Using stored sera and modelling techniques, we have been able to reconstruct the HIV-1 epidemic and to improve previous estimates of HIV seroconversion dates among persons with haemophilia. We have quantified the risk and covariates of death among the HIV-1 infected cohort. We can now test whether death is related to HIV-1 infection or to factor VIII. We studied survival among all people with haemophilia A who had adequate data on dose of non-heat-treated factor VIII concentrate. Subjects were grouped by factor VIII dose as high (>20 000 U/year) or low (20 000 U/year), and by HIV-1 as infected or uninfected. Individual HIV-1 seroconversion dates were ignored. Rather, irrespective of 1425
NS=not
Table:
statically significant, bpm=beats per minute. QT and ventricular fibrillation
differences were found between patients with ventricular fibrillation and patients without in QT intervals, QT dispersion, or in related variables (table).
*Miguel Fiol, Jaume Marrugat, Jaume Antonio Bayés de Luna
Bergadá, Josep Guindo,
*Coronary Care Unit and Intensive Care Unit, Hospital Son Dureta, Palma de Mallorca 07014, Spain; Departament d’Epidemiologia i Salut Pública, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain; and Departament de Cardiologia, Hospital Sant Pau, Barcelona
1 Higham PD, Furniss SS, Campbell RWF. Increased QT dispersion in patients with ventricular fibrillation following myocardial infarction. Circulation 1991; 84 (suppl II): 61 (abstr). 2 Van de Loo A, Avendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol 1994; 74: 1113-18. 3 4
Glancy JM, Garratt CJ, Woods KL, De Bono DP. QT dispersion and mortality after myocardial infarction. Lancet 1995; 345: 945-48. Leitch J, Basta M, Dobson A. QT dispersion does not predict early ventricular fibrillation after acute myocardial infarction. PACE 1995; 18: 45-48.
HIV-infected healthcare workers: results from a
straw
poll
be contacted, 83% thought this should be done via letters from the hospital; only 10% agreed with GP visits. Of the 618 GPs working in Glasgow, 82% responded to the questionnaire, 13% felt that direct contact should be made with all patients who have been under the care of an HIV-infected healthcare worker. 61% considered that all patients who had been operated on should be contacted, and 22% thought that only those undergoing exposureprone procedures should be contacted. 5% thought that no patients should be contacted directly. Of those who thought that some or all patients should be contacted, 79% felt that contact should ideally be made via letter from the hospital, 3% via a letter from the GP, 1% by a visit with the GP, and 17% by a visit with another healthcare worker. Only 5% of responding GPs agreed with the national guidelines being revised to incorporate the judge’s "face to face" recommendation. Among reasons given by the majority for opposing the revision, were: lack of time, lack of clerical support, lack of counselling skills, and lack of knowledge regarding transmission of HIV infection. A majority felt that notifying patients of possible HIV exposure in hospital was an inappropriate task for GPs; many felt they would be unable to ensure that all patients received comparable information and advice. In summary, most patients were reassured by the letter they received. Most patients and GPs felt that all patients operated on by an infected surgeon should be contacted, and that this should be done by means of a letter from the hospital. Very few patients of GPs felt that it would be appropriate for the information to be relayed face-to-face. The results of this study do not support alteration of existing recommendations so as to accommodate the Manchester
judge’s ruling. *J Pell, L Gruer Glasgow Health Board, Glasgow
surgeon in Glasgow was diagnosed as having HIV infection.’ The information was leaked to the news media, and the case received much publicity. An ad hoc team sent a letter of reassurance to all those patients who had been operated on by the surgeon during the previous 10 years, offering a telephone helpline and individual counselling if desired. This procedural
Greater
departed from national guidelines, which recommend that patients should only be notified if they have undergone "exposure-prone" procedures.2 Furthermore, in January, 1995, a judge in Manchester-in ruling that two health authorities had risked psychiatric injury to patients by notifying them in writing-advocated that any such notification should be made "face to face" by
3
SIR-In December,
1994,
a
response
a
3
patient’s general practitioner.
In view of these events, and 3 months after the
disease
surgeon’s
publicised, we sent questionnaires to all the Glasgow patients who had been sent a letter, and to all general practitioners (GPs) in greater Glasgow. Of 530 patients, 318 responded to a single mailing; 64 first became aware of the incident as a result of their original letter, and the remainder had been informed through media reports. Overall, whether first informed by the news media or not, 91% found the original letter helpful, and 80% were reassured by it. However, of those whose first inkling of was
exposure to risk came from the letter itself, 28% felt more anxious after reading it, whereas only 11 % of those already aware of the incident felt increased anxiety after reading the original letter. 89% of our responders thought that all patients treated by an HIV-infected healthcare worker should be informed of that person’s diagnosis; 9% thought that only those undergoing exposure-prone procedures should be informed, and 2% thought that letters of reassurance were unnecessary. Of 309 who thought that
1
2
G1 1ET, UK
Pell JP, Gruer L, Goldberg D. HIV-infected healthcare worker. December 1994: report and recommendations. Glasgow: Greater Glasgow Health Board, 1995. UK Departments of Health. AIDS-HIV infected healthcare workers: guidance on the management of infected healthcare workers. Department of Health, March 1994. A and B and Others vs Tameside and Glossop, and Salford and Trafford health authorities (High Court, Mr Justice French: unreported, 31 January 1995).
Mortality and haemophilia SIR-A recent study of mortality of people with haemophilia in the UK’ has been cited as convincing evidence that HIV-1 is the cause of AIDS. A countervailing theory is that AIDS results not from HIV but from exposure to combinations of pathogenic factors, including factor VIII concentrate which is used to treat haemophilia A. The Multicenter Haemophilia Cohort Study has enrolled 2041 people with haemophilia since 1982.2Using stored sera and modelling techniques, we have been able to reconstruct the HIV-1 epidemic and to improve previous estimates of HIV seroconversion dates among persons with haemophilia. We have quantified the risk and covariates of death among the HIV-1 infected cohort. We can now test whether death is related to HIV-1 infection or to factor VIII. We studied survival among all people with haemophilia A who had adequate data on dose of non-heat-treated factor VIII concentrate. Subjects were grouped by factor VIII dose as high (>20 000 U/year) or low (20 000 U/year), and by HIV-1 as infected or uninfected. Individual HIV-1 seroconversion dates were ignored. Rather, irrespective of 1425