Tonsillectomy is not a procedure of limited value - the unseen costs of tonsillitis and quinsy on hospital bed consumption.

Objectives To assess the impact of the introduction of the SIGN Clinical guidelines in 1999 and subsequent revision in 2005 on tonsillectomy, hospital admission with tonsillitis and peritonsillar abscess rates in four countries. Methods Retrospective analysis using English, Welsh, Australian and New Zealand National healthcare hospital admission databases between 2000 and 2013. Primary outcomes measures included tonsillectomy rates and hospital admission rates for tonsillitis and peritonsillar abscess. Secondary outcome measures included bed‐day usage in England and Wales. Linear forecasting was used to identify the potential impact of any trends. Results Following guideline introduction for tonsillectomy, a significant decline in tonsillectomy rates in England (P < 0.01) and Wales (P < 0.05) was seen. Hospital admissions for acute tonsil infections increased in England (P < 0.01) and Wales (P < 0.01). In Australia and New Zealand, tonsillectomy and admission for tonsillitis rates both increased (P < 0.01). During this time, the increased rate of admission for tonsillitis in England and Wales was significantly greater than Australasia (P < 0.01). Conclusions Following the introduction of these Clinical guidelines, there was a decrease in the rate of tonsillectomy in England and Wales and a presumed associated increase in admissions with tonsillitis. This did not occur in Australasia where tonsillectomy rates rose over time. If these trends continue, it is likely that they will have a significant deleterious impact on healthcare spending in the future

Case Histories of Soil Behaviour and Investigations for Seismically Distressed Earthen Dams of Kachchh Region in Gujarat, India

In the morning of January 26, 2001, a devastating earthquake of magnitude Mw 7.7 rocked the Gujarat State of India. The disastrous earthquake claimed thousands of human lives besides widespread destruction of the properties including damages to water resources projects of Kachchh region. This worst ever natural calamity of recent time posed challenging and daunting task of restoration and reconstruction works. A committee of experts was constituted by Government of Gujarat with a view to assess the damages occurred to the dams & other appurtenant structures and to recommend restoration and reconstruction works. Consequent to the event, dams of Kachchh region situated within radius of 200 km from the epicenter were inspected as per the guidelines of International Commission On Large Dams (ICOLD). Integrated geotechnical investigation program comprising soil exploration and laboratory testing was chalked out to determine the properties of foundation & embankment soils. The paper describes the seismic data on Bhuj Earthquake, geology of Kachchh region, geotechnical investigation including assessment of liquefaction potential and their considerations in the restoration measures of two earth dams

Ethnic differences in patient perceptions of heart failure and treatment: the West Birmingham heart failure project

Objective: To investigate further the hypothesis that ethnic groups would have different levels of knowledge and perceptions of congestive heart failure (CHF) and treatments for this condition, a cross sectional survey was conducted of patients who were attending the heart failure clinics in two teaching hospitals of Birmingham, UK, that serve a multiethnic population. Methods: 103 patients with CHF (66 men, 37 women) were surveyed by standard questionnaire: 42 were white, 34 Indo-Asian, 22 Afro-Caribbean, and 5 Oriental. Results: When asked about their beliefs about control of one’s health, 22 (64.7%) of Indo-Asians felt that God/fate controlled their health. The majority of white patients tended to believe that the greatest factor influencing their health was the doctor (15 (35.7%)). Of the total study cohort, only 68 (66%) of patients were aware of their primary diagnosis of heart failure; the majority of Indo-Asians (21 (61.8%)) were not aware of their diagnosis. Half of Indo-Asians (17 (50%)) felt that heart failure was not severe, in contrast to 40.9% (n  =  9) of Afro-Caribbeans and only 19.1% (n  =  8) of white patients. Of the study cohort, 38 (36.9%) were taking their drugs because their doctor told them to, a response most common among the Indo-Asians. The majority of Indo-Asians (22 (64.7%)) and Afro-Caribbeans (14 (63.6%)) stated that they did not have, or did not know whether they had enough, information about their drug. The corresponding figure for white patients was 21.4% (n  =  9). When asked whether they took their medication regularly as prescribed, 7 (31.8%) of Afro-Caribbeans reported that they did not take their drugs regularly. Conclusions: Our study has highlighted deficiencies in the knowledge of CHF among patients from ethnic minority groups, as well as deficiencies in the information being given to these patients. There is a clear need to invest more in patient education for CHF, with special emphasis on certain high risk subgroups