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In this paper we discuss the use of charts derived from the sequential probability ratio test (SPRT): the cumulative sum (CUSUM) chart, RSPRT (resetting SPRT), and FIR (fast initial response) CUSUM. The theoretical development of the methods is described and some considerations one might address when designing a chart, explored, including the approximation of average run lengths (ARLs), the importance of detecting improvements in a process as well as detecting deterioration and estimation of the process parameter following a signal. Two examples are used to demonstrate the practical issues of quality control in the medical setting, the first a running example and the second a fully worked example at the end of the paper. The first example relates to 30-day mortality for patients of a single cardiac surgeon over the period 1994-1998, the second to patient deaths in the practice of a single GP, Harold Shipman. The charts' performances relative to each other are shown to be sensitive to the definition of the 'out of control' state of the process being monitored. In light of this, it is stressed that a suitable means by which to compare charts is chosen in any specific application.

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If skilled histopathologists disagree over the same biopsy specimen, at least one must have an incorrect interpretation.

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Objective-To determine whether epoprostenol (prostacyclin, PGI,) or heartlung transplantation (HLT), or both improves survival of patients with severe pulmonary hypertension. Design-This was a prospective study where the effects of epoprostenol were compared with conventional treatment. Also, the benefits of epoprostenol and HLT were assessed by comparing survival Diagnostic right heart catheterisation was performed with a triple lumen flow directed catheter in all patients on entry to the study."3 A brachial artery cannula was also inserted.In nine of the 44 patients it was not possible to record pulmonary artery wedge pressure. The total pulmonary vascular resistance (mean pulmonary artery pressure/cardiac index) was therefore calculated. A further measurement similar to that in the Mayo clinic study was included. The mixed venous oxygen saturation, together with arterial oxygen saturation were recorded from blood samples. The degree of disability was assessed by the New York Heart Association (NYHA) classification. 14 The capacity to acutely vasodilate the pulmonary vasculature with epoprostenol was assessed in our patients during the catheter study.'5 The infusion rate of epoprostenol was increased step wise every 10 minutes until the