New episodes of asthma during the epidemic on 24 and 25 June 1994 were associated with a fall in air temperature and a rise in grass pollen concentration. Non-epidemic asthma was significantly associated with a greater number of environmental changes. This may indicate that the patients with thunderstorm associated asthma were a separate population, sensitive to different environmental stimuli.

Background and Purpose-The characteristics of intracerebral hemorrhage (ICH) may vary by ICH location because of differences in the distribution of underlying cerebral small vessel diseases. Therefore, we investigated the incidence, characteristics, and outcome of lobar and nonlobar ICH. Methods-In a population-based, prospective inception cohort study of ICH, we used multiple overlapping sources of case ascertainment and follow-up to identify and validate ICH diagnoses in 2010 to 2011 in an adult population of 695 335. Results-There were 128 participants with first-ever primary ICH. The overall incidence of lobar ICH was similar to nonlobar ICH (9.

The demand for primary care at St Mary's necessitates the provision of a primary care service, albeit for the first visit only. This can be provided by GPs in A&E. The features of the patients using the service suggests that discouraging first attendance is unrealistic, but using the visit to educate patients and return them to the care of the community is not.

Abstractand treatment for a wide range of minor Objective-To compare nurse practitioners injuries in adults and in children over the age with senior house officers (SHOs) for their of 10 years. ability to request and interpret correctly aThe nurse practitioners were able to request limited range of x ray views of patients x rays within set guidelines for injuries distal to attending a minor injuries unit.elbows and knees as well as soft tissue views for Design-Retrospective analysis of case foreign bodies. records.The A&E senior house officers (SHOs) and Methods-150 accident and emergency the nurse practitioners attended a one day (A&E) records with x ray requests were course on radiology; the SHOs also received a randomly selected from the SHOs' first, further eight hours' radiology teaching during second, and third 2-month period of their their six month appointment. The nurse prac-6-month appointments; 150 record cards titioners were trained in x ray interpretation by were randomly selected from a nearby a consultant radiologist. minor injuries unit over the same period.The red dot system' and priority next dayCopies of the records were reviewed blind reporting of all x rays were two safeguard and a decision made as to whether x ray mechanisms which were put in place at the requests were appropriate; x ray inter-MIU, as was already the established procedure pretation was compared with that of a in the A&E department.2 3 The x ray interconsultant radiologist.pretation by both the nurse practitioners and Results-106 x rays were taken on the MIU the SHOs was entered on the x ray request patients (71%) and 124 on the A&E patients form. The radiologist reporting the films then (83%). There was no statistically signifi-stated "agree" or "disagree", thereby facilicant differences in the ability of the nurse tating early identification of errors. practitioners and the SHOs to requestThe nurse practitioners work independently and interpret appropriate x rays. In both of the A&E department at St Mary's Hospital groups the decision to carry out an x ray which is two miles away, but have open access was considered appropriate in 70% of to second opinions from A&E consultants, patients; x rays were positive in about one senior registrars, and junior registrars for third. The sensitivity ofradiological inter-patients whose conditions fall outside the MIU pretation was 93%/o in both groups, and protocols. there were 2% missed positives. St Mary's Hospital has a major A&E Conclusions-Appropriately trained nursae department to which 27 634 new patients practitioners are at least as good as SHOs presented during the study period; 3498 in recognising the need for an x ray and patients were treated in the MIU during the are as competent in their interpretation. same period.

Background Hospital-based studies have reported variable associations between outcome after spontaneous intracerebral hemorrhage and peri-hematomal edema volume. Aims In a community-based study, we aimed to investigate the existence, strength, direction, and independence of associations between intracerebral hemorrhage and peri-hematomal edema volumes on diagnostic brain CT and one-year functional outcome and long-term survival. Methods We identified all adults, resident in Lothian, diagnosed with first-ever, symptomatic spontaneous intracerebral hemorrhage between June 2010 and May 2013 in a community-based, prospective inception cohort study. We defined regions of interest manually and used a semi-automated approach to measure intracerebral hemorrhage volume, peri-hematomal edema volume, and the sum of these measurements (total lesion volume) on first diagnostic brain CT performed at ≤3 days after symptom onset. The primary outcome was death or dependence (scores 3–6 on the modified Rankin Scale) at one-year after intracerebral hemorrhage. Results Two hundred ninety-two (85%) of 342 patients (median age 77.5 y, IQR 68–83, 186 (54%) female, median time from onset to CT 6.5 h (IQR 2.9–21.7)) were dead or dependent one year after intracerebral hemorrhage. Peri-hematomal edema and intracerebral hemorrhage volumes were colinear ( R2 = 0.77). In models using both intracerebral hemorrhage and peri-hematomal edema, 10 mL increments in intracerebral hemorrhage (adjusted odds ratio (aOR) 1.72 (95% CI 1.08–2.87); p = 0.029) but not peri-hematomal edema volume (aOR 0.92 (0.63–1.45); p = 0.69) were independently associated with one-year death or dependence. 10 mL increments in total lesion volume were independently associated with one-year death or dependence (aOR 1.24 (1.11–1.42); p = 0.0004). Conclusion Total volume of intracerebral hemorrhage and peri-hematomal edema, and intracerebral hemorrhage volume alone on diagnostic brain CT, undertaken at three days or sooner, are independently associated with death or dependence one-year after intracerebral hemorrhage, but peri-hematomal edema volume is not. Data access statement Anonymized summary data may be requested from the corresponding author.