A regression model for the nonepidemic level of influenza-like syndrome has been estimated from the 55,200 cases collected between October 1984 and August 1988 using the French Communicable Diseases Computer Network. The start of a major epidemic in 1988-89 was detected early. The size of the epidemic, for the entire country, was estimated at approximately 4.3 million cases. The excess cost of sick-leave, among those of working age, was estimated at $86 million.

The implementation of a training programme based on CRM in a multidisciplinary obstetrical setting is well accepted and contributes to a significant improvement in interprofessional teamwork.

The description and first results of the French Communicable diseases Network are reported. The network, initiated in November 1984, currently includes the National Department of Health, the local health offices and various clinical, biological, and epidemiological partners. Surveillance of influenza, viral hepatitis, acute urethritis, measles, and mumps is based upon reports from sentinel general practitioners throughout France who are equipped with terminals and can communicate their data on a 24-hour basis. The network distributes electronic bulletins summarizing the surveillance data, the regional statistics concerning other diseases, and epidemiological and administrative news. Electronic mail is used for data validation and enhances communication between the parties of the network. (Am J Public Health 1986; 76:1289-1292 Introduction Surveillance has been defined as a "continued watchfulness over the distribution and trends of incidence through the systematic collection, consolidation and evaluation of morbidity and mortality reports and other relevant data."' Surveillance allows health administrators to optimally allocate health resources2; in communicable diseases, effective surveillance is necessary to prevent the spread of diseases.3In most countries, including France, a notifiable disease reporting system is the basis for surveillance. It is recognized that the quality of reporting is generally high for severe and/or rare diseases but low for diseases of higher frequency and lesser severity. The sources of information for the surveillance of communicable diseases as well as the preventive measures involve a large number of individuals and institutions: physicians in hospitals or in private practice, clinical laboratories, and both medical and nonmedical sources. In the case of the more common illnesses such as influenza, viral hepatitis, or (in France) measles, general practitioners (GPs) are the most likely physicians to uncover the cases, yet their links with public health offices or with biological laboratories aie weak. This imposes a major limitation on the effective-

A multifaceted intervention can substantially decrease the number of requests for arterial blood gas analysis and increase their appropriateness without affecting patient safety.

During the induction phase of general anaesthesia, distracting events are frequent and affect significantly the task at hand. Future research should design and implement preventive strategies to minimize the occurrence of unnecessary distracting events during this critical phase of anaesthesia when calm and vigilance should prevail.

The temporal and spatial association of meningococcal disease and influenza-like syndrome (ILS) was assessed from surveillance data on these diseases in France for a 6-year period (1985-1990). Using time series methods to account for the usual seasonal pattern meningococcal disease, the incidence of meningococcal disease in a given week was found to be linked to incidence of ILS in the 5 previous weeks but not to that in subsequent weeks. Geographic spread of meningococcal disease correlated with spread of ILS. This study also suggests that meningococcal disease is more severe for a 2-month period during and after an ILS epidemic: The proportion of cases with purpura fulminans increased by 24% and those resulting in death by 26% during this period. No shift in the age distribution was observed. When an ILS epidemic is identified, medical practitioners should be informed of the likelihood of an increased incidence and severity of meningococcal disease.

A clinical pathway in a post-anaesthesia care unit can significantly reduce length of stay and can improve post-operative outcome.

By combining the implementation of a verification protocol with periodic audits with feedback, the intervention changed practice and increased compliance with patient identity and site of surgery checks. The impact of the intervention was limited by communication problems between patients and professionals, and lack of collaboration with surgical services.