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The role of the international reference thromboplastinspreparations (IRP) for WHO and the International Committee forStandardisation in Haematology (ICSH) was outlined by Dr J. M.Thomson (UK). The primary IRP (BCT/253) and two secondarypreparations (RBT/79 and OBT/79) were held by WHO and wereintended for the calibration of national reference preparations orworking reference thromboplastins. In addition, the EuropeanCommunity Bureau of Reference (BCR), together with ICSH,provided three reference materials coded BCT/099, OBT/79, andRBT/79. Supplies of these were more widely available. Necessarylimits on the supply of IRP and the financial charges imposed on theBCR materials had proved a barrier to implementation of thescheme in many developing and Eastern bloc countries. A furthersecondary IRP had recently been prepared on behalf of ICSH(BCT/441), to be available to designated national controllaboratories.Dr T. Exner (Australia) said that the ISI/INR system had been

applied with vigour in Australasia only since early 1986.

Approximately 60% of laboratories now used human brain

preparations similar to the Manchester comparative reagent so thatprothrombin ratios needed little adjustment for expression as INRs.The Royal College of Pathologists of Australasia’s quality assuranceprogramme had requested that all future results of prothrombintime surveys be expressed as INR.

Therapeutic ranges in oral anticoagulation based on the BritishSociety for Haematology recommendations were presented by ProfN. K. Shinton (UK). These were based on a review of the literature,a survey of current practice, and clinical experience of anticoagulanttherapy control in the UK. The following ranges are expressed asINR:

Clinical state2-0-2-5 Prophylaxis of deep vein thrombosis,

including high-risk surgery.2-0-3-0 Prophylaxis of deep vein thrombosis for hip surgery and

fractured femur.Treatment of deep vein thrombosis.Pulmonary embolism.Transient ischaemic attacks.

3’0-1 5 Recurrentdeepveinthrombosisandpulmonary embolism.Arterial disease including myocardial infarction.Arterial grafts.Cardiac prosthetic valves and grafts.

Dr B. McD. Duxbury (UK) discussed therapeutic qualitycontrol of anticoagulant treatment. The tools available had beengreatly improved. We now had sensitive and reliable

thromboplastins. Thromboplastin calibration had beenstandardised and the INR system introduced, but therapeuticquality control of oral anticoagulation was needed. Wide

therapeutic ranges had now been replaced by subdivided,narrower, and higher ranges according to the clinical condition. Ifthese new ranges were to be successfully implemented, therapeuticquality control must be applied.

ST JOHN’S HOSPITAL FOR DISEASES OF THE SKIN

SKIN diseases rarely kill people but they can be socially crippling.A London hospital with a national and international reputation forthe management of potentially disfiguring and other skindiseases-for example, by psoralen-ultraviolet A (PUVA)combination therapy for psoriasis and by thorough patch testing foreczema—is St John’s Hospital for Diseases of the Skin.The staff of St John’s Hospital include 21 senior dermatologists.

The hospital trains half the dermatologists around Britain and seesmore and more patients each year. In 1985, 75 620 patients weretreated at the hospital. Only 17% of these patients come from theSouth East Thames region, but this is the Health Authorityresponsible for St John’s and the hospital has experienced anerosion of its funds, as a result of inflation, to only 72 0,0 of the buyingpower of three years ago. The staff now fear even further attrition asa result of plans to amalgamate with St Thomas’ Hospital. St John’s

beds are presently housed at Homerton Grove (to be closed inOctober) and they are to be transferred to the north wing of StThomas’ Hospital as an interim measure until refurbishedaccommodation in the south wing is ready in about three years. It isanticipated that the outpatient department in Lisle Street, LeicesterSquare, will remain open until the spring of 1988, when it will alsomove to St Thomas’. The close liaison, of which St John’s staff areso justifiably proud, between the departments of radiotherapy andsurgery is likely to be lost in the vastness of St Thomas’. TheInstitute of Dermatology, closely connected with St John’s, willreceive protected funding for a further two years from the UnitedMedical and Dental Schools of Guy’s and St Thomas’ Hospitals. StJohn’s Hospital offers a multiregional, even international, servicewhich should, staff claim, be funded accordingly. Although moremoney may be available as a result of joining forces with StThomas’, St John’s may receive even less since Lambeth hasexperienced some of the worst of the recent cutbacks.

Postnatal Depression in Asian Women

Asian women ar not in the habit of analysing their moods and areunlikely to view themselves as depressed, so postnatal depressioncan cause misunderstandings between husband and wife anderosion of the bonding between mother and infant. The mostimportant thing is for women to know before the birth of each childthat she may become temporarily depressed afterwards, and to thisend the Asian Mother and Baby Campaign’ have produced aneducational video on postnatal depression.

Royal Free Hospital School of Medicine

The buildings which formerly housed the Royal Free HospitalSchool of Medicine in Hunter Street, London WC1, have been soldto the National Hospitals for Nervous Diseases and the Institute ofNeurology and will provide facilities for the National HospitalsCollege of Speech Sciences and for Bloomsbury Health Authoritygeneral practitioners.

Health Education in Schools

A booklet2 produced by the Department of Education andScience encompasses the range of subjects to be tackled by teachershoping to instil in their pupils some sort of knowledge about health.Health education should, it states, attempt to influence children’sbehaviour about, for example, choice of diet, smoking, road safety,and personal relationships.

University of Wales College of Medicine

The first honorary fellowship has been conferred upon DrHarold Scarborough, formerly professor of medicine, WelshNational School of Medicine.

Clinicians who might have suitable patients for a controlled trial of

cytomegalovirus hyperimmune immunoglobulin for neonates withCMV pneumonitis may obtain details of a multicentre trial which has justbegun and of methods for rapid diagnosis from the Royal Free Hospital, PondStreet, Hampstead, London NW3 2QG (telephone 01-794 0500, bleep 605,Dr Lever; bleep 669, ext 3210 or ext 3174, Dr Griffiths).

Dr John Langdale Reed, senior lecturer in the department of psychologicalmedicine, St Bartholomew’s Hospital, London, has been appointed seniorprincipal medical officer in the Department of Health and SocialSecurity. He succeeds Dr Pamela Mason.

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Dr S. J. Golding will speak on CT of Tumours in the Face and Neck ata meeting of the Institute of Laryngology and Otology, Royal NationalThroat, Nose and Ear Hospital, 330-332 Gray’s Inn Road, London WClX8EE, at 5.30 pm on Monday, July 28.

1. Asian Mother and Baby Campaign, Save the Children Fund, Mary Datchelor House,17 Grove Lane, London SE5 8RD (01-703 5400).

2. Health Education from 5 to 16. Curriculum Matters 6. Available (£2) from HMStationery Office