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T is safe to say that never before has medical knowledge and skill been at a higher level than at present; that public health work is more efficient and better organized than ever before; our standard of living has attained a relatively high level; our steadily declining mortality is a favorable expression of national health. In spite of these attainments, now that we are in a state of national emergency, we are faced with the fact that about 40 per cent of the young men of our country at ages 21 to 35 are either considered physically unfit to enter training for military service or are fit for limited service only. This fact may be considered as an important index of our national health at ages which are economically the most productive years of life. The physical status of the civilian population, because of its industrial and social value, is of grave concern to us, and it is this problem of health in national defense that was the subject of our round table conference.

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Sickle cell anaemia is common in certain ethnic groups, with well-recognized systemic manifestations. In the lung, these include a higher incidence of pneumonia, asthma, pulmonary thromboembolism, and pulmonary hypertension. In addition, nocturnal oxygen desaturation is more common, and sickle cell chronic lung disease (progressive breathlessness, abnormal pulmonary function, pulmonary hypertension) is thought to follow recurrent lung infection and infarction. A more acute presentation, the acute chest syndrome, with new pulmonary infiltrates, associated with fever, chest pain, and breathlessness, is thought to represent acute lung injury and may progress to ARDS and is one of the leading causes of death in sickle cell disease.

BackgroundChest drain displacement is a common clinical problem, occurring in 9–42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement.MethodsProspective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively-defined unintentional or accidental chest drain displacement.Results267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5/128, 3.9%; standard care displacement 13/129, 10.1%) but this was not statistically significant (Odds Ratio (OR) for drain displacement 0.36, 95% CI 0.13 to 1.0, χ2 1df=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall out rate (adjusted OR 0.27, 95% CI 0.08 to 0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59/131, 45.0%; standard care 18/132, 13.6%; χ2 1df=31.3, p<0.0001).ConclusionBalloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.