Staff Publication

Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures (2017)

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Type of publication:
Journal article

Author(s):
Pascale Trepanier, Kim Mallard, Danièle Meunier, Rachel Pike, Derek Brown, Janet P. Ashby, Hugo Donaldson, F. Mustafa Awad-El-Kariem, Indran Balakrishnan, Marc Cubbon, Paul R. Chadwick, Michael Doughton, Rachael Doughton, Fiona Hardiman, *Graham Harvey, Carolyne Horner, John Lee, Jonathan Lewis, Anne Loughrey, Rohini Manuel, Helena Parsons, John D. Perry, Gemma Vanstone, Graham White, Nandini Shetty, John Coia, Camilla Wiuff, Katie L. Hopkins and Neil Woodford

Citation:
Journal of Antimicrobial Chemotherapy, Feb 2017, vol. 72, no. 2, p.596-603

Abstract:
OBJECTIVES:
To estimate UK prevalence and incidence of clinically significant carbapenemase-producing Enterobacteriaceae (CPE), and to determine epidemiological characteristics, laboratory methods and infection prevention and control (IPC) measures in acute care facilities.
METHODS:
A 6 month survey was undertaken in November 2013-April 2014 in 21 sentinel UK laboratories as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project. Up to 10 consecutive, non-duplicate, clinically significant and carbapenem-non-susceptible isolates of Escherichia coli or Klebsiella pneumoniae were submitted to a reference laboratory. Participants answered a questionnaire on relevant laboratory methods and IPC measures.
RESULTS:
Of 102 isolates submitted, 89 (87%) were non-susceptible to ≥1 carbapenem, and 32 (36%) were confirmed as CPE. CPE were resistant to most antibiotics, except colistin (94% susceptible), gentamicin (63%), tigecycline (56%) and amikacin (53%). The prevalence of CPE was 0.02% (95% CI = 0.01%-0.03%). The incidence of CPE was 0.007 per 1000 patient-days (95% CI = 0.005-0.010), with north-west England the most affected region at 0.033 per 1000 patient-days (95% CI = 0.012-0.072). Recommended IPC measures were not universally followed, notably screening high-risk patients on admission (applied by 86%), using a CPE 'flag' on patients' records (70%) and alerting neighbouring hospitals when transferring affected patients (only 30%). Most sites (86%) had a laboratory protocol for CPE screening, most frequently using chromogenic agar (52%) or MacConkey/CLED agars with carbapenem discs (38%).
CONCLUSIONS:
The UK prevalence and incidence of clinically significant CPE is currently low, but these MDR bacteria affect most UK regions. Improved IPC measures, vigilance and monitoring are required.

Obstacles to consent for intravenous rtPAin acute stroke (clinical audit and survey) (2016)

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Type of publication:
Conference abstract

Author(s):
*Alamgir M., *Srinivasan M., *Ghani U.

Citation:
Cerebrovascular Diseases, May 2016, Vol. 41, Supplement 1, p.285-286

Abstract:
Introduction: Intravenous thrombolysis with rTPA is the standard of care for the treatment of acute ischaemic stroke within 3 hrs (up to 4.5 in suitable Pt) after stroke onset. Even with clear evidence of benefit there is increased risk of harm . Due to complex risk & benefit aspects of the treatment the current guidance recommends consent should be obtained for intravenous thrombolysis whenever possible. Our objective was to review the current practice in documentation of consent and also identify the factors which contribute in fauilu-re to obtain consnet Method: We have randomly selected 25 Patient's notes those were admitted from November 2014 to May 2015 and looked for the completed consent form or documentation elsewhere. We have also conducted a survey among Stroke Consultants and medical registrars (who are involved in administration of intravenous thrombolysis) to identify the reasons responsible for failure to obtain consent in acute setting. Results: The documentation of consent was noted to be very poor (either on consent form or documentation elsewhere in notes). Consent form was completed only in 27% cases and there was no clear documentation of reasons for not obtaining consent in the rest. Survey results showed that the only 40% were aware of the consent form in pathway. Reasons of not obtaining consent were , Time pressure = 40%, Patient factors = 40, Ignorance of statistics( Not sure about actual statistics) = 20 %. Conclusion: We have recommended that the use of a consent form with visual illustrations of statistics of risks & benefits to make consent process easier to understand for patients & save time in acute settings. Alternatively suggested that If patient does not have capacity for consent then there should be every effort made to involve the family and next of kin in decision making process (Figure Presented).

Link to more details or full-text: http://misc.karger.com/products/CED_2016_041_S1/index.html

A national colposcopy survey comparing destructive versus excisional treatment for CIN (2016)

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Type of publication:
Conference abstract

Author(s):
Parry-Smith W., *Papoutsis D., Parris D., *Panikkar J., Redman C., *Underwood M.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(99)

Abstract:
Introduction Women found to have high grade CIN should be offered either ablative treatment or large loop excision of the transformation zone with appropriate biopsy. Objective 1) To learn if a trial of ablative versus excisional treatment would be supported by fellow colposcopists in the UK 2) To investigate the current practice amongst colposcopists with regards to ablative treatment for high grade CIN 3) To gain an understanding of aspects of practice such as use of local anaesthetic during punch biopsies Methods An electronic questionnaire was sent to all registered colposcopists in the United Kingdom (total = 1677). Of these, 325 responded (19%). The study was granted ethical approval by the council of the British Society for Colposcopy and Cervical Pathology (BSCCP). Results The majority of colposcopists n = 248 (76%) felt that a study investigating the morbidity and Test of Cure outcomes comparing excisional and destructive treatments was needed. A reduced complication and morbidity rate would be the greatest factor to encourage colposcopists to use destructive treatments more often n = 250 (76.92%). If a destructive treatment were found to have a significantly reduced complication, morbidity, and equal or higher patient satisfaction rate during the procedure, but resulted in a slightly higher need for further treatment 5%, this was acceptable to n = 140 (43.1%) of those surveyed. However, a further treatment rate of 2.5% was acceptable to n = 196 (60.1%). The majority n = 182 (56%) of colposcopists did not perform destructive treatments for high grade disease; For those who did not perform destructive treatments the main reason was that they were not aware of sufficient evidence for its use n = 98 (30.2%) and had no experience nor training n = 33 (10.25%). Cold coagulation was the most common destructive treatment n = 100 (31%) that colposcopists could perform, with diathermy n = 70 (22%), laser n = 11 (3.4%) and cryotherapy n = 10 (3.1%) being less prevalent. The majority of colposcopists took two punch biopsies per patient n = 190 (58.5%), with only n = 45 (13.8%) taking three or more biopsies. Silver nitrate was the most favoured haemostatic technique following punch biopsy n = 217 (66.7%), with n = 269 (87.1%) using no local analgesia. Conclusion A study investigating morbidity and Test of Cure of excisional compared with destructive treatments for high grade CIN would be supported by most participating colposcopists. Variation in practice regarding both treatment and diagnosis exists. This has quality assurance implications for a standardised national screening programme.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00174&LSLINK=80&D=ovft

Haematocolpos. A 20-year review of cases at a District General Hospital (2016)

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Type of publication:
Conference abstract

Author(s):
*Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(24)

Abstract:
Introduction Paediatric and Adolescent care is now more structured within the gynaecology department and will often be undertaken by only one or two individuals. It would be useful to know the outcome after uncommon procedures to provide advice and reassurance to both the girls and their parents. Haematocolpos is a simple adolescent surgical intervention although the underlying pathology can be variable. Methods This was a retrospective study of 23 cases of haematocolpos identified using ICD codes, theatre records and theatre diaries at the Shrewsbury and Telford Hospitals trust over a 20 year period. More than half of the cases had been managed by the author. Results The age range of the girls was 11-17 years and those presenting with delayed menarche were aged 16 or 17 years at diagnosis. The commonest symptom was pain in 17 (74%) and then delayed menarche in 3 (13%) and urinary retention or difficult micturition in 3 (13%). There were three cases of Uterus Didelyphys and in these cases the girls had had menarche 1, 2 or 3 years before. Two cases of Transverse Vaginal Septum were identified and these girls required more extensive and repeated surgery to correct their problem following referral to a tertiary centre. The follow-up period for these patients is between 6 months to 20 years. Of the 23 cases identified 4 patients were lost to follow-up but all the others remain local. Five (22%) have gone on to successful pregnancies without difficulty. A further two cases have tried for pregnancies but one lady is awaiting a kidney transplant due to chronic renal failure and the other has a partner with sperm dysfunction and her BMI precludes her from infertility treatment at present. The remaining 12 do not appear to have any contact with maternity services yet or have a referral for infertility issues. There is no evidence that any of these women have endometriosis although two have had further surgery to open up their tight hymen and two have had vaginal dilators to stretch the hymen. Conclusion The management of heamatocolpos is relatively simple but follow-up of the cases highlights the variable out comes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00037&LSLINK=80&D=ovft

The incidence of and risk factors for a repeat obstetrical anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS (2016)

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Type of publication:
Conference abstract

Author(s):
*Papoutsis D., *Henderson K., *Tapp A., *Qadri Z.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(52)

Abstract:
Objective The aim of our study was to identify the incidence of and the risk factors for a repeat OASIS in the subsequent vaginal birth of a cohort of primiparous women who sustained an OASIS in their first vaginal delivery. Methods Retrospective collection of data from the obstetric database of our hospital for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Results We identified 603 primiparous women who sustained a first episode of OASIS in their first vaginal delivery (3a tear: 43%, 3b tear: 38.6%, 3c tear: 13.1%, 4th degree tear: 5.3%). This represents an incidence of first OASIS in the population of primiparous women delivering over the same time period of 5.4% (603/11 191). In the subgroup of women with a first episode of OASIS, the mean age was 27.8 years (SD = 5.7), 30.8% had an induction of labour and 38% had an instrumental delivery. Of this initial cohort of women, 243 (40.2%) had a subsequent pregnancy. In this subgroup, 190 (78.1%) had a vaginal delivery, 13 (5.4%) had an emergency CS delivery while in labour and 40 (16.5%) had an elective CS delivery. In those that delivered vaginally, 16 women had a repeat OASIS thus representing an incidence of 8.4%. After adjusting for several confounding factors, it was found in multivariable analysis that risk factors independently associated with the risk of a repeat OASIS were the use of epidural analgesia and an episiotomy in the first delivery, and a short labour (<3 h) in the second delivery. The time interval between the two vaginal births was not associated with any increased risk of a repeat OASIS. Conclusion We have found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00085&LSLINK=80&D=ovft

The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis (2016)

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Type of publication:
Journal article

Author(s):
Carbone M., Sharp S.J., Flack S., Paximadas D., Spiess K., Adgey C., Griffiths L., Lim R., Trembling P., Williamson K., Wareham N.J., Aldersley M., Bathgate A., Burroughs A.K., Heneghan M.A., Neuberger J.M., Thorburn D., Hirschfield G.M., Cordell H.J., Alexander G.J., Jones D.E.J., Sandford R.N., Mells G.F., Jones D., Kirby J., Hirschfield G., Alexander G., Sandford R., Taylor-Robinson S., Ch'ng C.L., Rahman M., Yapp T., Sturgess R., Healey C., Czajkowski M., Gunasekera A., Gyawali P., Premchand P., Kapur K., Marley R., Foster G., Watson A., Dias A., Subhani J., Harvey R., McCorry R., Ramanaden D., Gasem J., Evans R., Mathialahan T., Shorrock C., Lipscomb G., Southern P., Tibble J., Gorard D., Palegwala A., Dawwas M., Dolwani S., Prince M., Foxton M., Elphick D., Mitchison H., Gooding I., Karmo M., Saksena S., Mendall M., Patel M., Ede R., Austin A., Sayer J., Hankey L., Hovell C., Fisher N., Carter M., Koss K., Piotrowicz A., Grimley C., Neal D., Lim G., Levi S., Ala A., Broad A., Saeed A., Wood G., Brown J., Wilkinson M., Gordon H., Ramage J., Ridpath J., Ngatchu T., Grover B., Shaukat S., Shidrawi R., Abouda G., Ali F., Rees I., Salam I., Narain M., Brown A., Williams S., Grellier L., Banim P., Chilton A., Curtis H., Gess M., Drake I., Davies M., Jones R., McNair A., Srirajaskanthan R., Pitcher M., Sen S., Bird G., Barnardo A., Kitchen P., Yoong K., Chirag O., Sivaramakrishnan N., MacFaul G., Shah A., Evans C., Saha S., Pollock K., Bramley P., Mukhopadhya A., Fraser A., Mills P., Shallcross C., Campbell S., Shepherd A., Dillon J., Rushbrook S., Przemioslo R., Macdonald C., Metcalf J., Shmueli U., Davis A., Naqvi A., Lee T., Ryder S.D., Collier J., Klass H., Ninkovic M., Cramp M., Sharer N., Aspinall R., Goggin P., Ghosh D., Douds A., Hoeroldt B., Booth J., Williams E., Hussaini H., Stableforth W., Ayres R., Marshall E., Mann S., Lombard M., Richardson P., Patanwala I., Maltby J., Brookes M., Mathew R., Vyas S., Singhal S., Gleeson D., Misra S., *Butterworth J., George K., Harding T., Douglass A., Panter S., Shearman J., Bray G., Butcher G., Forton D., Mclindon J., Das D., Cowan M., Whatley G., Mandal A., Gupta H., Sanghi P., Jain S., Pereira S., Prasad G., Watts G., Wright M., Gordon F., Unitt E., Grant A., Delahooke T., Higham A., Brind A., Cox M., Ramakrishnan S., King A., Collins C., Whalley S., Li A., Fraser J., Bell A., Wong V.S., Singhal A., Gee I., Ang Y., Ransford R., Gotto J., Millson C., Bowles J., Harrison M., Galaska R., Kendall J., Whiteman J., Lawlor C., Gray C., Elliott K., Mulvaney-Jones C., Hobson L., Van Duyvenvoorde G., Loftus A., Seward K., Penn R., Maiden J., Damant R., Hails J., Cloudsdale R., Silvestre V., Glenn S., Dungca E., Wheatley N., Doyle H., Kent M., Hamilton C., Braim D., Wooldridge H., Abrahams R., Paton A., Lancaster N., Gibbins A., Hogben K., Desousa P., Muscariu F., Musselwhite J., McKay A., Tan L., Foale C., Brighton J., Flahive K., Nambela E., Townshend P., Ford C., Holder S., Palmer C., Featherstone J., Nasseri M., Sadeghian J., Williams B., Thomas C., Rolls S.-A., Hynes A., Duggan C., Jones S., Crossey M., Stansfield G., MacNicol C., Wilkins J., Wilhelmsen E., Raymode P., Lee H.-J., Durant E., Bishop R., Ncube N., Tripoli S., Casey R., Cowley C., Miller R., Houghton K., Ducker S., Wright F., Bird B., Baxter G., Keggans J., Hughes M., Grieve E., Young K., D. Williams, Ocker K., Hines F., Innes C., Valliani T., Fairlamb H., Thornthwaite S., Eastick A., Tanqueray E., Morrison J., Holbrook B., Browning J., Walker K., Congreave S., Verheyden J., Slininger S., Stafford L., Denise O'Donnell, Ainsworth M., Lord S., Kent L., March L., Dickson C., Simpson D., Longhurst B., Hayes M., Shpuza E., White N., Besley S., Pearson S., Wright A., Jones L., Gunter E., Dewhurst H., Fouracres A., Farrington L., Graves L., Marriott S., Leoni M., Tyrer D., Martin K., Dali-kemmery L., Lambourne V., Green M., Sirdefield D., Amor K., Colley J., Shinder B., Jones J., Mills M., *Carnahan M., Taylor N., Boulton K., Tregonning J., Brown C., Clifford G., Archer E., Hamilton M., Curtis J., Shewan T., Walsh S., Warner K., Netherton K., Mupudzi M., Gunson B., Gitahi J., Gocher D., Batham S., Pateman H., Desmennu S., Conder J., Clement D., Gallagher S., Orpe J., Chan P., Currie L., Lynn O'Donohoe, Oblak M., Morgan L., Quinn M., Amey I., Baird Y., Cotterill D., Cumlat L., Winter L., Greer S., Spurdle K., Allison J., Dyer S., Sweeting H., Kordul J.

Citation:
Hepatology, March 2016, vol./is. 63/3(930-950)

Abstract:
The biochemical response to ursodeoxycholic acid (UDCA)-so-called "treatment response"-strongly predicts long-term outcome in primary biliary cholangitis (PBC). Several long-term prognostic models based solely on the treatment response have been developed that are widely used to risk stratify PBC patients and guide their management. However, they do not take other prognostic variables into account, such as the stage of the liver disease. We sought to improve existing long-term prognostic models of PBC using data from the UK-PBC Research Cohort. We performed Cox's proportional hazards regression analysis of diverse explanatory variables in a derivation cohort of 1,916 UDCA-treated participants. We used nonautomatic backward selection to derive the best-fitting Cox model, from which we derived a multivariable fractional polynomial model. We combined linear predictors and baseline survivor functions in equations to score the risk of a liver transplant or liver-related death occurring within 5, 10, or 15 years. We validated these risk scores in an independent cohort of 1,249 UDCA-treated participants. The best-fitting model consisted of the baseline albumin and platelet count, as well as the bilirubin, transaminases, and alkaline phosphatase, after 12 months of UDCA. In the validation cohort, the 5-, 10-, and 15-year risk scores were highly accurate (areas under the curve: >0.90). Conclusions: The prognosis of PBC patients can be accurately evaluated using the UK-PBC risk scores. They may be used to identify high-risk patients for closer monitoring and second-line therapies, as well as low-risk patients who could potentially be followed up in primary care.

Link to full-text (access available to eligible users via an NHS OpenAthens account)

Current evidence and future perspectives on the effective practice of patientcentered Laboratory Medicine [Italian] Attualita e prospettive sull'efficacia pratica della Medicina di Laboratorio orientata al paziente (2016)

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Type of publication:
Journal article

Author(s):
*Hallworth M.J., Epner P.L., Ebert C., Fantz C.R., Faye S.A., Higgins T.N., Kilpatrick E.S., Li W., Rana S.V., Vanstapel F.

Citation:
Biochimica Clinica, 2016, vol./is. 40/2(143-153)

Abstract:
Systematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally. This review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care. To maximize the value of laboratory medicine, work is required in 5 areas: a) improved utilization of existing and new tests; b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

Comparison of the size of persistent foramen ovale and atrial septal defects in divers with shunt-related decompression illness and in the general population (2015)

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Type of publication:
Journal article

Author(s):
Wilmshurst P.T., Morrison W.L., Walsh K.P., Pearson M.J., Nightingale S.

Citation:
Diving and Hyperbaric Medicine, June 2015, vol./is. 45/2(89-93)

Abstract:
Introduction: Decompression illness (DCI) is associated with a right-to-left shunt, such as persistent foramen ovale (PFO), atrial septal defect (ASD) and pulmonary arteriovenous malformations. About one-quarter of the population have a PFO, but considerably less than one-quarter of divers suffer DCI. Our aim was to determine whether shunt-related DCI occurs mainly or entirely in divers with the largest diameter atrial defects. Methods: Case control comparison of diameters of atrial defects (PFO and ASD) in 200 consecutive divers who had transcatheter closure of an atrial defect following shunt-related DCI and in an historic group of 263 individuals in whom PFO diameter was measured at post-mortem examination. Results: In the divers who had experienced DCI, the median atrial defect diameter was 10 mm and the mean (standard deviation) was 9.9 (3.6) mm. Among those in the general population who had a PFO, the median diameter was 5 mm and mean was 4.9 (2.6) mm. The difference between the two groups was highly significant (P < 0.0001). Of divers with shuntrelated DCI, 101 (50.5%) had an atrial defect 10 mm diameter or larger, but only 1.3% of the general population studied had a PFO that was 10 mm diameter of larger. Conclusions: The risk of a diver suffering DCI is related to the size of the atrial defect rather than just the presence of a defect.

Link to more details or full-text:

The low-down on fresh gas flows (2016)

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Type of publication:
Conference abstract

Author(s):
*Keogh T., *Elcock D.

Citation:
Anaesthesia, June 2016, vol./is. 71, Supplement 3, p. 26

Abstract:
Inhalational anaesthetic agents are minimally metabolised and mostly exhaled unchanged; using a closed breathing system with CO<inf>2</inf> absorption, reduces waste of volatiles and permits the reduction of fresh gas flow (FGF) to providing only the patient's metabolic requirements [1]. In addition to reducing wastage of volatiles, low FGF benefits the environment and improves cost effectiveness with a potentially advantageous impact on care. We looked at practice in a typical district general hospital (The Royal Shrewsbury Hospital), with the aim of identifying potential cost savings; we surveyed FGF and investigated whether our volatile costs were influenced by use of the relatively expensive sevoflurane. Methods Theatre lists were inspected to identify cases anticipated to last > 60 min, and were then audited by going into theatre and recording data. A maximum of one case was analysed from each list per day so as to avoid bias by targeting a particular anaesthetist and to avoid influences on an individual's practice once they realised they were being surveyed. A range of specialities was audited and data were collected after at least 30 min on table to allow time for the anaesthetist to modify flows. Results Median flow rates (n = 49) were found to be 0.95 l.min<sup>-1</sup> with an interquartile range of between 0.70 l.min<sup>-1</sup> and 1.10 l.min<sup>-1</sup> (Fig. 1). While these are low flows compared with those required by non-circle systems, they are not basal flow rates and therefore an estimated saving of around 50% could be made if typical flows were < 0.5 l.min<sup>-1</sup> (roughly equal to 70 000/pa in the Trust). Based on our pharmacy costs, we estimate equivalent doses of sevoflurane to be roughly 14x the cost of isoflurane, suggesting a saving of up to 93% per case if only the latter were used. However we acknowledge that this is simplistic and may not offset the disadvantages of isoflurane. Discussion We may have underestimated FGF being used; it is probable that people do not use low-flows in the anaesthetic room, at the beginning of cases, or possibly at all in shorter cases. Results have shown a generally responsible use of FGF rates, and perhaps limiting the type of volatiles used would not be as cost-effective as may have been thought, but rather encouraging the use of 'minimal flows'(< 500 ml) may be more promising. The introduction of self-adjusting low FGF on newer anaesthetic machines will also weaken any case for preferring isoflurane on grounds of cost alone – indeed manufacturers may argue the cost of this type of technology is quickly offset by the savings made in volatile costs. We think that rather than trying to reduce costs by limiting use of sevoflurane, there is more to gain by promoting the use of 'minimal flow'. (Figure Presented) .

Link to more details or full-text: http://onlinelibrary.wiley.com/doi/10.1111/anae.13519/epdf

Consultants as victims of bullying and undermining: A survey of Royal College of Obstetricians and Gynaecologists consultant experiences (2016)

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Type of publication:
Journal article

Author(s):
Shabazz T., Parry-Smith W., *Oates S., Henderson S., Mountfield J.

Citation:
BMJ Open, June 2016, vol./is. 6/6(no pagination)

Abstract:
Objective: To explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine. Design: Questionnaire survey. Setting: Royal College of Obstetricians and Gynaecologists (RCOG). Participants: O&G consultant members/fellows of the RCOG working in the UK. Main outcome measures: Measures included a typology of 4 bullying and undermining consequences from major to coping. Results: There was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on 'frequency of occurrence', 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not. Conclusions: Significant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions.