JRSM short reports最新文献

Objectives: We set out to evaluate the impact of Foundation Year (FY) training on the doctors who had been through this training system.

Design: Doctors in training were surveyed using a structured web-based questionnaire.

Setting: Postgraduate training in the UK has been the subject of much upheaval in recent years.

Participants: A total of 1065 doctors in training were surveyed in late 2011 and early 2012, of which 638 were current FY doctors.

Main outcome measures: The survey was both quantitative and qualitative, focusing on selection, working hours, training quality, training assessments and the regulation of training.

Results: A MAJORITY OF CURRENT FY TRAINEES WORKED EXTRA WEEKLY HOURS WITH THE BREAKDOWN BEING: 5-10 hrs (54%), 10-15 hrs (17%), >15 hrs (9%) and no extra weekly hours (20%). All current FY trainees wanted to work for more than 40 h a week with the following breakdown of desired hours: per week 40-48 (22%), 48-60 (50%) and 60-70 h (19%). The average hours per week spent clerking emergency admissions by current FY trainees were as follows: zero hours (11%), 0-5 h (37%), 5-10 h (30%), 10-15 h (11%) and greater (11%). A large majority (90%) felt that it was possible for incompetent trainees to obtain satisfactory results from assessments and that the FY training program was poor at identifying failing trainees. There were high levels of dissatisfaction with the selection process.

Conclusions: FY training appears to be failing in several key areas with the lack of emergency exposure a particular area of concern. It is essential that any future reforms of training address these problem areas.

Interpreting information on diagnostic accuracy is an area that health professionals struggle with. In this paper, we use the example of Mr Samways, a 45-year-old man with joint symptoms, to illustrate how to apply the results of a diagnostic accuracy study in clinical practice. We consider the various measures used to quantify diagnostic accuracy and discuss their clinical utility. We provide an overview of potential biases to consider when evaluating a diagnostic accuracy study and consider how to determine whether the results can be applied to a particular patient.

Objectives: Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), has provoked much controversy and led to arguments between the medical profession and patient organizations. A particular focus for debate is the categorization of the condition as physical or psychological in its nature. The aim of this study was to compare how the written media, patient organizations and medical authorities regard the illness.

Design: Content analysis of newspaper articles, ME patient organization websites, and medical websites and textbooks were assessed by two independent assessors.

Setting: Three national UK newspapers, UK ME websites, and UK medical websites and textbooks, were accessed during 2010.

Participants: 146 source files were scored from 36 patients' organizations, 72 media articles and 38 medical authorities.

Main outcome measured: The overall opinion of an article or website was rated using a five point Likert scale, from 'extremely psychological' (scored as 1), 'moderately psychological' (2), 'both psychological and physical' (3), 'moderately physical' (4) or 'extremely physical' (5).

Results: Eighty-nine percent (32 of 36) of ME patient organizations considered the illness to be physical, compared with 58% (42/72) of newspaper articles, and 24% (9/38) of medical authorities. Sixty-three percent (24/38) of medical authorities regarded the illness as both physical and psychological. The inter-group differences of the Likert scores were statistically significant (χ(2) = 27.37, 2 df, P < 0.001).

Conclusion: The considerable disagreement, particularly between ME patient organizations and medical authorities, may help to explain the gulf in understanding between doctors and patients and the consequent reluctance of some patients to engage in behavioural treatments.

Objectives: Advances in oncological care have led to improved short and long-term outcomes of female patients with breast and gynecological cancer but little is known about their prognosis when admitted to the intensive care unit (ICU). Our aim was to describe the epidemiology of patients with women's cancer in ICU.

Design: Retrospective analysis of data of patients with breast and gynecological cancer in ICU between February 2004 and July 2008.

Setting: ICU in a tertiary referral centre in London.

Participants: Nineteen critically ill women with breast or gynaecological cancer.

Main outcome measures: ICU and six-month outcome.

Results: Eleven women had breast cancer and eight patients had gynaecological cancer. Twelve patients were known to have metastatic disease. The main reasons for admission to ICU were sepsis (94.7%), respiratory failure (36.8%) and need for vasoactive support (26.3%). ICU mortality was 31.6%. There was no difference in age and Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) score on admission to ICU between ICU survivors and non-survivors. During their stay in ICU, non-survivors had significantly more organ failure. Six-month mortality was 68.4%. Four patients had >1 admission to ICU.

Conclusions: ICU outcome of critically ill women with breast or gynaecological cancer was similar to that of other non-cancer patient cohorts but six-month mortality was significantly higher. The decision to admit patients with women's cancer to the ICU should depend on the severity of the acute illness rather than factors related to the underlying malignancy. More research is needed to explore the outcome of patients with women's cancer after discharge from ICU.

Objectives: To ascertain clinicians' knowledge of their patients when requesting radiological investigations, as required legally by UK government legislation 'Ionising Radiation (Medical Exposure) Regulations 2000' (IRMER 2000), following the implementation of European Working Time Directive.

Design: Cross sectional survey.

Participants: All doctors requesting radiological requests every Monday, following the weekend on-call, over an 8-week period. There were no exclusion criteria.

Main outcome measures: Baseline data analysis, including grade and specialty of requesting doctor, types of modality requested, knowledge of their patient, addressograph signature confirming identity and appropriateness of investigation.

Results: 164 requests were received, the majority (61%) were made by Foundation Programme 1 (FP1) doctors and general medical specialties accounted for the highest proportion of requests (45%). Ultrasound scanning was the most frequently requested investigation (47%), closely followed by computed tomography (CT) scans (42%). Almost a third (30%) of requests were made by doctors who had not seen the patient to be investigated, predominantly by FP1 doctors (p=0.003) and more frequently by general medical specialties (p=0.001). Signatures were absent on 20% of the addressographs and overall, 10% of requests were deemed inappropriate.

Conclusions: In almost a third of radiological requests, doctors have not seen patients to be investigated, most likely as a result of shift working patterns. This does not fulfil the IRMER 2000 criteria and potentially exposes patients to unnecessary and inappropriate radiation.

Objectives: To introduce atraumatic (Sprotte) lumbar puncture needles and compare complication rates with traumatic (Quincke) needles.

Design: Complication rates associated with traumatic needle use were retrospectively analysed over a four-week period. Atraumatic needles were then implemented and a prospective analysis of the complication rates was undertaken for a further six weeks.

Setting: A single-centre acute neurology unit in a London teaching hospital.

Participants: Traumatic needles (n = 24 patients); atraumatic needles (n = 36 patients).

Main outcome measures: Headache rates, use of over-the-counter medications, further medical assistance, time off work, nausea and vomiting, traumatic taps (as per the count of red blood cells per millilitre in the first sample of cerebrospinal fluid [CSF]) and back pain.

Results: A comparison of traumatic and atraumatic needles revealed a significant reduction in the incidence of post-lumbar puncture headaches (*P < 0.01), headaches requiring over-the-counter medication (*P < 0.00001), need for further medical assistance (*P < 0.006), time off work (*P < 0.003), nausea and vomiting (*P < 0.01) and traumatic taps as per the count of red blood cells per millilitre in the first sample of CSF (*P < 0.02). There was no significant difference in the incidence of back pain (P > 0.05).

Conclusions: Most complication outcomes are significantly lower with the use of atraumatic lumbar puncture needles. We present for the first time in the literature that the rate of 'traumatic taps' are significantly lower with atraumatic needles. The implementation of atraumatic needles in an acute neurology service is safe and produces reliable, reproducible results in keeping with previously published randomized controlled trials.

Objectives: To study the effect of an educational intervention on paediatricians' knowledge, attitudes and practices regarding children's environmental health and to identify the sources of information and common environmental history taking constrains.

Design: Before and after study.

Setting: Zagazig University Paediatric Hospital.

Participants: Practising paediatricians from all specialty units.

Main outcome measures: The outcome of a specifically designed educational programme about paediatric environmental health was assessed using structured pre- and post-test questionnaires.

Results: Nearly half the participants were aware about most of the paediatric environmental health-related topics. Textbooks/guidelines (85.7%) and the Internet (64.3%) were the main sources of information. The participants demonstrated relatively strong positive attitudes towards the importance of children's environmental health. However, less than half of them (44.6%) reported environmental history taking as a routine practice; where lack of time (94.6%), wide range of hazardous exposures (91.1%) and lack of expertise and training (91.1%) were the main constrains. Significant improvement in participants' knowledge, attitudes and practices was revealed after the educational programme.

Conclusions: There is a demand for continuous medical education about environmental health in paediatric practice, particularly environmental and occupational history taking.

Objectives: To determine if current validated psychometric evaluations could determine a difference in basic behavioural characteristics between surgical and medical specialties.

Design: Cross-sectional study.

Setting: Two district general hospitals and one University teaching hospital in England, UK.

Participants: Internal medicine (16) and trauma and orthopaedic (20) consultants.

Main outcome measures: Aggression levels as assessed by the Buss and Warren questionnaire. The self-administered questionnaire assesses aggression in terms of physical, verbal, anger, hostility, indirect hostility and an overall assessment of aggression.

Results: All participants had aggression scores below the population average. We found a significant difference (P < 0.01) in total level of aggression, with orthopaedic consultants scoring a mean of 61.1 (standard deviation [SD] 9.2) and physicians 51.3 (SD 9.5). When analysis of the five different subtypes of aggression was carried out, orthopaedic surgeons scored significantly higher in terms of verbal aggression (P = 0.005), hostility (P = 0.002) and indirect hostility (P = 0.03).

Conclusion: This study joins a growing evidence base for aspects of behaviour indicative of a given specialty. Aggression is a relatively stable behavioural characteristic from adolescence, and as such this is the first study of its type to suggest that the differences in behavioural characteristics seen between specialties are inherent, rather than learned. It is unclear if the differences observed represent an attraction of that specialty to the personality type or is required for success within the given specialty. Whether this can be used in terms of selection into higher specialty training, or influence training within specialties, requires further work.

Clinical case reporting in the form of case reports and case series reports has always been an integral part of medical literature. From the late 1970s the genre appeared to fall from grace and was marginalized in many medical journals. There was controversy as to its value as a research method. From the late 1990s and onwards, there has been an increased demand for and publication of case reports and case series. The various causes for its decline and subsequent return are discussed with an emphasis on the recent historical context.