Managing magnets: An audit of introduction of the Royal College of Emergency Medicine Best Practice Guideline.

AIM: To evaluate management of children and young people presenting to the Emergency Department (ED) with magnet ingestion before and after new guidance. METHODS: In May 2021, a National Patient Safety Agency and Royal College of Emergency Medicine (RCEM) Best Practice Guideline about management of ingested magnets was published. This was implemented in our department. Children and young people presenting after magnet ingestion were identified from SNOMED (coded routinely collected data) and X-ray requests between January 2016 and March 2022. Management was compared to national guidance. RESULTS: There were 138 patient episodes of magnet ingestion, with a rising incidence over the 5-year period. Following introduction of the guideline, there was a higher incidence of admission (36% vs. 20%) and operative intervention (15.7% vs. 8%). Use of follow-up X-ray increased from 56% to 90%. There was substantial variation in the management prior to guidance which reduced after introduction of the RCEM guidance. CONCLUSION: Management of magnet ingestion has become more standardised since introduction of the National RCEM Best Practice Guideline, but there is still room for improvement.

Evaluation of a workplace suicide prevention program in the Australian manufacturing industry: protocol for a cluster-randomised trial of MATES in manufacturing.

Males are at higher risk of death by suicide than females in Australia, and among men, blue-collar males are at higher risk compared to other working males. In response, MATES in Construction developed a workplace suicide prevention program for the construction sector in 2007 that has been widely implemented in Australia. In the current project, this program is being adapted and trialled in the manufacturing sector. The common aims of MATES programs are to improve suicide prevention literacy, help-seeking intentions, and helping behaviours. The program will be evaluated using a cluster randomised-controlled trial design with waitlist controls across up to 12 manufacturing worksites in Australia. We hypothesise that after 8 months of the MATES in Manufacturing program, there will be significantly greater improvements in help-seeking intentions (primary outcome) compared to waitlist controls. The project is led by Deakin University in collaboration with the University of Melbourne, and in partnership with MATES in Construction and a joint labour-management Steering Group.Trial registration: The trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry on 25 January 2022 (ACTRN12622000122752).Protocol version: 2.0, November 2022.

Norwich COVID-19 testing initiative pilot: evaluating the feasibility of asymptomatic testing on a university campus.

BACKGROUND: There is a high prevalence of COVID-19 in university-age students, who are returning to campuses. There is little evidence regarding the feasibility of universal, asymptomatic testing to help control outbreaks in this population. This study aimed to pilot mass COVID-19 testing on a university research park, to assess the feasibility and acceptability of scaling up testing to all staff and students. METHODS: This was a cross-sectional feasibility study on a university research park in the East of England. All staff and students (5625) were eligible to participate. All participants were offered four PCR swabs, which they self-administered over two weeks. Outcome measures included uptake, drop-out rate, positivity rates, participant acceptability measures, laboratory processing measures, data collection and management measures. RESULTS: 798 (76%) of 1053 who registered provided at least one swab; 687 (86%) provided all four; 792 (99%) of 798 who submitted at least one swab had all negative results and 6 participants had one inconclusive result. There were no positive results. 458 (57%) of 798 participants responded to a post-testing survey, demonstrating a mean acceptability score of 4.51/5, with five being the most positive. CONCLUSIONS: Repeated self-testing for COVID-19 using PCR is feasible and acceptable to a university population.

Core outcome set for uncomplicated acute appendicitis in children and young people.

BACKGROUND: Research studies to inform clinical practice and policy in children and young people with appendicitis are hampered by inconsistent selection and reporting of outcomes. The aim of this study was to develop a core outcome set for reporting all studies of uncomplicated acute appendicitis in children and young people. METHODS: Systematic literature reviews, qualitative interviews with parents and patients treated for uncomplicated acute appendicitis, and a Study-Specific Advisory Group informed a long list of outcomes. Outcomes were then prioritized by stakeholders based in the UK (patients, parents, and paediatric and general surgeons) in an online three-round Delphi consensus process, followed by face-to-face consensus meetings. RESULTS: A long list of 40 items was scored by 147 key stakeholders in the first Delphi round, of whom 90 completed the two subsequent Delphi rounds. The final core outcome set comprises 14 outcomes: intra-abdominal abscess, reoperation (including interventional radiology procedure), readmission to hospital, bowel obstruction, wound infection, antibiotic failure, wound complication, negative appendicectomy, recurrent appendicitis, death, patient stress/psychological distress, length of hospital stay, time away from full activity and child's quality of life. CONCLUSION: A core outcome set comprising 14 outcomes across five key domains has been developed for reporting studies in children and young people with uncomplicated acute appendicitis. Further work is required to determine how and when to measure these outcomes.

ANTECEDENTES: Los estudios de investigación que sirvan de base para la práctica clínica y la política en niños y adultos jóvenes con apendicitis se ven obstaculizados por inconsistencias en la selección y descripción de los resultados. El objetivo de este estudio fue desarrollar un conjunto central de resultados para todos los estudios de apendicitis aguda no complicada en niños y adultos jóvenes. MÉTODOS: Para establecer una lista de resultados se efectuaron revisiones sistemáticas de la literatura, entrevistas cualitativas con padres y pacientes tratados por apendicitis aguda no complicada, y consulta con un Grupo de Asesoramiento Específico para el Estudio. Seguidamente, los resultados se priorizaron de acuerdo con los intereses de las partes interesadas (pacientes, padres, y cirujanos pediátricos y generales) en el Reino Unido a través de un proceso de consenso Delphi de tres rondas en Internet, seguido de reuniones personales de consenso. RESULTADOS: Un total de 147 participantes puntuaron una larga lista de 40 ítems en la primera ronda Delphi, de los cuales 90 completaron las dos rondas Delphi subsiguientes. El conjunto final incluye 14 resultados: absceso intra-abdominal, reoperación (incluyendo procedimientos radiológicos intervencionistas), reingreso, obstrucción intestinal, infección de herida, otras complicaciones de la herida, fracaso del tratamiento con antibióticos, apendicectomía blanca, apendicitis recidivante, muerte, estrés del paciente/sufrimiento psicológico, duración de la estancia hospitalaria, tiempo alejado de todas sus actividades y calidad de vida. CONCLUSIÓN: Se ha desarrollado un conjunto central de resultados que incluye 14 resultados en cinco dominios clave para la descripción de estudios en niños y adultos jóvenes con apendicitis aguda no complicada. Se requieren más trabajos para determinar cómo y cuándo conviene medir estos resultados.

Diagnostic laparoscopy to exclude malrotation following inconclusive upper gastrointestinal contrast study in infants.

PURPOSE: We report the use of diagnostic laparoscopy as an alternative to laparotomy in the investigation of infants with clinical features concerning for malrotation and inconclusive upper gastrointestinal contrast study. METHOD: Case note review of all infants in whom laparoscopy was performed during 2016-2020 to investigate for possible malrotation. RESULTS: Eight infants were identified. All presented with acute clinical features of malrotation (bilious vomit) without evidence of an alternate explanatory diagnosis. All underwent upper gastrointestinal contrast study, with three also undergoing abdominal ultrasound. The radiological examinations could not exclude malrotation and all proceeded to laparoscopy. At laparoscopy, the small intestine was run to exclude the presence of midgut volvulus. In six cases, normal rotation was confirmed and no abnormal pathology was found. Two proceeded to laparotomy and underwent correction of malrotation. All infants recovered without complication. CONCLUSION: Laparoscopy is an excellent modality for further investigation of infants presenting acutely in whom intestinal malrotation cannot be formally excluded radiologically. The positive identification of the DJ flexure and cecum in correct anatomical sites, both fixed to the posterior abdominal wall, provides adequate reassurance of low risk of volvulus and avoids a full laparotomy. We recommend diagnostic laparoscopy in cases of inconclusive upper gastrointestinal contrast study.

Receiving essential health services on country: Indigenous Australians, native title and the United Nations Declaration.

OBJECTIVES: The aim of the study was to investigate the public health challenge to provide chronic disease management to Indigenous Australians who wish to remain on traditional lands and not cede tenure for health services. STUDY DESIGN: Within the context of the United Nations (UN) Declaration on the Rights of Indigenous Peoples (DRIP), this research is intended to reveal health aspects requiring holistic consideration and thus enhance the resilience of Australia's First Nations Peoples. METHODS: Lead authorship was by an Australian Aboriginal author, using methods of an information and literature review. A case study of chronic kidney disease illustrates the challenges remaining with native title land tenure. RESULTS: Despite continuing land tenure challenges, Indigenous Australians have demonstrated resilience and resourcefulness to engage and secure improvements in health and other basic services. CONCLUSIONS: The Australian Government needs to revisit its duty to respect, protect and fulfil its obligation to the country's First Nations people in a human rights-based approach towards improved, accessible and culturally appropriate health care for chronic diseases.

Diets of reef-dwelling labrids (Choerodon species) vary with body size, season and habitat: influence of foraging ability, specialization and opportunism.

Contemporary multivariate statistics were used to test the hypotheses that the dietary compositions of three populations of labrids on the west Australian coast are related to body size and undergo seasonal changes and to elucidate the relative extents and basis for any dietary differences within and between those populations. Gut content analyses determined the dietary compositions of Choerodon rubescens in marine waters of the outer reefs in the World Heritage Area of Shark Bay (26° S; 114° E) and of Choerodon schoenleinii in inner protected reefs of that large embayment. The dietary compositions of C. rubescens and C. schoenleinii differed significantly among length classes, progressed serially with increasing body size, both overall and almost invariably in each season and were more closely related to body size than season, whose effect was at best minimal. The size-related dietary change in C. rubescens involved, in particular, a shift from crustaceans and non-mytilid bivalves to mytilid bivalves and echinoid echinoderms. Although the diet of C. schoenleinii followed similar size-related changes, it contained a greater volume of gastropods when the fish were small and mytilids when large and only a small volume of echinoids. The dietary composition of C. rubescens in the Abrolhos Islands, 300 km to the south of Shark Bay, was related both to length class and season and differed from that of this labrid in Shark Bay with the ingestion of lesser volumes of mytilids and greater volumes of echinoids. The size-related changes in diet imply that these species shift from foraging over soft substrata to over reefs as their very well-developed jaws become sufficiently strong to remove attached and larger prey. The dietary compositions of C. rubescens and C. schoenleinii in Shark Bay and of C. rubescens at the Abrolhos Islands were related far more to habitat-locational differences than to length class and season. The above intraspecific and interspecific differences in diet are consistent with qualitative accounts of the relative abundances of the main prey in their respective environments, supporting the view that, despite specializations in their feeding apparatus, these labrids can feed opportunistically to a certain extent and could thus potentially respond to moderate changes in the composition of their prey caused by climate change and other anthropogenic effects.

Self-efficacy and comfort with partner-assisted skin examination in patients receiving follow-up care for melanoma.

The objective of this study was to examine the role of interpersonal variables on melanoma survivors' self-efficacy for performing skin self-examinations (SSEs) during melanoma follow-up care. Specifically, the impact of comfort with partner assistance for SSE, SSE support received from one's partner, general partner support, relationship satisfaction, as well as partner attendance at a SSE education session, were examined. One hundred and thirty-seven patients with melanoma between the ages of 18 and 70 years, who also reported being involved in a romantic relationship, received a standardized education on SSE, and completed self-report questionnaires. Results indicate that SSE support and SSE comfort predicted patients' SSE self-efficacy. Partner attendance at the SSE education moderated the relationship between SSE comfort and SSE self-efficacy. In other words, SSE self-efficacy was found to be affected by partner attendance at the SSE education only in cases where the patient reported lower levels of comfort having his or her partner assist with SSE. Results highlight the importance of partner involvement in SSE education, as well as patient comfort with a partner's assistance during skin examinations. Findings inform potential modifications to the follow-up care provided to melanoma survivors by demonstrating the importance of partner involvement in SSE education.

Biological characteristics of three co-occurring species of armorhead from different genera vary markedly from previous results for the Pentacerotidae.

Biological characteristics of Pentaceropsis recurvirostris, Paristiopterus gallipavo and Parazanclistius hutchinsi were determined from commercial gillnet samples from temperate south-western Australian coastal waters. Growth zones in otoliths, with more than a few such zones, were readily detectable only after the otoliths had been sectioned. Visual analyses and modelling of the trends in marginal increments on sectioned otoliths demonstrate that these opaque zones are formed annually. Maximum ages of 55, 36 and 49 years, derived for P. recurvirostris, P. gallipavo and P. hutchinsi, respectively, reflect relatively low mortalities. These longevities greatly exceed those estimated, using otoliths, for Pentaceros wheeleri and Pentaceros richardsoni, which belong to the other pentacerotid subfamily. These differences may be due to the counts of 'daily' growth zones in sectioned otoliths of P. wheeleri not representing the complete age range of that species and the zones detected in whole otoliths of P. richardsoni not constituting the complete range of annually-formed zones. Pentaceropsis recurvirostris, P. gallipavo and P. hutchinsi recruited into the fishery in the sampling area as 2-3 year-old fishes. Pentaceropsis recurvirostris and P. hutchinsi exhibited little or no subsequent growth throughout the remainder of their protracted life, whereas, P. gallipavo continued to grow for c. 5 years and then underwent little further growth. Spawning of P. recurvirostris and P. hutchinsi peaked in the austral winter and autumn, respectively, but in the austral spring and summer with P. gallipavo, which is more typical of temperate species. Although the females of P. gallipavo and P. hutchinsi were mature, this did not apply to a few P. recurvirostris, some of which were >20 years old, implying that any given female of this species does not always spawn every year. Ovarian mass greatly exceeded testis mass, indicative of pair spawning, which is consistent with field observations. In contrast to P. recurvirostris and P. hutchinsi, the sex ratio was heavily biased towards males and the spawning period longer in P. gallipavo, suggesting that selection pressures for spawning success were greater for this latter species.

Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study.

BACKGROUND: This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis. METHODS: Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage. RESULTS: Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003). CONCLUSIONS: Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.

Phylogenomics of the killer whale indicates ecotype divergence in sympatry.

For many highly mobile species, the marine environment presents few obvious barriers to gene flow. Even so, there is considerable diversity within and among species, referred to by some as the 'marine speciation paradox'. The recent and diverse radiation of delphinid cetaceans (dolphins) represents a good example of this. Delphinids are capable of extensive dispersion and yet many show fine-scale genetic differentiation among populations. Proposed mechanisms include the division and isolation of populations based on habitat dependence and resource specializations, and habitat release or changing dispersal corridors during glacial cycles. Here we use a phylogenomic approach to investigate the origin of differentiated sympatric populations of killer whales (Orcinus orca). Killer whales show strong specialization on prey choice in populations of stable matrifocal social groups (ecotypes), associated with genetic and phenotypic differentiation. Our data suggest evolution in sympatry among populations of resource specialists.

Determining critical nutrient thresholds needed to control harmful cyanobacterial blooms in eutrophic Lake Taihu, China.

Nutrient overenrichment has led to dramatic increases in harmful cyanobacterial blooms, creating serious threats to drinking water supplies, ecological and economic sustainability of freshwater ecosystems. Nutrient-cyanobacterial bloom interactions were examined in eutrophic Lake Taihu, China. In situ microcosm nutrient dilution bioassays and mesocosm nutrient addition experiments were conducted to determine nitrogen (N) and phosphorus (P) concentration and load thresholds needed to control cyanobacterial bloom formation. Blooms were dominated by toxic, non N2 fixing Microcystis spp, from May to December. Dilution bioassays showed seasonality in nutrient limitation, with P-availability controlling prebloom spring conditions and N-availability controlling summer-fall blooms. Nutrient dilution and enrichment bioassays indicated that total nitrogen (TN) and total phosphorus (TP) concentration thresholds should be targeted at below 0.80 mg L(­1) and 0.05 mg L(­1), respectively, to limit intrinsic growth rates of Microcystis dominated blooms. Based on estimates of nutrient loading and observed stoichiometry of phytoplankton biomass, 61­71% TN and 20­46% TP reduction are necessary to bring Taihu's phytoplankton biomass to "acceptable" sub-bloom conditions of less than 20 µg L(­1) chlorophyll a.

Colonic transit in the empty colon after defunctioning ileostomy: do we really know what happens?

BACKGROUND: There is disagreement amongst surgeons about the use of oral mechanical bowel preparation (MBP) prior to low anterior resection with diverting ileostomy. Colonic transit in the early post-operative period is an important factor in determining the role of MBP, as propagation of any stool remaining in the defunctioned colon may exacerbate morbidity in the event of anastomotic leak. We studied colonic transit time in the first 7 days following low anterior resection with diverting ileostomy. METHODS: We conducted a prospective observational study of patients with rectal cancer undergoing elective low anterior resection with diverting ileostomy in a tertiary colorectal unit. Twenty radio-opaque markers were inserted into the caecum via the distal limb of the loop ileostomy at surgery. Plain abdominal radiographs were taken on post-operative days 1, 3 and 5. The primary endpoint was passage of the markers to the neorectum. Data were collected on treatment, return of gastrointestinal function and complications. RESULTS: Twenty-two patients (mean age 68.5 years; 18 males) participated in the study. In 20 patients, all markers remained in the right colon on day 7. Three markers were present in the left colon in one patient, and eight markers were present in the neorectum in another patient, on the seventh day. CONCLUSIONS: Colonic transit may be abolished by the presence of diverting ileostomy. It should now be established whether clearance of the left colon alone, using enemas, is sufficient for patients undergoing low anterior resection, thus avoiding the morbidity associated with oral MBP.

Association of Toll-like receptor polymorphisms with HIV status in North Americans.

Single-nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) genes TLR2-4 and TLR7-9, but not in TLR1 and TLR6, have been previously evaluated regarding human immunodeficiency virus (HIV) acquisition and disease progression in various populations, most of which were European. In this study, we examined associations between a total of 41 SNPs in 8 TLR genes (TLR1-4, TLR6-9) and HIV status in North American subjects (total n=276 (Caucasian, n=102; African American, n=150; other, n=24)). Stratification of the data by self-identified race revealed that a total of nine SNPs in TLR1, TLR4, TLR6 and TLR8 in Caucasians, and two other SNPs, one each in TLR4 and TLR8, in African Americans were significantly associated with HIV status at P<0.05. Concordant with the odds ratios of these SNPs, significant differences were observed in the SNP allele frequencies between HIV+ and HIV- subjects. Finally, in Caucasians, certain haplotypes of single (TLR1 and TLR4) and heterodimer (TLR2_TLR6) genes may be inferred as 'susceptible' or 'protective'. Our study provides in-depth insight into the associations between TLR variants, particularly TLR1 and TLR6, and HIV status in North Americans, and suggests that these associations may be race specific.

Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units.

BACKGROUND: Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units. METHODS: This multicentre observational study included all children (aged less than 16 years) who had an appendicectomy at either a paediatric surgery unit or general surgery unit. The primary outcome was normal appendicectomy rate (NAR). Secondary outcomes included 30-day adverse events, use of ultrasound imaging and laparoscopy, and consultant involvement in procedures. RESULTS: Appendicectomies performed in 19 paediatric surgery units (242 children) and 54 general surgery units (461 children) were included. Children treated in paediatric surgery units were younger and more likely to have a preoperative ultrasound examination, a laparoscopic procedure, a consultant present at the procedure, and histologically advanced appendicitis than children treated in general surgery units. The unadjusted NAR was significantly lower in paediatric surgery units (odds ratio (OR) 0.37, 95 per cent confidence interval 0.23 to 0.59; P < 0.001), and the difference persisted after adjusting for age, sex and use of preoperative ultrasound imaging (OR 0.34, 0.21 to 0.57; P < 0.001). Female sex and preoperative ultrasonography, but not age, were significantly associated with normal appendicectomy in general surgery units but not in paediatric surgery units in this adjusted model. The unadjusted 30-day adverse event rate was higher in paediatric surgery units than in general surgery units (OR 1.90, 1.18 to 3.06; P = 0.011). When adjusted for case mix and consultant presence at surgery, no statistically significant relationship between centre type and 30-day adverse event rate existed (OR 1.59, 0.93 to 2.73; P = 0.091). CONCLUSION: The NAR in general surgery units was over twice that in paediatric surgery units. Despite a more severe case mix, paediatric surgery units had a similar 30-day adverse event rate to general surgery units. Service provision differs between paediatric and general surgery units.

The genome of the simian and human malaria parasite Plasmodium knowlesi.

Plasmodium knowlesi is an intracellular malaria parasite whose natural vertebrate host is Macaca fascicularis (the 'kra' monkey); however, it is now increasingly recognized as a significant cause of human malaria, particularly in southeast Asia. Plasmodium knowlesi was the first malaria parasite species in which antigenic variation was demonstrated, and it has a close phylogenetic relationship to Plasmodium vivax, the second most important species of human malaria parasite (reviewed in ref. 4). Despite their relatedness, there are important phenotypic differences between them, such as host blood cell preference, absence of a dormant liver stage or 'hypnozoite' in P. knowlesi, and length of the asexual cycle (reviewed in ref. 4). Here we present an analysis of the P. knowlesi (H strain, Pk1(A+) clone) nuclear genome sequence. This is the first monkey malaria parasite genome to be described, and it provides an opportunity for comparison with the recently completed P. vivax genome and other sequenced Plasmodium genomes. In contrast to other Plasmodium genomes, putative variant antigen families are dispersed throughout the genome and are associated with intrachromosomal telomere repeats. One of these families, the KIRs, contains sequences that collectively match over one-half of the host CD99 extracellular domain, which may represent an unusual form of molecular mimicry.

Biology of the harlequin fish Othos dentex (Serranidae), with particular emphasis on sexual pattern and other reproductive characteristics.

Key biological characteristics of the harlequin fish Othos dentex, a representative of a monospecific genus of the Anthiinae (Serranidae), were determined from samples collected around reefs on the south coast of Western Australia. The females of this relatively long-lived species (maximum recorded age in this study = 37 years) attained only a slightly greater maximum total length and age than males and neither the length nor the age-frequency distributions showed a conspicuous sex-based bimodality. Furthermore, gonads from a wide size and age range of O. dentex were shown by histology, at several locations along their length, to always comprise exclusively either ovarian or testicular tissues. Thus, O. dentex is a gonochorist, a sexual pattern only previously recorded definitively for one other anthiine serranid, i.e. Epinephelides armatus, which also occurs in south-western Australia. Similar to E. armatus, O. dentex possesses 'solid' testes with a central sperm duct, thereby differing in structure from those typically found in serranids, in which there is a central membrane-bound 'ovarian' lumen and peripherally located sperm sinuses. The gonadal characteristics and sexual pattern of these two gonochoristic anthiines are not consistent with a recent proposal for the trends exhibited by the evolution of gonochorism and protogyny within the Serranidae. Othos dentex has indeterminate fecundity and a protracted spawning period (7 months) and, on the basis of underwater observations and a low gonado-somatic index (I(G)) for males, is a pair spawner, which is unusual for a gonochorist of a serranid or member of a related family. While the large spots on the lower half of the body of O. dentex are shown quantitatively to be similarly yellow in juveniles and adult females, they then become blue in males at maturity and this intensifies during the spawning period, when they presumably play an important role in agonistic interactions among males and courtship with females. The attainment of maturity and rapid growth by O. dentex early in life may reflect selection pressures to reduce predation mortality during that period. Total mortality in the population is moderately low during later life, implying that the current fishing pressure on O. dentex is relatively light.

Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process.

INTRODUCTION: General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine whether GMC guidelines on disclosure of alternatives during consent are being followed in a real-world example which is disclosure of non-operative management as an alternative to appendicectomy in uncomplicated paediatric appendicitis. METHODS: We undertook a retrospective single-centre observational study and national consultant specialist paediatric surgeon survey. Two groups of 50 consecutively treated children (<16 years) with acute uncomplicated appendicitis were included in the observational study during two periods. UK-based consultant surgeons who treat appendicitis were included in the national survey. The main outcomes were disclosure and use of non-operative management (NOM) as an alternative to appendicectomy. RESULTS: Overall, in the observational study, NOM was disclosed in 30 (30%) children and 77% (23/30) opted for this treatment method when it was disclosed. There were 83 survey respondents representing all 25 eligible specialist paediatric surgery centres. Ten (12%) consultants reported routinely offering NOM, 39 (47%) offer it in select circumstances, and 34 (41%) never offer NOM. Only 25 (30%) respondents always disclose NOM as an alternative to appendicectomy, whereas 22 (27%) never do. Consultants who never disclose NOM are more likely to prefer appendicectomy over NOM compared with those who always disclose it (p<0.001). CONCLUSION: In this illustrative clinical scenario, observed and reported practice regarding disclosure of alternative treatments during the consent process do not meet GMC guidance. This risks depriving children and caregivers of a choice that they are entitled to.