Developing an engineered antimicrobial/prophylactic system using electrically activated bactericidal metals.

The increased use of Residual Hardware Devices (RHDs) in medicine combined with antimicrobial resistant-bacteria make it critical to reduce the number of RHD associated osteomyelitic infections. This paper proposes a surface treatment based on ionic emission to create an antibiotic environment that can significantly reduce RHD associated infections. The Kirby-Bauer agar gel diffusion technique was adopted to examine the antimicrobial efficacy of eight metals and their ionic forms against seven microbes commonly associated with osteomyelitis. Silver ions (Ag(+)) showed the most significant bactericidal efficacy. A second set of experiments, designed to identify the best configuration and operational parameters for Ag(+) based RHDs addressed current and ionic concentrations by identifying and optimizing parameters including amperage, cathode and anode length, separation between anode and cathode, and surface charge density. The system demonstrated an unparalleled efficacy. The concept was then implemented during in vitro testing of an antimicrobial hip implant, RHD.

Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.

Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective.