Consultation activities of clinical ethics committees in the United Kingdom: an empirical study and wake-up call.

OBJECTIVE: To identify the consultation activities of clinical ethics committees (CECs) in the UK and the views of CEC chairpersons regarding such activities. METHODS: An anonymous, password-protected online questionnaire was sent by e-mail to 70 CEC chairpersons. The questionnaire contained 14 items. RESULTS: Of the 70 CECs contacted, 30 responded (a response rate of 43%). There has been an almost fourfold increase in the number of CECs in the past 7 years. Over half of the CECs that responded had considered three or fewer active cases and three or fewer retrospective cases in the preceding year. Eighty percent of chairpersons felt that the number of active cases considered by their committee was too low. Seventy percent of CECs had rapid response teams. Aside from low consultation caseloads, chairpersons identified a number of concerns, including education and training of members, composition of CECs, low profile and lack of funding and support. Although most respondents believed there is a need for clinical ethics support in the NHS, many noted the limited use of the services, even after efforts to increase the visibility of their CEC. CONCLUSION: Despite a sharp increase in the absolute numbers of CECs across the UK, the number of cases considered by the majority of CECs is low. The findings presented here suggest we must reflect on the reasons for such low caseloads and pause to consider whether the committee model is most appropriate for the UK context.

Urinary incontinence.

The involuntary loss of urine in a quantity or frequency sufficient to cause a social or hygienic problem is known as urinary incontinence. This common condition, affecting over 10 million adults, afflicts an estimated 30% of all older persons, as well as 50% to 70% of older residents in nursing homes. The clinical importance of urinary incontinence is due primarily to its adverse effects on psychologic health and social interactions; effects on physical health, such as skin maceration and recurrent urinary tract infections, are relatively minor. Because symptomatic improvement or cure is possible in many cases, health care providers should ask specific questions about symptoms of urinary incontinence and then provide appropriate evaluation and management of this common condition.

Development of databases and registries. International issues.

This paper describes the U.S. Public Health Service (PHS) efforts to develop a National Xenotransplantation Registry (NXR). The function of the registry is discussed, paying particular attention to data collection and harmonization issues. The need for standardization and coordination on an international scale is presented and the benefits of such efforts are discussed. Finally, a recommendation for an international effort aimed at harmonization is made.

The effect of protein intake on 24-h energy expenditure during energy restriction.

OBJECTIVE: To investigate whether protein intake influences the decline in energy expenditure during energy restriction. DESIGN: Cross-over study of three diets of 4.2 MJ/d for 7 days: one diet with 36% energy as protein and two with 15% energy as protein, one high in carbohydrate and the other high in fat. SUBJECTS: Two men and six women aged 31-57 y. BMI 27.B-34.1 kg/m2. MEASUREMENTS: 24-h energy expenditure (24-h EE), sleeping metabolic rate (SMR) and body weight on days 0 and 7 of each diet; 24-h urinary nitrogen excretion (24-h UN) on days 0-7 of each diet. RESULTS: 24-h EE and SMR declined on all three diets but the decrease was significantly less on the high protein diet than on the two low protein diets. Weight loss was similar on all three diets. 24-h UN was less than N intake on the high protein diet but greater than N intake on the two low protein diets. CONCLUSIONS: Maintaining protein intake reduces the decrease in energy expenditure during energy restriction.