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4.
Anaesthesia ; 75(1): 21-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31236918

RESUMO

Previous studies on the safety of peri-operative transoesophageal echocardiography seem to suggest a low rate of associated morbidity and mortality. That said, there has been a paucity of prospective multicentre studies in this important area of clinical practice. We carried out a one-year prospective study in 2017, co-ordinated by the Association of Cardiothoracic Anaesthesia and Critical Care, to determine the rate and severity of complications associated with peri-operative transoesophageal echocardiography in anaesthetised cardiology and cardiac surgical patients. With the help of clinicians from 28 centres across the UK and Ireland, we recorded the total number of examinations conducted in anaesthetised patients during the study period. All major complications at each centre were prospectively reported and recorded. Of the 22,314 examinations, there were 17 patients diagnosed with a major complication which caused either palatal injury or gastro-oesophageal disruption. This corresponds to an incidence of 0.08% (95%CI 0.05-0.13%) or approximately 1:1300 examinations. There were seven deaths reported during the study period which were directly attributed to these complications, corresponding to an incidence of 0.03% (95%CI 0.01-0.07%) or approximately 1:3000. These figures are higher than previously reported and suggest a high probability of death following the development of a complication (~40%). Most complications occurred in patients without known risk factors for transoesophageal echocardiography associated gastro-oesophageal injury. We suggest clinicians and departments review their procedural guidelines, especially in relation to probe insertion techniques, together with the information communicated to patients when the risks and benefits of such examinations are discussed.


Assuntos
Anestesia em Procedimentos Cardíacos , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Transesofagiana/efeitos adversos , Auditoria Médica/estatística & dados numéricos , Assistência Perioperatória/efeitos adversos , Idoso , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Irlanda , Masculino , Assistência Perioperatória/métodos , Assistência Perioperatória/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Sociedades Médicas , Reino Unido
5.
Anaesthesia ; 75(1): 54-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531978

RESUMO

Patients eligible for emergency laparotomy who do not proceed to surgery are not as well characterised as patients who do proceed to surgery. We studied patients eligible for laparotomy, as defined by National Emergency Laparotomy Audit criteria, from August 2015 to October 2016. We analysed the association of individual variables with survival and two composite scores: P-POSSUM and a general survival model. Out of 314 patients, 214 (68%) underwent laparotomy and 100 (32%) did not. Median (IQR [range]) follow-up was 1.3 (0.1-1.8 [0.0-2.5]) years for the cohort, 1.5 (1.1-2.0 [0.0-2.6]) years after laparotomy and 0.0 (0.0-1.1 [0.0-2.2]) years without laparotomy. There were 126/314 (40%) deaths in the follow-up period, 52/214 (24%) deaths after laparotomy and 74/100 (74%) deaths without surgery. Ninety out of 126 deaths (71%) were within one month of hospital admission. Patient variables were different for the two groups, which when combined in the general survival model generated background median (IQR [range]) life expectancies of 12 (6-21 [0-49]) and 4 (2-6 [0-36]) years, respectively, p < 0.0001. 'Poor fitness' precluded laparotomy in 74/100 (74%) patients. The decision to not operate involved a consultant less often than the decision to operate: 66/100 (66%) vs. 178/214 (83%), p = 0.001. Our study supports the contention that survival beyond 30 postoperative days could be predicted reasonably accurately. Survival in patients who did not have laparotomy was shorter than expected. Emergency laparotomy might have prolonged survival in some patients.


Assuntos
Laparotomia/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso , Estudos de Coortes , Emergências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Reino Unido
6.
Equine Vet J ; 52(1): 13-27, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31657050

RESUMO

Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.


Assuntos
Analgesia/veterinária , Doenças dos Cavalos/tratamento farmacológico , Dor/veterinária , Guias de Prática Clínica como Assunto , Sociedades Científicas/normas , Medicina Veterinária/normas , Animais , Cavalos , Dor/tratamento farmacológico , Reino Unido
7.
Anaesthesia ; 75(1): 96-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31729019

RESUMO

Anaesthetists are thought to be at increased risk of suicide amongst the medical profession. The aims of the following guidelines are: increase awareness of suicide and associated vulnerabilities, risk factors and precipitants; to emphasise safe ways to respond to individuals in distress, both for them and for colleagues working alongside them; and to support individuals, departments and organisations in coping with a suicide.


Assuntos
Anestesistas/psicologia , Anestesistas/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Estresse Psicológico/diagnóstico , Suicídio/prevenção & controle , Suicídio/psicologia , Guias como Assunto , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Fatores de Risco , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Suicídio/estatística & dados numéricos , Reino Unido
8.
Br J Radiol ; 93(1105): 20190340, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596121

RESUMO

OBJECTIVE: To compare key characteristics of interventional radiology (IR) training in the UK with four other English-speaking countries (USA, Canada, Australia and New Zealand) and summarise requirements for training. METHODS: Main features examined were career pathway and requirements, examinations required, specific competition for IR and the process of applying for training as an international medical graduate. Data were collected from official governing body publications, literature and personal experience. RESULTS: Several differences were highlighted, including length of training (ranging from 6 to 9 years after medical school), length of IR-specific training (ranging from 1 to 3 years) and examinations required (USA and Canada have additional IR-specific examinations). The level of competition is generally high, in all countries. CONCLUSIONS: With the demand for IR services set to increase over the next few years, it is crucial that more IR specialists are trained to meet this demand. Awareness of training structures in other countries can highlight opportunity and pitfalls, and help ensure the number of highly trained interventional radiologists in the UK continues to grow.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Radiologia Intervencionista/educação , Austrália , Canadá , Escolha da Profissão , Avaliação Educacional , Humanos , Nova Zelândia , Reino Unido , Estados Unidos
9.
Br Dent J ; 227(11): 959-960, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31844222

RESUMO

Dental tooth whitening is used throughout the United Kingdom for patients who have aesthetic concerns regarding the colour of their teeth. Up until recent months it was also frequently used for paediatric patients with enamel opacities of cosmetic concern and discoloured non-vital anterior teeth. This safe and effective treatment option is now not available to paediatric dental patients due to changes in indemnity cover, and we demonstrate three cases from our department where dental whitening was the most appropriate treatment option. By removing this treatment option for selected paediatric patients, we are concerned that more destructive and less effective treatments may be performed with short- and long-term detriment to their oral health. Furthermore, failure to provide any treatment may negatively affect children's quality of life and psychological well-being.


Assuntos
Clareamento Dental , Dente , Criança , Estética Dentária , Humanos , Qualidade de Vida , Reino Unido
11.
Soins ; 64(840): 49-52, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31847971

RESUMO

The National Health Service (NHS) in the United Kingdom promotes the development of leadership across all functions. To achieve this objective, the NHS Leadership Academy was created in order to design a range of skills development programmes in this area.


Assuntos
Liderança , Cuidados de Enfermagem , Medicina Estatal , Academias e Institutos , Reino Unido
12.
BMJ ; 367: l6721, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852665

RESUMO

OBJECTIVES: To compare the proportional representation of healthcare workers in receipt of New Year honours (NYHs) with workers in other industries and to determine whether the NYH system has gender or geographical biases. DESIGN: Observational study of the UK honours system with a comparative analysis of proportional representation of the UK workforce and subgroup analyses of gender and geographical representations. PARTICIPANTS: Recipients of NYHs from 2009 to 2018. MAIN OUTCOME MEASURES: Absolute risk of receiving an NYH based on industry, gender, or region of the UK. Relative risk of receiving an NYH for services to healthcare compared with other industries. RESULTS: 10 989 NYHs were bestowed from 2009 to 2018, 47% of which were awarded to women. 832 awards (7.6%) were for services to healthcare. People working in sport and in the arts and media were more likely to receive NYHs than those working in healthcare (relative risks of 22.01 (95% confidence interval 19.91 to 24.34) and 5.84 (5.31 to 6.44), respectively). There was no significant difference between the rate of receiving honours for healthcare and for science and technology (P=0.22). 34% (3741) of awards were issued to people living in London and in the southeast of England, and only 496 of 1447 (34%) higher order awards (knighthoods, damehoods, companions of honour, and commanders of the order of the British empire) were received by women. CONCLUSIONS: In relation to the size of its workforce, a career in healthcare is not as "honourable" as careers in certain other industries. Geographical and gender biases might exist in the honours system.


Assuntos
Distinções e Prêmios , Geografia/estatística & dados numéricos , Indústrias/estatística & dados numéricos , Sexismo/estatística & dados numéricos , Recursos Humanos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
13.
J Law Med ; 27(1): 29-36, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682339

RESUMO

Victoria's Complex Adult Victim Sex Offender Management Review Panel recommended that an independent body be established to manage high-risk offenders with input from multi-agency panels. The Panel's recommendations were influenced by the Multi-Agency Public Protection Arrangements that exist across the United Kingdom. This column compares the operation of the sole Multi-Agency Panel that has been established in Victoria with that of the Multi-Agency Public Protection Panels (MAPPPs) in Scotland and the Risk Assessment and Management Panels set up to combat family violence in Victoria. It then provides a comparison of how information-sharing has been implemented in Victoria and Scotland. It concludes that, although the legislation governing each is similar, the implementation and operation of the two has been very different. This difference in approach has implications for how clinicians and health services interact with the process, and how issues of information-sharing and confidentiality are addressed.


Assuntos
Criminosos , Prisões , Adulto , Humanos , Medição de Risco , Reino Unido
14.
Lancet ; 394(10209): 1617, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31690445
17.
Zootaxa ; 4688(3): zootaxa.4688.3.3, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31719437

RESUMO

A mixed batch of sea cucumbers tentatively labelled as ?Thyone or ?Havelockia species was obtained on loan from the Natural History Museum, United Kingdom (NHMUK) for identifications and records. The material dates back to 1850 and originates from shallow waters from various parts of the world. The material includes two new species and one new subspecies which have already been described in an earlier paper (see Thandar, 2017). The remaining specimens comprise a few known or poorly known nominal species and several indeterminate forms. This paper describes the known species while adding some useful information about them. Of the indeterminate species included are several specimens most belonging to the genus Thyone or Havelockia which, because of their incompleteness and absence of ossicles, are not identified beyond their suspected genus or species.


Assuntos
Equinodermos , Pepinos-do-Mar , Animais , Museus , Reino Unido
18.
Zootaxa ; 4624(1): zootaxa.4624.1.2, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31716234

RESUMO

In this paper the primary types of Centris described by Amédée Lepeletier de Saint-Fargeau in 1841 deposited at Muséum National d'Histoire Naturelle, France and Hope Entomological Collection, Oxford University Museum of Natural History, United Kingdom were studied. To stabilize the application of some names, lectotypes were designated for C. bimaculata, C. collaris, C. decolorata, C. denudans, C. dorsata, C. ferruginea, C. fuscata, C. maculata (= C. decolorata), C. obsoleta, C. picea, C. poecila, C. trigonoides, C. violacea and C. vittata. Centris picea nomen oblitum is withdrawn from the synonymy of C. lanipes (Fabricius) and proposed as new junior synonym of C. trigonoides nomen protectum. Centris nigrescens is removed from the synonymy of C. vittata and revalidated, proposing C. merrillae Cockerell and C. lanipes ogilviei Cockerell as its new junior synonymies. Lectotypes for this latter species and for C. rubella Smith (= C. ferruginea) were also designated. In addition, due to the impossibility of identifying C. thoracica and the misplacement of its type material, it is proposed to consider it nomen dubium and place it incertae sedis.


Assuntos
Himenópteros , Distribuição Animal , Animais , Abelhas , Entomologia , França , Reino Unido
19.
Zootaxa ; 4560(3): zootaxa.4560.3.9, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-31716573

RESUMO

In his landmark revision of the Australian Dynastinae (Coleoptera: Scarabaeidae) Phil Carne (1957) described Novapus bifidus Carne, 1957 from males and females collected at Cape York and Thursday Island. The type series is in the Australian National Insect Collection, Canberra, Australia (ANIC); the Natural History Museum, London, United Kingdom; the South Australian Museum, Adelaide, Australia (SAM); and the Museum of Victoria, Melbourne, Australia. He noted "In the collections of the South Australian Museum there are specimens designated as types of bifidus Lea. No description of this species has been published, and it is now described under the same specific name". One of his paratypes is a female in SAM identified as "Lea's unpublished ♀ type" and two other paratypes are males in SAM. Cassis Weir (1992) noted that one of the SAM specimens has the registration number I4268, although they knew of only two paratypes (one male, one female) in that collection. The name has been attributed to Carne by most subsequent authors (Endrodi 1974, 1985; Carne Allsopp 1987; Cassis Weir 1992; Dechambre 2005; Atlas of Living Australia 2018.). Krajcik (2005, 2012) listed it in his scarab checklists but as "bifidus? Carne 1957".


Assuntos
Besouros , Animais , Feminino , Londres , Masculino , Reino Unido , Vitória
20.
Zootaxa ; 4661(3): zootaxa.4661.3.4, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31716698

RESUMO

The recent report of Nemoura lacustris Pictet, 1865 in Great Britain has raised doubts on its identity, given the isolation with respect to the Mediterranean and continental populations of this species. Using molecular analyses, we tested if populations from  the United Kingdom and the Iberian Peninsula were conspecific and tested the hypotheses of a recent colonization event versus a more ancient origin for the British populations. Phylogenetic analysis of the mitochondrial marker COI allowed us to conclude that the United Kingdom specimens morphologically ascribed to N. lacustris were conspecific with populations from France and the Iberian Peninsula. Based on the genetic divergence of the two reciprocally monophyletic clades from the Iberian Peninsula and Great Britain/France, respectively, the present distribution of N. lacustris can be postulated as a relatively recent dispersal or introduction into Great Britain from France.                Finally, we note the isolated position displayed by N. lacustris in the phylogenetic tree of Nemoura species based on COI sequences, as the sister to all included species of the genus. This isolated position corresponds with the specific morphology of N. lacustris genitalia and requires additional studies to ascertain clearer generic boundaries within the Nemouridae.


Assuntos
DNA Mitocondrial , Neópteros , Animais , Europa (Continente) , França , Variação Genética , Neópteros/genética , Filogenia , Reino Unido
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