A second independent audit of electroconvulsive therapy in England, 2019: Usage, demographics, consent, and adherence to guidelines and legislation

Objectives. To assess progress towards improving the administering of Electroconvulsive therapy (ECT) in England since an audit covering 2011, 2013 and 2015. The same information was gathered, for 2019, on usage, demographics, consent, and adherence to national guidelines and the Mental Health Act. Design and Methods. Freedom of Information Act requests were sent to 56 National Health Service Trusts. Results. Thirty-seven trusts (66%) provided data. The gradual decline in the use of ECT in England has levelled off at about 2,500 people per year. There was a 47-fold difference between the Trusts with the highest and lowest rates per capita. Most recipients are still women (67%), and over 60 (58%). Only one Trust could report how many people received psychological therapy prior to ECT, as required by government (N.I.C.E.) guidelines. More than a third of ECT (37%) is still given without consent, with 18% of Trusts non-compliant with legislation concerning second opinions. There were slight declines, compared to a previous audit, in the use of standardised depression scales, down to 30%, and standardised measures of cognitive dysfunction, down to 24%. Only six Trusts provided any data for positive outcomes; seven for adverse effects. None provided data on efficacy or adverse effects beyond end of treatment. Twelve used identical sentences to each other, verbatim, in response to one or more questions. Conclusions. Given the apparent failure of current monitoring and accrediting ECT clinics in England, by the Royal College of Psychiatrists’ ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed

Guidelines and the adoption of ‘lipid rescue’ therapy for local anaesthetic toxicity

Accepted versio

UBVRI photopolarimetry of the long period eclipsing AM Herculis binary V1309

We report simultaneous UBVRI photo-polarimetric observations of the long period (7.98 h) AM Her binary V1309 Ori. The length and shape of the eclipse ingress and egress varies from night to night. We suggest this is due to the variation in the brightness of the accretion stream. By comparing the phases of circular polarization zero-crossovers with previous observations, we confirm that V1309 Ori is well synchronized, and find an upper limit of 0.002 percent for the difference between the spin and orbital periods. We model the polarimetry data using a model consisting of two cyclotron emission regions at almost diametrically opposite locations, and centered at colatitude 35 (deg) and 145 (deg) on the surface of the white dwarf. We also present archive X-ray observations which show that the negatively polarised accretion region is X-ray bright.Comment: 11 pages, 12 figures (2 colour), Fig1 and Fig 4 are in lower resolution than in original paper, accepted for publication in Monthly Notices of the Royal Astronomical Societ

Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review

Study Design: Systematic review. Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options? Methods: A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine studies satisfied inclusion criteria. We found a trend toward lower risk of DVT in patients treated with enoxaparin. There were no significant differences in rates of DVT, PE, bleeding, and mortality between patients treated with different types of low-molecular-weight heparin or between low-molecular-weight heparin and unfractionated heparin. Combined anticoagulant and mechanical prophylaxis initiated within 72 hours of SCI resulted in lower risk of DVT than treatment commenced after 72 hours of injury. Conclusion: Prophylactic treatments can be used to lower the risk of venous thromboembolic events in patients with acute SCI, without significant increase in risk of bleeding and mortality and should be initiated within 72 hours. © 2017, © The Author(s) 2017

Political brand identity: an examination of the complexities of Conservative brand and internal market engagement during the 2010 UK General Election campaign

This paper seeks to build an understanding of the importance of internal communications when building a strong political brand. Using Kapferer’s brand prism as a conceptual framework, the paper explores UK Conservative Party members’ attitudes towards the development of the Conservative brand as personified by David Cameron. There are clear implications for political strategists as the findings suggest that it is crucial to engage the internal market in the co-creation of the marketing communications strategy for as brand evangelists they interpret the brand promise at the local level

An introduction to the New Online Journal Club - 'Surgery in Africa', and the first summary of a module - Compartment syndrome and diagnostic tests

No Abstrac

Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis.

Study Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status

A Population of Faint Non-Transient Low Mass Black Hole Binaries

We study the thermal and viscous stability of accretion flows in Low Mass Black Hole Binaries (LMBHBs). We consider a model in which an inner advection-dominated accretion flow (ADAF) is surrounded by a geometrically thin accretion disk, the transition between the two zones occurring at a radius R_tr. In all the known LMBHBs, R_tr appears to be such that the outer disks could suffer from a global thermal-viscous instability. This instability is likely to cause the transient behavior of these systems. However, in most cases, if R_tr were slightly larger than the estimated values, the systems would be globally stable. This suggests that a population of faint persistent LMBHBs with globally stable outer disks could be present in the Galaxy. Such LMBHBs would be hard to detect because they would lack large amplitude outbursts, and because their ADAF zones would have very low radiative efficiencies, making the systems very dim. We present model spectra of such systems covering the optical and X-ray bands.Comment: LateX, 37 pages, 11 figures; Accepted for publication in The Astrophysical Journa