Measuring the distress related to delirium in older surgical patients and their relatives

Objective: Delirium is a common postoperative complication with implications on morbidity and mortality. Less is known about the psychological impact of delirium in patients and relatives. This study aimed to; 1. Quantitatively describe distress related to postoperative delirium in older surgical patients and their relatives using the distress thermometer 2. Examine the association between degree of distress and features of delirium on the Delirium Rating Scale (DRS) 3. Examine the association between recall of delirium and features of delirium on the Delirium Rating Scale (DRS) Methods: This prospective study recruited postoperative patients and their relatives following delirium. The distress thermometer was used to examine the degree of distress pertaining to delirium and was conducted during the hospitalisation on resolution of delirium and then at 12 month follow up. Associations between delirium related distress in patient and relative participants and severity and features of delirium ( Delirium Rating Scale) were examined. Results: 102 patients and 49 relatives were recruited. Median scores on the distress thermometer in patients who recalled delirium were 8/10. Relatives also showed distress (median distress thermometer score 8/10). Associations were observed between severity of and phenotypic features of delirium (delusions, labile affect, agitation). Distress persisted at 12 months in patients and relatives. Conclusion: Distress related to postoperative delirium can be measured using a distress thermometer. Alongside approaches to reduce delirium incidence, interventions to minimise distress from postoperative delirium should be sought. Such interventions should be developed through robust research and if effective administered to patients, relatives or carers

The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists

Background: In 2014, the Royal College of Anaesthetists (RCoA) launched the Perioperative Medicine Programme to facilitate the delivery of best preoperative, intraoperative and postoperative care through implementation of evidence-based medicine to reduce variation and improve postoperative outcomes. However, variation exists in the establishment of perioperative medicine services in the UK. This survey explored attitudes and behaviours of anaesthetists towards perioperative medicine, described current anaesthetic-led perioperative medicine services across the UK and explored barriers to anaesthetic involvement in perioperative medicine. / Methods: Survey content based on the RCoA vision document was refined and validated using an expert panel. An anonymous electronic survey was then sent by email to the members of the RCoA. / Results: Seven hundred fifty-eight UK anaesthetists (4.5% of the RCoA mailing list) responded to the survey. Of these, 64% considered themselves a perioperative doctor, with 65% having changed local services in response to the RCoA vision. Barriers to developing perioperative medicine included insufficient time (75%) and inadequate training (51%). Three quarters of respondents advocate anaesthetists leading the development of perioperative medicine. / Conclusions: Despite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties

The export base model with a supply-side stimulus to the export sector

In the export-base model, the level of a region’s economic activity is underpinned by the performance of its export sector (Daly, 1940; Dixon and Thirlwall, 1975; Kaldor, 1970; North, 1955). This theory is now almost universally represented as a primitive version of the familiar Input-Output (IO) or Keynesian demand-driven approach, where regional output is linked to regional exports through a rather mechanistic multiplier process (Romanoff, 1974). Further, in a standard IO inter-regional framework, the expansion of output in one region always generates positive impacts on other regions. That is to say, there is always a positive spread, and no negative backwash, effect