Death on the table: anaesthetic registrars’ experiences of perioperative death

Background: A perioperative death can be a devastating event for which anaesthetists’ training does not necessarily prepare them. Previous authors have documented a range of reactions to this event. This study set out to explore individual personal and professional reactions amongst a group of senior anaesthetic trainees.Methods: A qualitative methodology was employed and purposive sampling used to select participants. Ten registrars in their fourth year of specialist training in the University of KwaZulu-Natal Department of Anaesthesia were interviewed. Transcripts of the interviews were thematically analysed.Results: Themes expressed by participants fell into three broad categories: professional role (responsibility, coping, functioning after a death), relationships with patients and families (nature of the case, emotional distress, bearing bad news), and personal impact (guilt, physical sequelae, support, desensitisation).Conclusion: Participants’ perceptions supported the notion of potential second (anaesthetist) and third (subsequent patient) victims after a perioperative death. These underscore the importance of the expressed need for debriefing and an interval before resuming duty. The phenomenon of desensitisation was expressed as a spectrum between being dissociated from the event and disconnected from the people involved, raising the possibility of perioperative death as a contributing factor to burnout. This study hopes to improve awareness of the potential consequences of perioperative death and the need for these consequences to be addressed.Keywords: anaesthesia training, debriefing, desensitisation, perioperative deat

Doctorates by thesis and publication in clinical medicine: an analysis of examiners' reports

National and institutional policies to escalate the production of doctorates have raised concerns about the quality of PhDs in South Africa. This study evaluates examiner reports of doctorates by thesis and publication in clinical medicine to ascertain the criteria that examiners used to define a successful doctoral thesis. A qualitative hermeneutic approach through document analysis was taken, involving 54 national and international examiner reports of 18 doctoral theses, half of which were by publication. The examiners rated the majority (81%) of these theses to be of a high quality. Our results show a scatter of positive and negative aspects distributed across all 18 theses, with corresponding commendations and criticisms. Notably, almost equal emphasis was placed on conceptual and communication issues. Ratings per thesis were not always concordant, with five theses each given widely divergent ratings by three respective examiners. The study also found differences in ratings between examiners, based on whether they were medical or non- medical, international or national, and with or without PhDs themselves. While no single criterion was identifiable as being diagnostic of doctoral quality, the identified strengths and shortcomings of these theses serve as a useful platform for supervisors and students aspiring to cross the doctoral threshold

Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

BACKGROUND: A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. DISCUSSION: Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. SUMMARY: The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards

The cognitive neuroscience of prehension: recent developments

Prehension, the capacity to reach and grasp, is the key behavior that allows humans to change their environment. It continues to serve as a remarkable experimental test case for probing the cognitive architecture of goal-oriented action. This review focuses on recent experimental evidence that enhances or modifies how we might conceptualize the neural substrates of prehension. Emphasis is placed on studies that consider how precision grasps are selected and transformed into motor commands. Then, the mechanisms that extract action relevant information from vision and touch are considered. These include consideration of how parallel perceptual networks within parietal cortex, along with the ventral stream, are connected and share information to achieve common motor goals. On-line control of grasping action is discussed within a state estimation framework. The review ends with a consideration about how prehension fits within larger action repertoires that solve more complex goals and the possible cortical architectures needed to organize these actions