Cent Of Responders Research Articles

GPs' views on emergency care treatment plans: an online survey.

A holistic approach to emergency care treatment planning is needed to ensure that patients' preferences are considered should their clinical condition deteriorate. To address this, emergency care and treatment plans (ECTPs) have been introduced. Little is known about their use in general practice. To find out GPs' experiences of, and views on, using ECTPs. Online survey of GPs practising in England. A total of 841 GPs were surveyed using the monthly online survey provided by medeConnect, a market research company. Forty-one per cent of responders' practices used Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans for ECTP, 8% used other ECTPs, and 51% used Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. GPs were the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community-based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of responders' practices. When compared with using a DNACPR form, GPs using a ReSPECT form for ECTP were more comfortable having conversations about emergency care treatment with patients (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.1 to 2.69) and family members (OR =1.85, 95% CI = 1.19 to 2.87). The potential benefits and challenges of widening the pool of health and social care professionals initiating and/or completing the ECTP process needs consideration. ReSPECT plans appear to make GPs more comfortable with ECTP discussions, supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened.

DS27 Establishing clinician and patient perspectives on a proposed trial investigating antibiotics in skin surgery

Abstract Surgical site infection (SSI) following excision of ulcerated skin cancers is a well-recognized complication; however, the exact risk is unknown and there is no consensus on antibiotic prescribing in this setting. The EXCISE trial (EXamining antibiotics for ulCerated skIn cancer Surgical Excision) aims to address this evidence gap. An online survey was distributed to the UK Dermatology Clinical Trials Network (UKDCTN), British Society for Dermatological Surgery and plastic surgery, ear, nose and throat (ENT) and maxillofacial surgery networks (December 2022). The survey aimed to establish clinicians’ views about the proposed EXCISE trial. A focus group with patient representatives with lived experience of skin cancer surgery was also conducted (n = 5). Ninety questionnaire responses were received: six plastic surgeons (7%), 19 oral and maxillofacial surgeons (21%), four ENT surgeons (4%) and 61 dermatologists (68%). Sixty-five per cent of responders were consultants, and 34% were registrars. Seventy-one (79%) were willing to recruit to the EXCISE trial. Forty-eight (53%) agreed to randomize patients to 0 (no antibiotics), 1, 2, 3, 5 or 7 days of postoperative flucloxacillin. Thirty-seven (41%) agreed a 6–10% absolute increase in risk of SSI would justify a shorter course of antibiotics (1–3 days) with fewer side-effects. Thirty-three (37%) felt a 0–5% absolute risk increase would be acceptable, 17 (19%) felt an absolute risk increase of 11% or greater was acceptable, and three (3%) did not respond. Eighty-one (90%) agreed that if the EXCISE trial demonstrated a reduction in SSI, they would prescribe antibiotics, 61 (68%) would prescribe longer courses (5–7 days) and 17 (19%) would prescribe shorter courses (1–3 days). Patients reported a preference for shorter antibiotic courses (1–3 days) vs. longer (5–7 days) if there were fewer side-effects and no increased risk of infection. All patients agreed, in principle, to randomization to the proposed groups and highlighted the need to recruit from diverse socioeconomic backgrounds. They also suggested highlighting zero days of postoperative antibiotics often reflects usual practice to encourage participation. All participants agreed with the proposed 10% noninferiority margin. In summary, our data demonstrate acceptability of the proposed EXCISE trial among both clinicians and patients. An absolute noninferiority margin of 10% between SSIs occurring in the context of longer courses of antibiotics vs. shorter courses of antibiotics is acceptable to patients when associated with fewer side-effects. Clinicians showed mixed responses, suggesting that further work is required to explore the barriers and facilitators to prescribing and for future implementation. Acknowledgments: The study was developed with support from the UK Dermatology Clinical Trials Network (UK DCTN). The UKDCTN is grateful to the British Association of Dermatologists and the University of Nottingham for financial support of the network.

Understanding the impacts of floods on learning quality, school facilities, and educational recovery in Indonesia.

This research is among the first pieces of work to use the comprehensive school safety (CSS) framework to assess the impacts of floods on quality learning and education infrastructure. The CSS framework is employed here to identify the level of disruption to education services following floods in Jakarta, Indonesia, in 2013. The paper poses three key questions, concerning: (i) disruption to children's access to quality education during the flood emergency in 2013 and the early recovery phase; (ii) the impact of the floods on a school's physical infrastructure; and (iii) the effectiveness and level of success of the 2013 flood responses by relevant stakeholders. Combining quantitative and qualitative strategies, the paper examines the experiences of 100 schools in Jakarta. The findings suggest that the CSS framework offers a more nuanced approach to assessing post-disaster education needs. Moreover, it is also relevant for examining the relationship between the COVID-19 pandemic and relative losses in the education sector.

Situation in 2020 of the requirements for the use of PCSK9 inhibitors in Spain: Results of a national survey

AimsDuring 2019 and 2020 a series of meetings over the country were carried out, with the aim of explaining the methodology and criteria for the ellaboration of the recommendations on the use of iPCSK9, published by the Spanish Society of Atherosclerosis (SEA in Spanish). At the end of the meetings, a survey was conducted among the participants, in order to describe the prescription requirements of these drugs in the Spanish regions. MethodologyButterfly Project was developed by a scientific Committee of experts in lipids. After the ellaboration of the materials for the project, a train the trainers program was carried out, imparted by 17 experts who were the Project coordinators. Later, 16 regional workshops were performed, with the attendance of 169 medical doctors involved in the management of hipercolesterolemia. The attendants responded the survey, where they were asked different questions on the use of iPCSK9 on their clinical practice. ResultsA high heterogeneity among centers regarding the requirements and difficulties for iPCSK9 prescription was revealed. Twenty one per cent of responders indicated to have low difficulties to prescribe iPCSK9 in their hospitals, whereas 78% found moderate or high difficulties. The difficulties came from burocracy-administrative aspects (18%), restrictions in the indication (41%) and both (38%). In general, the obstacles did not depend on the hospital level, neither the speciality, or the presence of lipid units, although the existance of lipid units was associated with a higher number of patients treated with iPCSK9. The factors which were associated with higher difficulty in the prescription were: the presence of an approval committee in the hospitals, the frequency in the revision of the treatment by hospital pharmacy, the temporal cadence of the prescription, the profile of patients seen and the criteria followed by the specialists for the prescription. ConclusionThe results show important diferences in the treatment with iPCSK9 in the context of clinical practice in Spain. The analysis of these results will permit to make proposals regarding future actions addressed to reach the equity in the access to iPCSK9 in Spain, with the main aim of maximizing their potential benefit according to the patients profile.

Situación en 2020 de los requerimientos para la utilización de inhibidores de PCSK9 en España: resultados de una encuesta nacional

AimsDuring 2019 and 2020 a series of meetings over the country were carried out, with the aim of explaining the methodology and criteria for the ellaboration of the recommendations on the use of iPCSK9, published by the Spanish Society of Atherosclerosis (SEA in Spanish). At the end of the meetings, a survey was conducted among the participants, in order to describe the prescription requirements of these drugs in the Spanish regions. MethodologyButterfly Project was developed by a scientific Committee of experts in lipids. After the ellaboration of the materials for the project, a train the trainers program was carried out, imparted by 17 experts who were the Project coordinators. Later, 16 regional workshops were performed, with the attendance of 169 medical doctors involved in the management of hipercolesterolemia. The attendants responded the survey, where they were asked different questions on the use of iPCSK9 on their clinical practice. ResultsA high heterogeneity among centers regarding the requirements and difficulties for iPCSK9 prescription was revealed. Twenty one per cent of responders indicated to have low difficulties to prescribe iPCSK9 in their hospitals, whereas 78% found moderate or high difficulties. The difficulties came from burocracy- administrative aspects (18%), restrictions in the indication (41%) and both (38%). In general, the obstacles did not depend on the hospital level, neither the speciality, or the presence of lipid units, although the existance of lipid units was associated with a higher number of patients treated with iPCSK9. The factors which were associated with higher difficulty in the prescription were: the presence of an approval committee in the hospitals, the frequency in the revision of the treatment by hospital pharmacy, the temporal cadence of the prescription, the profile of patients seen and the criteria followed by the specialists for the prescription. ConclusionThe results show important diferences in the treatment with iPCSK9 in the context of clinical practice in Spain. The analysis of these results will permit to make proposals regarding future actions addressed to reach the equity in the access to iPCSK9 in Spain, with the main aim of maximizing their potential benefit according to the patients profile.

SOCIAL ENVIRONMENT FOR PEOPLE WITH AUTISM IN RUSSIA: EXPERT ASSESSMENT OF THE ACCESSIBILITY ISSUE

Aim: To study expert opinion on the social system benefits for people with autism in Russia and barriers for their inclusive development and life. Methods: Two questionnaire-based surveys were performed in 67 regions of Russia. Pediatricians, neurologists, psychiatrists and other specialists (N = 400 in total) comprised the study base for the first survey. The second survey included psychologists and educators working with children with disabilities (N = 470). The results are presented as proportions. Results: Altogether, 42.4 % of psychologists and educators gave 1 of 5 points to the accessibility of the environment for people with autism. As many as 28.1 %, 22.7 % an 5.7 % provided 2, 3 and 4 points, respectively. Only 1.1 % of responders gave 5 points. Forty-eight per cent of responders indicated that the challenges of early intervention for children with autism and their families have not been addressed at all while 35.9 % responded that that they have been partially addressed. The most common answer (51.3 %) for the measures to support children with autism was "public and private rehabilitation centers for children with autism". Altogether, 17.4 % of the participants answered that there was no special support for children with autism. Conclusions: Professionals working with people with autism conclude that the availability of community resources for this vulnerable group is poor. At the same time, the experts acknowledge positive changes of the situation in Russia, the creation of new institutions to support children with autism and their families, as well as development of inclusive education. A comprehensive national program to improve social environment for people with autism is warranted.

Knowledge, Attitude and Practice of Eyelid Surgeries among Surgeons in Nigeria

Aim: To determine the level of knowledge, attitude and practice of eyelid surgeries among surgeons in Nigeria.
 Methods: A self-administered questionnaires about their knowledge, attitude and practice of eyelid surgeries were given to 135 medical practitioners attending the 49th Annual General Meeting and Scientific Conference of the International College of Surgeons (Nigeria National Section) held in Port Harcourt from 16th to 20th June 2015. Questions asked tested the Knowledge, Attitude and Practice of the medical practitioners on matters related to eyelid surgeries. Study participants’ knowledge, attitude and practice were graded as Good for scores of 75% and above, Fair for 50-74% score and Poor for scores less than 50%. Respondents’ demographic data, responses and corresponding scores were entered into computer software-Scientific Package for Social Sciences (SPSS) version 20 and analysed.
 Results: There were 135 responders, out of which 121 (89.62%) were male while 14 (10.38%) were females. They were aged between 21-70 years with a mean value of 51.6 +/- 8.6 years, range = 40 years and mean = 50 years. Specialist surgeons with college fellowship accounted for 84.4% while specialist surgeons in training (college membership) accounted for 15.6%. Most of the responders (73.3%) were in public service while 9% were in the private service and 17.7% were in both public and private service. Sixty seven per cent of responders had good knowledge of eyelid surgeries, 22.2% had fair knowledge while 11.1% had poor knowledge. Majority (73.3%) had poor attitude while only 26.7% had good attitude to eyelid surgeries. Responders with poor practice of lid surgeries accounted for 77.8%, fair practice were 13.4% while only 8.8% had good eyelid surgery practice.
 Conclusion: Most of our responders were experienced surgeons as shown by their ages, educational and professional status. Though majority of them had good knowledge of eyelid surgeries their attitude and practice of it were poor in spite of their experience in the field of surgery. This could be due to the paucity of oculoplastic surgeons in Nigeria. Measures should therefore be taking to improve on subspecialty training especially in oculoplastic surgery and collaborations should be encouraged amongst surgeons involved in facial surgeries.

A survey of the management of posterior malleolar ankle fractures in South Africa

Background: Posterior malleolus fractures are associated with poorer functional outcomes compared to simpler malleolar fractures. Traditional teaching states that if a posterior malleolus fracture involves less than 25% of the distal tibia, it can be managed without fixation. Current literature has shown that fixation should not be based on the size of the posterior fragment but rather on the fracture pattern, instability and awareness that reduction and fixation is biomechanically advantageous. We hypothesised that current management of ankle fractures with posterior malleolus involvement in South Africa is not evidence-based and is suboptimal. We sought to assess the training, experience and decision-making of surgeons and trainees who are involved in the management of ankle fractures. Another aim was to develop evidence-based algorithms for the management of posterior malleolus and complex ankle fractures. Methods: An email survey consisting of questions related to the management of ankle fractures was sent to specialists, registrars and medical officers who voluntarily completed an online survey. Results: A total of 103 out of 456 emails sent drew responses to the survey. Responses included 28% from consultants, 54% from registrars and 18% from medical officers. Forty-six per cent of responders believed that posterior malleolus fractures can be managed non-operatively if less than 20% of the tibial plafond is involved. Only 49% would CT scan a posterior malleolus prior to operating. Thirty-eight per cent of the responders were not familiar or comfortable with the posterior-lateral approach used for fixation of the posterior malleolus directly. Conclusion: Understanding of ankle fractures has progressed. A significant proportion of responders to the survey are not following best practice and current literature. Posterior malleolus fractures are not benign and have poorer outcomes compared to bi-malleolar or lateral malleolus ankle fractures. All patients with posterior malleolus fractures should receive pre-operative CT scan. All posterior malleolar fractures that can be held with a plate or screws should be fixed. Level of evidence: Level 5

Smoking and the eye: what Québec teenagers know and fear

BackgroundAlthough most people associate smoking with lung cancer and heart disease, few are aware of the impact of smoking on ocular health. Studies have suggested a better knowledge of this association might promote higher quit rates, particularly in teenagers. The purpose of our study was to determine the knowledge of teenagers about the effects of smoking on ocular health and the fear associated with several tobacco‐related health conditions.MethodsA self‐administered questionnaire was distributed to 180 high school students aged 14 to 17 years. Measured variables included socio‐economic demographics, smoking status, knowledge of the effects of smoking on general and ocular health, and level of fear as well as level of motivation to quit smoking associated with the following tobacco‐related conditions: lung cancer, cardiovascular disease, heart attack, blindness and deafness.ResultsResponse rate was 100 per cent. Eleven per cent of responders were smokers. The proportion of smokers who thought smoking could cause blindness was 64.3 per cent while it was 13.5 per cent for non‐smokers. The proportion of smokers fearing blindness was 30 per cent, as opposed to 69.8 per cent for non‐smokers. The proportion of respondents who thought the presented conditions were ‘extremely’ or ‘very good’ reasons to quit were similarly high for all smoking‐associated conditions.ConclusionThese findings suggest teenagers are unaware of the impact smoking can have on ocular health. Smokers did not seem more concerned about vision loss compared to other tobacco‐related diseases, as opposed to non‐smokers. Our findings suggest vision loss would be a strong motivator to prevent initiation, but not very effective regarding cessation in this group. However, optometrists should be aware teenagers seem receptive to the message that ‘smoking can cause blindness’ and use this strategy in order to prevent smoking initiation.

Do we need regional guidelines for breast cancer management in the MENA region? MENA Breast Cancer Guidelines project.

PurposeBreast cancer is the most common cancer among females worldwide in general and in the Middle East and the North African region (MENA region) in particular. Management of breast cancer in the MENA region faces a lot of challenges, which include younger age at presentation, aggressive behaviour, lack of national breast screening programmes and lack of reliable data registries as well as socioeconomic factors. These factors make applying the international guidelines for breast cancer management very challenging. The aim of this project is to explore the need for a regional breast cancer guideline as well as to screen the clinical practice of breast cancer management in the MENA region.MethodologyThree web-based designed surveys were sent to more than 600 oncologists in the MENA region from the period of August 2013 to October 2014. Full descriptive data and information regarding the application of international breast cancer guidelines were collected. The software was using the IP address to prevent duplication of collected data. Descriptive analysis and results were shown as numbers and percentages.ResultsDuring the period of the survey, 104 oncologists responded, representing around an 11% response rate. The majority of replies came from Egypt (59 responses (59%)), followed by Saudi Arabia (ten responses (9.6%)). Fifty-one per cent of responders had more than ten years of experience, and further 31.7% had 5–10 years of experience. Seventy-four per cent were working in governmental hospitals, which is our target sector. There was a major defect in having a genetic counsel unit (78.8% declared an absence of this service), presence of a national breast screening programme (55.8% declared an absence of this service), performing sentinel lymph node biopsy (43.3% declared an absence of this service). The need for regional guidelines for the management of breast cancer was agreed upon by 90.6% of responders.ConclusionThere is a clear need to improve the management of breast cancer in the MENA region. Creating a national breast screening programme and a reliable database is essential. A regional guideline is required to establish the best possible management of breast cancer according to the patients and disease specification as well as the regional socioeconomic factors and facilities available. There is also a need to improve clinical research that meets the region’s needs.

Choosing Surgery: Identifying Factors Leading to Increased General Surgery Matriculation Rate

Tulane graduates have, over the past six years, chosen general surgical residency at a rate above the national average (mean 9.6% vs 6.6%). With much of the recent career choice research focusing on disincentives and declining general surgery applicants, we sought to identify factors that positively influenced our students' decision to pursue general surgery. A 50-question survey was developed and distributed to graduates who matched into a general surgery between the years 2006 and 2014. The survey evaluated demographics, exposure to surgery, and factors affecting interest in a surgical career. We achieved a 54 per cent (61/112) response rate. Only 43 per cent considered a surgical career before medical school matriculation. Fifty-nine per cent had strongly considered a career other than surgery. Sixty-two per cent chose to pursue surgery during or immediately after their surgery clerkship. The most important factors cited for choosing general surgery were perceived career enjoyment of residents and faculty, resident/faculty relationship, and mentorship. Surgery residents and faculty were viewed as role models by 72 and 77 per cent of responders, respectively. This study demonstrated almost half of those choosing a surgical career did so as a direct result of the core rotation experience. We believe that structuring the medical student education experience to optimize the interaction of students, residents, and faculty produces a positive environment encouraging students to choose a general surgery career.

Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia: results of a survey.

AimsTo survey the perceived indications for magnetic resonance imaging of the small bowel (MRE) by experts, when MR enteroclysis (MREc) or MR enterography (MREg) may be chosen, and to determine how the approach to MRE is modified when general anaesthesia (GA) is required.Materials and methodsSelected opinion leaders in MRE completed a questionnaire that included clinical indications (MREg or MREc), specifics regarding administration of enteral contrast, and how the technique is altered to accommodate GA.ResultsFourteen responded. Only the diagnosis and follow-up of Crohn’s disease were considered by over 80 % as a valid MRE indication. The remaining indications ranged between 35.7 % for diagnosis of caeliac disease and unknown sources of gastrointestinal bleeding to 78.6 % for motility disorders. The majority chose MREg over MREc for all indications (from 100 % for follow-up of caeliac disease to 57.7 % for tumour diagnosis). Fifty per cent of responders had needed to consider MRE under GA. The most commonly recommended procedural change was MRI without enteral distention. Three had experience with intubation under GA (MREc modification).ConclusionViews were variable. Requests for MRE under GA are not uncommon. Presently most opinion leaders suggest standard abdominal MRI when GA is required.Main messages• Experts are using MRE for various indications.• Requests for MRE under general anaesthesia are not uncommon.• Some radiologists employ MREc under general anaesthesia; others do not distend the small bowel.

Work-up and management of lone atrial fibrillation: results of the European Heart Rhythm Association Survey.

The purpose of this European Heart Rhythm Association (EHRA) survey was to explore the work-up and management of lone atrial fibrillation (AF) among the European centres. Thirty-two European centres, all members of the EHRA electrophysiology (EP) research network, responded to this survey and completed the list of questions. The prevalence of lone AF has been reported to be ≤10% by 19 (60%) of the participating centres. The presence of isolated left atrial enlargement and left ventricular diastolic dysfunction represent heart disease according to 50 and 84% of the centres, respectively, and exclude the diagnosis of lone AF. Fifty-nine per cent of responders do not routinely consider genetic testing in lone AF patients. The initial therapeutic approach in symptomatic paroxysmal lone AF is antiarrhythmic drug therapy as reported by 31 (97%) of the centres. Pulmonary vein isolation only is the first ablation strategy for patients with symptomatic persistent lone AF at 27 (84%) of the responding centres. Assessment for sleep apnoea, obesity, and intensive sports activity in lone AF is performed at 27 (84%) centres. In conclusion, this EP Wire survey confirms that the term 'lone AF' is still used in daily practice. The work-up typically includes screening for known risk factors but not genetic testing. The preferred management of paroxysmal lone AF is rhythm control with antiarrhythmic drugs, whereas pulmonary vein isolation is the first ablation strategy for the majority of patients with symptomatic persistent lone AF.

Management of drug misuse: an 8-year follow-up survey of Scottish GPs

This study repeated a Scotland-wide survey of one-in-four GPs from 2000, to compare findings with 2008. A 60% response was achieved (of 1065). Almost 44% of GPs were treating drug misusers (62% in 2000). Enhanced services were provided by less than half of practices. Seven per cent of responders were only comfortable prescribing below the recommended minimum dose of 60 mg methadone, (33% in 2000). Over 70% offered blood-borne virus screening and 71% were aware of patients using psychostimulants. Recent changes, particularly the new GP contract may have decreased GP involvement in treating drug misusers.

Double-dose hepatitis B vaccination in cirrhotic patients on a liver transplant waiting list

Development of immunity to hepatitis B virus in cirrhotic patients waiting for liver transplantation is highly desirable. Though a double-dose regimen is available, little is know about its effectiveness. We examined the efficacy of double-dose hepatitis B virus vaccination in cirrhotic patients waiting for liver transplantation. We studied 43 patients who were waiting for liver transplantation. They were vaccinated with three doses of 40 mg hepatitis B vaccine at 0, 1 and 6 months; the normal dose is 20 microg. Efficacy was measured based on seroconversion of anti-HBs. Global response to the primary vaccination scheme was 67.5% (29 patients). Forty-one per cent of responders had anti-HBs titers above 1,000 IU/mL. No factors were associated with response, based on multivariate analysis. The vaccination scheme of 40 microg at 0, 1 and 6 months was superior to conventional vaccination doses (20 microg) for cirrhotic patients on a waiting list for liver transplantation.

Digest

Digest

A survey of stress ulcer prophylaxis in Intensive Care Units in the UK

Following the introduction of ‘ventilator care bundles’, which include stress ulcer prophylaxis but do not give any specific guidance, we decided to survey the use of agents prescribed for stress ulcer prophylaxis in ICUs in the UK. A total of 260 questionnaires were sent out and 198 (76%) responses received. Of these, 180 units (90%) stated that a protocol exists in their institution and 160 (81%) stated that stress ulcer prophylaxis was considered in all patients admitted to their ICU. For first line or standard stress ulcer prophylaxis sucralfate was used by 25 responders (13%), ranitidine by 131 (66%), nizatidine by two (1%), omeprazole 20 mg once daily by seven (3.5%), omeprazole 40 mg once daily by 15 (8%), lansoprazole 20 mg sublingual by four (2%), lansoprazole 30 mg orally by one (0.5%), lansoprazole 30 mg intravenously by two (1%), pantoprazole by 11 (5%) and combinations of drugs by 18 (9%). For high risk patients, sucralfate was used by six (3%), ranitidine by 25 (13%), omeprazole 20 mg once daily by nine (4.5%), omeprazole 40 mg once daily by 109 (55%), esomeprazole by one (0.5%), lansoprazole 30 mg intravenously by 16 (8%), pantoprazole by 32 (19%), and combinations of drugs by 30 (15%). Nosocomial or ventilator-associated pneumonia was not stated to be a factor in the choice of drug used by 119 of responders (60%), yet 13% of responders used sucralfate as first line prophylaxis and 3% used sucralfate in high risk groups. For standard prophylaxis, evidence-based medicine was stated as the reason for the choice of drug by 161 responders (81%). Trust or financial reasons were stated for the choice of drug by 30 (15%). For high risk patients, evidence-based medicine was stated as the reason for the choice of drug by 136 (69%), and Trust or financial reasons by 19 (10%). Evidence-based medicine is suggested as the reason for the choice of drug in 81% for first line prophylaxis compared with 69% in the high risk group. This is consistent with the literature suggesting that ranitidine is effective for stress ulcer prophylaxis in first line therapy but the evidence is less clear for high risk groups. There appears to be less certainty as to the reasons for the choice of drugs in the high risk group, with 18% providing no reason for their choice. Thirty-two responders (16%) stated that they would not stop prophylaxis when enteral feeding was established, and the rest would. This issue is controversial and continues to be investigated [1, 2]. A meta-analysis has suggested that there was strong evidence of reduced clinically important gastro-intestinal bleeding with H2 receptor antagonists and that sucralfate may be as effective in reducing bleeding as gastric pH altering drugs and is associated with lower rates of pneumonia and mortality [3]. A further study has observed a lower incidence of clinically important stress ulcers with ranitidine and a lower incidence of nosocomial pneumonia with sucralfate. Mortality and length of ICU stay were similar in both groups [4]. The use of intravenous proton pump inhibitors (PPIs) is now becoming widespread. There is preliminary work to suggest that PPIs are safe and effective for stress ulcer prophylaxis [5, 6]. Twenty per cent of responders used PPIs as first line prophylaxis in this study. These data show that application of the available evidence is not uniform. This is due to the data being inconclusive on all issues relating to stress ulcer prophylaxis. We believe that this uncertainty will remain.

Intratympanic gentamicin treatment in Meniere's disease: Patients' experiences and outcomes

The aim of this study was to assess the experiences and outcomes of patients receiving intratympanic gentamicin treatment for Ménière's disease in Norfolk, UK. This study was based on a retrospective questionnaire survey and a review of patients' medical records. Two district hospitals. All 29 patients treated between 1999 and 2001, with a minimum follow up of two years post-treatment, were included in the study. Twenty-three patients completed the questionnaires (79 per cent response rate). Glasgow benefit inventory (GBI) and vertigo symptom scale (VSS) scores, plus change in hearing thresholds. The mean GBI total score was +36, indicating substantial improvement in patients' overall quality of life following gentamicin treatment. The VSS scores demonstrated low levels of vertigo or unsteadiness in treated patients. Three patients suffered deterioration in their hearing thresholds following a single injection of gentamicin. However, 96 per cent of responders stated that they would be willing to have such treatment again, if necessary. Intratympanic gentamicin treatment ought to be offered to Ménière's patients suffering from disabling vertigo, with the proviso that they be made aware of the possibility of hearing deterioration.

Uptake of rotary NiTi technology within Australia

Rotary NiTi technology was introduced into Australia approximately 10 years ago. Little information is available in the dental literature to explain the adoption of new technology in dentistry. The aim of this paper is to identify and describe demographic features in the uptake of rotary NiTi technology within Australia. In 2001, a questionnaire survey was mailed to a stratified systematic sample of general dentists and endodontists in Australia. The numbers of dentists in each state adopting the new technology were recorded and the results tabulated and graphed. The response rate for the survey was 87 per cent. Overall, 26 per cent of responders used rotary NiTi instruments with a significantly higher proportion of endodontists (64 per cent) than general dentists (22 per cent). A significantly lower proportion of South Australian metropolitan general dentists used rotary NiTi compared with metropolitan dentists in all other states combined. The rate of uptake by South Australian dentists was lower than the other states. A significantly higher proportion of Queensland endodontists were using rotary NiTi compared with endodontists in New South Wales. A significantly greater proportion of rural dentists had tried and abandoned the new technology than metropolitan dentists. The adoption of rotary NiTi in Australia appears to conform to diffusion of innovation theory and has reached a critical mass making it self-sustaining.

Children's surgery performed by adult general surgeons in Scotland: The present and future

The aim of this study was to determine the extent and the future of paediatric surgery performed in Scotland outside of the designated surgical paediatric centres. An anonymous questionnaire was sent to all 111 Scottish members of the Association of Surgeons of Great Britain and Ireland. There was a response rate of 69%. Overall, 45% of responders operated on children. This was independent of the surgeon's age but was related to the type of hospital that the surgeon worked in. Eighty-four per cent of responders had a lower age limit under which they would not operate and 94% stated that there were specific circumstances where they would not operate. A mean of 18.5 elective procedures (range 0-250, median two) and six emergency procedures (range 0-30, median five) were carried out by each surgeon operating on children under the age of five per annum. Only 13% of responders thought that their successor would operate on children. Non-specialist paediatric surgery in Scotland is currently provided by a significant number of surgeons whose successors will not continue to provide a comparative paediatric service. This has implications for local provision of care, emergency management and capacity of existing children's hospitals in the future.