Oxford Hospitals Research Articles

Assessment of proximity of impacted mandibular third molar roots to the mandibular canal using intra oral periapical radiography and cone-beam computerized tomography: A comparative study

Objective: To assess the reliability of fi ve intra oral periapical radiography (IOPAR) radiographic signs, and to compare the reliability of IOPAR with that of cone-beam computerized tomography (CBCT) for determining the proximity of impacted mandibular third molar and mandibular canal. Methods: The present study consisted of 50 subjects, in age group of 18-30 years with impacted mandibular third molar visiting the department, Oxford Dental College and Hospital, Bengaluru. Relationship of impacted mandibular third molar with the mandibular canal was assessed using IOPAR signs and CBCT fi ndings. The 5 radiographic signs i.e. darkening of roots, diversion of canal, narrowing of canal, presence of cortication, and interruption of white line seen on IOPAR, were correlated for the proximity and involvement with CBCT fi ndings for the same. Results: In this study only 4% (2) subjects showed absence of corticalization on CBCT compared to diff erent radiographic (IOPAR) signs in all subjects. Among these two subjects diagnosed with an absence of corticalization, 50% (1) presented with a radiographic sign of darkening of roots and both i.e. 100% (2) presented interruption of white lines on IOPAR the mean and SD values of distance from mandibular third molar root to mandibular canal were 2.25 and 1.48 respectively in CBCT. Conclusion: This study showed the poor reliability of radiographic signs of IOPAR predicting the proximity of mandibular third molar root with mandibular canal related to CBCT fi nding. This creates the controversy and questions regarding the radiographic signs of IOPAR reliability with CBCT fi ndings that was found far more precise and accurate as per for future prospects.

Self-harm in Oxford, England: epidemiological and clinical trends, 1996-2010.

Self-harm is a major healthcare problem and changes in its prevalence and characteristics can have important implications for clinical services, treatment and prevention. We analysed data on all self-harm presentations to the general hospital in Oxford between 1996 and 2010 using the Oxford Monitoring System for Self-harm. We investigated trends in prevalence, methods and repetition of self-harm, and receipt of psychosocial assessment. For patients receiving a psychosocial assessment, we investigated trends in alcohol use and misuse, prior psychiatric treatment and self-harm, problems, and suicidal intent. Rates of self-harm rose in both genders between 1996 and 2002/2003, after which they declined. There was evidence of a possible cohort effect, whereby higher rates in younger males in earlier years transferred over time to older age groups. Self-cutting, hanging and jumping became more common. Paracetamol was involved in 44.9 % of all self-poisoning episodes. Overdoses of antidepressants (particularly selective serotonin reuptake inhibitors) increased, as did those of mood stabilisers, non-opiate analgesics excluding paracetamol (e.g. non-steroidal anti-inflammatory drugs), and non-ingestible poisons. Alcohol use in relation to self-harm and alcohol-related problems became more common, as did history of prior psychiatric treatment and, especially, of self-harm, and employment problems from 2008. Despite national guidance, the proportion of patients undergoing psychosocial assessment declined. Major changes in the extent and nature of self-harm occurred over the study period, some suggestive of increased psychopathology and others reflecting prescribing practices and changes in drinking patterns. The findings emphasise the need for psychosocial assessment following self-harm, to identify treatment needs and reduce repetition.

WHITE COATS AND NO TROUSERS: NARRATING THE EXPERIENCES OF WOMEN TECHNICIANS IN MEDICAL LABORATORIES, 1930-90.

Laboratory technicians are a vital part of any working lab. Not only is their knowledge and expertise important for the success of research, but they also often maintain the lab's intellectual and social life. Despite the importance of their work, they are rarely acknowledged in publications, and leave only a few traces within the historical recordthe voices of women laboratory technicians are even harder to uncover. This paper attempts to correct this imbalance by presenting the narratives of women who worked as laboratory technicians at places such as the National Institute for Medical Research (NIMR), the Wellcome Research Laboratories, and established hospital and university labs in Cambridge, Oxford and London. The data were collected though narrative interviews. Specifically, the paper looks at the roles of these women within the lab, their experiences of the social and gender dynamics of the lab, and the development of expertise in regard to the work they carried out and the extent to which they received credit for their contributions to science.

The Local Effect of Alendronate with Intra-alveolar Collagen Sponges on Post Extraction Alveolar ridge Resorption: A Clinical Trial.

Extraction of teeth is followed by resorption of the residual alveolar ridge that continues throughout life resulting in loss of alveolar height and width. Of the numerous techniques that have been used to arrest post extraction alveoloar ridge resorption, the placement of a graft material inside the socket immediately after extraction has been mostly followed. Type 1 collagen is one of the commonly used graft material that prevent resorption by providing dimensional stability to the socket. Bisphosphonates are an anti-osteoclastic drug that prevent resorption by disrupting the membrane ruffling of the osteoclasts. Alendronate a bisphosphonate, is primarily used in diseases with bone loss. It has been used to reduce active bone resorption significantly without interfering with bone mineralization and quality. The need for the study is to examine the inhibitory effect of alendronate on residual ridge resorption when applied locally in combination with type I collagen on alveolar bone immediately following tooth extraction. Twenty patients with age between 30 and 65years were selected from the out patient department of The Oxford Dental College and Hospital. The patients were divided into two groups. In the first group after extraction of teeth from premolar to midline the sockets were irrigated with saline and sutured. On the left side type I collagen sponge was placed and sutured. In the other group the right side was treated the same way after extraction as in first group where as in the left side sockets type I collagen soaked in 20mg/ml of alendronate was placed and sutured. Patients were evaluated clinically for any local irritation as well as radiologically with orthopantomograph X-rays were taken immediately after the extraction, 1month after extraction and 4months after extraction to determine the amount of bone loss prevented. The statistically significant bone loss prevented by the collagen alone was 22.8% and in collagen with alendronate group was 44.38% at the end of 4months. Type I collagen soaked with alendronate when placed in the socket immediately after extraction of teeth prevents post-extraction alveolar ridge resorption.

Continuous non-contact vital sign monitoring in neonatal intensive care unit.

Current technologies to allow continuous monitoring of vital signs in pre-term infants in the hospital require adhesive electrodes or sensors to be in direct contact with the patient. These can cause stress, pain, and also damage the fragile skin of the infants. It has been established previously that the colour and volume changes in superficial blood vessels during the cardiac cycle can be measured using a digital video camera and ambient light, making it possible to obtain estimates of heart rate or breathing rate. Most of the papers in the literature on non-contact vital sign monitoring report results on adult healthy human volunteers in controlled environments for short periods of time. The authors' current clinical study involves the continuous monitoring of pre-term infants, for at least four consecutive days each, in the high-dependency care area of the Neonatal Intensive Care Unit (NICU) at the John Radcliffe Hospital in Oxford. The authors have further developed their video-based, non-contact monitoring methods to obtain continuous estimates of heart rate, respiratory rate and oxygen saturation for infants nursed in incubators. In this Letter, it is shown that continuous estimates of these three parameters can be computed with an accuracy which is clinically useful. During stable sections with minimal infant motion, the mean absolute error between the camera-derived estimates of heart rate and the reference value derived from the ECG is similar to the mean absolute error between the ECG-derived value and the heart rate value from a pulse oximeter. Continuous non-contact vital sign monitoring in the NICU using ambient light is feasible, and the authors have shown that clinically important events such as a bradycardia accompanied by a major desaturation can be identified with their algorithms for processing the video signal.

Editorial introductions

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Paul T. HeathPaul T. HeathPaul T. Heath is a Professor and Honorary Consultant in Paediatric Infectious Diseases at St George's, University of London and Vaccine Institute in London, UK. His training in paediatrics and infectious diseases was at the Royal Children's Hospital, Melbourne, Australia, the John Radcliffe Hospital, Oxford, UK and St George's Hospital, London, UK. His particular research interests are in the epidemiology of vaccine preventable diseases, in clinical vaccine trials, particularly in at-risk groups, and in perinatal infections and he has published over 150 original or review papers in these areas. He sits on national committees concerned with neonatal infections, meningitis, group B streptococcus prevention and on immunisation policies in children. He is a Fellow of the Royal Australasian College of Physicians, a Fellow of the Royal College of Paediatrics and Child Health, a member of the research committee of the European Society of Paediatric Infectious Diseases and a member of the Science Board of the international Brighton Collaboration on vaccine safety. Dennis L. StevensDennis L. StevensDr Stevens received his PhD in Microbiology from Montana State University, USA and his MD from the University of Utah College of Medicine, USA. Following a residency in internal medicine at the University of Utah, Dr Stevens completed an infectious disease fellowship at Brooke Army Medical Center in San Antonio, Texas, USA and has been Chief of Infectious Diseases at the Veterans Affairs Medical Center in Boise, Idaho, USA, since 1979. Dr Stevens is Professor of Medicine at the University of Washington School of Medicine, USA and his major clinical interests have been in Staphylococcal and Streptococcal toxic shock syndromes and in skin and soft tissue infections including necrotizing fasciitis and gas gangrene. His research interests are centered around gram positive bacteria and the role of extracellular toxins in the pathogenesis of severe soft tissue infection caused by Streptococcus pyogenes, Clostridium perfringens and methicillin-resistant Staphylococcus aureus. Current research efforts investigate the mechanisms of toxin induced shock and organ dysfunction including cardiomyopathy, the effects of toxins on endothelial cells, granulocytes and platelets and the importance of the mechanisms of action of antibiotics in treating gram positive infections. Dr Stevens has published over 170 original research papers, 89 book chapters, 143 abstracts and three books, Streptococcal Infections: Clinical Aspects, Microbiology and Molecular Pathogenesis (co-authored with Dr. Edward Kaplan), An Atlas of Infectious Diseases: Skin and Soft Tissue, Bone and Joint Infections and Netter's Textbook of Infectious Diseases (co- authored with Dr. Elaine Jong). Dr Stevens is a member of the American Society of Microbiology, a Fellow in the American College of Physicians, a Fellow in the Infectious Disease Society of America and a member of the Association of American Physicians. In 2000, Dr Stevens received the Infectious Disease Society of America's Society Citation Award and in 2001, The William Altemier Award from the Surgical Infectious Disease Society. Dr Stevens has served as a consultant for the CDC Working Group on Invasive Group A streptococcal infections and for the WHO and NIH on similar matters. Dr Stevens is currently Chairman of the Infectious Disease Society of America Guidelines Committee on Skin and Soft Tissue Infections.

A UK experience of daycase cochlear implant surgery

ObjectivesThis study aims to assess the safety of daycase cochlear implant surgery.MethodsA retrospective review was conducted on all patients who underwent cochlear implant surgery at a teaching hospital in Oxford, UK between September 2008 and February 2012.ResultsOne hundred and sixteen patients underwent cochlear implant surgery. This included 73 adults and 43 children. Twenty-six patients underwent the procedure as a daycase procedure. There were no readmissions.DiscussionThe demand ‘to do more with less’ has led to increasing drives for efficiency and cost-effectiveness. Therefore, the role of daycase surgery is becoming increasingly widespread. Daycase surgery has been shown to be advantageous for both patients and hospitals.ConclusionDaycase cochlear implant surgery is feasible and can be safely conducted in a select group of patients.

Clinician awareness of tetanus prophylaxis guidelines in trauma wound management

s / International Journal of Surgery 11 (2013) 686e745 703 ABSTRACTS Method: First on-call doctors covering ENT in hospitals in Oxford and Wessex deaneries were contacted by telephone on a weekend in January 2013. Information on stage of training, primary specialty, ENT experience, senior support and confidence in managing emergencies was obtained. Results: 14 doctors from 9 hospitals participated in the survey. Their grades were FY1 (1), FY2 (7), CT1 (2), CT2 (2) and CT3 (2). Their experience in ENT varied from 0 to 16 months. 14% did not know how to do anterior nasal packing for epistaxis and had little confidence (score of less than 5 out of 10) in managing simple ENT emergencies. 29% had no specific ENT induction andwere only given information on ENTemergencies as part of a generic induction handbook. They all had a middle grade as second on-call for support. Conclusions: This regional snapshot analysis shows that ENT is still covered by trainees with little or no experience. It is important that proper ENT induction is given to cross-cover SHOs because of the implications on patient safety. A comprehensive regional analysis is recommended to ascertain the full extent of this problem. 1241: CLINICIAN AWARENESS OF TETANUS PROPHYLAXIS GUIDELINES IN TRAUMA WOUND MANAGEMENT Alan Quinn, Alastair McKay, Tristan McMillan. Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK. Introduction: Tetanus is a potentially fatal disease that may result from minor wounds as well as from those caused by major trauma and burns. Tetanus immunization and prophylaxis in the acute injury setting is frequently misunderstood and subsequently misused with well-documented poor guideline compliance. Methods: A questionnaire was compiled based on the Department of Health's Green Book of Immunisation to assess awareness of tetanus prophylaxis guidelines. Subjects were recruited from AE University of Sheffield, Sheffield, UK. Aims: Having developed a higher trainee-led procedural skills programme for core surgical trainees, we aimed to assess feasibility and outcomes of this novel programme. Methods: Competencies, learning outcomes and appropriate simulators were identified or devised. A pool of trainers, mainly HSTs, was identified and a website was created including a sign-up mechanism and access to learning resources. Written feedback was obtained for each session and an electronic survey used to explore experiences of simulation and outcomes. Results: 6 half-day practical wet and dry lab sessions were run, including comprehensive basic surgical skills, laparoscopy, general, orthopaedic and vascular skills. Trainees completed simulated workplace assessments (sWPAs) encouraging individualised structured feedback from trainers. Feedback revealed median overall satisfaction was 90%, including: opportunity to practice 92%, level of pitch 90%, realism of models 88% and trainer knowledge 90%. 32 electronic survey responses (59%) found 81% of CSTs agree that simulation benefits their training and 81% agreed that it improves confidence. 69% of CSTs found sWPAs to be beneficial. Conclusions: CST satisfaction of the trainee-led procedural skills programme was high. This pilot supports the cascade model of teaching and engaged senior trainees with simulation and teaching. The majority of CSTs valued the use of sWPAs. 1256: THE E-CRABEL SCORE: AN UPDATED METHOD FOR AUDITING MEDICAL RECORDS Tharsika Karunakaran, Oliver Turner, Bijan Doostdar. University College

ENT SHO out-of-hours cover: A snapshot analysis across Oxford and Wessex Deaneries' Hospitals

ENT SHO out-of-hours cover: A snapshot analysis across Oxford and Wessex Deaneries' Hospitals

Editorial introductions

Current Opinion in Infectious Diseases was launched in 1988. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of infectious diseases is divided into 11 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Paul T. HeathPaul T. HeathPaul Heath is a Professor and Honorary Consultant in Paediatric Infectious Diseases at St George's, University of London and Vaccine Institute in London, UK. His training in paediatrics and infectious diseases was at the Royal Children's Hospital, Melbourne, Australia, the John Radcliffe Hospital, Oxford, UK and St George's Hospital, London, UK. His particular research interests are in the epidemiology of vaccine preventable diseases, in clinical vaccine trials, particularly in at-risk groups, and in perinatal infections. He sits on national committees concerned with meningitis, group B streptococcus prevention and on immunisation policies in children. He is a Fellow of the Royal Australasian College of Physicians, a Fellow of the Royal College of Paediatrics and Child Health, a member of the education committee of the European Society of Paediatric Infectious Diseases and a member of the Science Board of the international Brighton Collaboration on vaccine safety. Dennis L. StevensDennis L. StevensDr Stevens received his PhD in Microbiology from Montana State University, USA and his MD from the University of Utah College of Medicine, USA. Following a residency in internal medicine at the University of Utah, Dr Stevens completed an infectious disease fellowship at Brooke Army Medical Center in San Antonio, Texas, USA and has been Chief of Infectious Diseases at the Veterans Affairs Medical Center in Boise, Idaho, USA, since 1979. Dr Stevens is Professor of Medicine at the University of Washington School of Medicine, USA and his major clinical interests have been in Staphylococcal and Streptococcal toxic shock syndromes and in skin and soft tissue infections including necrotizing fasciitis and gas gangrene. His research interests are centered around gram positive bacteria and the role of extracellular toxins in the pathogenesis of severe soft tissue infection caused by Streptococcus pyogenes, Clostridium perfringens and methicillin-resistant Staphylococcus aureus. Current research efforts investigate the mechanisms of toxin induced shock and organ dysfunction, the effects of toxins on endothelial cells, granulocytes and platelets and the importance of the mechanisms of action of antibiotics in treating gram positive infections. Dr Stevens has published over 150 original research papers, 60 book chapters, 110 abstracts and two books, Streptococcal Infections: Clinical Aspects, Microbiology and Molecular Pathogenesis (co-authored with Dr. Edward Kaplan) and An Atlas of Infectious Diseases: Skin and Soft Tissue, Bone and Joint Infections. Dr Stevens is a member of the American Society of Microbiology, a Fellow in the American College of Physicians, a Fellow in the Infectious Disease Society of America and a member of the Association of American Physicians. In 2000, Dr Stevens received the Infectious Disease Society of America's Society Citation Award and in 2001, The William Altemier Award from the Surgical Infectious Disease Society. Dr Stevens has served as a consultant for the Centers of Disease Control and PreventionWorking Group on Invasive Group A streptococcal infections and for the World Health Organization and National Institutes of Health on similar matters. Dr Stevens is currently Chairman of the Infectious Disease Society of America Guidelines Committee on Skin and Soft Tissue Infections.

Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating

The management of bicondylar tibial plateau fractures is challenging. A lateral locking plate offers an alternative method to traditional dual plating to avoid further stripping of soft tissue. Nevertheless, the rate of malreduction and fixation loss remains high. From 2007 to 2009, we performed open reduction and fixation with unilateral locked plating to directly reduce the fracture in 15 patients with bicondylar plateau fracture. The average follow-up duration was 16.2 months (range: 12–30 months), and the average age of the patients was 43 years (range: 19–64 years). All fractures were Orthopaedic Trauma Association type 41-C. Postoperative radiographic alignment was evaluated immediately and at 2–4 weeks, 8–12 weeks, 5–7 months, and 11–13 months. Both Oxford knee score and Hospital for Special Surgery knee score were used to evaluate functional outcomes. The average duration within which union was achieved was 4.8 months (range: 2–10 months). One patient incurred wound dehiscence; however, there was no case of deep infection. Malreduction occurred in one patient (6.7%) while fixation loss occurred in three patients (20%) with subsidence of the posteromedial fragment and varus malalignment. Despite the malreduction rate being lower in our study than in previous studies involving unilateral locked plating, a high rate of fixation loss was recorded. Per our limited experience, we believe that unilateral locked plating may have limitations in patients with selective patterns of bicondylar tibial plateau fractures.

Determining immunisation status of children from history: a diagnostic accuracy study

ObjectivesChildren presenting unplanned to healthcare services are routinely asked about previous immunisations as part of their assessment. We aimed to assess the accuracy of screening children for immunisation status by...

Survey of patient opinion on tobacco cessation counseling and services in a dental teaching institution and hospital.

The objective of this study was to assess the opinion of dental patients who use tobacco towards receiving tobacco cessation counseling and services in a dental college and hospital setting. A cross-sectional descriptive survey method using a structured questionnaire was used in this study. Participants were patients attending The Oxford Dental College, Hospital, and Research Center, Bengaluru, India. Each patient in the clinic waiting room was asked by the investigator to complete a 29-item self-administered questionnaire. Descriptive statistics and bivariate analysis using Fisher's exact tests were used for statistical analysis of the data. Ninety-six percent (n = 770) of tobacco users had previously attempted to quit tobacco and 95.7% were willing to quit. Sixteen percent (n = 132) of respondents reported that they currently used tobacco. About 83% of tobacco users agreed that the student dentist should ask patients whether or not they use tobacco, 79.4% agreed that the student dentist should advise tobacco users to quit, and 81.4% agreed that student dentists should offer information on quitting tobacco to patients who want to quit. Only 12.5% (n = 100) of the patients who use tobacco were aware of the community resources available to quit tobacco. This study shows that patients expect and felt comfortable with receiving tobacco cessation counseling services by oral health professionals in a dental hospital setting.

MP 8 Conversion disorder

BNPA Committee member, Christopher Butler is Academic Clinical Lecturer in Neurology at the University of Oxford. His research interests centre on mechanisms of human memory and their disruption in brain disease, particularly epilepsy. He trained in medicine at the Universities of Cambridge and Edinburgh and obtained his PhD for work conducted on the syndrome of Transient Epileptic Amnesia under the supervision of Adam Zeman. Together with Adam Zeman, he helps to coordinate the nationwide TIME (The Impairment of Memory in Epilepsy) Project. He runs a multidisciplinary Cognitive Disorders Clinic at the John Radcliffe Hospital in Oxford. Over the last decade, there have been major advances in our understanding of frontotemporal dementia (FTD) syndromes. In this update, I will briefly review research findings relating to clinical assessment and diagnosis, neuroimaging, histopathology, genetics and treatment of behavioural variant FTD. The emphasis will be on research that has implications for the clinical practice of neurologists and psychiatrists.

AD 2 Disruption of brain connectivity in schizophrenia

Ed Bullmore trained in clinical medicine at the University of Oxford and St Bartholomew9s Hospital in London, then worked as a Lecturer in Medicine at the University of Hong Kong, before specialist clinical training in psychiatry at St George9s Hospital and then the Bethlem Royal & Maudsley Hospital London. His research career started in the early 1990s as a Wellcome Trust Research Fellow and was initially focused on mathematical analysis of neurophysiological time series. Since moving to Cambridge as Professor of Psychiatry in 1999, his interest in systems-level analysis of brain function and structure has increasingly focused on using tools drawn from wavelet analysis and graph theory to investigate complex brain networks identified in human neuroimaging data (fMRI, MRI and MEG). Since 2005, he has worked half-time for GlaxoSmithKline as Head of GSK9s Clinical Unit in Cambridge and Vice-President, Experimental Medicine. He is Deputy Director of the Wellcome Trust/GSK funded training programme in Translational Medicine and Therapeutics, Clinical Director of the Wellcome Trust/MRC funded Behavioural & Clinical Neuroscience Institute, and an honorary Consultant Psychiatrist and co-director of CAMEO in Cambridgeshire & Peterborough Foundation NHS Trust. He has published about 270 peer-reviewed articles and his h-index is 67. The idea that schizophrenia reflects a disruption of brain connectivity dates back to the founding fathers of neuropsychiatry. Recent neuroimaging studies have provided fresh evidence for models of psychosis as disconnexion syndromes. I will review MRI studies of abnormal brain connectivity in schizophrenia with a focus on recent work using graph theory to measure the complex topological properties of human brain networks in healthy and psychotic individuals. These data clearly demonstrate abnormalities of the connectome in schizophrenia: they also raise questions for future research. In particular, how can we reconcile genetic and developmental models of pathogenesis with network abnormalities in schizophenia?

Surveillance of Infection Severity: A Registry Study of Laboratory Diagnosed Clostridium difficile

Changing clinical impact, as virulent clones replace less virulent ones, is a feature of many pathogenic bacterial species and can be difficult to detect. Consequently, innovative techniques monitoring infection severity are of potential clinical value. We studied 5,551 toxin-positive and 20,098 persistently toxin-negative patients tested for Clostridium difficile infection between February 1998 and July 2009 in a group of hospitals based in Oxford, UK, and investigated 28-day mortality and biomarkers of inflammation (blood neutrophil count, urea, and creatinine concentrations) collected at diagnosis using iterative sequential regression (ISR), a novel joinpoint-based regression technique suitable for serial monitoring of continuous or dichotomous outcomes. Among C. difficile toxin-positive patients in the Oxford hospitals, mean neutrophil counts on diagnosis increased from 2003, peaked in 2006-2007, and then declined; 28-day mortality increased from early 2006, peaked in late 2006-2007, and then declined. Molecular typing confirmed these changes were likely due to the ingress of the globally distributed severe C. difficile strain, ST1. We assessed the generalizability of ISR-based severity monitoring in three ways. First, we assessed and found strong (p<0.0001) associations between isolation of the ST1 severe strain and higher neutrophil counts at diagnosis in two unrelated large multi-centre studies, suggesting the technique described might be useful elsewhere. Second, we assessed and found similar trends in a second group of hospitals in Birmingham, UK, from which 5,399 cases were analysed. Third, we used simulation to assess the performance of this surveillance system given the ingress of future severe strains under a variety of assumptions. ISR-based severity monitoring allowed the detection of the severity change years earlier than mortality monitoring. Automated electronic systems providing early warning of the changing severity of infectious conditions can be established using routinely collected laboratory hospital data. In the settings studied here these systems have higher performance than those monitoring mortality, at least in C. difficile infection. Such systems could have wider applicability for monitoring infections presenting in hospital.

RCS promotes musical theatre

Easy listening music in the operating theatre could reduce anxiety for millions of patients undergoing operations using local anaesthetic each year, according to research. This is just one of the surgical news stories that captured the media's imagination last month. Surgeons from the plastic and reconstructive department at the John Radcliffe Hospital in Oxford measured the respiratory rates of emergency patients and asked them to rate their feelings of worry. Half the patients had their operation in a theatre with music playing and half without – the group who were exposed to music reported lower levels of anxiety and had a lower breathing rate.

Howard Shevrin – Pioneering Investigator of Psychoanalytic Science

Howard Shevrin – Pioneering Investigator of Psychoanalytic Science

Edward Stuart Mucklow

Edward Stuart Mucklow (“Ted”) was born in Cheltenham, Gloucestershire, on 24 January 1932, son of Drs Stuart and Alex Mucklow, and was educated at Cheltenham Junior School, Radley College, Exeter...

A Study of Deliberate Self-Harm and Its Repetition Among Patients Presenting to an Emergency Department

Marked differences have been found in the characteristics of people dying by suicide in Western and Asian countries. However, there is less information available on possible differences for deliberate self-harm (DSH). To compare the characteristics of people presenting to hospital in Hong Kong and Oxford (UK) with DSH, and to assess the outcome of those persons in Hong Kong. A sample of DSH patients admitted to the accident and emergency (A&E) department of a regional hospital in Hong Kong was assessed and followed up 6 months later to assess the risk of repetition of DSH, and was then compared with such patients in Oxford. The majority of patients in Hong Kong were female (male:female ratio of 1:2.4), young (59% were under 35), and had used self-poisoning (78%). Over one-third were single (37%) and one-fourth unemployed (26%). About half (49%) scored in the high or very high categories of the Beck's Suicide Intent Scale, considerably more so than in Oxford; 44.6% of patients defaulted psychiatric outpatient service during the 6-month follow-up period. The repetition rate within the following 6 months was 16.7%. The number of self-reported adverse life problems, history of childhood sexual and physical abuse, and repetitive self-mutilation were shown to be the factors most strongly correlated with the risk of re-attempt. Alcohol problems were much lower than in Oxford. The findings show that DSH patients in Hong Kong show some marked differences compared to those in Oxford. Implications for the prevention of repeated DSH in Hong Kong are discussed.