One-day career conference organised by Shared Services (formerly part of London Deanery)
Date : Friday 20 September 2013
Venue : Senate House, London University, Malet Street
The day includes practical sessions on the recruitment process, CV writing and preparing for interviews. 1:1 Rapid Review sessions with careers experts can be booked on the day.
Certificates of attendance will be issued to delegates who return a feedback form at the end of the conference. Certificates can be added to training portfolios.
Thursday, August 22, 2013
Thursday, July 18, 2013
The British Library e-journal collections
Although the British Library is open to those who has a genuine need to use its collections, most of its electronic resources and journal collections are only available from the BL workstations within the Library's Reading Rooms and Business & IP Centre, to access this resource you need to apply for a Reader Pass.
A Reader Pass will be given if you have a legitimate personal, work-related or academic research purpose or if the specialised material you wish to use is unavailable in other public or academic libraries.
You can apply in person at the Reader Registration office at the British Library's main site, 96 Euston Road, St Pancras, London NW1 2DB
You will need to bring identification : proof of home address and proof of signature.
Opening hours: 10am-8pm Monday; 9.30am-8pm Tuesday – Thursday; 9.30am-5pm Friday and Saturday
A Reader Pass will be given if you have a legitimate personal, work-related or academic research purpose or if the specialised material you wish to use is unavailable in other public or academic libraries.
You can apply in person at the Reader Registration office at the British Library's main site, 96 Euston Road, St Pancras, London NW1 2DB
You will need to bring identification : proof of home address and proof of signature.
Opening hours: 10am-8pm Monday; 9.30am-8pm Tuesday – Thursday; 9.30am-5pm Friday and Saturday
What are open access journals?
Open-access journals are scholarly journals available online to everyone without restriction. Most of these journals are available 12 months after publication but some are available immediately.
Some major sources of open access journals in biomedicine :
Some major sources of open access journals in biomedicine :
- PubMed Central® (PMC) : A free archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health's National Library of Medicine. Launched in February 2000, PMC is a repository for journal literature deposited by participating publishers as well as authors worldwide. Publishers and individual authors continue to hold copyright on their material in PMC and users must abide by the terms defined by the copyright holder.
- Europe PubMed Central :
The UK PubMed Central, mirrored on the US PMC was funded and developed by the Wellcome Trust and the British Library and available in January 2007. On 1 November 2012, it was rebranded Europe PubMed Central to reflect its wider international scope and content. This will increase the volume of open access material available to researchers, academics and the public. - BioMed Central
- Free Medical Journals Online Most titles are free 6 months after publication, some after a year.
Why we can't trust clinical guidelines - BMJ
Clinical guidelines are recommendations on the appropriate treatment and care of people with specific diseases and conditions. They are based on the best available evidence with the aim to help healthcare professionals in their work, but they do not replace their knowledge and skills.
A recent article published in the BMJ, written by a medical investigative journalist, raised the issue that despite repeated calls to limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists.
The article refers to the drug alteplase, a clot-busting drug given for acute stroke, the guideline recommendation was based on 12 studies, but only two of them found any benefit, and five of them had to be stopped early due to increased risk of brain haemorrhage or increased death rates.
Another example is the conflict between the 1990 guidelines recommending steroids for acute spinal injury and the 2013 cllinical recommendations against using steroids in acute spinal injury.
Based on a poll, the author finds that many doctors know that many guidelines are not supported by research evidence but would continue prescribing the treatment for the fear of "malpractice" or criticism by colleagues if they fail to follow the standard.
Another conflict of interest raised in the article is that many of the guideline committee members and panellists have strong ties with the industry and that their connection would have significant influence in deciding the best guidelines on good medical care and what doctors should prescribe. The author concluded that these problems are wide spread and this is the opportunity that the medical profession takes a long hard look at itself.
According to the BMJ website, this article is one of the most read and has sparkled a lot debate among the readers.
One of the responses came from the Delfini group (US) - saying that large number of physicians and others involved in health care decision-making may not understand that many research studies are not valid or reported sufficiently, they may also lack the skills to be able to critically appraise the research evidence. The remedy is ensuring the transparency in guidelines and that all guideline developers have basic critical appraisal skills.
Source : Jeanne Lenzer. Why we can’t trust clinical guidelines. BMJ 2013;346:f3998 (Published 19 June 2013) full text via Athens
Read all the responses
A recent article published in the BMJ, written by a medical investigative journalist, raised the issue that despite repeated calls to limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists.
The article refers to the drug alteplase, a clot-busting drug given for acute stroke, the guideline recommendation was based on 12 studies, but only two of them found any benefit, and five of them had to be stopped early due to increased risk of brain haemorrhage or increased death rates.
Another example is the conflict between the 1990 guidelines recommending steroids for acute spinal injury and the 2013 cllinical recommendations against using steroids in acute spinal injury.
Based on a poll, the author finds that many doctors know that many guidelines are not supported by research evidence but would continue prescribing the treatment for the fear of "malpractice" or criticism by colleagues if they fail to follow the standard.
Another conflict of interest raised in the article is that many of the guideline committee members and panellists have strong ties with the industry and that their connection would have significant influence in deciding the best guidelines on good medical care and what doctors should prescribe. The author concluded that these problems are wide spread and this is the opportunity that the medical profession takes a long hard look at itself.
According to the BMJ website, this article is one of the most read and has sparkled a lot debate among the readers.
One of the responses came from the Delfini group (US) - saying that large number of physicians and others involved in health care decision-making may not understand that many research studies are not valid or reported sufficiently, they may also lack the skills to be able to critically appraise the research evidence. The remedy is ensuring the transparency in guidelines and that all guideline developers have basic critical appraisal skills.
Source : Jeanne Lenzer. Why we can’t trust clinical guidelines. BMJ 2013;346:f3998 (Published 19 June 2013) full text via Athens
Read all the responses
Is using surgical death rates the best way to assess performance - The Lancet
The NHS England made public the mortality rates of 7 types of surgery for individual surgeons last week by publishing the data on the NHS Choices website with the aim that it would provide transparency, help patients choose their surgeons and improve the quality of care.
However a study carried out by researchers at the London School of Hygiene & Tropical Medicine, published in the Lancet, said concentrating on the death rates for individual surgeons will not spot poor performance in certain fields and could lead to "false complacency".
The researchers argued that for some specialties, the number of procedures that a surgeon does annually is low, so the chance of identifying poor performance is also low. Based on the number of surgeries performed over 3 years, they found that 75% of UK heart surgeons perform sufficient procedures to give 60% power to use death rate to identify the poor peformance, 56% perfom enough procedures to give 80% power. However, for other procedures, the number of surgeons performing enough surgeries is much lower, eg for bowel resection, only 17% of surgeons perform enough of these surgeries to give 60% power to use death rate to identify the poor peformance and no surgeons perofrm enough surgeries to give 80% power.
They also noted that experienced surgeons my be more likely to operate in high- risk cases that may have much higher risk of mortality, this does not necessarily indicate poor performance of these surgeons.
The authors recommended a number of options to assess performance more reliably including pooling death data over a longer period of time, pooling death rates within specialties or per hospital. Other patient outcomes, such as post-operative bleeding, bleeding, infection, pain , further surgery or readmission could also provide better assessment of surgical performance.
Source: Walker K, Neuburger J, Groene O, et al. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. The Lancet. Published online July 5 2013 ( f/t via Athens)
However a study carried out by researchers at the London School of Hygiene & Tropical Medicine, published in the Lancet, said concentrating on the death rates for individual surgeons will not spot poor performance in certain fields and could lead to "false complacency".
The researchers argued that for some specialties, the number of procedures that a surgeon does annually is low, so the chance of identifying poor performance is also low. Based on the number of surgeries performed over 3 years, they found that 75% of UK heart surgeons perform sufficient procedures to give 60% power to use death rate to identify the poor peformance, 56% perfom enough procedures to give 80% power. However, for other procedures, the number of surgeons performing enough surgeries is much lower, eg for bowel resection, only 17% of surgeons perform enough of these surgeries to give 60% power to use death rate to identify the poor peformance and no surgeons perofrm enough surgeries to give 80% power.
They also noted that experienced surgeons my be more likely to operate in high- risk cases that may have much higher risk of mortality, this does not necessarily indicate poor performance of these surgeons.
The authors recommended a number of options to assess performance more reliably including pooling death data over a longer period of time, pooling death rates within specialties or per hospital. Other patient outcomes, such as post-operative bleeding, bleeding, infection, pain , further surgery or readmission could also provide better assessment of surgical performance.
Source: Walker K, Neuburger J, Groene O, et al. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. The Lancet. Published online July 5 2013 ( f/t via Athens)
Thursday, April 11, 2013
Books for FRCA exam
Suggested books for FRCA exam :
Access to anaesthetics. Primary FRCA,; Pocket book 1, 2 3. Pharmacology and clinical MCQs / Kirsty MacLennan. 2007
Clinical notes for the FRCA / Charles D. Deakin. - 3rd ed. 2011
Dr Podcast scripts for the Final FRCA / edited by Rebecca A. Leslie ... [et al.]. 2011
MCQs for the primary FRCA / B.S.K. Kamath, Sarah Turle. 2010
MCQs for the primary FRCA / Khaled Elfituri ... [et al.] ; Tony Bailey, illustrations. 2010
SAQs for the final FRCA / James R. Shorthouse, Graham Barker, Carl Waldmann. 2011
SBA and MTF MCQs for the primary FRCA / James Nickells, Benjamin Walton.2012
SBAs and MCQs for the final FRCA / edited by Rakesh Tandon. 2012
SBAs for the final FRCA / James Nickells, Tobias Everett, Benjamin Walton. 2010
Structured oral examination practice for the final FRCA / edited by Rakesh Tandon. 2012
Total revision for the FRCA / James Holding, Sarah Chieveley-Williams, Tim Isitt. - 2nd ed. 2007
Total revision for the primary FRCA / Yogen Amin ... [et al.]. - 2nd ed. 2007
Access to anaesthetics. Primary FRCA,; Pocket book 1, 2 3. Pharmacology and clinical MCQs / Kirsty MacLennan. 2007
Clinical notes for the FRCA / Charles D. Deakin. - 3rd ed. 2011
Dr Podcast scripts for the Final FRCA / edited by Rebecca A. Leslie ... [et al.]. 2011
MCQs for the primary FRCA / B.S.K. Kamath, Sarah Turle. 2010
MCQs for the primary FRCA / Khaled Elfituri ... [et al.] ; Tony Bailey, illustrations. 2010
SAQs for the final FRCA / James R. Shorthouse, Graham Barker, Carl Waldmann. 2011
SBA and MTF MCQs for the primary FRCA / James Nickells, Benjamin Walton.2012
SBAs and MCQs for the final FRCA / edited by Rakesh Tandon. 2012
SBAs for the final FRCA / James Nickells, Tobias Everett, Benjamin Walton. 2010
Structured oral examination practice for the final FRCA / edited by Rakesh Tandon. 2012
Total revision for the FRCA / James Holding, Sarah Chieveley-Williams, Tim Isitt. - 2nd ed. 2007
Total revision for the primary FRCA / Yogen Amin ... [et al.]. - 2nd ed. 2007
Tuesday, March 19, 2013
Patients consciousness during surgery
According to the NewScientists, anaesthesia wears off in about 0.02% of surgeries worldwide. In 2008, a study conducted by Washington University School of Medicine in St. Louis found that around 30,000 Americans a year awaken during surgical procedures, more often in children, sometimes experiencing intense pain and terror.
Researchers at the Massachusetts Institute of Technology (MIT) led by Emery Brown used an EEG cap with 64 electrodes to keep track of patients' brain activity across multiple brain regions as unconsciousness was induced using general anaesthetic. The team identified patterns related to consciousness and unconsciousness, and were thereby able to determine when a patient was waking up.
In the UK, about 2 % of hospitals do EEG monitoring during surgery, but only 3 or 4 electrodes are used. It only monitors one region of the brain, but the MIT team’s 64-electrode cap could bring new insight into patients’ levels of awareness during surgery, although it requires patients to shave their heads and EEG measurements are very sensitive to mechanical and electrical interference. The technique is not yet available in clinical settings.
Source: Consciousness signature warns of awareness during surgery. New Scientists, March 2013
Fewer patients awake during surgery
A new report published by the Royal College of Anaesthetists found that 153 cases of accidental awareness reported in 2011 across the UK, about 1 in every 15,000 general anaesthetics, a lot less than had been thought. Previous study found that about 1 in 500 patients were aware or awake under general anaesthetics. However, the leader of the new report, Professor Jaideep Pandit, says that under-reporting is possible partly because anaesthetists do not routinely see patients after an operation, so may not be aware of the awareness report. Sometimes patients do not report the incident.
Pandit says brain monitoring systems are available in about two-thirds of UK hospitals, but most anesthesiologists do not use them and there is a debate over how useful the monitors are. He is planning more research to focus on patient experience.
Source: Pandit JJ, Cook TM, Jonker WR, et al. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. British Journal of Anaesthesia. Published online March 13 2013
Researchers at the Massachusetts Institute of Technology (MIT) led by Emery Brown used an EEG cap with 64 electrodes to keep track of patients' brain activity across multiple brain regions as unconsciousness was induced using general anaesthetic. The team identified patterns related to consciousness and unconsciousness, and were thereby able to determine when a patient was waking up.
In the UK, about 2 % of hospitals do EEG monitoring during surgery, but only 3 or 4 electrodes are used. It only monitors one region of the brain, but the MIT team’s 64-electrode cap could bring new insight into patients’ levels of awareness during surgery, although it requires patients to shave their heads and EEG measurements are very sensitive to mechanical and electrical interference. The technique is not yet available in clinical settings.
Source: Consciousness signature warns of awareness during surgery. New Scientists, March 2013
Fewer patients awake during surgery
A new report published by the Royal College of Anaesthetists found that 153 cases of accidental awareness reported in 2011 across the UK, about 1 in every 15,000 general anaesthetics, a lot less than had been thought. Previous study found that about 1 in 500 patients were aware or awake under general anaesthetics. However, the leader of the new report, Professor Jaideep Pandit, says that under-reporting is possible partly because anaesthetists do not routinely see patients after an operation, so may not be aware of the awareness report. Sometimes patients do not report the incident.
Pandit says brain monitoring systems are available in about two-thirds of UK hospitals, but most anesthesiologists do not use them and there is a debate over how useful the monitors are. He is planning more research to focus on patient experience.
Source: Pandit JJ, Cook TM, Jonker WR, et al. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. British Journal of Anaesthesia. Published online March 13 2013
Monday, March 18, 2013
Patient safety strategies - a call for physician leadership
According to the editorial articles in the March issue of the Annals of Internal Medicine , tens of thousands of patients die each year in the US of diagnostic errors, teamwork and communiction errors and failure to receive evidence-based interventions.
A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.
The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .
They recommended 10 patient safety strategies for immediate implementation.
Preoperative and anesthesia checklists
Bundles
that include checklists to prevent central line-associated bloodstream infections
Interventions to reduce urinary catheter use
Bundles of various strategies to prevent ventilator-associated pneumonia
Hand hygiene
The do-not-use list for hazardous abbreviations
Interventions to reduce pressure ulcers
Barrier precautions to prevent infections
Use of real-time ultrasonography for central line placement
Interventions to improve prophylaxis for venous thromboembolisms.
Other recommendations include developing interventions that focus on fall prevention, limiting adverse drug reactions, medication reconciliation, reducing radiation exposure from unnecessary medical procedures and developing better informed consent policies.
To read the free f/t articles :Editorial
Making Health Care Safer: A Critical Review of Evidence Supporting Strategies to Improve Patient Safety
A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.
The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .
They recommended 10 patient safety strategies for immediate implementation.
To read the free f/t articles :Editorial
- Strategies to improve patient safety: the evidence base matures
- Patient safety strategies: a call for physician leadership
Patient satisfaction - BMJ article
The patient satisfaction chasm: the gap between hospital management and frontline clinicians
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012 (f/t via Athens)
Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.
Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.
Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.
Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012 (f/t via Athens)
Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.
Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.
Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.
Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
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