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Terms modified by Serious Risk Selected AbstractsThe Effectiveness of a Color-Coded, Onset-Rime Decoding Intervention with First-Grade Students at Serious Risk for Reading DisabilitiesLEARNING DISABILITIES RESEARCH & PRACTICE, Issue 1 2009Sara J. HinesArticle first published online: 3 FEB 200 This study was an investigation into the effectiveness of a color-coded, onset-rime,based decoding intervention with first-graders at serious risk for reading disabilities using a single-subject multiple probe design. Students increased their ability to decode instructional words on average 73% over baseline. For novel words from instructed rime patterns, scores increased by an average of 56%. Transfer at the vowel level to uninstructed rime patterns was limited, with scores improving by an average of 29%. Students maintained decoding gains at 1-week and 1-month maintenance. While acknowledging the difficulty in predicting reading disabilities based on first-grade performance, the effectiveness of the early intervention is a promising step in finding an instructional approach that is successful with the most at risk or disabled students who often do not respond to effective remedial programs. [source] Changes in patterns of excessive alcohol consumption in 25 years of high security hospital admissions from England and WalesCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2003Celia McMahon Background It is now generally acknowledged that alcohol abuse increases the risk of violence among people with major mental disorder. Studies in the 1980s and earlier, however, tended to report an inverse relationship between their alcohol use and violence. Aims A study was undertaken to test a hypothesis that among people with major mental disorder considered to pose a serious risk to others the likelihood of excessive alcohol consumption in a period leading up to a violent or dangerous act has increased over time. Methods Analysis was made of annual high security hospital admission cohort case register data of 1 January 1975 to 31 December 1999; alcohol use data were taken from interview and records, and problem drinking defined as consumption of alcohol in excess of 21 units per week during the 12 months prior to the index offence or act. Results There was a linear increase in the proportion of patients in five-year admission cohorts who had engaged in excessive alcohol consumption during the year prior to their index offence or act. The increase was steeper among women than men, but cut across all diagnosis and offending groups. It was strongly associated with increasing tendency to abuse illicit drugs. Conclusions The greater proportion of patients affected by excessive alcohol consumption occurred in spite of a reduction over the same period in admission of people in the diagnostic groups most likely to be implicated in substance misuse (personality disorder). This increased trend may simply reflect similar trends in the general population, but may also be associated with a lack of services or current consensus on appropriate treatment for patients whose mental illness is complicated by excessive alcohol use. Regardless, the trend suggests a growing need for ,dual diagnosis' services within and outside high security hospital. Copyright © 2003 Whurr Publishers Ltd. [source] Oral trauma, mouthguard awareness, and use in two contact sports in TurkeyDENTAL TRAUMATOLOGY, Issue 5 2006Ibrahim Tulunoglu Abstract,,, The purpose of the present study was to evaluate the occurrence of dental hard and soft tissue injuries during participation in contact sports, and the awareness and use of mouthguards in a young adult sample of semi-professional or amateur boxers and tae kwon do participants in Turkey. The samples consisted of 274 young adults [174 male (63.5%) and 100 female (36.5%)] aged between 17 and 27 years of which 185 (67.5%) were tae kwon do practitioners, and 89 (32.5%) were boxers. The participants answered a standard questionnaire. All answers were evaluated and then statistical analyses were performed. Of the total sample, 61 of the subjects (22.3%) suffered dental trauma. Of these sufferers, 32 (17.3%) were boxers and 29 (32.6%) were tae kwon do practitioners. It was found that 19 (6.9%) athletes lost their teeth post-trauma. Of the 54 subjects (19.7%) suffering soft tissue injuries, 44 were female (81.5%), while only 10 were male (18.5%), of which 40 (74.1%) were tae kwon do practitioners and 14 (25.9%) were boxers. Of the total sample of 274 subjects, 228 (83.2%) were well informed about mouthguard usage. Of the total sample, 153 (55.8%) of the subjects used mouthguards, all of which were boil-and-bite type. The results of our study indicate that dentists and sports authorities in Turkey should promote the use of mouthguards in contact sports such as tae kwon do and boxing, which have a serious risk for dental and oral soft tissue trauma and tooth loss. [source] A retrospective evaluation of the impact of total smoking cessation on psychiatric inpatients taking clozapineACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010I. Cormac Cormac I, Brown A, Creasey S, Ferriter M, Huckstep B. A retrospective evaluation of the impact of total smoking cessation on psychiatric inpatients taking clozapine. Objective:, To investigate the effect of a complete smoking ban on a group of psychiatric inpatients maintained on the antipsychotic medication clozapine. Method:, Retrospective data on clozapine dose and plasma levels were collected from a three month period before and a six month period after the introduction of the smoking ban. Results:, Before the ban only 4.2% of patients who smoked had a plasma clozapine level ,1000 ,g/l but after the ban this increased to 41.7% of the sample within the six month period following the ban despite dose reductions. Conclusion:, Abrupt cessation of smoking is associated with a potentially serious risk of toxicity in patients taking clozapine. Plasma clozapine levels must be monitored closely and adjustments made in dosage, if necessary, for at least six months after cessation. [source] Fishing down the deepFISH AND FISHERIES, Issue 1 2006Telmo Morato Abstract Global landings of demersal marine fishes are demonstrated to have shifted to deeper water species over the last 50 years. Our analysis suggests deep-water fish stocks may be at serious risk of depletion, as their life histories render them highly vulnerable to overfishing with little resilience to over-exploitation. Deep-sea fisheries are exploiting the last refuges for commercial fish species and should not be seen as a replacement for declining resources in shallower waters. Instead, deep-water habitats are new candidates for conservation. [source] Using fishers' anecdotes, naturalists' observations and grey literature to reassess marine species at risk: the case of the Gulf grouper in the Gulf of California, MexicoFISH AND FISHERIES, Issue 2 2005Andrea Sáenz, Arroyo Abstract Designing fishing policies without knowledge of past levels of target species abundance is a dangerous omission for fisheries management. However, as fisheries monitoring started long after exploitation of many species began, this is a difficult issue to address. Here we show how the ,shifting baseline' syndrome can affect the stock assessment of a vulnerable species by masking real population trends and thereby put marine animals at serious risk. Current fishery data suggest that landings of the large Gulf grouper (Mycteroperca jordani, Serranidae) are increasing in the Gulf of California. However, reviews of historical evidence, naturalists' observations and a systematic documentation of fishers' perceptions of trends in the abundance of this species indicate that it has dramatically declined. The heyday for the Gulf grouper fishery occurred prior to the 1970s, after which abundance dropped rapidly, probably falling to a few percent of former numbers. This decline happened long before fishery statistics were formally developed. We use the case of the Gulf grouper to illustrate how other vulnerable tropical and semi-tropical fish and shellfish species around the world may be facing the same fate as the Gulf grouper. In accordance with other recent studies, we recommend using historical tools as part of a broad data-gathering approach to assess the conservation status of marine species that are vulnerable to over-exploitation. [source] Pressures generated in vitro during Stabident intraosseous injectionsINTERNATIONAL ENDODONTIC JOURNAL, Issue 5 2005J. M. Whitworth Abstract Aim, To test the hypothesis that the Stabident intraosseous injection is a potentially high-pressure technique, which carries serious risks of anaesthetic cartridge failure. Methodology, A standard Astra dental syringe was modified to measure the internal pressure of local anaesthetic cartridges during injection. Intra-cartridge pressures were measured at 1 s intervals during slow (approximately 15 s) and rapid (<10 s) injections of 2% Xylocaine with 1 : 80 000 adrenaline (0.25 cartridge volumes) into air (no tissue resistance), or into freshly prepared Stabident perforation sites in the anterior mandible of freshly culled young and old sheep (against tissue resistance). Each injection was repeated 10 times over 3 days. Absolute maximum pressures generated by each category of injection, mean pressures at 1 s intervals in each series of injections, and standard deviations were calculated. Curves of mean maximum intra-cartridge pressure development with time were plotted for slow and rapid injections, and one-way anova (P < 0.05) conducted to determine significant differences between categories of injection. Results, Pressures created when injecting into air were less than those needed to inject into tissue (P < 0.001). Fast injection produced greater intra-cartridge pressures than slow delivery (P < 0.05). Injection pressures rose more quickly and to higher levels in small, young sheep mandibles than in larger, old sheep mandibles. The absolute maximum intra-cartridge pressure developed during the study was 3.31 MPa which is less than that needed to fracture glass cartridges. Conclusions, Stabident intraosseous injection conducted in accordance with the manufacturer's instructions does not present a serious risk of dangerous pressure build-up in local anaesthetic cartridges. [source] The Effectiveness of a Color-Coded, Onset-Rime Decoding Intervention with First-Grade Students at Serious Risk for Reading DisabilitiesLEARNING DISABILITIES RESEARCH & PRACTICE, Issue 1 2009Sara J. HinesArticle first published online: 3 FEB 200 This study was an investigation into the effectiveness of a color-coded, onset-rime,based decoding intervention with first-graders at serious risk for reading disabilities using a single-subject multiple probe design. Students increased their ability to decode instructional words on average 73% over baseline. For novel words from instructed rime patterns, scores increased by an average of 56%. Transfer at the vowel level to uninstructed rime patterns was limited, with scores improving by an average of 29%. Students maintained decoding gains at 1-week and 1-month maintenance. While acknowledging the difficulty in predicting reading disabilities based on first-grade performance, the effectiveness of the early intervention is a promising step in finding an instructional approach that is successful with the most at risk or disabled students who often do not respond to effective remedial programs. [source] FDA drug prescribing warnings: is the black box half empty or half full?,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2006Anita K. Wagner PharmD Abstract Purpose Black box warnings (BBWs) are the Food and Drug Administration's (FDA) strongest labeling requirements for high-risk medicines. It is unknown how frequently physicians prescribe BBW drugs and whether they do so in compliance with the warnings. The purpose of the present study was to assess the frequency of use of BBW medications in ambulatory care and prescribing compliance with BBW recommendations. Methods This retrospective study used automated claims data of 929,958 enrollees in 10 geographically diverse health plans in the United States to estimate frequency of use in ambulatory care of 216 BBW drugs/drug groups between 1/1/99 and 31/6/01. We assessed dispensing compliance with the BBW requirements for selected drugs. Results During a 30-month period, more than 40% of enrollees received at least one medication that carried a BBW that could potentially apply to them. We found few instances of prescribing during pregnancy of BBW drugs absolutely contra-indicated in pregnancy. There was almost no co-prescribing of contra-indicated drugs with the two QT-interval-prolonging BBW drugs evaluated. Most non-compliance occurred with recommendations for baseline laboratory monitoring (49.6% of all therapy initiations that should have been accompanied by baseline laboratory monitoring were not). Conclusions Many individuals receive drugs considered to carry the potential for serious risk. For some of these drugs, use is largely consistent with their BBW, while for others it is not. Since it will not be possible to avoid certain drug- associated risks, it will be important to develop effective methods to use BBWs and other methods to minimize risks. Copyright © 2005 John Wiley & Sons, Ltd. [source] Predictors of hearing loss in New York farmersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2001Syni-An Hwang PhD Abstract Background Data from the telephone interview portion of the New York Farm Family Health and Hazard Surveillance were used to study self-reported hearing loss in New York farmers. Methods One thousand six hundred and twenty-two persons completed the hearing loss and noise exposure interview. Hearing loss was defined as at least some trouble hearing in one or both ears. Predictors of hearing loss were determined using logistic regression. Results Twenty-two percent of participants reported hearing loss. From the logistic regression, significant confounders are age (P,=,0.0001), gender (P,=,0.0001), being from a livestock farm (P,=,0.012), and loss of consciousness due to head trauma (P,=,0.04). Significant noise exposures are more hours of lifetime exposure to noisy farm equipment (P,=,0.001) and having had a noisy non-farm job (with some hearing protection P,=,0.002, without any hearing protection P,=,0.0001). Conclusions Farm noise exposure is a serious risk to the hearing of this population. Although use of hearing protection should be encouraged, replacing and modifying farm equipment to decrease noise at the source should be the first priority. Am. J. Ind. Med. 40:23,31, 2001. © 2001 Wiley-Liss, Inc. [source] State Fiscal Responses to Welfare Reform during Recessions: Lessons for the FuturePUBLIC BUDGETING AND FINANCE, Issue 3 2003Howard Chernick The 1996 welfare reform transformed open-ended matching grants to states to fixed block grants. This article considers whether, given the new regime, states will be able and willing to meet the need for public assistance during recessions. The accumulation of large balances of unspent federal welfare funds helped states weather the first year or so of the current recession without having to cut programs for needy families. While new fiscal rules promoted positive reform during a period of economic prosperity, they may be leaving states and their most vulnerable citizens at serious risk as the economic and fiscal slowdown continues. [source] REVIEW: Malaria in pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2005Christopher J.M. Whitty Malaria in pregnancy is one of the major causes of maternal morbidity worldwide, and leads to poor birth outcomes. There is a complex interaction between pregnancy and parasite,all favour the parasite and disadvantage the pregnant woman. Women who are semi-immune lose much of that immunity. They may present with placental malaria but with no parasites in their peripheral blood. A non-immune pregnant women and her fetus are at serious risk from falciparum malaria. The diagnosis and management of malaria in pregnancy, including the safety of antimalarial drugs and interactions of malaria with HIV in pregnancy are reviewed. [source] Extensive venous/lymphatic malformations causing life-threatening haematological complicationsBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2007J. Mazereeuw-Hautier Summary Background, Large venous/lymphatic slow-flow malformations (SFM) can be associated with a coagulopathy resulting in thrombosis and haemorrhage. Such potentially life-threatening complications of SFM have been reported only rarely. Objectives, To better define the clinical characteristics of haematological complications associated with SFM, to highlight the importance of recognition and to discuss the management of these difficult-to-treat patients. Patients and methods, A cohort of six children who presented with massive SFM associated with serious haematological complications was seen between January 1980 and June 2005 in the Department of Paediatric Dermatology, Great Ormond Street Hospital for Children, London, U.K. (tertiary referral centre for vascular anomalies). Clinical and haematological characteristics were recorded. Results, Patients were aged 1,20 years. All suffered with recurrent episodes of pain, localized skin necrosis and bleeding. All had intravascular coagulopathy and life-threatening complications. These included brain haemorrhage, massive bleeding from the uterus and colon, large and extensive thromboses of the deep vessels in the abdomen and pelvis and severe haemoptysis. One patient died suddenly at the age of 20 years from pulmonary thromboembolism and thrombosis within the deep vessels of the vascular malformation. The youngest patient underwent a leg amputation to remove the huge vascular malformation due to the major risk of complications and lack of limb function. Three of the patients underwent anticoagulation treatment and showed improvement in their coagulopathy. Conclusions, It is essential that patients with extensive SFM have their coagulation screened regularly to detect intravascular coagulopathy. This may progress to disseminated vascular coagulopathy and a serious risk of thrombosis and haemorrhage. Such patients require early anticoagulation in an attempt to prevent these secondary complications. [source] Stressor-induced modulation of immune function: a review of acute, chronic effects in animalsACTA NEUROPSYCHIATRICA, Issue 6 2002Alexander W. Kusnecov The present paper reviews recent studies on the effects of stress on immune function in laboratory animals. The emphasis is on those studies where a simultaneous comparison of acute and chronic stress regimens was determined, although additional relevant studies are also reviewed. The effects of stress on basic measurements of cellular and humoral immune measures are discussed, including the growing number of studies that have reported alterations in macrophage functions. The latter are key elements in the innate immune response, and like measurements of T cell function and antibody production, are inhibited and enhanced by stressor exposure. This review does not focus on the mechanisms by which stress alters immune function, there being little to add conceptually in terms of what was reported previously (see Kusnecov AW, Rabin BS, Int Arch Allergy Immunol 1994;105:107,121.). However, a question is raised in the conclusion as to how stressor effects on immune function should be interpreted, for it is clear that immunological processes in and of themselves elicit central nervous system responses that neurochemically and endocrinologically do not differ from those produced in response to psychological stressors. Therefore, at least in the short term stressor-induced immune changes may not necessarily reflect maladaptive adjustments, although, as demonstrated by some studies reviewed in this paper, they may pose a serious risk to health should stressor exposure be persistent and uncontrolled. [source] Controls on modern alluvial fan processes in the central Alps, northern ItalyEARTH SURFACE PROCESSES AND LANDFORMS, Issue 3 2004Giovanni B. Crosta Abstract Alluvial fan development in Alpine areas is often affected by catastrophic sedimentary processes associated with extreme ,oods events, causing serious risks for people living on the fans. Hazard assessment in these areas depends on proper identi,cation of the dominant sedimentary processes on the fans. Data from a set of 209 alluvial fans from the central Alps of Italy are presented in this paper and analysed with the help of various statistical techniques (linear regression, principal components analysis, cluster analysis, discriminant analysis and logistic regression). First, we used modern sedimentary facies and historical records (,ood events since 15th century), to distinguish between the two dominant sedimentary processes on alluvial fans: debris ,ows and stream,ows. Then, in order to analyse the main controls on past and present fan processes, 36 morphological, geological and land-use variables were analysed. As with observations for arid-environment fans, catchment morphology is the most in,uential factor in the study area, whereas geology and land use are minor controls. The role of climatic change and landsliding within the catchments also seems to be very important and is discussed. Statistical techniques also help in differentiating groups of alluvial fans by sets of controlling factors, including stage and type of evolution. Finally, by using discriminant analysis and logistic regression, we classi,ed alluvial fans according to the dominant sedimentary process, with a success rate ranging between 75 and 92 per cent. Copyright © 2004 John Wiley & Sons, Ltd. [source] Pressures generated in vitro during Stabident intraosseous injectionsINTERNATIONAL ENDODONTIC JOURNAL, Issue 5 2005J. M. Whitworth Abstract Aim, To test the hypothesis that the Stabident intraosseous injection is a potentially high-pressure technique, which carries serious risks of anaesthetic cartridge failure. Methodology, A standard Astra dental syringe was modified to measure the internal pressure of local anaesthetic cartridges during injection. Intra-cartridge pressures were measured at 1 s intervals during slow (approximately 15 s) and rapid (<10 s) injections of 2% Xylocaine with 1 : 80 000 adrenaline (0.25 cartridge volumes) into air (no tissue resistance), or into freshly prepared Stabident perforation sites in the anterior mandible of freshly culled young and old sheep (against tissue resistance). Each injection was repeated 10 times over 3 days. Absolute maximum pressures generated by each category of injection, mean pressures at 1 s intervals in each series of injections, and standard deviations were calculated. Curves of mean maximum intra-cartridge pressure development with time were plotted for slow and rapid injections, and one-way anova (P < 0.05) conducted to determine significant differences between categories of injection. Results, Pressures created when injecting into air were less than those needed to inject into tissue (P < 0.001). Fast injection produced greater intra-cartridge pressures than slow delivery (P < 0.05). Injection pressures rose more quickly and to higher levels in small, young sheep mandibles than in larger, old sheep mandibles. The absolute maximum intra-cartridge pressure developed during the study was 3.31 MPa which is less than that needed to fracture glass cartridges. Conclusions, Stabident intraosseous injection conducted in accordance with the manufacturer's instructions does not present a serious risk of dangerous pressure build-up in local anaesthetic cartridges. [source] Complete Recovery From Intractable Complex Regional Pain Syndrome, CRPS-Type I, Following Anesthetic Ketamine and MidazolamPAIN PRACTICE, Issue 2 2007Ralph-Thomas Kiefer MD Abstract Objective: To describe the treatment of an intractable complex regional pain syndrome I (CRPS-I) patient with anesthetic doses of ketamine supplemented with midazolam. Methods: A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm. Her pain was unmanageable with all standard therapy. As a last treatment option, the patient was transferred to the intensive care unit and treated on a compassionate care basis with anesthetic doses of ketamine in gradually increasing (3,5 mg/kg/h) doses in conjunction with midazolam over a period of 5 days. Results: On the second day of the ketamine and midazolam infusion, edema, and discoloration began to resolve and increased spontaneous movement was noted. On day 6, symptoms completely resolved and infusions were tapered. The patient emerged from anesthesia completely free of pain and associated CRPS signs and symptoms. The patient has maintained this complete remission from CRPS for 8 years now. Conclusions: In a patient with severe spreading and refractory CRPS, a complete and long-term remission from CRPS has been obtained utilizing ketamine and midazolam in anesthetic doses. This intensive care procedure has very serious risks but no severe complications occurred. The psychiatric side effects of ketamine were successfully managed with the concomitant use of midazolam and resolved within 1 month of treatment. This case report illustrates the effectiveness and safety of high-dose ketamine in a patient with generalized, refractory CRPS. [source] Behavioral issues in asthma managementPEDIATRIC PULMONOLOGY, Issue S21 2001Randall Brown MD Abstract Despite advances in drug treatment, outcomes in asthma remain unsatisfactory. Often overlooked in developing treatment strategies are important factors that affect outcomes in asthma, namely behavioral issues such as the low rate of patient adherence to the prescribed treatment regimen, inadequate physician-patient communication, and inconsistent implementation of evidenc-based treatment guidelines. The low adherence rates among asthma patients may be improved by education programs that emphasize both the potentially serious risks of this disease and a team approach to treatment that includes patients and their families in developing a treatment plan. Interactive physician education programs have been shown to improve guideline implementation and physician communication skills. Indeed, effective physician-patient communication may be the key to improving guideline implementation and patient adherence to treatment, resulting in meaningful decreases in asthma-related morbidity and mortality. Pediatr Pulmonol. 2001; Supplement 21:26,30. © 2001 Wiley-Liss, Inc. [source] Acute toxicity to zebrafish of two organophosphates and four pyrethroids and their binary mixturesPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 1 2010Zhi-Yong Zhang Abstract BACKGROUND: Environmental pollutants, including metals, pesticides and other organics, pose serious risks to many aquatic organisms. The acute toxicities to zebrafish (Brachydanio rerio Hamilton & Buchanan) were determined for two organophosphorus insecticides, four pyrethroid insecticides and 50:50 binary mixtures. RESULTS: At 24, 48, 72 and 96 h after treatment, LC50 of permethrin, tetramethrin, bifenthrin, etofenprox, dichlorvos and phoxim to zebrafish were 0.0052,0.0025, 0.0782,0.0460, 0.0065,0.0032, 0.0969,0.0791, 51.3,13.0 and 1.28,0.469 mg L,1 respectively. LC50 of permethrin + dichlorvos, permethrin + phoxim, tetramethrin + dichlorvos, tetramethrin + phoxim, bifenthrin + dichlorvos, bifenthrin + phoxim, etofenprox + dichlorvos and etofenprox + phoxim were 0.0082,0.0046, 0.0078,0.0042, 0.264,0.124, 0.141,0.121, 0.0251,0.0154, 0.0154,0.0087, 0.396,0.217 and 0.213,0.0391 mg L,1. CONCLUSION: Toxicity levels of all pyrethroid insecticides to the zebrafish were high or very high. The organophosphate dichlorvos showed low toxicity, but phoxim showed high or intermediate toxicities to zebrafish, and the toxicities of binary mixtures of permethrin and dichlorvos or phoxim, bifenthrin and dichlorvos or phoxim and etofenprox and phoxim (48, 72 and 96 h exposure) were very high. The toxicities of binary mixtures of tetramethrin and dichlorvos or phoxim, etofenprox and dichlorvos and etofenprox and phoxim (24 h exposure) were high. Copyright © 2009 Society of Chemical Industry [source] CR11 PATIENT RECALL OF INFORMED CONSENT INFORMATION PRIOR TO COLONOSCOPYANZ JOURNAL OF SURGERY, Issue 2007I. G. Thomson Purpose To determine if patients presenting for colonoscopy can remember information discussed in the informed consent process. Focusing on whether patients know of the possible risks. Methodology A prospective study of patients presenting for elective colonoscopy through the Colorectal Unit. Patients were consented in outpatient clinics prior to the procedure using the colonoscopy consent form supplied by Queensland Health. On the day of the procedure a 2 page questionnaire with 13 questions was completed by the patient prior to their colonoscopy. Indications for colonoscopy date of consent & procedure and seniority of consenting doctor were obtained from medical records. Results 100 patients completed the questionnaire. 94% of patients could correctly identify colonoscopy as the procedure being undertaken. 45% of patients were able to identify that there were any risks involved with the procedure. Only 28% of patients could name perforation as a possible risk. h regard to other investigative options 83% could not identify any from a list of three. Despite this 92% felt they were given enough information and were happy to proceed. Conclusion This study highlights room for improvement in the current informed consent process. The current process falls short in educating patients of the possible serious risks involved. Patients do not recall other therapeutic options given. The consent process does convey basic information allowing the patient to identify the name of the investigation and anatomical area investigated. Despite these shortcomings most patients felt they were given enough information to proceed. [source] ML08 CONDUCTING A REVIEW , THE IMPORTANCE OF PROCESSANZ JOURNAL OF SURGERY, Issue 2007A. F. Merry Reviews of practice tend to arise out of conflict between the person reviewed and the organisation requesting the review, usually after a failure of the two parties to resolve their differences at a lower level. It follows that legal challenges are likely, and this has been borne out by experience. Such challenges will generally be based on alleged failures in process. Furthermore, being reviewed is exceptionally stressful for any doctor and creates serious risks to his or her health and reputation. It is essential that these risks are minimized and that all parties emerge from the review believing that the process has been impartial, professional, confidential and fair. The key is to engage a senior lawyer with appropriate experience and expressly charge him or her (in writing) with the responsibility for process. This lawyer must be independent (the reviewing organisation's own lawyers are not appropriate for this position), directly accountable to the chair of the review panel, and have unrestricted time for this task. He or she should be present at all meetings between the panel and the reviewed doctor and should revise all documents produced by the panel. The panel chair should assign the primary responsibility for reviewing the professional competence of the doctor to other panel members and should focus instead on ,chairing', on process, and on the wider (or ,big picture') issues which surround the review. Previous experience in reviews is essential for this role. [source] | ||||||||||||||||