Guidelines on obtaining consent for systemic anti-cancer therapy in adults.

This guideline, initially drawn up for use in the UK, is essentially based on ethical principles and should be applicable across other jurisdictions. The document specifically addresses the issues which surround obtaining consent from adults for the administration of systemic anti-cancer therapy in the haemato-oncology setting. Consenting to a treatment or procedure is a complex medical, ethical, and legal issue. The process of obtaining consent and the general steps that should be taken by the healthcare professional involved in obtaining consent from a patient are discussed, and the potential legal and ethical pitfalls which can be encountered are outlined. Of fundamental importance are the requirements that agreement must be given voluntarily, based on adequate information, and the patient must have the ability to understand and retain the information given and be in a position to use it in order to reach a decision. The consenting process should include an explanation of the expected outcomes and possible side effects of treatment even if these are unlikely to occur, and the nature of the consenting process undertaken should be clearly documented. Obtaining consent in an emergency situation is also discussed, as is the process of consenting in individuals with impaired capacity or special needs. Withdrawal of consent and refusal of treatment are also considered.

Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May-September 2009).

BACKGROUND: During the first wave of pandemic H1N1 influenza in 2009, most cases outside North America occurred in the UK. The clinical characteristics of UK patients hospitalised with pandemic H1N1 infection and risk factors for severe outcome are described. METHODS: A case note-based investigation was performed of patients admitted with confirmed pandemic H1N1 infection. RESULTS: From 27 April to 30 September 2009, 631 cases from 55 hospitals were investigated. 13% were admitted to a high dependency or intensive care unit and 5% died; 36% were aged <16 years and 5% were aged > or = 65 years. Non-white and pregnant patients were over-represented. 45% of patients had at least one underlying condition, mainly asthma, and 13% received antiviral drugs before admission. Of 349 with documented chest x-rays on admission, 29% had evidence of pneumonia, but bacterial co-infection was uncommon. Multivariate analyses showed that physician-recorded obesity on admission and pulmonary conditions other than asthma or chronic obstructive pulmonary disease (COPD) were associated with a severe outcome, as were radiologically-confirmed pneumonia and a raised C-reactive protein (CRP) level (> or = 100 mg/l). 59% of all in-hospital deaths occurred in previously healthy people. CONCLUSIONS: Pandemic H1N1 infection causes disease requiring hospitalisation of previously fit individuals as well as those with underlying conditions. An abnormal chest x-ray or a raised CRP level, especially in patients who are recorded as obese or who have pulmonary conditions other than asthma or COPD, indicate a potentially serious outcome. These findings support the use of pandemic vaccine in pregnant women, children <5 years of age and those with chronic lung disease.

Science into policy: preparing for pandemic influenza.

Authoratative government pandemic preparedness requires an evidence-based approach. The scientific advisory process that has informed the current UK pandemic preparedness plans is described. The final endorsed scientific papers are now publicly available.

Comparison of community based service with hospital based service for people with acute, severe psychiatric illness.

OBJECTIVE: To compare the burden on relatives and outcome of people treated for severe acute psychiatric illness by a community service and a traditional hospital based service. DESIGN: Follow up of patients aged 16-65 who required admission to hospital or home treatment for psychiatric illness during January 1990 to February 1991. SETTING: Two Birmingham electoral wards, Sparkbrook and Small Heath; Sparkbrook has a community based service and Small Heath a traditional hospital based service. SUBJECTS: 69 patients from Sparkbrook and 55 from Small Health. MAIN OUTCOME MEASURES: Scores on present state examination, social behaviour assessment schedule, and general health questionnaire. RESULTS: 24 (35%) of Sparkbrook patients received some treatment in hospital during the initial episodes. Relatives of Sparkbrook patients were less distressed by their burden at the initial assessment than relatives of Small Health patients (mean score 0.11 v 0.29, p < 0.01). Relatives were also more satisfied with the support they received and the treatment received by patients. More patients from Sparkbrook than Small Health were in contact with a psychiatrist (81% (95% confidence interval 71% to 91%) v 62% (44% to 68%)) and community nurse (56% (44% to 68%) v 14% (13% to 24%)) one year after the initial episode. Sparkbrook patients spent significantly fewer days in hospital during the initial episode (8 days v 59 days) and the first year (20.6 v 67.9 days). CONCLUSION: The community based service is as effective as the hospital based service and is preferred by relatives. It is more effective in keeping people in long term contact with psychiatrists.

The effects of two anti-vertigo drugs (betahistine and prochlorperazine) on driving skills.

1. The effects of betahistine 72 mg three times daily, prochlorperazine 5 mg three times daily and placebo taken for 3 days before testing were compared on two actual driving tasks (weaving and gap estimation) and two psychomotor tasks (reaction time and kinetic visual acuity) in normal subjects in a double-blind prospectively randomised cross-over study. 2. The psychomotor effects of betahistine could not be distinguished from those of placebo. 3. Prochlorperazine impaired driving performance causing increased carelessness and slowing on the weaving test. 4. There was little subjective appreciation of impairment whilst taking prochlorperazine.

Home treatment for acute psychiatric illness.

OBJECTIVE: To determine the factors influencing the successful outcome of community treatment for severe acute psychiatric illnesses that are traditionally treated in hospital. DESIGN: All patients from a single electoral ward who were either admitted to hospital or treated at home over a two year period (1 October 1987 to 30 September 1989) were included in the study and their case notes audited. The second year of the study is reported. SETTING: Electoral ward of Sparkbrook, Birmingham. SUBJECTS: 99 Patients aged 16-65 with severe acute psychiatric illness. RESULTS: 65 Patients were managed by home treatment alone; 34 required admission to hospital. The location of treatment was significantly (all p less than 0.05) influenced by social characteristics of the patients (marital state, age (in men), ethnicity, and living alone) and by characteristics of the referral (occurring out of hours; assessment taking place at hospital or police station). DSM-III-R diagnosis was more weakly associated with outcome. Violence during the episode was significantly related to admission, although deliberate self harm was not. CONCLUSIONS: Home treatment is feasible for most patients with acute psychiatric illness. A 24 hour on call assessment service increases the likelihood of success because admission is determined more strongly by social characteristics of the patient and the referral than by illness factors. Admission will still be required for some patients. A locally based mental health resource centre, a 24 hour on call service, an open referral system, and an active follow up policy increase the effectiveness of a home treatment service.

Antidepressants and galactorrhoea.

Several antidepressants have been reported to produce hyperprolactinaemia, with or without galactorrhoea. We report a case of galactorrhoea associated with dothiepin and discuss the effects of a subsequent change in antidepressants.

Presentation of information to cancer patients: a comparison of two centres in the UK and USA.

A questionnaire survey was carried out to compare the views of cancer patients at a UK and USA hospital with respect to the nature and sources of the information they received about their condition. Although there were many similarities, differences did emerge in the way the diagnosis was confirmed to the patient, the desire for additional information and the sources of such information. Among the UK patients 20 per cent reported that confirmation of their diagnosis had been delegated to junior staff, 30 per cent felt that their doctors did not have sufficient time to talk to them and 70 per cent stated that they relied on non-medical sources for information about cancer. These findings indicate that there is considerable scope for improvement in communicating with cancer patients in the UK.