A transdisciplinary approach supports community-led water quality monitoring in river basins adjacent to the Great Barrier Reef, Australia.

Water quality monitoring programs (WQMPs) are crucial for assessment of water quality in river basins where agricultural intensification and development raise concerns in freshwater and marine environments. WQMPs if supported by scientists and local communities, and if based on the knowledge needs of all stakeholders, can provide vital information supporting resource management actions. Our paper focuses on the transdisciplinary development and implementation of a community-led pilot WQMP for the Tully River basin, adjacent to the Great Barrier Reef (GBR). The community-led pilot WQMP was established to fill some knowledge gaps identified during development of the Tully Water Quality Improvement Plan (WQIP) and to provide opportunities for active stakeholder participation in the monitoring. Results indicated some water quality parameters (i.e. nitrates and total phosphorus) had higher than expected values and exceeded state water quality guidelines. Hence, the results provided an evidence base for freshwater quality objective development to conserve, protect and improve water quality conditions in this basin and GBR. Leadership of Indigenous people in the pilot WQMP recognizes their deep desire to improve water resources outcomes and to care for country and people.

Analysis of clinical negligence claims following tonsillectomy in England 1995 to 2010.

OBJECTIVES: We determined the characteristics of medical negligence claims following tonsillectomy. METHODS: Claims relating to tonsillectomy between 1995 and 2010 were obtained from the National Health Service Litigation Authority database. The number of open and closed claims was determined, and data were analyzed for primary injury claimed, outcome of claim, and associated costs. RESULTS: Over 15 years, there were 40 claims of clinical negligence related to tonsillectomy, representing 7.7% of all claims in otolaryngology. There were 34 closed claims, of which 32 (94%) resulted in payment of damages. Postoperative bleeding was the most common injury, with delayed recognition and treatment of bleeding alleged in most cases. Nasopharyngeal regurgitation as a result of soft palate fistulas or excessive tissue resection was the next-commonest cause of a claim. The other injuries claimed included dentoalveolar injury, bums, tonsillar remnants, and temporomandibular joint dysfunction. Inadequate informed consent was claimed in 5 cases. CONCLUSIONS: Clinical negligence claims following tonsillectomy have a high success rate. Although postoperative bleeding is the most common cause of negligence claims, a significant proportion of claims are due to rare complications of surgery. Informed consent should be tailored to the individual patient and should include a discussion of common and serious complications.

Background rates of acute mountain sickness-like symptoms at low altitude in adolescents using Lake Louise score.

OBJECTIVE: To record the incidence of symptoms consistent with a diagnosis of acute mountain sickness (AMS), using the Lake Louise questionnaire, in adolescents hiking at low altitude. METHODS: The study was carried out on a cohort of 123 adolescents during a 3-day trip on Dartmoor, UK, at an altitude of less than 500 m. The incidence of symptoms experienced was measured using the Lake Louise questionnaire, which was completed twice daily by each participant. An episode consistent with AMS, but in the low altitude setting, was defined as a score of 3 or more on the Lake Louise questionnaire in the presence of a headache. RESULTS: There were 59 boys and 64 girls in the study with an average age of 16.7 years. The response rate was 100%. A total of 59 episodes of scores consistent with AMS was recorded during the 3-day period. Forty-two of these episodes were reported by girls (71%). AMS scores between 3 and 8 were recorded, and the daily incidence rates of scores consistent with AMS but at low altitude were between 7.3% and 11.3%. CONCLUSIONS: This study shows that adolescents at low altitude reported a background incidence of symptoms that at high altitude would lead to a diagnosis of AMS.

Toward safer practice in otology: a report on 15 years of clinical negligence claims.

OBJECTIVES/HYPOTHESIS: To determine the characteristics of medical negligence claims arising from otological practice. STUDY DESIGN: Retrospective analysis of medical negligence claims contained in the National Health Service Litigation Authority (NHSLA) database. METHODS: Claims relating to otology and neurotology between 1995 and 2010 were obtained from the NHSLA database and analyzed for cause of injury, type of injury, outcome of claim and costs. RESULTS: Over 15 years there were 137 claims in otology, representing 26% of all the claims in otolaryngology. Of these, 116 have been closed, and 84% of closed claims resulted in payment. Of the 97 successful claims, 63 were related to operative complications. This included six cases of wrong side/site surgery, and 15 cases of inadequate informed consent. The most common injuries claimed were hearing loss, facial paralysis, and additional/unnecessary surgery. Middle ear ventilation and mastoid surgery were the procedures most commonly associated with a successful claim. There were 15 successful claims of misdiagnosis/delayed diagnosis, with chronic suppurative otitis media the condition most frequently missed. There were nine successful claims related to outpatient procedures, of which seven were for aural toilet and six claims of medical mismanagement, including three cases of ototoxicity from topical medications. There were also four successful claims for morbidity due to delayed surgery. CONCLUSIONS: This is the first study to report outcomes of negligence claims in otology. Claims in otology are associated with a high success rate. A significant proportion of claims are not related to surgery and represent areas where safety should also be addressed.