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A questionnaire survey was conducted with 222 anaesthetists from 11 Scottish hospitals to measure their attitudes towards human and organisational factors that can have an impact on effective team performance and consequently on patient safety. A customised version of the Operating Room Management Attitude Questionnaire (ORMAQ) was used. This measures attitudes to leadership, communication, teamwork, stress and fatigue, work values, human error and organisational climate. The respondents generally demonstrated positive attitudes towards the interpersonal aspects of their work, such as team behaviours and they recognised the importance of communication skills, such as assertiveness. However, the results suggest that some anaesthetists do not fully appreciate the debilitating effects of stress and fatigue on performance. Their responses were comparable with (and slightly more favourable than) those reported in previous ORMAQ surveys of anaesthetists and surgeons in other countries.

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BackgroundSurgical placebos are controversial. This in-depth study explored the design, acceptability, and feasibility issues relevant to designing a surgical placebo-controlled trial for the evaluation of the clinical and cost effectiveness of arthroscopic lavage for the management of people with osteoarthritis of the knee in the UK.MethodsTwo surgeon focus groups at a UK national meeting for orthopaedic surgeons and one regional surgeon focus group (41 surgeons); plenary discussion at a UK national meeting for orthopaedic anaesthetists (130 anaesthetists); three focus groups with anaesthetists (one national, two regional; 58 anaesthetists); two focus groups with members of the patient organisation Arthritis Care (7 participants); telephone interviews with people on consultant waiting lists from two UK regional centres (15 participants); interviews with Chairs of UK ethics committees (6 individuals); postal surveys of members of the British Association of Surgeons of the Knee (382 surgeons) and members of the British Society of Orthopaedic Anaesthetists (398 anaesthetists); two centre pilot (49 patients assessed).ResultsThere was widespread acceptance that evaluation of arthroscopic lavage had to be conducted with a placebo control if scientific rigour was not to be compromised. The choice of placebo surgical procedure (three small incisions) proved easier than the method of anaesthesia (general anaesthesia). General anaesthesia, while an excellent mimic, was more intrusive and raised concerns among some stakeholders and caused extensive discussion with local decision-makers when seeking formal approval for the pilot.Patients were willing to participate in a pilot with a placebo arm; although some patients when allocated to surgery became apprehensive about the possibility of receiving placebo, and withdrew. Placebo surgery was undertaken successfully.ConclusionsOur study illustrated the opposing and often strongly held opinions about surgical placebos, the ethical issues underpinning this controversy, and the challenges that exist even when ethics committee approval has been granted. It showed that a placebo-controlled trial could be conducted in principle, albeit with difficulty. It also highlighted that not only does a placebo-controlled trial in surgery have to be ethically and scientifically acceptable but that it also must be a feasible course of action. The place of placebo-controlled surgical trials more generally is likely to be limited and require specific circumstances to be met. Suggested criteria are presented.Trial registration numberThe trial was assigned ISRCTN02328576 through http://controlled-trials.com/ in June 2006. The first patient was randomised to the pilot in July 2007.

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In order to distinguish between a maternal, fetal or maternal and fetal genetic predisposition towards severe pre-eclampsia, the first pregnancies of 158 mothers and 160 mothers-in-law of pre-eclamptic women and of matched controls were analysed. Fourteen per cent of mothers of pre-eclamptics were found to have had severe pre-eclampsia, confirming previous suggestions that the condition 'runs in families', in contrast to only a 3 % incidence amongst mothers of controls. The incidence in mothers-in-law of both pre-eclamptics and controls was 4%, in full agreement with a maternal genotype hypothesis and suggesting that the fetal genotype plays, at most, only a minor role in the aetiology of severe pre-eclampsia. The data are in agreement with the hypothesis that a single recessive gene acting in the mother could be responsible for severe pre-eclampsia, but multifactorial inheritance is not ruled out. Mild pre-eclampsia showed no such familial tendency, indicating that the mild and severe forms of pre-eclampsia may represent separate pathological entities.SEVERE pre-eclampsia is a ubiquitous complication of pregnancy whose primary cause remains unknown. There is, however, evidence of a strong familial factor to be found in various reports concerned with the incidence of severe pre-eclampsia in female relatives of affected 785

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