Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between doctors, its context and subsequent impact. In total, 606 doctors were surveyed across three teaching hospitals in England. Two structured focus groups were held with doctors at one teaching hospital. 31% of doctors described being subject to RDA communication multiple times per week or more often, with junior and registrar doctors affected twice as often as consultants. Rudeness was more commonly experienced from specific specialties: radiology, general surgery, neurosurgery and cardiology. 40% of respondents described that RDA moderately or severely affected their working day. The context for RDA communication was described in five themes: workload, lack of support, patient safety, hierarchy and culture. Impact of RDA communication was described as personal, including emotional distress and substance abuse, and professional, including demotivation. RDA communication between doctors is a widespread and damaging behaviour, occurring in contexts common in healthcare. Recognition of the impact on doctors and potentially patients is key to change.

D iabetic ketoacidosis (DKA) is an acute metabolic complication of type 1 diabetes mellitus. This study aimed to define the DKA mortality rate in a Birmingham population and to identify risk factors for mortality and repeat admissions. An evaluation of 137 patients' notes retrieved from five hospitals in and around Birmingham, UK, identified 278 admissions over a 9-year period (2000-2009). The International Classification of Disease 10 coding system for DKA, E101, was employed to identify notes. Overall five (1.8%) patients died. Mortality was significantly associated with age, presence of comorbidity and diabetic complications. Poor control and compliance, female sex, clinic non-attendance, presence of co-morbidity and psychological problems all increased the risk of recurrent DKA admissions. Our study supports a role for improving education and glycaemic control to reduce DKA and its associated mortality. Br J Diabetes Vasc Dis 2009;9:278-282

No abstract

BackgroundRheumatology department at a South West England District General Hospital.ObjectivesTo audit our use of biologic therapies in patients with inflammatory arthritis. To establish how many patients we are increasing the dosage interval, which patients we are choosing to do this for and what are the success rates from this. Evaluate what the financial implications are in doing this.MethodsUsing the “Homecare Patient List” patients with any inflammatory arthritis who were on a biologic medication were identified. Patients with a firm diagnosis of Rheumatoid Arthritis (RA) or Psoriatic Arthritis (PsA) were identified from this. Patients on one of 6 biologic medications (abatercept, adalimumab, certolizumab, etanercept, golimumab, and tocilizumab) were then included. Further inclusion criteria for the audit included being on a biologic medication for over 6 months (ie. Started before April 2015) and having regular follow up with our service (at least every 6 months).148 patients were identified as suitable (108 Rheumatoid arthritis, 40 Psoriatic arthritis). Demographics were collected from hospital electronic records and then information regarding biologic medications and clinical status was taken from clinic letters using Epro records. Clinic letters prior to 2013 were not viewed. Results were collected in MS Excel template.ResultsOf the 108 RA patients; 76 female and 36 male, mean age was 61 years with a range of 32 years to 78 years. In 40 of these patients we attempted to taper the interval of their biologic medication. 87% of these patients were on methotrexate as an anchor medication. Biologic medications that were tapered included adalimumab, etanercept and certolizumab. In the 40 patients tapered this change has been maintained or increased in 28 patients, giving a success rate of 70%. 12 patients have returned to the original dosing regimen due to increased disease activity.In the Psoriatic Arthritis patient group, there were 21 females, 19 males, with a mean age of 52 years (age range 31 years to 73 years). In 5 of these patients we have attempted to taper the interval of their medication. The majority of those tapered were on monotherapy adalimumab. The changes were maintained in 80% of patients.ConclusionsIn total we have attempted to taper 30% of RA and PsA patients on biologic therapies, 71% of these attempts have been maintained or increased. We are increasing the dosage intervals successfully by varying amounts, with a range from 16% to 55%, and by a mean of 30.58% over all medications included. Etanercept has successfully had the largest increase in interval with dosing intervals increasing by a mean of 55% compared to once every 7 day dosing. This has significant financial implications with an annual savings of £72,108.60 based on the data in this audit.Disclosure of InterestNone declared

No abstract