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Publication History View all

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    ABSTRACT: In the UK many practising GPs did not choose general practice as their first choice of career when they originally graduated as doctors. To compare job satisfaction of GPs who chose general practice early or later in their career. Questionnaires were sent to all UK-trained doctors who graduated in selected years between 1993 and 2000. Questionnaires were sent to the doctors 1, 3, 7 and 10 years after graduation. Of all 3082 responders working in general practice in years 7 and 10, 38% had first specified general practice as their preferred career when responding 1 year after graduation, 19% by year 3, 21% by year 5, and 22% after year 5. Job satisfaction was high and, generally, there was little difference between the first three groups (although, when different, the most positive responses were from the earliest choosers); but there were slightly lower levels of job satisfaction in the 'more than 5 years' group. For example, in response to the statement 'I find enjoyment in my current post', the percentages agreeing in the four groups, respectively, were 91.5%, 91.1%, 91.0% and 88.2%. In response to 'I am doing interesting and challenging work' the respective percentages were 90.2%, 88.0%, 86.6% and 82.6%. Job satisfaction levels were generally high among the late choosers as well as the early choosers. On this evidence, most doctors who turn to general practice, after preferring another specialty in their early career, are likely to have a satisfying career.
    British Journal of General Practice 11/2013; 63(616):726-733.
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    ABSTRACT: This paper discusses the nature of genomic information, and the moral arguments in support of an individual's right to access it. It analyses the legal avenues an individual might take to access their sequence information. The authors describe the policy implications in this area and conclude that, for now, the law appears to strike an appropriate balance, but new policy will need to be developed to address this issue.
    Medical Law Review 10/2013;
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    ABSTRACT: Objectives Medical schools need to ensure that graduates feel well prepared for their first medical job. Our objective was to report on differences in junior doctors' self-reported preparedness for work according to gender, ethnicity and graduate status.DesignPostal and electronic questionnaires.SettingUK.ParticipantsMedical graduates of 2008 and 2009, from all UK medical schools, one year after graduation.Main outcome measuresThe main outcome measure was the doctors' level of agreement with the statement that 'My experience at medical school prepared me well for the jobs I have undertaken so far', to which respondents were asked to reply on a scale from 'strongly agree' to 'strongly disagree'.ResultsWomen were slightly less likely than men to agree that they felt well prepared for work (50% of women agreed or strongly agreed vs. 54% of men), independently of medical school, ethnicity, graduate entry status and intercalated degree status, although they were no more likely than men to regard lack of preparedness as having been a problem for them. Adjusting for the other subgroup differences, non-white respondents were less likely to report feeling well prepared than white (44% vs. 54%), and were more likely to indicate that lack of preparedness was a problem (30% non-white vs. 24% white). There were also some gender and ethnic differences in preparedness for specific areas of work.Conclusions The identified gender and ethnic differences need to be further explored to determine whether they are due to differences in self-confidence or in actual preparedness.
    Journal of the Royal Society of Medicine 10/2013;
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    ABSTRACT: Nosocomial transmission of measles is a near avoidable event with the potential for serious sequelae. Those who acquire infection in hospitals may be particularly susceptible to serious disease. UK guidance recommends measles, mumps, rubella vaccine (MMR) vaccination for healthcare workers (HCWs) as a key preventative measure against nosocomial transmission. We report an incident of transmission of measles from a patient to an unvaccinated HCW, with subsequent onward transmission to a patient in a paediatric unit. Response to the incident was undertaken in accordance with guidance from the Health Protection Agency (now Public Health England) and UK Department of Health. The index case had travelled to France, where there was an ongoing outbreak. There were 110 contacts identified for this HCW, of whom 61 were advised to have MMR and 5 were given immunoglobulin. All three cases were found to have the same D4 genotype. The report highlights the large number of potential contacts in a hospital setting and the time and resource implications involved to prevent further cases. It also highlights the importance of timely identification of measles, early public health notification and complete contact tracing. Such incidents are nearly avoidable given the availability of an efficacious vaccine.
    Journal of Public Health 10/2013;
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    ABSTRACT: To evaluate the impact of maternal BMI on intrapartum interventions and adverse outcomes that may influence choice of planned birth setting in healthy women without additional risk factors. Prospective cohort study. Stratified random sample of English obstetric units. 17 230 women without medical or obstetric risk factors other than obesity. Multivariable log Poisson regression was used to evaluate the effect of BMI on risk of intrapartum interventions and adverse maternal and perinatal outcomes adjusted for maternal characteristics. Maternal intervention or adverse outcomes requiring obstetric care (composite of: augmentation, instrumental delivery, intrapartum caesarean section, general anaesthesia, blood transfusion, 3rd/4th degree perineal tear); neonatal unit admission or perinatal death. In otherwise healthy women, obesity was associated with an increased risk of augmentation, intrapartum caesarean section and some adverse maternal outcomes but when interventions and outcomes requiring obstetric care were considered together, the magnitude of the increased risk was modest (adjusted RR 1.12, 95% CI 1.02-1.23, for BMI > 35 kg/m(2) relative to low risk women of normal weight). Nulliparous low risk women of normal weight had higher absolute risks and were more likely to require obstetric intervention or care than otherwise healthy multiparous women with BMI > 35 kg/m(2) (maternal composite outcome: 53% versus 21%). The perinatal composite outcome exhibited a similar pattern. Otherwise healthy multiparous obese women may have lower intrapartum risks than previously appreciated. BMI should be considered in conjunction with parity when assessing the potential risks associated with birth in non-obstetric unit settings.
    BJOG An International Journal of Obstetrics & Gynaecology 09/2013;
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    ABSTRACT: To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). All 221 UK hospitals with obstetrician-led maternity units. All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. Prospective case identification through the monthly mailing of UKOSS. Median estimated blood loss, transfusion requirements. A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001). Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.
    BJOG An International Journal of Obstetrics & Gynaecology 08/2013;
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    ABSTRACT: In 2010, the World Health Organisation (WHO) published the World Health Report - Health systems financing: the path to universal coverage. The Director-General of the WHO, Dr Margaret Chan, commissioned the report "in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care". Given the current context of global economic hardship and difficult budgetary decisions, the report offered timely recommendations for achieving universal health coverage (UHC). This article analyses the current methods of healthcare financing in Ireland and their implications for UHC. Three questions are asked of the Irish healthcare system: firstly, how is the health system financed; secondly, how can the health system protect people from the financial consequences of ill-health and paying for health services; and finally, how can the health system encourage the optimum use of available resources? By answering these three questions, this article argues that the Irish healthcare system is not achieving UHC, and that it is unclear whether recent changes to financing are moving Ireland closer or further away from the WHO's ambition for healthcare for all.
    Health Policy 08/2013;
  • BJOG An International Journal of Obstetrics & Gynaecology 08/2013; 120(9):1039-41.
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    ABSTRACT: We estimate the impact of six diabetes-related complications (myocardial infarction, ischaemic heart disease, stroke, heart failure, amputation and visual acuity) on quality of life, using seven rounds of EQ-5D questionnaires administered between 1997 and 2007 in the UK Prospective Diabetes Study. The use of cross-sectional data to make such estimates is widespread in the literature, being less expensive and easier to collect than repeated-measures data. However, analysis of this dataset suggests that cross-sectional analysis could produce biased estimates of the effect of complications on QoL. Using fixed effects estimators, we show that variation in the quality of life between patients is strongly influenced by time-invariant patient characteristics. Our results highlight the importance of studying quality-of-life changes over time to distinguish between time-invariant determinants of QoL and the effect on QoL of specific events such as diabetes complications. Copyright © 2013 John Wiley & Sons, Ltd.
    Health Economics 07/2013;
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    ABSTRACT: The paper explores whether UK qualified junior doctors' certainty about their choice of eventual clinical specialty has changed in recent years following structural changes to postgraduate training. We analysed data from questionnaire surveys of all doctors who qualified in the UK in 11 'year of qualification' cohorts between 1974 and 2009. We report on responses to questions at years 1, 3 and 5 after qualifying. Overall, 1 year after qualification, 28.6% (6576/23018) of doctors specified that they were certain about their choice of future specialty, 47.7% specified that their choice was probable and 23.7% were uncertain about it. By year 3 after qualification, 88% of doctors specified that their current specialty choice was definitely or probably their final choice, as did 95% in year 5. Levels of certainty in year 1 showed little change across the cohorts who qualified between 1974 and 2002 (average 28% 'definite'), dropped in the 2005 cohort and then increased to 38% in the qualifiers of 2008 and 2009. Similar changes occurred in years 3 and 5 among doctors surveyed after 2005. There was large variation in certainty of choice by specialty chosen but no important difference between men and women. Levels of confidence about early choice of specialty are now higher than they were prior to the 2005 changes to postgraduate training.
    Postgraduate medical journal 07/2013;
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