Leicester General Hospital

About: Leicester General Hospital is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Transplantation. The organization has 2481 authors who have published 3034 publications receiving 107437 citations.

Knowledge of Down syndrome in pregnant women from different ethnic groups.

Abstract: The uptake of any screening test is influenced by knowledge of the condition being screened for. In the present study, the knowledge and the source of knowledge of women offered antenatal screening for Down syndrome (DS) was assessed by means of a self-administered questionnaire. The questionnaire was administered to 300 consecutive women booking for antenatal care, of the 245 (82%) women who completed and returned the questionnaire, 117 (48%) were Caucasian, 85 (35%) were Asian born outside the UK, 32 (13%) were Asian born in the UK and ten (4%) belonged to other categories. Only 30% of the cohort had a good understanding of the condition. Racial groups other than Caucasian had a poorer understanding of DS. The factors which affected knowledge of DS included quality of spoken English, knowing an affected child, parity and religion. The most significant factor affecting acceptance of screening was the woman's knowledge of DS. The source of information for the condition varied widely: 42% from a general practitioners (GP), 24% from the hospital and 16% from midwives. The proportion with good knowledge was similar in those women whose source of information was the GP (45%) and the midwife (41%). These proportions were, however, higher (though not significantly) when the source of information was from magazines and newspapers (67%) and from friends (53%). Uptake of the screening test was best in those with good knowledge (53%) compared to those with poor knowledge (23%) (p<0.02). Between 28% and 66% (depending on the ethnic group) of women had a screening blood test "allegedly" without knowing why it had been performed. In order to improve uptake of the screening test for DS there is need for better education and counselling of women attending for antenatal care.

Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years

Abstract: Early implants for total knee replacement were fixed to bone with cement. No firm scientific reason has been given for the introduction of cementless knee replacement and the long-term survivorship of such implants has not shown any advantage over cemented forms. In a randomised, prospective study we have compared cemented and uncemented total knee replacement and report the results of 139 prostheses at five years. Outcome was assessed both clinically by independent examination using the Nottingham knee score and radiologically using the Knee Society scoring system. Independent statistical analysis of the data showed no significant difference between cemented and cementless fixation for pain, mobility or movement. There was no difference in the radiological alignment at five years, but there was a notable disparity in the radiolucent line score. With cemented fixation there was a significantly greater number of radiolucent lines on anteroposterior radiographs of the tibia and lateral radiographs of the femur. At five years, our clinical results would not support the use of the more expensive cementless fixation whereas the radiological results are of unknown significance. Longer follow-up will determine any changes in the results and conclusions.

Model for directly assessing and improving clinical competence and performance in revalidation of clinicians.

Abstract: It is now clear that revalidation and clinical governance will drive continuing professional development in medicine in the United Kingdom. 1 2 Thus patients, society, and the profession are to be assured that individual doctors not only are fit to practise but are providing high quality care for patients. The focus of professional revalidation is rightly moving from the requirement that practitioners merely provide evidence of participation in continuing education towards the requirement that they provide evidence that better reflects their clinical practice. 3 4 Nevertheless, the primary screening procedures that have been proposed for revalidation are indirect (see box).4 If used at all, tests of clinical competence come much later in the process, but few tests include direct observation of practice. We present the case for the primacy of obtaining direct evidence of clinical competence of any doctor being revalidated; discuss the essential attributes of any process of obtaining such evidence; describe the ways in which such evidence can be gathered; explore the limitations of review tools currently available; and suggest an appropriate model for performance review. #### Summary points The measures currently proposed for assessing competence in clinician revalidation are mainly indirect or proxy As the consultation is the single most important event in clinical practice, the central focus of revalidation should be the assessment of consultation competence Such assessment should be by direct observation and satisfy five criteria—reliability, validity, acceptability, feasibility, and educational impact Assessment of consultation competence would be followed by assessment of specific skills and regular performance review Such an assessment procedure is recommended for use in the revalidation of all clinicians #### Recent proposed components of revalidation in United Kingdom Indirect …