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BACKGROUND: Understanding of doctors' attitudes towards disclosing their own mental illness has improved but assumptions are still made. AIMS: To investigate doctors' attitudes to disclosing mental illness and the obstacles and enablers to seeking support. METHODS: An anonymous, UK-wide online survey of doctors with and without a history of mental illness. The main outcome measure was likelihood of workplace disclosure of mental illness. RESULTS: In total, 1954 doctors responded and 60% had experienced mental illness. There was a discrepancy between how doctors think they might behave and how they actually behaved when experiencing mental illness. Younger doctors were least likely to disclose, as were trainees. There were multiple obstacles which varied across age and training grade. CONCLUSIONS: For all doctors, regardless of role, this study found that what they think they would do is different to what they actually do when they become unwell. Trainees, staff and associate speciality doctors and locums appeared most vulnerable, being reluctant to disclose mental ill health. Doctors continued to have concerns about disclosure and a lack of care pathways was evident. Concerns about being labelled, confidentiality and not understanding the support structures available were identified as key obstacles to disclosure. Addressing obstacles and enablers is imperative to shape future interventions.

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OBJECTIVE: To evaluate the effectiveness and cost utility of a universally provided early years parenting programme. DESIGN: Multicentre randomised controlled trial with cost-effectiveness analysis. SETTING: Early years centres in four deprived areas of South Wales. PARTICIPANTS: Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control. INTERVENTION: The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions. MAIN OUTCOME MEASURES: Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures. RESULTS: There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With '+' indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI -1.90 to 3.69); in supportive parenting, +0.17 (95%CI -0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485-46 578) over 5 years and £18 954 (range 11 664-25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up. CONCLUSIONS: Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains. TRIAL REGISTRATION: The trial is registered with Current Controlled Trials ISRCTN13919732.

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AIM: While there is evidence that laparoscopy creates fewer adhesions, evidence regarding decreased episodes of adhesive obstruction in laparoscopic colorectal resection (LCR) is still lacking. The aim of our study was to compare the incidence of adhesion-related admissions/surgery in patients undergoing LCR and open colorectal resection (OCR). METHOD: We conducted a retrospective analysis of a prospectively collected database that included all patients undergoing LCR and OCR between 2001 and 2010. Patients with <6 months of follow-up were excluded. Patients who were converted to open surgery were included in the laparoscopic group. Details regarding readmission rates and surgery for adhesive obstruction were obtained from clinical portals and the theatre database. Statistical analysis was performed using Fisher's exact test, the Mann-Whitney U-test and the Student's t-test. RESULTS: One-hundred and forty-four patients had LCR with a median (range) follow-up of 24.5 (6-108) months. One-hundred and eighty-seven patients underwent OCR, with a median (range) follow-up of 49 (6-104) months. Six (4.2%) of 144 patients in the LCR group had adhesion-related admission/obstruction compared with 13 (6.95%) of 187 patients in the OCR group (P = 0.34). Three (2.1%) of 144 patients who had LCR required surgery for adhesive obstruction compared with five (2.7%) of 187 who had OCR (P = 0.73). CONCLUSION: In our study there was no statistically significant difference in the incidence of postoperative adhesive intestinal obstruction between LCR and OCR groups.

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OBJECTIVE: This study sought to compare the characteristics of aggressive incidents occurring on inpatient (medical and surgical) wards with those occurring in the accident and emergency department in terms of assailant, employee and other factors. METHOD: A prospective interview-based survey design was adopted. Forty-eight assaulted staff were interviewed about 69 incidents within 7 days on average of the incident occurring. The presence or absence of various assailant, employee, situation, interaction and outcome factors derived from the UK Health Services Advisory Committee's model was compared between the two settings. RESULTS: Inpatient ward incidents were significantly more likely to have the following characteristics: female perpetrator, perpetrator aged over 70 years, daytime occurrence in a restricted area, resolved by support from other health care staff. CONCLUSION: Aggression frequently occurs on inpatient (medical and surgical) wards of a general hospital. Aggression management training for staff working in both accident and emergency and inpatient settings should be cognisant of the similarities and differences within general health care specialisms.

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Patients with atrial fibrillation or atrial flutter (AF) are candidates for radiofrequency (RF) catheter ablation of the atrioventricular (AV) node with the aim being to control heart rate. As patients with AF can have markedly impaired ventricular function, information concerning the hemodynamic effects of AV node ablation using RF current would be valuable. Fourteen consecutive patients (mean age 65 +/- 3 years) with drug-resistant AF underwent AV node catheter ablation with RF current and had permanent pacemaker implantation. The mean left ventricular ejection fraction (EF) by two-dimensional echocardiography immediately before ablation was 42 +/- 3% (range 14%-54%) and their mean exercise time was 4.4 +/- 0.4 minutes. Complete AV block was achieved in all 14 patients with 6 +/- 2 RF applications (range 1-18). There was no evidence of any acute cardiodepressant effect associated with delivery of RF current, and EF 3 days after ablation was 44 +/- 4%. By 6 weeks after ablation, the left ventricular EF was significantly improved compared to baseline (47 +/- 4% postablation vs 42 +/- 3% preablation; P < 0.05), and this modest increase in EF was accompanied by an improvement in exercise time (5.4 +/- 0.4 min). In conclusion, delivery of RF current for AV node catheter ablation in patients with AF and reduced ventricular function is not associated with any acute cardiodepressant effect. On the contrary, improved control of rapid heart rate following successful AV node ablation is associated with a modest and progressive improvement in cardiac performance.

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This study investigates patterns of vocal fold movement in normal speakers. With the use of new computer software, laryngograph (Lx) waveforms from 100 normal speakers were examined. Specifically, four phases of the Lx waveform were observed and measured. These were then compared on both an interpersonal and intrapersonal basis. The results indicated that four phases were clearly identifiable in almost all subjects and that measurements of the closure and closed phases showed a high degree of consistency. The opening and open phases were more variable. In addition the onset and offset patterns of phonation were observed. Clear patterns were identified, consistent between speakers. The results are discussed with reference to the degree of consistency that can be expected in the vocal fold movement of normal speakers.

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The ultrastructure of the peritrophic membrane of the female sandfly Phlebotomus papatasi has been studied at various times after blood meals. The membrane begins to form within four hours of the blood meal with the secretion by the entire midgut epithelium of an electron-dense amorphous material. Subsequently, the membrane is stabilized and strengthened by the production of a layer of irregular chitinous microfibres, the whole membrane then forming a complete and resilient sac apparently unaffected by boiling 9 M potassium hydroxide. The membrane appears redundant 48 hours after the blood meal and fragments, possibly as a result of chitinase activity. The membrane's main functions are probably the prevention of clogging of the microvillous brush border by the blood meal and the confinement of large proteins, particularly serum trypsin inhibitors, to the endoperitrophic space while allowing sandfly proteases access to the blood meal periphery. Blood is not required to stimulate membrane production. Saline taken by blood feeding into the midgut also stimulates membrane formation. Phlebotomus papatasi females may lack an efficient anticoagulant, at least in the midgut, as blood meals frequently include fibrin clots.

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