Learning from the report of the independent medicines and medical devices safety review: “first do no harm”

This is a review of the learning points from the Independent Medicines and Medical Devices Safety Review, 1 chaired by Baroness Julia Cumberlege CBE DL. This system-wide review was initiated by the then Secretary of State for Health and Social Care, following patient-led campaigns. It looked at how the “healthcare system reacted as a whole, and how that response can be made more robust, speedy and appropriate”. We aim to highlight the learning points for doctors in Obstetrics and Gynaecology as these are relevant to our current practice and future changes in our healthcare system. These are: Aims of the review: why it was initiated and how it was conducted Overarching themes and missed opportunities to prevent avoidable harm Three clinical scenarios: their histories, issues and adverse events associated with their use and the current response in Scotland The hormone pregnancy test - Primodos The anti-epileptic drug - sodium valproate Surgical mesh for prolapse & incontinence The recommendations made by the review and implementation guidance Responses to the review, such as apologies issued by BSUG 2 /BAUS 3 /RCOG, 4 and compensations schemes such as the Scottish scheme as recommended by the review

Does One Size Fit All? A Case Study to Discuss Findings of an Augmented Hands-Free Robot Teleoperation Concept for People with and without Motor Disabilities

Hands-free robot teleoperation and augmented reality have the potential to create an inclusive environment for people with motor disabilities. It may allow them to teleoperate robotic arms to manipulate objects. However, the experiences evoked by the same teleoperation concept and augmented reality can vary significantly for people with motor disabilities compared to those without disabilities. In this paper, we report the experiences of Miss L., a person with multiple sclerosis, when teleoperating a robotic arm in a hands-free multimodal manner using a virtual menu and visual hints presented through the Microsoft HoloLens 2. We discuss our findings and compare her experiences to those of people without disabilities using the same teleoperation concept. Additionally, we present three learning points from comparing these experiences: a re-evaluation of the metrics used to measure performance, being aware of the bias, and considering variability in abilities, which evokes different experiences. We consider these learning points can be extrapolated to carrying human–robot interaction evaluations with mixed groups of participants with and without disabilities.

Synergistic cortisol suppression by ketoconazole–osilodrostat combination therapy

Summary Here, we describe a case of a patient presenting with adrenocorticotrophic hormone-independent Cushing’s syndrome in a context of primary bilateral macronodular adrenocortical hyperplasia. While initial levels of cortisol were not very high, we could not manage to control hypercortisolism with ketoconazole monotherapy, and could not increase the dose due to side effects. The same result was observed with another steroidogenesis inhibitor, osilodrostat. The patient was finally successfully treated with a well-tolerated synergitic combination of ketoconazole and osilodrostat. We believe this case provides timely and original insights to physicians, who should be aware that this strategy could be considered for any patients with uncontrolled hypercortisolism and delayed or unsuccessful surgery, especially in the context of the COVID-19 pandemic. Learning points Ketoconazole–osilodrostat combination therapy appears to be a safe, efficient and well-tolerated strategy to supress cortisol levels in Cushing syndrome. Ketoconazole and osilodrostat appear to act in a synergistic manner. This strategy could be considered for any patient with uncontrolled hypercortisolism and delayed or unsuccessful surgery, especially in the context of the COVID-19 pandemic. Considering the current cost of newly-released drugs, such a strategy could lower the financial costs for patients and/or society.

Pheochromocytoma due to a novel SDHD variant presenting as unilateral visual loss

Summary A 53-year-old female presented to a tertiary ophthalmology referral centre complaining of unilateral painless loss of vision. Subsequent assessment revealed malignant hypertension causing right-sided cystoid macular oedema. During the course of secondary hypertension workup, she was diagnosed with a 7.8 cm phaeochromocytoma which was resected. Testing for a panel of all predisposing phaeochromocytoma-causing variants using next-generation sequencing resulted in the diagnosis of a novel SDHD variant. Learning points Screening for secondary causes of hypertension is indicated when there is evidence of hypertension-mediated end-organ damage (1). Testing for a predisposing variant should be considered in all patients with phaeochromocytoma or paraganglioma due to the high heritability rate and prevalence of somatic variants (2, 3, 4). Novel variants are commonly uncovered in the Succinate Dehydrogenase (SDH) subunit; proving pathogenicity is a complex, time-consuming process and one challenge of next-generation sequencing (3). SDHB immunohistochemistry as a tool for demonstrating pathogenicity is associated with reduced sensitivity when assessing SDHD variants (5, 6).

Striking a Balance: Improving Practice as a Student Doing Group Music Therapy with Adults with Substance Abuse and Dependence

<p>An action research project was devised to help a music therapy student improve her practice in a group alcohol and drug treatment setting. The project initially focussed on improving practice by delivering more creative, sustained and holistic experiences. Four action cycles of one week each were carried out, each cycle comprising planning, action and reflection stages. Data sources were gathered in the form of clinical notes, a reflective journal and supervision notes from meetings and session de-briefs with counselling staff at the facility. The data was then woven into narrative accounts of each cycle, and key learning points for each cycle were identified. Cycles were also examined for common themes, and nine themes were identified. Findings show the student developing a deeper understanding of practice through the examination of structure and flexibility in facilitation style and musical interactions, and how and when to find balance between structure and freedom. Other key factors relevant to improving practice such as building confidence and working with the interdisciplinary team, are explored. Findings are discussed, along with ideas about the value of carrying out an Action Research project, and suggestions for future projects focussed on improving practice with this client group.</p>

Striking a Balance: Improving Practice as a Student Doing Group Music Therapy with Adults with Substance Abuse and Dependence

<p>An action research project was devised to help a music therapy student improve her practice in a group alcohol and drug treatment setting. The project initially focussed on improving practice by delivering more creative, sustained and holistic experiences. Four action cycles of one week each were carried out, each cycle comprising planning, action and reflection stages. Data sources were gathered in the form of clinical notes, a reflective journal and supervision notes from meetings and session de-briefs with counselling staff at the facility. The data was then woven into narrative accounts of each cycle, and key learning points for each cycle were identified. Cycles were also examined for common themes, and nine themes were identified. Findings show the student developing a deeper understanding of practice through the examination of structure and flexibility in facilitation style and musical interactions, and how and when to find balance between structure and freedom. Other key factors relevant to improving practice such as building confidence and working with the interdisciplinary team, are explored. Findings are discussed, along with ideas about the value of carrying out an Action Research project, and suggestions for future projects focussed on improving practice with this client group.</p>

Using forensic handwriting principles for rapid signature screening

Examination of a signature is a lengthy process conducted under laboratory conditions, requiring precision and caution. When a rapid screening of signatures is required, the basic principles of forensic signature comparison can be adapted. Learning points from signature screening examinations are outlined to aid handwriting experts in carrying out similar procedures.

Waterflood Analysis in Compartmentalised Reservoir Using Multiwell Retrospective Testing and Tracers

The study field consists of four oil pays and is currently going through a waterflood trial. Due to a presence of high amplitude faulting it becomes crucially important to understand the geology of the field and reservoir connectivity prior to progressing the waterflood project. The results of the cross-well tracers have indication (some strong and some vague) of communication between a trial water injector and all oil producers in the same and adjacent compartment. Since the wells were equipped with permanent downhole pressure gauges it was possible to decipher the cross-well communication using the Multiwell Retrospective Testing (MRT) technique based on multiwell deconvolution algorithm (MDCV). The results of MRT study were showing no traceable communication between trial water injector and offset wells in adjacent compartment except one producer which showed a strong response across the fault. By correlating the MRT results with seismic profile and well completion it became possible to establish how exactly the main pay is communicating between the compartments. It also carried few learning points on how to interpret results of cross-well tracers and MRT in terms of reservoir properties.