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Papers by oliver dearlove

Anaesthesia, Aug 1, 1998

Recently some correspondence has been generated in this journal regarding remifentanil in the cri... more Recently some correspondence has been generated in this journal regarding remifentanil in the critically ill, some of it urging care in its unfettered use prior to 'well-designed studies'. Surely some circumspection is called for when considering its use as a sedative over a

BMJ, Jan 13, 1996

paediatric transfer by non-specialists,3 surely they are too non-specific to assess the performan... more paediatric transfer by non-specialists,3 surely they are too non-specific to assess the performance of a specialist team. A study by Edge et al,4 in which a specialist retrieval team did not seem to reduce physiological deterioration during transfer as assessed by these criteria, may be criticised on the grounds that the two groups were not comparable. The patients transferred by a non-specialist team were significantly older and included a higher proportion of victims of trauma. The diagnoses in the patients transferred by a specialist team were not stated. Also, although physiological deterioration occurred in 11% of the patients transferred by the specialist teams and 12% of the patients transferred by the non-specialist teams, the data from the two groups were pooled together, making further analysis impossible. It would be interesting if Britto and colleagues' study was repeated, with more sensitive criteria being used to assess morbidity during transfer, perhaps by the inclusion of a specified percentage deterioration in physiological variables before transfer.

BMJ, Aug 23, 1997

We received many letters commenting on the cluster of papers on salt that we published in May las... more We received many letters commenting on the cluster of papers on salt that we published in May last year. We had several problems with the letters but have now resolved these and are publishing the letters now. These 10 letters and three others are available on the BMJ's website (www.bmj.com).

Pediatric Anesthesia, May 1, 1998

A review of a case series of sixteen anaesthetics in eight cases was undertaken to determine whet... more A review of a case series of sixteen anaesthetics in eight cases was undertaken to determine whether children with Prader-Willi syndrome present particular problems to the anaesthetist. Children in an early stage of the condition who are below their centile for weight present no specific problems. Children who are heavier than 97th centile weight have problems associated with their obesity: difficult intravenous access and sleep apnoea. Scoliosis was noted in both groups and was not associated with problems after minor surgery.

Antihistamines and anaesthesia

The Lancet, Dec 1, 1997

Anaesthesia, Dec 1, 2001

Letters (two copies) must be typewritten on one side of the paper only and double spaced with wid... more Letters (two copies) must be typewritten on one side of the paper only and double spaced with wide margins. Copy should be prepared in the usual style and format of the Correspondence section. Authors must follow the advice about references and other matters contained in the Notice to Contributors to Anaesthesia printed at the back of each issue. The degree and diplomas of each author must be given in a covering letter personally signed by all the authors. Correspondence presented in any other style or format may be the subject of considerable delay and may be returned to the author for revision. If the letter comments on a published article in Anaesthesia, please send three copies; otherwise two copies of your letter will suffice.

BMJ, Dec 5, 1998

Editor-The increased death rate with selegiline in the Parkinson's Disease Research Group's trial... more Editor-The increased death rate with selegiline in the Parkinson's Disease Research Group's trial highlights the problem of interpreting the results of a small trial in isolation. Ben-Shlomo et al emphasised the internal consistency of this finding, 1 which is not surprising because much of the original data were reanalysed. The hazard ratio was lower than in the original report (1.32 v 1.57), which suggests that the trial might have stopped on a random high.

Pediatric Anesthesia, Nov 1, 1998

A four-year-old boy was admitted to intensive care via casualty having suffered an apnoeic episod... more A four-year-old boy was admitted to intensive care via casualty having suffered an apnoeic episode due to compression of his chest by a heavy cattle bar. A petechial rash was noted on the upper chest and arms. A chest radiograph showed pulmonary oedema which resolved over a few hours following positive pressure ventilation and positive end expiratory pressure. We believe this to be an unusual presentation of obstructive pulmonary oedemia (Negative Pressure Pulmonary Oedema).

Tuberculous perforation of the bowel

Pediatric Anesthesia, Jul 1, 1996

... Tuberculous perforation of the bowel. Oliver Dearlove FRCA,; Adam Dobson FRCA. Article first ... more ... Tuberculous perforation of the bowel. Oliver Dearlove FRCA,; Adam Dobson FRCA. Article first published online: 30 JAN 2007. DOI: 10.1111/j.1460-9592.1996.tb00466.x. Issue. Pediatric Anesthesia. Volume 6, Issue 4, page 344, July 1996. Additional Information. How to Cite. ...

Anaesthesia in pyruvate dehydrogenase deficiency

Anaesthesia, Aug 1, 2001

Bernice McCarthy notes that trainees ask the following questions [1]. Why am I learning? What wil... more Bernice McCarthy notes that trainees ask the following questions [1]. Why am I learning? What will I learn? How will I learn it? What if I don't agree, can't learn, and don't like it? Educators must help find the answers to these questions. A registrar-teaching programme should provide the means to learn the knowledge, skills and attitudes necessary for trainees to pass their exams and become successful anaesthetists. Many believe the best way to organise a programme is through dialogue between trainers and trainees [2, 3]. The resulting synthesis provides an environment for adult learning that is both enjoyable and achieves its stated goals as well as constructing a `built in' improvement cycle. Many institutions have implemented teaching programmes developed through dialogue but few or no data exist in the United Kingdom on how changes from a caring but one-sided registrar training programme to a programme synthesised from the input of trainees and trainers affects outcome. We were presented with an opportunity to measure attitudinal changes between groups of our registrars during a reorganisation of the teaching programme for Specialist Registrars in anaesthesia, which was undertaken over the course of two successive 3month modules with different groups of trainees in paediatric anaesthesia in the Northwest Region. The first module followed the pattern that had been used for many years. The second module included changes in design based on criticism from registrars. Records were kept of tutorial attendance during the two modules and an identical questionnaire was given to trainees at the end of each module. The Mann±Whitney test (p , 0.05) was used to test statistical significance. The new programme was based on the assumption that increased motivation would be the key to improved learning [3]. This would come from trainees having a larger part to play in the content and presentation of tutorials and teaching. The following changes were added: mutually agreed objectives, registrar presentation at each tutorial, practice exams to be marked by postFellowship registrars, contribution of papers to a departmental file, 6-week review of trainees' progress by trainer and completion of feed-back forms by both trainers and trainees at the end of the module. Questionnaire response rates were similar for the two groups. Module 1: 12/17 (70%), Module 2: 13/16 (81%). Changes in the organisation of the teaching coincided with statistically significant improvements in attendance at tutorials and improved perception of the usefulness of tutorials, handouts, presentations and exam practice. Selfassessment of clinical skills, confidence and enjoyment of the module were not affected significantly. Overall, no assessed categories were graded as worse in the second module. Improvements came in categories most affected by tutorials. Tutorials are more easily controlled environments and were targeted for change. These improvements are likely due to the increased input from trainees and more enthusiastic teaching that arises from a motivated energised atmosphere. Although continued subjective evaluation and objective testing of knowledge retention would be desirable to substantiate the claimed improvements, these results provide support to those programmes that have instituted similar changes and stimulus to those considering them. A programme based on mutually agreed objectives, explicit content and defined process with built in assessment and flexibility answers McCarthy's questions and provides potential for improvement too dramatic to allow a return to the previous organisation.

Anaesthesia, Nov 1, 1999

One thousand, eight hundred and fifty-seven patients underwent magnetic resonance imaging followi... more One thousand, eight hundred and fifty-seven patients underwent magnetic resonance imaging following the establishment of a structured sedation programme. Forty-eight of these patients came from the intensive care unit with a secure airway and were therefore excluded from any further analysis. Oral sedation was to be given to children aged 5 years and below. For children Ն 6 years old, oral sedation could be given only if their level of co-operation was judged to be inadequate by the referring physician. Oral sedation consisted of chloral hydrate 90 mg.kg ¹1 (maximum 2.0 g) orally with or without rectal paraldehyde 0.3 ml.kg ¹1 . All magnetic resonance imaging requests for children who failed oral sedation as well as those referred for general anaesthesia from the outset were reviewed by a consultant anaesthetist who then allocated patients to undergo the procedure with either general anaesthesia or intravenous sedation. Scans requiring intravenous sedation or general anaesthesia were performed in the presence of a consultant anaesthetist. Intravenous sedation consisted of either a propofol 0.5 mg.kg ¹1 bolus followed by an infusion (maximum 3 mg.kg ¹1 .h ¹1 ) or midazolam 0.2-0.5 mg.kg ¹1 boluses. General anaesthesia was given using spontaneous ventilation with a mixture of 66% nitrous oxide in oxygen and isoflurane following either inhalation (sevoflurane) or intravenous (propofol) induction. One thousand and thirty-nine (57.4%) of the scans were done without sedation whereas 93 scans were performed during the consultant anaesthetist supervised sessions. Oral sedation failed in 50 out of 727 patients (6.9%). Eighty-seven per cent of children aged 5 years and below needed sedation compared with 4.5% of those aged over 10 years. Two patients who had only received chloral hydrate developed significant respiratory depression. This structured sedation programme has provided a safe, effective and efficient use of limited resources.

Legal safeguards for audit are a good idea

Edgar Hope-Simpson as a Beaminster GP

A Life Celebrated, a Departure regretted

Journal of Clinical Pathology, Apr 1, 1997

A Patient Who Changed Our Practice

BMJ, Feb 11, 1995

Cockayne syndrome is a rare, worldwide, autosomal recessive condition.1 2 It presents most common... more Cockayne syndrome is a rare, worldwide, autosomal recessive condition.1 2 It presents most commonly in childhood as a progressive failure of growth and development. Few patients exceed 20 kg in weight or 115 cm in height. Typically the syndrome produces a thin, dwarfed child with deep set eyes, prominent teeth, and a narrow receding chin. The skin is dry, scaly, highly photosensitive, and seems prematurely aged. Neurological impairment is universal owing to generalised brain atrophy. These children are mentally retarded with impaired or absent speech. Mobility is diminished because of a combination of spasticity, ataxia, and limb contractures. Convulsions occur in 5–10% of patients. Increasing visual loss is expected because of …

BMJ, Mar 18, 2004

Editor-Although I agree with Empey that the recent direction from the Department of Health on the... more Editor-Although I agree with Empey that the recent direction from the Department of Health on the suspension of doctors represents progress-major progress with the mandatory need for referral to the National Clinical Assessment Authority (NCAA)-he has glossed over the fact that it has taken nine years for it to be produced. 1 He also failed to highlight the risk to patients' safety that is caused by suspensions and threats of suspensions, as exemplified by case 8 in the National Audit Office's report, in which a trust's culture was such that consultants feared bullying and victimisation if they raised any concerns about safety issues. 2 Badly planned and executed suspensions compromise care for patients and put them at risk; in view of the requirements of the October 2002 Code of Conduct for Managers to give top priority to protecting patients from risk the rash, rushed, arbitrary suspension of a doctor should not be happening these days. If it does then the responsible manager should be held to account by either the trust board or even the NHS chief executive under the terms of the code. If those pathways of accountability fail then MPs on the Committee of Public Accounts can hold the Department of Health to account on behalf of the public. The procedure and processes around suspensions of both senior managers and consultants are complex and require specialist human resources and legal skills and good, non-biased judgment to avoid unfair dismissal and inappropriate suspensions. A case could be made for establishing a central unit. Alternatively a more loose network of appropriate legal and human resources experts could be established to be called on by any trust to help in these difficult cases so that the proper processes are followed.