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Background Audit and feedback is widely used in healthcare improvement, with evidence of modest yet potentially important effects upon professional practice. There are approximately 60 national clinical audit programmes in the UK. These programmes often develop and adapt new ways of delivering feedback to optimise impacts on clinical practice. Two such programmes, the National Diabetes Audit (NDA) and the Trauma Audit Research Network (TARN), recently introduced changes to their delivery of feedback. We assessed the extent to which the design of these audit programmes and their recent changes were consistent with best practice according to the Clinical Performance Feedback Intervention Theory (CP-FIT). This comprehensive framework specifies how variables related to the feedback itself, the recipient, and the context operate via explanatory mechanisms to influence feedback success. Methods We interviewed 19 individuals with interests in audit and feedback, including researchers, audit managers, healthcare staff, and patient and public representatives. This range of expert perspectives enabled a detailed exploration of feedback from the audit programmes. We structured interviews around the CP-FIT feedback cycle and its component processes (e.g. Data collection and analysis, Interaction). Our rapid analytic approach explored the extent to which both audits applied features consistent with CP-FIT. Results Changes introduced by the audit programmes were consistent with CP-FIT. Specifically, the NDA’s increased frequency of feedback augmented existing strengths, such as automated processes (CP-FIT component: Data collection and analysis) and being a credible source of feedback (Acceptance). TARN’s new analytic tool allowed greater interactivity, enabling recipients to interrogate their data (Verification; Acceptance). We also identified scope for improvement in feedback cycles, such as targeting of feedback recipients (Interaction) and feedback complexity (Perception) for the NDA and specifying recommendations (Intention) and demonstrating impact (Clinical performance improvement) for TARN. Conclusions The changes made by the two audit programmes appear consistent with suggested best practice, making clinical improvement more likely. However, observed weaknesses in the feedback cycle may limit the benefits of these changes. Applying CP-FIT via a rapid analysis approach helps identify strengths and remediable weaknesses in the design of audit programmes that can be shared with them in a timely manner.

Introduction Hereditary inclusion body myopathy (IBM) with Paget's disease of the bone (PDB) and frontotemporal dementia (FTD) (IBMPFD) is a rare autosomal dominant disorder due to mutations in the valosin-containing protein gene (VCP). The identification of mutations in different exons emphasises that full gene sequencing is required to exclude VCP-related disease.

Background/aims The views of people with inherited retinal disease are important to help develop health policy and plan services. This study aimed to record levels of understanding of and attitudes to genetic testing for inherited retinal disease, and views on the availability of testing. Methods Telephone questionnaires comprising quantitative and qualitative items were completed with adults with inherited retinal disease. Participants were recruited via postal invitation (response rate 48%), approach at clinic or newsletters of relevant charitable organisations. Results Questionnaires were completed with 200 participants. Responses indicated that participants’ perceived understanding of genetic testing for inherited retinal disease was variable. The majority (90%) considered testing to be good/very good and would be likely to undergo genetic testing (90%) if offered. Most supported the provision of diagnostic (97%) and predictive (92%) testing, but support was less strong for testing as part of reproductive planning. Most (87%) agreed with the statement that testing should be offered only after the individual has received genetic counselling from a professional. Subgroup analyses revealed differences associated with participant age, gender, education level and ethnicity (p<0.02). Participants reported a range of perceived benefits (eg, family planning, access to treatment) and risks (eg, impact upon family relationships, emotional consequences). Conclusions Adults with inherited retinal disease strongly support the provision of publicly funded genetic testing. Support was stronger for diagnostic and predictive testing than for testing as part of reproductive planning.

Aims With one in four children starting school overweight, prevention needs to start in the preschool years. BERTIE (Babies and Early-years Risk: Trying to Implement the Evidence) aims to help health professionals identify babies at risk of obesity to provide appropriate guidance. Methods Systematic review of the effect of selected perinatal factors associated with later obesity. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method was used to evaluate and synthesise the evidence and rate the quality of evidence for recommendations. A consensus meeting of experts debated the findings and their suitability. Results The consensus meeting identified maternal obesity, infant weight centile, infant weight gain, and smoking in pregnancy as the factors that would be most helpful in identifying infants at the greatest risk of later obesity. Socioeconomic status and ethnicity merited further exploration, though it was recognised that usefully measuring these factors would present challenges. Evidence relating to the other factors (birth weight, diabetes in pregnancy, infant sleep pattern, breastfeeding and weight gain in pregnancy) was not considered strong enough to suggest they would be useful perinatal predictors of later obesity risk. Conclusion These findings provide guidance for how families might be targeted for obesity prevention. Given the importance of parental obesity, training health professionals to sensitively engage with families is needed to ensure those at high risk receive the intervention required.

Two cases are described of cardioversion from stable supraventricular tachycardia after venepuncture. In both cases usual vagal manoeuvres at home and in the casualty department were unsuccessful. However, attempts to site intravenous cannulas by the attending medical staff terminated his supraventricular tachycardia. Venepuncture is probably the commonest vagal manoeuvre performed in hospital but has not previously been reported as a method of cardioversion.

AIMS: To evaluate the Sentinel automated blood culture system and to compare its performance with that of Bactec. METHODS: The Sentinel blood culture system was evaluated in three centres. The performance of the system was assessed in comparison with the routine blood culture method used in these centres, the Bactec system. RESULTS: Blood culture sets (n = 2180) consisting of Sentinel aerobic and anaerobic, and Bactec aerobic and anaerobic bottles yielded 218 (10%) clinically important isolates. One hundred and fifty five (71%) of the isolates were detected by both systems; 35 (16%) were detected by Sentinel only; and 28 (13%) by Bactec only. For the duration of the evaluation, the Sentinel system was deliberately configured so that it was impossible to detect positive results during the first 12 hours. The times to positivity after the first 12 hours were similar. Data gathered during and subsequent to the evaluation have been used by the manufacturer to refine the algorithm so that positive results can be detected at a minimum of 2.25 hours. CONCLUSIONS: After a period of familiarization the Sentinel system was considered easy to use. Sentinel is a useful addition to the methods available for the detection of bacteria in blood cultures.

Two developments of major importance followed Pasteur's discovery of anaerobiosis: Lister revolutionized surgery by recognizing the importance of Pasteur's germ theory of disease and by introducing the antiseptic surgical method. The day of the anaerobe hunter had dawned. The discovery of many anaerobic bacteria linked etiologically to human disease followed, so that by 1900 most of the pathogenic anaerobes were recognized. The frequent occurrence of anaerobic bacterial intoxications, during the two World Wars stimulated the study of clostridia, organisms that dominated the study of anaerobes until the 1960s. During the next decade the emphasis shifted to the non-spore-forming anaerobes due to the work of Finegold in Los Angeles, and Moore and Holdeman in Virginia. Their pioneer studies initiated and carried forward the \"anaerobe revolution,\" and exerted an influence that transformed the clinical and microbiologic approach to anaerobic bacterial infections in almost every field of medical practice. In considering the question, \"Where do we go from here?\" the author discusses some aspects of anaerobic infections that remain areas of debate or provide pathways for future exploration. Reference is made to the acceptable \"anaerobic specimen,\" and to the problem of \"mixed infections.\" Pseudomembranous colitis is noted and the role of anaerobes in tonsillitis and pharyngitis, bronchitis, and nonspecific vaginitis (vaginosis) is discussed.

Gas-liquid chromatographic analysis of samples of pus provides a rapid and reliable means for the presumptive differentiation of anaerobic from aerobic infections.Gas-liquid chromatographic analysis of samples of pus provides a rapid and reliable means for the presumptive differentiation of anaerobic from aerobic infections.

Anaerobic bacteria were isolated from all tonsils removed from children at routine tonsillectomy; 75.6% of specimens yielded moderate to heavy growth and 80% of tonsils contained more than one anaerobic species. This recovery rate fell to 56% after a 10-day course of metronidazole before tonsillectomy--in only 14.6% of cases were anaerobes isolated in significant numbers. Surface swabbing of the tonsils permitted recovery of a similar spectrum of anaerobic bacteria but resulted in an overall loss of both aerobic and anaerobic pathogens. A comparison was made between the flora of acutely inflamed tonsils and \"healthy' tonsils: over 90% of both groups yielded anaerobic bacteria, but they were present in significant numbers in 56.2% of swabs taken from acutely inflamed tonsils compared with 24% of swabs from \"healthy' children. The isolation rate for anerobic pathogens was 37.5% and 16% respectively.

From in-vitro studies of breast and cow's milk preparations, and of the faeces from breast-fed and bottle-fed infants, a number of factors seemed likely to influence the production and maintenance of a lactobacillary flora and low pH in the faeces of newborn infants. These were mainly attributable to the nature of the feed. It is suggested that responsible factors in breast milk include its high lactose, low protein, low phosphate content, together with its poor buffering capacity. Importance is also attached to the fact that breast milk seems to provide a fluid feed of small bulk and low residue, and that its use is unlikely to include periods of starvation. Cow's milk, on the other hand, which has a low lactose, high protein, high phosphate content, and a high buffering capacity, is a relatively bulky, high-residue feed. Feeding regimens which employ it are likely to include periods of starvation.