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When I was first asked by the College to write a short article on the talk I had given earlier in the year on the history of medicine, I was initially hesitant for the simple reason that the subject was so vast to do justice to, and moreover that it had to be accessible to everyone. The diplomatic and persuasive skills of my colleagues encouraged me to write this short article on an extremely fascinating and illustrious period in the life of medicine and healthcare – the period from the 8th to the 15th century.

I am passionate about patient-centred and evidence-centred medicine, and hope to show how these principles were taken to unprecedented levels of excellence and refinedness in this period by Islamic medicine in a way that is to be seen in very few other areas of the history of medical science. When one elucidates each story in this history it can only be described by Bolt’s phrase: sophistication upon sophistication. Due to prescribed editorial limits, the article will centre on only three illustrious individuals: Abulcasis, Ibn al-Nafis and Avicenna. Firstly, the article looks at the overall contribution, and then secondly at the specific contribution and impact of these master clinicians.

Trigger warning: This article discusses baby loss

1 in 225 foetuses die before or during delivery in the UK each year. A third of these are term babies – born at 37 weeks or beyond – who were considered healthy before their death.

Women in the UK are routinely offered induction of labour after 41 weeks gestation. The risk of stillbirth increases from 0.11 per 1,000 pregnancies at 37 weeks to 3.18 per 1,000 at 42 weeks. In mothers whose pregnancy continued to 41 weeks, there is a 64 per cent increase in the risk of stillbirth compared with mothers who delivered at 40 weeks.¹

Authors:

• Dr Natalie Silvey, ST7 Anaesthetics, London School of Anaesthesia; DAS Trainee Representative
• Dr Moon-Moon Majumdar, ST5 Anaesthetics, London School of Anaesthesia; DAS Trainee Representative
• Dr Abhijoy Chakladar, Consultant Anaesthetist, University Hospitals Sussex NHS Foundation Trust; DAS Surveys Co-ordinator
• Dr Barry McGuire, Consultant Anaesthetist, Ninewells Hospital and Medical School, Dundee; DAS Immediate Past President

‘Her death was wholly avoidable and was contributed to in major part by neglect.’

This was the conclusion of the coroner examining the death of Mrs Glenda Logsdail following her death from hypoxic-ischaemic encephalopathy after an unrecognised oesophageal intubation.

Her death, like those of Sharon Rose Grierson and Peter Saint in 2016, has placed this issue at the forefront of safety strategy within the anaesthetic community. Following Glenda Logsdail’s death, the coroner issued a Regulation 28 report to prevent future deaths: several teaching aids and educational materials were released in the subsequent six months. We wanted to establish what was being done in individual departments to prevent unrecognised oesophageal intubation.

Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities scheduled for elective revision hip surgery at a stand-alone surgical unit without Level 2 or 3 care facilities. 

The surgical procedure was prolonged, and intraoperatively there was prolonged significant hypotension. In recovery this hypotension continued, but despite this the patient was discharged to the ward, where she sustained cardiac arrest. 

After delayed transfer to a facility with critical care, she was found to be in multiple organ failure with a profound metabolic acidosis, leading to a further cardiac arrest from which, tragically, she died.
The coroner, finding concerns regarding preoperative risk assessment and poor communication between the surgical team and anaesthetist, issued a Report to Prevent Future Deaths to the RCoA and the Royal College of Surgeons for action.

I have been appointed as the new SAS representative for the Faculty of Pain Medicine Training and Assessment Committee (FPMTAC). After graduating in 1992, I worked in some of the renowned hospitals in India in anaesthesia and intensive care. I moved to the UK in 2003 to improve my anaesthetic skills and knowledge.

I had my introduction to pain medicine in 2009. I enrolled myself for an MSc in pain management, and achieved a diploma in 2011 from Cardiff University. I went into a training post in 2013, but had to leave training for medical reasons. I continued working at Cardiff and Vale University Health Board as a fellow in regional anaesthesia, where my interest in acute pain started.

Authors:

• Dr Geevithan Kumaran, CT2 Anaesthetics
• Dr Alice Yearwood, CT2 Anaesthetics, Central London School of Anaesthesia

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

We would like to use this Bulletin issue to present some data on the College’s CPD event-accreditation scheme over the previous 12 months. 

Applications continue to be welcome from regional bodies and specialist societies and associations. Accredited events appear on the College website and in the Lifelong Learning Platform (LLP) – if you have attended an event aimed at a regional or national audience please always first check in the LLP if it has been approved. You will then be able to save duplication of effort by associating the event to your newly created CPD activity.

7 November 1925 to 9 May 2022

DSc, MD, PhD, MB ChB, FRCA ( Hon), FGS, FRCS(Hon), FANZCA (Hon), FCAI(Hon)

Dr John Francis Nunn died after an acute episode of respiratory failure. He had spent the last four years of his life in residential care due to progressive vascular dementia.

John read medicine at Birmingham University, during which period he developed passions for climbing and geology. On graduation he went to Svalbard on a geological expedition as medical officer and ‘rock carrier’.

He returned to Birmingham to undertake his house jobs and, having married in 1949, went to Penang in lieu of conventional national service. There he became an anaesthetist, learning the art by hands-on experience and the science by correspondence with seniors back home.

A new year signals a new Editor for the Bulletin, and it gives me immense pleasure to welcome you to the January 2023 edition. As I write this, the UK’s NHS is experiencing winter pressures, nurse strike action seems imminent, purple seems the new black in terms of hospital bed status, and elective surgical recovery targets seem an insurmountable challenge. It would be easy to feel discouraged, but a new year always heralds new hope.

Scrolling through the articles in this Bulletin, I am filled with delight at the examples and opportunities for change during these uncertain times. Innovation has long been the forte of our specialties – doing things differently, more efficiently, and more safely for the betterment of patient care. Whether it is the small tweaks made to TIVA settings, the slight adjustment of the ultrasound image during a nerve block, or refining the ergonomics of running an operating theatre list or ICU ward round, continuous improvement is innate to our specialties and specialists.