Why do Women Sue?

Statistics published by the National Health Service Litigation Authority relating to ten years of maternity claims provoke a sharp intake of breath. The total value of these claims over the first decade of the 21st century was £3,117,649,888 (NHS Litigation Authority 2012). The United Kingdom is not the only country to witness an astronomical increase in the level of litigation relating to maternity services. As far afield as Saudi Arabia (Henary et al 2012) and the United States (Berkowitz 2011), reports are being published of the demands on maternity budgets as a result of dissatisfaction with care received during pregnancy, labour and birth. The papers referenced above attribute adverse outcomes to negligence, misdiagnosis, surgical blunders and inefficient administration. Berkowitz(2011:7) suggests that what is needed is wholesale and whole-hearted adoption of ‘…electronic fetal monitoring [EFM] certification for all staff working on their Labor and Delivery floor, protocols for managing common clinical scenarios, simulation drills for dealing with uncommon dangerous events, and pre-procedure checklists’. The NHS Litigation Authority (2012:5) recommends that Trusts ‘…engage with the risk management process at all levels; provide suitable learning and training; ensure appropriate supervision and support; have in place up-to-date protocols and guidance with which staff are familiar; learn lessons from claims’. It is relatively easy to ensure that staff are sent on fetal heart rate (FHR) training days (although whether use of EFM produces better outcomes has, of course, never been clearly demonstrated (Alfirevic et al 2013) and that protocols for managing events during labour and birth are drawn up and even put into practice. It’s uncertain, however, whether doing so will make the problem of maternity litigation go away. There is something ‘rotten in the state of Denmark’ that is fuelling women’s dissatisfaction and which ‘the system’ has not been able to get its head round.

Determination of the Maximum Rate of Eccrine Sweat Glands’ Ion Reabsorption Using the Galvanic Skin Conductance to Local Sweat Rate Relationship

Purpose The purpose of the present study was to develop and describe a simple method to evaluate the rate of ion reabsorption of eccrine sweat glands in human using the measurement of galvanic skin conductance (GSC) and local sweating rate (SR). This purpose was investigated by comparing the SR threshold for increasing GSC with following two criteria of sweat ion reabsorption in earlier studies such as 1) the SR threshold for increasing sweat ion was at approximately 0.2 to 0.5 mg/cm2/min and 2) exercise-heat acclimation improved the sweat ion reabsorption ability and would increase the criteria 1. Methods Seven healthy non-heat-acclimated male subjects received passive heat treatment both before and after 7 days of cycling in hot conditions (50% maximum oxygen uptake, 60 min/day, ambient temperature 32°C, and 50% relative humidity). Results Subjects became partially heat-acclimated, as evidenced by the decreased end-exercise heart rate (p<0.01), rate of perceived exhaustion (p<0.01), and oesophageal temperature (p=0.07), without alterations in whole-body sweat loss, from the first to the last day of training. As hypothesised, we confirmed that the SR threshold for increasing GSC was near the predicted SR during passive heating before exercise heat acclimation, and increased significantly after training (0.19 ± 0.09 to 0.32 ± 0.10 mg/cm2/min, p<0.05). Conclusions The reproducibility of sweat ion reabsorption by the eccrine glands in the present study suggests that the relationship between GSC and SR can serve as a new index for assessing the maximum rate of sweat ion reabsorption of eccrine sweat glands in humans.