Protocol: The effect of restorative justice interventions for young people on offending and reoffending: A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows. The primary aim of this mixed methods review is to synthesise the available evidence regarding the effectiveness of restorative justice interventions (RJIs) for reducing offending and reoffending outcomes in children and young people. We are also particularly interested in the impact of RJIs on children and young peoples' violent offending and violent reoffending. A second aim of the review is to examine whether the magnitude of effectiveness of RJIs may be influenced by study characteristics such as the population (e.g., age, ethnicity, or sex), the form of intervention (e.g., face-to-face mediation compared to family group conferencing), the place of delivery of the intervention (e.g., in independent office, in court), implementation (e.g., trained facilitators, dose, fidelity) and methodology (e.g., randomised controlled trial). The third aim of the review is to synthesise the qualitative evidence about RJ to develop a better contextual understanding of how these programmes may work and to elucidate factors that might increase the efficacy and implementation of RJ interventions. The specific research questions this systematic review aims to address are: (1) Do RJ interventions reduce children and young people's involvement in offending or reoffending relative to a comparison group? [RQ1]. (2) Is there variation in the impact of different RJ approaches on young people's involvement in offending or reoffending? [RQ2]. (3) Is there variation in the impact of RJIs on children and young people's offending or reoffending depending on the characteristics of the participants taking part in the RJI (e.g., sex, age, ethnicity)? [RQ3]. (4) What characteristics of RJIs, influence the effectiveness of RJIs for children and young people's offending and reoffending? [RQ4]. (5) What are the most notable barriers and facilitators, as reported by participants (e.g., the victims, children/young people, or mediators who have taken part in an evaluation of an RJI, or those children or young people who were meant to take part in an evaluation but ultimately did not), to the implementation of RJIs to reduce later offending or reoffending? [RQ5].

Mediators of change in psychological interventions for adult offenders with personality disorders: A scoping review of the literature

Offenders with personality disorder cause disproportionate harm to society and pose significant challenges for those responsible for their care and rehabilitation. Personality disorders are heterogeneous in terms of symptoms, as well as their pathways to offending behaviour. Thus, there is limited evidence regarding effective interventions. One solution might be to focus on how interventions are delivered as well as what is delivered. Within the non-offender personality disorder literature, the identification of potential mediators of change has enabled interventions to focus on 'how' they are delivered (e.g., therapeutic alliance) rather than the intervention itself. We explore the evidence and present a scoping review of the available literature on the mechanisms of change in psychological treatments for offenders with personality disorder. Only one study was found in the scoping review, highlighting a significant gap in the evidence base. We discuss the implications of this finding and potential future directions.

PROTOCOL: School-based interventions for reducing disciplinary school exclusion: An updated systematic review

The primary goal of the present mixed methods review is to systematically examine the available evidence for the effectiveness of different types of school-based interventions for reducing disciplinary school exclusion. Quantitative evidence will help to understand the overall size of the impact, as well as the factors that better explain it. Qualitative evidence will help to better understand how these programmes may work, and what factors aid or hinder implementation and success. The research questions underlying the quantitative review are as follows: Do school-based programmes reduce the use of exclusionary sanctions in schools?Are some school-based approaches more effective than others in reducing exclusionary sanctions?Do participants' characteristics (e.g., age, sex, or ethnicity) affect the impact of school-based programmes on exclusionary sanctions in schools?Do characteristics of the interventions, implementation, and methodology affect the impact of school-based programmes on exclusionary sanctions in schools?Do school-based programmes have an impact on reducing the involvement of children and young people in crime and violence?Do participants' characteristics (e.g., age, gender, ethnicity) affect the impact of school-based programmes on crime and violence? If sufficient data are available, we will compare different approaches (e.g., school-wide management, classroom management, restorative justice, cognitive-behavioural interventions) and identify those that could potentially demonstrate larger effects. We will also (potentially) run analysis controlling for characteristics of participants (e.g., age, ethnicity, level of risk); interventions (e.g., theoretical bases, components); implementation (e.g., facilitators' training, doses, quality); and methodology (e.g., research design). The research questions underlying the qualitative review are defined as follows: What are the barriers and facilitators to implementation of interventions to reduce school exclusions?What are the barriers and facilitators to implementation of interventions to reduce the involvement of children and young people in crime and violence?

Psychometric properties of the Basic Empathy Scale in Polish children and adolescents

The Basic Empathy Scale is widely used to measure cognitive and affective empathy in different age groups. Although empathy is studied throughout the world, research on this important psychological construct in Eastern European populations needs to be increased. In order to accomplish this, validated instruments to measure empathy are needed in this geographic area. This study was conducted to analyze the psychometric properties of the Basic Empathy Scale in Poland. The sample included 1052 children and adolescents aged 9 to 16, enrolled in Primary and Middle schools. This was a cross-sectional study conducted with a survey that was filled in by the participants during their regular classroom hours. Confirmatory Factor Analyses were conducted, together with concurrent validity analyses and comparisons between younger and older participants, and between females and males were undertaken. A final 12-item version of the Basic Empathy Scale was obtained with affective empathy and cognitive empathy factors. The Polish version of the scale showed good psychometric properties. Females scored higher on affective, cognitive and total empathy than males. Younger male participants scored higher on affective, cognitive and total empathy than older male participants. This validated measure of empathy in Polish children and adolescents can be used to study the relation between empathy and both antisocial and prosocial behaviors. In addition, this measure will allow for Poland to be included in cross-country comparisons of empathy and also used to evaluate programs focused on enhancing empathy in Poland.

Suitability of a three-dimensional model to measure empathy and its relationship with social and normative adjustment in Spanish adolescents: a cross-sectional study

OBJECTIVES

(1) To examine the psychometric properties of the Basic Empathy Scale (BES) with Spanish adolescents, comparing a two and a three-dimensional structure;(2) To analyse the relationship between the three-dimensional empathy and social and normative adjustment in school.

DESIGN

Transversal and ex post facto retrospective study. Confirmatory factorial analysis, multifactorial invariance analysis and structural equations models were used.

PARTICIPANTS

747 students (51.3% girls) from Cordoba, Spain, aged 12-17 years (M=13.8; SD=1.21).

RESULTS

The original two-dimensional structure was confirmed (cognitive empathy, affective empathy), but a three-dimensional structure showed better psychometric properties, highlighting the good fit found in confirmatory factorial analysis and adequate internal consistent valued, measured with Cronbach's alpha and McDonald's omega. Composite reliability and average variance extracted showed better indices for a three-factor model. The research also showed evidence of measurement invariance across gender. All the factors of the final three-dimensional BES model were direct and significantly associated with social and normative adjustment, being most strongly related to cognitive empathy.

CONCLUSIONS

This research supports the advances in neuroscience, developmental psychology and psychopathology through a three-dimensional version of the BES, which represents an improvement in the original two-factorial model. The organisation of empathy in three factors benefits the understanding of social and normative adjustment in adolescents, in which emotional disengagement favours adjusted peer relationships. Psychoeducational interventions aimed at improving the quality of social life in schools should target these components of empathy.

Factors associated with progression in the London pathway project

BACKGROUND

The London Pathways Partnership (LPP) Community Service is an approach to mainstreaming the identification of offenders with severe personality disorder to address their needs and reduce their risk.

AIMS

To evaluate the result of the full-scale implementation of the LPP and evaluate factors associated with an offender's progression on the pathway.

METHOD

The data collected as part of the LPP project and Offender Assessment System data were used to evaluate who was screened into the pathway and their progression on the pathway.

RESULTS

Over 3,400 offenders were screened into the pathway in the first 48 months of implementation but fewer were recorded as having progressed. It was not possible to determine whether this attrition reflected appropriate pathway action, inefficient service provision or weak recording procedures. Certain types of offenders were represented at progressive stages of the pathway. Those who had violent or sexual offences, had received custodial sentences, had more personality disorder indicators and were of higher risk were more likely to be found at progressive stages of the pathway. When probation areas began implementing the service was also found to be related to pathway movement. Also, those of Non-White ethnicity were no less likely than those of White ethnicity to be recommended or referred for services but were significantly less likely to start services.

CONCLUSIONS

The LPP attempts to balance breadth (covering all offenders being convicted in London) with depth (developing a feasible pathway for all offenders identified with severe personality disorder) and has done so with some success.

IMPLICATIONS

Future research should examine the continued rollout of the LPP service, and importantly the relationship between salient individual, risk and personality features, pathway inputs and measures of later reoffending. Copyright © 2017 John Wiley & Sons, Ltd.

Evaluating the impact of the London Pathway Project

BACKGROUND

The London Pathway Project (LPP) is an innovative whole-systems approach to addressing the needs of offenders who have severe personality disorder, with the goal of reducing their risk of harm. Previous research has evaluated the initial implementation of the LPP.

AIMS

This paper focused on evaluating the impact of the LPP on a number of criminogenic needs over time and its impact on the risk of reoffending and harm compared with a similar group who did not experience the pathway.

METHOD

Data for men who had been identified for the LPP were used to explore changes in key criminogenic needs an average of 11 months after commencing on the pathway. In addition, Offender Assessment System data was used to match men who had experienced the LPP for at least 12 months to a comparison group on key demographic and criminal history variables. Changes in validated risk assessment devices and changes in practitioners' perception of risk were examined.

RESULTS

The LPP was associated with desirable within-individual change for most of the criminogenic needs explored. However, strong non-desirable changes in lifestyle and associates were also identified, but this was particularly the case for those sentenced to prison. When compared with a matched group, those identified for the pathway showed a significant reduction on an objective measure of risk of reoffending but were rated as having significantly increased risk of harm on the basis of practitioner's perceptions. There was no evidence that greater progression along the pathway was associated with greater benefits.

CONCLUSIONS

This is the first impact evaluation of the LPP, and the results were generally positive in terms of its relation to criminogenic needs and risks. Much more research that clearly links project inputs to actual behavioural outcomes, such as later reoffending, is needed.

IMPLICATIONS

This initial evaluation of the impact of the LPP could be used as baseline data to examine the impact of the pathway over time, and with greater precision (e.g. matching on personality features). Copyright © 2017 John Wiley & Sons, Ltd.

Systematic review of early risk factors for life-course-persistent, adolescence-limited, and late-onset offenders in prospective longitudinal studies

This paper builds on our previous systematic review of prospective longitudinal studies and examines the early risk factors associated with life-course persistent offending (LCP), adolescence-limited (AL) and late-onset (LO) offending. Out of the 55 prospective longitudinal studies which theoretically could possess the relevant information, only four provided information about risk factors associated with the different offending types. An additional three provided data so that relevant analyses could be conducted. The results suggested that there was little evidence that specific early risk factors were associated with specific offending types. There was also limited evidence that specific risk factors predicted specific offending types when criminal career duration was included in the definitions of LCP, AL, and LO offending. However, LCP offenders tended to have a greater number of risk factors, and the magnitude of these was somewhat greater than for AL offenders, who in turn tended to have more risk factors (and of a greater magnitude) than LO offenders. LCP and AL offenders may differ more in degree (in the number and magnitude of risk factors) than in kind (in the specific risk factors that are predictive). Importantly, as the potential criminal career duration was increased in defining the offending types, those with longer careers tended to have more risk factors, but, LCP and AL offenders were not predicted by different risk factors. Much more research is needed on risk factors for offending types defined according to criminal career durations.

Characteristics of Empathy in young people measured by the Spanish validation of the Basic Empathy Scale

BACKGROUND

Empathy is a personality feature that can play a major role in predicting the emotional and social functioning of adolescents (Jolliffe & Farrington, 2006). Recent research confirms the existence of two fundamental dimensions embedded within this construct, Affective Empathy (experiencing a congruent emotional response with another person) and Cognitive Empathy (understanding rationally the emotions of another person). The Basic Empathy Scale (Jolliffe & Farrington, 2006) is an up-to-date instrument which has been reported to satisfactorily measure these two dimensions.

METHOD

We used a sample of 752 adolescents (339 males, 413 females) aged 14-25 who completed the Spanish adaptation of BES.

RESULTS

Confirmatory factor analysis showed that the Spanish adaptation of the scale had the same bi-factorial structure as the original (CFI = .93). This adaptation also showed both satisfactory reliability (Cronbach’s alpha coefficient > .92) and discriminant and convergent validity with regard to measurements of Narcissism, Psychoticism and Agreeableness. Females were found to have higher scores than males both in Affective and Cognitive Empathy. Both subscales show a direct significant correlation with age.

CONCLUSIONS

The evidence suggested that this revised scale possessed good psychometric properties for evaluating empathy in Spanish young people.

Holistic Facial Composite Creation and Subsequent Video Line-up Eyewitness Identification Paradigm

The paradigm detailed in this manuscript describes an applied experimental method based on real police investigations during which an eyewitness or victim to a crime may create from memory a holistic facial composite of the culprit with the assistance of a police operator. The aim is that the composite is recognized by someone who believes that they know the culprit. For this paradigm, participants view a culprit actor on video and following a delay, participant-witnesses construct a holistic system facial composite. Controls do not construct a composite. From a series of arrays of computer-generated, but realistic faces, the holistic system construction method primarily requires participant-witnesses to select the facial images most closely meeting their memory of the culprit. Variation between faces in successive arrays is reduced until ideally the final image possesses a close likeness to the culprit. Participant-witness directed tools can also alter facial features, configurations between features and holistic properties (e.g., age, distinctiveness, skin tone), all within a whole face context. The procedure is designed to closely match the holistic manner by which humans' process faces. On completion, based on their memory of the culprit, ratings of composite-culprit similarity are collected from the participant-witnesses. Similar ratings are collected from culprit-acquaintance assessors, as a marker of composite recognition likelihood. Following a further delay, all participants--including the controls--attempt to identify the culprit in either a culprit-present or culprit-absent video line-up, to replicate circumstances in which the police have located the correct culprit, or an innocent suspect. Data of control and participant-witness line-up outcomes are presented, demonstrating the positive influence of holistic composite construction on identification accuracy. Correlational analyses are conducted to measure the relationship between assessor and participant-witness composite-culprit similarity ratings, delay, identification accuracy, and confidence to examine which factors influence video line-up outcomes.

Assessing children's empathy through a Spanish adaptation of the Basic Empathy Scale: parent's and child's report forms

The aim of the current research was to study cognitive and affective empathy in children aged 6-12 years old, and their associations with children's family environment and social adjustment. For this purpose, we developed the Spanish version of the Basic Empathy Scale (BES), self- and parent-report forms. Factorial analyses confirmed a two-component model of empathy in both self- and parent-report forms. Concordance between parent-child measures of empathy was low for cognitive and affective factors. Analyses of variance on the cognitive and affective components brought a significant effect of age for self-reported cognitive empathy, with older children scoring higher than younger ones. Gender brought out a significant principal effect for self-reported affective empathy, with girls scoring higher than boys. No other main effects were found for age and gender for the rest of the factors analyzed. Children's empathy was associated with socioeconomic status and other family socialization processes, as well as children' social behaviors. Overall the new measures provided a coherent view of empathy in middle childhood and early adolescence when measured through self and parent reports, and illustrate the similarity of the validity of the BES in a European-Spanish culture.

Testing the Cambridge quality checklists on a review of disrupted families and crime

BACKGROUND

Systematic reviews of the relationship between non-manipulated factors (e.g. low empathy) and offending are becoming more common, and it is important to consider the methodological quality of studies included in such reviews.

AIMS

To assess aspects of the reliability and validity of the Cambridge Quality Checklists, a set of three measures for examining the methodological quality of studies included in systematic reviews of risk factors for offending.

METHODS

All 60 studies in a systematic review of disrupted families and offending were coded on the CQC and codes compared with the effect sizes derived from the studies.

RESULTS

Overall, the CQC was easy to score, and the relevant information was available in most studies. The scales had high inter-rater reliability. Only 13 studies scored high on the Checklist of Correlates, 18 scored highly on the Checklist of Risk Factors and none scored highly on the Checklist of Causal Risk Factors. Generally, studies that were of lower quality had higher effect sizes.

CONCLUSIONS

The CQC could be a useful method of assessing the methodological quality of studies of risk factors for offending but might benefit from additional conceptual work, changes to the wording of some scales and additional levels for scoring.

Is low empathy related to bullying after controlling for individual and social background variables?

This paper examines the relationship between low empathy and bullying while also controlling for the impact of a number of other individual and social background variables linked with bullying. This included the relationship to the prevalence of bullying, but also to the frequency and type of bullying. Questionnaires were completed by 720 adolescents (344 females, 376 males) aged 13-17 in three secondary schools in England. The results suggested that low affective empathy was independently related to bullying by males, but not females. There was no evidence that low cognitive empathy was independently related to bullying, but high impulsivity was related to all forms of male bullying and to female bullying. The implications of the findings for research and practice are discussed.

Development and validation of the Basic Empathy Scale

In developing the Basic Empathy Scale (BES), 40 items measuring affective and cognitive empathy were administered to 363 adolescents in Year 10 (aged about 15). Factor analysis reduced this to a 20-item scale that was administered 1 year later to 357 different adolescents in Year 10 in the same schools. Confirmatory factor analysis verified the two-factor solution. Females scored higher than males on both affective and cognitive empathy. Empathy was positively correlated with intelligence (for females only), extraversion (cognitive empathy only) neuroticism (affective empathy only), agreeableness, conscientiousness (for males only), and openness. Empathy was positively related to parental supervision and socioeconomic status. Adolescents who would help victims of bullying had high empathy.

A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet® /Daivobet® /Taclonex® ) in the treatment of psoriasis vulgaris

BACKGROUND

The calcipotriol/betamethasone dipropionate two-compound product Dovobet/Daivobet/Taclonex(LEO Pharma A/S, Ballerup, Denmark) has been shown to be safe and effective in the treatment of psoriasis for up to 8 weeks. As psoriasis is a chronic disease, long-term treatment may be required, so there is a need to investigate the safety of its use over a longer period of time.

OBJECTIVES

To investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks in the treatment of patients with psoriasis.

METHODS

Patients (n = 634) were randomized double-blind to treatment with: (i) 52 weeks of the two-compound product (two-compound group); (ii) 52 weeks of alternating 4-week periods of the two-compound product and calcipotriol (alternating group); or (iii) 4 weeks of the two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Treatments in all groups were used once daily when required.

RESULTS

Adverse drug reactions (ADRs) occurred in 45 (21.7%) patients in the two-compound group, 63 (29.6%) in the alternating group and 78 (37.9%) in the calcipotriol group. The odds ratio for an ADR in the two-compound group relative to the calcipotriol group was 0.46 (95% confidence interval 0.30-0.70; P < 0.001). ADRs of concern associated with long-term topical corticosteroid use occurred in 10 (4.8%) patients in the two-compound group, six (2.8%) in the alternating group and six (2.9%) in the calcipotriol group; those with the highest incidence were skin atrophy, occurring in four (1.9%), one (0.5%) and two (1.0%) patients, respectively, and folliculitis, in three (1.4%), one (0.5%) and no patients, respectively.

CONCLUSIONS

Treatment with the two-compound product for up to 52 weeks appears to be safe and well tolerated whether used on its own or alternating every 4 weeks with calcipotriol treatment.

Extent of overweight among US children and adolescents from 1971 to 2000

CONTEXT

The prevalence of overweight (OW) among children in the United States has increased during the last three decades, but prevalence measures fail to reveal the extent to which OW children exceed the OW threshold.

OBJECTIVE

To measure the amount by which OW children exceed the OW threshold. To examine the trend in this measure over the last three decades using data with measured weights and heights.

DESIGN, SETTING AND PARTICIPANTS

Data used for analysis are from the National Health and Nutrition Examination Survey (NHANES) for persons between 2 and 19 y of age from 1971 to 2000. Anthropometric measures were obtained by trained health technicians, and the sample sizes range from 4037 in 1999-2000 to 10,590 in 1988-1994.

MAIN OUTCOME MEASURE

The extent of OW is measured as the average amount by which each child's body mass index (BMI) exceeds their age and gender-specific OW threshold. This measure is examined by sex, age group and race/ethnicity. The OW threshold for those aged 2-19 y is defined as at or above the 95th percentile of the sex-specific BMI for age growth charts.

RESULTS

The extent of child OW has been increasing faster than the prevalence of child OW for all classifications considered in this paper, including the analysis by age, sex, race and ethnicity. The prevalence of OW for children aged 2-19 y increased by 182% between 1971-1974 and 1999-2000, while the extent of OW increased by 247% over the same time period.

CONCLUSIONS

Unlike prevalence measures, the measure of the extent of child OW is sensitive to changes in the BMI distribution of the overweight. This analysis reveals that not only have more children become OW in the last three decades, but OW children have been getting heavier.

Predictive, concurrent, prospective and retrospective validity of self-reported delinquency

BACKGROUND

The self-report method is widely used to measure offending. Previous studies suggest that it is generally valid, but that its validity may be lower for blacks than for whites. AIM To assess the validity of self-reported offending in relation to court referrals, and to investigate how it varies with types of offences, sex and race.

METHOD

Annual court and self-report data were collected between ages 11 and 17 for eight offences in the Seattle Social Development Project, which is a prospective longitudinal survey of 808 youths.

RESULTS

Self-reports predicted future court referrals. Predictive validity was highest for drug offences, for males and for whites, and lowest for females and Asians. The probability of youths with a court referral reporting offences and arrests was highest for drug offences, for males, for whites and for blacks. Retrospective ages of onset agreed best with prospective ages for drug offences, Asians and whites. More Asians than blacks or whites failed retrospectively to report offences that had been reported prospectively.

CONCLUSIONS

The validity of self-reports of offending was high, especially for drug offences, for males and for whites. Contrary to prior research, validity was high for black males. It was lowest for Asian females. Sex and race differences in validity held up after controlling for socioeconomic status. Differential validity probability did not reflect police bias.

The concentration of offenders in families, and family criminality in the prediction of boys' delinquency

The main aims of this study were to investigate inter-relationships among offending by three generations of relatives (fathers, mothers, sons, daughters, uncles, aunts, grandfathers and grandmothers) and the concentration of offending in families. This study also investigates how far criminal relatives predict a boy's delinquency. The parents of 1395 Pittsburgh boys aged 8, 11 or 14 reported arrests by all relatives. Parent reports of boys' arrests predicted their later referrals to juvenile court, demonstrating predictive validity. Offenders were highly concentrated in families; if one relative had been arrested, there was a high likelihood that another relative had also been arrested. Arrests of relatives were compared with arrests of the boy, court petitions of the boy, and the boy's reported delinquency (according to the parent, boy and teacher). Arrests of brothers, sisters, fathers, mothers, uncles, aunts, grandfathers and grandmothers all predicted the boy's delinquency. The most important relative was the father; arrests of the father predicted the boy's delinquency independently of all other arrested relatives. Studies of explanatory variables suggested that having a young mother, living in a bad neighbourhood, and low guilt of the boy may be links in the causal chain between arrested fathers and delinquent boys.

The spouse as a kidney donor: ethically sound?

A shortage of cadaver donor organs requires transplant units to examine all possible alternatives. Transplantation from living donors accounts for only approximately 10% of kidney transplants in the UK. Recent studies have shown that the results of kidney transplantation between spouses are at least as good as those of well-matched cadaver organs, but very few transplants of this type have been performed in this country so far. As part of the assessment process, the proposed donor and recipient are required to provide written statements about the issues. We reproduce here the personal statements made by one of our patients and his wife: we believe that the statements support our contention that spousal transplantation is ethically justifiable and should be more widely available. We report our early experience in Bristol with seven kidney transplants from spousal donors and we encourage other renal units in this country and elsewhere to consider this method of improving the prospects of kidney transplantation for their patients.

Comparison of remifentanil in combination with isoflurane or propofol for short-stay surgical procedures

There are few data in the literature that describe the use of remifentanil when administered as a component of an inhalation or total i.v. anaesthetic (TIVA) technique. We studied 251 male and female patients, aged 18-75 years, ASA I-II, undergoing inguinal hernia repair, arthroscopic knee surgery or varicose vein surgery of at least 30 min duration without premedication. Patients were randomized to receive a remifentanil loading dose of 1.0 microgram kg-1 followed by a continuous infusion of 0.5 microgram kg-1 min-1 in combination with isoflurane (end-tidal concentration 0.6%), (Group I, n = 115) or propofol (initial infusion rate 9 mg kg-1 h-1 reduced to 6 mg kg-1 h-1 after 10 min), (Group P, n = 118). The remifentanil infusion rate was reduced by 50%, 5 min after tracheal intubation. Intraoperative stresses were treated with a remifentanil bolus (1 microgram kg-1) followed by an increase in the remifentanil infusion rate. At the insertion of the last suture, the remifentanil infusion and concomitant anaesthetic were switched off simultaneously. Times to spontaneous respiration, adequate respiration and tracheal extubation were significantly shorter in group I compared with group P (6.4 min vs 7.6 min, P < 0.01; 7.6 min vs 9.3, P < 0.003; 7.8 min vs 9.5 min, P < 0.015). Overall mean systolic blood pressures during surgery were greater in group P compared with group I (P < 0.05) but the absolute differences were clinically insignificant (4-5 mm Hg).

Cardiac effects of sodium stibogluconate

Sodium stibogluconate although potentially cardiotoxic is the drug of choice for Kalaazar and cutaneous leishmaniasis due to Leishmania braziliensis. Increasing use of this drug in the British Army has necessitated a formal evaluation of its cardiac side-effects. Consequently a detailed study of the cardiac effects of sodium stibogluconate was undertaken in 22 male soldiers using for the first time modern non-invasive techniques. Intravenous sodium stibogluconate 600 mg daily for 10 days did not affect blood pressure, heart rate, left ventricular contractile function or rhythm. Electrocardiography showed a reversible reduction of T wave amplitude.