Classics in ECT- Pippard's Audit of ECT in England in1992

"Classics in ECT" brings you this paper from the British Journal of Psychiatry in 1992:

Audit of electroconvulsive treatment in two national health service regions.

Pippard J.Br J Psychiatry. 1992 May;160:621-37. doi: 10.1192/bjp.160.5.621.PMID: 1591572
The abstract is copied below:
The practice of ECT has been surveyed by visits to all 35 NHS hospitals and five private clinics where it is used in the North East Thames and East Anglian Regions, and observation of ECT administration in 29 NHS and two private clinics. Since 1981 there has been much improvement in the physical conditions in which ECT is given and in anaesthetic practice. Nursing is good or excellent in a majority. About half the clinics have the most effective Ectron constant-current series 5 apparatus; the rest have older models with which 'missed' fits and undertreatment are frequent. Stimulus-dosing is usually by habit rather than rational strategy, and routine instrument settings differ fourfold between clinics. Most hospitals have nominated consultants in charge of ECT, but few of these are closely involved and little has changed in the unsatisfactory training and supervision of those who give the treatment. The use of ECT has fallen by 55% in North East Thames Region since 1979, but has risen by 20% in the East Anglian Region. There are up to 12-fold differences in usage between districts.

The pdf is here.

This classic paper is an intermediate report on the state of affairs of ECT in Great Britain, between the scathing 1980 audit (Lancet, 1981) and the modern quality control of ECTAS and SEAN.
Dr. Pippard found much improved, but much still lacking in the early 1990s. He is highly laudatory of American efforts to improve ECT standards of the time, and fully endorses the concept of stimulus dose titration and the theory of dose-over-seizure -threshold as determinant of seizure efficacy.
He thanks Drs. Fink, Sackeim and Weiner for their assistance in his audit endeavors.
Dr. Pippard died in 2012 (please see obituary here.)

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