Pippard J
Research Unit, Royal College of Psychiatrists.
Br J Psychiatry. 1992 May;160:621-37. doi: 10.1192/bjp.160.5.621.
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.
通过走访泰晤士河东北部和东安格利亚地区使用ECT的所有35家国民保健服务医院及5家私人诊所，并观察29家国民保健服务医院和2家私人诊所的ECT施用情况，对ECT的使用情况进行了调查。自1981年以来，ECT施用时的物理条件和麻醉操作有了很大改善。大多数情况下护理良好或出色。约半数诊所配备了最有效的Ectron恒流5系列仪器；其余诊所使用的是旧型号，经常出现“错过”合适剂量和治疗不足的情况。刺激剂量通常是凭习惯而非合理策略确定，各诊所的常规仪器设置相差四倍。大多数医院都指定了负责ECT的顾问，但其中很少有人密切参与，对实施治疗人员的培训和监督仍不尽人意，几乎没有什么变化。自1979年以来，泰晤士河东北部地区ECT的使用量下降了55%，但东安格利亚地区则上升了20%。不同地区的使用量相差高达12倍。
