The Academy of Medical Royal College's report Quality improvement-training for better outcomes sets a path for the normalisation of quality improvement as part of all health professionals' jobs. This accompanies similar calls to action by the King's Fund and the Faculty of Medical Leadership and Management and is aligned with NHS Improvement and Health Education England future strategies. These exhortations to action come on the backdrop of increased fi scal constraints within the NHS, low morale, a burgeoning volume of research evidence and audit outputs and increasing complexity of how we deliver care in a bewildering NHS landscape. Asking the question 'how can we do something better?' or 'do we really need to do this?', and building our resilience and capability to respond effectively gives us new purpose, the right skills and a means to infl uence and make a difference to the safety, effectiveness and experience of patient care. Most importantly, we do this through harnessing the talents of multiprofessional teams-with meaningful patient involvement-to rediscover the joy and optimism in our work and what truly motivates us and to see this translated into improved sustainable outcomes for our patients and our working days.

Objectives: Notoriety bias is defined as "a selection bias in which a case has a greater chance of being reported if the subject is exposed to the studied factor known to cause, thought to cause, or likely to cause the event of interest". This study aimed to determine the existence of notoriety bias in FDA Adverse Event Reporting System (FAERS) database and estimate its impact on signal strength. Methods: Publicly available FAERS data was used for analysis. 31 drugs which had label change/safety alert issued by FDA were considered. These drugs were reviewed four quadrants before and after the safety alert for number of reports, Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR). Wilcoxon signed rank test was used to compare the number of reports and signal strength before and after the alert. Results: There was increased reporting for 11 drugs after the safety alert/label change by FDA. The reporting of 20 drugs decreased or remained unchanged after the safety alert/label change by FDA. Wilcoxon signed rank test showed that there is no statistically significant difference with respect to the number of reports before and after the safety alert (p: 0.330, Z: -0.974). 14 (45.16%) drugs had increase in ROR, while 17 (54.83%) drugs had decrease in ROR after safety alert issued by FDA (p: 0.953, Z: -0.059). 14 (45.16%) drugs had increase in PRR, while 17 (54.83%) drugs had decrease in PRR after safety alert (p: 0.914, Z: -0.108). Conclusions: Although few FDA safety alert/ warnings had strong and immediate impact, many had no impact on reporting of AE and signal strength. This study found that over reporting due to notoriety bias does not exist in the FAERS database and the overall disproportionality in signal estimates is not altered by safety alert.

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The 2014 Varsity Medical Ethics debate convened upon the motion: “This house believes that genetic information should not be commoditised”. This annual debate between students from the Universities of Oxford and Cambridge, now in its sixth year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the circumstances under which genetic material should be considered patentable, the possible effects of this on the research and development of novel therapeutics, and the need for clear guidelines within this rapidly developing field.The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. Two Oxford medical students, Mahiben Maruthappu and Sanjay Budheo founded the event. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate