London Department Research Articles

Reported recreational drug and new psychoactive substance use versus laboratory detection of substances by high-resolution mass spectrometry in patients presenting to an emergency department in London with acute drug toxicity

Introduction Clinicians managing patients with acute recreational drug or new psychoactive substance toxicity typically depend on self-reported drug(s) used. This study compares patient self-report (and/or from other sources) to the substance(s) that were subsequently identified in serum. Methods A prospective sample of 1,000 adults presenting to a tertiary care, urban emergency department in London, United Kingdom, with acute recreational drug/new psychoactive substance toxicity was collected from 1 February 2019 to 2 February 2020. A total of 939 appropriate samples underwent qualitative analysis by high-resolution mass spectrometry with comparison to a database of drugs/metabolites. Data on the stated drug(s) used were extracted from the routine medical chart/records; results were batched by drug class, when appropriate, and analysis was performed using R software. Results Seven hundred and ninety-nine (85.1%) patients were male with a median (IQR) age of 34 years (27 to 42 years). Six hundred and thirty-five (67.6%) patients reported using two or more drugs. The median (IQR) positive predictive value of a self-report substance having been taken was 0.68 (IQR: 0.44–0.86); conversely, the median negative predictive value of a substance having not been taken was 0.90 (IQR: 0.53–0.95). There was variability in the accuracy of reporting. For example, self-reported opioid use had a 90.5% likelihood that opioids were detected on analysis, whereas hallucinogens were only detected in 18.8% of samples when use was reported. Individuals were also mostly accurate in not underreporting substances. For example, those not explicitly reporting gamma-hydroxybutyrate use were 97.5% truly negative. Discussion Overall, most users were relatively accurate in their self-report of what class of drugs they had used, although there was variability in this accuracy. However, other drugs were present even when not reported, for example, opioids with disproportionate detection of prescription and over-the-counter (non-prescription) opioids that were unreported. Conclusions Self-report (and/or collateral reports) had overall relatively high concordance with the likelihood that a substance was, or was not, recently used. Therefore, clinicians can make initial treatment decisions based on the self-reported drug(s) used in most cases.

A machine learning system to optimise triage in an adult ophthalmic emergency department: a model development and validation study

A substantial proportion of attendances to ophthalmic emergency departments are for non-urgent presentations. We developed and evaluated a machine learning system (DemDx Ophthalmology Triage System: DOTS) to optimise triage, with the aim of reducing inappropriate emergency attendances and streamlining case referral when necessary. DOTS was built using retrospective tabular data from 11,315 attendances between July 1st, 2021, to June 15th, 2022at Moorfields Eye Hospital Emergency Department (MEH) in London, UK. Demographic and clinical features were used as inputs and a triage recommendation was given ("see immediately", "see within a week", or "see electively"). DOTS was validated temporally and compared with triage nurses' performance (1269 attendances at MEH) and validated externally (761 attendances at the Federal University of Minas Gerais - UFMG, Brazil). It was also tested for biases and robustness to variations in disease incidences. All attendances from patients aged at least 18 years with at least one confirmed diagnosis were included in the study. For identifying ophthalmic emergency attendances, on temporal validation, DOTS had a sensitivity of 94.5% [95% CI 92.3-96.1] and a specificity of 42.4% [38.8-46.1]. For comparison within the same dataset, triage nurses had a sensitivity of 96.4% [94.5-97.7] and a specificity of 25.1% [22.0-28.5]. On external validation at UFMG, DOTS had a sensitivity of 95.2% [92.5-97.0] and a specificity of 32.2% [27.4-37.0]. In simulated scenarios with varying disease incidences, the sensitivity was ≥92.2% and the specificity was ≥36.8%. No differences in sensitivity were found in subgroups of index of multiple deprivation, but the specificity was higher for Q2 when compared to Q4 (Q4 is less deprived than Q2). At MEH, DOTS had similar sensitivity to triage nurses in determining attendance priority; however, with a specificity of 17.3% higher, DOTS resulted in lower rates of patients triaged to be seen immediately at emergency. DOTS showed consistent performance in temporal and external validation, in social-demographic subgroups and was robust to varying relative disease incidences. Further trials are necessary to validate these findings. This system will be prospectively evaluated, considering human-computer interaction, in a clinical trial. The Artificial Intelligence in Health and Care Award (AI_AWARD01671) of the NHS AI Lab under National Institute for Health and Care Research (NIHR) and the Accelerated Access Collaborative (AAC).

1009 Improving Accuracy and Extractability of Electronic Operative Documentation Data in a Hand Trauma Unit

Abstract Aim Accurate and thorough operative documentation is essential for continuity of patient care, audit purposes, and the medicolegal protection of patients and doctors. In a hand trauma department in central London, challenges to this include a fast turnover of junior doctors, busy trauma lists, and complex, multidisciplinary cases. ‘Pathpoint’ is an online system with functionality for operative note templates and pre-filled data. However, it is unclear how much this is utilised in the department. This project aimed to evaluate operative documentation for hand trauma and the utilisation of templates for data input. Method All hand trauma cases performed in a one-month period were requested from Pathpoint. Operation notes were initially screened for directly extractable data in template-form then manually checked for free-text data entry using prior-agreed criteria. Results The initial search yielded 51 procedures. Nerve repairs were best documented (18% data missing), terminalisation procedures were worst documented (38% data missing). Overall, only 18.3% of all data were directly extractable; 0% data were extractable for dressings, post-operative antibiotics, follow-up and movement restrictions. Best documented topics were hand trauma findings, skin closure, and follow-up. >90% of data in each of these were freetext. Worst documented topics were CEPOD category, ASA grade, intra-operative antibiotics, and tourniquet details. Conclusions Despite overall good documentation, multiple important omissions are noted. Furthermore, the majority of data is not recorded in an extractable format. Templates have been distributed within the department. Re-auditing in subsequent months will assess whether accuracy of documentation and ease of data extraction have improved.

The Evolution of the Sustainable, Intelligent City

Abstract Grant Powell MBCS spoke to Professor Julie McGann, Head of the Adaptive Emergent Systems Engineering (AESE) group at the Imperial College London's Department of Computing to discuss how data-driven insights can help to develop greener, cleaner cities.

Administering Disseminations: Film Exhibition and Censorship During the Great War in India

ABSTRACT This article explores the debates on film exhibition and censorship during the war years in India. The First World War (1914–18) was a watershed moment for the rapidly burgeoning cinema exhibition business in India. During the war, the government of India was caught by surprise at the pace with which the business had spread in the country. When the need for cinema propaganda arose in India, the government began to assess the nature of commercial networks the cinema exhibition companies had been able to build. Throughout the war years, the Government of India debated ways of intervening in the cinema business either by competing with the monopolistic cinema companies or by introducing censorship laws to control exhibition spaces and content. At the behest of the war propaganda department in London, the government of India found itself playing a reluctant arbitrator in a bitter competition between two influential cinema companies – Madan and Bandman – for the exhibition of Britain Prepared. This article further draws attention to the continuities between pre-war censorship debates and the war-year debates that led to the enactment of the first Cinematograph Act (1918) in India. By exploring the pre-war censorship debate about the exhibition of Johnson-Jeffries film, this article reviews a commonly held assumption in Indian film history that film censorship began in the country during the war years.

Screening for Chronic Infectious Diseases by Serology in Those Presenting with Malaria in London, United Kingdom.

The United Kingdom's cases of malaria infection are primarily acquired in sub-Saharan Africa, with the majority of infections presenting in London.1 When patients go to a hospital with malaria, there is a screening opportunity for other geographically associated chronic infections. We identified patients who were diagnosed with malaria after presenting to our emergency department in London over a 2-year period, to assess whether there may be clinical benefit in screening for chronic viral (hepatitis B, hepatitis C, HIV) or parasitic (schistosomiasis, strongyloidiasis) infection in this cohort. Over this period, 131 patients were diagnosed with malaria. Crude seropositivity rates for HIV, hepatitis B, and strongyloidiasis were higher than expected compared with local population estimates, 7 and 28 times higher for HIV and hepatitis B, respectively. Those patients with previously unidentified cases were offered appropriate treatment. These findings support the potential clinical and public health benefits of screening for other infectious diseases in the context of a malaria diagnosis.

Development and evaluation of an electronic medical device training passport to identify nurses' training needs.

All nurses, particularly those working in critical care settings, are required to use medical devices when providing patient care. However, inconsistent practice and variations in documentation can make it challenging for nurses and nurse managers to identify what medical device training is required and when. To develop and evaluate the use of an electronic medical device training passport to identify the training needs of nurses in intensive care units (ICUs). A pilot study was conducted in a multi-unit critical care department in London, England, to determine if the passport could make it easier to identify ICU nurses' medical device training needs compared with existing practice. Nine participants were first asked to identify their needs using existing spreadsheets or paper records, then asked to identify them using the passport. The participants were also interviewed to identify their training requirements before and after using the passport. The data were analysed quantitatively and qualitatively. The electronic passport significantly improved identification of medical device training needs compared with paperwork or spreadsheets for all device groups, except for medical devices used on high dependency units ( P ≤0.005). However, there may be issues related to nurses' behaviours and expectations, particularly that staff do not always recognise their need for training. The findings of this pilot study suggest that the use of an electronic medical device training passport has many benefits and could make it easier to identify ICU nurses' training needs in clinical practice.

Safety of "hot" and "cold" site admissions within a high-volume urology department in the United Kingdom at the peak of the COVID-19 pandemic.

ObjectivesTo determine the safety of urological admissions and procedures during the height of the COVID‐19 pandemic using “hot” and “cold” sites. The secondary objective is to determine risk factors of contracting COVID‐19 within our cohort.Patients and methodsA retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high‐volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a “cold” site requiring a negative COVID‐19 swab 72‐hours prior to admission and patients were required to self‐isolate for 14‐days preoperatively, while all acute admissions were admitted to the “hot” site.Complications related to COVID‐19 were presented as percentages. Risk factors for developing COVID‐19 infection were determined using multivariate logistic regression analysis.ResultsA total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44‐70) were admitted under the urology team; 101 (16.5%) on the “cold” site and 510 (83.5%) on the “hot” site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID‐19 postoperatively with one (0.2%) postoperative mortality due to COVID‐19. Overall, COVID‐19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID‐19 in our cohort (OR 1.25, 95% CI 1.13‐1.39).ConclusionsContinuation of urological procedures using “hot” and “cold” sites throughout the COVID‐19 pandemic was safe practice, although the risk of COVID‐19 remained and is underlined by a postoperative mortality.

Patient consent in emergency cardiovascular medicine: lessons from the ARREST trial in out-of-hospital cardiac arrest

Abstract Introduction Randomised trials in emergency cardiovascular medicine are challenging but vital for improving patient care. Obtaining informed consent in such an environment is a particular issue and can be controversial. The ARREST trial is assessing whether out-of-hospital cardiac arrest patients without an obvious cause should be taken to a specialist heart centre or the closest emergency department in London, UK. This patient group presents specific difficulties: patients lack capacity to consent, presentation is unpredictable, care must not be delayed, and mortality rates can be >50%. Purpose Within existing consent and methodological frameworks we aimed to design a randomised clinical trial to pragmatically, safely and ethically recruit cardiac arrest patients pre-hospital. Methods During the set-up of ARREST we accessed the following sources of information: 1) ARREST research team; 2) cardiovascular patient groups; 3) researchers running similar trials; 4) regulatory bodies; and, 5) published literature on research in emergency contexts. The information that we collected guided the design of the trial with a focus on patient consent, documentation and follow-up. Results The ARREST trial uses deferred consent with remote online randomisation to enrol patients without delaying care. To minimise the risk of bias, baseline and primary endpoint data are collected on patients who die or are discharged prior to consent. Remote follow-up using electronic health records reduces the burden on the patients and researchers. Full ethical approval was received in January 2018 and the first patient was enrolled in February 2018. ARREST is recruiting to target and is on track to finish within the projected timelines. Conclusions Deferred consent has been key to the success of ARREST and patients have been receptive. However, further research into the experience of patients in emergency cardiovascular medicine trials using deferred consent is needed to better understand when it is an appropriate model. More broadly, there is a shortfall in high quality research in challenging environments such as emergency cardiovascular care. Innovation in consent methods and proportional research governance would facilitate higher quality research and benefit patient care. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Barriers to university-industry collaboration in an academic university department in London, United Kingdom

PurposeUniversity-industry collaboration yields numerous advantages resulting in potential benefits in funding research and innovation. Despite the numerous benefits, there are various perceived disadvantages of such collaboration especially in the field of child and adolescent psychiatry in prominent academic institutes in London, UK. The purpose of this study is to explore the perceptions, opinions, beliefs and attitudes of the academics and clinicians in an academic university department towards industry collaboration.Design/methodology/approachTwo methods were applied, quantitative and qualitative. The quantitative method used an online questionnaire of four-point Likert-Scale, the link of which was emailed to 80 members of the department with a response rate of 32%. The qualitative method included a one-to-one interview with eight researchers from the department to garner in-depth information on the attitude of researchers in child and adolescent psychiatry towards industry collaboration.FindingsThe online questionnaire was completed by 26 researchers, the vast majority perceived industry as biased to favour their product and as having a bad or mixed reputation. One-on-one interviews with eight prominent researchers allowed us to share their perception and attitude towards industry collaboration, although the researchers believe that availability of funding was the major advantage of working in collaboration with industry, many did not know how to access such grants and some raised concerns about industry’s record of presenting partial results.Research limitations/implicationsBecause of the chosen research approach, the research results may lack generalisability. Therefore, researchers are encouraged to test the proposed propositions further.Practical implicationsThis paper will shed light on how prominent researchers perceive collaboration with industry.Originality/valueAlthough researchers are very reluctant to collaborate with industry because of its public opinion and sometimes unethical and lack of integrity among the industry, with rigorous ethical guidelines and policies, the pharmaceutical industry can be a potential and significant source of funding of high-quality research and innovation.

A Novel Particle Swarm Optimization Approach for Patient Clustering From Emergency Departments

In this paper, a novel particle swarm optimization (PSO) algorithm is proposed in order to improve the accuracy of traditional clustering approaches with applications in analyzing real-time patient attendance data from an accident & emergency (A&E) department in a local U.K. hospital. In the proposed randomly occurring distributedly delayed PSO (RODDPSO) algorithm, the evolutionary state is determined by evaluating the evolutionary factor in each iteration, based on whether the velocity updating model switches from one mode to another. With the purpose of reducing the possibility of getting trapped in the local optima and also expanding the search space, randomly occurring time-delays that reflect the history of previous personal best and global best particles are introduced in the velocity updating model in a distributed manner. Eight well-known benchmark functions are employed to evaluate the proposed RODDPSO algorithm which is shown via extensive comparisons to outperform some currently popular PSO algorithms. To further illustrate the application potential, the RODDPSO algorithm is successfully exploited in the patient clustering problem for data analysis with respect to a local A&E department in West London. Experiment results demonstrate that the RODDPSO-based clustering method is superior over two other well-known clustering algorithms.

Implementation of a Highly Accurate Rapid Point-of-Care Test for Group a Streptococcus Detection at a Large Pediatric Emergency Department in South London.

Rapid group A Streptococcus point-of-care testing is not currently used in the United Kingdom in the management of acute tonsillitis. This prospective, observational study describes a strong association between a molecular-based point-of-care testing result and outpatient antibiotic prescribing (odds ratio = 48; P < 0.001) in 339 children seen at our center. It highlights challenges in implementing new rapid diagnostics.

P132: Trampoline park safety perceptions of caregivers of patients presenting to the paediatric emergency department in London, Ontario

Introduction: Trampoline injuries are frequent complaints of children presenting to paediatric emergency departments (PED) in Canada. The medical community has recognized the danger of recreational trampoline use, with the Canadian Paediatric Society (CPS) formally recommending against their use. A new type of trampoline recreation has recently emerged in the form of trampoline parks. Trampoline parks are dangerous, with similar rates of injury as backyard trampolines, and an increased likelihood of injuries warranting hospital admission. No current Canadian governmental or industry regulations exist for trampoline parks. This study aimed to determine the public perspective of trampoline park safety in order to provide a basis for addressing the current lack of safety recommendations around trampoline parks. Methods: Parents/caregivers of children seeking care in the PED were approached to participate in a survey regarding trampoline safety. Parents/caregivers of patients with severe injury/illness were excluded. Survey questions included demographics, safety perceptions of both home trampolines and trampoline parks, as well as awareness of the CPS statement regarding trampoline use. The survey was completed in the Research Electronic Data Capture System. Results: To date, 68 participants have completed the survey. 66% of participants (45/68) were aware of the new trampoline parks recently opening in the community. 31/68 (46%) of participants had allowed their child to visit a trampoline park. A comparison of the perception of the relative safety of trampoline parks found that 31% of participants (21/67) considered home trampolines “safe/very safe” while 39% of participants (26/66) considered trampoline parks “safe/very safe.” The median [IQR] age at which participants thought children could safely play at trampoline parks was 10 [3-15]. 43% of participants (29/67) thought the current CPS statement about backyard trampolines should apply to trampoline parks, and 93% of participants (62/67) thought the Ontario government should institute mandatory standards for trampoline parks. Conclusion: Trampoline parks are a significant emerging source of paediatric injury. Trends in preliminary data suggest that participants consider trampoline parks to be safer than backyard trampolines, and perceive that young children can safely participate in trampoline park activities. Should final survey data analysis support these trends, a call for adjustment of CPS guidelines and public policy should proceed.

Who’s in charge of Sino-African resource politics? Situating African state agency in Ghana

The research presented in this paper was funded by Economic and Social Research Council (ESRC) studentship, ES/J500057/1. Fieldwork was also supported by travel grants from King’s College London Department of Geography and School of Social Science and Public Policy.

Een bijzondere aankoop voor de KB: Huddes Specilla circularia

In this article, the acquisition by the KB | National Library of the Netherlands is discussed of the only known printed copy of the book Specilla circularia, written by Johannes Hudde in 1656. The existence of this small but innovative booklet on the optical properties of telescope lenses was only known from contemporary scholarly correspondence. The content was unknown for a long time, but in 1995 two manuscripts revealing the text of Hudde’s Specilla circularia were discovered and subsequently pub- lished. In 2016 an extremely rare printed copy of Hudde’s booklet surfaced in an auction at the London department of Christies. Research by the auctioneer (and confirmed by other scholars), showed that this copy probably came from the library of Gerard Meerman, auctioned in The Hague in 1824. The extreme rarity of the booklet, its provenance and its contents led to the idea that the KB | National Library of the Netherlands would be the appropriate place for this booklet, written by a Dutch math- ematical heavyweight. After all, the KB houses an important Spinoza collection and a major collection of books written by Hudde’s contemporaties. Thus the KB attempted to acquire the Specilla circularia and this proved successful: Hudde’s printed leaflet is now one of the highlights of this library.

Analytical confirmation of synthetic cannabinoids in a cohort of 179 presentations with acute recreational drug toxicity to an Emergency Department in London, UK in the first half of 2015

Context: Synthetic cannabinoid receptor agonists are the largest group of new psychoactive substances reported in the last decade; in this study we investigated how commonly these drugs are found in patients presenting to the Emergency Department with acute recreational drug toxicity.Methods: We conducted an observational cohort study enrolling consecutive adult patients presenting to an Emergency Department (ED) in London (UK) January–July 2015 (6 months) with acute recreational drug toxicity. Residual serum obtained from a serum sample taken as part of routine clinical care was analyzed using high-resolution accurate mass-spectrometry with liquid-chromatography (HRAM-LCMSMS). Minimum clinical data were obtained from ED medical records.Results: 18 (10%) of the 179 patient samples were positive for synthetic cannabinoid receptor agonists. The most common was 5F AKB-48 (13 samples, concentration 50–7600 pg/ml), followed by 5F PB-22 (7, 30–400 pg/mL), MDMB-CHMICA (7, 80–8000 pg/mL), AB-CHMINACA (3, 50–1800 pg/mL), Cumyl 5F-PINACA (1, 800 pg/mL) and BB-22 (1, 60 pg/mL). Only 9/18 (50%) in whom synthetic cannabinoid receptor agonists were detected self-reported synthetic cannabinoid receptor agonist use. The most common clinical features were seizures and agitation, both recorded in four (22%) individuals. Fourteen patients (78%) were discharged from the ED, one of the four admitted to hospital was admitted to critical care.Conclusions: Synthetic cannabinoid receptor agonists were found in 10% of this cohort with acute recreational drug toxicity but self-reported in only half of these. This suggests that presentations to the ED with acute synthetic cannabinoid receptor agonist toxicity may be more common than reported.

Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy.

IntroductionGait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy.Methods and analysis60 adolescents (Gross Motor Function Classification System level I–III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle–tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme.Ethics and disseminationThis trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London—Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and distributed to adolescents, families and healthcare professionals through the media with the assistance of the STAR advisory group.Trial registration numberISRCTN90378161; Pre-results.

PTU-307 The hidden endoscopic burden of sleeve gastrectomy and its comparison with roux-en-y gastric bypass

<h3>Introduction</h3> In the UK, 61.9% of adults are obese and associated co-morbidity is estimated to cost the NHS £5 billion annually.¹NICE recommends bariatric surgery as a treatment option for some obese patients.²Complications of bariatric surgery are commonly diagnosed and managed by the use of endoscopic procedures, such as endoscopic stent insertion or pneumatic balloon dilatation. This study aims to assess the burden of bariatric surgery-related endoscopy at our hospital, one of the main centres for bariatric surgery in the West Midlands. This is a parallel and enhanced study to “The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass” (RYGB) published in Frontline Gastroenterology in 2013³and now also includes data for sleeve gastrectomy. <h3>Method</h3> The retrospective study included all 211 patients undergoing sleeve gastrectomy over a 34 month period. We also utilised the previously collected data for the RYGB patient cohort which included 553 patients over 29 months. In both cohorts, the minimum follow up was 180 days. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications felt to be surgery related. <h3>Results</h3> 16.6% of the sleeve gastrectomy patients required post-operative gastroscopy, of which 11.4% of procedures were therapeutic. This compares to 20.4% of the RYGB cohort of which 50.4% of procedures were therapeutic (p &lt; 0.001). 1.9% of sleeve gastrectomy patients encountered a post-operative staple-line leak and collectively required 29 procedures including 8 stent insertions. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated a cost of £114,458 in endoscopy tariffs, or £105 per RYGB and £267 per sleeve gastrectomy performed. <h3>Conclusion</h3> Bariatric surgery can have significant complications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> NICE Guidance 2014. Obesity: identification, assessment and management of overweight and obesity in children, young people and adults. CG189. London Department of Health Policy. Reducing obesity and improving diet. 2013. [Online]. Available from: https://www.gov.uk/government/policies/reducing-obesity-and-improving-diet[Accessed 1st July 2014] Steed H, Golar H, Manjunath S. The hidden endoscopic burden of Roux-en-Y gastric bypass surgery. Frontline Gastroenterol. 2013;4:69–72

Co-operatives in the Cultural Industries

This podcast is a recording of a roundtable discussion on Co-operatives in the Cultural Industries, that took place at City University London on April 1, 2015, organised by Marisol Sandoval and Jo Littler. Speakers were Robin Murray, Rhiannon Colvin, Sion Whellens and Tara Mulqueen. The lives of cultural workers are complex and contradictory; often combining work satisfaction, pleasure and autonomy with job insecurity, low pay, long hours, anxiety and inequality.The roundtable discussed the potentials and limits of worker co-operatives as an alternative way of organizing cultural work. It explored how worker co-operation might contribute to new collaborative forms of cultural production; how they do, or might, strengthen a 'cultural commons'; and the role cultural co-ops play in the wider context of movements for workers' rights. Questions that were discussed include: To what extent can worker co-operatives be a means to confront precariousness and individualisation in work in the cultural sector? Do worker co-ops open up new possibilities for the collaborative production of cultural commons? What role can worker co-operatives play within a broader movement for creating more just, equal and humane cultural work and an alternative to capitalist economies? Where lies the boundary between neoliberal calls for self-help and individual responsibility and a radical co-op movement? What is the relation between worker co-ops and other forms of progressive politics such as the union movements, social protests and civil society activism? Can cultural co-ops contribute to reinventing the meaning and practice of work in the 21st century? About the speakers:Marisol Sandoval is a Lecturer at the Department of Culture and Creative Industries at City University London. Her research critically deals with questions of power, responsibility, commodification, exploitation, ideology and resistance in the global culture industry. Jo Littler is Senior Lecturer at City University London's Department of Culture and Creative Industries. Her work explores questions of culture and power from an interdisciplinary, cultural studies-informed perspective. Rhiannon Colvin after graduating in 2010 to find the world of work competitive and brutal, Rhiannon founded AltGen to empower young graduates to get together and create their own work. http://www.altgen.org.uk/ Tara Mulqueen is a PhD candidate at Birkbeck College School of Law. Her thesis concerns the development of legislation for co-operatives in the 19th century. Robin Murray is an industrial economist. He was Director of Industry at the Greater London Council (GLC) in the 1980s, and has been a Research Fellow at the University of Sussex, the Director of Development for the Government of Ontario and co-founder of Twin and Twin Trading. He is an associate of Co-operatives UK and author of Co-operation in the age of Google. http://www.uk.coop/ageofgoogle Sion Whellens is a member of the graphic design and print co-operative Calverts. As part of the Principle Six partnership, he also advises and supports co-ops in creative industries. http://www.calverts.coop

Childhood injury in Tower Hamlets: Audit of children presenting with injury to an inner city A&E department in London

IntroductionChildhood injury is a leading cause of mortality and morbidity worldwide with the most socio-economically deprived children at greatest risk. Current routine NHS hospital data collection in England is inadequate to inform or evaluate prevention strategies. A pilot study of enhanced data collection was conducted to assess the feasibility of collecting accident and emergency data for national injury surveillance. AimsTo evaluate the reliability and feasibility of supplementary data collection using a paper-based questionnaire and to assess the potential relationship between income deprivation and incidence of paediatric injury. MethodsClinical staff conducted an audit of injuries in all patients under 16 years between June and December 2012 through completion of a questionnaire while taking the medical history. Descriptive statistics were produced for age, sex, time of arrival, activity at time of injury, mechanism and location of injuries. The association between known injury incidence and area level income deprivation (2010 English Index of Multiple Deprivation [IMD] Income Deprivation Domain from home postcode) was assessed using Spearman's rank correlation. Representativeness of the audit was measured using z-test statistics for time of arrival, age, sex and ethnicity. ResultsThe paper audit captured 414 (6.5%) of the 6358 under-16 injury-related attendances recorded on the NHS Care Record Service Dataset. Comparison of the audit dataset with NHS records showed that the audit was not representative of the larger dataset except for sex of the patient. There was a positive correlation between injury incidence and income deprivation measured using IMD score where data were available (n=384, p<0.001). Nearly half of the attendances were due to falls, slips or trips (49.8%) and more than half were due to either leisure (32.9%) or sport (18.1%) activities. ConclusionThere is evidence of area level income inequalities in injury incidence among children attending the Royal London Hospital. The audit failed to capture a high proportion of cases, likely due to the paper-based format used. This study highlights the importance of routinely collecting enhanced injury data in computerized hospital admission systems to provide the necessary evidence base for effective injury prevention. The findings have contributed to plans for implementation.