Merseyside Region Research Articles

Experiences of Physiotherapy and Occupational Therapy Undergraduates and Placement Educators of Blended Practice-Based Learning

Securing sufficient practice-based learning opportunities for health care students is long-standing and well documented and not unique to the United Kingdom (Beveridge & Pentland 2020; Martin et al., 2004). Increasing Allied Health Professional learners on healthcare programmes and the COVID-19 pandemic have highlighted the need for radical change and innovative ways of working to address placement capacity. Due to the capacity pressures, blended practice-based placements were implemented in partnership with clinical collaboration across the Cheshire and Merseyside region. As this placement model had not been robustly tested, a decision was made to pilot this across different settings and ethical approval was sought and granted, to fully evaluate this approach. The participants consisted of second-year physiotherapy and first- and second-year occupational therapy learners. The aims of the study were to: ascertain the value and experiences of a newly introduced blended placement-based learning through the anonymous collection of data from an online questionnaire (quantitative) and focus groups (qualitative) in response to challenges relating to placement capacity. Initial findings suggest there are benefits for learners including new skill acquisition, such as organisational and adaptability skills, the ability to influence change in patient care and improved clinical reasoning. Challenges for learners include the type and length of project not being comparable to their peers, reduced clinical time, perceived discrepancies in marking during the placement and opportunities to develop confidence. Alternative placement models are required to meet ongoing capacity demands. This work adds to the growing body of placement related literature.

Assessment of oral disease burden among head and neck cancer patients in the Merseyside region.

Introduction Head and neck cancer (HANC) significantly impacts the oral cavity and dental health issues may complicate cancer treatment and post-treatment quality of life. Pre-treatment dental evaluation is critical for identifying and managing existing oral health problems. However, limited literature exists on the dental health status of patients at the time of HANC diagnosis. This study aims to address this gap and emphasise the importance of dental care in the management of HANC.Methods A retrospective analysis of medical records was conducted on patients scheduled for radiotherapy for HANC. Data on demographic characteristics, tumour characteristics and dental exam findings were extracted from the patient record.Results Of the 191 included patients, the average age was 62.9 years (SD: 10.09), with 80% being men. The prevalence of dental disease revealed 59% of cases presenting with unstable periodontal disease and an average decayed, missing, and filled teeth score of 19.9. Two-thirds of patients exhibited one or more carious lesions.Conclusion This retrospective study sheds light on the dental health status of patients with HANC at their pre-treatment evaluation. The high prevalence rates of dental caries and unstable periodontal disease highlight the importance of dental evaluation and intervention as part of the overall management of HANC patients.

Restructuring of the UK Vascular Services: does the hub versus spoke model affect patient mortality in ruptured abdominal aortic aneurysms?

Background: Ruptured abdominal aortic aneurysms (AAA) are a frequently fatal vascular condition. The centralisation of vascular services in the UK was driven by the positive volume–outcome relationship witnessed within vascular surgery and other major surgical specialities. In 2018, The Get It Right First Time (GIRFT) programme officially recommended the restructuring of vascular services in England to a hub and spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region. Methods: We conducted a retrospective review from 1 January 2017 to 31 December 2020, identifying 110 patients with a ruptured AAA presenting to hub and spoke sites. We determined if there was any association between mortality and the presenting site. Results: Forty-one patients presented to the hub site (Royal Liverpool University Hospital) and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in Accident and Emergency or were palliated. 57% of those who underwent an intervention survived. The overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p=0.585). Conclusion: This study is concordant with further published data supporting the centralisation of services for ruptured AAA.

Effectiveness of the BNT162b2 (Pfizer-BioNTech) and the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines for reducing susceptibility to infection with the Delta variant (B.1.617.2) of SARS-CoV-2

BackgroundFrom January to May 2021 the alpha variant (B.1.1.7) of SARS-CoV-2 was the most commonly detected variant in the UK. Following this, the Delta variant (B.1.617.2) then became the predominant variant. The UK COVID-19 vaccination programme started on 8th December 2020. Prior to the Delta variant, most vaccine effectiveness studies focused on the alpha variant. We therefore aimed to estimate the effectiveness of the BNT162b2 (Pfizer-BioNTech) and the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines in preventing symptomatic and asymptomatic infection with respect to the Delta variant in a UK setting.MethodsWe used anonymised public health record data linked to infection data (PCR) using the Combined Intelligence for Population Health Action resource. We then constructed an SIR epidemic model to explain SARS-CoV-2 infection data across the Cheshire and Merseyside region of the UK. Vaccines were assumed to be effective after 21 days for 1 dose and 14 days for 2 doses.ResultsWe determined that the effectiveness of the Oxford-AstraZeneca vaccine in reducing susceptibility to infection is 39% (95% credible interval [34, 43]) and 64% (95% credible interval [61, 67]) for a single dose and a double dose respectively. For the Pfizer-BioNTech vaccine, the effectiveness is 20% (95% credible interval [10, 28]) and 84% (95% credible interval [82, 86]) for a single-dose and a double dose respectively.ConclusionVaccine effectiveness for reducing susceptibility to SARS-CoV-2 infection shows noticeable improvement after receiving two doses of either vaccine. Findings also suggest that a full course of the Pfizer-BioNTech provides the optimal protection against infection with the Delta variant. This reinforces the need to complete the full course programme to maximise individual protection and reduce transmission.

51 Restructuring of the UK Vascular Services: Does the Hub and Spoke Model Affect Patient Mortality in Ruptured AAAs?

Abstract Aim Ruptured Abdominal Aortic aneurysms (rAAA) are a fatal vascular condition. In 2018, The Get It Right First Time Programme (GRIFT) recommended the restructuring of vascular services in England to a Hub and Spoke model where AAA repairs should be performed in higher volume centres, the hub sites. This study aims to assess the mortality rates in patients presenting at hub versus spoke sites in the Merseyside region. Method We conducted a retrospective review, 1st January 2017 to 31st December 2020, recognising 110 patients with a rAAA presenting to hub and spoke sites in the Merseyside Region. We determined if there was any association in mortality and the presenting site. We also assessed the mean time to theatre for both Hub and Spoke patients. Results 41 patients presented to Hub site and 69 patients to the spoke sites. 81% underwent operative intervention and 19% died in A+E or were palliated. 57% of those who underwent an intervention survived. Overall mortality rate in hospital was 53% (58 patients). There was no association between mortality and transfer from a spoke site (p = 0.58). The median time to theatre for Hub patients was 160 minutes from presentation and 315 minutes from Spoke sites. Time to theatre had no overall effect on mortality (p = 0.1) Conclusions This study indicates that the GRIFT programme does not have a negative effect on mortality irrespective of time taken to theatre. Therefore, transferring patients to a specialist hub site will positively influence patient outcomes.

Limited Evidence of Associations Between Executive Functioning and Alcohol Involvement In UK Adolescents.

AimsDeficits in motor inhibitory control and working memory have been hypothesized to be both a cause and consequence of heavy alcohol use. Adolescence is a critical developmental stage for inhibitory control and working memory, and it is also a stage when individuals are most likely to initiate alcohol use. This study aimed to examine whether inhibitory control and working memory would predict alcohol use and involvement in a group of UK adolescents.MethodsWe recruited 220 (N = 178, female) adolescents, aged between 16 and 18, from eight higher education settings in the Merseyside region of the UK. Alcohol use was examined using the Timeline Follow-Back and involvement (and related problems) using the Adolescent Alcohol Involvement Scale. A reward-based inhibitory control task (Go/No-Go) was used to examine the inhibition and reward sensitivity, and a self-ordered pointing task was used to measure working memory.ResultsMultiple regression demonstrated that neither inhibitory control (b = 0.02 (95% confidence interval (CI): −0.21, 0.24)) nor working memory (b = −0.12 (95% CI: −0.30, 0.07)) were significant predictors of alcohol use (units consumed). Inhibitory control (b = 0.61 (95% CI: 0.12, 1.09), specifically, in the no reward condition and school deprivation (b = 0.67 (95% CI: 0.06, 1.28) significantly predicted alcohol-related problems.ConclusionsOur findings demonstrated limited evidence that deficits in specific mechanisms of executive functioning (i.e. motor inhibition and working memory) were associated with alcohol-related problems in UK adolescents. This study adds to an increasing body of literature suggesting weak or non-existent links between inhibitory control, working memory and alcohol use.

Clinical Characteristics of COVID-19 Patients in a Regional Population with Diabetes Mellitus: The ACCREDIT Study

Background: It is known that diabetes is associated with greater COVID-19 mortality. However, what remains unclear is whether characteristics specific to this cohort contribute to the prognosis of COVID-19. We identified clinical and biochemical characteristics associated with mortality and the need for intensive care amongst an inpatient population with diabetes and COVID-19.Methods: We conducted a retrospective cohort study across the North West Merseyside region assessing clinical and biochemical characteristics associated with 7-day, 30-day mortality, and ITU admission as primary outcomes. All patients with diabetes infected with COVID-19 admitted to 7 hospitals within the region from 1 January to 30 June 2020 were included and data collected directly from medical notes by clinicians managing the condition. We calculated the inpatient mortality rates for this cohort. Statistical analyses included multivariate logistic regression to examine the effect of the aforementioned characteristics on the primary outcome. We also performed a series of Kaplan-Meier curves to assess the mortality rate trend over time.Findings: This study analysed 1004 hospitalised patients with diabetes with COVID-19. Mean age was 74.1 (± 12.6) years. They were predominantly men (60.7%). 45% belonged to the two most deprived deciles in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. Most had a diagnosis of T2DM (94.8%) and the mean HbA1c was 61.2 ± 19.7 mmol/mol (7.7 ± 4%). Microvascular and macrovascular complications of diabetes were evident in 49.6% and 56.2% respectively. The primary outcome of death by day 7 was observed in 24%, which increased to 33% by day 30. In univariate analysis, characteristics associated with the primary outcome were age and CRP (pInterpretation: The results of this regional analysis of persons with diabetes infected with COVID-19 showed that CRP and age were associated and predictive for in-hospital death by day 7.Funding: None.Conflict of Interest: NoneEthical Approval: The study was approved by the Regional Research ethics committee.

Digitising a consultant radiographer led palliative radiotherapy service

Keywords: Palliative Radiotherapy; Digitisation; Service Redesign; Audit. Introduction: The Clatterbridge Cancer Centre is a specialist tertiary centre covering the Cheshire and Merseyside region. A Palliative Radiotherapy Service was setup over 3 years ago as a once weekly clinic, led by a Consultant Clinical Oncologist (CCO). With the appointment of a Consultant Radiographer in Palliative Radiotherapy in place of a CCO, the service has expanded to provide greater access to patients requiring palliative radiotherapy. Method and Materials: In order to ensure equitable access to the service, a digitisation project was completed to streamline the referral and recording process. Historically, the services referral form would be received via several routes (fax / e-mail / hand-delivered / dictated). Dependent on the route of entry, this could introduce significant delay in patient management. With the development of a clear pathway for both internal and external referrals, they can now all be managed via a single integrated system which links directly to each patients record, allowing for ‘Live’ update of their notes. Results: Key data is now easily captured, including information such as time from referral to review, and treatment, allowing for on-going audit of the service. This will allow for further adaptations to be made in order to best meet future patient requirements. The digitisation of this clinical pathway not only has the ability to reduce time for referral vetting, but also to reduce the burden on the wider team who have previously been required to scan referral documents to the system, handle faxes from external referral sites, and continually review e-mail for information / feedback on the next steps of referrals. A survey of all service users is currently underway, with formal reporting expected in the coming month. Conclusion and Discussion: The Palliative Radiotherapy Service strengthens and works across traditional organisational boundaries within community, primary, secondary and tertiary care. The digitisation of this service has not only improved efficiency, promoted clearer data recording, and ensured a smoother referral process for professionals; it also aides to showcase the benefit of using specialist allied health professionals in areas where a clinical presence was previously a requirement. Numerical

Fearing for Merseyside: Liverpool, its Defences and the French Invasion Scare of 1858–1859

From the spring of 1858 to the winter of 1859, Britain was gripped by fears of a French invasion. These were prompted by a fraying of Anglo-French relations, following the attempted assassination of the French Emperor Napoleon III by a group of revolutionaries that included British citizens. The fear that Napoleon might take military action against Britain in response first arose in the spring of 1858, whereafter the national feeling intensified over the summer of 1859, when the emperor launched a successful invasion of Italy, raising the spectre of Britain having to deal with a new Bonaparte who could match his famous namesake both ambition and martial ability. The purpose of this article is to re-assess the French invasion scare of 1858–59, focusing on how the fear was both nurtured and responded to, not at a national, but at a local, level. Specifically, the focus here is on one of Britain’s key port cities, Liverpool which, as a maritime and commercial centre, seemed to many on Merseyside as a probable target for a waterborne attack. By analysing how the press and public of the greater Merseyside region responded to this perceived threat, this article sheds light on the division between fears and reality in public perceptions, and the understudied, localised reaction of Liverpudlians to this apparent national crisis.

Monitoring Impacts of Urbanisation and Industrialisation on Air Quality in the Anthropocene Using Urban Pond Sediments

The release of toxic atmospheric pollutants since the Industrial Revolution is a major global challenge, driving climate change and damaging human health. Spatial health inequalities highlight the need to explore air pollution in different localities throughout the Anthropocene. Air quality monitoring programmes are spatially and temporally limited. We show how suitable urban sediment archives provide site specific records of long-term particulate matter (PM) releases, in cities and urban landscapes, that are or have been subjected to high pollution levels. High-resolution PM records spanning from the mid-20th century were reconstructed from an urban pond in Chongqing, southwest China, one of the fastest growing Chinese urban centres in the late 20th century. Temporal variations in pollution proxies including geomagnetic, geochemical and spheroidal carbonaceous particle trends correspond to key phases of industrial and urban developments, that are representative of the locality. Observed increases in air pollution proxies post-1960 coincide with the location of military-related industries to Chongqing and industrial intensification. Post-1997 pollution mirrors rapid urbanisation that occurred following the designation of Chongqing as a government-controlled municipality at this time and reveals a steadily increasing pollution trend to present day (2015). In comparison to Chongqing, an atmospheric depositional history was constructed from an urban pond in the Merseyside region of northwest England that has experienced a legacy of contamination since the early 19th century. In northwest England, changing characteristics of pollution are related to the establishment of localised, modern industries, power generation, urban sprawl, increased combustion-derived pollution post-1990 and effective pollution legislations. Whereas a reduction in air pollution has occurred post-2000 in Merseyside, in Chongqing, however, air pollution has continued to increase in spite of national efforts in pollution control. These urban sediments reveal the changing nature of air pollution in different urban landscapes, allowing us to assess air quality impacts of progressive industrial activity, increased road and air travel, urban expansion and the efficacy of pollution controls. It appears that air pollution remains an inevitable consequence of global industrialisation. It is therefore crucial to understand pollution histories in densely populated urban regions to determine environmental burdens of pollution on health over generational timescales.

Socioeconomic deprivation and the burden of head and neck cancer-Regional variations of incidence and mortality in Merseyside and Cheshire, North West, England.

The aim of this longitudinal study was to examine the distribution of head and neck cancer (HANC) disease burden across the region comparing it to national trends. We undertook a retrospective study of routine data combining it with indicators of deprivation and lifestyle at small geographical areas within the 9 Local Authorities (LAs) of Merseyside and Cheshire Network (MCCN) for head and neck cancers. Data from the North West of England and England were used as comparator regions. This research was undertaken by the Cheshire and Merseyside Public Health Collaborative, UK. The Merseyside and Cheshire region serves a population of 2.2 million. Routine data allowed us to identify HANC patients diagnosed with cancers coded ICD C00-C14 and C30-C32 within 3 cohorts 1998-2000, 2008-2010 and 2009-2011 for our analysis. Directly age-standardised incidence rates and directly age-standardised mortality rates in the LAs and comparator regions were measured. Lifestyle and deprivation indicators were plotted against them and measured by Pearson's correlation coefficients. The incidence of head and neck cancer has increased across the region from 1998-2000 to 2008-2010 with a peak incidence for Liverpool males at 35/100000 population. Certain Middle Super Output Areas contribute disproportionately to the significant effect of incidence and mortality within LAs. Income deprivation had the strongest correlation with incidence (r=.59) and mortality (r=.53) of head and neck cancer. Our study emphasises notable geographical variations within the region which need to be addressed through public health measures.

PWE-325 Do we practice what we preach with complete responders in rectal cancer?

Introduction There is a lack of conclusive long-term studies evaluating risk and benefit in the surgical management of complete pathological response to rectal cancer. The trend in practice is becoming increasingly conservative, especially with an ageing population with increasing comorbidity, with recent data supporting a ‘watch and wait’ approach to complete responders. A recently published article utlilsing decision-analytical modelling predicted no difference in survival in 60 year old male patients between those managed conservatively and operatively. More interestingly they predicted a significant improvement in absolute survival in 80 year olds managed conservatively. Given the trend of the current evidence we aimed to determine the regional practice in Merseyside. We questioned whether increased age and/or comorbidity influenced surgeon decision when complete pathological response was detected. Method A questionnaire was submitted to all the colorectal cancer surgeons within the greater Merseyside region, in the north west of England, United Kingdom. The participants were asked for their practice in managing 3 patient cohorts (60, 70, 80 years of age) with complete pathological response and of varying comorbid status. They were then asked for their preference should they be faced with the same clinical scenario personally. Results 10 colorectal cancer units with 33 colorectal surgeons were surveyed. The response rate was 23/33 (70%). 5% of surgeons would offer surgery to 70–80 year old patients with multiple comorbidities, whereas 22% would if the patient was 60 years of age. 27% of surgeons would offer surgery to patients who were 80 years of age who had no medical comorbidities, and 55% would if they were 60 years of age with no comorbidities. 66% of surgeons would not want any surgery if they personally had a completely responding rectal cancer. 44% would want different treatment from what they would offer their patients. One surgeon would not routinely offer surgery but would personally want one. Conclusion Patients with complete pathological response get different treatment according to surgeon preference in Merseyside. 44% of surgeons would advise their patients something they would not choose should they be faced with the same scenario. More study into the long-term risk and benefit of surgical vs. conservative management of complete responders is required, in order that surgeons can offer a more evidence based treatment for the patient, a treatment they would wish upon themselves. Disclosure of interest None Declared.

Reprint of: Health-related quality of life and fear of recurrence in survivors of differentiated thyroid cancer

Background: The diagnosis and treatment of malignant disease can have a considerable impact on health-related quality of life (HRQoL). Fear of recurrence (FoR) is a common cause of concern for cancer patients that can adversely affect emotional and psycho-social well-being. This issue has been researched in various types of cancer, but studies in thyroid cancer are lacking. This study was conducted to explore HRQoL and FoR in patients treated for differentiated thyroid cancer (DTC) through the thyroid multi-disciplinary team (MDT) in the Merseyside and Cheshire region. Health-related quality of life and fear of recurrence in survivors of differentiated thyroid cancerEuropean Journal of Surgical OncologyVol. 40PreviewBackground: The diagnosis and treatment of malignant disease can have a considerable impact on health-related quality of life (HRQoL). Fear of recurrence (FoR) is a common cause of concern for cancer patients that can adversely affect emotional and psycho-social well-being. This issue has been researched in various types of cancer, but studies in thyroid cancer are lacking. This study was conducted to explore HRQoL and FoR in patients treated for differentiated thyroid cancer (DTC) through the thyroid multi-disciplinary team (MDT) in the Merseyside and Cheshire region. Full-Text PDF

Parental Decision-Making and Acceptance of Newborn Bloodspot Screening: An Exploratory Study

ObjectiveNewborn bloodspot screening is an internationally established public health measure. Despite this, there is a paucity of information relating to the decision-making process that parents go through when accepting newborn screening. This is important as screening panels are expanding; potentially leading to an increasing amount of complex information. This study sought to understand the factors that influence parental decisions and roles they play in the decision-making process.Patients and MethodsQualitative thematic evaluation of semi structured interviews with parents whose children had recently undergone newborn screening in the Merseyside and Cheshire region of England, UK.ResultsEighteen interviews with first time parents (n = 12) and those with previous children (n = 6). Seven factors were identified as being either explicitly or implicitly related to parental decision-making: Experience, Attitudes to medicine, Information-seeking behaviour, Perceived knowledge, Attitudes to screening, and Perceived choice, all of which ultimately impact on Perceived decisional quality.ConclusionsThese results indicate that while content is important, other contextual factors such as personal experience, perceived choice, and general attitudes toward medicine, are also highly influential. In particular, relationships with key healthcare professionals are central to information collection, attitudes toward screening, and the level of deliberation that is invested in decisions to accept newborn bloodspot screening.

Memories of hard won victories: amateur moviemaking contests and serious leisure

Contests are one of the most successful stimuli to production within the amateur moviemaking sector. Despite pleas from some commentators that moviemakers should view their practice as non-competitive civic participation, many more consciously sought out the public recognition that came from winning an award at regional, national and international film competitions. The ‘Ten Best’, an annual production competition that ran from 1936 to 1986, is of particular note as it was the highlight of the year for many amateur moviemakers who referred to it as ‘our Oscars’. Focusing on a Ten Best prize-winning film from the Merseyside region, War Declared (1985), consideration of this title encourages empirical data gathering to be extended beyond primary print sources by drawing on original interviews conducted with local cine-club members. While some filmmakers see the pursuit of awards as a superficial path to follow, others viewed the ‘Ten Best’ as setting the standard for others to aspire to. These interviews revealed that amateur moviemakers have mixed feelings about the central role of contests and awards in the amateur sector. However, the potential satisfaction and/or ‘compensation’, which winning can provide, overrides the perceived costs and secures the cultural value of participants’ work.

Maxillofacial trauma and the role of alcohol

Interpersonal violence is often associated with alcohol misuse. Most injuries that result from interpersonal violence affect the face, and maxillofacial surgeons are responsible for their treatment. Consequently maxillofacial surgeons are well placed to audit and help multi-agency task groups to address this social problem. An audit was undertaken of two years’ emergency referrals within the Merseyside region to assess the association of maxillofacial trauma and alcohol. The age and sex distribution were assessed together with the cause and place where the injury occurred. Results show an involvement of alcohol with interpersonal violence of 72%, which is the highest published association. We also analysed the type of injury and the place where each injury occurred, and the association with alcohol in each circumstance. In an attempt to identify alcohol misuse, an Alcohol use Disorders Identification Test questionnaire (AUDIT) was used to offer a brief intervention to educate and modify hazardous, harmful, or dependent alcoholic behaviour.

Complementary therapy services for mental health service users: Results of a consultation project

Objective The aim of this paper is to report on the findings of a consultation project exploring demand for mental health related complementary therapy services in the local area. The project and findings are reported with reference to historical context and the literature from service user, healthcare policy and complementary therapy fields. Design The consultation was commissioned by a voluntary sector mental health organisation to establish whether a case could be made for the development of a mental health related complementary therapy service, and what form such a service might take. The researchers sought breadth and balance by seeking views from four standpoints: mental health service users, informal carers, health and social care professionals, and complementary therapy providers. Setting The consultation activities took place in statutory and voluntary sector settings in Liverpool and surrounding areas. The Merseyside region is an area of long term social disadvantage and environmental neglect, currently subject to extensive regeneration activity with significant UK and EU funding. Method Service user views were captured through a combination of focus groups, in mental health centres, and questionnaires, completed at these events or distributed through mental health groups. Health and social care professionals' views were elicited through group meetings, questionnaires or interviews based on the questionnaire structure. Complementary therapy providers completed questionnaires or were interviewed using the questionnaire structure. Results The consultations discovered a high level of interest and confidence in holistic forms of therapy amongst service users, carers and professionals, together with interest and expertise in helping with mental health related problems amongst the therapists. Conclusion This main contribution to knowledge is in the wealth of detail about potential therapeutic applications and suggested organisational principles for complementary therapy services in the mental health field. The findings are inconclusive on the macro question of service design.

A Survey of Self-Perceived Educational Needs of General Dental Practitioners in the Merseyside Region

The aim of this study was to evaluate the self-perceived educational needs of a randomly selected group of general dental practitioners (GDPs) in the Merseyside region (UK). Eighty-seven GDPs were randomly selected from 850 in the region and asked to complete a self-evaluation questionnaire regarding their self-perceived educational needs. Seventy-five (86%) responded, of which 52 (69.3%) were male and 23 (30.7%) female. There was no significant difference in self-perceived knowledge in any of the dental disciplines when gender and period of time since qualification were used as predictor variables. The majority of the GDPs felt they had a good knowledge of restorative dentistry and dental radiography. Some of the GDPs felt they had poor knowledge in implant dentistry, oral medicine, orthodontics, dental sedation techniques, oral surgery, endodontics, periodontics and dental radiography. None of the respondents felt they had poor knowledge in restorative dentistry, prosthodontics and paediatric dentistry. Seventy-four (98.7%) of the responding GDPs were motivated to attend continuing professional development (CPD) courses because of an interest in a particular dental discipline and only one reported attending out of personal learning needs. Implant dentistry was indicated by 30 (40.0%) of the respondents as their training programme of choice. The respondents had high self-perceived knowledge of restorative dentistry, dental radiography, periodontics, endodontics, paediatric dentistry and prosthodontics. The respondents had low self-perceived knowledge of implant dentistry, orthodontics, oral medicine and dental sedation techniques. Of GDPs surveyed, 98.7% applied for courses they liked to attend, rather than needed to attend. Fifty-two per cent of male GDPs surveyed expressed a desire for training in implant dentistry.

Factors affecting non-attendance in an ophthalmic outpatient department.

The object of the study was to establish the non-attendance rates in an ophthalmic outpatient department and any non-attendance patterns that may be useful in managing future outpatient resources. A detailed retrospective survey of monthly non-attendance rates was carried out in the outpatient department of a dedicated eye hospital over a 1 year period looking at differences in non-attendance between morning and afternoon clinics and new and review patients. A total of 43,004 scheduled outpatient appointments predominantly from the suburban population of the Merseyside region were made at St Paul's Eye Hospital from the 1 February 1990 to 31 January 1991. Five thousand four hundred and twenty-four appointments were missed giving an overall non-attendance rate of 12.6%. Non-attendance rates for morning and afternoon appointments were 12.0% and 13.0%, respectively: and for new and review patients, 11.9% and 12.8%, respectively. Logistic regression analysis showed that patients with afternoon appointments were on average 1.10 times more likely to non-attend than morning patients (P = 0.002), and that review patients were 1.09 times more likely to non-attend than new patients (P = 0.04). In order to maximize outpatient department efficiency, a reduction in non-attendance is essential. Establishing patterns for non-attendance provides us with a framework around which we can plan measures to compensate for outpatient non-attendance.

Time trends in the outcome of lung cancer management: a study of 9,090 cases diagnosed in the Mersey Region, 1974-86

The purpose of this paper is to describe temporal trends in the treatment of lung cancer in the Merseyside Region of England over the years 1974-86. A detailed analysis of 9,090 cases of histologically confirmed tumours showed that age at diagnosis and histological type were important prognostic factors, with the 5 year survival of adenocarcinoma, squamous carcinoma, undifferentiated carcinoma and small cell carcinoma after treatment being 22.5%, 18.5%, 10% and 3.5% respectively. An analysis of 741 cases of small cell carcinoma given chemotherapy over the same period showed progressive improvement in 2 year survival from 2.5 to 7.5% (P less than 0.001) and this was shown to be closely associated with the increasing use of intravenous combination chemotherapy. The survival of patients who underwent surgical resection in the three periods 1974-77, 1978-81 and 1982-86 showed a continuous improvement in median survival from 13 to 30 months (P less than 0.001). Overall survival curves of all treated cases showed a significant improvement in median survival from 8 to 10 months and 5 year survival from 12.5 to 17.5% (P = 0.001). With improved staging assessment, the value of surgical resection of all histological types is emphasised, and in the case of the small cell subtype, the increasing use of combination chemotherapy would appear to have paralleled an increase in median and 2 year survival. These data support the argument that with appropriate case selection, there is a survival benefit associated with active treatment for lung cancer.