North London Research Articles

Using simulated bronchoscopy to improve training on intensive care units in a north London NHS trust

Flexible bronchoscopy is a vital tool that is used for both diagnostic and therapeutic indications on the intensive care unit. During the COVID pandemic, training opportunities to perform such a skill were decreased and novel methods of teaching, including using bronchoscopy simulators, were explored out of necessity. The aim of this quality improvement project was to investigate how training on an intensive care unit prepared trainees for carrying out bronchoscopy, and whether a simulated bronchoscopy session with a high-fidelity simulator could be a useful adjunct to gain experience. Our pilot, although limited in patient numbers, suggested that current teaching methods might not be adequate for building trainee confidence and that a session with a bronchoscopy simulator could serve as a remedy to this with a significant increase in self-reported confidence. Moving forwards in a post-pandemic era, this serves as a lesson learnt from COVID and would benefit from further development in this area.

Reducing single-use plastics in dental practice: a quality improvement project.

Introduction Climate change is a major issue facing the global population. Healthcare services, including dentistry, have an obligation to examine current practice and reduce the carbon footprint of their services. Single-use plastics, for example, those used to cover dental equipment, are not necessarily essential for cross-infection purposes.Materials and methods This quality improvement project was carried out in 2023 across 12 dental practices in the North London dental foundation training scheme. Baseline financial and environmental costs were estimated for the weekly single-use barrier plastics used in each practice. This was communicated to each practice. Practices using single-use plastics were contacted three months later to see if they had made any changes.Results In total, 10 out of 12 practices were using one or more of the single-use plastics at baseline, with an estimated carbon footprint ranging from 0.07-27.02 kg carbon dioxide equivalent (CO2e) per week. Three practices reduced or eliminated their single-use plastics as a result of this quality improvement project, which resulted in an equivalent saving of 46.87 kg CO2e per week.Discussion and conclusion The use of single-use plastic barriers varies widely between dental practices and is associated with a financial and environmental cost. Infection control guidelines are unclear with their recommendations. The authors urge dental services to reduce their single-use plastic barriers and would encourage infection control guidelines to consider the environmental impact when making recommendations.

“We just want to sing”: how a small London evangelical church responded to Covid-19

ABSTRACT This article documents the myriad ways in which a north London evangelical church responded to Covid-19 when it was decanted from its church building into cyberspace. By focusing on three aspects of Hovland’s framework of place-making—materiality, personhood, and transcendence (Hovland 2016), I analyse how church members viewed their experience of attending an online church. Apart from contributing to the literature on non-charismatic, non-Pentecostal evangelicalism, it suggests that the importance of singing together, as well as the silence and bodily stillness that sometimes ensue, in the everyday life of a church deserves further attention in a comparative anthropology of Christianity.

‘It depends on where you were born…here in the North East, there’s not really many job opportunities compared to in the South’: young people’s perspectives on a North-South health divide and its drivers in England, UK

BackgroundImproving the public’s understanding of how regional and socioeconomic inequalities create and perpetuate inequalities in health, is argued to be necessary for building support for policies geared towards creating a more equal society. However, research exploring public perceptions of health inequalities, and how they are generated, is limited. This is particularly so for young people. Our study sought to explore young people’s lived experiences and understandings of health inequalities.MethodsWe carried out focus group discussions (n = 18) with 42 young people, aged 13–21, recruited from six youth organisations in England in 2021. The organisations were located in areas of high deprivation in South Yorkshire, the North East and London. Young people from each organisation took part in three interlinked focus group discussions designed to explore their (i) perceptions of factors impacting their health in their local area, (ii) understandings of health inequalities and (iii) priorities for change. Due to the Covid-19 pandemic, most discussions took place online (n = 15). However, with one group in the North East, we carried out discussions face-to-face (n = 3). Data were analysed thematically and we used NVivo-12 software to facilitate data management.ResultsYoung people from all groups demonstrated an awareness of a North-South divide in England, UK. They described how disparities in local economies and employment landscapes between the North and the South led to tangible differences in everyday living and working conditions. They clearly articulated how these differences ultimately led to inequalities in people’s health and wellbeing, such as linking poverty and employment precarity to chronic stress. Young people did not believe these inequalities were inevitable. They described the Conservative government as prioritising the South and thus perpetuating inequalities through uneven investment.ConclusionsOur study affords important insights into young people’s perceptions of how wider determinants can help explain the North-South health divide in England. It demonstrates young people’s contextualised understandings of the interplay between spatial, social and health inequalities. Our findings support calls for pro-equity policies to address the structural causes of regional divides in health. Further research, engaging young people in deliberative policy analysis, could build on this work.

A Cross-Sectional Evaluation of the Virtual Outpatient Management of People With Mpox.

To report on the implementation and outcomes of a virtual ward established for the management of mpox during the 2022 outbreak, we conducted a 2-center, observational, cross-sectional study over a 3-month period. All patients aged ≥17 years with laboratory polymerase chain reaction-confirmed monkeypox virus managed between 14 May and 15 August 2022, at the Hospital for Tropical Diseases at University College London Hospitals National Health Service (NHS) Foundation Trust and sexual health services at Central North and West London NHS Foundation Trust, were included. Main outcomes included the proportion of patients managed exclusively on the virtual ward, proportion of patients requiring inpatient admission, proportion of patients with human immunodeficiency virus, and duration of lesion reepithelialization. Among confirmed cases (N = 221), 86% (191/221) were managed exclusively on the virtual ward, while 14% (30/221) required admission. Treatment for concomitant sexually transmitted infections was provided to 25% (55/221) of patients, antibiotics for other infective complications to 16% (35/221), and symptomatic relief to 27% (60/221). The median time from onset to complete lesion reepithelialization and de-isolation was 18 days (range, 8-56 days). Eleven percent (24/221) of individuals disengaged from services within 4 days of testing. The virtual ward model facilitated safe and holistic outpatient management of mpox, while minimizing admissions. This approach could serve as a model for future outbreak responses.

Patriarchal “Love School”: Entrepreneurial Heroic Masculinity and Neoliberalism in A Pentecostal Church in London

Many Pentecostal churches founded in the Global South are now rapidly growing in European cities. Although research is catching up with this development, we know little about how these processes affect gendered and racialized practices regarding sexualities, bodies, and masculinities in former colonial metropolises shaped by neoliberal capitalism. This article addresses this gap by interrogating the transnational movement of Pentecostal masculinities and their economic, sexual, and political dimensions in a church in North London. The contribution argues that the church promotes what I call entrepreneurial heroic masculinity, which consists of three main elements: a gendered conversion narrative, a pastoral masculinity of dominating behavior, and the cultivation of anti-affective, rational love. In this way, traditionalist masculinist tropes are mapped onto a world allegedly full of opportunities for material blessings where becoming a man of God means becoming a faithful self-entrepreneur, which requires strict autonomy from emotions, family, and the government. The article contributes to the critical debate on masculinity and transnational religious movements by demonstrating how the demands and promises of neoliberal capitalism are deeply entangled with the reconstitution of heroic patriarchal subjectivity.

Analyzing The Sense Of Belonging From A Bourdieusian Perspective: Women From Türkiye In North London

Analyzing the sense of belonging from a Bourdieusian perspective: Turkish women in North London Abstract The Cambridge Dictionary defines belonging as the feeling of safety and comfort in a given place. For migrants, defining belonging is complicated as it also means establishing good relations with other members of society. A sense of belonging encompasses being included in the family, the country in which one lives, and the group to which one belongs. This study sought to answer the question “How is the sense of belonging established in a diaspora?” It also poses the question “Does the sense of belonging differ between generations in a diaspora? This study was conducted in North London between 2017–2019. In-depth interviews were conducted with 8 first-generation women, 10 second-generation women and 7-third generation young women. Interviews were conducted at the North London Alevi Association. Although the first step of this study was to identify a sense of belonging and how it is established, also generational differences regarding belonging were examined. The analysis was conducted within the framework of Bourdieu’s concepts of habitus, field, and capital. Generally, it is observed that first-generation womens’ sense of belonging is still concentrated in the home country they left, whereas for the younger generation it is related to the country in which they were born or went there when they were children.

Patient perspectives on the unwanted effects of multidisciplinary pain management programmes: A qualitative study

Objective This study aimed to understand the impact of pain management programmes, focusing on the unwanted effects and their influence on patients’ long-term use of self-management strategies. Design Qualitative study. Setting Specialist musculoskeletal hospital in North London, England. Participants Patients with chronic musculoskeletal pain that have completed a pain management programme. Intervention Multidisciplinary pain management programmes. Main measures Data were collected regarding patients’ experiences and unwanted effects from the pain management programme using semi-structured interviews. Data were analysed using thematic analysis. Results Fourteen participant interviews were included in the analysis (median age 54 years, 12 females). Four themes were generated from the data: Benefits and burdens, Pain management programme and real life, Social support and Healthcare interventions. Unwanted effects included heightened anxiety related to negative interactions with peers, being in a new environment, worries about ability to cope with the programme, social anxiety from being in a group, the strain on families due to participants being away from home and a sense of abandonment at end of the programme. Burdens associated with implementing pain management strategies were identified, including the emotional burden of imposing their self-management on close family and competing demands with time and energy spent on self-management at the expense of work or home commitments. Conclusions Pain management programmes have an important role in helping patients to learn how to self-manage chronic pain. Their unwanted effects and the treatment burdens associated with long-term self-management may be an important consideration in improving the longevity of their beneficial effects.

Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer’s disease

BackgroundDisease-modifying therapies (DMTs) for Alzheimer’s disease (AD) have early evidence of efficacy. Widespread delivery of DMTs will require major service reconfiguration. Treatment pathways will need to include triaging for eligibility,...

Personal and organisational health literacy in the non-specific symptom pathway for cancer: An ethnographic study.

People being investigated for cancer face a wealth of complex information. Non-specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner 'gut feeling', who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways. This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowingand clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy. Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge. We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help-seeking post-discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtestingor inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors. Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.-A. M.) was involved in data analysis and writing the manuscript.

Using social media to infer the diffusion of an urban contact dialect: A case study of Multicultural London English

AbstractSociolinguistic research has demonstrated that ‘urban contact dialects’ tend to diffuse beyond the speech communities in which they first emerge. However, no research has attempted to explore the distribution of these varieties across an entire nation nor isolate the social mechanisms that propel their spread. In this paper, we use a corpus of 1.8 billion geo‐tagged tweets to explore the spread of Multicultural London English (MLE) lexis across the United Kingdom. We find evidence for the diffusion of MLE lexis from East and North London into other ethnically and culturally diverse urban centres across England, particularly those in the South (e.g. Luton), but find lower frequencies of MLE lexis in the North of England (e.g. Manchester), and in Scotland and Wales. Concluding, we emphasise the role of demographic similarity in the diffusion of linguistic innovations by demonstrating that this variety originated in London and diffused into other urban areas in England through the social networks of Black and Asian users.

University students' access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England.

In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy - that is, how different needs are deemed deserving of health service attention - was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources.

Geographic inequalities in need and provision of social prescribing link workers a retrospective study in primary care.

Long-term health conditions are major challenges for care systems. Social prescribing link workers have been introduced via primary care networks (PCNs) across England since 2019 to address the wider determinants of health by connecting individuals to activities, groups, or services within their local community. To assess whether the rollout of social prescribing link workers was in areas with the highest need. A retrospective study of social prescribing link workers in England from 2019 to 2023. Workforce, population, survey, and area-level data at the PCN-level from April 2020 to October 2023 were combined. Population need before the rollout of link workers was measured using reported lack of support from local services in the 2019 General Practice Patient Survey. To assess if rollout reflected need, linear regression was used to relate provision of link workers (measured by full-time equivalent [FTE] per 10 000 patients) in each quarter to population need for support. Populations in urban, more deprived areas and with higher proportions of people from minority ethnic groups had the highest reported lack of support. Geographically these were in the North West and London. Initially, there was no association between need and provision; then from July 2022, this became negative and significant. By October 2023, a 10-percentage point higher need for support was associated with a 0.035 (95% confidence interval = -0.634 to -0.066) lower FTE per 10 000 patients. Rollout of link workers has not been sufficiently targeted at areas with the highest need. Future deployments should be targeted at those areas.

The alcohol liaison service: 12 months on

A previous article published in this journal discussed an outpatients clinic in north London to illustrate the way it can treat patients effectively to keep them engaged and allow them to benefit from treatment. This article provides a 12-month update and further evidences the positive outcomes that can be achieved with an outpatients clinic treating patients who are admitted to hospital with alcohol dependency, using two case studies as examples.

Making sense of what families leave behind: a middle-class schoolgirl’s diaries in 1920s London

The article is based on original, contemporaneous data in the form of personal diaries from the perspective of a middle-class secondary schoolgirl living in North London in the 1920s. It first considers the use of personal diaries in social science. The article’s particular contribution is to demonstrate the value of diaries to understanding everyday social practices in relation to family life, school and friends and to make sense of them through the intersecting lenses of gender, social class, time and place. The article’s overall argument is that a focus on a particular case enables the researcher to set everyday social practices within a particular social context.

Clinical and cost-effectiveness of an adapted intervention for preschoolers with moderate to severe intellectual disabilities displaying behaviours that challenge: the EPICC-ID RCT.

Stepping Stones Triple P is an adapted intervention for parents of young children with developmental disabilities who display behaviours that challenge, aiming at teaching positive parenting techniques and promoting a positive parent-child relationship. To evaluate the clinical and cost-effectiveness of level 4 Stepping Stones Triple P in reducing behaviours that challenge in children with moderate to severe intellectual disabilities. A parallel two-arm pragmatic multisite single-blind randomised controlled trial recruited a total of 261 dyads (parent and child). The children were aged 30-59 months and had moderate to severe intellectual disabilities. Participants were randomised, using a 3 : 2 allocation ratio, into the intervention arm (Stepping Stones Triple P; n = 155) or treatment as usual arm (n = 106). Participants were recruited from four study sites in Blackpool, North and South London and Newcastle. Level 4 Stepping Stones Triple P consists of six group sessions and three individual phone or face-to-face contacts over 9 weeks. These were changed to remote sessions after 16 March 2020 due to the coronavirus disease 2019 pandemic. The primary outcome measure was the parent-reported Child Behaviour Checklist, which assesses the severity of behaviours that challenge. We found a small non-significant difference in the mean Child Behaviour Checklist scores (-4.23, 95% CI -9.98 to 1.52, p = 0.146) in the intervention arm compared to treatment as usual at 12 months. Per protocol and complier average causal effect sensitivity analyses, which took into consideration the number of sessions attended, showed the Child Behaviour Checklist mean score difference at 12 months was lower in the intervention arm by -10.77 (95% CI -19.12 to -2.42, p = 0.014) and -11.53 (95% CI -26.97 to 3.91, p = 0.143), respectively. The Child Behaviour Checklist mean score difference between participants who were recruited before and after the coronavirus disease 2019 pandemic was estimated as -7.12 (95% CI -13.44 to -0.81) and 7.61 (95% CI -5.43 to 20.64), respectively (p = 0.046), suggesting that any effect pre-pandemic may have reversed during the pandemic. There were no differences in all secondary measures. Stepping Stones Triple P is probably value for money to deliver (-£1057.88; 95% CI -£3218.6 to -£46.67), but decisions to roll this out as an alternative to existing parenting interventions or treatment as usual may be dependent on policymaker willingness to invest in early interventions to reduce behaviours that challenge. Parents reported the intervention boosted their confidence and skills, and the group format enabled them to learn from others and benefit from peer support. There were 20 serious adverse events reported during the study, but none were associated with the intervention. There were low attendance rates in the Stepping Stones Triple P arm, as well as the coronavirus disease 2019-related challenges with recruitment and delivery of the intervention. Level 4 Stepping Stones Triple P did not reduce early onset behaviours that challenge in very young children with moderate to severe intellectual disabilities. However, there was an effect on child behaviours for those who received a sufficient dose of the intervention. There is a high probability of Stepping Stones Triple P being at least cost neutral and therefore worth considering as an early therapeutic option given the long-term consequences of behaviours that challenge on people and their social networks. Further research should investigate the implementation of parenting groups for behaviours that challenge in this population, as well as the optimal mode of delivery to maximise engagement and subsequent outcomes. This study is registered as NCT03086876 (https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis±Angela&draw=1&rank=1). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: HTA 15/162/02) and is published in full in Health Technology Assessment; Vol. 28, No. 6. See the NIHR Funding and Awards website for further award information.

A love letter to the north London working class

A love letter to the north London working class

CADMUS: A Novel MRI-Based Classification of Spontaneous Intracerebral Hemorrhage Associated With Cerebral Small Vessel Disease

Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.

Professionalisation of home economists in Britain from the 1950s to the 1980s: mediating small domestic electrical appliances

ABSTRACT This article explores the role of home economists from the 1950s until the 1980s in relation to small domestic electrical appliances when home economists promoted these small electrical products and began to have a role in their development and evaluation. It is argued that education for home economists and their professional role developed during this period as they became mediators between producers and consumers. It captures the changing role of women in the electricity and appliance industry during the period up to the late 1980s, when the role of the home economist in these areas began to decline. Further and higher education syllabuses were developed and refined in response to the growth of employment opportunities, particularly for home economists in the electricity and appliance industry. This article therefore draws upon both a case study of the Polytechnic of North London home economics syllabuses and an oral history of Jenny Webb, a leading home economist in the electricity industry.

Keeping children within the family: Changing patterns in the use of special guardianship orders

Special Guardianship Orders (SGOs) provide family courts with an alternative to adoption, typically through permanent placement within the extended family. Using court administrative data, this study charts the use of SGOs as a way of promoting stability and recovery for these vulnerable children who cannot remain safely with their parents.
 The study cohort is based on administrative population data produced routinely by Cafcass and accessed via the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University. The unit of analysis is children subject to s.31 care and supervision proceedings in England between 2007/08 and 2021/22, providing a retrospective observational window of fifteen years. Descriptive statistics were used to compare SGOs to other permanency final legal orders (placement, child arrangements, supervision and no order), and survival modelling was employed to look at stability over time and return to court. Finally, regional and over time variations in the data were examined.
 The percentage of children placed on a SGO as a proportion of all children subject to s.31 proceedings rose from 12% to 18% between 2011/12 and 2021/22. Over the same period the percentage of children with a placement order that frees the way for adoption fell from 24% to 14%. This shift in pattern was more pronounced than for any other legal order we examined for children unable to remain with birth parents. The highest usage per region was in the North East and London and the lowest was in the Midlands. We estimate that 9% of children on SGOs would return to court within 10 years. Older children (5-17 years old) were more likely to return to court after SGOs than younger children.
 The study showed that SGOs have become a main route out of public care, outstripping the use of placement orders. These findings have major implications for policy and practice. They demonstrate that special guardianship provides a stable and sustainable permanency option for children unable to remain with their birth parents.