Northern Region Of England Research Articles

Economic growth before the Industrial Revolution: Rural production and guilds in the European Little Divergence

This paper explains how England became a high-income economy from the 15th to 18th centuries. The appropriate level of natural land suitability in the northern region of England before the Industrial Revolution was pivotal in weakening guilds’ power and the diffusion of rural manufacturing. Unlike other European countries, those elements turned into a more efficient allocation of capital between cities and the rural areas and a more efficient shift of labor time from agriculture to manufacturing in the countryside, resulting in a higher income per capita by 1750.

EP-583 Review of lower limb orthoplastic flap monitoring protocol

Abstract Aim To improve upon the existing muscle and fascio-cutaneous flap monitoring protocol. The objective is to follow the patient's journey from the time of admission up to discharge and then follow up, in a tertiary care hospital in the Northern region of England, United Kingdom. Method The patients were selected from the online plastic surgery audit tool regularly used for documentation, handover and maintaining continuity of care. We looked at the patients requiring free muscle flaps, pedicled muscle flaps and fascio-cutaneous flaps, following fractures sustained to the lower limb, from April 2016 to April 2021. The exclusion criteria were elective free flaps or pedicled flaps and open fracture with no wound management concerns. The parameters being evaluated were patient observations, flap observations, urine output, bloods, intravenous fluids, patient-controlled analgesia, oxygen, dressing, nutrition, mobility and follow up. Following analysis of the results, a more standardised protocol was distributed across the wards. The response to the new monitoring protocol was measured based on continuity of care, staff satisfaction and outcomes. Results There was an initial need for standardisation of monitoring protocols and elimination of multiple charts. This included the nutrition status, use of blood products, dressings and physiotherapy, in addition to the previously mentioned parameters. Conclusion The staff feedback was positive and felt better equipped. It removed the ambiguity and patients were aware of their follow up dates prior discharge. The collaboration with the physiotherapy team was well coordinated. This led to an organised recovery period.

Recommendations for delivering oral health advice: a qualitative supplementary analysis of dental teams, parents\u2019 and children\u2019s experiences

BackgroundTooth decay has a significant impact on children, their families and wider society. The dental consultation provides an opportunity to prevent tooth decay by engaging in an effective oral health conversation with parents and children. However, there is limited literature which explores how these oral health conversations are delivered, received, and understood.AimTo explore the common facilitators of delivering oral health advice from dental teams, parents' and children's experiences, to identify and inform practical recommendations for clinical practice.MethodThe current paper used a qualitative supplementary analysis to reanalyse data of existing published studies by applying a different research question. Qualitative focus groups were undertaken following a semi-structured interview guide with 27 dental team members (dentists, dental nurses, practice managers and receptionists), 37 parents and 120 children (aged 7–10 years old) in the northern region of England. Thematic analysis informed the identification of themes and aggregation of findings.ResultsThree overarching themes were developed: (1) An engaging and personalised dental visit for parents and children; (2) Dental teams, parents and children working collaboratively to improve oral health habits; and (3) Recommending appropriate oral health products. Many parents and children had little recollection of any preventive oral health conversations when visiting the dentist. Practical solutions were identified by different stakeholders to facilitate three-way, personalised, non-judgemental and supportive oral health conversations. Adopting these innovative approaches will help to enable parents and their children to adopt and maintain appropriate oral health behaviours.ConclusionUnderstanding the context and triangulating the experiences of stakeholders involved in preventive oral health conversations for young children is an essential step in co-designing a complex oral health intervention. This study has provided recommendations for dental practices and wider paediatric health care services. Furthermore, the findings have informed the design of a complex oral health intervention called "Strong Teeth".

Implementation and Evaluation of a Standardized Non-Vitamin K Oral Anticoagulant (NOAC) Patient Safety Alert Card Across the Northern Region of England.

Many patients are prescribed anticoagulants. Newer non–vitamin K oral anticoagulants, NOACs, were launched in 2008 and are increasingly commonly used. However, they may still be unfamiliar to patients and health care professionals. It is mandated by the National Patient Safety Agency and European Society of Cardiology to provide written safety information for patients receiving anticoagulants. We developed a standard patient alert card with the support of the North of England Strategic Clinical network (NESCN) to clearly provide key safety information for patients and health care professionals. This is the only card in the United Kingdom that is used over such a wide geographical area. We recognized that this would avoid duplication of work devising a similar card across all the sites in primary and secondary care. Given that staff and patients commonly move about the region it would also lead to better ease of recognition. The NESCN card was developed with input from all the key stakeholders, including cardiology, stroke, hematology, acute medicine, primary care, and patient groups. It was launched in 2015 across the Northern region, which includes over 3 million people. It was distributed to general practitioners (GPs), primary and secondary care pharmacists. Electronic and face-to-face education was carried out alongside to pharmacists, GPs, and hospital physicians. We gathered patient and clinical staff feedback regarding the card and found the alert card was widely embedded within practice across the region and patient feedback was good. The evaluation shows a simple and inexpensive intervention delivered with no formal funding can address this patient safety concern. We have engaged with Clinical Commissioning Groups and secondary care trusts in the region to ensure the legacy of the project. In response to requests from other regions and organizations, the card has been widely shared and implemented across many areas of the United Kingdom.

The Clinicians’ Skills, Capability, and Organisational Research Readiness (SCORR) Tool

A research-active healthcare workforce contributes to improved quality of care. Clinicians may be unaware that they are applying early research skills during their everyday practice. Greater understanding of their level of research attainment may improve their awareness and confidence in their research skills. This article describes the development of the Clinicians Skills, Capability, and Organisational Research Readiness (SCORR) Tool, a simple innovation that assesses and captures research skills and attainment at 1) clinician, and 2) organisational level. The SCORR Tool was initially developed to assess levels of research attainment and to promote discussion during annual appraisals for podiatrists working across secondary and community care in a northern region of England. The levels (1 to 5) of attainment recognise UK Health and Care Professions Council (HCPC) registration requirements for chiropodists/podiatrists (Standards 12 to 14). Following testing and feedback, research levels were adapted (Levels 0 to 5) to accommodate all healthcare professionals (with the exception of doctors and dentists). The SCORR Tool may be used individually by clinicians, or in collaboration with their manager, to better understand the level of research attainment and to prompt discussion to increase research activity. It may also be used across a workforce (e.g. during an appraisal) to understand the organisational research readiness. The SCORR Tool requires additional testing and evaluation to validate it as a tool for use across a variety of organisational environments.

Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study

ObjectiveThe positive deviance approach seeks to identify and learn from exceptional performers. Although a framework exists to apply positive deviance within healthcare organisations, there is limited guidance to support its...

Double hit lymphoma in the northern region of England—A retrospective analysis of patient and disease characteristics, treatment delivered and survival

Double hit lymphoma in the northern region of England—A retrospective analysis of patient and disease characteristics, treatment delivered and survival

Acute paediatric paraplegia: A case series review

Paediatric paraplegia resulting from spinal cord pathology of any cause is rare; hence prognostic information for children less than 16 years is limited. This case series review aims to ascertain all cases of paediatric paraplegia from 1997 to 2012 in the former Northern Region of England. MethodsChildren presenting with sudden paraplegia before the age of 16 years were multiply ascertained from databases in the regional paediatric neurology, neuroradiology, neuro-oncology and adult spinal injuries units. Data were obtained from retrospective case note review. ResultsA total of 44 cases (24 female) were identified. The incidence is estimated at 0.49 per 100,000 children under 16/year (95% confidence interval 0.41–0.57). Mean age of onset was 8.8 years and the most common aetiology was inflammatory. Twelve months post presentation, mortality was zero and a good outcome (defined as Gross Motor Function Classification System grades I or II) was seen in 66.6%. Motor outcome at 12 months was associated with the presence of bladder/bowel signs at presentation, previous viral illness and initial severity of paraplegia. Bladder signs at presentation were the strongest predictor of prognosis (OR for poor motor outcome 10.3). We were unable to demonstrate a relationship between aetiology and late outcome. ConclusionPaediatric paraplegia is rare. Mortality rates are low and 66.6% have a good outcome with fully or nearly independent walking. Bladder signs are the strongest predictor of prognosis.

The epidemiology of arrhythmia in infants: A population‐based study

Cardiac arrhythmias are an important cause of morbidity in infants. Although the spectrum of types of arrhythmia has been reported, there has been no previous population-based study of the incidence of arrhythmias in infancy. Our aim was to define the population incidence of arrhythmia in infants. We based this study on the Northern Region of England with a resident population of 3.1 million and an annual live birth rate of 33,000. We identified all clinically significant arrhythmias in infants in 1991-2010 from the regional cardiac database. All diagnoses were based on analysis of the electrocardiogram. Infants with only the substrate for arrhythmia (such as QT prolongation or ventricular pre-excitation) were excluded. In 20 years, there were 662,698 live births. We identified 162 cases of newly diagnosed arrhythmia of which 22 had associated structural cardiovascular malformations. The incidence of arrhythmia was 24.4 per 100,000 live births. The most common arrhythmia was atrioventricular re-entry tachycardia with an incidence of 16.3 per 100,000. Complete atrioventricular block and atrial flutter both occurred at 2.1 cases per 100,000 live births, and other arrhythmias were rare. This study is the first to report a population incidence of arrhythmia in infants.

PWE-188 Using a “conversion factor” to estimate adenoma detection rate

IntroductionAdenoma detection rate (ADR) is the recommended surrogate marker for a thorough colonoscopic examination. Collecting histology makes its calculation arduous so polyp detection rate (PDR) is often used instead. It...

Space–time clustering of elevated thyroid stimulating hormone levels

Previous studies of congenital hypothyroidism (CHT) have reported an increasing incidence which may suggest that environmental factors play an aetiological role. If so, then cases may exhibit space-time clustering, where cases occur at similar times and close proximities to other cases. In this study we investigated whether space-time clustering of elevated thyroid stimulating hormone (TSH) in newborns exists. All infants born in the Northern Region of England are screened by measuring levels of circulating TSH using a blood spot assay. Data on 207 cases of elevated TSH values, as a proxy for CHT, in newborns born from 1994 to 2006 inclusive were available and analysed using rigorous space-time clustering statistical methods. Analysis showed statistically significant evidence of space-time clustering. The strength of clustering was most marked for cases born within 0.1-0.7 year (1-8 months) of one another. This is the first study to find significant space-time clustering of cases of elevated TSH levels in newborns, a surrogate for space-time clustering of CHT. Whilst the reasons for the clustering are unclear, it would appear from this analysis that transient environmental exposures are likely to be involved, although environmental determinants of genetic mutations and epigenetic factors cannot be ruled out. Further research is required to a) validate these results in other populations and b) to assess in more detail the potential environmental determinants of increased CHT risk.

Impact of deprivation on short- and long-term outcomes after colorectal cancer surgery

The aim of the study was to determine the association between short- and long-term outcomes and deprivation for patients undergoing operative treatment for colorectal cancer in the Northern Region of England. This was a retrospective analytical study based on the Northern Region Colorectal Cancer Audit Group database for the period 1998-2002. The Index of Multiple Deprivation 2004, an area-based measure, was recalibrated and used to quantify deprivation. Patients were ranked based on their postcode of residence and grouped into five categories. Of 8159 patients in total, 7352 (90·1 per cent) had surgery; 6953 (94·6 per cent) of the 7352 patients underwent tumour resection and 4935 (67·7 per cent) of 7294 had a margin-negative (R0) resection. Deprivation was not associated with age, sex, tumour site, stage or other tumour-related factors. Compared with the most affluent group, the most deprived patients had fewer elective operations (72·9 versus 76·4 per cent; P = 0·014), more adverse co-morbidity (P < 0·001) and fewer curative resections (65·5 versus 71·2 per cent; P < 0·001). In multivariable analysis, deprivation was not an independent predictor of postoperative death (odds ratio (OR) 0·72, 95 per cent confidence interval 0·48 to 1·06; P = 0·101) but it was a predictor of curative resection (OR 1·24, 1·01 to 1·52; P = 0·042), overall survival (HR 0·83, 0·73 to 0·95; P = 0·006) and relative survival (HR 0·74, 0·58 to 0·95; P = 0·023). Deprivation, both independently and by influencing other surgical predictors, impacts on short- and long-term outcomes of patients with colorectal cancer.

The Outcome of Expectant Management of Congenital Cystic Adenomatoid Malformation of the Lung

INTRODUCTION: The appropriate management of asymptomatic congenital cystic adenomatoid malformations of the lung (CCAM) remains controversial. The aim of this study is to determine the outcome of expectant management of these lesions and the sensitivity of antenatal ultrasound diagnosis. MATERIAL AND METHODS: A retrospective review was undertaken of all cases identified from prospectively collected databases with an antenatal or postnatal diagnosis of CCAM in the Northern region of England between 1985 and 2006 where such lesions underwent resection only when symptomatic. RESULTS: Thirty-seven cases of confirmed CCAM were identified antenatally or postnatally. Twenty-six (70%) were identified by antenatal ultrasound scans (during a period of near-universal antenatal scanning), of whom 21 (81%) were liveborn. In total, 16 of 29 (55%) liveborn infants with CCAM were symptomatic, and either died within the first postnatal week or underwent resection. Thirteen (45% of livebirths) were managed expectantly and remained asymptomatic. The sensitivity of antenatal ultrasound screening for CCAM increased over the period to 90% in the latter half of the study (p=0.035), although the positive predictive value (66%) did not improve. CONCLUSIONS: Expectant management was a reasonable option for almost half of the babies, but over one third required surgery for CCAM, most becoming symptomatic in infancy. In view of the uncertainty that surrounds decisions regarding expectant or pre-emptive resection in asymptomatic infants, the authors advocate having an open and honest discussion when counselling parents (particularly antenatally) regarding surveillance or expectant management as a reasonable strategy.

Evaluation of enteropathy-associated T-cell lymphoma comparing standard therapies with a novel regimen including autologous stem cell transplantation

AbstractEnteropathy associated T-cell lymphoma (EATL) is a rare type of peripheral T-cell lymphoma. At present, there are no standardized diagnostic or treatment protocols for EATL. We describe EATL in a population-based setting and evaluate a new treatment with aggressive chemotherapy and autologous stem cell transplantation (ASCT). From 1979 onward the Scotland and Newcastle Lymphoma Group prospectively collected data on all patients newly diagnosed with lymphoma in the Northern Region of England and Scotland. Between 1994 and 1998, records of all patients diagnosed with EATL were reviewed, and 54 patients had features of EATL. Overall incidence was 0.14/100 000 per year. Treatment was systemic chemotherapy (mostly anthracycline-based chemotherapy) with or without surgery in 35 patients and surgery alone in 19 patients. Median progression-free survival (PFS) was 3.4 months and overall survival (OS) was 7.1 months. The novel regimen IVE/MTX (ifosfamide, vincristine, etoposide/methotrexate)–ASCT was piloted from 1998 for patients eligible for intensive treatment, and 26 patients were included. Five-years PFS and OS were 52% and 60%, respectively, and were significantly improved compared with the historical group treated with anthracycline-based chemotherapy (P = .01 and P = .003, respectively). EATL is a rare lymphoma with an unfavorable prognosis when treated with conventional therapies. The IVE/MTX-ASCT regimen is feasible with acceptable toxicity and significantly improved outcome.

Abstract 2237: Expression of the trefoil protein TFF3 in human breast cancers

Abstract Expression of the trefoil protein TFF3 in human breast cancers The purpose of this study is to investigate expression of the trefoil factor family protein, TFF3 in a large series of human breast cancers. Trefoil factors are small secreted proteins that are expressed in mucus secreting epithelia. They are involved in mucosal protection in part by stimulation of cell motility. It has been proposed that the motogenic actions of trefoil proteins may facilitate tumor cell invasion and metastasis. Expression of TFF3 mRNA is regulated by estrogen in human breast cancer cell lines and strong association between estrogen receptor and TFF3 mRNA expression has been demonstrated in breast tumors by expression microarray analyses. A tissue microarray was constructed from 300 primary breast tumors and 76 metastatic deposits of breast tumors from patients who presented in the northern region of England between 2002 and 2003. TFF3 expression was evaluated by immunohistochemistry with an antibody raised against correctly-folded human TFF3 protein. Each sample was analyzed in duplicate. The intensity of the immunoreactions in 1,000 tumor cells was evaluated as: absent, weak, moderate or strong. The association of TFF3 expression with various clinico-pathological features and with estrogen receptor protein expression was tested statistically with SPSS software (p&amp;lt;0.01). Clear TFF3 expression is demonstrated in normal and malignant breast epithelial cells. There is no expression in stromal, endothelial or immune cells. Expression of TFF3 varied enormously between tumor samples. TFF3 expression is highest in mucinous and tubular breast adenocarcinomas. TFF3 is expressed at higher levels in lobular than in ductal breast cancers. TFF3 expression is associated strongly with estrogen receptor expression. There is a negative association between TFF3 expression and tumor grade. There is however a positive association between TFF3 expression and presence of vascular invasion and TFF3 expression is higher in metastatic breast tumor cells than in primary breast tumor cells. This is the first report of TFF3 protein expression in a large series of human breast tumors. The strong association between TFF3 and estrogen receptor suggests that TFF3 expression is dependent on estrogen in a significant proportion of breast tumors. The high expression of TFF3 in breast tumors with vascular invasion and in metastatic breast tumor cells supports the hypothesis that TFF3 predisposes towards breast cancer cell invasion. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2237.

The Outcome of Expectant Management of Congenital Cystic Adenomatoid Malformations (CCAM) of the Lung

The appropriate management of asymptomatic congenital cystic adenomatoid malformations of the lung (CCAM) remains controversial. The aim of this study is to determine the outcome of expectant management of these lesions and the sensitivity of antenatal ultrasound diagnosis. A retrospective review was undertaken of all cases identified from prospectively collected databases with an antenatal or postnatal diagnosis of CCAM in the Northern region of England between 1985 and 2006 where such lesions underwent resection only when symptomatic. Thirty-seven cases of confirmed CCAM were identified antenatally or postnatally. Twenty-six (70%) were identified by antenatal ultrasound scans (during a period of near-universal antenatal scanning), of whom 21 (81%) were liveborn. In total, 16 of 29 (55%) liveborn infants with CCAM were symptomatic, and either died within the first postnatal week or underwent resection. Thirteen (45% of livebirths) were managed expectantly and remained asymptomatic. The sensitivity of antenatal ultrasound screening for CCAM increased over the period to 90% in the latter half of the study (p=0.035), although the positive predictive value (66%) did not improve. Expectant management was a reasonable option for almost half of the babies, but over one third required surgery for CCAM, most becoming symptomatic in infancy. In view of the uncertainty that surrounds decisions regarding expectant or pre-emptive resection in asymptomatic infants, the authors advocate having an open and honest discussion when counselling parents (particularly antenatally) regarding surveillance or expectant management as a reasonable strategy.

PTH-021 A survey of endoscopy workload in northern England: lower gastrointestinal endoscopy workload exceeds British Society of Gastroenterology projections

Introduction The BSG working party report on the Provision of Endoscopy Related Services in District General Hospitals (2001) made clear projections of the estimated endoscopic workload in an average district general hospital.1 The Northern Region Endoscopy Group (NREG) is a network connecting all endoscopy units in the North East of England with the aim of promoting collaboration and endoscopy based research. The aim of this study was to measure current endoscopic workload in the Northern Region Endoscopy Goup and compare it to the BSG recommendations. Methods Questionnaires were sent to each of the 16 endoscopy units within the Northern Region of England. Completed questionnaires were received from all 16 endoscopy units in nine trusts. Results The total population served by endoscopy units within NREG is 3.5 million people. Ninety-five thousand endoscopic procedures were performed across the region last year, 45 194 (47%) were upper GI, 27 541 (29%) colonoscopies, 17 912 (19%) flexible sigmoidoscopies and 2688 (3%) were ERCPs. Across the region 13 gastroscopies per 1000 population, 7.9 colonoscopies, 5.1 flexible sigmoidoscopies and 0.77 ERCPs were performed per 1000 population per annum. Conclusion Current endoscopic workload figures for upper GI endoscopy and ERCP are in line with the BSG working party9s estimations of 2001. The burden of lower GI work within the Northern Region is greater than the BSG predictions with nearly twice as many procedures as predicted being performed. Contributing factors include changing referral practices, the Bowel Cancer Screening Programme, and more widespread open access services. Current lower GI endoscopy workload figures are considerably higher than those quoted in the NICE document “Improving Outcomes on Colorectal Cancers” (2004)2 and the Royal College of Physicians publication “Consultant Physicians Working with Patients” (2004).3 Current workload is in line with Healthcare commission9s 2006 survey.4 The implications of these data include: Financial and manpower planning needs to take into account the increased burden on endoscopy services. The BSG estimates for lower GI endoscopy workload should be revised. A similar evaluation of changes in endoscopy workload should be performed at a national level. Abstract submitted on behalf on the Northern Region Endoscopy Group (NREG).

Increasing Incidence, but Lack of Seasonality, of Elevated TSH Levels, on Newborn Screening, in the North of England

Previous studies of congenital hypothyroidism have suggested an increasing incidence and seasonal variation in incidence, which may suggest nongenetic factors involved in aetiology. This study describes the incidence of elevated thyroid stimulating hormone (TSH) values in newborns, a surrogate for congenital hypothyroidism, measured as part of the screening programme for congenital hypothyroidism, over an eleven-year period (1994–2005), and assesses whether seasonal variation exists. All infants born in the Northern Region of England are screened by measuring levels of circulating TSH using a blood spot assay. Data on all 213 cases born from 1994 to 2005 inclusive were available. Annual incidence increased significantly from 37 per 100,000 in 1994 to a peak of 92.8 per 100,000 in 2003. There was no evidence of seasonal variation in incidence. The reasons for the increasing incidence are unclear, but do not appear to involve increasing exposure to seasonally varying factors or changes in measurements methods.

Prevalence of genetic muscle disease in Northern England: in-depth analysis of a muscle clinic population.

We have performed a detailed population study of patients with genetic muscle disease in the northern region of England. Our current clinic population comprises over 1100 patients in whom we have molecularly characterized 31 separate muscle disease entities. Diagnostic clarity achieved through careful delineation of clinical features supported by histological, immunological and genetic analysis has allowed us to reach a definitive diagnosis in 75.7% of our patients. We have compared our case profile with that from Walton and Nattrass' seminal study from 1954, also of the northern region, together with data from other more recent studies from around the world. Point prevalence figures for each of the five major disease categories are comparable with those from other recent studies. Myotonic dystrophies are the most common, comprising 28.6% of our clinic population with a point prevalence of 10.6/100,000. Next most frequent are the dystrophinopathies and facioscapulohumeral muscular dystrophy making up 22.9% (8.46/100,000) and 10.7% (3.95/100,000) of the clinic population, respectively. Spinal muscular atrophy patients account for 5.1% or 1.87/100,000 patients. Limb girdle muscular dystrophy, which was described for the first time in the paper by Walton and Nattrass (1954) and comprised 17% of their clinic population, comprises 6.2% of our clinic population at a combined prevalence of 2.27/100,000. The clinic population included patients with 12 other muscle disorders. These disorders ranged from a point prevalence of 0.89/100 000 for the group of congenital muscular dystrophies to conditions with only two affected individuals in a population of three million. For the first time our study provides epidemiological information for X-linked Emery-Dreifuss muscular dystrophy and the collagen VI disorders. Each of the X-linked form of Emery-Dreifuss muscular dystrophy and Ullrich muscular dystrophy has a prevalence of 0.13/100,000, making both very rare. Bethlem myopathy was relatively more common with a prevalence of 0.77/100,000. Overall our study provides comprehensive epidemiological information on individually rare inherited neuromuscular conditions in Northern England. Despite the deliberate exclusion of relatively common groups such as hereditary motor and sensory neuropathy (40/100,000) and mitochondrial disorders (9.2/100,000), the combined prevalence is 37.0/100,000, demonstrating that these disorders, taken as a group, encompass a significant proportion of patients with chronic disease. The study also illustrates the immense diagnostic progress since the first regional survey over 50 years ago by Walton and Nattrass.

Twenty-year survival of children born with congenital anomalies: a population-based study

To estimate the survival, up to age 20 years, for a range of congenital anomaly groups and subtypes. Population-based registry (Northern Congenital Abnormality Survey, NorCAS). The former Northern Region of...