Scoping Survey Research Articles

Exploring the Challenges of Recruiting Older People for a Randomised Trial Assessing the Feasibility of Treating White Coat Hypertension in the UK General Practices: A Mixed-methods study.

There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients > 75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow-up study, we sought to explore the reasons for not recruiting. Furthermore, using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS), UK, were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics. Nineteen (19) individuals responded to the online questionnaires (15 primary care staff, 4 CRN staff). Moreover, using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes are established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient- facing study documents, limited research resources in primary care, and identification of eligible patients using existing coding. Our experience showed that recruiting older people from primary care to a WCH study was not feasible. A national scoping survey amongst primary care physicians in the UK, as well as robust patient and public involvement (PPI) targeting older people with WCH, might improve recruitment in future studies addressing the management of WCH in older people.

Chronic health conditions and disability are prevalent among community users of a digital mental health service: a scoping survey

Objectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions. Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively. Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility. Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.

O-111 Premature ovarian insufficiency: new data and updated guidance

Abstract Premature ovarian insufficiency (POI) presents a significant challenge to women's health, with significant implications both physically and emotionally. Despite its life-altering impact, there remain substantial unknowns in the causes this condition and how to optimally manage its various sequelae While such unknows provide direction for future research, they also underscore the need for clinical guidance. In 2015, under the auspices of ESHRE, a group of experts evaluated the existing best evidence and published the first European guideline on the management of premature ovarian insufficiency. The update of this Guideline was performed in an international collaboration of experts representing American Society for Reproductive Medicine (ASRM), International Menopause Society (IMS), and the Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL). The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including musculoskeletal health, cardiovascular health, neurological health, sexual function and general well being, and treatment options, including hormone therapy. The list of clinical questions was expanded from the questions included in the guideline from 2015. Based on a scoping survey and appreciation of emerging knowledge of POI, questions were added on the role of AMH in the diagnosis of POI, fertility preservation, muscle health, and specific considerations for hormone treatment in iatrogenic POI. Additionally, the topic on complementary treatments was extended with specific focus on non-hormonal treatments and lifestyle management options. The draft guideline published for stakeholder review includes a total of 142 recommendations. One third of these recommendations were formulated as good practice points. Of the evidence-based recommendations, almost 80% were formulated as strong recommendations, even if the evidence base for most evidence-based recommendations was limited to observational data (level very low or low), supporting a call for future research. The guideline group hope that the new POI Guideline will improve the clinical management of this devastating condition.

Electro-Mechanical Engineer Degree Level Apprenticeships: An initial reflection on improving distance-learner engagement and motivation

This concept paper discusses the proposed implementation of learning supports via motivational scaffolding as method for improving engagement and motivation of Electro-Mechanical Engineering degree-level apprentices at the University of Nottingham. The paper focuses on a block-release programme where a large proportion of learning occurs online asynchronously. These apprentices have generally entered degree-level study from background vastly different from typical undergraduate students. Combined with the management of their normal job with their university study, there is a step-change in mind set required to be successful on the programme. Anecdotal feedback has previously suggested that around half of the apprentices on the programme found it challenging to settle into a successful work pattern within the first 6 weeks of the programme. The proposed intervention aims to provide learners with the environment to learn and excel rather than spending time finding the study materials, or working out what is required of them. The intervention was developed in conjunction with a focus group of apprentices and a scoping survey released to all cohorts on the programme. The success of the intervention will be evaluated over the next academic year through further feedback surveys, focus group discussions and comparison of grades and engagement of online content.

Unveiling beekeepers’ use and preference of precision apiculture systems

Amid growing ecological concerns surrounding honey bee colony mortality, Precision Apiculture Systems (PAS) emerge as promising monitoring tools to safeguard bee health as well as to improve the beekeeping practices and economic sustainability of apiary operations. These systems offer critical insights into colony dynamics, aiding decision-making processes in beekeeping. Despite a surge in relevant academic research, knowledge of actual PAS usage and preference among beekeepers remains limited. To fill this gap, a standardized survey was conducted among beekeepers in France, Germany, and Greece. This focused geographical scope survey aimed to determine the extent of current and potential PAS adoption, the motivations behind usage or avoidance, and ascertain future preferences. Among the 538 respondents, 45% reported utilizing some form of PAS, with beekeeping scales being the most commonly used. The study revealed that the use of PAS positively correlates with both the number of hives managed and the distance of the apiary from the beekeeper’s residence. Overall, 90% of respondents expressed a certain degree of satisfaction with their use of PAS, although the high costs of these tools were identified as a primary obstacle to broader adoption. About 48% of the beekeepers preferred systems with external sensors, highlighting a clear demand for non-invasive health-related colony information. The advantages that foster PAS usage include decision-making support and improved efficiency in monitoring colony growth and honey productivity. These findings can assist in making PAS more accessible to beekeepers, with the aim to enhance colony performance and decision-making capabilities, thus addressing honey bee colony mortality.

Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom.

Limb reconstruction surgery (LRS) has a wide range of clinical applications within orthopaedic and trauma surgery. We sought a consensus view from limb reconstruction healthcare practitioners across the United Kingdom to help guide research priorities within LRS. Our aim is to guide future clinical research in LRS, and assist healthcare practitioners, clinical academics, and funding bodies in identifying key research priorities to improve patient care. A modified Delphi approach was used; it involved an initial scoping survey and a 2-round Delphi process to identify the consensus research priorities in both adult and paediatric LRS. Participants were asked to rank approved submitted questions according to perceived importance on a 5-point Likert scale, where 1 represented lowest importance and 5 indicated highest importance. Mean scores were calculated to identify a consensus of the top ten research priorities for adult and paediatric LRS. One hundred and fifteen participants primarily from across the United Kingdom working in LRS contributed to the modified Delphi process. Participants ranked and then re-ranked the presented research topics in terms of perceived importance. This led to the identification of a top ten research priorities in both adult and paediatric LRS, respectively, based on the collective responses of LRS practitioners. The highest-ranked questions in both adult and paediatric practice related to how to best assess and record patient-reported outcome measures (PROMs) in LRS patients. Other priorities included the effectiveness of specialist physiotherapy, the use of patient-focused psychological support, and the use of various operative management strategies for infection and limb length discrepancies. We present a consensus-driven research priority study that outlines the key research topics and themes determined by healthcare professionals within LRS in the United Kingdom. These questions will assist funding bodies in prioritising where research funding may be best utilised and help drive future improvement in patient care. British Limb Reconstruction Society Research Collaborative. Identifying Research Priorities in Limb Reconstruction Surgery in the United Kingdom. Strategies Trauma Limb Reconstr 2024;19(1):1-8.

A Scoping Survey to Inform Design of Digital Dementia Risk Reduction Interventions for Adults Concerned about their Cognitive Health.

Digital dementia risk reduction interventions are cost-effective and scalable. However, it is unknown how they are perceived by people already experiencing cognitive concerns or decline. To understand the current use, interest, and preferences for online learning courses and interest in learning about factors influencing brain health and dementia risk among adults ≥45. To explore potential differences between individuals experiencing cognitive concerns and those without. Adults aged 45 and older completed a survey on technology use and healthy ageing (n = 249, Mean age = 65.6, 76.3% female). The Memory Assessment Clinic-Questionnaire was used to assess subjective memory decline, and 153 participants met the study criteria for cognitive concerns (≥25). Almost all participants (98.4%) reported using two or more digital devices, and 51.8% reported increasing device usage following COVID-19. Most (92.1%) were interested in learning about healthy living and memory within an online course, and over 80% indicated a high interest in learning about dementia risk factors. People with cognitive concerns were more likely to report using a 'routine or system' to aid memory than people without (82.4% versus 62.9%, p = 0.001). However, no significant difference was found in technology use, course preferences, or interest in learning about different risk factors. We conclude that adults 45 years and over are interested in online methods for learning about brain health and offer unique insights into adapting dementia prevention programs for cognitive concerns.

Perceived Barriers Toward Patient-Reported Outcome Implementation in Cancer Care: An International Scoping Survey.

Implementation of patient-reported outcomes (PROs) collection is an important priority in cancer care. We examined perceived barriers toward implementing PRO collection between centers with and without PRO infrastructure and administrators and nonadministrators. We performed a multinational survey of oncology practitioners on their perceived barriers to PRO implementations. Multivariable regression models evaluated for differences in perceived barriers to PRO implementation between groups, adjusted for demographic and institutional variables. Among 358 oncology practitioners representing six geographic regions, 31% worked at centers that did not have PRO infrastructure and 26% self-reported as administrators. Administrators were more likely to perceive concerns with liability issues (aOR, 2.00 [95% CI, 1.12 to 3.57]; P = .02) while having nonsignificant trend toward less likely perceiving concerns with disruption of workflow (aOR, 0.58 [95% CI, 0.32 to 1.03]; P = .06) and nonadherence of PRO reporting (aOR, 0.53 [95% CI, 0.26 to 1.08]; P = .08) as barriers. Respondents from centers without PRO infrastructure were more likely to perceive that not having access to a local PRO expert (aOR, 6.59 [95% CI, 3.81 to 11.42]; P < .001), being unsure how to apply PROs in clinical decisions (aOR, 4.20 [95% CI, 2.32 to 7.63]; P < .001), and being unsure about selecting PRO measures (aOR, 3.36 [95% CI, 2.00 to 5.66]; P < .001) as barriers. Heat map analyses identified the largest differences between participants from centers with and without PRO infrastructure in agreed-upon barriers were (1) not having a local PRO expert, (2) being unsure about selecting PRO measures, and (3) not recognizing the role of PROs at the institutional level. Perceived barriers toward PRO implementation differ between administrators and nonadministrators and practitioners at centers with and without PRO infrastructure. PRO implementation teams should consider as part of a comprehensive strategy including frontline clinicians and administrators and members with PRO experience within teams.

MSW program directors in the United States: a scoping survey of responsibilities, preparation, and support

ABSTRACT A survey of Master of Social Work (MSW) program directors in the United States investigated their current role including their environment, tasks and preparation, and support. Most respondents were untenured when they assumed the role, only 20% were head of their unit, and few had received any training. Despite working an average of 50 hours a week, lack of time for scholarship and managing competing priorities were top stressors, while joys included their students and colleagues. Respondents identified their top training needs as conflict management, their role as middle managers, and finance-related topics. While the vast majority felt supported by their colleagues and their administration, a number of those with marginalized gender and racial identities experienced difficulties, both within and outside of their program, due to these identities. These data indicate a precarious state of the preparedness of MSW program leadership. Role stressors may place tenure-track program directors at risk of not attaining promotion as time for scholarship may be lost to administrative responsibilities, while non-tenured individuals may be ill-positioned to advocate for their program. Providing adequate training and support, especially for those with marginalized identities, is needed to ensure a solid MSW program director workforce.

Exploring the State of Natural language Processing: A Survey of Recent Advances, Challenges and Future Scope

Abstract: Recent developments in deep learning have largely been responsible for the excellent performance on benchmark datasets of natural language processing algorithms. These advancements have greatly enhanced the capabilities of NLP systems utilised in programmes like sentiment analysis, speech recognition, and virtual assistants. However, the vulnerability of these systems to adversarial attacks has revealed the limitations in their robustness and language understanding abilities, which poses challenges when deploying NLP systems in real-world scenarios. This study provides a thorough analysis of studies on NLP robustness, providing a structured overview across multiple dimensions. We explore a variety of robustness-related topics, including as methodologies, measures, embedding, and benchmarking. Moreover, it emphasizes the need for a multidimensional perspective on robustness and offer insights into ongoing research efforts while identifying gaps in the literature. We propose potential directions for future exploration aimed at addressing these gaps and enhancing the robustness of NLP systems.

1983 Exploring barriers to recruiting older people to a white-coat hypertension study

Abstract Introduction There is a recognised association between white coat hypertension (WCH) and adverse cardiovascular outcomes in older adults. However, there is no consensus on the management of WCH in this group. The objective of the Hypertension in the Very Elderly Trial (HYVET-2) study was to assess the feasibility of randomising 100 patients &amp;gt;75years with WCH from General Practice in the UK to treatment or usual care. The study did not randomise any patients. In this follow up study, we sought to explore the reasons for not recruiting. Methods Using a mixed-methods study design, staff from 29 General Practice (GP) sites and the Clinical Research Network (CRN) in Kent, Surrey, and Sussex (KSS) were sent an online questionnaire about local research facilities and infrastructure, and HYVET-2 study methodology and target population demographics. Results Nineteen (19) individuals responded the questionnaires (15 primary care staff, 4 CRN staff). Using a framework approach, we identified six themes summarising challenges to HYVET-2 recruitment. These themes were: established approaches of primary care towards managing WCH in older people, target patient demographics, study design complexity, patient-facing study documents, limited research resources in primary care and identification of eligible patients using existing coding. Conclusion Our experience showed that recruiting older people to a WCH study from primary care was not feasible. A national scoping survey amongst primary care physicians in the UK, and a robust patient and public involvement (PPI) targeting older people with WCH might improve recruitment in future studies of WCH in older people.

Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: A mixed-methods study protocol.

The COVID-19 pandemic has raised concerns about the global capacity for timely outbreak reporting. However, gaps remain in our understanding of barriers and enablers to outbreak reporting, particularly at the local level. Field epidemiology training program (FETP) fellows often participate in the outbreak reporting process as part of both their training and the public health roles they assume after graduating; they therefore represent a potentially valuable source of information for better understanding these barriers and enablers. This study will investigate the barriers and enablers to outbreak reporting through a mixed methods approach that will encompass a review of the existing literature as well as surveying and interviewing FETP trainees and graduates from the Asia-Pacific region. This study will begin with a scoping review of the literature to identify existing evidence of barriers and enablers to outbreak reporting. Based on our findings from the scoping review, we will administer a survey to FETP trainees and graduates from the World Health Organization Western Pacific and South-East Asian Regions and conduct interviews with a subset of survey respondents to investigate the survey findings in more detail. We will summarise and compare the survey results according to various country-level economic and political indicators, and we will employ thematic analysis to evaluate the interview responses. Based on the findings from the scoping review, survey, and interviews, we will construct a model to comprehensively describe the various barriers and enablers to outbreak reporting. This study will contribute to our understanding of the determinants of outbreak reporting across several geographic, political, and economic contexts by eliciting the viewpoints and experiences of persons involved with outbreak reporting, particularly at the local level. This information will help improve the outbreak reporting process, allowing for more timely reporting and helping prevent future outbreaks from becoming pandemics.

Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services.

This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. A structured questionnaire including a self-assessment scale to measure teams' adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation. The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision. The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts.

A consensus process to identify research priorities in paediatric urology in the United Kingdom

Paediatric urologists manage a spectrum of conditions, much of the evidence for relevant treatment pathways is of low quality. For many conditions treatment varies according to location and surgeon; children with the same condition might have surgery in one unit but watchful waiting in another. Underlying this variation are differences in opinion, and insufficient high-level evidence with few prospective randomized studies. Such studies may be challenging to design, fund and recruit into, and are more likely to succeed if there is a collaborative approach. Research prioritization is a tool to identify the research of most value. Delphi methodology is an interpretive technique aiming to gain the consensus view of interested parties. The British Association of Paediatric Urologists (BAPU) set out to ascertain consensus on what paediatric urologists, working in the UK, consider to be areas of priority for research. This paper describes the process used, and the resulting list of research questions. A scoping survey of paediatric urologists in the UK was undertaken to identify an initial set of research questions. These were refined by the BAPU research committee (BAPU RC), then prioritized using a modified Delphi process. During Stage 1a multiple new research questions were submitted leading to Stage 1b, an interim process. All UK paediatric urologists were invited to take part in Stage 2 of the prioritization process. Sixty-five questions were submitted to the scoping survey by 24 paediatric urologists. The BAPU RC refined these to 60 questions, which were submitted to Stage 1a of the modified Delphi process. Sixty-seven people completed Stage 1a, at the same time submitting 224 additional research questions. The BAPU RC revised the entire question set, ensuring the key subject of the original question was not altered and novel questions were retained. The BAPU RC undertook interim scoring of the resultant 79 questions, the top scoring 25 questions plus 5 lower scoring 'wild card' questions (to ensure the breadth of the specialty was represented) were put forward to Stage 2. A total of 65 people completed Stage 2, including a lay representative. A list of 30 priority research questions was generated; the top 10 includes management of neuropathic bladder, posterior urethral valves, antibiotic prophylaxis, DSD & CAH, continence, male external genitalia, VUR and transition care (Table). This process has provided BAPU, paediatric urologists in the UK, and funders with areas of research considered a priority in the specialty.

Recommendations to align higher education teaching with the UN sustainability goals – A scoping survey

Global challenges such as climate change, limited resources, and an ever-growing world population demonstrate a perceptible impact on the lives of people around the globe. To tackle the arising issues and to enable peace and prosperity in the future, the United Nations (UN) have defined 17 interlinked sustainable development goals. A major facilitator to achieve these goals is considered through education. Consequently, higher education institutes have started to align their curricula with sustainable development. Yet, lesser attention has been paid to teaching methods themselves. Hence, in this paper, a scoping survey is performed on how higher education teaching can be inspired by the UN sustainable development goals, specifically, by a summarized subset of 7 goals: (1) Tackle Poverty, (2) Enable Good Health and Well-Being, (3) Establish Quality Education, (4) Reduce Inequalities, (5) Embrace Environmental Sustainability, (6) Foster Innovation, and (7) Establish Partnerships. Overall, the discussed recommendations show a promising potential towards having a positive impact on higher education, yet, also unveil conflicts between different goals. Nevertheless, this paper could provide an orientation to critically reflect on current means of higher education teaching.

Intersections of informal work status, gender and tuberculosis diagnosis: Insights from a qualitative study from an Indian setting.

There is evidence that more than one third of tuberculosis (TB) cases in India go undiagnosed each year and it is more pronounced among female patients. While there are studies available on the socioeconomic, cultural and gender-related dimensions of TB diagnosis delays among female patients in India, intersections of gender, informal work and diagnosis delays are not sufficiently studied. The present study aims to fill this gap by examining the TB diagnosis delay that are linked to the contingencies of working in informal arrangements for women from lower socio economic background. The study draws on 80 qualitative in-depth interviews conducted among female patients from lower socio-economic background, who were working or recently stopped working in informal arrangements and undergoing Directly Observed Therapy, Short-course (DOTS) treatment in Bengaluru (India) city and 60 willing significant others of the patients. The participants were identified through a scoping survey that covered 188 female patients from 18 DOTS centres in the city. Other than the already known reasons for the delay in TB diagnosis for women such as normalisation of symptoms, stigma and the gender-related discrimination leading to low prioritisation of women's illness, the present study identifies reasons related to work informality. These are normalisation of symptoms as workplace health problems; work related concerns that restricted formal help seeking; non TB specific narratives of symptoms, often incorrectly assumed to be work related health issues or comorbidities and thus confounding the early accurate diagnosis by the medical personnel and shifting between formal and informal systems of help-seeking. Further, the study found that mere knowledge of TB symptoms did not always translate to early diagnosis for patients from the lower socioeconomic groups working in informal arrangements due to the fear of losing work and wages owing to hospital visits. The workplace focus, especially the informal sector where a huge majority of India's workforce is employed, is notably absent in the TB elimination programme. The study indicates the need to adopt a comprehensive approach in the ongoing TB elimination programme in India in which family, living environment and workplace should be integral parts.

P049 The need for a funded, national HLH service: a scoping survey assessing the provision of specialist HLH services across the UK

Abstract Background/Aims Haemophagocytic lymphocytosis (HLH) is a multi-system hyperinflammatory syndrome with high mortality. Early treatment and multi-disciplinary team (MDT) management improves outcomes. In 2021, NHS England released guidelines for HLH treatment with anakinra; these mandate MDT discussion prior to treatment. HLH is rare and expertise varies throughout the UK, causing potential inequality in access to care. This scoping study aimed to assess HLH service provision across the UK. Methods An online survey was designed and disseminated via professional networks, including Hyperinflammation and HLH across specialty collaboration (HiHASC) members (www.hihasc.org) and contacts at individual hospitals. Quantitative data were analysed using SurveyMonkeyTM analysis. The survey was created to inform national service development, response was voluntary and data have been anonymized. Results 93 survey responses were obtained from 80 healthcare trusts, including three in Scotland and two in Wales. Responses covered 39/42 integrated care boards (ICBs) in England, representing all 7 clinical commissioning regions. Respondent’s specialties included Rheumatology, Haematology, Paediatrics, and Intensive Care. In 33% (13/39) of ICBs, Scotland and Wales no formal HLH provision existed; management relied on individual practice or informal discussions. 36% (14/39) of ICBs utilised ad hoc MDTs to manage HLH. Formal provision of HLH MDTs existed in 31% (12/39) of ICBs although these did not cover all trusts in the ICB. Only one MDT had a paid administrator.20% (n = 16) of trusts had an agreed HLH guideline; 7 were developed locally and 9 utilised external guidelines. Anakinra had been prescribed for HLH in 31% of trusts since 2021. Prescribing requirements were satisfied via ad hoc discussions in 33% of trusts, local Haematology or Rheumatology MDTs in 24% of trusts, and involvement of tertiary centres in 7% of trusts. A further 25% of trusts used a single HLH MDT for anakinra discussions. Only 10% (n = 8) of consultants had HLH included in job plans. A further 36% (n = 29) wanted this. 96% (n = 69) of respondents would value a national or regional HLH MDT. 20% (n = 14) of respondents offered to lead an MDT, with a further 53% (n = 37) willing to offer expertise. The most frequently proposed model for this MDT was a regular, online meeting with advance referrals. The largest barrier to MDT participation was lack of time. Other barriers included limited exposure to HLH and lack of funding or paid administrative support. Conclusion Specialist HLH services are inconsistently provided throughout the UK, suggesting inequitable access to care. Many ICBs rely on ad hoc HLH provision or have no formal HLH service. In areas providing HLH MDT services, these are often outside of job plans and lack administrative support. There is unsustainable reliance on a single centre. Strong support exists for national or regional HLH MDTs, which will require funding. Disclosure M.F. Cox: None. J.J. Manson: None. R.S. Tattersall: None.

Return to sport after forearm fractures in children: A scoping review and survey.

A common question faced by clinicians is when a child may return to sport after treatment for a pediatric forearm fracture. There are few published recommendations and fewer supported by evidence. The aims of this study were to summarize existing published recommendation for return to sport after pediatric forearm fractures and to conduct a survey to determine usual clinical recommendations. A scoping review was performed on Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar in accordance with the Joanna Briggs Institute guidelines. In addition, 64 orthopedic surgeons were anonymously surveyed asking for recommendations regarding return to sport after pediatric forearm fractures. Participants were to assume children were 9 years old and played a sport with an average risk of forearm injury. Twenty-two publications for return to sport were retrieved. Children with distal radius buckle fractures safely commonly returned to sport by 4 weeks after initial injury, while survey respondents recommended over 6 weeks. Survey respondents valued fracture stability the highest when making return to sport recommendations. Children with simple, metaphyseal, single-bone fractures were usually allowed to return to sport at 8-10 weeks post-injury. Diaphyseal and complete fractures were prescribed longer return to sport intervals. Australian respondents also prescribed longer return to sport intervals. Children with distal radius buckle fractures may return to sport by 4 weeks after initial injury, sooner than recommended. Published recommendations remain limited for other fractures. However, our survey suggests children with simple, metaphyseal, single-bone fractures may return to sport at 8-10 weeks. Children with diaphyseal and complete fractures should abstain from sport for longer than metaphyseal and greenstick fractures, respectively. level V.

Arctic Heritage at Risk: Insights into How Remote Sensing, Robotics and Simulation Can Improve Risk Analysis and Enhance Safety

Increased and enhanced utilisation of remote sensing and robotics in the Arctic can further enhance cultural safety and well-being and reduce the risks posed to archaeologists, heritage workers and others in the field. In this preliminary scoping survey, the authors review the current use of these technologies and consider a range of related issues, from cultural safety to nefarious use by criminals. Initial discussions with experts have informed areas of concern; and the potential for further integration. In the future, the University of Tromsø’s new Tromsø Arctic Simulation Integration Centre (TASIC) will be utilised to evaluate a range of scenarios to inform risk analysis and contribute towards safety enhancement in the Arctic Heritage at Risk Project (Arctic-HARP). The following is an overview of the significant state-of-the-art technologies and related matters.

Perinatal mental health in medical school curricula: a national scoping survey of British universities and student psychiatry societies.

With increasing recognition of the prevalence and impact of perinatal mental health (PMH) disorders comes a responsibility to ensure that tomorrow's doctors can support families during the perinatal period. Online surveys seeking information about the inclusion of PMH education in undergraduate curricula were sent to psychiatry curriculum leads and student psychiatry societies from each university medical school in the UK between April and September 2021. Responses were received from 32/35 (91.4%) medical schools. Two-thirds reported specific inclusion of PMH content in the core curriculum, typically integrated into general adult psychiatry or obstetric teaching. Students at the remaining schools were all likely to be examined on the topic or see perinatal cases during at least one clinical attachment. PMH education offers an opportunity for collaboration between psychiatry and other disciplines. Future work looking at educational case examples with objective outcomes would be valuable.