UK Aim Research Articles

The development of international wound debridement best practice recommendations: Consensus between nurses specialized in Wound, Ostomy and Continence Canada and the society of tissue viability

Debridement is an important component of wound management and can improve outcomes for patients. Debridement needs to be done by an appropriately trained health professional, but the scope of practice, credentials, training, competencies, and regulatory requirements regarding wound debridement can differ. Best Practice Recommendations were created to positively influence patient safety related to all methods of debridement, across the continuum of care, and to be implemented widely by nurses at all professional levels in Canada. AimTo further develop the Best Practice Recommendations for wound debridement, with an international perspective, by creating a consensus document to support the global adoption of evidence-based debridement practice for health professionals. MethodsA consensus meeting utilising Delphi methods was conducted between the authors to review the consensus statements. Once 80 % agreement was achieved, a wide range of wound care experts were identified by the authors and invited to participate in an external review of the statements. ResultsFifteen consensus statements about wound debridement were agreed upon and are presented in this paper. ConclusionsThese best practice recommendations have been reviewed by a wide range of practitioners from across the UK and Canada and aim to provide guidance on the standardisation of debridement practices for healthcare professionals.

Online gambling among young men: a rising tide?

Young people, in particular young men, are at risk of harm from gambling. Indeed, gambling disorder is a neglected public health issue. Recent government proposals in the UK aim to address the problem, but they may not be enough. In this article the authors explore the complex issues around gambling disorder, especially as it relates to online gambling, including some of the factors that put young men at greater risk.

Assessing protective factors to prevent post-discharge violent behaviour: Towards an assets-based approach for clinical risk management

Medium secure forensic psychiatric units (MSUs) in the UK aim to be recovery-oriented to enable discharge to community-based services. Risk assessments are key to discharge planning, but clinical practice tends to focus on risk factors for violence rather than protective factors associated with a decrease in risk. The aims of this study were to investigate the reliability and validity of the Structured Assessment of Protective Factors (SAPROF) as a useful measure to support an assets-based approach when planning discharge from MSUs. A prospective cohort follow-up design was chosen for this study using a confidential inquiry design to ensure a total sample of all discharges. All forensic patients discharged from 32 NHS MSUs over a 12-month period were assessed at discharge and followed-up at six and 12 months post discharge. The occurrence and frequency of post-discharge violence were compared with discharge SAPROF scores. The inter-rater reliability between SAPROF raters was very high and the SAPROF significantly predicted community violence and scores were strongly correlated with violence frequency. The higher the SAPROF score the higher the protection against violence and the risk significantly diminished. Assessing protective factors is essential to identify assets and prevent violence with a focus on what makes somebody safe. This study supports the use of the SAPROF to inform discharge planning. Cultivating protective factors is likely to be motivating for patients and the SAPROF can provide an objective, reliable measure of internal, motivational and external assets that reduce risk and support defensible decision making at discharge.

Parents’ experiences of their child's assessment on an epilepsy surgery pathway: A qualitative study

PurposeChildren's epilepsy surgery services (CESS) in the UK aim to improve outcomes for young children by increasing access to surgery. Consideration for surgery is complex and time consuming, yet there is lack of research exploring how this process might impact on families. This study aimed to explore parents’ experiences of their child consideration for epilepsy surgery to inform future service development and delivery. MethodsSemi-structured interviews with parents of children (aged < six years) considered for surgery within the previous three years. Recruitment was through social media and purposive sampling of medical records. Data were analysed using a thematic and iterative approach. Results15 parents of 14 children were interviewed (13 mothers and 2 fathers). Initial discussions of epilepsy surgery were described as ‘shocking’ but also as a source of hope. However, unclear communication between staff and parents, including lack of information about the steps, assessments/investigations and timeframes involved in the process of assessment for surgery led to some feeling ‘out of control,’ uncertain and in some cases distressed. Parents described examples of positive support from staff, yet many felt they needed additional general and emotional support throughout the epilepsy surgery pathway. ConclusionsFindings highlight the importance of providing clear and consistent information about the epilepsy surgery assessment to minimise parental distress and help facilitate a sense of control. Recommendations include providing parents with advance warning that surgery will be discussed at their next appointment, improved access to psychosocial and clinical psychological support and a step-by-step guide of the process with realistic timelines.

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Assessing Protective Factors to Prevent Post-Discharge Violent Behaviour: Towards an Assets-Based Approach for Clinical Risk Management

Background: Medium secure forensic psychiatric units (MSUs) in the UK aim to be recovery-oriented to enable discharge to community-based services. Risk assessments are key to discharge planning, but clinical practice tends to focus on risk factors for violence rather than protective factors associated with a decrease in risk. The aims of this study were to investigate the reliability and validity of the Structured Assessment of Protective Factors (SAPROF) as a useful measure to support an assets-based approach when planning discharge from MSUs. Method: A prospective cohort follow-up design was chosen for this study using a confidential inquiry design to ensure a total sample of all discharges. All forensic patients discharged from 32 NHS MSUs over a 12-month period were assessed at discharge and followed-up at six and 12 months post discharge. The occurrence and frequency of post-discharge violence were compared with discharge SAPROF scores. Findings: The inter-rater reliability between SAPROF raters was very high, the SAPROF significantly predicted community violence and scores were strongly correlated with violence frequency. The higher the SAPROF score the higher the protection against violence and risk significantly diminished. Interpretation: Assessing protective factors is essential to identify assets and prevent violence with a focus on what makes somebody safe. This study supports the use of the SAPROF to inform discharge planning. Cultivating protective factors is likely to be motivating for patients and the SAPROF can provide an objective, reliable measure of internal, motivational and external assets that reduce risk and support defensible decision making at discharge. Funding: The study was funded by The National Institute for Health Research Programme Grants for Applied Research programme. Declaration of Interest: None to declare. Ethical Approval: The North West England Multi Site Research Ethics Committee approved the study.

Psychologists’ perspectives on the contribution of psychology to acute adult mental health inpatient, crisis response home treatment and mental health liaison services

Background There are significant pressures and quality issues in acute adult mental health services in the UK Aims To understand the contribution of psychologists in acute services to patient care and service quality. Methods Forty-nine psychologists with experience in Adult Mental Health Inpatient Services, Crisis Resolution Home Treatment Teams and Liaison Mental Health Services responded to a questionnaire-based survey. Results The first theme “Direct interventions” identified the value of psychological assessment, formulation and adapted brief interventions. The second theme “Indirect Interventions”, viewed psychology as an integral part of the Multi-Disciplinary Team, enabling psychologically informed care, increasing psychological skills in the workforce and supporting staff wellbeing. The third theme outlined a lack of psychological resources in services and limited understanding about their potential benefits. The potential of increased resources to promote psychologically informed cultures, staff wellbeing, and improve patient choice through greater access to psychological treatments was noted. Conclusions This is the largest UK study of psychologists within acute mental health care, identifying benefits for patients and services. Further research is needed on the impact of psychological interventions on patient outcomes and workforce wellbeing.

Evaluating the uptake rate of the flu vaccination during pregnancy in England

Maternal vaccination programmes in the UK aim to protect pregnant women and their young babies against seasonal influenza and babies from birth against pertussis. However, the rate of uptake flu vaccination during pregnancy in England was only 42.3% in 2015-16.

Consequences of Brexit and options for a 'Global Britain’

AbstractThe United Kingdom has opted to leave the European Union. The consequences of Brexit on international trade are large and negative. While the UK aims for new, ambitious trade agreements after Brexit, it is not explicit about the type of agreements it envisions or with whom specifically. This paper considers the UK's options. We confirm Brexit's substantial, negative trade effects for the UK, EU, and major countries around the world. After reviewing all potential options, our answer to the question whether the UK has an alternative for the existing agreement with the EU is: No. Paradoxically, only a trade agreement with the EU can compensate for Brexit's trade losses.

Sanctuary Cities: Policies and Practices in International Perspective

AbstractSanctuary cities in the USA, UK, and Canada aim to accommodate illegalized migrants and refugees in their communities. The concept of the “sanctuary city,” however, is highly ambiguous: it refers to a variety of different policies and practices, and focuses on variable populations in different national contexts. In this article, I examine the international literature to show how urban sanctuary policies and practices differ between national contexts and assess whether there are common features of sanctuary cities. I uncover legal, discursive, identity‐formative, and scalar aspects of urban sanctuary policies and practices. These aspects assemble in ways that differ between countries. The article concludes by raising important practical and theoretical questions about urban sanctuary.

CR-18A REVIEW OF VISUAL OUTCOMES IN CHILDHOOD CRANIOPHARYNGIOMA TREATED WITH A HYPOTHALAMIC SPARING, SURGICAL AND RADIATION STRATEGY

CR-18. A REVIEW OF VISUAL OUTCOMES IN CHILDHOOD CRANIOPHARYNGIOMA TREATED WITH A HYPOTHALAMIC SPARING, SURGICAL AND RADIATION STRATEGY Victoria Smith1, Bronwen Walters1, Alki Liasis1, Kristian Acquilina1, Helen Spoudeas1, Katrina Prise1, Christos Moraitis1, and Richard Bowman1,2; Great Ormond Street Hospital, London, UK; UCL Institute of Child Health, London, UK AIM: To review visual outcomes in childhood craniopharyngioma. METHOD: Retrospective longitudinal case review. RESULTS: 27 (19M) patients diagnosed at mean age 88 months and followed for 26 months. VISUAL ACUITY: At first assessment 2 patients were classified as blind, (light perception & 1.325) and one having low vision (limited following) employing the WHO classification (binocular vision). Post-intervention one patient remained blind (no light perception) and 2 had low vision (1.10, 0.60). A further 6 patients had monocular vision loss (worse than 1.30) at presentation versus 7 post-intervention. Older children tended to have better visual acuity pre and post treatment (p 1⁄4 0.05). 20 (74%) patients retained final binocular vision of 0.20 LogMAR or better. VISUAL FIELDS: 9 children underwent Goldmann kinetic perimetry in at least one eye (17 eyes) graded by Wall and George classification. At diagnosis 6 (36%) eyes had minimal or mild loss, 9 eyes (53%) had moderate loss and 2 eyes (11%) had marked loss. Post-intervention 3 (17%) eyes showed no visual field loss, 6 (36%) eyes had minimal or mild loss and 8 (47%) eyes showed moderate loss. Grades improved/ were stable in 15 eyes (89%) and deteriorated in 2 (11%). OPTIC ATROPHY: Optic disc pallor was similar between first and last visit, 56% versus 50%. CONCLUSIONS: Although visual field loss and optic pallor are common most children retain good vision in at least one eye and where formal testing was possible, field deficits improved/ stabilised in most eyes (15/17). Neuro-Oncology 18:iii18–iii23, 2016. doi:10.1093/neuonc/now068.18 #The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Gemcitabine-loaded and antibody-tagged superparamagnetic iron oxide nanoparticles as targeted drug vehicles in pancreatic cancer cell lines

S. Nandi, P. D. Sykes, E. Hasan, C. Rubbi, M. Barrow, J. P. Neoptolemos, E. Costello, M. Rosseinsky and C. M. Halloran University of Liverpool, UK Aims: Despite advances in the surgical management and adjuvant chemotherapy, pancreatic cancer still has a very poor prognosis. Nanotechnology provides a novel approach for targeted drug delivery, possibly reducing the offset effects of systemic chemotherapy. Superparamagnetic iron oxide nanoparticles (SPIONs) are inorganic particles that can be functionalised as targeted drug vehicles with a stealth polymer coating and a specific antibody tag to recognise appropriate antigen expressing cells. Our aim is to develop and investigate the effects of SPIONs capable of targeted cell death of pancreatic cells by release of its chemotherapy payload. Methods: Micellar SPIONs, incorporating a gemcitabine pro-drug, conjugated to isotype and anti-CA19.9 antibodies (NP:CA19.9) were manufactured using self assembly methodology. Cellular uptake was assessed using transmission electron and co-localisation fluorescent microscopy. Antigen expression of cell lines was determined using indirect immunofluorescence. Antibody targeting was assessed using EZ4U cytotoxicity assay in BxPC-3 (Ca-19-9 +ve) and MiaPaCa-2 (Ca-19-9 -ve) cell lines. Results: Endocytosis of the SPIONs was demonstrated by their presence in endosomes and corroborated by colocalisation analysis (Manders coefficient = 0.92). The IC50 of gemcitabine was significantly improved using a nanohybrid attached with specific antibody targeting in BxPC-3 cells (10.245I/4 M vs 5.143I /4 M) [p < 0.001] but absent in MiaPaCa-2 cells (2.322I/4 M vs 2.486I /4 M) [n = 3]. Conclusions: We have developed a novel nanohybrid to target antigen expressing pancreatic cancer cells using a specific antibody tag. When loaded with modified gemcitabine, these SPIONs act as pH-triggered delivery vehicles capable of intracellular drug release. This could reduce off target effects leading to increased chemotherapy agent efficacy and offer the prospect for new treatments in pancreatic cancer.

The role of guideline reinforcement in improving quality of referrals to a specialist breast clinic

The role of guideline reinforcement in improving quality of referrals to a specialist breast clinic

Rural hospital outcomes versus non-rural hospital outcomes following emergency laparotomy: A Scottish retrospective cohort study

Rural hospital outcomes versus non-rural hospital outcomes following emergency laparotomy: A Scottish retrospective cohort study

Audit of pharyngeal pouch surgery in derby from 2007–2014, are we following nice guidance?

Audit of pharyngeal pouch surgery in derby from 2007–2014, are we following nice guidance?

An audit cycle of consent form completion to improve training and service standards in a regional hand centre

An audit cycle of consent form completion to improve training and service standards in a regional hand centre

Does addition of a pericardial drain in patients undergoing isolated aortic valve replacement reduce post-operative complication: A comparative study of single versus two drains in the early post-operative period?

Does addition of a pericardial drain in patients undergoing isolated aortic valve replacement reduce post-operative complication: A comparative study of single versus two drains in the early post-operative period?

Non-consultant hospital doctors in Ireland; A survey of satisfaction in training

Non-consultant hospital doctors in Ireland; A survey of satisfaction in training

Opportunity for cardiovascular risk factor reduction in AAA surveillance programs: a systematic review and meta-analysis of cardiovascular mortality in patients with small AAA

Opportunity for cardiovascular risk factor reduction in AAA surveillance programs: a systematic review and meta-analysis of cardiovascular mortality in patients with small AAA

Sepsis in emergency surgical patients: Is management optimal?

Sepsis in emergency surgical patients: Is management optimal?