Practice In UK Research Articles

Discussion: Overflow erosion of levees and dams – UK practice and research needs

Discussion: Overflow erosion of levees and dams – UK practice and research needs

‘Powerful knowledge’, ‘cultural literacy’ and the study of literature in schools

AbstractThere is no doubting the influence of E.D. Hirsch and Michael Young on UK education policy and practice over the last ten years. Hirsch’s notion of ‘cultural literacy’ and Young’s idea of ‘powerful knowledge’ are the theoretical drivers of a national shift towards ‘knowledge‐led’ or ‘knowledge‐rich’ school curricula. Evidence of this shift is plain to see in the current iteration of the National Curriculum for England and in the mission statements of a growing number of schools and academy trusts across the country.According to Robert Eaglestone, however, there is a mistake under the floorboards of the new, knowledge‐rich curriculum. It is a mistake that damages and distorts teaching in a number of curriculum subjects, but Eaglestone ‐ a literary critic and theorist ‐ focuses on its disastrous impact on the teaching of literature. Both Hirsch and Young fall prey to scientism: they take knowledge in the natural sciences as a template for knowledge across the board. Eaglestone shows first how scientism is baked into the theories of ‘cultural literacy’ and ‘powerful knowledge’, then how the adoption of these theories in schools has disfigured and diminished the teaching of literature.Eaglestone’s argument is arresting, timely and compelling. For those tasked with planning and teaching English curricula in schools, his penetrating analysis of where things have gone wrong and how to put them right will be revelatory and transformative. And for those concerned with curriculum theory and education policy more generally, it will reinvigorate and reorient the debate about what is helpful and what is not in the work of E.D. Hirsch and Michael Young.

‘Wot do u call it? Doof doof’: Articulations of glocality in Australian grime music

Grime music emerged at the turn of the millennium in the United Kingdom. While grounded and street-level at its outset, the form has since become global in reach. This article focuses on performance practice in the East Australian grime scene and its development over time. Principally, it attends to how MCs and DJs articulate a sense of belonging to both the UK and their local communities in Melbourne and Sydney, through lyrical and musical signification. These articulations are shown to be an example of ‘glocal’ performance practice, which is locally situated yet globally rendering. The article also demonstrates how these artists’ conceptions of legitimate practice are heavily mediated by YouTube videos of canonical UK practice, owing to their geographical dislocation from the genre’s initial point of origin. As a result, radio performances – known as ‘sets’ – and live shows are often prioritized over recorded releases. These findings are supported by interviews with Australian artists, and musical analysis of two key performances: a radio set on Australian broadcaster Triple J from November 2018 and a global grime showcase on London’s Rinse FM from January 2019.

04. ARE WE OVERTREATING BREAST CANCERS FOLLOWING PREVIOUS BREAST AUGMENTATION? LESSONS FROM IBRA

Introduction: Bilateral breast augmentation (BBA) remains the most commonly performed cosmetic operation in the UK, but there is no consensus regarding the surgical management of these patients that subsequently develop breast cancer. We aimed to identify current UK practice regarding mastectomy and IBR in this group and assess its safety profile.

Management of osteoarthritis at the base of the thumb.

Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life. Our aim was to assess current UK practice in secondary care with regard to the nature of non-surgical treatments, the surgical procedures most commonly performed, and factors influencing the surgical decision-making process. Ten consecutive patients undergoing surgery for BTOA between March 2017 and May 2019 were prospectively identified in 15 UK centres. Demographic details, duration of symptoms, radiological grade, non-surgical management strategies, and surgery conducted were recorded. A supplementary consultant questionnaire consisting of four multiple-choice-questions (MCQ) based on hypothetical clinical scenarios was distributed. A total of 150 patients were identified with a mean age of 64 years (SD 9), comprising 119 females and 31 males. Median duration of symptoms prior to surgery was 24 months (Interquartile range (IQR) 12 to 40). Hand therapy was used in 67 patients (45%), splints in 80 (53%), and 121 patients (81%) received one or more intra-articular injections, of which 81 (67%) were image-guided (14 (12%) ultrasound and 67 (55%) fluoroscopic). Only 48 patients (32%) received all three non-surgical treatments. Simple trapeziectomy (79 patients) and trapeziectomy with ligament reconstruction and/or tendon interposition (69 patients) were the most commonly performed operations. One patient was treated with arthrodesis, and one with arthroplasty. The supplementary questionnaire revealed that no specific patient or disease characteristics significantly influenced the type of surgery undertaken. We found considerable variation in practice of both non-surgical and surgical management of BTOA. The proportion of patients exhausting non-surgical strategies before being offered surgery is low. Surgeons tend to favour a single type of surgery irrespective of patient or disease characteristics. Cite this article: Bone Joint J 2020;102-B(5):600-605.

The use of a patch to augment rotator cuff surgery - A survey of UK shoulder and elbow surgeons.

Rotator cuff tears are a common cause of shoulder pain and can result in prolonged periods of pain, disability and absence from work. Rotator cuff repair surgery is increasingly used in an attempt to resolve symptoms but has failure rates of around 40%. There is a pressing need to improve the outcome of rotator cuff repairs. Patch augmentation increasingly being used within the NHS in an attempt to reduce repair failures. The aim of this survey was to determine current UK practice and opinion relating to the factors that influence choice of patch, current patient selection and willingness to assist with generation of improved evidence. An online survey was sent to the surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent demographics, experience with patches, indications for patch augmentation and willingness to be involved in a randomised trial of patch augmented rotator cuff surgery. The response rate was 105/550 (19%). 58% of respondents had used a patch to augment rotator cuff surgery. 70% of patch users had undertaken an augmented repair within the last 6 months. A wide surgical experience in augmentation was reported (ranging 1 to 200 implants used). However, most surgeons reported low volume usage, with a median of 5 rotator cuff augmentation procedures performed. At least 10 different products had been used. Most of the patches used were constructed from human decellularised dermis tissue, although porcine derived and synthetic based patches had also been used. Only 3-5% stated they would undertake an augmented repair for small tears across ages, whereas 28-40% and 19-59% would do so for large or massive tears respectively. When assessing patient suitability, patient age seemed relevant only for those with large and massive tears. Half of the surgeons reported an interest in taking part in a randomised controlled trial (RCT) evaluating the role of patch augmentation for rotator cuff surgery, with a further 22% of respondent's undecided. A variety of patches have been used by surgeons to augment rotator cuff repair with a wide range of operator experience. There was substantial uncertainty about which patch to use and differing views on which patients were most suitable. There is a clear need for robust clinical evaluation and further research in this area.

Does Modernizing Union Administrative Practices Promote or Hinder Union Revitalization? A Comparative Study of US, UK and Australian Unions

AbstractCan a union be both democratic and administratively efficient, or are these goals always at odds? Building on the Webbs’ focus on this critical question, this article analyses and compares the changing administrative policies and practices of US, UK and Australian trade unions over a 25‐year period. We conducted surveys of unions in all three countries to gather information on union policies and practices involving the unions’ human resources, hiring, budgeting and strategic planning. Using these novel longitudinal data, we contribute to industrial relations scholarship by showing that unions have increasingly adopted formal, systematic practices in these areas. The article is grounded in theory and also has practical relevance given the important implications that our findings may have for the revitalization of unions in the three countries and beyond.

Expanding Donor Age Criteria: The UK Experience

Transplant programmes are increasingly considering extended criteria donors, including previous smokers and older-age donors. In January 2018, the UK lung donor offering criteria was increased to 74 years (74 years and 364 days) for both DBD and DCD lung donors, where the donor was a life-time non-smoker or had not smoked within the last 10 years. Prior to this, the upper age limit was 64 years for DCD donors and 69 years for DBD donors. This study aims to assess the impact of the UK extended lung donor age criteria on lung utilisation and transplant. Data were obtained from the UK Transplant Registry on all lung offers from DBD donors over 69 years and DCD donors over 64 years ('older donors'), between January 2018 and September 2019. Utilisation was defined as at least one lung accepted and transplanted. One-hundred and seventy-eight donors meeting the criteria for analysis were identified. Of these, 110 proceeded to donation of at least one solid organ. Lungs were offered from 52 potential DBD donors aged 70-74 years and 126 potential DCD donors aged 65-74 years. Six (11.5%) of the 52 DBD lungs were transplanted and 2 (1.6%) of the 126 DCD lungs were transplanted. Recipient age ranged from 50-66 years. One recipient was listed as urgent at the time of transplant. One-hundred and seventy older donor lung offers were declined. The most common primary reasons for decline recorded were 'past history' (29%), 'poor function' (20%), and 'age' (19%). The cardiothoracic retrieval team attended 28 of the total 178 older donor offers. Although the utilisation rate from older lung donors is low, expanding the donor age criteria in the UK has resulted in an additional 8 transplants, a 1.2% increase. This appears to have benefited the older, non-urgent recipient. Despite the published increases to the donor offering age criteria, 'age' continues to be documented as a reason for organ decline. Further work is required to understand and improve utilisation rates throughout UK lung transplant practice, including the use of older donors. We will continue to review the impact of expanding lung donor age criteria on UK practice, including analysis of recipient outcomes from older age donors.

Strategic investment decision-making practices in large manufacturing companies

Strategic investment decision-making practices in large manufacturing companies

Patient initiated follow up after gynaecological malignancy: National survey of current UK practice

ObjectiveTo establish the prevalence of follow up regimes following treatment for gynaecological malignancies in the UK. Study designOnline questionnaire Survey of gynaecological cancer centres across the UK. All members of the British Gynaecological Cancer Society (BGCS) and the National Forum of Gynaecological Oncology Nurses (NFGON) were invited to complete the survey between 12/07/2018 and 12/04/2019. Responses were grouped into cancer centres for analysis. Results90 % (44/49) of cancer centres from across the UK responded. All centres offer consultant follow up, most commonly for 5 years (77 %). Routine CA125 surveillance was performed for ovarian cancer in 27 % and cervical or vault cytology for cervical cancer in 9 %. Cancer centres also utilised patient initiated follow up (PIFU) (42 %), telephone follow up (36 %) and nurse led follow up (45 %). PIFU was most commonly offered in endometrial cancer (100 %) but also in vulval (26 %), cervical (32 %) and ovarian (26 %) cancer. Timing of PIFU initiation following completion of treatment varied by cancer stage and grade in endometrial cancer. For patients with grade 1 stage 1a endometrial cancer, PIFU was initiated within 3 months in 82 % of centres that use PIFU. ConclusionNon hospital based follow up regimes are increasingly prevalent in the UK following gynaecological malignancy. The appointment and cost savings in secondary care may be significant however there is likely to be a substantial impact on the primary care sector. There is no evidence regarding the impact of PIFU on overall survival and a randomised controlled trial is strongly recommended.

A study to investigate habits with tooth wear assessments among UK and non-UK dental practitioners.

Aim To assess the habits of tooth wear risk assessment and charting using a tooth wear index, by UK and non-UK dental practitioners.Design A questionnaire-based evaluation.Methods Three hundred and two completed questionnaires were returned and the outcomes analysed using descriptives, Chi-squared test and Fisher's exact test in SPSS. Significance was inferred at p <0.05.Results Based on a sample of 297 responses, 81% agreed to the need to undertake risk assessment for all dental patients attending for a first-time consultation. Fifty-nine percent undertook risk assessments for 'new patients' previously identified with signs of severe tooth wear. The routine use of a clinical index to perform tooth wear charting was described by 13.5%, with 5% documenting the frequent use of the BEWE tool. While specialist dental practitioners or those with further post-graduate training were more likely to use a tooth wear index (p <0.05), there were no other significant relationships between any of the variables in the sample and the practising habits assessed.Conclusion This investigation alludes to good levels of professional awareness of tooth wear. However, the need for improvement with the actual undertaking of risk assessments for tooth wear and consistency with tooth wear assessment and charting was determined. The need for appropriate professional guidance for the undertaking of tooth wear assessments is supported by the outcomes of this investigation.

Paediatric Rational Prescribing: A Systematic Review of Assessment Tools.

Rational prescribing criteria have been well established in adult medicine for both research and quality improvement in the appropriate use of medicines. Paediatric rational prescribing has not been as widely investigated. The aims of this review were to identify and provide an overview of all paediatric rational prescribing tools that have been developed for use in paediatric settings. A systematic literature search was made of MEDLINE, Embase, CINAHL and IPA from their earliest records until July 2019 for all published paediatric rational prescribing tools. The characteristics of the tools were recorded including method of development, types of criteria, aspects of rational prescribing assessed, and intended practice setting. The search identified three paediatric rational prescribing tools: the POPI (Pediatrics: Omissions of Prescriptions and Inappropriate Prescriptions) tool, the modified POPI (UK) tool, and indicators of potentially inappropriate prescribing in children (PIPc). PIPc comprises explicit criteria, whereas POPI and the modified POPI (UK) use a mixed approach. PIPc is designed for use in primary care in the UK and Ireland, POPI is designed for use in all paediatric practice settings and is based on French practice standards, and the modified POPI (UK) is based on UK practice standards and is designed for use in all paediatric practice settings. This review describes three paediatric rational prescribing tools and details their characteristics. This will provide readers with information for the use of the tools in quality improvement or research and support further work in the field of paediatric rational prescribing.

Let's Talk: African Caribbean Women, Mothering Motherhood, and Well-Being.

In the UK, African Caribbean women's experiences of mothering and motherhood are often studied in isolation from how “race” structures and shapes their lives and everyday health and well-being. This failure to connect women's wellbeing and racialized injustices also occurs in debates around “gangs” and “urban gun crime” (UGC). The women's experiences and the effects on their health and well-being are absented from the discussions. This paper, based on my doctoral research, uses an intersectional analysis to explore the views of mothers engaged in community activities to limit “urban gun crime.” Like me, they defined themselves as of Black Caribbean heritage and we created “spaces” where we could “reason,” share experiences of womanhood, motherhood and mothering in a racist society and centre what is habitually ignored. They highlight the importance of getting mothering “right” with the stress and anxiety about the dire consequences of getting it “wrong.” They show their love, commitment and aspirations for their child/ren and the emotional and intellectual labor needed in their daily strategies to keep them from harm caused by state institutions and life “on road.” The research confirms the impact of “race,” racialization and racism to our lives and experiences of health and well-being and raises critical questions for the dominant and normative views of mothering and/ or motherhood that underpin UK policy and practice.

Complaints: traditional and modern considerations

What follows is obviously based on UK practices but, no doubt, similar circumstances apply elsewhere. Informal complaints, ‘dissatisfactions’, can often be resolved by prompt face-to-face explanations with detailed listening and...

New psychoactive substances: Pharmacology influencing UK practice, policy and the law.

This review covers the last 20 years of UK drug control policy leading up to the recent Psychoactive Substances Act. It explores policy decision made in relation to MDMA and mephedrone that not only were associated with increased drug harms overall but also had a significant detrimental effect on the UK research base. The new UK legislation on synthetic cannabinoids and other novel psychoactive substances threatens to do the same, showing that there is still much to learn from the decisions of the past. In future input from academic societies such as the BPS could help improve policy evaluation and policy development and so help avoid such problems in the future.

Smith and Aitkenhead’s Textbook of Anaesthesia, 7th ed

Smith and Aitkenhead’s Textbook of Anaesthesia, 7th ed

Improving post-resuscitation care after out-of-hospital cardiac arrest

Introduction:The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries.Aims:This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres.Methods:Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes.Results:Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur.Conclusion:Further research into specific care pathways and centralised care should be carried out, and an OHCA post-resuscitation care pathway should be developed to improve the delivery of care and survival.

An investigation of the vitamin D Knowledge, Attitudes and Practice of UK practising doctors and nurses: the D-KAP study

An investigation of the vitamin D Knowledge, Attitudes and Practice of UK practising doctors and nurses: the D-KAP study

Surgical resection of breast cancer liver metastases: A snapshot of UK practice

Background: Liver is the third most common site of breast cancer metastases. Resection of breast cancer liver metastases (BCLM) is a treatment option which remains controversial. Recently there is increased interest in offering liver resection for BCLM. However, the evidence remains low quality. This study aims to review the current practice of UK Hepato-pancreato-biliary (HPB) units regarding hepatic resections for BCLM as part of setting up a protocol for a multicentre randomised control trial. Materials and Methods: HPB units across UK were asked to take part in an online survey comprised of 11 questions. The questionnaire covered three years of clinical practice up to 2015. The survey was voluntary and anonymous. Results: 26 HPB units responded including 5, 19 and 2 from Scotland, England and Northern Ireland respectively. Majority of the HPB units performed more than 50 liver resections and up to 30 radiofrequency ablations (RFA) for all types of liver cancers per year. 75% of the HPB units performed less than 5 liver resections or RFA procedures for BCLM over the three years period. Out of 26 HPB units, 23 showed interest to participate in the RCT. Conclusion: Liver resections for BCLM are infrequently performed in the UK. There is an inclusive interest of participation in a future RCT.

Pancreaticoduodenectomy in octogenarians: A UK multicentre case-control study

Presenter: Joseph Attard MD, MSc, MRCSEd | Queen Elizabeth Hospital Background: As a result of the ageing population, pancreaticoduodenectomy is increasingly being offered as curative therapy for periampullary tumours in patients 80 years of age and older. Our aim was to evaluate clinical outcomes and provide evidence on current UK practice in the elderly population after pancreaticoduodenectomy. Methods: A multicentre retrospective case-control analysis of prospectively-maintained databases was performed. This included pancreaticoduodenectomies undertaken between January 2008 and December 2017. Octogenarians who underwent pancreaticoduodenectomy were matched with consecutively-operated younger patients with 1:1 ratio, based on extent of surgery (venous, arterial or additional resection). Pre-operative comorbidities, intra-operative variables, post-operative complications and mortality were compared. Chi-Square, Fisher’s Exact and Mann-Whitney U tests were used as appropriate to compare variables and outcomes between the two groups, with statistical significance set at p<0.05. A survival analysis, using Kaplan-Meier estimators, was also performed to determine overall survival as well as disease-free survival. Results: Six UK specialist HPB centres participated in this study. 181 octogenarians (median age 81 years, range: 80 - 90) who underwent pancreaticoduodenectomy (either classical or pylorus-preserving) were compared to the same number of controls (median age 67 years, range: 31 - 79). Gender and ASA (octogenarians median grade 2 [range: 1 - 4] versus median grade 2 [range: 1 - 3] for controls) were comparable (p=0.75 and p=0.82 respectively). The distribution of performance status scores (octogenarian median score 0 [range: 0 - 3] versus median score 0 [range: 0 - 2] for non-octogenarians) was found to be significantly different (p=0.02). Similarly, Charlson Comorbidity Index scores were significantly higher overall for octogenarians (median 7 [range: 6 - 11] versus 5 [range: 2 -9], p=0.001). Ninety-nine percent of octogenarians and 97% of controls were offered upfront resection. The remainder underwent neoadjuvant treatment prior to surgery. Median length of hospital stay was longer in octogenarians, 17 days (range: 3 – 120 days) compared to 13 days (range: 5 – 81 days) for controls (p=0.001). Negative resection margin (R0) rates were comparable for the two groups, 61% for octogenarians and 58% for controls (p=0.57), as were lymph node ratios, median 0.1 (range: 0 – 0.8) for octogenarians and 0.095 (range: 0 – 1) for controls, p=0.77. Complication rates across the Clavien-Dindo classification categories were not statistically significant (p>0.05 in all categories). Thirty-day mortality was 3 % for octogenarians and 2% for controls (p=0.54). Ninety-day mortality was 7% for octogenarians versus 3% for controls. This difference was not statistically significant (p=0.1). A survival analysis revealed that, while median overall survival was significantly longer for controls, 59 months versus 23 months for octogenarians, (p=0.006); disease-free survival was not statistically different between both groups, with a median of 19 months for octogenarians and 28 months for controls (p=0.22). Median follow-up was 13 months (range: 0 – 100) for octogenarians and 17 months (0 – 111) for controls. Conclusion: Despite the higher ninety-day mortality, pancreaticoduodenectomy outcomes in octogenarians are comparable to their younger counterparts. Pancreaticoduodenectomy should therefore be offered as a curative surgical option in this cohort, in specialised centres after meticulous preoperative assessment.