Practice In UK Research Articles

Return to work following arthroscopic supraspinatus repair: a survey of UK practice

Return to work following arthroscopic supraspinatus repair: a survey of UK practice

A Survey of UK Centres on Low Iodine Diet Recommendations prior to Radioiodine Ablation Therapy for Differentiated Thyroid Cancer

Background: Guidelines suggest that a low iodine diet (LID) is advised prior to radioiodine ablation (RIA) for thyroid cancer. We aim to describe current practice regarding LID advice in the UK, determine uptake of the 2016 UK LID Working Group diet sheet and discover whether there are differences in practice. Methods: We used an online survey distributed between November 2018 and April 2019 to centres in the UK that administer ¹³¹I. We asked questions on whether a LID is advised, for how long, how advice is presented, whether and how compliance is measured and whether treatment is delayed if LID advice is not followed. Results: Fifty-six clinicians from 47 centres that carry out RIA for thyroid cancer responded. Forty-four centres (94%) advise a LID prior to RIA, the majority for 14 days (82%). Two-thirds of the centres use the UK LID Working Group diet sheet. Patients are told to resume normal eating when ¹³¹I is administered at 17 centres (39%), with 18 (41%) advising waiting for 24–48 h after administration. Most centres (95%) use only a simple question or do not assess compliance. Only 2 (5%) indicate that RIA would be delayed if someone said they had not followed LID advice. Conclusions: UK practice regarding LID prior to RIA for thyroid cancer is consistent with current guidelines, but non-adherence does not usually delay RIA. The UK Low Iodine Diet Working Group diet sheet is widely recognised and used. Practice could be improved by centres working to harmonise advice on when to restart a normal diet.

2019 Special Issue: Psychological Wellbeing and Distress in Higher Education

Many universities around the world have now initiated wellbeing strategies that encompass psychological wellbeing. These resources can be leveraged for change to better support students. Associate Professor Lydia Woodyatt from Flinders University, Adelaide and Dr Abi Brooker from the University of Melbourne are guest editors for this very special issue which includes a collection of articles from scholars and practitioners in Australia, Canada, the US, UK and Germany addressing student (and staff) psychological wellbeing in higher education. Broadly, articles discuss the scope of mental wellbeing and psychological distress, identify specific cohorts (including international students and refugees), profile targeted means of support (via the curriculum, the co-curriculum and strategic policy and planning initiatives) and also identify the need for ‘psychological literacy’ via leadership.

O97 ADJUVANT CHEMORADIOTHERAPY IS BENEFICIAL IN MARGIN POSITIVE PATIENTS FOLLOWING NEO-ADJUVANT CHEMOTHERAPY AND SURGERY FOR LOWER OESOPHAGEAL AND GOJ ADENOCARCINOMA

Abstract Aim The aim of this study was to assess the survival benefit of adjuvant therapy in margin positive patients following neo-adjuvant chemotherapy and surgery for lower oesophageal and GOJ adenocarcinoma. Background & Methods The role of adjuvant therapy in oesophago-gastric adenocarcinoma patients treated by neo-adjuvant chemotherapy is contentious. In UK practice, surgical resection margin status is often used to stratify patients into receiving adjuvant treatment. Two prospectively collected UK institutional databases were combined. Patients were classified by the adjuvant therapy received. Crude and adjusted Cox regression analyses compared overall and recurrence free survival according to the adjuvant treatment, stratified by resection margin status. Recurrence patterns were assessed as a secondary outcome. Results From a total of 616 patients, 242 had positive margins. In this R1 resection group, 112 patients (46%) received adjuvant chemoradiotherapy compared to 46 patients (19%) who received adjuvant chemotherapy and 84 patients (35%) who received no adjuvant treatment. On adjusted analysis, pathological N3 status (p<0.001) and poor differentiation (p=0.024) were independently associated with overall survival. When stratified by tumour response to neo-adjuvant chemotherapy, a significant survival benefit in non-responders (Mandard Grade 4&5, adjuvant chemoradiotherapy HR 0.61 95%CI 0.38-0.97; p=0.037) was observed. Additionally, adjuvant chemoradiotherapy significantly improved recurrence free survival (HR 0.59 95%CI 0.38-0.94; p=0.026) with a specific benefit for systemic recurrence (HR 0.56 95%CI 0.33-0.94; p=0.027) in both responder (Mandard Grade 1-3) and non-responder (Mandard Grade 4&5) patient groups. Conclusion Adjuvant chemoradiotherapy improves overall survival, recurrence-free survival and systemic recurrence rates in R1 resection patients. This pattern is most pronounced in non-responders (Mandard 4&5) to neo-adjuvant chemotherapy suggesting a change in strategy to be effective for this specific patient group.

P96 THE CURRENT ROLE OF ADJUVANT THERAPY IN PATIENTS FOLLOWING NEO-ADJUVANT CHEMOTHERAPY AND R0 RESECTION FOR LOWER OESOPHAGEAL AND GOJ ADENOCARCINOMA

Abstract Aim The aim of this study was to assess the survival benefit of adjuvant therapy in R0 resection patients following neo-adjuvant chemotherapy and surgery for lower oesophageal and GOJ adenocarcinoma. Background & Methods The role of adjuvant therapy in oesophago-gastric adenocarcinoma patients treated by neo-adjuvant chemotherapy is contentious. In UK practice surgical resection margin status is often used to stratify patients into receiving adjuvant treatment. Two prospectively collected institutional databases were combined. Patients were classified by the adjuvant therapy received. Crude and adjusted Cox regression analyses compared overall and recurrence free survival according to the adjuvant treatment, stratified by resection margin status. Recurrence patterns were assessed as a secondary outcome. Results A total of 616 patients were included (373 R0, 243 R1). In hospital mortality following surgery was 1% and these patients were excluded from analysis (n=7). In the R0 resection group 220 patients (59%) had no adjuvant treatment and 137 patients (37%) had adjuvant chemotherapy. On adjusted analysis pathological N status (p<0.0001), poor differentiation (p=0.005) and poor response to neo-adjuvant chemotherapy (p=0.001) were independently associated with poor survival. The benefit of adjuvant chemotherapy did not reach independent significance (HR 0.65 95% CI 0.40-1.06; p=0.087) compared to no treatment. However, it was observed that responders to neo-adjuvant chemotherapy (Mandard 1-3) were more likely to demonstrate a survival benefit from adjuvant chemotherapy (HR 0.42 95%CI 0.15-1.11; p=0.081) than those who are deemed to be non-responders (Mandard 4&5, HR 0.71 95%CI 0.39-1.32; p= 0.280). Conclusion Adjuvant chemotherapy may have a survival benefit in R0 resection patients following surgery, but this is likely to be limited to patients exhibiting a good response to neo-adjuvant chemotherapy.

A national survey: Evaluating current practice and risk assessment in morcellation amongst gynaecologists in the United Kingdom

ObjectiveTo evaluate current practice and adherence to AAGL and BSGE power morcellation guidelines. Study designCross-sectional survey. SettingUnited Kingdom. Patients/Population157 National Health Service (NHS) hospital trusts (organisation comprising of one or more hospitals) offering gynaecological services. InterventionA questionnaire was emailed between March–July 2018 and completed by Lead/ Directors of Gynaecology within each organisation. Descriptive statistics were used to present results from this study. Measurements/ResultsWe assessed power morcellation practice patterns, informed consent processes and outcomes over the last 12 months. We received 136 responses (87 % response rate). Power morcellation was performed by a third (59, 37.6 %) of all UK hospitals. The median number of gynecologists performing morcellation per organisation was 2 (Q1-Q3: 2–4). A median of 7 morcellators (Q1-Q3: 0–17) were purchased and 7 morcellators (Q1-Q3: 1.25–15.75) used per annum. A median of 10 (Q1-Q3: 2.0–15.0) laparoscopic hysterectomies and 5 (Q1-Q3: 0.5–9.0) myomectomies requiring morcellation were performed per annum. Almost, a third of hospitals did not perform an endometrial biopsy or MRI. 79.7 % (47) of trusts consented for power morcellation and 76 %, (46) explained risk of inadvertent leiomyosarcoma. 83.3 %, (50) had no patient literature and almost half had no audit process 45 %, (27). ConclusionCurrent UK practice does not reflect recommendations from the AAGL or BSGE. Deficiencies were identified in pre-operative evaluation, local governance procedures, and consenting practices regarding use of a power morcellator and risk of occult leiomyosarcoma.

A Multicentre, Retrospective Observational Study to Evaluate the Clinical Outcomes of Patients with Chronic Lymphocytic Leukaemia (CLL) Treated with Idelalisib and Rituximab in the UK (RETRO-idel) - a Cohort of 110 Patients

Background: B-cell receptor signalling pathway plays a key role in CLL pathogenesis. Overexpression of phosphatidylinositol 3-kinase delta isoform (PI3Kδ) is a characteristic of malignant lymphoid cells {Zhang 2014}. Idelalisib is an oral, selective PI3Kδ inhibitor approved for the treatment of CLL {Brown 2014}. Since its approval there has been a paucity of real world clinical effectiveness and safety data on idelalisib-rituximab (IDELA-R). A large U.S.-based national, retrospective series of 682 CLL patients (pts) explored the optimal sequence of targeted agents in this setting, but included only 62 (9%) pts treated with IDELA-R {Mato 2017}. Aims: To evaluate the effectiveness of IDELA-R in pts with CLL in routine clinical practice in the UK through a protocol-led, retrospective cohort study; RETRO-idel (NCT03582098). Methods: Secondary or tertiary care centres (sites) across the UK were invited to participate. Data were collected retrospectively from sites by study personnel from source data-verified medical records using electronic case report forms (eCRFs). Eligible pts included those who initiated IDELA-R as part of routine clinical management of CLL from Sep 2014 (following European approval), up to and including 31 Dec 2017. Primary endpoint was overall response rate (ORR) defined as the proportion of pts who achieved an objective clinical response after the initiation of IDELA-R treatment. Secondary endpoints included overall survival (OS), progression free survival (PFS), time to next treatment (TTNT), duration of response (DOR), and safety (including serious adverse events [SAE] and AEs of special interest [AESI]). Results: A total of 110 pts were included in the study from 16 UK sites, of whom 74 (67.3%) were males and the median age at IDELA-R initiation was 72 years (range 48 - 90) (Fig 1a). Median number of prior therapies was 1 (range 0 - 8; 23.6% 1st line). Seven (6.4%) pts had received prior ibrutinib. Median time since diagnosis was 7 years (range: 0 - 23), and 54 (49.1%) pts tested had TP53 mutated / del (17p) CLL. Median duration of follow-up was 39.1 months (range 0.1 - 51.9), with 65 (59.1%) pts followed >2 years. Ninety-two (83.6%) pts received pneumocystis jirovecii pneumonia (PJP) prophylaxis and 8 (7.3%) pts had received a stem-cell transplant (SCT) [(before IDELA-R; 2 (1.8%) alloSCT; 2 (1.8%) autoSCT); after IDELA-R; 4 (3.6%) alloSCT)]. The median duration of therapy with IDELA was 12 months (range 0 - 41). The ORR was 88.2% (95% CI: 82.2 - 94.2) and median DOR 32.7 months (95% CI 19.7 - NR). Seven (6.4%) pts had no documented response and response data were missing for 6 (5.4%) pts. Median OS was not reached (95% CI: 31.5 - NR) and median PFS was 29.5 months (95% CI: 22.1, NR) (Fig 1b, c). Median TTNT was 29.2 months 95% CI; 25.3 - 42.8). Overall, 108 (98.2%) pts experienced an SAE or AESI. Diarrhoea was reported in 34 (30.9%) pts, followed by lower respiratory tract infection [LRTI] in 24 (21.8%), neutropenia in 23 (20.9%), rash in 18 (16.4%) and pneumonia in 18 (16.4%). Ten (9.1%) pts had colitis, of which Gr 3/4 colitis occurred in 6 (5.5%). A total of 71 (64.5%) pts experienced a Gr 3/4 AEs including pneumonia in 14 (12.7%), LRTI in 10 (9.1%), neutropenia in 7 (6.4%), diarrhoea in 7 (6.4%) and neutropenic sepsis in 7 (6.4%). There were 85 (77.2%) discontinuations; 54 (56.3%) due to toxicity, 18 (18.8%) due to PD, 11 (11.5%) by investigator discretion, and 2 (2.1%) by subject decision. There were 11 (11.5%) deaths reported whilst pts were receiving IDELA-R. Richter's transformation was documented in 1 (0.9%) pt. At the time of analysis, 46 (41.8 %) pts had died. Conclusions: We report to our knowledge the largest cohort of CLL pts treated with IDELA-R outside of the clinical trial setting. Our findings corroborate those from interventional studies of IDELA {Furman 2014, Sharman 2019}. Longer PFS observed in our study versus prospective trials probably reflects the relatively fewer median number of prior therapies. Median TTNT was slightly shorter than median PFS possibly due to certain pts discontinuing IDELA-R without PD and continuing to a subsequent therapy. Safety profile of IDELA-R was consistent with trial experience, and no new safety signals were identified. IDELA-R remains an effective treatment option for CLL pts. Analyses assessing a) response duration and TTNT in pts stopping therapy due toxicity and b) predictors of PFS (univariable and multivariable analysis) are ongoing and will be presented. Disclosures Eyre: Janssen: Honoraria; Roche: Honoraria; Gilead: Consultancy, Honoraria, Other: commercial research support; Abbvie: Honoraria. Islam:Gilead: Honoraria, Other: Conference attendance sponosrship. Nicholson:Pfizer: Other: Conference attendance sponosrship; Takeda: Other: Conference attendance sponsorship. Fegan:Gilead: Honoraria; Roche: Honoraria; Janssen: Honoraria; Abbvie: Consultancy, Other: Conference attendance sponsorship. Smith:Gilead: Employment, Equity Ownership. Cursley:Gilead: Employment. Ramroth:Gilead Sciences: Employment. Rajakumaraswamy:Gilead Sciences, Inc.: Employment.

Use of preoperative opioids increases duration of hospital stay following elective lower limb arthroplasty. - A snapshot of UK practice

This study is one of the first in the UK where to assess the link between pre-operative opioid use and length of stay or complications. The primary objective was to test our hypothesis; that low dose pre-operative opioids will not lead to an increase in complications and LOS in lower limb arthroplasty patients. 640 records were found and 625 patients were included whom received elective primary or revision surgery. It was found that Pre-operative opioids >12 MED does increase LOS.

Evaluation of M-Payment Technology and Sectoral System Innovation—A Comparative Study of UK and Indian Models

The paper constructs a sectoral system of innovation model specifically for the mobile payments (m-payments) sector. Both the UK and Indian sectoral system of innovation were studied in regards of the actors involved in providing the m-payment service with an emphasis on emergent business models. We integrated open innovation and Ogle’s ideas into our model and demonstrated the importance of active agency in shaping innovation systems, for example in leveraging existing social networks. The research draws upon original interviews with companies and regulators in both India and the UK. Our overall conclusion is that the m-payments sectoral system of innovation in India is more customer-oriented and far-reaching as compared to the practices in UK. It concludes that no matter the context, the importance of integrating firms’ activity into integrated service systems in demand-driven innovation is key for success.

A Practitioner Concept of Contemporary Creativity

This article reviews conceptualizations from three academic areas: the sociology of art, the psychology of creativity, and research on the cultural and creative industries. These are compared with findings from a critical discursive study with UK practitioners. The meanings and associations these maker artists attach to creativity are discussed as a practitioner concept. For the practitioners, the association of creativity with art carries a promise of transcendence and escape from ordinary life but also a potential challenge to their own entitlement and claims to a creative status. These findings demonstrate that the academic areas utilize different and conflicting conceptualizations and, second, that the practitioner concept is not consistent with any one of these. In conclusion, the contemporary celebration of creativity is based on different meanings and unacknowledged conflicts. Future social psychological research on creativity requires a more critical approach to the concept.

How do acupuncture practitioners use pattern identification – An international web-based survey?

IntroductionTraining and practice of Traditional East Asian Medicine (TEAM) varies globally although similar diagnostic methods are used based on patients presenting signs and symptoms. These methods assist in determining disease patterns and treatment principles. The use of diagnostic principles and pattern identification (PI) was explored in this survey of TEAM practice across different countries. MethodsA web-based survey was disseminated to acupuncture professional membership organisations in UK, Australia, Italy, Korea and China using a Survey Monkey link between December 2015 and September 2017. ResultsThe 618 fully completed responses were available for comparison (UK 66, Australia 106, China 87, Italy 226, Korea 133). Demographic characteristics varied; UK practitioners were more likely to be female (71%) compared to the other countries (51-59%), Koreans tended to be under 40yrs (80%), compared to elsewhere (14-27%). Korean, UK and Australian respondents had fewer practitioners with biomedical training, 95% of the Italians had a biomedical qualification. TEAM diagnostic methods were more likely practised in the UK and Australian samples ( > 90%) but were lowest for the Italian sample (78%). TCM differential diagnosis was the predominant type of PI. PI was rated essential by 85% of Chinese practitioners, versus 32% Koreans, 45% Italians, 67% UK and 68% Australian respondents. ConclusionThis first international survey about acupuncturists use of PI demonstrated wide variation. The sample was limited to certain countries and relied on dissemination by specific professional bodies and participants completing an electronic questionnaire which may have affected responses but provides a platform for future studies.

1668 A National Survey: Evaluating Current Practice and Risk Assessment in Morcellation Amongst Gynecologists in the United Kingdom

Study Objective To evaluate current practice and adherence to AAGL and BSGE power morcellation guidelines. Design Multiple-choice questionnaire. Setting United Kingdom. Patients or Participants 157 NHS hospitals offering gynaecological services. Interventions n/a. Measurements and Main Results Power morcellation practice patterns, informed consent processes and outcomes over the last 12 months. We received 136 responses (87% response rate). Power morcellation was performed by a third (59, 37.6%) of all UK hospitals. The median number of gynecologists performing morcellation per organisation was 2 (Q1-Q3: 2-4). A median of 7 morcellators (Q1-Q3: 0-17) were purchased and 7 morcellators (Q1-Q3: 1.25-15.75) used per annum. A median of 10 (Q1-Q3: 2.0-15.0) laparoscopic hysterectomies and 5 (Q1-Q3: 0.5-9.0) myomectomies requiring morcellation were performed per annum. Almost, a third of trust did not perform an endometrial biopsy or MRI. 79.7% (47) of trusts consented for power morcellation and 76%, (46) explained risk of inadvertent leiomyosarcoma.83.3%, (50) had no patient literature and almost half had no audit process 45%, (27). Conclusion Current UK practice does not reflect recommendations from the AAGL or BSGE. Deficiencies were identified in pre-operative evaluation, local governance procedures, and consenting practices regarding use of a power morcellator and risk of occult leiomyosarcoma.

Attracting and retaining nurses through a clinical fellowship programme.

Shortages in nursing are the single biggest and most urgent workforce issue that the NHS needs to address. This article sets out the early success of the Nurse Clinical Fellowship Programme established by The Royal Wolverhampton NHS Trust. The unique programme aims to attract and retain nurses by offering a staff nurse post with supported access to academia, fully funded by the NHS Trust. To date, the Trust has attracted 90 nurses (both UK and international registered nurses) to the programme. The programme is also offered internally and the Trust has a cohort of 10 internal nursing staff enrolled onto the programme completing either their BSc (top-up) or Masters, with a second cohort of 60 internal nurses due to start in September 2019. To support international registered nurses with demonstrating their competence to meet Nursing and Midwifery Council requirements the Trust has also established an objective structured clinical examination preparation course designed to embrace and enhance the existing knowledge and skills, while guiding staff in transferring these in line with UK and Trust policies and practices.

Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

ObjectiveTo conduct an audit of the management of urethral pathology in men presenting for reconstructive urethral surgery in the UK.MethodsBetween 1 June 2010 and 31 May 2017, data on men presenting with urethral pathologies requiring reconstruction were entered onto a secure online data platform. Surgeon‐entered information was collected in 95 fields regarding the stricture aetiology, prior management, mode of presentation, type of surgery and outcomes, with a potential 283 variable responses in the 95 fields. Data were analysed to compare UK practice with that reported in the contemporary literature and with guidelines.ResultsData on 4809 men were entered by 39 centres and 50 surgeons. Field completeness was 70.7%, 74.3% and 53.7% for preoperative, operative and follow‐up data, respectively. Referral for stricture reconstruction frequently followed two prior endoscopic procedures and the stricture was not always assessed anatomically before surgery. Urinary retention was a common symptom in men awaiting reconstruction. Short unifocal strictures of the anterior urethra were the commonest reason for referral, whilst lichen sclerosus and hypospadias generated a significant volume of revisional stricture surgery. Lower numbers of very complex interventions are required for the management of posterior urethral pathology. Although precise criteria for determining success are not clear, management of urethral reconstruction in the UK was found to have a low risk of Clavien–Dindo grade 3 or higher complications, and was associated with outcomes similar to those reported in contemporary series except in the management of posterior urethral fistulae.ConclusionsOnline databases can provide volume data on the management of reconstructive urethral surgery across a multiplicity of centres in one country. They can also indicate compliance with accepted standards of, and expected outcomes from, this tertiary practice.

IMRiS phase II study of IMRT in limb sarcomas: Results of the pre-trial QA facility questionnaire and workshop

IntroductionSoft tissue sarcomas of the extremities (STSE) are rare malignancies. We report current UK practice for immobilisation of soft tissue sarcoma of STSE, as part of the initial study set-up within the IMRiS trial, a phase II study of intensity modulated radiotherapy (IMRT) in primary bone and soft tissue sarcoma. MethodsA facility questionnaire (FQ) was circulated to 29 IMRiS centres investigating the variation in immobilisation devices, planning techniques, and imaging protocols. A workshop was held to address concerns raised by centres. It focused on STSE immobilisation and patient set-up. Robustness of patient set-up at each centre was evaluated based on the following criteria: evidence of local set-up audit, calculation of margins based on set-up audit results, imaging frequency, and number of patients treated per centre per annum. ResultsTwenty-seven (93%) questionnaires were returned. 30% (8/27) of responders routinely treated STSE with IMRT. The remaining 70% (19/27) had little or no experience with IMRT for STSE. Vacuum bags were the most frequent immobilisation device (9/27), followed by thermoplastic shells (7/27). Nine centres had audited their local set-up; however, only 4 had calculated margins in response to the results. Ten centres were classified as having high level of robustness. ConclusionsImmobilisation devices and planning techniques for STSE are inconsistent across centres. Robustness of set-up is an important tool to ensure quality of results in a multicentre trial setting with such different levels of experience. The IMRiS trial Quality Assurance programme encourages centres to assess robustness of set-up through local audit and subsequent calculation of treatment margins. Implications for practiceThis is the first study that used robustness criteria to tailor QA support to individual centres.

Patient satisfaction with tracheostomy care—a snapshot of UK practice

Patient satisfaction with tracheostomy care—a snapshot of UK practice

Diagnosis and management of bile acid diarrhoea: a survey of UK expert opinion and practice

ObjectiveBile acid diarrhoea (BAD), which includes bile acid malabsorption, causes a variety of digestive symptoms. Diagnostic rates and management vary considerably. We conducted a survey of current practice to review...

Exploring the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults (aged 18–25): A qualitative research study

Alcohol use peaks in early adulthood and can contribute both directly and indirectly to unhealthy weight gain. This is the first qualitative study to explore the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults. We conducted 45 in-depth interviews with 18–25-year-olds in North-East England to inform development of a dual-focused intervention to reduce health risk due to excess weight gain and alcohol use. Data were analysed thematically, following the principles of constant comparison, resulting in three intersecting themes: (1) how food and alcohol consumption currently link together for this population group; (2) influences upon linked eating and drinking behaviours and (3) young adults’ feelings and concerns about linked eating and drinking behaviours. Socio-cultural, physical and emotional links between food and alcohol consumption were an unquestioned norm among young adults. Eating patterns linked to alcohol use were not tied only to hunger, but also to sociability, traditions and identity. Young adults conceptualised and calculated risks to weight, appearance and social status, rather than to long-term health. This study is the first to evidence the deeply interconnected nature of food and alcohol consumption for many young adults. Findings have important implications for intervention development, UK public health policy and practice, and point to a need for similar research in other countries.

A typology of barriers and enablers of scientific evidence use in conservation practice

Over the last decade, there has been an increased focus (and pressure) in conservation practice globally towards evidence-based or evidence-informed decision making. Despite calls for increased use of scientific evidence, it often remains aspirational for many conservation organizations. Contributing to this is the lack of guidance on how to identify and classify the array of complex reasons limiting research use. In this study, we collated a comprehensive inventory of 230 factors that facilitate or limit the use of scientific evidence in conservation management decisions, through interviews with conservation practitioners in South Africa and UK and a review of the healthcare literature. We used the inventory, combined with concepts from knowledge exchange and research use theories, to construct a taxonomy that categorizes the barriers and enablers. We compared the similarities and differences between the taxonomies from the conservation and the healthcare fields, and highlighted the common barriers and enablers found within conservation organizations in the United Kingdom and South Africa. The most commonly mentioned barriers limiting the use of scientific evidence in our case studies were associated with the day-to-day decision-making processes of practitioners, and the organizational structures, management processes and resource constraints of conservation organizations. The key characteristics that facilitated the use of science in conservation decisions were associated with an organization's structure, decision-making processes and culture, along with practitioners' attitudes and the relationships between scientists and practitioners. This taxonomy and inventory of barriers and enablers can help researchers, practitioners and other conservation actors to identify aspects within their organizations and cross-institutional networks that limit research use – acting as a guide on how to strengthen the science-practice interface.

The WHEAT pilot trial—WithHolding Enteral feeds Around packed red cell Transfusion to prevent necrotising enterocolitis in preterm neonates: a multicentre, electronic patient record (EPR), randomised controlled point-of-care pilot trial

IntroductionNecrotising enterocolitis (NEC) is a potentially devastating neonatal disease. A temporal association between red cell transfusion and NEC is well described. Observational data suggest that withholding enteral feeds around red...