United Kingdom Hospitals Research Articles

Prevalence and Predictors of Sepsis Death in Patients With Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction.

BackgroundNoncardiovascular death is increasingly common in people with chronic heart failure (CHF), yet its causes remain poorly characterized. We aimed to define the prevalence of sepsis death in people with CHF and to ascertain its risk marker profile.Methods and ResultsWe conducted a prospective cohort study of 1802 patients with CHF and left ventricular ejection fraction ≤45% attending CHF clinics in 4 United Kingdom hospitals between 2006 and 2014. Mode of death was defined over a 10.3‐year follow‐up period (mean 4 years). Competing risk regression defined mode‐specific hazard ratios for sepsis, other noncardiovascular, progressive heart failure, and sudden cardiac death in relation to established heart failure prognostic markers. Of 737 deaths, 173 (23.5%) were due to sepsis; respiratory tract infections accounted for 69.9% (n=121) of these events. Those who died from sepsis were older, had higher platelet counts, and had a higher prevalence of chronic obstructive pulmonary disease than those who died from other causes. Sepsis death was independently associated with older age (hazard ratio=1.05; 95% confidence interval 1.03‐1.07), greater prevalence of chronic obstructive pulmonary disease (2.43; 1.74‐3.40), male sex (1.73; 1.16‐2.60), lower log serum vitamin D (0.68; 0.49‐0.95), and higher platelet count (1.002; 1.000‐1.005) than nonsepsis death. Established heart failure prognostic markers exhibited different patterns of association with sepsis death, other noncardiovascular death, progressive heart failure death, and sudden cardiac death.ConclusionsSepsis is a major contributor to death in people with CHF and has a different risk marker profile from other modes of death, suggesting that it may be amenable to targeted preventative strategies.

Engagement with peer observation of teaching by a dental school faculty in the United Kingdom.

Well-conducted peer observation of teaching (POT) programmes are effective in enhancing teaching quality and teacher development in higher education including healthcare teaching. This study evaluated POT's use in dental education and involved predominantly clinical dental educators working in a United Kingdom (UK) dental school and hospital. It aimed to (i) audit their engagement with POT, (ii) review the design(s) of POT in use, (iii) assess participant's perceived value of POT and (iv) explore ways that the existing programme could be enhanced to maximise its utility. Dental educators' teaching role and experience, current engagement and experience of POT were explored using an anonymous mixed methodology questionnaire survey which was administered during 2016. Free-text responses were subjected to thematic analysis to identify emerging themes. Of 65 surveys distributed, 57 (88%) completed surveys were returned. The majority of respondents reported that POT was a useful process which resulted in self-perceived enhanced teaching quality. Choice of observer emerged as fundamental to POT's success. Despite recognising its utility, only 46% of the academic teaching faculty underwent POT during a 12-month period. Utilisation of a reciprocal, "critical friends" approach was infrequent. A number of barriers to its regular and effective use emerged. POT is an effective method for dental educator development through feedback and self-reflection. Strategies to enhance the Dental Institute's POT programme are suggested. The quality of the POT process rather than its frequency is an important factor to consider. POT may be an effective developmental intervention for part-time teachers.

Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline

BackgroundViral bronchiolitis is one of the most common causes of hospitalisation in young infants. It has previously been shown that many United Kingdom (UK) hospital Trusts were not compliant with many aspects of the National Institute for Health and Care Excellence (NICE) bronchiolitis guideline prior to its publication. ObjectivesThis study aimed to investigate changes in the management of bronchiolitis by hospital Trusts between 2015 (before NICE guideline publication) and 2017, after publication. Study designWe prospectively surveyed paediatricians at UK hospital Trusts on the management of bronchiolitis before (March to May 2015) and after (January to May 2017) the NICE bronchiolitis guideline publication in June 2015, using an electronic, structured questionnaire. ResultsIn 2015 111 Trusts were represented and in 2017 100 Trusts. Significant improvements were seen in the use of nebulised bronchodilators and hypertonic saline and provision of parental written guidance. However, full compliance with the guideline did not change with 18% of Trusts compliant before publication of the guideline in 2015 and 19% fully compliant with the guideline in 2017. ConclusionsOverall there were modest but important improvements in the reported management of bronchiolitis after the publication of the NICE guideline.

PRM128 - Analyzing Prescription Data to Target Hard-To-Identify Patient Populations for Clinical Trials: A Case Study in Narcolepsy

Clinical research organizations (CROs) face challenges in patient recruitment arising from the increasing complexity of clinical trials. Delays caused by failing to achieve patient recruitment goals [1-3] and protocol amendments [4] contribute to CROs missing pre-launch expectations. These challenges are exacerbated in oncology and rare disease, where patient populations are historically difficult to identify and recruit for trials. The objective of this study was to identify United Kingdom hospitals with narcolepsy patients in order to support patient recruitment. Real-world data on drug prescriptions from the UK healthcare sector was analyzed to identify hospitals with higher numbers of narcolepsy patients. Prescribing of modafinil was used as a proxy measure for this patient population. The prescribing data was then combined with physician data to identify neurologists working at the identified hospitals. Over 130 hospitals were identified with a narcolepsy patient population. Approximately 1300 neurologists were identified as specialists working at these hospitals. Identification of UK hospitals and physicians treating narcolepsy patients enabled these sites and physicians to be contacted to engage them in clinical trial activity. This approach may help to expedite patient recruitment and reduce the cost associated with clinical trial enrollment.

The professional and personal debriefing needs of ward based nurses after involvement in a cardiac arrest: An explorative qualitative pilot study

BackgroundCurrent research demonstrates that debriefing staff post cardiac arrest in clinical practice is rare, with little evidence of effectiveness. ObjectivesThe aim of this pilot study was to identify the needs of ward based nurses for debriefing after involvement in a cardiac arrest and to identify any barriers to participating in debriefing. MethodologyAn explorative qualitative study was undertaken with a purposive sample of seven nurses working on acute adult wards in a United Kingdom hospital. Data were collected by audio-recorded interviews and analysed using framework analysis. FindingsTwo key themes emerged relating to the nurses debriefing needs post a cardiac arrest. Nurses expressed ‘professional needs’ to use the experience as an opportunity to learn and improve practice, and ‘personal needs’ for reassurance and validation. Nurses identified barriers to engaging in debriefing including lack of awareness and uncertainty about the role of a debrief, identifying time for debriefing and the lack of clear guidance from organisational protocols. ConclusionNurses make a distinction between ‘professional’ and ‘personal needs’ which may be met through debriefing. Debriefing is an untapped opportunity, which has the potential to be capitalised on after every cardiac arrest in order to improve care of patients and nurses.

Urinary Biomarkers of Aminoglycoside-Induced Nephrotoxicity in Cystic Fibrosis: Kidney Injury Molecule-1 and Neutrophil Gelatinase-Associated Lipocalin

Aminoglycosides are commonly used for the treatment of pulmonary exacerbations in patients with cystic fibrosis (CF). However, they are potentially nephrotoxic. This prospective observational cohort study aimed to investigate the potential validity of two urinary renal biomarkers, Kidney Injury Molecule-1 (KIM-1) and Neutrophil Gelatinase-associated Lipocalin (NGAL), in identifying aminoglycoside-induced nephrotoxicity in children with CF. Children and young adults up to 20 years of age with a confirmed diagnosis of CF were recruited from ten United Kingdom hospitals. Participants provided urine samples for measurement of KIM-1 and NGAL concentrations, at baseline, at regular outpatient appointments, and before, during and after exposure to clinically-indicated treatment with the aminoglycoside tobramycin. 37/158 patients recruited (23.4%) received at least one course of IV tobramycin during the study. The median peak fold-change during tobramycin exposure for KIM-1 was 2.28 (IQR 2.69) and 4.02 (IQR 7.29) for NGAL, in the absence of serum creatinine changes. Baseline KIM-1 was positively associated with cumulative courses of IV aminoglycosides (R2 = 0.11; β = 0.03; p < 0.0001). KIM-1, in particular, may be a useful, non-invasive, biomarker of acute and chronic proximal tubular injury associated with exposure to aminoglycosides in patients with CF, but its clinical utility needs to be further evaluated in prospective studies.

Is magnetic resonance imaging helpful in detecting significant prostate cancer in patients with haematospermia, normal prostate specific antigen level and digital rectal examination. A single institution, observational, and retrospective study in a United Kingdom hospital.

IntroductionHaematospermia is an uncommon clinical condition that may be associated with prostate cancer. The optimal investigation of haematospermia is unknown. The aim of this study was to investigate haematospermia as a presenting symptom of significant pathology and to assess the diagnostic value of magnetic resonance imaging (MRI).Material and methodsPatient and treatment parameters were collected from a practice cohort of men referred to a urology center presenting with haematospermia. We used a multivariate logistic regression model to test the independent significance of MRI in detecting prostate cancer (PCa) after adjusting for other known predictors of PCa detection.ResultsA total of 125 men (median age 58 years) were evaluated between 2012–2015. In the univariate and multivariate logistic regression model MRI was a significant predictor of PCa diagnosis after adjusting for age, prostate specific antigen (PSA) and digital rectal examination (DRE) results (Odds Ratio (OR) 14.15, p = 0.001). Of 107 patients who underwent MRI prostate imaging, 31 (28.9%) had reports suspicious of PCa. In 26 patients, other benign conditions were detected on MRI. PCa was detected in 12 (25.5%) of the 47 men (median age 61 years; range 43 to 85) who underwent prostate biopsies. Eight (17%) of these patients had Gleason ≥7 grade cancer. The persistence of haematospermia was not an independent predictor of cancer diagnosis (OR 0.20, p = 0.15).ConclusionsPCa is not commonly associated with haematospermia. MRI seems to be improving detection rate of a significant PCa, particularly in patients presenting with haematospermia and normal PSA levels and DRE examination. Duration of haematospermia does not predict the presence of PCa.

The use of imaging in acute pancreatitis in United Kingdom hospitals: findings from a national quality of care study.

To assess use of imaging in patients admitted to UK hospitals with acute pancreatitis (AP). 4,479 patients had a diagnosis AP in the first 6 months of 2014. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) selected patients with more severe AP for case review. Clinicians completed 712 questionnaires and case reviewers assessed 418 cases. The use of imaging in patients with AP is reported. The common causes of AP were gallstones (46.5%) and alcohol excess (22%) with no cause identified in 17.5%. Imaging was needed to diagnose AP in 12%. 60.1% of patients had one or more CT scan. The timing of the CT scan(s) was appropriate in 90% of patients. The number of CTs was appropriate in all except 6.6% (equally split between too many and too few). AP collection intervention was radiological in 49/613 and surgical in 23/613. 69.8% had an ultrasound scan which diagnosed gallstones in 46.4% and bile duct dilatation in 12.9%. At least 21% had ultrasound scan inappropriately omitted. The National Confidential Enquiry into Patient Outcome and Death recommends gallstones are excluded in all patients with AP, including suspected alcohol-related AP. 29.8% underwent magnetic resonance cholangio--pancreatography diagnosing gallstones in 62.4%, bile duct dilatation in 25.4% and common bile duct stones in 14.4%. 20.6% had recurrent pancreatitis with gallstones accounting for a third. 17% with gallstone AP had a cholecystectomy within the guideline recommended time period. Imaging is rarely required for the diagnosis of AP. CT is used responsibly in AP management. Imaging should be used more to exclude gallstones, including in presumed alcohol related AP. Increased diagnostic efforts will not reduce recurrent biliary AP unless matched by earlier gallstone treatment. Advances in knowledge: Whilst CT is used responsibly in AP greater use of other diagnostic modalities is required to identify reversible causes, in particular gallstones, in order to prevent recurrent AP.

Deconstructing stigma in psychogenic nonepileptic seizures: An exploratory study.

Psychogenic nonepileptic seizures (PNES) are classified as a mental disorder, the manifestations of which superficially resemble epileptic seizures. There is a notable lack of in-depth qualitative or quantitative studies investigating the stigma attached to PNES. The current study is an exploratory analysis into the nature of perceived stigma in those with PNES when compared with individuals with epilepsy. Individuals with epilepsy (n=78) and PNES (n=47) were recruited from a United Kingdom hospital or membership-led organizations for individuals living with seizures. Participants were asked to complete a series of questionnaires investigating health-related quality-of-life components (NEWQOL-6D), anxiety (GAD-7), depression (NDDI-E), seizure frequency and severity (LSSS-3), and illness perception (B-IPQ). Perceived stigma was measured using one question taken from the NEWQOL-6D. Individuals with PNES reported a greater level of perceived stigma than those with epilepsy (p=0.04). Our results indicate that the risk of experiencing perceived stigma in PNES was 42% higher than the risk in epilepsy. In epilepsy, but not PNES, perceived stigma was significantly associated with seizure frequency, anxiety, depression, and many of the sequelae of the condition. In both conditions, self-control was associated with stigma (rho≥0.34, p≤0.01). This study was exploratory, and so definitive conclusions cannot be made; however, our findings suggest that the majority (87.2%) of individuals with PNES reported experiencing some degree of perceived stigma, the risk of which is greater than that in epilepsy. Further research is needed into the prevalence, nature, and consequences of stigma in PNES.

8 Patients’ perspectives of living with epilepsy or psychogenic non-epileptic seizures: a thematic analysis investigating patients’ writings

<h3>Objective</h3> This study examines the subjective experience of living with epilepsy or psychogenic non-epileptic seizures (PNES) by qualitatively analysing patients’ written accounts. Qualitative methodologies can produce fine grained and rich detail, as patients are able to describe, in their own words, what is important to them. Writing is an individual act allowing for private exploration and expression, and has previously been used to reveal insights into the phenomenology of other conditions. <h3>Method</h3> Patients were recruited from a United Kingdom hospital and from membership-led organisations for individuals living with seizures. This dataset was collected in the context of a randomised control trial investigating a writing intervention for patients with seizures. The current data was captured by asking patients to handwrite or type: about their very deepest thoughts and feelings about their condition; a letter to their condition; a letter to their younger self; and about a personal value and why it is important to them. Patients were asked to write for at least 20 min per question, at home, in private and on separate days. Questions were used to guide patients towards reflecting on their experiences of living with seizures. The four questions were adapted from the literature investigating writing therapies for clinical populations. All the writings were analysed thematically using a theory and data driven approach. <h3>Results</h3> Patients with epilepsy (n=20) and PNES (n=19) were matched on sample size, age, gender, education, quality of life, seizure severity, and words written. In the writings of patients with epilepsy, five key-themes and 22 sub-themes emerged from the data. The five themes reflected experiences of seizure onset, seizure symptoms, treatment and outcome, living with epilepsy, and displays of coping. In patients with PNES, six key-themes and 29 sub-themes emerged. The six themes reflected accounts of: aetiology and development, seizure symptoms, emotions, living with PNES, lack of understanding by themselves, others, and healthcare professionals, and treatment and outcome. <h3>Conclusion</h3> Thematic differences were observed between the two conditions. Patients with PNES regularly described their symptoms and how people have reacted to their condition, especially themselves and healthcare professionals. Patients with epilepsy focused on how the condition has affected their lives, in which, they portray themselves as coping and ‘fighting’ to live a ‘normal’ life. The findings from this study add to the growing research applying qualitative methodologies to investigate the phenomenology of epilepsy and PNES. Understanding patients’ experiences can hold diagnostic, treatment and prognostic implications.

Written accounts of living with psychogenic nonepileptic seizures: A thematic analysis

PurposeQualitative studies examining lived experiences of psychogenic nonepileptic seizures (PNES) have predominantly relied on datasets collected using clinical or research interviews. This study pursued a different approach by investigating individuals’ written accounts of their condition. MethodsParticipants (n=19) were recruited from membership-led organisations for individuals living with seizures and from a United Kingdom hospital. Participants were instructed to produce four pieces of writing: 1) about their thoughts and feelings about their condition; 2) a letter to their condition; 3) a letter to their younger self; and 4) about a personal value. All writings were analysed using thematic analysis. ResultsSix main-themes emerged from the data. Theme 1: ‘living with PNES’ demonstrated that all participants presented the condition as having a debilitating effect. Theme 2: ‘Emotions’ revealed that individuals were struggling with anxiety, low mood and self-worth. Theme 3: ‘Seizure symptoms’ showed variability was a prominent feature in the description of ictal events. Theme 4: ‘Treatment and outcomes’ demonstrated that individual’s perception of diagnosis and therapy differed greatly. Theme 5: ‘Causation and development’ revealed that the majority of participants spontaneously reported experiencing a traumatic event in the past. Theme 6: ‘Lack of understanding’ by themselves, the public and healthcare professionals appeared to pose considerable challenges to participants. ConclusionsQualitative research has an important role to play for improving our understanding of PNES. The findings contribute to the literature by highlighting the nature of stigma that people with PNES experience, and also their proneness to demonstrate problems with self-worth.

Written accounts of living with epilepsy: A thematic analysis.

This study examines the subjective experience of living with epilepsy by thematically analyzing participants' written accounts of their condition. Writing is seen as an individual act allowing for private exploration, reflection and expression of thoughts and feelings. Participants (n=20) were recruited from a United Kingdom hospital and from membership-led organizations for individuals living with seizures. Participants were asked to produce four pieces of writing: 1) about their thoughts and feelings about their condition; 2) a letter to their condition; 3) a letter to their younger self; and 4) about a personal value. All writings were analyzed thematically using a theory- and data-driven approach. Five main-themes and 22 sub-themes emerged from the data. Theme 1: 'seizure onset' demonstrated that the development of seizures and subsequent diagnosis was an important event that could change an individuals' identity. Theme 2: 'seizure symptoms' revealed participants externalized their seizures as an intrusive agent with a constant presence in their lives. Theme 3: 'treatment and outcome' reflected medication as an essential means to controlling seizures with subsequent side effects being perceived as a compromise. Theme 4: 'living with epilepsy' explored the consequences of the condition including restrictions and stigma. Theme 5: 'displays of coping' demonstrated that, for the most part, participants were keen to present themselves as living well with epilepsy. The results add to the growing research applying qualitative methodologies to investigate the phenomenology of epilepsy. Qualitative research can improve our understanding and awareness of the condition, as well as inform clinical practice.

Panic symptoms in transient loss of consciousness: Frequency and diagnostic value in psychogenic nonepileptic seizures, epilepsy and syncope

PurposePrevious studies suggest that ictal panic symptoms are common in patients with psychogenic nonepileptic seizures (PNES). This study investigates the frequency of panic symptoms in PNES and if panic symptoms, just before or during episodes, can help distinguish PNES from the other common causes of transient loss of consciousness (TLOC), syncope and epilepsy. MethodsPatients with secure diagnoses of PNES (n=98), epilepsy (n=95) and syncope (n=100) were identified using clinical databases from three United Kingdom hospitals. Patients self-reported the frequency with which they experienced seven symptoms of panic disorder in association with their episodes. A composite panic symptom score was calculated on the basis of the frequency of symptoms. Results8.2% of patients with PNES reported “never” experiencing any of the seven panic symptoms in their episodes of TLOC. Patients with PNES reported more frequent panic symptoms in their attacks than those with epilepsy (p<0.001) or syncope (p<0.001), however, patients with PNES were more likely “rarely” or “never” to report five of the seven-ictal panic symptoms than “frequently” or “always” (45–69% versus 13–29%). A receiver operating characteristic analysis demonstrated that the composite panic symptom score distinguished patients with PNES from the other groups (sensitivity 71.1%, specificity 71.2%), but not epilepsy from syncope. ConclusionsPatients with PNES report TLOC associated panic symptoms more commonly than those with epilepsy or syncope. Although panic symptoms are reported infrequently by most patients with PNES, a composite symptom score may contribute to the differentiation between PNES and the other two common causes of TLOC.

A survey of the dose of inhalational agents used to maintain anaesthesia in infants.

Various animal studies suggest that currently used anaesthetics are toxic to the developing brain. Many reviews advise that the total anaesthetic drug exposure should be reduced but the dose usually used in clinical practice has not been clearly elucidated. To provide an overview of the dose ranges currently used in clinical practice during the maintenance phase of anaesthesia in infants undergoing anaesthesia for noncardiac surgery and diagnostic procedures. A two-centre mixed prospective (London) and retrospective (Utrecht) observational cohort study. Two independent tertiary paediatric referral centres in March and November 2013; Great Ormond Street Hospital (GOSH), London, United Kingdom and Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), The Netherlands. A total of 76 infants were included in the analysis, 38 infants from each hospital. Patients from GOSH were matched by procedure, age and weight with patients from the UMCU. The end-tidal concentrations of the inhalational agents were investigated from anaesthetic charts during the maintenance phase and corrected for the age-specific minimal alveolar concentration (MAC), expressed as a percentage from the MAC (%MAC). Three different types of inhalational anaesthetics were used: sevoflurane, desflurane, isoflurane. The mean %MAC was 0.85. No significant differences in %MAC were found between GOSH and the UMCU (P = 0.329); the mean %MAC in GOSH was 0.87 and in the UMCU was 0.82. There was a significant increase in the %MAC in relation to age (slope = 0.036 MAC month, P < 0.001). Of all patients, 75% had an end-tidal concentration lower than 1 MAC. There was no significant effect of the use of analgesia on the end-tidal concentration of inhalational anaesthetics (P = 0.366). The concentration of inhalational anaesthetics in %MAC increased with age and was lowest in neonates. Most young infants received inhalational anaesthetics at a concentration below 1 MAC, which accords with current guidance to minimise anaesthetic drug exposure but may have unintended consequences.

Predictors of health-related quality of life in patients with epilepsy and psychogenic nonepileptic seizures

Epilepsy and psychogenic nonepileptic seizures (PNES) are associated with reduced health-related quality of life (HRQoL). The present study investigated the profile, relationship, and predictive power of illness perceptions, psychological distress (depression and anxiety), seizure activity, and demographic factors on HRQoL in these patient groups. Patients with epilepsy (n=62) and PNES (n=45) were recruited from a United Kingdom hospital and from membership-led organizations for individuals living with seizures. Patients completed a series of self-report questionnaires assessing: anxiety (GAD-7), depression (NDDI-E), illness perceptions (B-IPQ), HRQoL (NEWQOL-6D), and seizure frequency and severity (LSSS-3). Correlational and hierarchical multiple regression analyses were conducted. Patients with epilepsy reported higher HRQoL and scored lower on measures of depression and anxiety. Patients with PNES perceived their condition as more threatening overall. In both conditions, HRQoL was negatively correlated with more severe illness perceptions and psychological distress. In epilepsy and PNES, psychological distress (epilepsy: 27%; PNES: 24.8%) and illness perceptions (epilepsy: 23.1%; PNES: 23.3%) accounted for the largest amount of variance in HRQoL. Clinical factors were found not to be significant predictors, while demographic factors predicted HRQoL in epilepsy (12.6%), but not in PNES. Our findings support the notion that psychological factors are a stronger predictor of HRQoL in epilepsy and PNES than condition-related and demographic variables. Prior research suggests that anxiety and depression are key predictors of HRQoL; this study demonstrates that the relationship between illness perceptions and HRQoL is similarly close. These findings highlight the importance of addressing patients' beliefs about their condition.

Pancreatitis: Preventing catastrophic haemorrhage.

Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.

Identifying and Classifying User Typologies Within a United Kingdom Hospital Library Setting: A Case Study

Objective – To identify available health library user typology classifications and, if none were suitable, to create our own classification system. This is to inform effective future library user engagement and service development due to changes in working styles, information sources and technology.&#x0D; &#x0D; Methods – No relevant existing user typology classification systems were identified; therefore, we were required to create our own typology classification system. The team used mixed methods research, which included literature analysis, mass observation, visualization tools, and anthropological research. In this case study, we mapped data across eleven library sites within NHS Greater Glasgow and Clyde Library Network, a United Kingdom (U.K.) hospital library service.&#x0D; &#x0D; Results – The findings from each of the NHS Greater Glasgow and Clyde Library Network’s eleven library sites resulted in six user typology categories: e-Ninjas, Social Scholars, Peace Seekers, Classic Clickers, Page Turners and Knowledge Tappers.&#x0D; &#x0D; Each physical library site has different profiles for each user typology. The predominant typology across the whole service is the e-Ninjas (28%) with typology characteristics of being technically shrewd, IT literate and agile – using the library space as a touch down base for learning and working.&#x0D; &#x0D; Conclusions – We identified six distinct user types who utilize hospital library services with distinct attributes based on different combinations of library activity and medium of information exchange. The typologies are used to identify the proportional share and specific requirements, within the library, of each user type to provide tailored services and resources to meet their different needs.

A NATIONAL SURVEY TO IDENTIFY HOW DISPLACEMENT VALUE INFORMATION IS USED AND PRESENTED TO CLINICAL STAFF IN NHS HOSPITALS

AimThe use of displacement values (DVs) when preparing intravenous (IV) medication for children enables accurate doses to be given1 and is assumed to be common paediatric practice. This survey aimed...

A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care and the emergency department

BackgroundThe 4th National Audit Project of the Royal College of Anaesthetists’ and Difficult Airway Society (NAP4) made recommendations to improve reliability and safety of airway management in hospitals. This survey examines its impact. MethodsA survey was sent to all UK National Health Service hospitals to examine changes in practice in response to NAP4. We performed a ‘gap analysis’ to determine whether NAP4 had reduced the ‘safety gap’ between actual and ideal practice. ResultsThe response rate was 62% (192 of 307 hospitals), and 78% answered all questions. Most (97%) respondents reported changes in practice in response to NAP4 but these differed by specialty: 95% in anaesthesia; 80% in intensive care (ICU) and 59% in the emergency department (ED). Approximately 25% reported changes in organizational aspects of airway and human factors teaching. Practice changes led to a median closure of the ‘safety gap’ in anaesthesia of 39% (IQR 14–66%, range 11–83%), 59% in ICU (IQR 54–73%, range 31–81%) and 48% in ED (IQR 39–53%, range 35–53%). ConclusionsPublication of NAP4 was followed by changes in practice in the majority of responding departments within two yr. Improvements included improved provision of difficult airway equipment and more widespread routine use of capnography. The biggest change occurred in ICU; the impact on training nursing and junior staff was modest and here, significant safety gaps remain.

Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial.

Objective: To evaluate whether patients who had received early class III protraction facemask treatment were less likely to need orthognathic surgery compared with untreated controls. This paper is a 6-year follow-up of a previous clinical trial. Design: Multi-centre 2-arm parallel randomized controlled trial. Setting: Eight United Kingdom hospital orthodontic departments. Participants: Seventy three 7- to 9–year-old children. Method: Patients were randomly allocated, stratified for gender, into an early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). The primary outcome, need for orthognathic surgery was assessed by panel consensus. Secondary outcomes were changed in skeletal pattern, overjet, Peer Assessment Rating (PAR), self-esteem and the oral aesthetic impact of malocclusion. The data were compared between baseline (DC1) and 6-year follow-up (DC4). A per-protocol analysis was carried out with n = 32 in the CG and n = 33 in the PFG. Results: Thirty six percent of the PFG needed orthognathic surgery, compared with 66% of the CG (P = 0.027). The odds of needing surgery was 3.5 times more likely when protraction facemask treatment was not used (odds ratio = 3.34 95% CI 1.21–9.24). The PFG exhibited a clockwise rotation and the CG an anti-clockwise rotation in the maxilla (regression coefficient 8.24 (SE 0.75); 95% CI 6.73–9.75; P < 0.001) and the mandible (regression coefficient 6.72 (SE 0.73); 95% CI 5.27–8.18; P < 0.001). Sixty eight per cent of the PFG maintained a positive overjet at 6-year follow-up. There were no statistically significant differences between the PFG and CG for skeletal/occlusal improvement, self-esteem or oral aesthetic impact. Conclusions: Early class III protraction facemask treatment reduces the need for orthognathic surgery. However, this effect cannot be explained by the maintenance of skeletal cephalometric change.