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Participation is increasingly used to legitimize and improve environmental decision making. However, in practice participants often find the process empty and frustrating. This has adverse consequences for environmental planning and consenting processes, where participants become disillusioned, and negative feelings develop into active opposition, causing delays, spiraling costs, and conflict. This paper addresses the gap between participatory ideals and unsatisfactory environmental decision-making in practice. We take a fresh look at how participatory ideals can be implemented and propose a new framework based on translating participatory ideals into practice. We identified commitments and values for fair and achievable participatory environmental decision-making from science and technology studies (STS), procedural environmental justice, and deliberative democracy. These were synthesized and organized into a set of principles (inclusivity, process-orientation, empowerment, and reflection) and then translated into "practical" criteria. The result is a new framework that links participatory ideals to practice. [ABSTRACT FROM AUTHOR]

BACKGROUND Thermal burn scars can have catastrophic impact on the quality of life and personal image, and over time can lead to profound physical and psychological debilitation. There are no established treatments to significantly improve burn scars. OBJECTIVE To demonstrate the safety, efficacy, and tolerability of fractionally ablative Er:YAG resurfacing of mature burn scars. METHODS Sixteen subjects were enrolled and received 3 treatments of fractionally ablative Er:YAG resurfacing at monthly intervals. Twelve completed the study. Scars were scored with the Vancouver Scar Scale (VSS) by the patient and physician before and after treatment. Blinded photographic analysis (Visual Analog Scale [VAS]) and blinded histologic analysis of tissue before and after treatment was also performed. RESULTS Significant Improvement in VSS scores were seen in all 12 patients, reported by patients and the evaluating physician alike. Photographic analysis demonstrated subjective improvement in all 12 patients. Histologically, there was significant improvement in collagen architecture and the number of vessels per highpower field. The treatments were tolerated well by patients, and 1 superficial skin infection occurred. CONCLUSION Fractionally ablative Er:YAG laser resurfacing is a safe and effective modality in the treatment of thermal burn scars with subjective and objective improvement as seen from the patient and physician. [ABSTRACT FROM AUTHOR]

Introduction: Readmissions are a recognised challenge for providers of healthcare and incur financial penalties in a growing number of countries. However, the scale of unscheduled hospital contacts including attendances at emergency departments that do not result in admission is not well known. In addition, little is known about the route to readmission for patients recently discharged from an emergency hospital stay. Methods: This is an observational study of national hospital administration data for England. In this retrospective cohort study, we tracked patients for 30 days after discharge from an emergency admission for heart failure (HF) or chronic obstructive pulmonary disorder (COPD). Results: The majority of patients (COPD:79%; HF:75%) had no unscheduled contact with secondary health care within 30 days of discharge. Of those who did have unscheduled contact, the most common first unscheduled contact was emergency department (ED) attendance (COPD:16%; HF:18%). A further 5% of COPD patients and 4% of HF patients were admitted for an emergency inpatient stay, but not through the ED. A small percentage of patients (COPD:<1%, HF:2%) died without any known contact with secondary care. ED conversion rates at first attendance for both COPD and HF were high: 75% and 79% respectively. A quarter of patients who were not admitted during this first ED attendance attended the ED again within the 30-day follow-up period, and around half (COPD:56%; HF:63%) of these were admitted at this point. Patients who live alone, had an index admission which included an overnight stay and were comorbid had higher odds of being admitted through the ED than via other routes. Conclusion: While the majority of patients did not have unscheduled contact with secondary care in the 30 days after index discharge, many patients attended the ED, often multiple times, and many were admitted to hospital, not always via the ED. More frail patients were more likely to be admitted through the ED, suggesting a possible area of focus as discharge bundles are developed. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines offer an accessible synthesis of the best evidence of effectiveness of interventions, providing recommendations and standards for clinical practice. Many guidelines are relevant to the diagnosis and management of the acutely unwell patient during the first 24-48 h of admission. Care bundles are comprised of a small number of evidence-based interventions that when implemented together aim to achieve better outcomes than when implemented individually. Care bundles that are explicitly developed from guidelines to provide a set of related evidence-based actions have been shown to improve the care of many conditions in emergency, acute and critical care settings. This study aimed to review the implementation of two distinct care bundles in the acute medical setting and identify the factors that supported successful implementation.Methods: Two initiatives that had used a systematic approach to quality improvement to successfully implement care bundles within the acute medical setting were selected as case studies. Contemporaneous data generated during the initiatives included the review reports, review minutes and audio recordings of the review meetings at different time points. Data were subject to deductive analysis using three domains of the Consolidated Framework for Implementation Research to identify factors that were important in the implementation of the care bundles.Results: Several factors were identified that directly influenced the implementation of the care bundles. Firstly, the availability of resources to support initiatives, which included training to develop quality improvement skills within the team and building capacity within the organisation more generally. Secondly, the perceived sustainability of changes by stakeholders influenced the embedding new care processes into existing clinical systems, maximising their chance of being sustained. Thirdly, senior leadership support was seen as critical not just in supporting implementation but also in sustaining longer-term changes brought about by the initiative. Lastly, practitioner incentives were identified as potential levers to engage junior doctors, a crucial part of the acute medical work force and essential to the initiatives, as there is currently little recognition or reward for involvement CONCLUSIONS: The factors identified have been shown to be supportive in the successful implementation of care bundles as a mechanism for implementing clinical guidelines. Addressing these factors at a practitioner and organisational level, alongside the use of a systematic quality improvement approach, should increase the likelihood that care bundles will be implemented successfully to deliver evidence based changes in the acute medical setting. [ABSTRACT FROM AUTHOR]

At an international level, public, political and economic pressures are increasing awareness of the high level of variation in the quality of health care provision. This knowledge has brought with it the realisation that a translational gap exists between the production of evidence-based scientific knowledge and the application of this evidence into everyday practice to improve patient experience, clinical outcomes and quality of care at a population level. Improvement science has emerged as a transdisciplinary effort to address this challenge. Evidence-based care recommendations typically stem from research that is conducted in controlled and artificial settings with additional resource and highly qualified staff. In comparison, real world frontline healthcare settings are complex adaptive social systems, and research from a wide range of academic disciplines suggests that it is a leap of faith to assume that outputs from research will simply translate to improvements in practice. The philosophy of improvement science questions the value of science to society. This paper considers the challenges that the philosophy of improvement science brings to traditional models for thinking about the value of science. The paper uses healthcare and healthcare research as an example to explore these concepts in detail and propose a new model, the Cycle for Improvement, to help reframe the relationship between science and society. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The National Burn Repository (NBR) currently only contains inpatient data from participating United States burn centres. However, the majority of the patients treated in burn centres are managed as outpatients. Unfortunately, this significant demographic is not represented in the NBR annual report. The purpose of this study is to compare the difference in aetiology and demographics between inpatient and outpatient burn patients. In addition, the workload demands for data entry of inpatient and outpatient records in the burn registry will be compared. Methods: Outpatient and inpatient burn data at an American Burn Association-Verified Burn Center were prospectively collected during fiscal year 2008. Data collected included age, burn size and aetiology of burn. Aetiology was also stratified by age group. Inpatient data were compared with outpatient data with Fisher's exact test. The amount of time taken to enter inpatients’ and outpatients’ data parameters in the TRACS v5.0 database was also recorded. Results: Data were collected for 241 inpatients and for 543 outpatients during fiscal year 2008. No significant differences in gender or race were found between the two groups. When comparing demographics, outpatients tended to be younger (26±19years vs. 32±22years, p =0.01) with a smaller burn size (2.5±7% vs. 6.8±12%, p <0.001) and a lower frequency of full-thickness burns (17% vs. 41%, p <0.001). Of the patients managed as an outpatient, a total 29.7% were eventually admitted to the hospital. Just over half of those (16.7%) initially managed in the outpatient setting were admitted for a planned surgical procedure. The other 13% were admitted for pain control and wound-care issues. Injury was more likely to be caused by flame in inpatients (p <0.001). Scald injuries were more common in the outpatient setting (34% vs. 27%), but this difference did not reach statistical significance (p =0.079). Outpatients were more likely to be injured with a contact burn (p <0.0001). Outpatient injury was more likely to be work-related than inpatient injury (p =0.0497), but less likely to be related to recreational activity (p =0.006) or arson/abuse/assault (p =0.0158). An experienced TRACSv5.0 user required 11±0.6min to enter an inpatient record and 6±0.6min to enter an outpatient record in the system (p =0.002). Conclusions: Inpatient injury is more likely to be caused by flame, whereas outpatient injury is more likely to be caused by scald and contact burns. Work-related burn is more likely to be treated in the outpatient setting. Outpatient burn data also take less time to enter. Since significant differences in aetiology exist, outpatient data should be reported separately from inpatient data in order to understand the full spectrum of burn aetiology. The NBR and other registries should be modified to track outpatient burn data and outcomes. [Copyright &y& Elsevier]

The New Labour government in the UK encouraged all local authorities to develop quality-of-life indicators. Development of these indicators was intended to engage local people in a shared vision for their area and to effect improvements in local well-being and sustainability. However, international research has reported a failure of such instruments to generate concrete policy change. This paper reports on a three-year ethnographic study in one local authority in North East England which took a discursive approach to analysing indicator development. The research shows how indicator development acted as a 'site of struggle' between competing discourses. These discursive struggles may have hampered the development of a set of indicators, but they allowed different conceptions of well-being, participation, indicators, and the policy-making process to be discussed and deliberated, inducing discursive shifts in the political arena. Policy makers and scholars should therefore place more focus on the process of developing indicators rather than the indicators that are produced, as it is these which have the potential to produce longer term effects on policy making. [ABSTRACT FROM AUTHOR]

Climate change raises questions of justice. Some people are enjoying the benefits of energy use and other emissions-generating activities, but those activities are causing other people to suffer the burdens of climate change. Political philosophers have begun to pay more attention to the problem of "climate justice." However, contributors to the literature have made quite different methodological assumptions about how we should develop a theory of climate justice and defend principles of climate justice. So far, there has been little systematic or detailed discussion of these methodological issues. One way to approach these issues is by developing a methodological framework for thinking about climate justice, or more specifically, a five-stage framework, drawing on recent work on two issues: first, the distinction between "ideal" and "non-ideal" theory; and second, the distinction between "integrationist" and "isolationist" approaches to environmental and climate justice. This methodological framework can also be used to inform critical analysis of extant theories of climate justice, for example, through a critical discussion of two key features of the theory of climate justice developed by Simon Caney. [ABSTRACT FROM AUTHOR]

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the journal's 21st anniversary and history is commented on.

Our widely cited 2005 explanatory framework for considering public responses to wind farm developments distinguished two gaps: a ‘social gap’ between the high support for wind energy reported in surveys and the low success rate for wind farm applications; and an ‘individual gap’ whereby an individual supports wind energy in general but opposes a local wind farm (NIMBYism). The popular assumption that NIMBYism was the only explanation for the ‘social gap’ was contested. Instead, three explanations of the social gap were provided – democratic deficit, qualified support, and NIMBYism – and a range of different policy responses was suggested. This analysis is re-visited in order to take account of the theoretical and empirical developments since its publication. The original explanatory framework is expanded and revised and new conclusions are drawn about the likely causes of the ‘social gap’. [ABSTRACT FROM PUBLISHER]

Many organisations in both public and private sectors have recognised the challenge posed by climate change and have developed ‘Climate Champion’, ‘Green Team’ or ‘Environmental Coordinator’ schemes. On the basis of interviews with 36 champions in large organisations and analysis of their role as ‘environmental citizens’ in the workplace, it is argued that, overall, the champions are thoroughly embedded in a neoliberal understanding of social change. They conceived of their colleagues (and their employers) as neoliberal agents and accepted that a neoliberal ethic should govern their relations with others. However, when asked about their own motivations for action, champions used a much wider range of discourses. They often appealed to ideas of ‘justice’, ‘responsibility to future generations’ and ‘doing the right thing’. Encouraging climate champions to engage in ‘ordinary moral reasoning’ about climate change with their colleagues might be an important first step to prompting critical reflection on the limits of a neoliberal approach to social change. [ABSTRACT FROM AUTHOR]

The article outlines the excusable-ignorance argument in the literature on the ethics of climate change. It considers the legal precedent argument for the strict liability of excusably ignorant emitters. It examines in detail one objection to the principle of historic responsibility as well as four considerations in favor of strict liability suggested by philosopher Stephen Gardiner's brief discussion.

An introduction is presented in which the editors discuss various reports within the issue on topics including the moral importance of climate change's effects on displacement and the loss of a sense of place, the case for a precautionary approach, and the responsibilities of individuals.

Ambulatory emergency care (AEC), ie managing emergency patients without an overnight hospital stay, offers an alternative to routine hospital admission and improved patient experience. The Directory of ambulatory emergency care for adults identifies 49 clinical scenarios which present acutely but could potentially be managed in an ambulatory manner. The Society for Acute Medicine and the NHS Institute for Innovation and Improvement conducted a national survey of 131 UK acute hospitals to understand the current level of AEC provision. Seventy-nine per cent of respondents indicated their site provided some AEC, but the number of conditions covered was limited and AEC tended to be ad hoc and informal at most sites. Weekend access was limited. Only deep vein thrombosis ambulatory protocols were well-established (65%), with other conditions formally implemented as ambulatory pathways at 0-35% of responding sites. There is a significant opportunity for further expansion of AEC through increased awareness and support. [ABSTRACT FROM AUTHOR]

In July 2006, public health services investigated an outbreak of acute gastroenteritis among staff and visitors of a popular ski resort in southern New Zealand. The source of the outbreak was a drinking water supply contaminated by human sewage. The virological component of the investigation played a major role in confirming the source of the outbreak. Drinking water, source stream water, and 31 fecal specimens from gastroenteritis outbreak cases were analyzed for the presence of norovirus (NoV). Water samples were concentrated by ultrafiltration, and real-time reverse transcription-PCR (RT-PCR) was used for rapid detection of NoV from both water and fecal samples. The implicated NoV strain was further characterized by DNA sequencing. NoV genogroup GI/5 was identified in water samples and linked case fecal specimens, providing clear evidence of the predominant pathogen and route of exposure. A retrospective cohort study demonstrated that staff who consumed drinking water from the resort supply were twice as likely to have gastroenteritis than those who did not. This is the first time that an outbreak of gastroenteritis in New Zealand has been conclusively linked to NoV detected in a community water supply. To our knowledge, this is the first report of the use of ultrafiltration combined with quantitative real-time RT-PCR and DNA sequencing for investigation of a waterborne NoV outbreak. [ABSTRACT FROM AUTHOR]

If approximately 80% of the public in the UK support wind energy, why is only a quarter of contracted wind power capacity actually commissioned? One common answer is that this is an example of the ‘not in my backyard’ (Nimby) syndrome: yes, wind power is a good idea as long as it is not in my backyard. However, the Nimby claim that there is an attitude–behaviour gap has been rightly criticised. This article distinguishes between two kinds of gap that might be confused, namely the ‘social gap’ – between the high public support for wind energy expressed in opinion surveys and the low success rate achieved in planning applications for wind power developments – and the ‘individual gap’, which exists when an individual person has a positive attitude to wind power in general but actively opposes a particular wind power development. Three different explanations of the social gap are distinguished, only one of which depends upon the individual gap. In the second section of the article the relevance of our three explanations for policy is considered. It is argued that the different explanations suggest different policy responses and that the success of efforts to increase wind energy capacity may depend on developing a better understanding of the relative significance of the three explanations. [ABSTRACT FROM AUTHOR]

The most common policy strategies for promoting sustainable development are regulatory and economic. However, there is increasing interest in an alternative or complementary idea, namely, ‘environmental citizenship’. This article seeks to develop a particular interpretation of environmental citizenship. It is argued that a consistent political liberalism must conceive of its citizens as ‘citizens of an environment’. An account of liberal environmental citizenship is proposed, and the rights and duties of the liberal environmental citizen are outlined and discussed. [ABSTRACT FROM AUTHOR]

The pervasiveness of metaphor in environmental discourse suggests important questions about the role of metaphor in environmental learning. A conception of environmental thinking and action is proposed, which identifies five analytically distinct ‘moments’ of ‘environmental sensemaking’: conceptualising, knowing about, knowing how to respond, responding and acting. The (much-criticised) ‘information deficit’ model of environmental learning requires that the second moment—knowing about the environment—is the only locus of environmental learning. On the information deficit model the only role of metaphor is didactic. On the proposed conception, all five moments of environmental sense-making may be independent moments of environmental learning. Metaphor can have a rhetorical role (encouraging responsiveness) and, more importantly, conceptual metaphors can frame our understanding of the environment. The development of new metaphors plays a key role in environmental learning. The ‘natural capital’ and ‘real options’ metaphors are considered as ‘case studies’ of conceptual (or first-moment) learning. It is argued that while they may be important innovations in environmental sense-making, our general discussion of the role of metaphor in environmental learning suggests that we need to look beyond economic metaphors to improve our understanding of the environment-human relationship. [ABSTRACT FROM AUTHOR]

It is widely acknowledged that low-income and minority communities in liberal democratic societies suffer a disproportionate burden of environmental hazards. Is "environmental injustice" a necessary feature of liberal societies or is its prevalence due to the failure of existing liberal democracies to live up to liberal principles of justice? One leading version of liberalism, John Rawls' "justice as fairness," can be "extended" to accommodate the concerns expressed by advocates of environmental justice. Moreover, Rawlsian environmental justice has some significant advantages over existing conceptions of environmental justice. [ABSTRACT FROM AUTHOR]

This paper considers whether the promotion of an environmental ethic in schools is compatible with the political liberal's commitment to ‘neutrality’. A new account of the implications of John Rawls's political liberalism for the ‘basic structure’ of education is developed. The prima facie incompatibility of political liberalism and the promotion of an environmental ethic is misleading. Rawls's political liberalism requires—as a matter of intergenerational justice—the promotion of the ‘sustainability virtues’. Moreover, it permits the promotion of ‘greener’ ideals. [ABSTRACT FROM AUTHOR]

Examines the four aspects of criticisms made by the British House of Commons Select Committee against the Environment Agency for England and Wales. Lack of coherent vision; Problem with public profile; Failure as regulator; Lack of accountability; Factors which were not considered by critics.

Examines the Escherichia coli very-short-patch repair required in the dam of the Adenine methylase. Implication on the defective very-short-patch repair system; Deamination of the 5-methylcytosine mismatches; Posttranscriptional regulation of Vsr by Dam.

OBJECTIVES: International guidelines recommend IV crystalloid as the primary fluid for sepsis resuscitation, with 5% human albumin solution (HAS) as the second line. However, it is unclear which fluid has superior clinical effectiveness. We conducted a trial to assess the feasibility of delivering a randomized controlled trial comparing balanced crystalloid against 5% HAS as sole early resuscitation fluid in patients with sepsis presenting to hospital. DESIGN: Multicenter, open, parallel-group randomized feasibility trial. SETTING: Emergency departments (EDs) in 15 U.K. National Health Service (NHS) hospitals. PATIENTS: Adult patients with sepsis and a National Early Warning Score 2 greater than or equal to five requiring IV fluids withing one hour of randomization. INTERVENTIONS: IV fluid resuscitation with balanced crystalloid or 5% HAS for the first 6 hours following randomization. MEASUREMENTS AND MAIN RESULTS: Primary feasibility outcomes were recruitment rate and 30-day mortality. We successfully recruited 301 participants over 12 months. Mean (SD) age was 69 years (+/- 16 yr), and 151 (50%) were male. From 1303 participants screened; 502 participants were potentially eligible and 300 randomized to receive trial intervention with greater than 95% of participants receiving the intervention. The median number of participants per site was 19 (range, 1-63). Thirty-day mortality was 17.9% (n = 53). Thirty-one participants died (21.1%) within 30 days in the 5% HAS arm, compared with 22 participants (14.8%) in the crystalloid arm (adjusted odds ratio, 1.50; 95% CIs, 0.84-2.83). CONCLUSIONS: Our results suggest it is feasible to recruit critically ill patients to a fluid resuscitation trial in U.K. EDs using 5% HAS as a primary resuscitation fluid. There was lower mortality in the balanced crystalloid arm. Given these findings, a definitive trial is likely to be deliverable, but the point estimates suggest such a trial would be unlikely to demonstrate a significant benefit from using 5% HAS as a primary resuscitation fluid in sepsis. [ABSTRACT FROM AUTHOR]

Examines the use of a guideline based questionnaire to audit hospital care of acute asthma in Great Britain. Comparison of the care given by chest physicians and general physicians; Occurrence of deviations from the guidelines; Proof on the use of questionnaire for both doctor and audit physicians.

Derek Bell reports on the early findings of a project which aims to address the needs of teachers who wish to access and develop scientific understanding of primary school children with moderate to severe learning difficulties. Traditionally, this group of children have been given little in the way of scientific problems to explore. However, Bell asserts that the contribution science can make to this and similar groups is significant, provided that approaches are properly conceived and systematically presented. [ABSTRACT FROM AUTHOR]

The article discusses the factors behind the rise of acute medicine in Great Britain and hospital medicine in the U.S. and how these distinct healthcare systems have impacted their structure. It states that the number of U.S. hospitalists has increased to 30,000 in 2012 from a few hundred 15 years before. Studies have discovered that U.S. hospitalists decrease costs and lengths of hospital stays without harming patient satisfaction and quality. It mentions that in both the countries, economic pressures and increasing availability of advanced diagnostic testing and therapeutics have pushed more complex healthcare into outpatient setting.

The article focuses on a retrospective study which investigates the importance of blood glucose in chronic obstructive pulmonary disease (COPD) exacerbations. It notes that blood glucose is a pathophysiological response to acute illness. Data in relation to hyperglycaemia and acute exacerbations of COPD are claimed emerging.

Discusses David Miller's advocation of a republican conception of citizenship in his book `Citizenship and Pluralism,' in preference to John Rawl's liberal conception. Fundamentalists' view on Rawl's doctrine; Rawls' concern about public justifiability; Republican view on justice.

Hydroxocobalamin is used for cyanide toxicity after smoke inhalation, but diagnosis is challenging. Retrospective studies have associated hydroxocobalamin with acute kidney injury (AKI). This is a retrospective analysis of patients receiving hydroxocobalamin for suspected cyanide toxicity. The primary outcome was the proportion of patients meeting predefined appropriate use criteria defined as ≥1 of the following: serum lactate ≥8 mmol/L, systolic blood pressure (SBP) <90 mmHg, new-onset seizure, cardiac arrest, or respiratory arrest. Secondary outcomes included incidence of AKI, pneumonia, resolution of initial neurologic symptoms, and in-hospital mortality. Forty-six patients were included; 35 (76%) met the primary outcome. All met appropriate use criteria due to respiratory arrest, 15 (43%) for lactate, 14 (40%) for SBP, 12 (34%) for cardiac arrest. AKI, pneumonia, and resolution of neurologic symptoms occurred in 30%, 21%, and 49% of patients, respectively. In-hospital mortality was higher in patients meeting criteria, 49% vs. 9% (95% CI 0.16, 0.64). When appropriate use criteria were modified to exclude respiratory arrest in a post-hoc analysis, differences were maintained, suggesting respiratory arrest alone is not a critical component to determine hydroxocobalamin administration. Predefined appropriate use criteria identify severely ill smoke inhalation victims and provides hydroxocobalamin treatment guidance. • Clinical use criteria may identify appropriate candidates for hydroxocobalamin treatment. • Criteria applied: hypotension, cardiac or respiratory arrest, seizure, or elevated lactate. • Respiratory arrest alone may not be an indicator for hydroxocobalamin treatment. • Time to treatment should be optimized at institutions using hydroxocobalamin. • Emerging associations of hydroxocobalamin with kidney injury require further study. [ABSTRACT FROM AUTHOR]

Early detection, timeliness and competence of clinical response are a triad of determinants of clinical outcome in people with acute illness. In 2012, the Royal College of Physicians published the National Early Warning Score (NEWS) with the aim of standardising the response to, assessment of and monitoring of acutely ill patients. This was subsequently updated in December 2017 to become NEWS2. Alongside the development of NEWS/NEWS2, it was clear that a supportive educational package was going to be essential for dissemination, learning and national adoption of NEWS/NEWS2 across all healthcare settings. Another driver for the early development of an e-learning package to accompany the launch of NEWS in 2012 was the opportunity that it provided not only to standardise the early warning system across the NHS but also to use that standardised process to facilitate better and more consistent education and training across the entire healthcare system; building on the concept of NEWS providing a common language. [ABSTRACT FROM AUTHOR]

Aims To compare the predictors of unplanned readmission by primary diagnosis and time since discharge in heart failure ( HF) patients. Methods and results We used national hospital administrative data for England to analyse unplanned readmission by primary diagnosis ( HF and non- HF) at 7, 30, 90, 182, and 365 days after the index discharge. A total of 84 212 adult patients had their first HF admission between April 2008 and March 2010; 14 104 (16.8%) died during the index admission and were excluded. Of the remaining 70 108, half were readmitted and 28.7% died during 1 year from discharge (overall mortality rate of 40.6%). Patients had an average of three co-morbidities. Hierarchical logistic regression showed that arrhythmias [odds ratio ( OR) = 1.13] and valvular disease ( OR = 1.12) had significantly higher odds only for HF readmission; dementia ( OR = 1.29), stroke ( OR = 1.29), and mental health conditions ( OR = 1.25) had higher odds only for non- HF. Ischaemic heart disease, renal disease, and chronic lung disease predicted both. Same-day discharge occurred for 6% of patients and was strongly associated with higher readmission for HF at 7 days, less so thereafter, and not for non- HF after 7 days. Other relationships changed little between 7 and 365 days. Prior outpatient non-attendance was associated with 5-10% higher odds of any readmission per appointment missed. Conclusion In HF patients, some predictors of readmission for HF, especially some common co-morbidities, differ from those for non- HF. In contrast, the time since discharge made little difference to the results. [ABSTRACT FROM AUTHOR]

Introduction of the specialty of acute medicine and of acute medical units (AMUs) in the UK have been associated with improvements in mortality, length of stay and flow, but there is no literature on the patient experience during the early phase of acute medical admissions. We analysed the Adult Inpatient Survey (AIPS) findings for short-stay unscheduled medical admissions who did not move from their first admission ward (n=3325) and therefore are likely to have been managed entirely in the AMU. We compared these with short-stay emergencies in other specialties (n=3420) and short-stay scheduled admissions (n=10,347). Scheduled admissions reported a better experience for all survey items. Scores for unscheduled admissions were worse in medical patients compared with other specialties for pain control, privacy, involvement, information, and for a number of questions relating to information on discharge. The specialty of acute medicine should work to improve future patient experience. [ABSTRACT FROM AUTHOR]

National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in NHS 111 calls. The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics. Caller's action is 'compliant with advice given if first subsequent service interaction following contact with NHS 111 is consistent with advice given. We found that most calls were made by women (58%), adults aged 30–59 years (33%) and people in the white ethnic category (36%). The most common advice was for caller to contact their General Practitioner (GP) or other local services (18.2%) with varying times scales. Overall, callers followed advice given in 49% of calls. Compliance with triage advice was more likely in calls for children aged <16 years, women, those from Asian/Asian British ethnicity, and calls made out of hours. The highest compliance was among callers advised to self-care without the need to contact any other healthcare service. This is one of the largest studies to describe pathway adherence following telephone advice and associated clinical and demographic features. These results could inform attempts to improve caller compliance with advice given by NHS 111, and as the NHS moves to more hybrid way of working, the lessons from this study are key to the development of remote healthcare services going forward. [ABSTRACT FROM AUTHOR]

Wernicke's encephalopathy (WE) is a serious medical emergency whose pathogenesis is well understood and reviewed in this paper. Summarizing the evidence for its prophylaxis and management, the authors suggest that, in the UK, there is evidence that many patients identified as being at risk of WE currently do not receive appropriate treatment, despite the availability (not universal) of guidelines and protocols. [ABSTRACT FROM AUTHOR]

Wernicke's encephalopathy (WE) is a serious medical emergency whose pathogenesis is well understood and reviewed in this paper. Summarizing the evidence for its prophylaxis and management, the authors suggest that, in the UK, there is evidence that many patients identified as being at risk of WE currently do not receive appropriate treatment, despite the availability (not universal) of guidelines and protocols. [ABSTRACT FROM PUBLISHER]