Search

Introduction: Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. Methods: The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Results: Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. Discussion: We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications. [ABSTRACT FROM AUTHOR]

Background: PROs are valuable tools in clinical care to capture patients' perspectives of their health, symptoms and quality of life. However the COVID-19 pandemic has had profound impacts on all aspects of life, in particular healthcare and research. This study explores the views of UK and Irish health professionals, third sector and pharmaceutical industry representatives and academic researchers on the impact of COVID-19 on PRO collection, use and development in clinical practice. Methods: A volunteer sample took part in a 10 question cross sectional qualitative survey, on the impact of COVID-19, administered online via Qualtrics. Demographic data was descriptively analysed, and the qualitative free text response data was subject to thematic analysis and summarised within the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Results: Forty nine participants took part located in a range of UK settings and professions. Participants highlighted staff strengths during the pandemic including colleagues' flexibility and ability to work collaboratively and the adoption of novel communication tools. Weaknesses were a lack of staff capacity to continue or start PRO projects and insufficient digital infrastructure to continue studies online. Opportunities included the added interest in PROs as useful outcomes, the value of electronic PROs for staff and patients particularly in relation to integration into systems and the electronic patient records. However, these opportunities came with an understanding that digital exclusion may be an issue for patient groups. Threats identified included that the majority of PRO research was stopped or delayed and funding streams were cut. Conclusions: Although most PRO research was on hold during the pandemic, the consensus from participants was that PROs as meaningful outcomes were valued more than ever. From the opportunities afforded by the pandemic the development of electronic PROs and their integration into electronic patient record systems and clinical practice could be a lasting legacy from the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Dispersal is a main determinant of community assembly. Landscape configurations of rivers, lakes, or ponds are often independently considered in this framework. However, these systems share species conforming to a waterscape with different environments coupled by dispersal. While empirical results support a main role of this coupling on biodiversity organization, it is difficult to assess its importance at large geographic scales. Using a theoretical approach, we quantified the potential role of dispersal through different freshwater ecosystems of the United Kingdom and Ireland on biogeographic diversity patterns. We implemented a coalescent model considering 11,131 communities connected by distance-dependent dispersal and with species that have different performances for recruitment in three different aquatic habitats. Biogeographic diversity patterns were estimated for each habitat alone or for the whole waterscape combining ephemeral, temporal, and permanent waters. The results indicated that the coupling between different types of environments fostered local diversity, in a magnitude that increased from the ephemeral to permanent waters and from poorer to richer communities. Furthermore, a strong spatial structure in the potential effect of dispersal among different freshwater environments was observed, indicating that freshwater biogeography was likely determined by the connection among freshwater ecosystems to a larger extent than previously thought. [ABSTRACT FROM AUTHOR]

Background: For some adults with Attention-Deficit/Hyperactivity Disorder (ADHD), nonstimulants need to be considered either as a monotherapy or as an adjunct to stimulants. Objectives: The objectives of this systematic review and meta-analysis were to assess the efficacy, acceptability, and tolerability of nonstimulants in adults with ADHD. Methods: Data sources, searches, and study selection were based on a previously published network meta-analysis of randomized clinical trials (RCTs) by Cortese at al. (Lancet Psychiatry 5(9):727–738, 2018), which we updated in March 2022. Specifically, we searched PubMed, BIOSIS Previews, CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE, PsycINFO, OpenGrey, Web of Science Core Collection, ProQuest Dissertations and Theses (UK and Ireland), ProQuest Dissertations and Theses (abstracts and international), and the WHO International Trials Registry Platform, including ClinicalTrials.gov for double-blind RCTs with a placebo arm, lasting at least one week, including adults with a diagnosis of ADHD based on DSM-III, DSM-III-R, DSM-IV(TR), DSM-5 or ICD-9- or 10, and reporting data on efficacy, tolerability (drop-out due to side effects) and acceptability (drop-out due to any cause) of guanfacine, clonidine, or atomoxetine. Additionally, we searched for RCTs of viloxazine extended release (ER), approved for ADHD in 2021. Random-effects meta-analyses were conducted, and the risk of bias for individual RCTs was assessed using the Cochrane Risk of Bias tool. Results: We included 18 studies in the meta-analyses (4308 participants) plus one additional study in the narrative synthesis (374 participants). The meta-analysis showed that atomoxetine (15 RCTs) (Hedge's g = − 0.48, 95% CI [− 0.64; − 0.33]), guanfacine (two RCTs) (Hedge's g = − 0.66, 95% CI [− 0.94; − 0.38]) and viloxazine ER (one RCT) were significantly more efficacious than placebo. Atomoxetine was less well tolerated than placebo, while tolerability of guanfacine and viloxazine ER could not be meta-analysed, since only one study, for each medication, reported on it. Conclusions: All investigated nonstimulants were more efficacious in the treatment of ADHD in adults, than placebo, while the placebo had better acceptability and tolerability. Protocol: https://osf.io/5vnmt/?view_only=2bf87ed12ba94645babedceeee4c0120. [ABSTRACT FROM AUTHOR]

Purpose: The low rates of colonic malignancy detected on interval colonoscopy for patients diagnosed with diverticulitis have led recent studies to question the utility of the practice. The aim of this study was to assess the detection rate of colorectal cancer on colonoscopy for patients with a first episode of acute uncomplicated diverticulitis across three separate centres in Ireland and the UK. Methods: A retrospective review was performed of patients with a first episode of acute, uncomplicated diverticulitis who underwent interval colonoscopy at three separate centres in the UK and Ireland between 2007 and 2019. The follow-up period was one year. Results: A total of 5485 patients were admitted with acute diverticulitis between the three centres. All patients had CT verified diverticulitis. A 90.8% (n = 4982) underwent subsequent colonic evaluation with colonoscopy. Of these, a histologically proven diagnosis of colorectal carcinoma was made in 1.28% (n = 64). Conclusion: Routine colonoscopy following an episode of acute, uncomplicated diverticulitis may not be necessary in every patient. It may be appropriate to reserve this more invasive investigation for those with higher risk factors for malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Due to the risk of intracranial aneurysm (IA) recurrence and the potential requirement for re-treatment following endovascular treatment (EVT), radiological follow-up of these aneurysms is necessary. There is little evidence to guide the duration and frequency of this follow-up. The aim of this study was to establish the current practice in neurosurgical units in the UK and Ireland. Methods: A survey was designed with input from interventional neuroradiologists and neurosurgeons. Neurovascular consultants in each of the 30 neurosurgical units providing a neurovascular service in the UK and Ireland were contacted and asked to respond to questions regarding the follow-up practice for IA treated with EVT in their department. Results: Responses were obtained from 28/30 (94%) of departments. There was evidence of wide variations in the duration and frequency of follow-up, with a minimum follow-up duration for ruptured IA that varied from 18 months in 5/28 (18%) units to 5 years in 11/28 (39%) of units. Young patient age, previous subarachnoid haemorrhage and incomplete IA occlusion were cited as factors that would prompt more intensive surveillance, although larger and broad-necked IA were not followed-up more closely in the majority of departments. Conclusions: There is a wide variation in the radiological follow-up of IA treated with EVT in the UK and Ireland. Further standardisation of this aspect of patient care is likely to be beneficial, but further evidence on the behaviour of IA following EVT is required in order to inform this process. [ABSTRACT FROM AUTHOR]

We conducted a systematic review to answer the following: (a) Is there any evidence to support increased prevalence of suicidality and self-harm (i.e. self-harm or suicidality) in urban versus rural environments? (b) What aspects of the urban environment pose risk for suicidality and self-harm? Thirty-five studies met our criteria. Our findings reflect a mixed picture, but with a tendency for urban living to be associated with an increased risk of suicidality and self-harm over rural living, particularly for those living in deprived areas. Further research should focus on the clustering and additive effects of risk and protective factors for suicidality and self-harm in urban environments. [ABSTRACT FROM AUTHOR]

Collaboration and successful teamworking are important components of clinical practise, and these skills should be cultivated early in medical school. The breadth of current medical school curricula means that students often have limited exposure to clinical neurosciences. Since its inception in 2009, the Neurology and Neurosurgery Interest Group (NANSIG) has become a national (UK and Republic of Ireland) example of student and junior doctor synergistic collaboration to deliver educational materials, research, conferences, seminars and workshops, as well as advocating for diversity in this field. Recently, it has expanded to incorporate an international audience and cater for a larger group of young medical professionals. The organisation has overcome numerous challenges and is constantly innovating new approaches to harness the necessary knowledge, skills and network to succeed in a career in neurosciences, neurology and neurosurgery. This article summarises the initiatives undertaken by the group over its first 10 years of existence and its organisational structure, as well as its future plans. [ABSTRACT FROM AUTHOR]

Background: Assessing the quality of diagnostic images is subjective and influenced by factors such education, skills, and experience of the assessor. This study aims to explore the radiographers' assessments of medical usefulness or rejection of X-ray images in specific cases. Results: Eighty-one radiographers from different countries responded to the questionnaire distributed online at the EFRS research HUB at ECR 2020 (a 15% response rate). Forty-two percent of the respondents practiced in the UK and Ireland. In addition to rejecting or keeping images in the presented 30 cases and giving a main reason for the images rejected, the participants explained their choice using comments, 1176 comments were obtained. Sixty percent of the comments were on kept images. The respondents kept on average 63% of the images. In the "Keep", "Could keep", and "Reject" categories on average 84%, 63% and 43% of images were kept respectively. The most common reasons given for rejecting an image were suboptimal positioning and centering. Potential diagnostic value and radiation protection were indicated as reasons to keep an image perceived as of low quality reported in n = 353 and n = 33 comments respectively. Conclusions: There is an agreement internationally on what makes a good quality X-ray image. However, the opinion on medical usefulness of images of low or poor quality compared to image criteria varies. Diagnostic capability and radiation protection was the rationale used for keeping images not fulfilling image criteria. There seems to be a need for diagnostic quality to be included in image assessment in clinical practice. [ABSTRACT FROM AUTHOR]

Landslides involving peat are relatively common in Ireland, upland areas of Great Britain and subantarctic islands. Bogflows and bog slides are less common types of peat failure and almost unknown outside Ireland. Unusually, three of these occurred in 2020 including one bogflow at a windfarm that gained much adverse media attention, and a small but damaging peat slide was also reported. The aim of this paper is to determine the extent to which the new bog slide and bogflows are consistent with previous examples in terms of their contexts, characteristics and possible causes, particularly relating to commercial forestry operations. Aerial video footage of all three landslides obtained by local people using drones, and ground-based footage of one of them in progress, allowed a detailed examination of their characteristics and contexts to be made despite the global travel and activity restrictions caused by the coronavirus pandemic. The windfarm bogflow appears to have resulted from removal of toe support by an earlier peat flow that was itself probably caused by construction of an access road; the other two landslides were most likely triggered by rainfall. All three are consistent with previous examples of their respective types in their general characteristics and appear to be associated with well-known causal factors including hydrological, topographic and/or forestry influences. Forestry operations probably contributed to the occurrence of two of the landslides and restricted the expansion of two of them. [ABSTRACT FROM AUTHOR]

Organic food fraud is a significant challenge in the food testing sector—high price premiums, ease of access to produce to be relabelled and difficulties in developing testing strategies that can detect such frauds make organic foods particularly attractive and thus highly vulnerable to fraud. Samples of conventional and organic cattle taken across meat plants in Ireland and the United Kingdom, consisting of the neck (supraspinatus), rump (gluteus), and shin (flexor carpi radialis) regions of the carcass were analysed using a high resolution time-of-flight based rapid evaporative ionisation mass spectrometry (REIMS) system. The resulting untargeted lipidomic data (m/z 600–1000) was used to generate PCA-LDA models for production system and for muscle type, for these models, it was found that the production system model could differentiate organic from conventional beef with an accuracy of 84%, whilst the muscle type model could identify the cut of meat with a 98% accuracy; additionally, samples can be assessed against multiple models simultaneously, reducing analysis time and sample numbers. The use of REIMS showed considerable promise in its ability to detect different forms of meat fraud; its accuracy in differentiating organic from conventional beef is superior to stable isotope ratio mass spectrometry, with the added advantages of substantially shorter analysis times and lower sample analysis costs. The ability to rapidly confirm the cut of meat also demonstrates the potential of REIMS to concurrently determine multiple aspects of beef authenticity in a close to real time analysis. [ABSTRACT FROM AUTHOR]

Background: Radio-frequency ablation (RFA) for Barrett's oesophagus (BE)-related neoplasia is currently used after endoscopic resection of visible neoplasia. The HALO 360 balloon has been used to ablate long segment BE. The Barrx™ 360 Express RFA self-sizing catheter ('RFA Express') may potentially allow quicker ablation times and improved treatment outcomes. The aim of this paper is to present real world data on the use of the 360 Express Device. Methods: Centres in the UK and Ireland submitted cases where the RFA Express was used. The primary outcome was regression of BE at 3 months. Secondary outcomes were the rate of symptomatic stricture formation and resolution of intestinal metaplasia (CR-IM) and dysplasia (CR-D) at End of Treatment (EoT). Results: 11 centres submitted 123 consecutive patients. 112 had a follow up endoscopy. The median age was 67 years (IQR 62–75). 3 dosimetries were used. The mean reduction in Circumferential (C) length was 78% ± 36 and mean reduction in Maximal length (M) was 55% ± 36. 17 patients (15%) developed strictures requiring dilation. There was a higher rate of stricture formation when the 12 J energy was used (p < 0.05). 47 patients had EoT biopsies, 40 (85%) had CR-D and 34(76%) had CR-IM. Conclusions: The RFA 360 Express catheter shows reduction in length of baseline BE at 3 months after index treatment, and eradication of intestinal metaplasia and dysplasia at 12 months similar to other studies with earlier devices. It appears that the symptomatic stricture rate is slightly higher than previous series with the HALO 360 catheter. This study was performed as part of the HALO registry and has been approved by the Research Ethics Committee - MREC Number 08/H0714/27 Local project reference 08/0104 Project ID 15,033 IRAS Number 54678 EudraCT 2009-015980-1. Registered on ISRCTN as below: ISRCTN93069556. https://doi.org/10.1186/ISRCTN93069556 [ABSTRACT FROM AUTHOR]

Introduction: Burnout is becoming an increasingly recognised phenomenon within the medical profession. This study aims to investigate the presence of burnout amongst neurosurgical trainees in the UK and Ireland as well as investigating potential exacerbating and protective factors. Method: An online survey was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainees' Association (BNTA) mailing list. Responding participants anonymously completed the Copenhagen Burnout Inventory (CBI) and answered questions about known risk factors for burnout including workplace environment, workplace bullying, time spent on leisure activities and sleep and reported likelihood of leaving neurosurgery. We also collated data on responders' demographics. We compared CBI scores for participants with and without risk factors to determine correlation with CBI. Results: There were 75 respondents (response rate 42%) from a range of ages and all training grades, 72% of whom were male. The median CBI score was 38.85 (IQR 17.76). Participants showed a higher degree of personal and workplace burnout (median CBIs of 47.02, IQR 25.00; and 49.14, IQR 19.64, respectively) compared with patient-related burnout (median CBI 18.67, IQR 25.00). Participants with the following self-reported risk factors were significantly more likely to have higher CBIs: workplace bullying (p = 0.01), getting on less well with colleagues (p < 0.05), working longer hours (p < 0.05) and insufficient sleep, exercise and leisure time (all p < 0.01). Those with higher CBI scores were more likely to consider leaving neurosurgical training (p = 0.01). Conclusion: We identified a high burnout incidence in a cohort representative of UK neurosurgical trainees, although our results may have been skewed somewhat by selection bias. We determined potential risk factors for burnout related to specific workplace stressors and time for non-work activities. In the future, changes to training curricula should address these issues, aiming to improve training, enhance patient care and reduce attrition rates. [ABSTRACT FROM AUTHOR]

In this paper, it is argued that the industrial revolution in eighteenth century Great Britain had its origins in the arrival of 100,000–140,000 Protestant refugees in England and Ireland in the sixteenth, seventeenth and eighteenth centuries. Specifically, it is argued that their arrival prompted both Schmooklerian pull and push factors. The pull factor was the thousands of refugee merchants and ship owners/captains to England and Ireland resulting in the creation of the Protestant International (1550-1750). This increased the demand for tradables which in turn spurred invention and innovation among refugees (push factor) and their descendants as well as in the local population. These factors were self-reinforcing, leading in time to the industrial revolution. The result is a novel account of the origins of the industrial revolution, one that is consistent with competing explanations. [ABSTRACT FROM AUTHOR]

New mothers in Western societies report being influenced by ideologies which suggest mothering comes naturally to women and is joyful and fulfilling. However, research reveals motherhood-related negative thoughts are common even among non-depressed new mothers, and it has been suggested experiencing such thoughts may be related to guilt and shame. This study updates and extends Hall and Wittkowski's (2006) prevalence survey of motherhood-related negative thoughts by assessing new mothers' perceptions of the social acceptability of negative thoughts, and by exploring relationships with guilt, shame and psychological distress. A cross-sectional survey design was used. A self-selected sample of non-clinical new mothers (N = 395) from the United Kingdom and Ireland completed online questionnaires including measures of the frequency and social acceptability of motherhood-related negative thoughts, shame and guilt proneness, depression and motherhood experience. Hierarchical regression analyses were used to explore relationships between variables. The frequency of negative thoughts was much higher than reported by Hall and Wittkowski. After controlling for demographic variables and social support, frequency of negative thoughts significantly predicted shame and guilt, whereas social acceptability of negative thoughts significantly predicted guilt. Negative thoughts, shame, guilt and motherhood experience relative to expectations significantly predicted depression score. These results suggest that negative thoughts are more common in early motherhood than previously reported, are considered socially unacceptable, and are related to guilt, shame and depression scores. The findings increase our understanding of postnatal distress in non-clinical populations. Future research should explore information and/or interventions aimed at "normalising" negative thoughts in early motherhood. Highlights: Negative thoughts were more frequent in non-clinical new mothers than previously reported. New mothers found negative thoughts related to motherhood difficult to share with others. Frequency of negative thoughts in new mothers was related to guilt and shame. Frequency of negative thoughts, guilt and shame were related to depression score. Interventions for mothers that "normalise" negative thoughts should be considered. [ABSTRACT FROM AUTHOR]

There has been a drive towards increased digitalisation in healthcare. The aim was to provide a snapshot of current apps, instant messaging, and smartphone photography use in paediatric emergency care. A web-based self-report questionnaire was performed. Individual physicians working in paediatric emergency care recorded their personal practice. One hundred ninety-eight medical doctors completed the survey. Eight percent of respondents had access to institutional mobile devices to run medical apps. Eighty-six percent of respondents used medical apps on their personal mobile device, with 78% using Apple iOS devices. Forty-seven percent of respondents used formulary apps daily. Forty-nine percent of respondents had between 1–5 medical apps on their personal mobile device. Respondents who used medical apps had a total of 845 medical apps installed on their personal device, accounted for by 56 specific apps. The British National Formulary (BNF/BNFc) app was installed on the personal mobile device of 96% of respondents that use medical apps. Forty percent of respondents had patient confidentiality concerns when using medical apps. Thirty-eight percent of respondents have used consumer instant messaging services, 6% secure specialist messaging services, and 29% smartphone photography when seeking patient management advice. Conclusion: App use on the personal mobile devices, in the absence of access to institutional devices, was widespread, especially the use of a national formulary app. Instant messaging and smartphone photography were less common. A strategic decision has to be made to either provide staff with institutional devices or use software solutions to address data governance concerns when using personal devices. What is Known: • mHealth use by junior doctors and medical students is widespread. • Clinicians' use of instant messaging apps such as WhatsApp is the widespread in the UK and Ireland, in the absence of alternatives. What is New: • Personal mobile device use was widespread in the absence of alternatives, with the British National Formulary nearly universally downloaded to physicians' personal mobile devices. • A third of respondents used instant messaging and smartphone photography on their personal mobile device when seeking patient management advice from other teams in the absence of alternatives. [ABSTRACT FROM AUTHOR]