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Summary: Remote dermatology consultations largely superseded face‐to‐face (FTF) consultations during the peak of the COVID‐19 pandemic in the UK. Remote examination of patients with hidradenitis suppurativa (HS) brings particular challenges, given the propensity of HS to affect intimate body areas. To understand the impact of remote consultations on the care of patients with HS, a retrospective analysis was conducted of all consultations from 2 April to 29 October 2020 at the HS clinic at Imperial College Healthcare NHS Trust. In this group of patients with HS, 46.3% were black, compared with 7.0% of patients attending general dermatology clinics (P < 0.001). The majority (65.9%) of patients had previously received or were currently taking adalimumab. All consultations were performed by telephone and in 50.7% of the consultations, patients were assessed as having unstable (u)HS, with 81.1% of these uHS episodes leading to a change in pharmacological therapy. The decision‐making process was aided by patient‐submitted photographs at only 8.1% of consultations involving uHS, for reasons of patient privacy, comfort and data security. The data suggest that HS is an inherently unstable disease despite maximal medical therapy, and this study highlights important reasons for the assessment of patients with HS by FTF consultations where safely possible. [ABSTRACT FROM AUTHOR]

Background: This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes between benign and malignant disease. Methods: Data on adrenalectomies were extracted from a national surgeon‐reported registry. Preoperative diagnosis, surgical technique, length of hospital stay, morbidity and in‐hospital mortality were examined. Results: Some 3994 adrenalectomies were registered among patients with a median age of 54 (i.q.r. 43–65) years (55·9 per cent female). Surgery was performed for benign disease in 81·5 per cent. Tumour size was significantly greater in malignant disease: 60 (i.q.r. 34–100) versus 40 (24–55) mm (P < 0·001). A minimally invasive approach was employed in 90·2 per cent of operations for benign disease and 48·2 per cent for cancer (P < 0·001). The conversion rate was 3·5‐fold higher in malignant disease (17·3 versus 4·7 per cent; P < 0·001). The length of hospital stay was 3 (i.q.r. 2–5) days for benign disease and 5 (3–8) days for malignant disease (P < 0·050). In multivariable analysis, risk factors for morbidity were malignant disease (odds ratio (OR) 1·69, 1·22 to 2·36; P = 0·002), tumour size larger than 60 mm (OR 1·43, 1·04 to 1·98; P = 0·028) and conversion to open surgery (OR 3·48, 2·16 to 5·61; P < 0·001). The in‐hospital mortality rate was below 0·5 per cent overall, but significantly higher in the setting of malignant disease (1·2 versus 0·2 per cent; P < 0·001). Malignant disease (OR 4·88, 1·17 to 20·34; P = 0·029) and tumour size (OR 7·47, 1·52 to 39·61; P = 0·014) were independently associated with mortality in multivariable analysis. Conclusion: Adrenalectomy is a safe procedure but the higher incidence of open surgery for malignant disease appears to influence postoperative outcomes. [ABSTRACT FROM AUTHOR]

Aim To explore attitudes towards insulin acceptance an ethnically diverse population of people with Type 2 diabetes. Methods We conducted semi-structured interviews using a topic guide based on a literature review and findings from our previous study, which explored the perspectives of healthcare professionals about insulin initiation and management. Analysis of data involved undertaking an abductive reasoning approach in response to emerging themes. Results Participants discussed not only their concerns about insulin therapy, but also their views and beliefs about the necessity of insulin. Their attitudes to insulin treatment could be mapped into four main typologies. These fitted with an attitudinal scale based on the Necessity-Concerns Framework described in the medication adherence literature, comprising four attitudes: accepting, sceptical, ambivalent and indifferent. Decisions about accepting insulin involved balancing concerns (such as needle size) against the perceived necessity of insulin (generally, inadequacy of oral medication). The South Asian and white participants had similar concerns, but these were sometimes greater in South Asian participants, because of the influence of negative views and experiences of other insulin users. Conclusions When discussing insulin with people with Type 2 diabetes, healthcare providers need to ensure that they explore and contribute to patients' understanding and interpretation of the necessity of insulin as well as discussing their concerns. Furthermore, they should be aware of how an individual's social context can influence his/her perceptions about the necessity of insulin as well as their concerns, and that this influence may be greater in some South Asian populations. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 1311-1316 (2012) Abstract Aim To explore barriers to prescribing of insulin, particularly delays in initiation, from the perspective of healthcare professionals involved in managing Type 2 diabetes in a multi-ethnic setting. Methods The study was carried out in a UK population with high numbers of people of South Asian (mainly Indian) origin. Semi-structured interviews were conducted with 14 healthcare professionals from primary and secondary care. Analysis involved exploring interview transcripts in terms of themes and sub-themes identified through a process of progressive focusing. Results Initiation of insulin therapy was described as challenging in all patients irrespective of ethnicity, but some barriers were perceived to be accentuated because of language needs and lower levels of understanding about diabetes and insulin. Additionally, some South Asians were viewed as more likely than their white European counterparts to be influenced by negative observations and experiences about insulin therapy within community networks. Time restrictions were seen as a barrier that was accentuated in the management of South Asian patients. Participants suggested strategies for overcoming patient barriers; with South Asians these included involvement of families and patient peers and availability of South Asian healthcare providers. Conclusion The challenge for healthcare providers is to how to address the tension between the optimal clinical time for commencing insulin therapy and the time when the patient feels psychologically ready. To help make these two time points coincide, our findings suggest the need to adopt a holistic approach involving consideration of the cultural context of patients, including their ethnic background. [ABSTRACT FROM AUTHOR]

Objective: Many people seek health information from internet sources. Understanding this behaviour can help inform healthcare delivery. This study aimed to review Google Trends as a method for investigating internet-based information-seeking behaviour related to throat cancer in terms of quantity, content and thematic analysis. Method: Data was collected using Google Trends. Normalised data was created using the search terms 'throat cancer', 'cancer', 'HPV', 'laryngeal cancer' and 'head and neck cancer'. The search data was used to analyse the temporal and geographical interest pattern of these terms from 2004 to 2015. Results: Three important peaks in searches for 'throat cancer' were identified. The first and greatest increase in interest was in September 2010, and there were also peaks in June 2013 and in October 2011. Conclusion: Internet-search analysis can provide an insight into the information-seeking behaviour of the public. Mass media can hugely affect this information-seeking behaviour. Possessing tools to investigate and understand information-seeking behaviour may be used to improve healthcare delivery. [ABSTRACT FROM AUTHOR]

This study of people newly diagnosed of living with HIV (ND-PLHIV) calculated the use, cost and outcome of HIV services at a London HIV centre. ND-PLHIV were followed July 2017-October 2018. Hospital data included inpatient days (IP), outpatient (OP), dayward (DW) visits, tests and procedures, and anti-retroviral drugs (ARVs). Community services were recorded in daily diaries. Mean per patient-year (MPPY) use was multiplied by unit costs. 13.6 MPPY (95%CI 12.4–14.9) OP visits, 0.4 MPPY (95%CI 0.1–0.7) IP days, 0.09 MPPY (95%CI 0.01–0.2) DW visits and 4.6 MPPY community services (95%CI 3.4–5.8). Total annual costs per patient-year (CPPY) was £11,483 (95%CI £10,369–12,597): ARVs comprised 63% and community services 2%. White participants used fewer hospital and more community services compared with minority ethnic community (MEC) participants. Costs for White ND-PLHIV was £10,778 CPPY (95%CI £9629–11,928); £13,214 (95%CI £10,656–15,772) for MEC ND-PLHIV (p < 0.06). Annual costs were inversely related to CD4 count at entry (r = −5.58, p = 0.02); mean CD4 count was 476 cells/mm3 (95%CI 422–531) versus 373 cells/mm3 (95%CI 320–425) for White and MEC participants respectively (p = 0.03). Annual costs for ND-PLHIV with CD4 ≤ 350 cells/mm3 was £2478 PPY higher compared with CD4 count >350 cells/mm3 (p = 0.04). [ABSTRACT FROM AUTHOR]

Abstract: HIV is no longer an absolute contraindication to solid organ transplantation. However, few reports have been published with regards to pancreas or simultaneous pancreas kidney transplantation in the HIV-positive recipient. We report, to our knowledge, the first simultaneous pancreas kidney transplantation (SPK) performed in an HIV-positive patient in the United Kingdom. We reflect on the article recently published by Miro et al in Transplantation Proceedings and highlight strategies used by our department to prevent drug interactions in these complex patients. [Copyright &y& Elsevier]

Objective The optimum management of dual anti-platelet therapy (DAPT) in patients undergoing dentoalveolar surgery is controversial. The lack of guidelines has meant clinicians have been left to manage these cases from specialist advice or past experience. In view of this the British Association of Oral Surgeons (BAOS) membership was surveyed to assess current practice.Design An electronic survey consisting of nine closed multiple-choice questions was circulated to all 435 registered BAOS members. A section for open comments was also included. The data was transcribed, organised and reduced to themes by hand and finally analysed.Results One hundred and eighty members completed the questionnaire giving a response rate of 41%. Ninety-two percent of clinicians had direct involvement in managing patients on DAPT and of these 80% had not encountered a bleeding complication. DAPT was continued for simple dental extraction under local anaesthetic by 83% of respondents and 73% for surgical extractions. Two thirds of the respondents did not follow any guidelines but for those that did the most common was the UK Medicines Information protocols. Only 10% of respondents reported a significant post-operative bleeding complication following surgery in patients on DAPT.Conclusion This survey confirmed the continued variable management of patients on DAPT undergoing dentoalveolar surgery. Reported bleeding rates were low with over 75% of patients not having their DAPT treatment interrupted. [ABSTRACT FROM AUTHOR]

Colorectal cancer is the fourth most prevalent cancer in the UK. Fortunately, with modern surveillance programmes, more patients are being diagnosed at an earlier stage. Although surgical excision remains the gold standard, many patients have co-morbidities that preclude them from having radical surgery. Additionally, a number of patients do not wish to live with a permanent colostomy. Radiotherapy has an established role in the non-surgical treatment of patients with rectal cancer. Increasing the radiation dose to the tumour increases the chance of local control. Using contact X-ray brachytherapy (CXB) it is possible to escalate the dose to the tumour and minimise the dose received by surrounding normal tissues. The aim of this study was to evaluate the outcomes of patients from our centre who have undergone CXB with or without external beam radiotherapy. A prospectively maintained and locally managed colorectal database was used to collect clinical details and outcomes for colorectal cancer patients. All patients who were treated with CXB at our institution from the commencement of the service in April 2014 to the end of December 2019 were analysed. There was a minimum of 18 months of follow-up. One hundred and ninety-three patients received at least one fraction of CXB. The median age at first treatment was 72 years (range 33–103 years). Seventy-three per cent of patients were male. Of the operable or high surgical risk patients, 105 were treated radically with radiotherapy, 28 were treated radically with radiotherapy after local resection and 22 patients were medically unfit for surgery. Most patients received external beam radiotherapy 45 Gy/25 fractions (87/146) or 25 Gy in five fractions (35/146). Forty-seven patients received CXB as sole treatment (51% had previous radiotherapy). Of those with a response assessment, with a median follow-up of 35 months, 78% of all patients achieved a clinical complete response (cCR) or a near cCR, 6% had a partial response and 16% had persistent disease. Of 154 radically treated patients with a response assessment, 84% achieved cCR or near cCR, 19% (24/129) of these subsequently relapsed. This series shows that CXB is a well-tolerated and effective treatment in a diverse cohort of patients with rectal cancer. Comparable favourable oncological outcomes were seen, in keeping with previously published work. • Contact brachytherapy (CXB) increases rates of organ preservation in rectal cancer. • A cohort of 193 patients from a single centre treated with CXB is presented. • 85% of 95 patients treated with radical intent achieved complete or near response. • Local relapse occurred in 14% and disease-free survival was 75% at 5 years. • 100% of 28 patients treated with CXB after local excision had complete response. [ABSTRACT FROM AUTHOR]

Objective: To explore differences in the background knowledge of Endometrial Cancer (EC), its risk factors, symptoms and prognosis of Endometrial Cancer (EC) between British White (BW) and British South Asian (BSA) women who had undergone treatment for stage I endometrial cancer within the past 3-years.Study Design: Face-to-face, semi-structured interviews exploring knowledge; diagnosis; treatment; follow-up; and survivorship were undertaken and analysed using Thematic Analysis.Results: Twenty-one women were interviewed (13 BW and 8 BSA). BW and BSA women reported similar views, experiences and concerns with regards to EC. Knowledge appeared to differ amongst the two groups with BSA women reporting being more aware that unscheduled vaginal bleeding could be associated with a malignancy but having lower levels of knowledge of the risk factors that can lead to EC, compared to BW women. There was a lack of understanding of the difference between cervical cancer and EC and as a result, many women reported taking reassurance from negative cervical cytology as excluding EC. There was also the misconception amongst some of the women that there was a link between sexual behaviour and EC. Women from both groups used the lay healthcare system to discuss their situation/symptoms, however BSA women reported to have specifically sought out women within their social network who had previously undergone treatment for EC.Conclusions: Greater effort is needed to raise awareness in both the BW/BSA communities of the symptoms associated with EC that should prompt medical review. Educational efforts are required to overcome the reported perception that EC is synonymous with cervical cancer and cannot be detected by cervical screening. [ABSTRACT FROM AUTHOR]

Pompe disease is a rare, progressive, multisystemic disease. Here we report results of an online quantitative survey of people living with late-onset Pompe disease (LOPD) in the UK, with the aim to better understand and quantify their experiences throughout the disease journey. 37 participants (male, n=19 [51%]; mean age, 54.1 years; mean age at symptom onset, 33.2 years; mean age at LOPD diagnosis, 42.5 years; received ≥1 misdiagnosis, n=17 [46%]) completed the survey consisting of 42 questions in January 2022. Results revealed that most participants received assistance with day-to-day living (n=30, 81%), with the most frequent LOPD-associated symptoms being walking difficulties (n=35, 95%), fatigue (n=35, 95%) and muscle weakness (n=34, 92%). 26 participants (70%) were being treated with standard-of-care enzyme replacement therapy (ERT) at the time of the survey; 14 (54%) of those for >10 years and 20 (77%) deeming their condition to have deteriorated since treatment began. Several patients receiving ERT mentioned the need for more efficacious or novel treatments (n=6, 23%) and the use of a delivery method less invasive than intravenous (n=5, 19%) as desired improvements to ERT. Many participants stated the provision of ancillary therapies (eg physiotherapy [n=27, 73%], dietary advice [n=18, 49%]) and mental health counselling [n=17, 46%]) would help them better manage their condition. The COVID-19 pandemic has been a period of increased anxiety and physical deterioration for many participants, with 50% (n=13) of those on ERT stating their treatment had been interrupted due to the pandemic. However, several people mentioned initiation of home-based/self-administered therapies (n=4, 11%) and reduced travel (n=5, 14%) as beneficial outcomes of the pandemic. Findings from this study further characterise the challenges faced by people living with LOPD, highlighting the need for varied patient support and more efficacious treatment options. [ABSTRACT FROM AUTHOR]

Pompe disease is a rare, progressive, multisystemic disease. We evaluated the burden, unmet needs and management landscape of people living with late-onset Pompe disease (LOPD) based on their own experiences and the opinions of healthcare professionals (HCPs). The objectives were to better understand the experiences of LOPD patients in the UK, including their diagnostic and treatment journeys; the impact of LOPD on quality of life; their experiences during the COVID-19 pandemic; and the concordance between patients' and HCPs' perceptions of living with LOPD. In-depth qualitative interviews were conducted with 27 participants living with LOPD (male, n=13 [48%]; mean age, 56 years; mean age at diagnosis, 43 years). Interviews revealed that the diagnostic process was typically long and distressing, with most participants emphasising a desire for reduced times to diagnosis, referral to a specialist and treatment initiation. The most frequently reported LOPD-associated symptoms were walking difficulties (n=27, 100%) and fatigue (n=26, 96.3%). For many participants, the COVID-19 pandemic has been a period of increased anxiety and physical deterioration. In-depth qualitative interviews were also conducted with 8 HCPs (specialist nurses, n=4; metabolic consultants, n=2; cardiologist, n=1; physiotherapist, n=1): although HCPs had similar views to patients of the challenges of living with LOPD and patients' unmet needs, their responses suggested a reduced awareness of the acute emotional changes experienced by patients at different stages of the disease journey. HCPs emphasised the need to manage patients' expectations around available therapies, and that the increased use of technology in consultations and treatment was a positive outcome of the COVID-19 pandemic. Findings from this study further characterise the challenges faced by people living with LOPD, particularly during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Aims To conduct a pilot study evaluation of an interprofessional education tool that could improve healthcare professional confidence, knowledge and quality of inpatient diabetes care. Methods Diabetes specialists designed an education tool for use in the hospital environment to educate qualified pharmacists, nurses, healthcare assistants and junior doctors. The interprofessional learning enabled professionals to learn from and about each other. The education tool was piloted at four hospitals. Diabetes specialists delivered the education programme to 31 healthcare professionals over 8 h either as three individual teaching blocks or a whole day. Healthcare professionals completed a multiple choice questionnaire before and after the education intervention to evaluate acquisition of knowledge. The maximum score was 20. Confidence was evaluated using categorical questions. Diabetes specialists used a clinical audit form before and after the education programme, to evaluate the quality of diabetes care. Results Healthcare professional's confidence improved from 58 to 94% ( P < 0.05) and knowledge improved from 12.4 ± 0.6 to 15.0 ± 0.6 (mean ± sem, P < 0.05). There was a reduction in management errors from 74 to 44% ( P < 0.05) and improvement in appropriate blood glucose monitoring from 67 to 92% ( P < 0.05). The number of patients with documented foot assessment improved from15 to 33% ( P < 0.05). Improvement in the number of appropriate diabetes referrals and reduction in prescribing errors did not reach statistical significance. Conclusion The education tool improved healthcare professional confidence, knowledge and may improve the quality of inpatient diabetes care. [ABSTRACT FROM AUTHOR]

Objective This project aims to: (1) describe the frequency of news coverage in mass media related to the National Institute for Health and Clinical Excellence (NICE) draft or final guidance; (2) analyse the types of evidence and sources of information that was quoted in the news; (3) compare whether the patterns of coverage differ between media. Design A survey of news articles related to decisions made by NICE's Health Technology Appraisal committees was conducted. Relevant news articles were retrieved from websites of major UK news media. Inclusion criteria were: (1) news articles related to specific NICE decision(s); (2) articles were written by a reporter/writer/editor of the news media. Articles that mentioned NICE for other reasons, columns and readers' letters were excluded. Setting Major UK news media, including national newspapers and news channels. Samples News articles published during 2007–2008 in 13 different sources of media including tabloids (Daily Express, Daily Mail, News of the World, The Mirror, The Sun), broadsheets (Independent, Guardian, The Telegraph, The Times) and news channels (BBC, ITN, Sky News and Reuters). Main outcome measure The following data were collected by one author and checked by another: nature of guidance (disease area; positive or negative recommendation), use of generic or brand name and source/type of evidence that was quoted. Descriptive statistics were compiled and comparisons between types/sources of news media were made using χ test. Results 329 articles were included. BBC, Daily Mail and The Telegraph published more than 50 articles related to health technology appraisal whereas ITN and News of the World published less than 10 articles during the 2-year period assessed. Two-thirds (220/329) of the articles were related to negative recommendations. There was significant difference in the proportion of articles relating to negative recommendations between individual sources of media (p=0.001) but not between types of media (p=0.286). Cancer (33%), neurology–mainly Alzheimer's disease (22%), ophthalmology (13%) and rheumatology (10%) were most frequently covered areas. 58% (192/329) of the articles quoted only brand names without mentioning generic names of the drugs. Approximately 50% of articles included statements of effectiveness without referring to the source of evidence and another 40% did not describe clinical effectiveness. 24% of articles did not mention drug costs or cost-effectiveness. Conclusion NICE decisions on new drugs, particularly negative recommendations, attracted significant media attention but the coverage and contents varied substantially between individual sources. [ABSTRACT FROM PUBLISHER]

AimTo assess the value of the modified international classification system in screening high-risk patients with bilateral age-related maculopathy (ARM) from those with lower risk characteristics.MethodsIn total, 164 digital images of 106 patients with either bilateral ARM (group A) or the fellow eyes of unilateral exudative age-related macular degeneration (AMD) (Group B) were included. Patients with no signs of ARM in both eyes or those with bilateral late AMD were excluded. The images were randomised and then graded by two masked ophthalmologists based on the modified International Classification of ARM.ResultsThe interobserver consistency between the two graders was high with a Kappa value of 0.82 (SE 0.34, P<0.0001). There were no significant differences in the distribution of the stages of ARM between the two subgroups. Stage 3 was the most common stage in each group for both graders followed by stage 2a in the bilateral drusen group. Stages 1a, 2a and 2b were equally the next common stage in the fellow eye of chordial neovascularisation group.ConclusionA screening system based on clinical characteristics would be of value in risk prediction in a clinical setting. Type of Drusen alone, as identified by the modified International grading system, may not be reliably predictive in screening for patients who are at high risk of developing choroidal neovascularisation.Eye (2006) 20, 199–202. doi:10.1038/sj.eye.6701852; Published online 4 March 2005 [ABSTRACT FROM AUTHOR]