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Background: Urogynaecological conditions, such as pelvic organ prolapse, urinary incontinence, and urinary tract infection, can have a profound impact on people's lives. The Independent Medicines and Medical Devices Safety Review highlights missed opportunities to prevent harm when patient voices are not incorporated into healthcare policy and practice. This resonates with the Women's Health Strategy for England. The National Institute for Health and Care Research (NIHR) Policy Research Programme funded this in-depth qualitative exploration of people's experiences of living with urogynaecological conditions, and of seeking healthcare treatment, to inform health and social care improvements in the UK. Methods: We conducted in-depth interviews online or by telephone (April 2021-December 2021) and used reflexive thematic analysis to develop themes that cut across urogynaecological conditions. Results: We spoke to seventy-four adults aged 22–84 across a range of backgrounds and lived experiences of urogynaecological conditions, including pelvic organ prolapse, urinary incontinence and persistent or recurring urinary tract infection. Eight themes were developed: [1] I get no respite from my own body; [2] I feel confined and separated; [3] I can no longer be 'me'; [4] I am constrained by stigma, shame and silence; [5] I feel fragmented and lost in the healthcare system; [6] I need to be heard, believed, and valued; [7] I need respect as an equal partner in healthcare; and [8] (Re)connected to a more open community. Conclusions: High quality care focuses on the whole person rather than their body parts. Openness and candour support a shared decision-making model of care. A culture of shame can have a negative impact on access to health care and recovery. [ABSTRACT FROM AUTHOR]

We describe the development of a water-use strategy for horticulture in England and Wales. Data were gathered from a literature review as well as from industry and grower surveys, and combined with information from interviews with key informants, in order to assess current practices and underlying trends in water-use within seven horticultural sectors. The spatial distribution of horticultural holdings relative to water availability and stress were mapped for both direct abstraction and mains water supplies. From this, a strategy was developed to define the key priorities at grower and industry levels, and the actions required, including research, communication, and knowledge transfer, to improve water-use efficiency and to reduce environmental water impacts. The key priorities identified included: improving our knowledge of the impacts of irrigation on diffuse pollution, including leaching of nitrate, phosphate, and pesticides; the need to improve grower understanding of water regulation; and quantifying the links between poor uniformity of irrigation, crop production, and profitability. [ABSTRACT FROM AUTHOR]

England and Wales received their revised children's legislation first, with the Children Act 1989. After a long battle, children's legislation was finally introduced into Parliament in 1994 for Scotland and Northern Ireland, resulting in the Children (Scotland) Act 1995 and the Children (NI) Order 1995. The three pieces of legislation introduce key principles of the United Nations Convention into their respective legal jurisdictions. Both the 1989 Act and the 1995 Order begin with key principles that apply to court intervention in children's lives under the legislation. Research was undertaken to explore the conceptualization and application of Section 22(6) to Section 22(8) of the Children Act 1989 in England and Wales, in order to consider the parallel provisions for Scotland. This research was funded by the John Robertson Bequest (University of Glasgow) and supported by the Association of Directors of Social Services. Section 22(6) to Section 22(8) appears little used in practice in England and Wales, and has been virtually untested in court. The subsections seem to represent a familiar qualification to prioritizing children's welfare, to those involved in social work, in relation to children who are violent. Practitioners are particularly unsure of the relationship between the subsections and secure accommodation; certain respondents felt that Section 22(6) to Section 22(8) was unnecessary, given secure accommodation provisions.

Background: Previous studies, mainly from the United States, have reported worse outcomes from lower limb bypass procedures in ethnic minority populations. Limited nationwide data are available from ethnic minority populations from Europe. The aim of this study is to investigate outcomes from lower limb bypass procedures in ethnic minorities from England., Methods: We enquired the "Hospital Episode Statistics" database, using ICD-10 codes to identify all cases of femoral-popliteal bypass operations from English NHS Hospitals from 01/01/2006 to 31/12/2015. Every case was followed up for 2 years for subsequent events. The primary outcomes were mortality and major leg amputation. Patients were broadly categorised according to Black, Asian and White ethnicity. Chi-square test was used to the ethnic groups and odds ratios (OR) were calculated using White ethnic group with the largest numbers of participants as a reference category., Results: In the examined 10-year period, 20825 femoral-popliteal bypass procedures (250 of Black, 167 of Asian, and 20.408 of White ethnicity) were recorded. Thirty-day and 2-year mortality were 2.8% and 16.8% with no significant ethnic differences. Patients of Black ethnicity had higher risk of limb loss compared to Whites (23.2% vs. 15.6%, OR = 1.63, 95% confidence interval (CI) 1.21-2.19, P < 0.01). There was no significant difference in amputation rates between Asians and Whites (16.2% vs.. 15.6%, P = 0.94)., Conclusions: Patients of Black ethnicity are at higher risk of limb loss after a femoropopliteal bypass procedure. Further research is needed to identify the causes of this discrepancy., (Copyright © 2021. Published by Elsevier Inc.)

Background: Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit., Methods: A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO 2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure., Conclusion: Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.