Search

Background: Women considering immediate breast reconstruction require high-quality information about the likely need for secondary reconstruction and the long-term risk of revisional surgery to make fully informed decisions about different reconstructive options. Such data are currently lacking. This study aimed to explore the impact of reconstruction type on the number of revisions and secondary reconstructions performed 3, 5, and 8 years after immediate breast reconstruction in a large population-based cohort. Methods: Women undergoing unilateral mastectomy and immediate breast reconstruction for breast cancer or ductal carcinoma in situ in England between 1 April 2009 and 31 March 2015 were identified from National Health Service Hospital Episode Statistics. Numbers of revisions and secondary reconstructions in women undergoing primary definitive immediate breast reconstruction were compared by procedure type at 3, 5, and 8 years after index surgery. Results: Some 16 897 women underwent immediate breast reconstruction with at least 3 years' follow-up. Of these, 14 069 had a definitive reconstruction with an implant only (5193), latissimus dorsi flap with (3110) or without (2373) an implant, or abdominal free flap (3393). Women undergoing implant-only reconstruction were more likely to require revision, with 69.5 per cent (747 of 1075) undergoing at least one revision by 8 years compared with 49.3 per cent (1568 of 3180) in other reconstruction groups. They were also more likely to undergo secondary reconstruction, with the proportion of women having further reconstructive procedures increasing over time: 12.8 per cent (663 of 5193) at 3 years, 14.3 per cent (535 of 3752) at 5 years, and 17.6 per cent (189 of 1075) at 8 years. Conclusion: Long-term rates of revisions and secondary reconstructions were considerably higher after primary implant-based reconstruction than autologous procedures. These results should be shared with patients to support informed decision-making. [ABSTRACT FROM AUTHOR]

Unlike clinicians, no established competency framework or career pathway exists for the non-clinical workforce from which to establish formal training. This study tests the feasibility of implementing what the authors believe is the first competency framework of its kind for the non-clinical workforce, at level two of a four-tiered career pathway. Level two includes care navigation and signposting roles, capable of reducing clinical workload and improving patient care. Five Community Education Provider Networks (CEPNs) in South London collaborated to deliver training using the competency framework developed by OHSEL. They recruited employees from community health and social care providers, with predominant interest from primary care. Training included Apprenticeships and CEPN-developed modular training. Results for this largely part-time workforce identified enthusiasm for learning; increased confidence and commitment; a desire for career progression and preference for flexible training with skills directly usable at work. Workplace findings included the need for manager training in coaching and mentoring to support employees implementing new skills, and willingness from clinicians and managers to embrace new roles. Feedback was overwhelmingly positive with outcomes used to develop on-line accredited training. Larger studies are needed to confirm the impact on clinical time and patient care. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to explore the acceptability of antenatal enquiry for domestic abuse from the perspective of women using maternity services. The researchers detail the multimethod approach in data collection procedure and outcomes. It implies that women patients support and have positive views of antenatal enquiry for domestic abuse in healthcare settings.

This paper considers the residential distribution of the Scotland-and Wales-born in London in relation to other migrant groups. It goes on to consider the ecological character of the neighbourhoods in which they are concentrated, and it uses the 1991 SARs to identify individual-level characteristics. Overall the Wales-born are shown to have a higher level of educational and occupational attainment than those born in Scotland and to be associated with more middle-class neighbourhoods. However, evidence is presented that the Scotland-born are a more varied population, with contrasts between those living in the inner and outer parts of London. The paper concludes with a discussion of the role that London plays in the migration and urban systems of the United Kingdom as a whole. Key words: Scotland; Wales; London; migrants. [ABSTRACT FROM AUTHOR]

Offers a look at the history of plays and theaters in England in the 1580s. Problem encountered by scholars interested in plays of high literary merit; Implications of the decrease in plays in the 1580s; Titles of some famous plays during the period.

Contemporary international migration flows into European cities are now more diverse than used to be the case. The movement of less-skilled labour migrants has been replaced by the circulation of high-skill executives and specialist personnel involved in transnational corporations and in the financial services and other sectors affected by economic globalisation. To these are added other new service migrants and increased flows of students and independent young people. As a result, world cities are now witnessing the emergence of important categories of non-racialised international migrant groups. This paper considers whether such groups form distinctive residential concentrations in Greater London and uses the limited aggregate data available from the census to establish a general view of the geography of developed world migrants. There are important implications for urban theory and for discussions of urban ethnicity. [ABSTRACT FROM AUTHOR]

Focuses on experiences gathered in the appointment of teaching fellows to support lower-level teaching in the Department of Geography at the University of Sheffield. Selection and appointment process; Advantages of the presence of teaching fellows to the established staff; Financial implications and other potentials of teaching fellow appointments; Problems in the use of teaching fellowships.

Dementia represents a substantial threat to the self. However, to date, there is no reliable way to measure how threatened people feel by dementia. This article reports on two online studies. In Study 1, 248 participants rated statements about dementia according to their threat to well-being. In Study 2, 99 participants (all students at the University of the West of England) completed the emerging scale (the Threat of Dementia Scale or ToDS). We validated this by examining its associations with conceptually related measures, including the revised Fraboni Scale of Ageism and the Fear of Alzheimer's Disease Scale. Study 1 yielded 13 statements that were highly intercorrelated and comprised a single factor. In Study 2, the ToDS demonstrated good construct validity and acceptable test–retest reliability. Higher levels of distancing predicted lower scores on the ToDS. The ToDS is a reliable and valid instrument that is the first statistically validated method of examining the extent to which dementia threatens well-being. [ABSTRACT FROM AUTHOR]

Objective: a follow-up study to evaluate the degree to which practice changes identified in the 2004/2005 evaluation of the Bristol Pregnancy Domestic Violence Programme (BPDVP) for routine enquiry for domestic abuse have been maintained., Methods: a multimethod approach was adopted, using a follow-up survey and focus groups., Setting: an acute Trust within the South West of England., Participants: 58 midwives completed the survey, 73% (n=36) of whom had taken part in the original study in 2004/2005. Eleven of those surveyed also participated in focus group interviews., Measurements: participating midwives completed a 54-item questionnaire, where possible the questions were the same as those utilised in the original follow-up questionnaire. Similar to the previous study, the questionnaire was divided into a number of sections, including view of professional education, knowledge of domestic violence and abuse, attitudes and efficacy beliefs, barriers and support. The aim of the focus groups discussion was to obtain the overall views of midwives with the regard to the on-going implementation of routine enquiry. Frequency distributions for midwife responses in 2010 were compared with the corresponding frequency distributions in 2004/2005 and a statistical assessment of differences was performed using the χ(2) test of association., Results: midwives have to feel confident in their abilities to ask about abuse and the findings from this study demonstrate that across the cohort there was a tendency to have an increase in confidence in asking about domestic violence. Midwives have to feel confident in their abilities to ask about abuse. The findings from this study demonstrate that across the cohort there was a statistically significant increase in self-reported confidence in asking women about domestic abuse. In addition, there was a statistically significant increase in the degree of self-reported knowledge of how to deal with a disclosure of domestic violence when comparing the 2010 data with 2005 data., Conclusions: results suggest that improvements in antenatal enquiry for domestic violence and abuse developed through the 2004/2005 BPDVP have improved over time, with the support of mandatory training. Nevertheless, barriers continue to exist, which include presence of a male partner and lack of face to face interpreting services, both these obstacles need to be addressed if all women and, in particular those who are most at risk of abuse are to be identified and supported., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: Ultrasonography is an important skill for obstetricians and gynecologists; however, trainees have highlighted ultrasonography as an area of deficiency in their training. We undertook a prospective cross-sectional comparative study to assess content and construct validity of an ultrasound virtual reality (VR) simulator (UltraSim)., Methods: Twenty-six physicians and sonographers of varied ultrasonography experience were recruited and divided into trainees (no formal ultrasonography training) and expert (certified) categories. They performed a VR simulation crown-rump length (CRL) ultrasound scan and growth ultrasound scan measuring biparietal diameter, occipitofrontal diameter, abdominal anteroposterior and transverse diameters, and femur length. Maximum pool depth (MPD), placental site, and fetal presentation were also assessed. Outcome measures included the mean absolute deviation and the variance of the absolute deviation from true measurements. Accuracy of determining placental site, fetal presentation, and MPD was assessed. The time taken to perform each type of scan was recorded., Results: Trainees had significantly greater variation of measurement of CRL (P = 0.025) than the expert group. For late-pregnancy fetal biometry, the absolute deviation and the degree of variability for all measurements differed. These differences were statistically significant (P < 0.05) for all measurements except abdominal diameters and MPD. Trainees took significantly longer time to obtain CRL and fetal biometric scans (P < 0.001). All subjects correctly identified fetal presentation and placental site., Conclusions: Clinicians with differing ultrasonography expertise showed differing skill with the UltraSim VR simulator, demonstrating construct validity for skills needed in simulation. Consideration should be given to investigating whether trainees with minimal scanning experience can improve their clinical skills and efficiency with VR simulation.

Aim: The aim of this paper is to report a study to establish the extent and type of psychosocial needs of outpatients attending for treatment of a wide range of disfiguring conditions., Background: Visible disfigurements can be associated with extensive psychosocial difficulties. The majority of research to date has been carried out with people identified by themselves or others as experiencing difficulties. Little is known about levels of distress in the broader population of patients receiving treatment for a range of disfiguring conditions., Methods: A cross-sectional survey was conducted, with a convenience sample. Participants (n = 458) drawn from 15 outpatient clinics completed standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and avoidance (Derriford Appearance Scale short-form) and quality of life (World Health Organization Quality of Life Brief Scale). A semi-structured interview was used to generate further quantitative and qualitative data about individual concerns, and satisfaction with the provision of care. Staff views about levels of psychosocial distress were elicited through group discussions., Results: The results revealed high levels of psychological distress in the sample, compared with normative values. The majority of difficulties related to problems experienced in social situations. Patient satisfaction with care was generally high; however, and 71% of participants expressed a moderate to strong desire for a health care professional with training to deal with their appearance-related concerns. Nursing staff felt unable to address patients' appearance-related difficulties because of time constraints, lack of an environment conducive to the discussion of patients' concerns, and lack of appropriate knowledge and training., Conclusion: A significant proportion of participants experienced psychosocial distress in relation to their visible difference. Psychosocial needs were poorly met in current outpatient care provision, and a range of options could be considered to address these more effectively.

Background: There is substantial national interest in the widening gap in socio-economic inequalities. The aim of this study was to examine time trends in age-specific mortality in Trent Region comparing rates by socio-economic deprivation from 1988 to 1998., Methods: Mortality rates from 1988 to 1998 were calculated for each of five deprivation categories (derived using 1991-based enumeration district level Townsend scores) for men and women aged 45-54, 55-64, 65-74 and 75-84 years. Rate ratios (95 per cent confidence intervals) were calculated for the years 1988-1990 and 1996-1998, comparing the most deprived with the least deprived categories., Results: For men aged 45-54, the rate ratio for the most deprived relative to the least deprived category was 2.42 (2.2-2.67) in 1988-1990 and 2.4 (2.17-2.65) in 1996-1998. Amongst women the ratio fell from 2.14 (1.88-2.42) to 1.67 (1.47-1.88). For men aged 55-64, the rate ratio fell from 2.07 (1.95-2.19) to 1.79 (1.67-1.91). For women the fall was from 1.99 (1.84-2.14) to 1.59 (1.46-1.73). For those aged 65-74, the fall was from 1.65 (1.58-1.72) to 1.33 (1.28-1.39) for men and from 1.55 (1.47-1.63) to 1.37 (1.30-1.45) for women. For people aged 75-84, no clear convergence in rates was seen., Conclusion: There appear to be decreases in socio-economic inequalities in mortality between 1988 and 1998 in Trent Region. These trends run counter to those described in the majority of recent literature.