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Objectives Later life is often categorized by higher-than-average levels of loneliness, but individual differences are vast and not well understood. Emerging evidence indicates that broad-based contextual factors such as the coronavirus disease 2019 (COVID-19) pandemic—and the use of the internet throughout—are differentially associated with the experience of loneliness. We, therefore, target internet usage and loneliness among middle-aged and older adults during the pandemic and examine the moderating role of age, gender, and limiting illness therein. Methods We applied hierarchical regression models to data from the COVID-19 substudy Wave 1 (June/July 2020) of the English Longitudinal Study of Ageing (N  = 4,790; M age = 70.2; standard deviation = 9.0; range: 50–90; 43.5% male). Results Infrequent internet use was associated with less loneliness compared with very frequent users—an association that strengthened with age. Conversely, the purpose of internet use was associated with more loneliness, with higher levels exhibited by those searching for health-related information—an effect stronger among those with a limiting illness. Discussion Findings imply that infrequent internet use may reduce loneliness, while health-related internet searches may increase loneliness among older adults with different physical capacities. Findings are contrary to prepandemic reports, underscoring the importance of broad-based contextual factors for understanding loneliness across adulthood and old age. [ABSTRACT FROM AUTHOR]

Chemistry summer schools for 17-18 year old school students in the UK were run by Bristol ChemLabS, a Centre for Excellence in Teaching and Learning in Chemistry at the University of Bristol. Students attending were all studying Chemistry at post-16 level (A level in the UK) and experienced not only new practical techniques but also lectures on cutting-edge science as well as interacting with postgraduate role models. The students completed pre and post summer school questionnaires to ascertain the impact of the summer school on them. Paired t-tests were used to ascertain significant changes at the 2s level. There was no significant difference observed for self-concepts in Chemistry and Mathematics. For creative self-concept there was a significant increase (1s) for females but not males and a significant increase in academic selfconcept for the whole cohort. There was a high level of enjoyment of the summer school. There were a range of reasons for students attending the summer school and the benefits they produced and these are discussed. Interestingly, one of the main reasons for attending was to help students make choices of subject to study at University; however, the summer school opened the students' eyes to more possibilities rather than narrow the choices open to them.

Polymer Chemistry days run by Bristol ChemLabS at the School of Chemistry, University of Bristol for year 10 (14-15 year olds) school students are described. Pre and post questionnaires were analysed to determine the impact on attitudes to science. There was no change in attitudes to the importance of science or practical work in science, but increases were observed in attitudes to learning science in school, self-concept in science, science outside of school and future participation in science. Using a two-tailed t-test at the 2s level of significance (95% confidence level) or higher a "combined interest in science" (combining items from learning science in school, science outside of school and future participation in science) was significantly increased. Using a two-tailed t-test at the 3s level of significance (99% confidence level) or higher self concept in science was increased. Such an increase at such a high tolerance level is noteworthy. Both males and females attitudes to science increased as a result of the polymer workshops but scores for males were consistently higher than for females. Students studying individual science subjects (triple science) and combined science at GCSE (UK) both returned very high scores for enjoyment of the day. The results of these surveys are discussed in detail in the paper.

Two summer schools focused on practical chemistry, one involving secondary school students and one involving visually impaired adults (i.e., not involving undergraduates) have produced students that appeared to be on the way to achieving the basic criteria set out by Buckley and Kempa (1971) in terms of practical skills. These criteria being that laboratory work should aim to encourage students to gain: (1) Manipulative skills, (2) Observational skills, (3) The ability to interpret experimental data, and (4) The ability to plan experiments. Extensive pre-laboratory work, blocking of laboratory time to ensure that a series of practicals could be worked through and continuity of the course, where ideas are built upon, were identified as key aspects that contributed to the students development during the summer school. Assessment is often seen as the driver for either surface level or deep level learning, here these summer schools did not have formal assessments but the emphasis was on assessing practical skills rather than assessing a long practical write-up. Follow-up interviews after 2-5 years of the school students showed that the chance to experience University, meet like-minded students and make friends is as strong a motivation as learning new practical skills.

Background: Commonly heard statements such as "Christmas comes around more quickly each year" suggest that the passage of time between annual events can become distorted, leading to the sensation of time passing more quickly than normal. At present however, it is unclear how prevalent such beliefs are and, what factors are predictive of it. Aim: To explore the prevalence of beliefs that annual events such as Christmas (Study 1 UK sample) and Ramadan (Study 2 Iraqi sample) feel like they come around more quickly each year. To establish the association between distortions to the passage of time between annual events and emotional wellbeing, event specific enjoyment, memory function and self-reported attention to time. Methods: Participants completed an online questionnaire exploring their subjective experience of time in relation to Christmas and Ramadan. In addition, measures of attention to time, memory function, quality of life and event specific emotion were also taken. Findings: There was widespread agreement that Christmas and Ramadan appeared to come around more quickly each year. In both countries, this belief was associated with greater prospective memory errors, greater attention to time and greater enjoyment of the event. Furthermore, in the UK greater belief that Christmas comes around more quickly was associated with lower social quality of life and in Iraq, greater belief that Ramadan comes around more quickly each year was associated with lower age and female gender. Conclusions: Distortions to the passage of time for annual events are widespread, occur across multiple cultures and are consistently predicted by prospective function, event enjoyment and attention to time. The absence of an association between older age (above 55 years) and a faster passage of time suggests that caution should be taken when concluding that time passes more quickly with increasing age. [ABSTRACT FROM AUTHOR]

Background: Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. Objective: To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure‐16 (FROM‐16). Methods: A cross‐sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM‐16. Results: 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM‐16. The FROM‐16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM‐16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non‐malignant conditions (mean = 11, SD = 7.4, n = 56, p <.01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM‐16 score>16) on their quality of life. Conclusions: Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM‐16, identify those most affected and should consider how to provide appropriate holistic support within routine practice. [ABSTRACT FROM AUTHOR]

Aim: The surgeon's personality contributes to variation in surgical decision‐making. Previous work on surgeon personality has largely been reserved to Anglo‐Saxon studies, with limited international comparisons. In this work we built upon recent work on gastrointestinal surgeon personality and aimed to detect international variations. Method: Gastrointestinal surgeons from the UK and the Netherlands were invited to participate in validated personality assessments (44‐item, 60‐item Big Five Inventory; BFI). These encompass personality using five domains (open‐mindedness, conscientiousness, extraversion, agreeableness and negative emotionality) with three subtraits each. Mean differences in domain factors were calculated between surgeon and nonsurgeon populations from normative data using independent‐samples t‐tests, adjusted for multiple testing. The items from the 44‐item and 60‐item BFI were compared between UK and Dutch surgeons and classified accordingly: identical (n = 16), analogous (n = 3), comparable (n = 12). Results: UK (n = 78, 61.5% male) and Dutch (n = 280, 65% male) gastrointestinal surgeons had marked differences in the domains of open‐mindedness, extraversion and agreeableness compared with national normative datasets. Moreover, although surgeons had similar levels of emotional stability, country of work influenced differences in specific BFI items. For example, Netherlands‐based surgeons scored highly on questions related to sociability and organization versus UK‐based surgeons who scored highly on creative imagination (p < 0.0001). Conclusion: In a first cross‐cultural setting, we identified country‐specific personality differences in gastrointestinal surgeon cohorts across domain and facet levels. Given the variation between Dutch and UK surgeons, understanding country‐specific data could be useful in guiding personality research in healthcare. Furthermore, we advocate that future work adopts consensus usage of the five factor model. [ABSTRACT FROM AUTHOR]

Introduction: Semaglutide, the only glucagon-like peptide-1 receptor agonist (GLP-1 RA) available in subcutaneous and oral formulation for treatment of type 2 diabetes (T2D), has demonstrated clinically significant improvements in glycaemic control and weight in clinical trials. This study aimed to gain insights into the use of both formulations and evaluate their clinical effectiveness in a secondary care clinic in Wales. Methods: This was a retrospective observational analysis of adults with T2D initiated on oral or subcutaneous semaglutide. Changes from baseline in glycated haemoglobin (HbA1c), weight and other metabolic parameters were evaluated. Results: At baseline, participants (n = 103) had a mean age of 57.3 years, mean HbA1c of 79.1 mmol/mol (9.38%), mean weight of 111.8 kg and body mass index (BMI) of 39.6 kg/m2 (no statistically significant differences between oral and subcutaneous groups). At 6-month follow-up, statistically significant improvements in HbA1c (− 19.3 mmol/mol [− 1.77%] and − 20.8 mmol/mol [− 1.90%]), body weight (− 9.0 kg and − 7.2 kg), and BMI (− 3.3 kg/m2 and − 2.5 kg/m2) were observed for oral and subcutaneous semaglutide, respectively. No statistically significant differences between the formulations were observed, and safety profiles were comparable. Conclusions: Both formulations of semaglutide provided clinically and statistically significant reductions in HbA1c and weight in real-world practice. Oral GLP-1 RA may offer a practical and effective option for the management of T2D. [ABSTRACT FROM AUTHOR]

Objective: Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available. Methods: Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample. Results: The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance). Conclusions: The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available. [ABSTRACT FROM AUTHOR]

Background: This study examined perceptions of coercion, pressures and procedural injustice and how such perceptions influenced psychological well-being in those who experienced a UK COVID-19 lockdown, with a view to preparing for the possibility of future lockdowns. Methods: 40 individuals categorised as perceiving the lockdown(s) as either highly or lowly coercive took part in one of six asynchronous virtual focus groups (AVFGs). Results: Using thematic analysis, the following key themes were identified in participants' discussions: (1) Choice, control and freedom; (2) threats; (3) fairness; (4) circumstantial factors; and (5) psychological factors. Conclusions: As the first qualitative study to investigate the psychological construct of perceived coercion in relation to COVID-19 lockdowns, its findings suggest that the extent to which individuals perceived pandemic-related lockdowns as coercive may have been linked to their acceptance of restrictions. Preparing for future pandemics should include consideration of perceptions of coercion and efforts to combat this, particularly in relation to differences in equity, in addition to clarity of public health messaging and public engagement. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experiences, observations, and reflections on aspects of British culture, identity, and academia, delving into intimate details and emotions to offer insights into their journey and perspectives.

Background: A rail passenger delay compensation scheme aiming at improving attractiveness of rail services and providing minimum customer service standards for delayed passengers operates in the European Union and Great Britain. British rail passengers are eligible to claim 50% of fare for delays of more than 30 min and 100% for delays of over 1 h. The scheme rules were chosen arbitrarily and are homogeneous across all ticket types and journey lengths. As longer journeys are usually more expensive and subjected to longer delays, long distance operators are likely to see more passengers being eligible to claim compensation. This, combined with higher engagement rates due to differences in sensitivity to lateness or opportunity cost of not claiming compensation is likely to have an impact on the differing revenue burden for operating companies. Objective: Against this background, this study aims to quantify the revenue impact of homogeneity of scheme rules for different types of train operators to advance understanding of the scheme's costs and motivate further research into the economic rationale behind the scheme's provision and design. Methodology: An econometric model was constructed to empirically test the impact of performance levels and train operator characteristics on the compensation payments made to passengers through the 'Delay Repay' scheme in Great Britain. Results: The combined differences in the nature of operation and engagement levels mean that with delay levels and engagement increasing with journey length and fare, short, medium and long distance train operating companies (TOCs) repay on average respectively 0.3%, 0.8% and 1.8% of their ticket revenues, increasing the scheme's proportionate burden on the revenues of long distance operators. Further research is needed to either explain the economic or regulatory reasons behind the differing revenue impact of the scheme on different types of TOCs or suggest how the scheme can be redesigned to take these differences into account. [ABSTRACT FROM AUTHOR]

An undergraduate practical exercise has been designed to provide hands-on, instrument-based experience of advanced characterization techniques. A research experience approach is taken, centered around the concept of solid-state polymorphism, which requires a detailed knowledge of molecular and crystal structure to be gained by advanced analytical techniques normally considered as the preserve of a research facility. Powder and single crystal diffraction techniques are primarily required and implemented via the unique approach of the students themselves using benchtop instruments dedicated to teaching, as opposed to more complex and difficult to access research instruments. Furthermore, the manual instructions for performing the practical are delivered via an adapted Electronic Laboratory Notebook system where, for each specific aspect of the practical, students note their intentions, actions, observations, and inferences. Assessors can access the notebooks and provide targeted online feedback for each individual section. Evaluation of the approach is based on interviews and surveys with the first cohort of 65 students that performed the practical.

Summary: The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12‐month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri‐operative cardiac arrest, the initial rhythm was non‐shockable in 723 (82%) cases, most commonly pulseless electrical activity. There were 665 (75%) patients who survived the initial event and 384 (52%) who survived to hospital discharge. A favourable functional outcome (based on modified Rankin Scale score) was reported for 249 (88%) survivors. Outcomes varied according to arrest rhythm. The highest rates of survival were seen for bradycardic cardiac arrests with 111 (86%) patients surviving the initial event and 77 (60%) patients surviving the hospital episode. The lowest survival rates were seen for patients with pulseless electrical activity, with 312 (68%) surviving the initial episode and 156 (34%) surviving to hospital discharge. Survival to hospital discharge was worse in patients at the extremes of age with 76 (40%) patients aged > 75 y and 9 (45%) neonates surviving. Hospital survival was also associated with surgical priority, with 175 (88%) elective patients and 176 (37%) non‐elective patients surviving to discharge. Outcomes varied with the cause of cardiac arrest, with lower initial survival rates for pulmonary embolism (5, 31%) and bone cement implantation syndrome (9, 45%), and hospital survival of < 25% for pulmonary embolism (0), septic shock (13, 24%) and significant hyperkalaemia (1, 20%). Overall care was rated good in 464 (53%) cases, and 18 (2%) cases had overall care rated as poor. Poor care elements were present in a further 245 (28%) cases. Care before cardiac arrest was the phase most frequently rated as poor (92, 11%) with elements of poor care identified in another 186 (21%) cases. These results describe the management and outcomes of peri‐operative cardiac arrest in UK practice for the first time. [ABSTRACT FROM AUTHOR]

Summary: The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri‐operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In‐date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri‐operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri‐operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri‐operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri‐operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with 'hot' debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri‐operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative. [ABSTRACT FROM AUTHOR]

Summary: We report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri‐operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and 165 (84%) hospitals, respectively. There was no paediatric intensive care unit on‐site in 144 (87%) hospitals caring for children, meaning transfer of critically ill children is required. Remote site anaesthesia is provided in 182 (92%) departments. There was a departmental resuscitation lead in 113 (58%) departments, wellbeing lead in 106 (54%) and departmental staff wellbeing policy in 81 (42%). A defibrillator was present in every operating theatre suite and in all paediatric anaesthesia locations in 193 (99%) and 149 (97%) departments, respectively. Advanced airway equipment was not available in: every theatre suite in 13 (7%) departments; all remote locations in 103 (57%) departments; and all paediatric anaesthesia locations in 23 (15%) departments. Anaesthetic rooms were the default location for induction of anaesthesia in adults and children in 148 (79%) and 121 (79%) departments, respectively. Annual updates in chest compressions and in defibrillation were available in 149 (76%) and 130 (67%) departments, respectively. Following a peri‐operative cardiac arrest, debriefing and peer support programmes were available in 154 (79%) and 57 (29%) departments, respectively. While it is likely many UK hospitals are very well prepared to treat anaesthetic emergencies including cardiac arrest, the survey suggests this is not universal. [ABSTRACT FROM AUTHOR]

Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families. Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. Participants were invited to take part in an exit interview. Thirty-three families completed the study. Sampling using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years. Multi-niche self-sampling at home can be used by adults and children for longitudinal surveillance of respiratory microorganisms, providing key data for design of future studies. [ABSTRACT FROM AUTHOR]

Laboratory classes form an important aspect of bioscience education. However, this environment is challenging for students due to cognitive load and lack of confidence. Familiarising students with aspects of their laboratory classes prior to the session can improve this. This study compares the pre-laboratory scaffolding that bioscience and chemistry students experience across UK HE institutions. Typically, bioscience modules used fewer types of activities than chemistry although reading the protocol was the most common activity for both disciplines. Within bioscience, pre-laboratory activities differed by level: first year undergraduates were more likely to be asked to read the protocol, watch videos or do calculation practice in their modules whereas final year undergraduates were more likely to experience experimental design or contextualised activities. Alongside this, this paper discusses an institutional case study of the development and evaluation of technical laboratory videos as pre-laboratory scaffolding for first year students. These were found to benefit both student focus and enhance confidence: implying that using the videos impacted on cognitive load and hence learning. Exploring barriers to the uptake of these resources identified a lack of awareness of them as a major factor, suggesting that greater integration of such resources would enhance engagement and impact. [ABSTRACT FROM AUTHOR]

Objectives: To review long‐term outcomes of dogs with acute oropharyngeal stick injuries managed with rigid endoscopy at a UK referral centre. Materials and Methods: Retrospective analysis and follow‐up with referring veterinary surgeons and owners of patients treated between 2010 and 2020. A medical record search was performed and data regarding signalment, clinical presentation, treatment and long‐term outcomes were recorded. Results: Sixty‐six dogs with acute oropharyngeal stick injury were identified and 46 (70.0%) of these had endoscopy of the wound. The dogs were of various breeds, ages (median=3 years; range 0.6 to 11 years) and weights (median=20.4 kg; range 7.7 to 38.4 kg) and 58.7% of patients were male. The median time from injury to referral was 1 day (range 2 hours to 7 days). Patients were anaesthetised, and injury tracts were explored using 0° and 30° forward‐oblique, 2.7 mm diameter, 18 cm length rigid endoscopes with a corresponding 14.5 French sheath using saline infusion via gravity. All foreign material that could be grasped was removed using forceps. Tracts were flushed with saline and reinspected to confirm removal of all visible foreign material. Out of 40 dogs with long‐term follow‐up, 38 (95.0%) had no major long‐term complications. The remaining two dogs developed cervical abscessation after endoscopy, one of which resolved after repeat endoscopy and the other resolved after open surgery. Clinical Significance: Long‐term follow‐up of dogs with acute oropharyngeal stick injury managed with rigid endoscopy showed an excellent outcome in 95.0% of cases. [ABSTRACT FROM AUTHOR]

The moderate-to-vigorous physical activity (MVPA) of 70 children (age 8.6 years; 40 boys) was measured and gender and age differences were compared. Boys spent 28 minutes per day more than girls in MVPA (p=0.02, d=0.54), and younger children accumulated 24 minutes more MVPA than older peers (p=0.0001, d=0.91). Similar gender and age-related trends were apparent during segmented periods of the day. The majority of daily MVPA was accrued during school-related time (56.4 [plus or minus] 9.1%; p=0.0001, d=1.57). The findings reinforce the significance of schools as key environments for MVPA participation and promotion. (Contains 1 table, 2 figures and 3 notes.)

In this article, we report the observed differential uptake and use of computer programs and activities of seven boys and girls of high, medium and low attainment in a classroom in the UK where over 40 children aged 10 and 11 have a networked PC on their desk all day and every day. We observed the detail of what happened in the small space between the pupil and the screen over the period of 1 year in the social and instructional context of the classroom. We found interesting individual differences superseding the expected variation based on gender and attainment. We suggest some possible "within child" and external factors which may contribute to these differences and consider some of the implications for teaching and learning through ICT and the need for further research to investigate the nature of these differences.

This paper gives a synopsis of an extensive programme of case studies on real uses of computer-assisted learning (CAL) materials within UK engineering degree programmes. The programme was conducted between 2000 and 2003 and followed a questionnaire-based survey looking at CAL use in the UK and in Australia. The synopsis reveals a number of key messages for academic tutors and authors including students' enthusiasm for notes, self-tests and features to aid visualisation. Publishers should also consider pricing and licensing arrangements suited to the individual user. (Contains 5 tables.)

Summary: Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3–4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient‐level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non‐obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4–69.1) to 52.8 (32.1–69.2) years. The median (IQR) BMI increased from 24.9 (21.5–29.5) to 26.7 (22.3–31.7) kg.m–2. The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID‐19 pandemic on the anaesthetic population, though patients with confirmed COVID‐19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri‐operative services significantly. [ABSTRACT FROM AUTHOR]

Background: The ORI-EGI-02 study was designed to test the hypothesis that rectal mucus collected using a novel rectal sampling device (OriCol™), contains sufficient human deoxyribonucleic acid (DNA) of the required quality for Next Generation Sequencing (NGS), for colorectal disease genetic signature discovery. Methods: Using National Institute for Health and Care Research methodology, an internal pilot study was performed in January 2020–May 2021, at four sites in the United Kingdom, to assess the process of recruitment, consent, specimen acquisition and viability for analysis. Following an OriCol™ test, the sample was stabilized with a buffer solution to preserve the material, which was posted to the laboratory. Samples were processed using QIAamp® DNA Blood Midi kit to extract DNA and Quant-iT™ PicoGreen® dsDNA Reagent to quantify the retrieved DNA. DNA integrity was measured by Agilent TapeStation system. 25 ng of human amplifiable DNA was prepared for Next Generation Sequencing (NGS), which was performed on an Illumina NextSeq550 sequencer using the 300-cycle high output kit v2.5. Results: This study assessed the first 300 patients enrolled to the ORI-EGI-02 Study (n = 800). 290/300 (96.67%) were eligible to undergo OriCol™ sampling procedure and 285/290 (98.27%) had a successful OriCol™ sample taken. After transportation, extraction and quantification of DNA, 96.20% (279/290) of the samples had NGS successfully performed for bioinformatic analysis. Conclusions: Our internal pilot study demonstrated that the OriCol™ sampling device can capture rectal mucus from unprepared bowel in subjects who could undergo a digital rectal examination. The technique could be applied irrespective of age, frailty, or co-morbidity. Completion of the study to 800 patients and analysis of NGS data for colorectal cancer mutations will now proceed. [ABSTRACT FROM AUTHOR]

Background: Dysarthria after stroke is when speech intelligibility is impaired, and this occurs in half of all stroke survivors. Dysarthria often leads to social isolation, poor psychological well-being and can prevent return to work and social lives. Currently, a variety of outcome measures are used in clinical research and practice when monitoring recovery for people who have dysarthria. When research studies use different measures, it is impossible to compare results from trials and delays our understanding of effective clinical treatments. The aim of this study is to develop a core outcome set (COS) to agree what aspects of speech recovery should be measured for dysarthria after stroke (COS-Speech) in research and clinical practice. Methods: The COS-Speech study will include five steps: (1) development of a long list of possible outcome domains of speech that should be measured to guide the survey; (2) recruitment to the COS-Speech study of three key stakeholder groups in the UK and Australia: stroke survivors, communication researchers and speech and language therapists/pathologists; (3) two rounds of the Delphi survey process; (4) a consensus meeting to agree the speech outcomes to be measured and a follow-up consensus meeting to match existing instruments/measures (from parallel systematic review) to the agreed COS-Speech; (5) dissemination of COS-Speech. Discussion: There is currently no COS for dysarthria after stroke for research trials or clinical practice. The findings from this research study will be a minimum COS, for use in all dysarthria research studies and clinical practice looking at post-stroke recovery of speech. These findings will be widely disseminated using professional and patient networks, research and clinical forums as well as using a variety of academic papers, videos, accessible writing such as blogs and links on social media. Trial registration: COS-Speech is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database, October 2021 https://www.comet-initiative.org/Studies/Details/1959. In addition, "A systematic review of the psychometric properties and clinical utility of instruments measuring dysarthria after stroke" will inform the consensus meeting to match measures to COS-Speech. The protocol for the systematic reviews registered with the International Prospective Register of Systematic Reviews. PROSPERO registration number: CRD42022302998. [ABSTRACT FROM AUTHOR]

Background: There is an emerging role for radiological evaluation of psoas muscle as a marker of sarcopenia in trauma patients. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross-sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods: Patients aged 65 or above, who presented as a trauma call over a 1-year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analysed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan–Meier plots were used to determine association of sarcopenia with outcomes. Results: There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Pearson's correlation indicated a weakly positive linear relationship (r = 0.35, p < 0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47–9.73, p = 0.006) and at 2 years (adjusted HR 1.90, 95% CI 1.11–3.25, p = 0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p = 0.001). Conclusion: Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2-year mortality. Our study did not support prognostic relevance of M-CSA. [ABSTRACT FROM AUTHOR]

To highlight the potential risk of herpetic eye disease (HED) reactivation following COVID-19 vaccine. Retrospective analysis of all patients who presented with HED within 28 days post-first dose COVID-19 vaccination. Eleven eyes (n = 10 patients) were included. The mean interval between COVID-19 vaccination and ocular symptoms/signs was 12.3 ± 10.3 days. Four (40%) patients presented with HSV keratitis, and six (60%) patients presented with VZV keratitis (five had concurrent other signs of herpes zoster ophthalmicus). Common ocular signs included multiple scattered dendritic/pseudodendritic corneal epitheliopathy (90.9%), anterior uveitis (63.6%), and endothelitis (27.3%). All cases were successfully treated with topical and systemic antiviral treatment and/or topical corticosteroids (mean healing time = 3.9 ± 1.6 weeks). Our case series highlights the potential temporal association between HED and COVID-19 vaccine. Prophylactic antiviral treatment is recommended in patients with a history of HED prior to COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the frequency and risk factors for Cushing's syndrome in dogs under UK primary veterinary care. Materials and Methods: Dogs with Cushing's syndrome were identified by searching electronic patient records of primary‐care veterinary practices. Pre‐existing and incident cases of Cushing's syndrome during 2016 were included to estimate the 1‐year period prevalence. Incident cases were used to estimate the annual incidence and to identify demographic risk factors for the diagnosis of Cushing's syndrome in dogs, through multivariable logistic regression. Results: Analysis included 970 pre‐existing and 557 incident cases of Cushing's syndrome from a population of 905,544 dogs. The estimated 1‐year period prevalence for Cushing's syndrome in dogs under veterinary care was 0.17% (95% confidence interval 0.16 to 0.18) and incidence was 0.06% (95% confidence interval 0.05 to 0.07). In multivariable logistic regression modelling, the Bichon frise (odds ratio=6.17, 95% confidence interval 4.22 to 9.00), Border terrier (5.40, 95% confidence interval 3.66 to 7.97) and Miniature schnauzer (3.05, 95% confidence interval 1.67 to 5.57) had the highest odds of Cushing's syndrome. The Golden retriever (0.24, 95% confidence interval 0.06 to 0.98) and Labrador retriever (0.30, 95% confidence interval 0.17 to 0.54) were the most protected breeds. Increasing age, bodyweight greater than the breed‐sex mean and being insured also showed increased odds of Cushing's syndrome. Clinical Significance: As Cushing's syndrome is predominately diagnosed and managed in primary‐care practice, this study provides valuable new information of its epidemiology in this setting. Demographics reported are supportive of previous work and additional novel associations identified, such as the Border terrier, could enhance the index of suspicion for veterinarians. [ABSTRACT FROM AUTHOR]

Purpose: The burden of major trauma within the UK is ever increasing. There is a need to establish research priorities within the field. Delphi methodology can be used to develop consensus opinion amongst a group of stakeholders. This can be used to prioritise clinically relevant, patient-centred research questions to guide future funding allocations. The aim of our study was to identify key future research priorities pertaining to the management of major trauma in the UK. Methods: A three-phased modified Delphi process was undertaken. Phase 1 involved the submission of research questions by members of the trauma community using an online survey (Phase 1). Phases 2 and 3 involved two consecutive rounds of prioritisation after questions were subdivided into 6 subcategories: Brain Injury, Rehabilitation, Trauma in Older People, Pre-hospital, Interventional, and Miscellaneous (Phases 2 and 3). Cut-off points were agreed by consensus amongst the steering subcommittees. This established a final prioritised list of research questions. Results: In phase 1, 201 questions were submitted by 65 stakeholders. After analysis and with consensus achieved, 186 questions were taken forward for prioritisation in phase 2 with 114 included in phase 3. 56 prioritised major trauma research questions across the 6 categories were identified with a clear focus on long-term patient outcomes. Research priorities across the patient pathway from roadside to rehabilitation were deemed of importance. Conclusions: Consensus within the major trauma community has identified 56 key research questions across 6 categories. Dissemination of these questions to funding bodies to allow for the development of high-quality research is now required. There is a clear indication for targeted multi-centre multi-disciplinary research in major trauma. [ABSTRACT FROM AUTHOR]

Summary: Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID‐19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID‐19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID‐19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter‐hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra‐hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty‐five patients underwent inter‐hospital transfers compared with 92 intra‐hospital transfers. There was no significant change in median compliance 6 h pre‐transfer, immediately post‐transfer and 24 h post‐transfer in patients who underwent either intra‐hospital or inter‐hospital transfers. For inter‐hospital transfers, there was an initial drop in median PaO2/FIO2 ratio: from median (IQR [range]) 25.1 (17.8–33.7 [12.1–78.0]) kPa 6 h pre‐transfer to 19.5 (14.6–28.9 [9.8–52.0]) kPa immediately post‐transfer (p < 0.05). However, this had resolved at 24 h post‐transfer: 25.4 (16.2–32.9 [9.4–51.9]) kPa. For intra‐hospital transfers, there was no significant change in PaO2/FIO2 ratio. We also found no meaningful difference in pH; PaCO2;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID‐19 undergoing mechanical ventilation of the lungs may have short‐term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Automated insulin delivery (AID) systems can enable improved glycaemic outcomes with reduced mental burden. Open-source AID (OS-AID) systems overcome some of the developmental and access barriers enabling a wider use of these systems. Limited data are available on healthcare professional (HCP) opinions and current practice regarding these systems. The aim of this survey was to gain insight into HCP perceptions and practices around OS-AID. Methods: This survey was developed collaboratively with OS-AID users and distributed to adult and children's teams, using an online survey tool. Results were received between February and April 2019. Responses were assessed using simple descriptive statistics with analyses stratified by respondent characteristics. Results: 317 responses were obtained from a range of HCPs in both adult and paediatric services. Key results include: HCP perception of OS-AID as "risky in the wrong hands" (43%); 91% felt uncomfortable initiating discussions around OS-AID because of lack of regulation (67%) and/or their own lack of knowledge (63%). Half of HCPs (47%) reported that they would choose OS-AID if they themselves had type 1 diabetes. Conclusions: HCPs are generally supportive of OS-AID users but many feel uncomfortable with the technicalities of the systems given the lack of approval. Knowledge around the use of these systems was limited. Re-assessment of HCP perceptions should be performed in the future given the evolving landscape of diabetes technology, recent consensus statements and emerging ethical and legal perspectives. Plain Language Summary: Open-source automated insulin delivery systems are an increasingly encountered diabetes technology. These involve a small glucose sensor and an insulin delivery device called an insulin pump. These two devices interact to allow adjustment of insulin delivery to maintain glucose levels in a desirable range. The computer codes which drive these systems are developed by people with diabetes or their families rather than by device companies; as such, they have not been through formal approval processes and therefore there is limited formal evidence concerning whether they are safe or beneficial to use. Users report high satisfaction with these devices and improvements in their diabetes management. This survey was performed to assess the opinions of UK healthcare professionals and their usual practice. Key results include: UK healthcare professionals would not routinely recommend the use of these devices and there was concern about the medicolegal implications of use. However, UK healthcare professionals were generally supportive of those who chose to use the devices. Interestingly, almost half of the healthcare professionals would use the systems if they had diabetes. [ABSTRACT FROM AUTHOR]

Anastrazole has recently been approved for the prevention of breast cancer in high-risk women in the UK. When given to high-risk women anastrazole halves the risk of developing breast cancer but doesn't reduce the risk of breast cancer death and is associated with significant harms. Women need to be counselled about both the benefits and risks associated with anastrazole use to enable an informed treatment choice. [ABSTRACT FROM AUTHOR]

Background: Uncomplicated acute appendicitis can be managed with non-operative (antibiotic) treatment, but laparoscopic appendicectomy remains the first-line management in the UK. During the COVID-19 pandemic the practice altered, with more patients offered antibiotics as treatment. A large-scale observational study was designed comparing operative and non-operative management of appendicitis. The aim of this study was to evaluate 90-day follow-up. Methods: A prospective, cohort study at 97 sites in the UK and Republic of Ireland included adult patients with a clinical or radiological diagnosis of appendicitis that either had surgery or non-operative management. Propensity score matching was conducted using age, sex, BMI, frailty, co-morbidity, Adult Appendicitis Score and C-reactive protein. Outcomes were 90-day treatment failure in the non-operative group, and in the matched groups 30-day complications, length of hospital stay (LOS) and total healthcare costs associated with each treatment. Results: A total of 3420 patients were recorded: 1402 (41 per cent) had initial antibiotic management and 2018 (59 per cent) had appendicectomy. At 90-day follow-up, antibiotics were successful in 80 per cent (1116) of cases. After propensity score matching (2444 patients), fewer overall complications (OR 0.36 (95 per cent c.i. 0.26 to 0.50)) and a shorter median LOS (2.5 versus 3 days, P<0.001) were noted in the antibiotic management group. Accounting for interval appendicectomy rates, the mean total cost was e1034 lower per patient managed without surgery. Conclusion: This study found that antibiotics is an alternative first-line treatment for adult acute appendicitis and can lead to cost reductions. [ABSTRACT FROM AUTHOR]

Deformed wing virus (DWV) has been linked to the global decline of honey bees. DWV exists as three master variants (DWV-A, DWV-B, and DWV-C), each with differing outcomes for the honey bee host. Research in the USA showed a shift from DWV-A to DWV-B between 2010 to 2016 in honey bee colonies. Likewise, in the UK, a small study in 2007 found only DWV-A, whereas in 2016, DWV-B was the most prevalent variant. This suggests a shift from DWV-A to DWV-B might have occurred in the UK between 2007 and 2016. To investigate this further, data from samples collected in 2009/10 (n = 46) were compared to existing data from 2016 (n = 42). These samples also allowed a comparison of DWV variants between Varroa-untreated (feral) and Varroa-treated (managed) colonies. The results revealed that, in the UK, DWV-A was far more prevalent in 2009/10 (87%) than in 2016 (43%). In contrast, DWV-B was less prevalent in 2009/10 (76%) than in 2016 (93%). Regardless if colonies had been treated for Varroa (managed) or not (feral), the same trend from DWV-A to DWV-B occurred. Overall, the results reveal a decrease in DWV-A and an increase in DWV-B in UK colonies. [ABSTRACT FROM AUTHOR]

Background: Apps have been shown to be an effective tool in changing patients' behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published. Objectives: To evaluate the quality of these apps aiming to change behaviour. To assess BCTs used in patient focused orthodontic apps. Methods: The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors. Results: BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly 'prompts/cues', and 'information about health consequences'. All apps were shown to be of moderate quality (range 3.1–3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent. Conclusions: The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients' compliance with treatment. [ABSTRACT FROM AUTHOR]

Background: Delayed (or "backup") antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the United Kingdom. This study aimed to identify factors influencing preferences among the UK public for delayed prescription, and understand their relative importance, to help increase appropriate use of this prescribing option.Methods and Findings: We conducted an online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondents were presented with 12 scenarios in which they, or their child, might need antibiotics for a respiratory tract infection (RTI) and asked to choose either an immediate or a delayed prescription. Scenarios were described by 7 attributes. Data were collected between November 2018 and February 2019. Respondent preferences were modelled using mixed-effects logistic regression. The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). The samples reflected the UK population in age, sex, ethnicity, and country of residence. The most important determinant of respondent choice was symptom severity, especially for cough-related symptoms. In the adult sample, the probability of choosing delayed prescription was 0.53 (95% confidence interval (CI) 0.50 to 0.56, p < 0.001) for a chesty cough and runny nose compared to 0.30 (0.28 to 0.33, p < 0.001) for a chesty cough with fever, 0.47 (0.44 to 0.50, p < 0.001) for sore throat with swollen glands, and 0.37 (0.34 to 0.39, p < 0.001) for sore throat, swollen glands, and fever. Respondents were less likely to choose delayed prescription with increasing duration of illness (odds ratio (OR) 0.94 (0.92 to 0.96, p < 0.001)). Probabilities of choosing delayed prescription were similar for parents considering treatment for a child (44% of choices versus 42% for adults, p = 0.04). However, parents differed from the adult sample in showing a more marked reduction in choice of the delayed prescription with increasing duration of illness (OR 0.83 (0.80 to 0.87) versus 0.94 (0.92 to 0.96) for adults, p for heterogeneity p < 0.001) and a smaller effect of disruption of usual activities (OR 0.96 (0.95 to 0.97) versus 0.93 (0.92 to 0.94) for adults, p for heterogeneity p < 0.001). Females were more likely to choose a delayed prescription than males for minor symptoms, particularly minor cough (probability 0.62 (0.58 to 0.66, p < 0.001) for females and 0.45 (0.41 to 0.48, p < 0.001) for males). Older people, those with a good understanding of antibiotics, and those who had not used antibiotics recently showed similar patterns of preferences. Study limitations include its hypothetical nature, which may not reflect real-life behaviour; the absence of a "no prescription" option; and the possibility that study respondents may not represent the views of population groups who are typically underrepresented in online surveys.Conclusions: This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Certain groups appear to be more amenable to delayed prescription, suggesting particular opportunities for increased use of this strategy. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses. [ABSTRACT FROM AUTHOR]

Background: Perioperative malnutrition is common and is associated with increased mortality, complications and healthcare costs. Patients having surgery for cancer and gastro-intestinal disease are at particular risk. It is a modifiable pre-operative risk factor and perioperative clinicians are well placed to identify those at risk and instigate interventions shown to improve outcome. Thus, we conducted a survey of Perioperative Medicine Leads with the aim of assessing the current provision of nutritional screening and intervention pathways in the UK. Methods: Perioperative Medicine Leads registered with the Royal College of Anaesthetists were asked to complete an online survey exploring current practice in screening, assessment and management of malnutrition in the perioperative period. The survey included a mixture of open and closed questions, graded response questions and options for free text. Where a response was not received, departments were phoned directly and e-mails sent to non-responders. Results: We received 121 completed questionnaires from 167 Perioperative Medicine Leads (response rate of 72.5%). Seventy respondents (57.9%) reported using the Malnutrition Universal Screening Tool to screen patients; however, only 61 (50.4%) referred patients at nutritional risk onto a dietitian. Sixty (49.6%) lacked confidence in local ability to identify and manage malnutrition perioperatively, with 28 (23.1%) reporting having a structured pathway for managing malnourished patients. One hundred eleven respondents (91.7%) agreed that malnutrition impacts on quality of life after surgery and 105 (86.8%) felt adopting a standard protocol would improve outcomes for patients. Those reporting a lack of confidence in dealing with malnutrition perioperatively cited a lack of organisational support, patients being seen too close to surgery and lack of clarity around responsibility as key reasons for difficulties in managing this group of patients. Conclusions: Malnutrition in the perioperative period is a modifiable risk factor which is common and results in increased morbidity for patients and increased cost to healthcare systems. This survey highlights areas of practice where perioperative clinicians can improve the assessment and management of patients at nutritional risk prior to elective surgery. [ABSTRACT FROM AUTHOR]

Background: Unstable ankle fractures represent a substantial burden of disease, accounting for a mean hospital stay of nine days, a mean cost of £4,491 per patient and 20,000 operations per year. There is variation in UK practice around weight-bearing instructions after operatively managed ankle fracture. Early weight-bearing may reduce reliance on health services, time off work, and improve functional outcomes. However, concerns remain about the potential for complications such as implant failure. This is the protocol of a multicentre randomised non-inferiority clinical trial of weight-bearing following operatively treated ankle fracture.Methods: Adults aged 18 years and over who have been managed operatively for ankle fracture will be assessed for eligibility. Baseline function (Olerud and Molander Ankle Score [OMAS]), health-related quality of life (EQ-5D-5L), and complications will be collected after informed consent has been obtained. A randomisation sequence has been prepared by a trial statistician to allow for 1:1 allocation to receive either instruction to weight-bear as pain allows from the point of randomisation, two weeks after the time of surgery ('early weight-bearing' group) or to not weight-bear for a further four weeks ('delayed weight -bearing' group). All other treatment will be as per the guidance of the treating clinician. Participants will be asked about their weight-bearing status weekly until four weeks post-randomisation. At four weeks post-randomisation complications will be collected. At six weeks, four months, and 12 months post-randomisation, the OMAS, EQ-5D-5L, complications, physiotherapy input, and resource use will be collected. The primary outcome measure is ankle function (OMAS) at four months post-randomisation. A minimum of 436 participants will be recruited to obtain 80% power to detect a non-inferiority margin of -6 points on the OMAS 4 months post-randomisation. A within-trial health economic evaluation will be conducted to estimate the cost-effectiveness of the treatment options.Discussion: The results of this study will inform national guidance with regards to the most clinically and cost-effective strategy for weight-bearing after surgery for unstable ankle fractures.Trial Registration: ISRCTN12883981 , Registered 02 December 2019. [ABSTRACT FROM AUTHOR]

Purpose: Diphoterine® is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury (CEI). However, its use is not widely adopted in current clinical practice, primarily attributed to limited clinical evidence. This study aims to highlight the experience in using Diphoterine for managing CEI in a UK tertiary referral centre. Methods: This retrospective case series included all patients who presented with CEI and treated with Diphoterine at the James Cook University Hospital, UK, between April 2018 and February 2020. Results: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years (ranged, 3–70 years) and 85.7% were male. All patients presented with an alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median (±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of 0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the eyes were of grade-I and -IV CEI, respectively. All eyes received normal saline/water as the first irrigation fluid and Diphoterine as second irrigation fluid. The mean pH improved slightly after first irrigation (8.4 ± 0.7; p = 0.13) and significantly after second irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation used was significantly less for Diphoterine (520 ± 193 mL) than for normal saline/water (2700 ± 2451 mL; p = 0.016). At final follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28 logMAR (p = 0.60). One patient developed near-total limbal stem cell deficiency as a complication of grade-IV injury and was awaiting limbal stem cell transplantation at last follow-up. Conclusion: This study represents the first case series in the United Kingdom, reporting the use of Diphoterine in managing CEI. The rapid pH-neutralising action of Diphoterine, with less volume required, makes it an ideal initial treatment for efficiently managing adult and paediatric patients with CEI in clinics. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK). Methods: Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up. Results: The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive. Conclusion: COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond. [ABSTRACT FROM AUTHOR]

Summary: Patients with acne are increasingly using sunbeds as a self treatment despite the harmful effects. Little is known about sunbed use in adult patients with acne under dermatology care. This questionnaire study explored prevalence and behaviours surrounding sunbed use in patients with acne at a UK dermatology centre. Over a quarter (26%) of respondents used sunbeds and of these, 72% used them at least weekly. Respondents using sunbeds were more likely to be older, to be female, to have a longer duration of acne diagnosis and to have previously been offered blue‐light therapy by their doctor (P < 0.05 for all) Reasons for use included recommendations from external sources (including the Internet), the perceived greater efficacy compared with physician‐prescribed treatments and that light therapy was not offered by their doctor. Nearly half (49%) of respondents were taking isotretinoin at the time of sunbed use, which carries an increased risk for photosensitivity and sunburn in this cohort. Dermatologists have a responsibility to address this gap in public awareness by directly counselling patients at risk of sunbed use, particularly for those concomitantly prescribed oral retinoid therapy. [ABSTRACT FROM AUTHOR]

Background: Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods: Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results: Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions: The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites. [ABSTRACT FROM AUTHOR]

Aim: The aim was to determine the importance of a colorectal surgeon's personality to patients and its influence on their decision‐making. Methods: We present a two‐part mixed methods study using the Guidance for Reporting Involvement of Patients and the Public (GRIPP‐2) long form. Part 1 was an online survey (25 questions) and Part 2 a face‐to‐face patient and public involvement exercise. Part 1 included patient demographics, details of surgery, overall patient satisfaction (net promoter score) and patient views on surgeon personality (Gosling 10 Item Personality Index). The thematic analysis of free‐text responses generated four themes that were taken forward to Part 2. These themes were used to structure focus group discussions on surgeon–patient interactions. Results: Part 1 yielded 296 responses: 72% women, 75.3% UK‐based and 55.1% aged 40–59 years. Inflammatory bowel disease (45.3%) and cancer (40.2%) were the main indications. 84.1% of respondents reported satisfaction with their surgical experience (net promoter score). Four key themes were generated from Part 1 and validated in Part 2: (i) surgeon personality stereotypes (media differed from patients' perspective); (ii) favourable and unfavourable surgical personality traits (openness, conscientiousness, emotional stability preferred over risk‐taking and narcissism); (iii) patient–surgeon interaction (mutual respect and rapport valued); (iv) impact of surgeon personality on decision‐making (majority unaware of second opinion option; management of postoperative complications). Conclusion: Patients believe surgeon personality influences shared decision‐making. Low levels of emotional stability and conscientiousness are perceived by patients to increase the likelihood of postoperative adverse events. Further work is required to explore the potential influence of surgeon personality on shared decision‐making and postoperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this longitudinal, observational study was to investigate change over time in ability to perform activities of daily living in myotonic dystrophy type 1 (DM1). Methods: Adults with genetically confirmed DM1 were recruited as part of the PhenoDM1 study in the UK. Data on activities of daily living were recorded through the DM1-ActivC at baseline and a follow-up visit after 12 (± 3) months. A subset of patients had advanced genetic testing to determine the size of the progenitor allele. Results: Our sample comprised 150 patients with DM1 (mean age: 45 years; 52% female). Mean follow-up was 383 days. Mean DM1-ActivC total score at baseline was 71.24 (95% confidence interval 67.77–74.71) and at the follow-up visit 69.04 (65.54–72.54). Approximately 43% of patients had a lower score at the follow-up visit (indicating a decreased ability to perform activities of daily living), 24% a higher score (indicating an increased ability), and 33% the same score at baseline and follow-up. The mean annual change in the DM1-ActivC total score, estimated at − 2.06 (− 3.54 to − 0.59), was significantly related to patients' baseline score, but not sex, disease duration, timed test results, or cytosine-thymine-guanine repeat length. Conclusions: Change over time in ability to perform activities of daily living as recorded through the DM1-ActivC varies substantially between patients with DM1. Our data contribute to the understanding of the natural evolution of the disease, and should be helpful to inform the design of future trials based on the DM1-ActivC. [ABSTRACT FROM AUTHOR]

Pain arising for the teeth and supporting structures is a very common complaint, affecting around 9% of adults in the UK, and it can sometimes be difficult to determine the exact cause. In this narrative review, we explore the underlying neurophysiology of odontogenic pain and describe the relevance of this to clinical practise. We discuss characteristic features of pain arising from the various dentoalveolar structures and common oral disorders, and consider that non‐odontogenic pain may occasionally present as toothache. As well as describing current approaches to reaching a reliable diagnosis, we also discuss some innovative techniques and potential future developments in this area. [ABSTRACT FROM AUTHOR]