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An editorial is presented on broad range of UK professionals involved in the care of patients with head and neck cancer. Topics include underpinning the basis of care of patients with head and neck cancer, which apply across the spectrum of management; and guidelines can be also used as an educational resource for clinicians, and for insight into head and neck cancer care for non-clinicians.

Orthodontic societies play a significant role in raising public awareness of the profession, and supporting patient care by debunking misinformation and helping patients make informed and appropriate decisions. In this article we highlight four web-based and social media campaigns run or supported by the British Orthodontic Society, namely 'Hold that Smile', '#KeepStokeSmiling', 'Your Jaw Surgery' and 'SafeSmiles'. We describe the rationale, aim, target audience, format and content of these campaigns and evaluate how they were publicised. We also discuss the impact and level of engagement of the campaigns as well as lessons learned for future campaigns. Professionals are highly encouraged to contribute to the distribution of these campaigns by endorsing them on social media platforms, ensuring that this information reaches and benefits patients. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has highlighted health disparities affecting ethnic minority communities. There is growing concern about the lack of diversity in clinical trials. This study aimed to assess the representation of ethnic groups in UK-based COVID-19 randomised controlled trials (RCTs). Methods: A systematic review and meta-analysis were undertaken. A search strategy was developed for MEDLINE (Ovid) and Google Scholar (1st January 2020–4th May 2022). Prospective COVID-19 RCTs for vaccines or therapeutics that reported UK data separately with a minimum of 50 participants were eligible. Search results were independently screened, and data extracted into proforma. Percentage of ethnic groups at all trial stages was mapped against Office of National Statistics (ONS) statistics. Post hoc DerSimonian-Laird random-effects meta-analysis of percentages and a meta-regression assessing recruitment over time were conducted. Due to the nature of the review question, risk of bias was not assessed. Data analysis was conducted in Stata v17.0. A protocol was registered (PROSPERO CRD42021244185). Results: In total, 5319 articles were identified; 30 studies were included, with 118,912 participants. Enrolment to trials was the only stage consistently reported (17 trials). Meta-analysis showed significant heterogeneity across studies, in relation to census-expected proportions at study enrolment. All ethnic groups, apart from Other (1.7% [95% CI 1.1–2.8%] vs ONS 1%) were represented to a lesser extent than ONS statistics, most marked in Black (1% [0.6–1.5%] vs 3.3%) and Asian (5.8% [4.4–7.6%] vs 7.5%) groups, but also apparent in White (84.8% [81.6–87.5%] vs 86%) and Mixed 1.6% [1.2–2.1%] vs 2.2%) groups. Meta-regression showed recruitment of Black participants increased over time (p = 0.009). Conclusions: Asian, Black and Mixed ethnic groups are under-represented or incorrectly classified in UK COVID-19 RCTs. Reporting by ethnicity lacks consistency and transparency. Under-representation in clinical trials occurs at multiple levels and requires complex solutions, which should be considered throughout trial conduct. These findings may not apply outside of the UK setting. [ABSTRACT FROM AUTHOR]

In this article, the outcome of an interventional nephrology workshop at last year's UK Kidney Week is thoroughly reviewed [ABSTRACT FROM AUTHOR]

Recent health policies in the United Kingdom (UK) and internationally have focussed on digitisation of healthcare. We examined UK policies for evidence of government action addressing health inequalities and digital health, using cardiometabolic disease as an exemplar. Using a systematic search methodology, we identified 87 relevant policy documents published between 2010 and 2022. We found increasing emphasis on digital health, including for prevention, diagnosis and management of cardiometabolic disease. Several policies also focused on tackling health inequalities and improving digital access. The COVID-19 pandemic amplified inequalities. No policies addressed ethnic inequalities in digital health for cardiometabolic disease, despite high prevalence in minority ethnic communities. Our findings suggest that creating opportunities for digital inclusion and reduce longer-term health inequalities, will require future policies to focus on: the heterogeneity of ethnic groups; cross-sectoral disadvantages which contribute to disease burden and digital accessibility; and disease-specific interventions which lend themselves to culturally tailored solutions. [ABSTRACT FROM AUTHOR]

The number of pupils who have English as an Additional Language (EAL) in English schools is increasing, with an influx of migrants from Europe. This paper investigates how schools are addressing the needs of these children. Using survey and interviews with teachers and paraprofessionals the identification of personal assumptions and challenges of EAL provision are explored. Early indications suggest huge differential practice for EAL provision, support and training. Many staff suggested that they are culturally unaware and have little experience of supporting EAL children. Furthermore, the key challenge for leaders is how best to cater for all EAL children using a diverse workforce creatively and within tight financial constraints and competing school priorities. (Contains 4 tables.)

This article explores a paradox, namely the rhetoric of engagement with diversity and social justice among education leaders, yet the paucity in forward-looking critical theory and practice to develop that engagement. It draws upon relatively new as well as established concepts, including the Capabilities Approach, to suggest how and why diversity management and social justice might be elevated to first-order constructs that inform leadership and its development. The evidence base is recent research for the Learning and Skills Sector, but the implications inform other parts of the education sector in which, as yet, approaches to diversity appear to have changed little. It is suggested that researchers, theorists and policy makers need to join with the education practitioner community to revitalize theory and practice.

Background: The coronavirus disease 2019 pandemic led to increased pressure on health services, which, combined with variable social restrictions, led to decreased referrals for head and neck cancer. This study assessed whether there were lasting changes to head and neck cancer referrals during different stages of the pandemic response in 2020 and 2021. Methods: A retrospective review was conducted of all cases referred for suspected head and neck cancer to our institution in January 2020, April 2020, April 2021 and June 2021. Results: There was a rebound 91 per cent increase in referrals between April 2020 and April 2021 following the 59 per cent decrease in referrals between January 2020 and April 2020. Males made up 47.1 per cent of referrals in January 2020, 40 per cent in April 2020 and 37.82 per cent in April 2021. Conclusion: Further research is recommended to investigate the reasons why there is a continued decline in male referrals and the effect this has on their outcomes. [ABSTRACT FROM AUTHOR]

Objective: Cone beam computed tomography is an imaging technique that can be used for the paranasal sinuses. This study assessed how widely it is used and the impact it has on chronic rhinosinusitis management in the ENT department of one hospital. Method: A nationwide survey was conducted to assess the use of cone beam computed tomography throughout ENT UK members. A retrospective analysis of four-year rhinology clinic data for patients presenting with chronic rhinosinusitis symptoms was subsequently performed to assess how many scans were achieved the same day and the subsequent patient management. Results: The survey results indicated that a majority of staff do not use cone beam computed tomography to image sinuses (86.5 per cent), and this was largely because of lack of access (92 per cent). This study assessed 355 cone beam computed tomography requests. Overall, 306 cases had a cone beam computed tomography scan on the same day as their clinic appointment with the majority seen back in clinic during the same hospital attendance for the results. Overall, 97 patients were discharged on the same day. Conclusion: This study suggested a lack of awareness and understanding of cone beam computed tomography in managing rhinosinusitis. The 'one-stop' rhinology clinic model offers benefits including reduced patient hospital attendance. [ABSTRACT FROM AUTHOR]

Background: The relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis. Method: We conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment–paranoia association. Results: We identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self‐ and other‐beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment‐secure people with psychosis are more likely to seek help and engage with services than attachment‐insecure people. Conclusions: Attachment styles impact help‐seeking behaviours in people with psychosis and are likely to influence paranoia via self‐ and other‐beliefs, cognition fusion, and emotion regulation – these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia. Practitioner points: Insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes.People with psychosis who are attachment‐secure are more likely to seek help and engage with services than those who are attachment‐insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help‐seeking behaviours in people with psychosis.Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change. [ABSTRACT FROM AUTHOR]

Advocacy is a recognised competency for medical graduates. Many medical students engage in advocacy, but research on this topic is limited. This study aimed to explore the views and experiences of medical student advocates. Qualitative study using semi-structured interviews. Nine medical students from advocacy organisations were recruited by purposive sampling. Thematic analysis was used to generate codes and develop themes. There were five themes: triggers and enablers; barriers and disablers; knowledge, skills, and attributes; advocacy in the role of health professionals, and career aspirations; and teaching and assessment of advocacy. Triggers and enablers included internal drivers (e.g. experiencing injustice), and external drivers (e.g. role models). Obstacles included lack of institutional support, personal challenges, and discomfort around professionalism in advocacy. Student enhanced their knowledge of social issues and improved communication skills. Advocacy activities strongly influenced students' future plans. Most agreed that advocacy is an important topic in medical education, suggesting teaching it early in medical school via small-group tutorials and role-modelling. For assessment, a reflective approach was preferred over written exams. Medical students' engagement in advocacy has complex facilitators and barriers, and the relationship between advocacy and professionalism requires clarity. Benefits of advocacy include fostering empathy and other transferable skills required of future doctors. Advocacy teaching was welcomed by students, with suggested approaches proposed. The optimal learning and assessment strategy remains uncertain, and further research is needed. [ABSTRACT FROM AUTHOR]

Introduction: One-stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is a quick diagnosis and early management while simultaneously improving patient experience. Objectives: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to a number of appointments required for formulating management plan and a number of 'one stop' visits. Design: Retrospective observational study Setting: Regional Head and Neck Cancer Center (Secondary care hospital) Participants: Patients referred by General practitioner with symptoms of a neck lump Main outcome measures: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in a number of appointments, one-stop visits, the requirement of Ultrasound and efficiency of Fine needle aspiration. Results and conclusions: Improved efficacy of OSNLC was noted as patients seen in the clinic required a lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic. [ABSTRACT FROM AUTHOR]

This article reflects on the evolution of orthodontics over the past fifty years in the UK and provides a glimpse into the future of the field. It highlights the changes in societal perception of orthodontics, from being seen as a medical necessity to a desire for aesthetic outcomes with psychosocial benefits. The article also discusses advances in materials and products, such as the transition from metal bands to bonding teeth and the development of aesthetic brackets and wires. It explores the integration of technology in orthodontics, including clear aligner systems, digital orthodontics, and the use of artificial intelligence for treatment monitoring. The article concludes by addressing the challenges faced by the NHS in meeting patient needs and the impact of orthodontic treatment on patients' confidence and quality of life. [Extracted from the article]

[Display omitted] • Samphire is rich in minerals and amino acids. • Minerals and amino acids of samphire are responsible of its salty taste. • Samphire can be used as a salt substitute for developing food products. Salicornia species have been explored as a substitute for salt, however the intensity of salty taste elicited remains unexplained by the sodium content alone. To investigate this, a study was conducted to determine the nutrient profile of samphire extract and relate this to its sensory quality in a nachos base. Freeze dried samphire extracts contain minerals, including Na (12–14 g/100 g), K (1–1.5 g/100 g) and Mg (0.3–0.5 g/100 g) and free amino acids such as lysine (28–41 mg/100 g), glutamic acid (20–31 mg/100 g), aspartic acid (20–56 mg/100 g) and arginine (54–109 mg/100 g), which are known to influence salty taste. The sensory panel found that 2.5 % addition of samphire extract produced a significantly saltier taste than the control product (0.7 % NaCl) at an equivalent sodium level. These findings suggest that the minerals and amino acids in samphire extract may collectively contribute to its salty taste, making it a viable option for reducing sodium in food products. [ABSTRACT FROM AUTHOR]

Summary: Background: Conventionally, patients with functional dyspepsia are subgrouped based on upper gastrointestinal symptoms, according to the Rome criteria. However, psychological co‐morbidity and extraintestinal symptoms are also relevant to functional gastrointestinal disorders. Aim: To investigate whether it is possible to subgroup people with functional dyspepsia using factors beyond upper gastrointestinal symptoms. Methods: We collected demographic, symptom and psychological health data from adult subjects meeting the Rome III criteria for functional dyspepsia in two secondary care cross‐sectional surveys in Canada and the UK. We performed latent class analysis, a method of model‐based clustering, to identify specific subgroups (clusters). For each cluster, we drew a radar plot, and compared these by visual inspection, describing cluster characteristics. Results: In total, 400 individuals met Rome III criteria for functional dyspepsia in the Canadian cohort, and 262 the UK cohort. A four‐cluster model was the optimum solution and the characteristics of the clusters were almost identical between the two cohorts. The clusters were defined by a pattern of gastrointestinal symptoms and were further differentiated by the extent of extraintestinal and psychological co‐morbidity. Cluster 1 (mean age 46.7 years, 66.7% female) consisted of epigastric pain and nausea with high psychological burden, cluster 2 (mean age 41.5 years, 77.7% female) high overall gastrointestinal symptom severity with high psychological burden, cluster 3 (45.8 years, 67.2% female) oesophageal symptoms and early satiety with low psychological burden, and cluster 4 (mean age 40.4 years, 71.5% female) postprandial fullness with low psychological burden. We validated the model derived using the Canadian study population externally by applying it to the UK dataset. We demonstrated reproducibility; it would perform similarly when applied to a different dataset. Conclusions: Latent class analysis identified four distinct functional dyspepsia subgroups characterised by varying degrees of gastrointestinal symptoms, extraintestinal symptoms and psychological co‐morbidity. Further research is needed to assess whether they might be used to direct treatment. [ABSTRACT FROM AUTHOR]

Background Modeling of the London hepatitis C virus (HCV) epidemic in men who have sex with men (MSM) and are living with human immunodeficiency virus (HIV) suggested that early access to direct-acting antiviral (DAA) treatment may reduce incidence. With high rates of linkage to care, microelimination of HCV within MSM living with HIV may be realistic ahead of 2030 World Health Organization targets. We examined trends in HCV incidence in the pre- and post-DAA eras for MSM living with HIV in London and Brighton, United Kingdom. Methods A retrospective cohort study was conducted at 5 HIV clinics in London and Brighton between 2013 and 2018. Each site reported all acute HCV episodes during the study period. Treatment timing data were collected. Incidence rates and reinfection proportion were calculated. Results A total of 378 acute HCV infections were identified, comprising 292 first infections and 86 reinfections. Incidence rates of acute HCV in MSM living with HIV peaked at 14.57/1000 person-years of follow-up (PYFU; 95% confidence interval [CI], 10.95–18.20) in 2015. Rates fell to 4.63/1000 PYFU (95% CI, 2.60 to 6.67) by 2018. Time from diagnosis to starting treatment declined from 29.8 (2013) to 3.7 months (2018). Conclusions We observed a 78% reduction in the incidence of first HCV episode and a 68% reduction in overall HCV incidence since the epidemic peak in 2015, which coincides with wider access to DAAs in England. Further interventions to reduce transmission, including earlier access to treatment and for reinfection, are likely needed for microelimination to be achieved in this population. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients. Method: This is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020. Results: There was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent. Conclusion: It is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals. [ABSTRACT FROM AUTHOR]

Background: The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.Aims: We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.Method: This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.Results: Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).Conclusions: Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities. [ABSTRACT FROM AUTHOR]

Objective: This study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches. Methods: A prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care. Results: In total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively. Conclusion: Intracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases. [ABSTRACT FROM AUTHOR]

Background: There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP). Methods: Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case–control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded. Results: VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls. Conclusions: This case–control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context. [ABSTRACT FROM AUTHOR]

Background: Excess mortality among people with severe mental illness (SMI) is largely attributed to co-morbid physical illness. Improving the physical health of this population is critically important; however, physical health monitoring among people with SMI is often inadequate. Aims: This study aimed to facilitate an enhanced understanding of barriers to successfully attend to clients’ physical health in mental health settings, through exploring care coordinators’ views and experiences regarding their ability to monitor physical health in clients with SMI (specifically, psychosis). Methods: Semi-structured interviews were conducted with seven care coordinators from a South East London (UK) community mental health team. Data were analysed using thematic analysis principles. Results: Three themes were identified in these data, capturing (1) how care coordinators viewed the professional roles of other clinical staff and themselves, (2) views on barriers to the provision of physical healthcare and (3) factors that motivated care coordinators to attend to clients’ physical health. Conclusion: Our findings can inform efforts to implement physical healthcare interventions within mental health settings. Such insights are timely, as academic literature and guidelines regarding clinical practice increasingly promote the value of integrated provision of mental and physical healthcare. [ABSTRACT FROM AUTHOR]

This study investigated the leadership skills Early Years leaders demonstrated through their daily practice of teaching, assessing and teamwork within their setting. It explored how revealing the potential of Early Years leaders could have a positive impact on the leadership practice of other leaders in the same setting to improve pupil outcomes. A qualitative approach using interviews with Early Years leaders in 20 primary settings from the East Midlands and Bedfordshire areas was undertaken by two academics from two different UK based universities. Ethical guidelines ensuring anonymity and trustworthiness were followed. Using verbatim comments, data were analysed in themes against contemporary Early Years literature. Findings showed the skills of Early Years leaders could support pedagogy and practice but some of these skills were not utilized beyond this age phase. Our conclusion suggested that Early Years leaders had a range of leadership skills which were deemed specialist as they were unique to the success of the age phase, but needed to be exposed beyond Early Years for wider success and impact. [ABSTRACT FROM AUTHOR]

We explore the ideology associated with gender equality that despite primary schools and initial teacher education (ITE) institutions doing all they can to recruit men into primary education, a huge gender imbalance still exists. We frame our study around the notions of gender equality and professional responsibility. Using a multi-case study approach, this inquiry examined views of men and women from 12 English primary schools and one ITE institution regarding the cause and effect of gender bias. Findings show a differentially large gender gap in the sample schools and that there is good practice where schools are successful in attracting and retaining men teachers. Implications of these findings suggest that leaders in primary schools need to take a more active role to help change and shape the perceptions of men teachers in education. We conclude that leaders also need to help close the teacher gender gap in schools and ITE institutions through collaborative dialogue. [ABSTRACT FROM PUBLISHER]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Salivary gland tumours are rare and have very wide histological heterogeneity, thus making it difficult to generate high level evidence. This paper provides recommendations on the assessment and management of patients with cancer originating from the salivary glands in the head and neck. [ABSTRACT FROM AUTHOR]

Background. The relationship between childhood adversity (CA) and psychotic disorder is well documented. As the adequacy of the current categorical diagnosis of psychosis is being increasingly questioned, we explored independent associations between different types of CA and specific psychotic symptom dimensions in a well-characterized sample of first-episode psychosis (FEP) patients. Method. This study involved 236 FEP cases aged 18-65 years who presented for the first time to psychiatric services in South London, UK. Psychopathology was assessed with the Positive and Negative Syndrome Scale and confirmatory factor analysis was used to evaluate the statistical fit of the Wallwork/Fortgang five-factor model of psychosis. CA prior to 17 years of age (physical abuse, sexual abuse, parental separation, parental death, and being taken into care) was retrospectively assessed using the Childhood Experience of Care and Abuse Questionnaire. Results. Childhood sexual abuse [β = 0.96, 95% confidence interval (CI) 0.40-1.52], childhood physical abuse (β = 0.48, 95% CI 0.03-0.93) and parental separation (β = 0.60, 95% CI 0.10-1.11) showed significant associations with the positive dimension; while being taken into care was associated with the excited dimension (β = 0.36, 95% CI 0.08-0.65), independent of the other types of CA. No significant associations were found between parental death and any of the symptom dimensions. Conclusions. A degree of specificity was found in the relationships between different types of CA and psychosis symptom dimensions in adulthood, suggesting that distinct pathways may be involved in the CA-psychosis association. These potentially different routes to developing psychosis merit further empirical and theoretical exploration. [ABSTRACT FROM AUTHOR]

This paper explores the ideology of social justice through links between equality and equity within Early Years and what remain the challenges for leadership. Questionnaires and interviews in English multi-cultural and mono-cultural schools with Early Years age phases were conducted. The findings showed that the ideology of social justice, equality and equity was interpreted differently in each Early Years setting. The multi-cultural schools used a variety of activities to embed social justice principles that involved their diverse communities more to enrich the curriculum in contrast to the mono-cultural schools. In mono-cultural schools however, leadership had to be more creative in promoting equality and equity, given the smaller proportion of their diverse pupil and staff population. Our conclusions suggest that most schools are struggling initially with implementing the current changes in Early Years, therefore their vision for permeating this curriculum with an equality and equity focus is at the early stages. [ABSTRACT FROM AUTHOR]

This study carried out research focusing on diverse learners, such as pupils who have English as additional language (EAL) in primary schools in the Midlands, England. Essentially, we wanted to know how they are supported to become global learners. Therefore, questions were posed to school leaders on their understanding of the concept of globalisation; how globalisation is developed, supported, monitored and evaluated. Research on the concept of globalisation is contentious, with as many definitions as there are cultural contexts. But the central message is that the movement of a global economy brings with it the potential to make knowledge and information accessible to all. We interviewed senior leaders in primary schools over a period of 3 months and our sampling is opportunistic rather than truly random. The findings suggest the need for strong leadership for embedding globalisation in the curriculum, an enabling team structure, and partnership development locally and globally. [ABSTRACT FROM PUBLISHER]

ABSTRACT Gingival recession is apical migration of the gingival tissues resulting in exposure of the underlying root surface. This can cause significant esthetic concerns for the patient, especially when it affects the anterior teeth. The gingival veneer is a prosthesis indicated for challenging clinical situations where there are esthetic concerns because of gingival recession, particularly loss of interdental papillae. Replacement crowns, surgery, or extraction of teeth, and provision of a removable partial denture are other treatment options; however, these have a significant biologic and financial cost compared with gingival veneers. This article aims to revisit the gingival veneer: its uses, advantages, disadvantages, and its fabrication. The cases discussed here highlight two different clinical situations where the gingival veneer prosthesis helped in achieving optimum esthetics and patient satisfaction thus proving to be a feasible and simple treatment modality in certain clinical cases. This may offer a good interim solution for patients who may wish to have time to consider their options of more advanced and complex treatment. Some patients may choose to wear the veneer as a long-term solution when the burden/risk of further advanced treatment may outweigh the benefits, as perceived by the patients. CLINICAL SIGNIFICANCE The gingival veneer is a viable treatment option for restoring anterior esthetics in clinical situations where there are esthetic concerns caused by significant gingival recession. Case selection is important for a predictable and successful outcome. (J Esthet Restor Dent ••:••-••, 2012) [ABSTRACT FROM AUTHOR]

Pancreatic cancer is the tenth most common cancer in the UK and the fifth leading cause of cancer death (UK). According to the Office for National Statistics, there were 8085 new cases and 7781 deaths in 2008, highlighting its extremely poor prognosis. The average-size GP practice is likely to see at least one case of pancreatic cancer per year. Currently, only 13% of cases are diagnosed through the 2 week wait referral pathway, with 47% presenting as hospital emergencies. Delay in diagnosis can be multifactorial. Early symptoms tend to be non-specific and signs and symptoms such as painless jaundice and weight loss do not present until late stages. Early recognition by the GP is crucial as surgical resection offers the best chance of survival. GPs also play a crucial role in providing palliative care in patients who have unresectable disease. [ABSTRACT FROM AUTHOR]

Objective To examine how the 2004 introduction of behind-the-counter ( BTC) simvastatin in the United Kingdom affected utilization, prices, and expenditures. Data Sources/Study Setting Secondary data on simvastatin utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries. Study Design We used a difference-in-differences approach to estimate how the introduction of BTC simvastatin affected utilization, prices, and expenditures. This approach compares outcomes in the United Kingdom before and after the introduction of BTC simvastatin, using outcomes in countries where the drug remained prescription only to control for possible confounders. Data Collection/Extraction Methods Data on simvastain utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries were obtained from an outside vendor. Principal Findings The introduction of BTC simvastatin in the United Kingdom led to a significant increase in utilization of simvastatin and a significant decline in expenditures for simvastatin purchases. Our results are robust to alternate model specifications. Conclusions Behind-the-counter statins have the potential to simultaneously increase use of statins and lower expenditures. [ABSTRACT FROM AUTHOR]

The article discusses a study which determined the proportion of cleft lip and/or cleft palate (CL±P) children diagnosed prenatally from 1999-2008 in patients referred to the Royal Hospital for Sick Children in Glasgow, Scotland (RHSC). The study also compared the percentage of children prenatally diagnosed in 2008 and those diagnosed in other cleft treatment centers in Great Britain. It notes that the percentage of CL±P incidences diagnosed prenatally increased from 1999-2008.

Purpose: To evaluate the effectiveness, technical feasibility, outcomes, and complications of phacoemulsification and intraocular lens (IOL) implantation combined with 23-gauge transconjunctival sutureless vitrectomy. Setting: Ophthalmology Department, Calderdale Royal Hospital, Halifax, United Kingdom. Method: This retrospective noncomparative interventional case series evaluated the results of 23-gauge transconjunctival sutureless vitrectomy combined with phacoemulsification and IOL implantation. Primary outcome measures included suture, complication, and hypotony rates; logMAR visual acuity; and intraocular inflammation. Results: Sixty consecutive patients (60 eyes) were included. The mean visual acuity was 0.87 logMAR ± 0.68 (SD) preoperatively and 0.46 ± 0.34 logMAR 6 weeks postoperatively; the improvement was statistically significant (P<.0001). The 23-gauge ports were self-sealing in all eyes but 4 (6.7%), in which a single pars plana port was sutured. The mean intraocular pressure was 24.0 ± 15.6 mm Hg 1 day postoperatively. Eight eyes (13.0%) had postoperative hypotony (<10 mm Hg); all recovered spontaneously within 24 hours. Of the eyes in which long-term tamponade was not necessary (n =12), all 3 with no endotamponade and 3 of 9 with air tamponade had postoperative hypotony; the difference was not statistically significant (P = .09). Conclusions: Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in managing simultaneous cataract and vitreoretinal pathology. The self-sealing incisions did not adversely affect the overall surgical or visual outcomes, led to faster visual rehabilitation, and reduced ocular inflammation. The use of air tamponade when no long-term endotamponade was necessary appeared to reduce the risk for hypotony. [Copyright &y& Elsevier]

Presents letters to the editor on a variety of medical subjects as of March 29, 2003. Empowerment of patients in the British National Health Service Plan; Discussion of breast self-examinations; Readability of British and American medical prose; Ultrasound-guided central venous access; Use of drugs in children; Others.

The article discusses the authors' experience in conducting a teaching session to hospital senior house officers and general practitioner (GP) registrars within the vocational training scheme program in Great Britain. Accordingly, they were given four scenarios two weeks before the event which were written by an experienced GP. During the consultation, they were confused on the behavior of the physicians and find it hard to admit that they did not understand the case.

Background: Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescribers.Objective: The goal of the research was to forecast gaps in implementation, adoption and evaluation of game-based interventions, and co-design solutions with antimicrobial clinicians and digital and behavioral researchers.Methods: A co-development workshop with clinicians and academics in serious games, antimicrobials, and behavioral sciences was organized to open the International Summit on Serious Health Games in London, United Kingdom, in March 2018. The workshop was announced on social media and online platforms. Attendees were asked to work in small groups provided with a laptop/tablet and the latest version of the game On call: Antibiotics. A workshop leader guided open group discussions around implementation, adoption, and evaluation threats and potential solutions. Workshop summary notes were collated by an observer.Results: There were 29 participants attending the workshop. Anticipated challenges to resolve reflected implementation threats such as an inadequate organizational arrangement to scale and sustain the use of the game, requiring sufficient technical and educational support and a streamlined feedback mechanism that made best use of data arriving from the game. Adoption threats included collective perceptions that a game would be a ludic rather than professional tool and demanding efforts to integrate all available educational solutions so none are seen as inferior. Evaluation threats included the need to combine game metrics with organizational indicators such as antibiotic use, which may be difficult to enable.Conclusions: As with other technology-based interventions, deploying game-based solutions requires careful planning on how to engage and support clinicians in their use and how best to integrate the game and game outputs onto existing workflows. The ludic characteristics of the game may foster perceptions of unprofessionalism among gamers, which would need buffering from the organization. [ABSTRACT FROM AUTHOR]

The authors comment on the "NHS Five Year Forward View" report published by the British National Health Service (NHS) on October 23, 2014. They discuss the success of the NHS in accomplishing its goals, changes that need to be implemented by the NHS, the priority of the NHS, and its leadership in health care innovations.

Aims: There are limited data on emergency catheter ablation (CA) for ventricular arrhythmia (VA) storm. We describe the feasibility and safety of performing emergency CA in an out-of-hours setting for VA storm refractory to medical therapy at 2 tertiary hospitals., Methods and Results: Twenty-five consecutive patients underwent out-of-hours (5pm-8am [weekday] or Friday 5pm-Monday 8am [weekend]) CA for VA storm refractory to anti-arrhythmic drugs and sedation. Baseline and procedural characteristics along with outcomes were compared to 91 consecutive patients undergoing weekday daytime-hours (8am-5pm) CA for VA storm. More patients undergoing out-of-hours CA had a left ventricular ejection fraction ≤35% (68% vs. 42%, P = 0.022), chronic kidney disease (60% vs. 20%, P < 0.001), and presented following a resuscitated out-of-hospital cardiac arrest (56% vs. 5%, P < 0.001), compared to the daytime-hours group. During median follow-up (377 [interquartile range 138-826] days), both groups experienced similar survival free from recurrent VA and VA storm. Survival free from cardiac transplant and/or mortality was lower in the out-of-hours group (44% vs. 81%, P = 0.007), but out-of-hours CA was not independently associated with increased cardiac transplant and/or mortality (hazard ratio 1.34, 95% confidence interval 0.61-2.96, P = 0.47). Of the 11 patients in the out-of-hours group who survived follow-up, VA-free survival was 91% and VA storm-free survival was 100% at 1-year after CA., Conclusion: Out-of-hours CA may occasionally be required to control VA storm and can be safe and efficacious in this scenario. During follow-up, cardiac transplant and/or mortality is common but undergoing out-of-hours CA was not predictive of this composite endpoint., Competing Interests: Conflict of interest: S.K. is supported by the NSW early-mid Career Fellowship. S.K. has received research grants from Abbott Medical and Biotronik; he has received honoraria from Biosense Webster, Abbott Medical, Biotronik, and Sanofi Aventis. All other authors have reported no other relationships relevant to the contents of this paper to disclose., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Since the early 1970s, the efficacy of acupuncture for treating clinical conditions has been evaluated in several hundred randomized trials. Results from these trials have been synthesized in systematic reviews. A well-designed systematic review provides the highest level of evidence for establishing the efficacy of a clinical intervention., Objectives: The present study assesses the source of original literature contributing to Cochrane reviews on acupuncture. Databases searched to retrieve original studies are evaluated. The distribution of controlled trials in acupuncture across different topic areas and journals, the ability of the reviews to provide conclusive results, and the proportion of original studies indexed with MEDLINE are evaluated., Methods: Systematic reviews on acupuncture were extracted from the Cochrane Database of Systematic Reviews. The key search term used was "acupuncture." When more than one systematic review was retrieved on the same topic, the most recent review was included. Indexing of individual clinical trials with MEDLINE was searched using the Single Citation Matcher in PubMed., Results: A total of 94 papers were retrieved from the Cochrane database, of which 10 were included in the analysis. The most common subject areas were related to chronic pain. Considerable heterogeneity was observed in the number of databases searched (median 5, range 3-12). A total of 69% (74/108) papers were indexed with PubMed. Only 13% (14/108) of the papers were published in the primary acupuncture journals. Conclusive statements about the efficacy of acupuncture were made in only 2 of the 10 systematic reviews., Conclusions: Considerable methodological diversity exists in the comprehensiveness of database searches for Cochrane systematic reviews on acupuncture. This diversity makes the reviews prone to bias and adds another layer of complexity in interpreting the acupuncture literature.