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Aims: This evaluation combines clinical and non-clinical collaborative breast referral triage to gain an understanding relating to the value of triage, by identifying 'suspected cancer' and 'cancer not suspected' populations, improve the patient pathway, and facilitate optimised resource availability. Method: An iterative service improvement method was used, with distinct phases of the process outlined to facilitate testing of ideas. The evaluation ran for 13 weeks in 2022. Regular team member meetings were arranged to discuss and agree improvement aims and outcomes. Findings: A triage flowchart was developed collaboratively, and subsequently adopted by the non-clinical booking team. Bespoke clinics were established, demonstrating no evidence of increased risk to patients, and meeting 28-day Faster Diagnosis Standard (FDS) requirements. Conclusion: breast referral triage of 'suspected cancer' and 'cancer not suspected' patients, using a clinical and non-clinical collaborative approach facilitates improved service visibility, prioritisation, management, and measurement. This also supports delivery of the 2019 NHS Long Term Plan to enhance earlier and faster cancer diagnosis by optimising access to diagnostic resources where required. [ABSTRACT FROM AUTHOR]

Background: Nutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre‐HCT in UK centres. Methods: An anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time. Results: Seventy‐seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre‐HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty‐two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non‐dietitians most routinely provided dietary advice pre‐HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high‐energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre‐HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre‐HCT. Conclusions: Nutrition and prehabilitation pre‐HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent. Key Points: Prehabilitation was considered important in the context of haematopoietic stem cell transplantation care by all health care professionals (HCPs), although only 12.5% of centres had a dedicated prehabilitation service.There are inequities in nutritional care provision prior to haematopoietic cell transplantation (HCT) between transplantation centres.Lack of nutrition screening and systematic approaches to body composition assessments may limit the potential to identify and optimise nutritional and functional health prior to HCT.Non‐dietitians most frequently provided dietary advice pre‐HCT. Dietary advice focused on total energy intake (71.1%, n = 32) over protein (46.7%, n = 21), fat (44.4%, n = 20) and fibre (24.4%, n = 11). [ABSTRACT FROM AUTHOR]

Understand the practice and beliefs of healthcare professionals (HCPs) supporting the decision-making of people with MND (pwMND) about gastrostomy placement, including identifying differences between professions. An online cross-sectional survey disseminated to HCPs who support the decision-making of pwMND about gastrostomy placement. A total of 139 participants completed the survey including representation from a range of healthcare professions. A third (36/101, 36%) initiated discussions about gastrostomy later in practice than they believed was ideal. In relation to the outcome of declining compared to accepting gastrostomy, participants were more likely to discuss aspiration (80% vs. 68%), choking (76% vs. 58%) and prognosis (36% vs. 22%). Participants believed gastrostomies should be placed after a mean 8.1% weight loss since symptom-onset. More participants favored gastrostomy placement before pwMND presented with respiratory symptoms (45%) compared to onset of dysphagia (11%). Half believed pwMND placed gastrostomies too late. Participants were more likely to 'often'/'always' recommend pwMND to have a gastrostomy (23%) than continue without (7%) or decline (4%) gastrostomy, when believing these were the best option for pwMND. Nurses and dietitians discussed the broadest range of information, while doctors were more likely to discuss mortality risk and prognosis. There is variation in HCPs practice and beliefs about initiating discussions, the sharing of information and recommendations, and timing, about gastrostomy placement. The information shared varies by profession and there is evidence of sub-optimal communication between HCPs. Further research is required to understand how these findings may impact on the decision-making of pwMND about gastrostomy. [ABSTRACT FROM AUTHOR]

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.

Explores economic aspects of a national electronic reserve service using Ithink Analyst, a modeling software package. Describes the model, which was based on developments within the United Kingdom higher education community; considers copyright clearance and digitization; and concludes that economically this service does not compare favorably with a print reserve collection. (Author/LRW)

Explores economic aspects of a resource discovery network (RDN) in the United Kingdom consisting of a center and eight sub-based hubs using Ithink Analyst, a modeling software package. Results suggest that with a combination of sponsorship and subscription income a RDN could succeed without grant funding within 10 years of its launch. (Author/LRW)

Describes research that focused on the acquisition of critical thinking skills by vocational education students in Further Education colleges in the United Kingdom, and in particular on the development of the skills of reasoned argument via practice. Discusses the use of modeling and peer-based critiquing exercises. (LRW)

In Britain, 25 adults returning to formal education conducted analytical reflection on their life and work. Results were sued to support the argument that vocational institutions should attempt to develop broader student interests rather than trying to improve the relevance of vocational knowledge. (SK)

Objective: Cervical cancer remains a significant health threat amongst women globally despite most cervical cancers being preventable through screening and Human Papilloma Virus (HPV) vaccination. With the introduction of HPV testing and vaccination, evidence suggests that the frequency of cervical screening for women can be reduced. However, there is limited evidence on women's attitudes to possible changes to the cervical screening programme. This study explored attitudes, perceptions and beliefs of women in the United Kingdom (UK) regarding potential changes to the National Cervical Screening Programme. Method: Forty‐four women were interviewed between November 2018 and March 2019. Reflexive thematic analysis was used to identify key themes. Results: Most participants were opposed to any reduction in cervical screening frequency. Reasons included perceptions that disease would develop undetected, disempowerment, increased anxiety, reduced motivation to attend, and inefficient use of health care resources. Women perceived that they were ill‐informed about the reasons for the proposed change, and that access to evidence for the basis of proposed changes may persuade them to accept reduced screening frequency. Women believed that cervical screening is a test for cancer and that HPV vaccination does not provide reliable protection against cervical cancer. These beliefs suggest that women's perception that they require more information about the basis for reduced screening frequency is correct. Conclusion: Any changes to cervical screening frequency need to ensure public support and trust through a robust public health initiative clearly identifying the rationale for any changes. [ABSTRACT FROM AUTHOR]

Background. Ischaemia with nonobstructive coronary arteries is most commonly caused by coronary microvascular dysfunction but remains difficult to diagnose without invasive testing. Myocardial blood flow (MBF) can be quantified noninvasively on stress perfusion cardiac magnetic resonance (CMR) or positron emission tomography but neither is routinely used in clinical practice due to practical and technical constraints. Quantification of coronary sinus (CS) flow may represent a simpler method for CMR MBF quantification. 4D flow CMR offers comprehensive intracardiac and transvalvular flow quantification. However, it is feasibility to quantify MBF remains unknown. Methods. Patients with acute myocardial infarction (MI) and healthy volunteers underwent CMR. The CS contours were traced from the 2-chamber view. A reformatted phase contrast plane was generated through the CS, and flow was quantified using 4D flow CMR over the cardiac cycle and normalised for myocardial mass. MBF and resistance (MyoR) was determined in ten healthy volunteers, ten patients with myocardial infarction (MI) without microvascular obstruction (MVO), and ten with known MVO. Results. MBF was quantified in all 30 subjects. MBF was highest in healthy controls (123.8 ± 48.4 mL/min), significantly lower in those with MI (85.7 ± 30.5 mL/min), and even lower in those with MI and MVO (67.9 ± 29.2 mL/min/) (P < 0.01 for both differences). Compared with healthy controls, MyoR was higher in those with MI and even higher in those with MI and MVO (0.79 (±0.35) versus 1.10 (±0.50) versus 1.50 (±0.69), P = 0.02). Conclusions. MBF and MyoR can be quantified from 4D flow CMR. Resting MBF was reduced in patients with MI and MVO. [ABSTRACT FROM AUTHOR]

This paper identifies a form of non-compliance with COVID-19 lockdown restrictions in the UK: "creative non-compliance". Here, individuals justify breaking restrictions as meeting the "spirit of the law" if not the "letter of the law". Drawing on interview and focus group data collected between April and August 2020, we outline this concept of "creative non-compliance," detailing how: (i) our participants undertook a purposive construction of rules, (ii) balanced their behavior against these aims, and (iii) how Government messaging informed these rationalizations. We conclude by outlining the implications of our "creative non-compliance" theory both for studies of compliance and rationalizations for deviant behavior under the COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Lumbar epidural is the most effective form of pain relief in labor with around 30% of laboring women in the UK and 60% in the USA receiving epidural analgesia. Associations of epidural on maternal, obstetric, and neonatal outcomes have been the subject of intense study, though a number of uncertainties persist. The present narrative review explores important areas of research surrounding epidural analgesia in obstetric patients including methods of initiation and administration, choice of local anesthetic solution, and the addition of adjuvants. Key meta‐analyses exploring associations of epidural analgesia on maternal and neonatal outcomes are identified and summarized. Synopsis: The present narrative review explores important areas of research surrounding epidural analgesia in labor and the effect on obstetric, maternal, neonatal, and childhood outcomes. [ABSTRACT FROM AUTHOR]

Objective: Evidence suggests that cervical screening intervals can be extended and lifetime cervical screening for human papillomavirus (HPV)‐vaccinated women could be reduced. This study examines UK women's attitudes to extending screening intervals and assesses associations between knowledge, risk perception and HPV vaccination status, and acceptability of changes. Methods: Using a convenience sampling strategy, an anonymous mixed‐methods online survey was used and data recorded from 647 women (mean age = 28.63, SD = 8.69). Results: Across the full sample, 46.1% of women indicated they would wait 5 years for their next cervical screening, while 60.2% of HPV‐vaccinated women would be unwilling to have as few as three cervical screens in a lifetime. Multivariate analysis revealed those who are regular screened, those who intend to attend when invited, and those who perceive greater personal risk of cervical cancer are less likely to accept a 5‐year screening interval. Qualitative findings relating to benefits of extending intervals included convenience of less tests, less physical discomfort, and psychological distress. Concerns identified included the likelihood of developing illness, increased psychological distress relating to what may be happening in the body, and worries about increased risk of cervical cancer. Conclusion: Women need clear and specific information about HPV timelines, their relationship with cancer risk, and the rationale for extending screening intervals. [ABSTRACT FROM AUTHOR]

Background: People living with amyotrophic lateral sclerosis (ALS) face many challenges with respect to taking adequate nutrition. Growing evidence links weight loss with negative prognostic outcomes. We aimed to explore the practice of dietitians in the UK with regard to the nutritional management of ALS. Methods: A national online survey was disseminated via professional groups, social media and newsletters to UK healthcare professionals between September and November 2018. The survey examined the nutritional management of ALS. Dietitian responses are reported in the present study. Results: In total, 130 dietitians responded to the survey. Two‐thirds reported that ALS comprised less than 20% of their total patient caseload. Forty‐two percent reported that nutritional screening took place in their organisation. One‐half of dietitians reported that patients were referred for dietetic assessment at 'about the right time', although 44% reported referrals were made too late. The majority (83%) of dietitians used resting energy expenditure predictive equations not validated in ALS. When setting weight goals, dietitians reported most frequently recommending weight maintenance if the patient's body mass index was 18.5–25 kg m−2 (72%), 25–30 kg m−2 (98%), and > 30 kg m−2 (79%). In addition, 43% reported that people with ALS were not weighed sufficiently frequently. Conclusions: Although the importance of early nutritional assessment is recognised, the timeliness of dietetic input and on‐going monitoring of nutritional status in ALS care might not currently be ideal. Dietitians report using energy requirement predictive equations and setting weight goals that may not promote positive outcomes. Further research is required to understand the optimal nutritional management of ALS. [ABSTRACT FROM AUTHOR]

The increasing prevalence of patients with aortic stenosis worldwide highlights a clinical need for improved and accurate prediction of clinical outcomes following surgery. We investigated patient demographic and cardiovascular magnetic resonance (CMR) characteristics to formulate a dedicated risk score estimating long-term survival following surgery. We recruited consecutive patients undergoing CMR with gadolinium administration prior to surgical aortic valve replacement from 2003 to 2016 in two UK centres. The outcome was overall mortality. A total of 250 patients were included (68 ± 12 years, male 185 (60%), with pre-operative mean aortic valve area 0.93 ± 0.32cm2, LVEF 62 ± 17%) and followed for 6.0 ± 3.3 years. Sixty-one deaths occurred, with 10-year mortality of 23.6%. Multivariable analysis showed that increasing age (HR 1.04, P = 0.005), use of antiplatelet therapy (HR 0.54, P = 0.027), presence of infarction or midwall late gadolinium enhancement (HR 1.52 and HR 2.14 respectively, combined P = 0.12), higher indexed left ventricular stroke volume (HR 0.98, P = 0.043) and higher left atrial ejection fraction (HR 0.98, P = 0.083) associated with mortality and developed a risk score with good discrimination. This is the first dedicated risk prediction score for patients with aortic stenosis undergoing surgical aortic valve replacement providing an individualised estimate for overall mortality. This model can help clinicians individualising medical and surgical care. Trial Registration ClinicalTrials.gov Identifier: NCT00930735 and ClinicalTrials.gov Identifier: NCT01755936. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how nutritional management services for people with Amyotrophic Lateral Sclerosis (pwALS) are structured in the UK, in order to gain insight into current practice and identify key barriers and enablers to delivering and providing services. Methods: A three-part, sequential mixed-methods study was conducted that comprised (i) a thematic analysis of data from five focus groups (with 47 ALS health professionals from 41 UK organizations and four service user representatives), (ii) a nationwide cross-sectional survey (281 ALS healthcare professionals) and (iii) a freedom of information request (251 organizations). Results: UK nutritional management services for pwALS are coordinated from specialist (n = 22) and non-specialist care centers (n = 89), with national variability in the organization and delivery of services. Multidisciplinary working was highlighted to facilitate the coordination of nutritional care. However, the need to provide evidence-based continuing education for HCPs was evident. Overall, the lack of clear guidelines on the nutritional management of people with ALS was identified as a key barrier to the delivery of effective nutritional care, as was the lack of transparency and consistency in the commissioning of nutritional services. Further concerns over the timeliness of the dietetic intervention and equity of access and provision were raised. Conclusions: Our findings suggest that development of guidelines for nutritional management, particularly at diagnosis and pre-gastrostomy, could drive standardization of high quality nutritional care for pwALS. Such guidance has the potential to reduce inequalities in geographical provision by providing clarity for those commissioning specialist nutrition services. [ABSTRACT FROM AUTHOR]

Paediatric major trauma is relatively uncommon (6% of all traumas) and therefore unfamiliar to many radiologists. The indications for and interpretation of imaging are different to those commonly encountered in adults. In a centre that rarely encounters paediatric trauma, there can be trepidation over the best way to image children due to concerns regarding radiation and the injury patterns that occur at various ages. Within paediatric trauma, as per the Royal College of Radiologists "paediatric trauma protocols" guidelines and National Institute for Health and Care Excellence (NICE) guidance, the main reliance is on computed tomography (CT) and plain radiographs. This review of paediatric trauma from a busy UK major trauma centre demonstrates the most appropriate use of different imaging techniques, the extent of imaging, and the types of injuries that occur in a selection of paediatric trauma patients with a variety of trauma mechanisms. Cases include trauma related to road traffic accidents, bicycle handlebar injuries, falls, and even stabbings. Important learning points highlighted include the use of targeted body part imaging in children, the significance of handlebar injuries, and the importance of assessing for underlying injury in paediatric rib fractures and abdominal bruising and tenderness. We hope these examples will help to support and guide radiologists when encountering paediatric trauma within their own centres. [ABSTRACT FROM AUTHOR]

The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to treat pituitary adenoma and related sellar pathologies. The recently adopted expanded endonasal approach (EEA) has improved access to the ventral skull base whilst retaining the principles of minimally invasive surgery. Despite the advantages these approaches offer, cerebrospinal fluid (CSF) rhinorrhoea remains a common complication. There is currently a lack of comparative evidence to guide the best choice of skull base reconstruction, resulting in considerable heterogeneity of current practice. This study aims to determine: (1) the scope of the methods of skull base repair; and (2) the corresponding rates of postoperative CSF rhinorrhoea in contemporary neurosurgical practice in the UK and Ireland. We will adopt a multicentre, prospective, observational cohort design. All neurosurgical units in the UK and Ireland performing the relevant surgeries (TSA and EEA) will be eligible to participate. Eligible cases will be prospectively recruited over 6 months with 6 months of postoperative follow-up. Data points collected will include: demographics, tumour characteristics, operative data), and postoperative outcomes. Primary outcomes include skull base repair technique and CSF rhinorrhoea (biochemically confirmed and/or requiring intervention) rates. Pooled data will be analysed using descriptive statistics. All skull base repair methods used and CSF leak rates for TSA and EEA will be compared against rates listed in the literature. Formal institutional ethical board review was not required owing to the nature of the study – this was confirmed with the Health Research Authority, UK. The need for this multicentre, prospective, observational study is highlighted by the relative paucity of literature and the resultant lack of consensus on the topic. It is hoped that the results will give insight into contemporary practice in the UK and Ireland and will inform future studies. [ABSTRACT FROM AUTHOR]

Plankton form the base of the marine food web and are sensitive indicators of environmental change. Plankton time-series are therefore an essential part of monitoring progress towards global biodiversity goals, such as the Convention on Biological Diversity Aichi Targets, and for informing ecosystem-based policy, such as the EU Marine Strategy Framework Directive. Multiple plankton monitoring programmes exist in Europe, but differences in sampling and analysis methods prevent the integration of their data, constraining their utility over large spatio-temporal scales. The Plankton Lifeform Extraction Tool brings together disparate European plankton datasets into a central database from which it extracts abundance time-series of plankton functional groups, called ‘lifeforms', according to shared biological traits. This tool has been designed to make complex plankton datasets accessible and meaningful for policy, public interest, and scientific discovery. It allows examination of large-scale shifts in lifeform abundance or distribution (for example, holoplankton being partially replaced by meroplankton), providing clues to how the marine environment is changing. The lifeform method enables datasets with different plankton sampling and taxonomic analysis methodologies to be used together to provide insights into the response to multiple stressors and robust policy evidence for decision making. Lifeform time-series generated with the Plankton Lifeform Extraction Tool currently inform plankton and food web indicators for the UK's Marine Strategy, the EU's Marine Strategy Framework Directive, and for the Convention for the Protection of the Marine Environment of the North- East Atlantic (OSPAR) biodiversity assessments. The Plankton Lifeform Extraction Tool currently integrates 155,000 samples, containing over 44 million plankton records, from 9 different plankton datasets within UK and European Seas, collected between 1924 and 2017. Additional datasets can be added, and time-series updated. The Plankton Lifeform Extraction Tool is hosted by The Archive for Marine Species and Habitats Data (DASSH) at https://www.dassh.ac.uk/lifeforms/. The lifeform outputs are linked to specific, doi-ed, versions of the Plankton Lifeform Traits Master List and each underlying dataset. [ABSTRACT FROM AUTHOR]

Background: The present study assessed the quantity and quality of nutritional advice and support given to colorectal cancer survivors in the UK. Methods: A descriptive cross‐sectional survey was completed by 75 colorectal cancer survivors recruited through social media and bowel cancer support groups in the UK. The survey consisted of open‐ended and closed questions that aimed to explore the nutritional needs, nutritional advice given and other sources of information accessed by colorectal cancer survivors. Results: Sixty‐nine percent of respondents reported that they did not receive any nutritional advice or support from their healthcare team throughout diagnosis, treatment and post‐treatment. Colorectal cancer survivors accessed nutritional advice from a variety of sources, mainly cancer charity websites. Respondents expressed their desire for individualised advice relating to their nutritional problems. Conclusions: The results obtained in the present study indicate that a high proportion of colorectal cancer patients are not receiving the nutritional support that they need to overcome nutritional difficulties. There is an urgent need to improve clinical practice to ensure colorectal patients receive nutritional advice that is both consistent between healthcare professionals and personalised throughout each stage of diagnosis, treatment and post‐treatment. [ABSTRACT FROM AUTHOR]

Introduction: In the UK, guidelines from the Royal College of Pathologists (RCPath) facilitate consistent and reproducible reporting and classification of fine needle aspiration cytology (FNAC) thyroid specimens. The aim was to audit our department against RCPath guidelines to refine and improve our reporting process. Methods: Two‐cycle retrospective observational audit of all patients undergoing thyroid FNAC over a 2‐year period (1 year for each cycle). Final histology was correlated. The positive predictive value (PPV) for malignant neoplastic lesions was calculated; for Thy1, Thy1c, Thy2 and Thy2c all cases without final histology were assumed to be benign, while for Thy3a, Thy3f, Thy4 and Thy5 samples the PPV calculation was based only on those cytology samples with corresponding histology. False positive and false negative cases were reviewed. Results: In total, 288 cytology samples were included in the first cycle; 96 (33.3%) had corresponding histology. There were 287 samples included in the second cycle; 119 (41.5%) had follow‐up histology. The rate of non‐diagnostic samples (Thy1/1c) decreased from 39.6% to 30.0%. The PPV for malignant neoplastic lesions was Thy1/1c 2.6%, Thy2/2c 0.0%, Thy3a 40.0%, Thy3f 19.4%, Thy4 75.0%, Thy5 100.0% (first cycle); Thy1/1c 4.7%, Thy2/2c 0.7%, Thy3a 13.3%, Thy3f, 7.7%, Thy4, 50.0%, Thy5 100.0% (second cycle). Conclusions: Our department was able to reduce the rate of non‐diagnostic FNAC samples and improve the diagnostic accuracy of FNAC. Auditing local outcomes helps refine and improve the reporting process. Review of false positive and false negative cases helps examine potential pitfalls of cytology. This article describes an audit within a diagnostic cytology department against national guidelines for the reporting of thyroid cytology specimens. This helped to reduce the rate of non‐diagnostic samples and improve the diagnostic accuracy. Case review of 'false positive' and 'false negative' samples helps improve reporting and classification of thyroid cytology samples. [ABSTRACT FROM AUTHOR]

In some ways, IR is a victim of its own success with increasing reliance of the NHS on IR services, often replacing or supporting other more invasive established treatments. The RCR must continue to work with the British Society of Interventional Radiologists (BSIR), heads of school and training programme directors to significantly expand the training capacity for those preferencing specialty training (ST) year 1 IR training (trainee's going directly into an IR training in the 1st year of radiology training) as well as maintaining the ability for trainees to enter an IR training programme in year ST4 (trainee's choosing to train in IR in there 4th year of radiology training). Reviewing current IR job plans to help improve the working life of IR consultants including senior IRs would benefit IRs at all stages of their career. [Extracted from the article]

Motor neuron disease (MND), also known as amyotrophic lateral sclerosis, is a neurodegenerative disorder that causes progressive muscle paralysis and typically leads to death within 3 years. As no cure is currently available, symptomatic management is the mainstay of treatment. An important part of this is optimizing nutritional intake with evidence that this may positively affect survival and quality of life. Health care professionals (HCPs) play a pivotal role in nutritional management of people with MND (pwMND) but, to date, their views on the psychological barriers faced by pwMND have not been explored. Such an exploration may identify ways in which the delivery of nutritional care for pwMND can be optimized.Methods: Five qualitative focus groups were carried out across the United Kingdom in June 2018 with 51 participants, including 47 HCPs involved with MND care and four service user representatives. Data were analysed through thematic analysis.Results: Four overarching themes were identified: psychological adjustment and patient engagement; nutrition and the need for control; knowledge of nutrition and the complexity of MND; and the psychosocial nature of eating.Conclusions: The findings suggest that the nutritional management of pwMND should be mindful of factors such as the impact of distress at the time of diagnosis, the availability of clear information on nutrition and MND, as well as the importance of illness perceptions and coping strategies. Moreover, tailored psychological interventions should be considered to mitigate the impact on MND on the experience of eating. Statement of contribution What is already known on this subject? Since weight loss and reduced body mass index (BMI) have been identified as independent risk factors for prognosis and survival in motor neuron disease (MND), nutritional management represents an important component of the symptomatic care of people with MND (pwMND) aimed at prolonging survival and maintaining or improving quality of life. However, the current guidelines and quantitative and qualitative literature on the topic are mainly focused on issues around enteral feeding and gastrostomy insertion, and very little is currently known about potential psychological enablers or barriers to earlier nutritional management, especially from the perspectives of health care professionals (HCPs) involved in the delivery of nutritional care in pwMND. What does this study add? First qualitative investigation of enablers or barriers to nutritional care in pwMND from the perspective of HCPs. New insight into psychological factors (e.g., adjustment, avoidance, loss of control) in nutritional care for pwMND. Practical implications and novel clinical suggestions for HCPs involved in nutritional care of pwMND. [ABSTRACT FROM AUTHOR]

One of the most challenging areas of radiological imaging in children is the diagnosis of physical abuse. There is a dearth of paediatric radiologists willing to act as expert witnesses, particularly in the family courts. There are a number of reasons why radiologists may not be interested or willing to put themselves forward to work as expert witnesses in this field. A group of imaging experts recently formed the "British Society of Paediatric Radiology (BSPR) Working Group on Imaging in Suspected Physical Abuse (SPA)". The group comprises radiologists and neuroradiologists with current or previous experience of providing expert witness reports to the court in cases of SPA. The group met in January 2019 to explore pragmatic solutions to the chronic inefficiencies in both medical and legal practices and the challenges that arise from working in a legal arena with different structures, goals, and assessment criteria. Key issues concerned organisational inefficiencies, variable support from National Health Service Trusts and the Royal College of Radiologists to conduct this work, and the risk/benefit of involvement. This work is important for the patient, parents, and society in general, and highly rewarding for clinical practitioners who are involved, but there are several issues with current practices that discourage active participation. With several members of the group either retired or close to retirement, the shortage of experts is becoming a pressing issue within the UK, which requires an engaged multidisciplinary group to come up with creative solutions. Here, the group provide a consensus opinion highlighting the current barriers and potential facilitators to increasing the number of radiologists willing to provide opinions to the court. [ABSTRACT FROM AUTHOR]

As health is increasingly recognized as a key component of human welfare, a new line of research on intergenerational mobility has emerged that focuses on broad measures of health. We extend this research to consider two key components of health: physical health and mental health. We use rich survey data from the United Kingdom linking the health of adult children at around age 30 to their parents. We estimate that the rank–rank slope in health is 0.17 and the intergenerational health association is 0.19 suggesting relatively rapid mobility compared to other outcomes such as income. We find that while both mental and physical health have a similar degree of intergenerational persistence, parents' mental health is much more strongly associated with broad measures of adult children's health than parents' physical health. We also show that the primacy of parent mental health over physical health on children's health appears to emerge during early adolescence. Finally, we construct a comprehensive measure of welfare by combining income and health and estimate a rank–rank association of 0.27. This is considerably lower than the comparable estimate of 0.43 from the US suggesting that there is greater mobility in welfare in the UK than in the US. [ABSTRACT FROM AUTHOR]

Research suggests that partner support is one of the biggest determinants of women's health choices (Scott et al, 2006), yet partner inclusion in maternity care is often overlooked. This article critically reflects on a personal encounter with a breastfeeding woman and her husband that highlights these issues. It explores the literature on breastfeeding influences, focusing on partner support and sociocultural background. This personal reflection also examines how greater knowledge of these factors helps to foster more meaningful communication with women and their families. [ABSTRACT FROM AUTHOR]

There is a need for greater conceptual clarity in place‐based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident‐led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident‐led partnerships across England are tackling the day‐to‐day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth. [ABSTRACT FROM AUTHOR]

Background. Hip osteoarthritis (OA) is common, painful, and disabling. Physical therapists have an important role in managing patients with hip OA; however, little is known about their current management approach and whether it aligns with clinical guideline recommendations. Objective. The objective of this study is to describe United Kingdom (UK) physical therapists' current management of patients with hip OA and to determine whether it aligns with clinical guidelines. Design. The design is a cross-section questionnaire. Methods. A questionnaire was mailed to 3126 physical therapists in the UK that explored physical therapists' self-reported management of a patient with hip OA using a case vignette and clinical management questions. Results. The response rate was 52.7% (n = 1646). In total, 1148 (69.7%) physical therapists had treated a patient with hip OA in the last 6 months and were included in the analyses. A treatment package was commonly provided incorporating advice, exercise (strength training 95.9%; general physical activity 85.4%), and other nonpharmacological modalities, predominantly manual therapy (69.6%), and gait retraining (66.4%). There were some differences in reported management between physical therapists based in the National Health Service (NHS) and non--NHS-based physical therapists, including fewer treatment sessions being provided by NHS-based therapists. Limitations. Limitations include the potential for nonresponder bias and, in clinical practice, physical therapists may manage patients with hip OA differently. Conclusion. UK-based physical therapists commonly provide a package of care for patients with hip OA that is broadly in line with current clinical guidelines, including advice, exercise, and other nonpharmacological treatments. There were some differences in clinical practice between NHS and non--NHS-based physical therapists, but whether these differences impact on clinical outcomes remains unknown. [ABSTRACT FROM AUTHOR]

Aim: to examine ward staff perceptions on the role of the ‘hospital at day’ advanced nurse practitioner (ANP). This term is used locally to refer to a model first introduced into ‘hospital at night’ teams, in response to changes in working patterns of junior doctors, where an advanced nurse practitioner is based on the ward—the model was subsequently rolled out to daytime teams. Methods: a qualitative descriptive phenomenological approach was adopted to carry out this study with a purposive sample of ten participants. Participants were interviewed individually using semi-structured interviews to gain insights into their perceptions on the role of the ANP, following Colaizzi’s analytical model of data analysis. Findings: four major themes were identified. The first overarching theme was effectiveness of the ANP role. There was evidence that the role was not only clinically effective in the ward but also in relation to organisational priorities such as impact on patient flow. Secondly it was acknowledged that having an ANP based on the ward and as a ‘constant’ in the ward area, when medical teams rotate, provides team stability and improves the functioning of the ward area. Despite the positivity recognised, the third theme identified that having a ward-based ANP may affect skill acquisition and development and may lead to the ‘de-skilling’ of staff. Lastly it was acknowledged that there remains an overall confusion about the role of the ANP. Conclusion: the themes identified reflect what is already known about the wider perceived role of the ANP. Moreover, this study adds to the limited literature available specifically on the benefits of the ANP within ‘hospital at day’ roles. [ABSTRACT FROM AUTHOR]

Women’s ability to effect changes in welfare policy during the later workings of the new Poor Law has been presented as a ‘marginal influence’ within past historiography. This perspective is contested in recent empirical work, which argues for a more positive view of female agency. The Brabazon Employment Scheme was a charitable initiative, which occupied the poor unable to take part in the routine work of public institutions. Findings from its operation in Glasgow demonstrate how women drew upon philanthropic experience as well as elected positions in the management of institutions to secure the scheme’s introduction in these settings. While the initiative originated in the English workhouses, local women extended the Brabazon activities to address gaps in welfare provision for asylum patients. In doing so, the article shows how organised charity continued to function as an avenue of support for the poor alongside municipal relief into the early 20th century. [ABSTRACT FROM PUBLISHER]

Crisis theory suggests that in addition to presenting a threat to mental well-being, crises are also opportunities where successful interventions can lead to successful outcomes. UK mental health crisis teams aim to reduce hospital admission by treating people at home and by building resilience and supporting learning from crisis, yet data on repeat crisis episodes suggest this could be improved. This qualitative study sought to explore the Wellness Recovery Action Plan (WRAP) as a means of supporting resilience-building and maximising the opportunity potential of crisis. The following themes emerged: The meaning of crisis; Engaging with the WRAP process; WRAP and self-management; and Changes and transformations. This research suggests that WRAP has potential in supporting recovery from crisis, revealing insights into the nature of crisis which can inform the further development of crisis services. [ABSTRACT FROM AUTHOR]

Aim: To compare paediatric radiology provision across the UK with national standards published by the Department of Health and the Royal College of Radiologists (RCR).Materials and Methods: Audit standards and indicators for paediatric imaging were derived from "Delivering quality imaging services for children",1 "Standards for imaging in cases of suspected non-accidental injury"2 and "Improving paediatric interventional radiology services"3 and agreed jointly by the Clinical Radiology Audit Committee and the British Society of Paediatric Radiology. A questionnaire was sent to all hospitals and NHS trusts imaging children aged 16 or younger in the UK in October 2013. The target for all indicators was 100%. Eighty-seven of 196 (44%) eligible institutions submitted data, the size distribution of the institutions was representative when compared to data from "Facing the future: a review of paediatric services"4 published by the Royal College of Paediatrics and Child health.Results: Only 65% of paediatric images were obtained by staff who had had specific training and only 60% were reported by radiographers or radiologists with appropriate training. Sixty-two percent of centres did not have access to a paediatric opinion 24 hours a day, 7 days a week all year; only 34% of radiographers who regularly imaged children had had any access to continuing professional development (CPD) in the 12 months of the audit. Although all hospitals had facilities for image transfer, only 57% had any formal funding arrangements in place for external reporting of images.Conclusions: The standards set for a network approach to paediatric radiology provision in "Delivering quality imaging services for children" are largely unmet. This failure to make the most of the workforce and resources puts vulnerable children at risk. The authors urge NHS England to work with the RCR to organise and administer a national network for paediatric imaging. [ABSTRACT FROM AUTHOR]

Street-level bureaucratic theory is now at a fairly mature stage. The focus on street-level bureaucrats as ultimate policymakers is now as familiar as it is important. Likewise, the parallel sociolegal study of the implementation of public law in public organizations has demonstrated the inevitable gap between law-in-the-books and law-in-action. Yet, the success of these advances comes at the potential cost of us losing sight of the importance of law itself. This article analyzes some empirical data on the decision making about one legal concept- vulnerability in UK homelessness law. Our analysis offers two main contributions. First, we argue that, when it comes to the implementation of law, the legal abilities and propensities of the bureaucrats must be taken into account. Bureaucrats' abilities to understand legal materials make a difference to the likelihood of legal compliance. Second, we must also pay attention to the character of the legal provisions. Where a provision is simple, it is more likely to facilitate legal knowledge and demands nothing of bureaucrats in terms of legal competence. Where the provision is also inoffensive and liveable, it is less likely to act as an impediment to legal conscientiousness. [ABSTRACT FROM AUTHOR]

Background Patients with chemotherapy-induced neutropenia are at increased risk of infection. Historically, dietary restrictions commonly referred to as 'clean', 'low bacteria', 'low-microbial' or 'neutropenic' diets have been prescribed to reduce the risk of foodborne infection. Although research does not support their effectiveness, they continue to be used in clinical practice. The present study aimed to investigate the use of dietary restrictions in patients with cancer in the UK by surveying registered dietitians ( RDs). Methods An online questionnaire was distributed to 573 RDs via local and specialist interest groups of the British Dietetic Association. Results One hundred and ten questionnaires were returned. Of these, 67.8% of RDs prescribed dietary restrictions to patients, with 'neutropenic diet' being the most commonly used term. Specialist oncology or haematology RDs were more likely to use the diet than nonspecialist RDs ( P < 0.005). The variety of foods restricted varied greatly and was often contradicting. Unpasteurised dairy products and raw or lightly cooked meat or fish were most commonly restricted. Less than half (43.6%) of RDs had a policy in place for the use of neutropenic diets, with specialist oncology and haematology RDs more likely to report this ( P < 0.005). Conclusions Neutropenic dietary advice provided by dietitians in the UK varies greatly. Further high-quality research is required to create an evidence base from which national clinical guidelines can be formed. [ABSTRACT FROM AUTHOR]

This paper reviews the implications of climate change for the water environment and its management in England. There is a large literature, but most studies have looked at flow volumes or nutrients and none have considered explicitly the implications of climate change for the delivery of water management objectives. Studies have been undertaken in a small number of locations. Studies have used observations from the past to infer future changes, and have used numerical simulation models with climate change scenarios. The literature indicates that climate change poses risks to the delivery of water management objectives, but that these risks depend on local catchment and water body conditions. Climate change affects the status of water bodies, and it affects the effectiveness of measures to manage the water environment and meet policy objectives. The future impact of climate change on the water environment and its management is uncertain. Impacts are dependent on changes in the duration of dry spells and frequency of ‘flushing’ events, which are highly uncertain and not included in current climate scenarios. There is a good qualitative understanding of ways in which systems may change, but interactions between components of the water environment are poorly understood. Predictive models are only available for some components, and model parametric and structural uncertainty has not been evaluated. The impacts of climate change depend on other pressures on the water environment in a catchment, and also on the management interventions that are undertaken to achieve water management objectives. The paper has also developed a series of consistent conceptual models describing the implications of climate change for pressures on the water environment, based around the source-pathway-receptor concept. They provide a framework for a systematic assessment across catchments and pressures of the implications of climate change for the water environment and its management. [ABSTRACT FROM AUTHOR]

Objective The aim of the current study was to identify predictors of paraprosthetic aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and examine its influence on short/medium-term mortality using the UK TAVI Registry. TAVI is an effective treatment for high-risk patients with severe symptomatic aortic stenosis (AS), but paraprosthetic AR has been associated with increased in-hospital and mid-term mortality. Methods Between January 2007 and December 2011, 2584 TAVI procedures were performed in the UK. Patients undergoing 'valve-in-valve' procedures, patients with aortic regurgitation as the primary pathology and with no recorded severity of AR were excluded from this analysis (n=144). In total, therefore, 2440 patients were included. Balloon-expandable and self-expanding devices were implanted in 52.7 and 47.2%, respectively, using either transfemoral (67.7%) or non-transfemoral, surgical access (32.3%). Results Postprocedural AR was observed in 68%, mild AR in 57% and moderate-severe in 10%. A large aortic annulus, high preprocedural transaortic gradient, and use of self-expanding valve were independent predictors of moderate-severe AR. Moderate-severe (but not mild) AR was associated with increased mortality, and this relationship appeared significant for the balloon-expandable but not the self-expanding device. Conclusions Our data suggest that a large aortic annulus, high preprocedural transaortic gradient, and use of the self-expanding valve predict moderate-severe AR after TAVI. Such a degree of AR is associated with a significantly worse outcome with the balloon-expandable, but not with the self-expanding valve. Further studies are needed to verify this and explore potential mechanisms. [ABSTRACT FROM AUTHOR]

Background Children with maltreatment associated psychiatric problems are at increased risk of developing behavioural or mental health disorders. Dyadic Developmental Psychotherapy (DDP) was proposed as treatment for children with maltreatment histories in the USA, however, being new to the UK little is known of its effectiveness or cost-effectiveness. As part of an exploratory study, this paper explores the feasibility of undertaking economic analysis of DDP in the UK. Methods Feasibility for economic analysis was determined by ensuring such analysis could meet key criteria for economic evaluation. Phone interviews were conducted with National Health Service staff and social service therapists trained and accredited or in the process of becoming accredited DDP practitioners. Three models were developed to represent alternative methods of DDP service delivery. Once appropriate comparators were determined, economic scenarios were constructed. Cost analyses were undertaken from a societal perspective. Finally, appropriate outcome measurement was explored through clinical opinion, literature and further discussions with clinical experts. Results Three DDP models were constructed: DDP Full-Basic, DDP Home-Based and DDP Long- Term. Two potential comparator interventions were identified and defined as Consultation with Carers and Individual Psychotherapy. Costs of intervention completion per case were estimated to be: £6,700 (DDP Full-Basic), £7,100 (Consultations with Carers), £7,200 (DDP Home-Based), £11,400 (Individual Psychotherapy) and £14,500 (DDP Long-Term). None of the models of service delivery were found to currently measure effectiveness consistently. The Strengths and Difficulties Questionnaire (SDQ) was deemed an appropriate primary outcome measure, however, it does not cover all disorders DDP intends to treat and the SDQ is not a direct measure of health gain. Inclusion of quality of life measurement is required for comprehensive economic analysis. Conclusions Economic analysis of DDP in the UK is feasible if vital next steps are taken to measure intervention outcomes consistently, ideally with a quality of life measurement. An economic analysis using the models constructed could determine the potential cost-effectiveness of DDP in the UK and identify the most efficient mode of service delivery. [ABSTRACT FROM AUTHOR]

How to cite this article: Halliday V., Porock D., Arthur A., Manderson C. & Wilcock A. (2012) Development and testing of a cancer appetite and symptom questionnaire. J Hum Nutr Diet. 25, 217-224 Abstract Background: Poor appetite and weight loss are common in patients with cancer, contributing to an increase in morbidity and mortality. Early identification of those at greatest risk is problematic. The Council on Nutrition Appetite Questionnaire (CNAQ) is short and easy to use, although it is not specific to cancer populations. The present study aimed to build on the CNAQ to develop a cancer appetite and symptom questionnaire (CASQ) for predicting weight loss in patients with cancer. Methods: The content validity of the CNAQ was assessed by an expert panel ( n = 41) using the content validity index (CVI). The resulting CASQ was tested for reliability among patients receiving radiotherapy ( n = 34). Predictive validity of the CASQ was determined in patients with lung or upper gastrointestinal cancer ( n = 185), comparing CASQ scores (possible range 0-48) recorded at baseline with percentage weight change after 12 weeks. Results: In all but one CNAQ item, the CVI was above the minimum level of agreement (>0.70). Comments from expert panel members led to minor modifications and the introduction of new items resulting in the 12-item CASQ. The intraclass correlation coefficient of the CASQ was 0.80 [95% confidence interval (CI) = 0.68-0.92] and the difference between total scores at two time points was −0.20 (95% CI = −1.21 to 0.80). The optimum cut-off point of the instrument to predict >10% weight loss was 29/30 (area under curve = 0.75; sensitivity 71%, specificity 66%, positive predictive value 19%, negative predictive value 95%) [Correction added on 30 April 2012, after first online publication: in the preceding sentence, <10% was corrected to >10%]. Conclusions: The CASQ can predict weight loss among patients with lung and upper gastrointestinal cancer. Acknowledgment of the low positive predictive value is needed if the instrument is to be used within clinical practice. [ABSTRACT FROM AUTHOR]

A biography of British painter Algernon Mayow Talmage is presented, with focus given to his work painting scenes of the Canadian Army Veterinary Corps during World War I for the Canadian War Memorials Fund. Talmage's focus on landscape painting throughout his career is discussed, and the exhibition of his early works in London, England is detailed. The work of the Veterinary Corps throughout the conflict is also explained.

The Carotid Disease and Cardiac Surgery Consensus Meeting was convened as a multidisciplinary gathering to consider the management of patients undergoing cardiac surgery who are found to have asymptomatic carotid artery disease. There are no randomized trials concerning whether carotid interventions are of value in this situation and the natural history is unclear. Bilateral carotid artery disease (≥70% stenosis) should be regarded clinically relevant when considering hemodynamic and short-term surgical stroke risk. However, this may be because the presence of significant carotid disease is also a marker for aortic arch and intracerebral disease. A natural history study is urgently needed to determine the incidence, predictive factors, and natural history of asymptomatic carotid disease in patients undergoing contemporary cardiac surgical interventions to inform the design of any future randomized trial. [ABSTRACT FROM PUBLISHER]

Abstract: When volatile flammable vapours are released, they can mix with surrounding air and form a vapour cloud. Ignition of this fuel/air mixture will produce a flame front that will flash through the vapour. Items exposed to the flame front, including a suspect''s clothing and footwear, may sustain superficial heat damage. At The Forensic Science Service Ltd this is referred to as flashburning. This paper describes the concept of flashburning, the laboratory methodology used to identify it and how an assessment on the overall distribution of that damage may allow a scientist to evaluate its evidential significance. Two anonymised casework examples are used to demonstrate how this information has been interpreted and used in evidence in United Kingdom courts of law. [Copyright &y& Elsevier]

Background: The role of the dietetic support worker (DSW) was developed to provide cost-effective support to dietetic services in the National Health Service (NHS). However, there is little evidence about how the role is perceived or the impact of the introduction of Agenda for Change in 2004 (a guide to pay terms and conditions for NHS staff) on role definition. The present study aimed to gather evidence from DSWs and dietitians on the current role of the DSW to help inform the future development of the role. Methods: A questionnaire survey was conducted on DSWs and dietitians in 10 trusts in the East of England. Issues included qualifications, experience, training, satisfaction with Agenda for Change, supervision and responsibility. Themes were further explored by semi-structured telephone interviews conducted on a subsample. Results: Eighteen out of 24 DSWs and 62 out of 98 dietitians responded to the questionnaire. The role of the DSW is highly valued by dietitians. Over three-quarters of DSWs and over 90% of dietitians agree that the employment of DSWs improved the working lives of dietitians. Only 50% of DSWs were happy with their Agenda for Change banding, although this did not adversely affect their job satisfaction. Both groups saw the role of the DSW becoming more specialised, despite concerns about access to appropriate training and the lack of a structured career pathway. Conclusions: This study identified issues relating to the future development of the role of the DSW from the viewpoint of DSWs and dietetic assistants. [ABSTRACT FROM AUTHOR]

In July 1549 the Oxfordshire commons rose in large number, and without gentry support. Somewhere in the region of several hundred armed participants marched from the south-east to the north-west of the county, pillaging parks as they went, until eventually retreating into the town of Chipping Norton. The principal catalyst for the 1549 rising seems, given the rebels’ targets and timing, to have been the common perception that the goods of the county's churches were about to be seized by the commissioners for church goods. Consequently, Oxfordshire's rebels did not head for London – they were not opposing religious reforms per se, but were contesting the Edwardian reforms as they had been imposed within their parishes. [ABSTRACT FROM AUTHOR]