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Additional file 1. National health record systems.

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe. © 2020 The Author(s).

Having completed my morning clinic and witnessing first-hand how well our local services have done in delivering the COVID-19 vaccine, I cannot help but reflect on how our medical counterparts are doing internationally. We should not only all be proud of our frontline staff delivering this historic vaccine roll-out and count ourselves fortunate, but we should also recognise the health inequalities around us and further abroad. It has been eye opening to see the challenges each nation has faced in trying to deliver these crucial vaccinations in order to return to some form of normality. That being said, normality for …

There have been significant efforts in the UK to embrace health technology to improve provisions of care. Yet, healthcare offers unique challenges to innovation, particularly with regard to data siloing. Blockchain is a shared distributed ledger technology that decentralises information storage with the potential to improve health outcomes by concurrently optimising data sharing practices and data privacy. In this paper, we explore how blockchain technology may facilitate the handling of health data in the context of regulatory frameworks, patient rights, cybersecurity and provider-centric perspectives. This is essential if this developing technology is to be considered for implementation at scale.

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe. The workshop participants received funding from the European Union Seventh Program for Research, Technological Development and Demonstration (FP7) and Horizon Research and Innovation Program (H2020) and other European Union programs under the following grant agreements: AETIONOMY (Developing an Aetiology-based Taxonomy of Human Disease—Approaches to Develop a New Taxonomy for Neurological Disorders, IMI-no115568), ANTI-SUPERBUG PCP (ANTISUPERBUG Precommercial Procurement, H2020-no688878), B-CAST (Breast CAncer Stratification understanding the determinants of risk and prognosis of molecular sub-types, H2020-no633784), BRIDGE Health (Bridging information and data generation for evidence-based health policy and research, H2020-no664691), CASyM (Coordinating Action Systems Medicine—Implementation of Systems Medicine across Europe, FP7-n°305033), CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI, FP7-no602150), CECM (Centre for New Methods in Computational Diagnostics and Personalized Therapy, H2020-no763734), COLOSSUS (Advancing a Precision Medicine Paradigm in Metastatic Colorectal Cancer: Systems based patient stratification solutions, H2020-no754923), COMPARE (COllaborative Management Platform for detection and Analyses of (Re-)emerging and foodborne outbreaks in Europe, H2020-no643476), CONNECARE (Personalized Connected Care for Complex Chronic Patients, H2020-no689802), CREATIVE (Collaborative REsearch on ACute Traumatic brain Injury in intensiVe care medicine in Europe, FP7-no602714), DEFORM (Define the global and financial impact of research misconduct H2020-no710246), ECCTR (European Cornea and Cell Transplant Registry, FP7-n°709723), E-COMPARED (European COMPARative Effectiveness Research on online Depression, FP7-no603098), ECRIN-IA (European Clinical Research Infrastructures Network- Integrating Activity, FP7-no284395), EHR4CR (Electronic Health Records Systems for Clinical Research, IMI-no115189) eInfraCentral (European E-infrastructures Services Gateway, H2020-no731049), ELIXIR (European Life-science Infrastructure for Biological Information, FP7-n°211601), ELIXIR-EXCELERATE (Fast track ELIXIR implementation and drive early user exploitation across the life sciences, H2020-no676559), eMEN (e-mental health innovation and transnational implementation platform North West Europe, H2020), EMIF (European Medical Information Framework, IMI-no115372), ERA PerMed (ERA-net Cofund in Personalized Medicine, H2020-no779282), eTRIKS (Delivering European Translational Information and Knowledge Management Services, IMI-1-no115446), EuroPOND (Data-driven models for progression of neurological diseases, H2020-n°666992), EurValve (Personalized Decision Support for Heart Valve disease, H2020-no689617), HBP SGA1/SGA2 (Human Brain Project specific grant agreements, H2020-n°720270/785907), ICT4DEPRESSION (User-friendly ICT tools to enhance self-management and effective treatment of depression in the EU, FP7-n°248778), ImpleMentAll (Towards evidence-based tailored implementation strategies for eHealth, H2020-no733025), INSTRUCT-ULTRA (Releasing the full potential of instruct to expand and consolidate infrastructure services for integrated structural life sciences research, H2020-no731005), MASTERMIND (Management of Mental Disorders through Advanced Technologies, CIP-no621000), MeDALL (Mechanisms of the Development of ALLergy, FP7-n°261357), MedBioinformatics (Creating medically-driven integrative bioinformatics applications focused on oncology, CNS disorders and their comorbidities, H2020-n°634143), MIDAS (Meaningful Integration of Data, Analytics and Services, H2020-no727721), MultipleMS (Multiple manifestations of genetic and non-genetic factors in Multiple Sclerosis disentangled with a multi-omics approach to accelerate personalized medicine, H2020-no733161), myPEBS (Randomized Comparison Of Risk-Stratified versus Standard Breast Cancer Screening European Women Aged 40–74, H2020-no755394), OpenAIRE-Advance (Advancing Open Scholarship, H2020-no777541), OpenMedicine (OpenMedicine, H2020-n°643796), PanCareSurFup (PanCare Childhood and Adolescent Cancer Survival Care and Follow-up Studies, FP7-n°257505), PIONEER (Prostate Cancer DIagnOsis and TreatmeNt Enhancement through the Power of Big Data in EuRope, H2020-IMI-2-n°777492), PREPARE (Platform for European Preparedness Against (Re-)emerging Epidemics, FP7-n°602525), Regions4PerMed (Interregional coordination for a deep and fast uptake of personalized health, H2020-no825812), RD-CONNECT (An integrated platform connecting registries, biobanks and clinical bioinformatics for rare disease research, FP7-no305344), Solve-RD (Solving the unsolved Rare Diseases, H2020-no779257), SPIDIA4P (SPIDIA for Personalized Medicine-Standardization of generic Pre-analytical procedures for In-vitro DIAgnostics for Personalized Medicine, H2020-no733112), SYSCID (A Systems medicine approach to chronic inflammatory disease, H2020-no733100), SysCLAD (Systems prediction of Chronic Allograft Dysfunction, FP7-n°305457), SYSCOL (Systems Biology of Colorectal Cancer, FP7-no258236), SysMedPD (Systems Medicine of Mitochondrial Parkinson’s Disease, H2020-n°668738), U-BIOPRED (Unbiased BIOmarkers for the PREDiction of respiratory disease outcomes, IMI-n°115010), VPH-share (Virtual Physiological Human: Sharing for Healthcare—A Research Environment, FP7-n°269978).

Objective To undertake a pilot study and examine whether the communication assessment tool (CAT) is useful in assessing patient perceptions of dentists' interpersonal skills. Design Cross-sectional questionnaire study. Setting Three speciality dental clinics in a University teaching hospital in the United Kingdom. Participants, materials and measures One hundred patients, seen by 20 dentists, were recruited to the study. Patients completed the CAT after their consultation. Main outcome measures Patient ratings of excellent interpersonal skills within a dental consultation according to dentists' experience, gender and speciality. Results Complete data was received from 95 patients. On average, dentists' communication skills were rated as excellent 73% of the time. Patients were least satisfied with opportunities to ask questions within their consultation and with their level of involvement in decision-making. There were suggested differences in patients' perceived satisfaction with communication according to dentists' experience and gender. Conclusion Overall, patients are satisfied with the quality of communication with their dentist. Our findings are comparable to those from larger studies suggesting that the CAT is an effective tool to use in a dental context. The CAT would be useful in documenting the development of dentists' and students' interpersonal skills.

A 71-year-old patient underwent a transabdominal preperitoneal right inguinal hernia repair and presented to the emergency department 48 hours postoperatively with nonspecific abdominal and chest pain and was diagnosed an abdominal abscess at the umbilicus by computed tomography. Laparotomy showed a vitello-intestinal duct injury caused by the umbilical trocar at his previous laparoscopic surgery. We will discuss this rare complication and how to avoid it in future practice.

Introduction. Each year around 2,200 people in the UK are diagnosed with laryngeal SCC (Office of National Statistics 2009). Compared to pharyngeal carcinoma, it is a highly curable disease with a survival rate of around 60% for all stages and all forms of treatment.Case Presentation. We present the case of a 60-year-old man with a previously treated T4 N2c transglottic squamous cell carcinoma (SCC), who developed an isolated swelling in the extensor compartment of his right forearm at 6 months after radical laryngectomy with bilateral neck dissection. Fine needle aspiration of the forearm lesion revealed SCC consistent with a metastasis from the laryngeal primary. MRI revealed that the lesion was confined to the muscle. Initial staging CT showed no distant metastases or signs of advanced disease, including no evidence of axillary nodal involvement.Conclusion. This case is therefore unusual, as one of only 2 cases reported in the scientific literature of isolated distant muscular metastasis from a laryngeal squamous cell carcinoma. We conclude that any muscular swelling, in the setting of previous head and neck malignancy, should be treated with a high degree of suspicion for metastasis and investigated promptly.

Introduction. Each year around 2,200 people in the UK are diagnosed with laryngeal SCC (Office of National Statistics 2009). Compared to pharyngeal carcinoma, it is a highly curable disease with a survival rate of around 60% for all stages and all forms of treatment. Case Presentation. We present the case of a 60-year-old man with a previously treated T4 N2c transglottic squamous cell carcinoma (SCC), who developed an isolated swelling in the extensor compartment of his right forearm at 6 months after radical laryngectomy with bilateral neck dissection. Fine needle aspiration of the forearm lesion revealed SCC consistent with a metastasis from the laryngeal primary. MRI revealed that the lesion was confined to the muscle. Initial staging CT showed no distant metastases or signs of advanced disease, including no evidence of axillary nodal involvement. Conclusion. This case is therefore unusual, as one of only 2 cases reported in the scientific literature of isolated distant muscular metastasis from a laryngeal squamous cell carcinoma. We conclude that any muscular swelling, in the setting of previous head and neck malignancy, should be treated with a high degree of suspicion for metastasis and investigated promptly.

Introduction Anastomotic leakage is generally assumed to occur from approximately 5 days after surgery unless there has been a technical error in anastomotic construction. In order to investigate whether this assumption is correct, clinical changes associated with anastomotic leakage were studied in a homogeneous group of patients. Method Individuals were included from a prospectively collected database of patients undergoing laparoscopic total colectomy and ileorectal anastomosis (LTC and IRA) for familial adenomatous polyposis (FAP) between 2006–2013 at a single institution. Patients suffering anastomotic leakage (case group) were compared with controls that did not leak. These controls were selected as the consecutive case before and after each leak case (2 controls for each case). Panel data was collected as repeated measures of continuous post-operative parameters and time-series regression performed using a double subscript structure. A generalised least squares multivariate approach was applied in a random effects setting to calculate correlations for observations with the dependent outcome of anastomotic leak. Regression calculations were performed according to individual observations at each time point to identify outcome correlations. Results Data from 95 patients who underwent LTC and IRA for FAP between 2006 and 2013 was available for analysis. All operations were performed laparoscopically within an enhanced recovery programme. 10 patients (10.5%) developed International Classification Grade C leakage (requiring laparotomy), with a mean time to diagnosis of 7.5 +/- 2.6 days. The mean age of the 10 leak patients and 20 controls was 31.9 (+/-17.0) years. There was no significant difference between groups in age, sex, ASA grade, physiology, and operative score. Multivariate analysis of physiological parameters demonstrated a significant difference between leak patients and controls in respiratory rate, urine output, diastolic blood pressure, and heart rate within 48 h of operation. Biochemical parameters, including white cell count, neutrophil count, albumin, and C-reactive protein, did not differ significantly. Conclusion Following anastomotic leakage, significant changes in physiological parameters are identifiable within 48 h of surgery. Leakage may occur earlier than has previously been thought and identification may provide opportunities for earlier intervention in order to improve outcome. Disclosure of interest None Declared.

The Intercollegiate Basic Surgical Skills course has a long history and runs regionally and internationally at multiple centres. The Royal College of Surgeons of England ran 81 courses for a total of 1,083 participants between 1 July 2011 and 30 June 2012. The fifth edition was officially launched on 25 September 2012 with content agreed by representatives from the four Royal Colleges of Surgeons. As a result of feedback from faculty, participants and centres running the course, it has been reduced to two days, in alignment with the ISCP for basic surgical skills and without losing vital hands-on practice.

Waterpipe tobacco smoking (WTS) is a growing public health concern. This exploratory study sought to assess the WTS knowledge and attitudes of healthcare professionals by distributing an anonymous, 12-item, cross-sectional survey to GPs in two areas; Brent: a socially-deprived, ethnically-diverse area of outer London known for its high prevalence of WTS1 (response rate 49 out of 251 [19.5%]), and Lancashire: an area of the north west of England not typically known for its WTS popularity …