Sadie Bennett, Martin Stout, Thomas E. Ingram, Keith Pearce, Timothy Griffiths, Simon Duckett, Grant Heatlie, Patrick Thompson, Judith Tweedie, Jo Sopala, Sarah Ritzmann, Kelly Victor, Judith Skipper, Benoy N. Shah, Shaun Robinson, Andrew Potter, Daniel X. Augustine and Claire L. Colebourn (2022) Clinical indications and triaging for adult transthoracic echocardiography: a consensus statement by the British Society of Echocardiography in collaboration with British Heart Valve Society Echo research and practice 9(1) p.5
Abstract: Transthoracic echocardiography (TTE) is widely utilised within many aspects of clinical practice, as such the demand placed on echocardiography services is ever increasing. In an attempt to provide incremental value for patients and standardise patient care, the British Society of Echocardiography in collaboration with the British Heart Valve Society have devised updated guidance for the indications and triaging of adult TTE requests for TTE services to implement into clinical practice. Copyright © 2022. The Author(s).
Full Text Check: https://libkey.io/libraries/1656/10.1186/s44156-022-00003-8

Christopher J. Black, Peter A. Paine, Anurag Agrawal, Imran Aziz, Maria P. Eugenicos, Lesley A. Houghton, Pali Hungin, Ross Overshott, Dipesh H. Vasant, Sheryl Rudd, Richard C. Winning, Maura Corsetti and Alexander C. Ford (2022) British Society of Gastroenterology guidelines on the management of functional dyspepsia Gut 71(9) p.1697-1723
Abstract: Functional dyspepsia (FD) is a common disorder of gut-brain interaction, affecting approximately 7% of individuals in the community, with most patients managed in primary care. The last British Society of Gastroenterology (BSG) guideline for the management of dyspepsia was published in 1996. In the interim, substantial advances have been made in understanding the complex pathophysiology of FD, and there has been a considerable amount of new evidence published concerning its diagnosis and classification, with the advent of the Rome IV criteria, and management. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based diagnosis and treatment of patients. The approach to investigating the patient presenting with dyspepsia is discussed, and efficacy of drugs in FD summarised based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of pairwise and network meta-analyses. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system. These provide both the strength of the recommendations and the overall quality of evidence. Finally, in this guideline, we consider novel treatments that are in development, as well as highlighting areas of unmet need and priorities for future research. Copyright © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Full Text Check: https://libkey.io/libraries/1656/10.1136/gutjnl-2022-327737

H. Gorring, P. Divall, S. Gardner, A. Gray, A. McLaren, L. Snell, E. Thackeray, A. Tocock and G. Young (2022) NHS librarians collaborate to develop a search bank peer reviewing and sharing COVID-19 searches - an evaluation Health Information and Libraries Journal Abstract: Background: Responding to the COVID-19 pandemic, Health Education England (HEE) mobilised a group of expert searchers from NHS libraries in England to develop a platform for librarians to share peer reviewed search strategies and results on the Knowledge for Healthcare website. Objective(s): (1) To document the origins of the COVID-19 search bank, (2) evaluate attitudes of NHS librarians in England towards the search bank and (3) identify lessons learned and consider whether the initiative might be developed further. Method(s): Structured interviews with the peer reviewers (n = 10) were conducted, and a questionnaire survey of the NHS library community using the search bank was undertaken. Result(s): The interviews confirmed the value of collaboration. Expert searchers worked in pairs to peer review submitted search strategies. The survey (85 responses) indicated that a majority had used the search bank, and approved of the project, with some differences of opinion on functionality and future developments. Discussion(s): Collaborative working for the search bank probably saved time for individual NHS librarians. The quality of the searches submitted was variable as were librarians' approaches to presentation and development of search strategies. Peer review benefits from a buddy approach among expert searchers and agreement about feedback provided to contributors. Conclusion(s): Search strategies are the most useful element of a search bank. Peer review can be challenging and would benefit from a formal structure, but it is professionally rewarding. Copyright © 2022 The Authors Health Information and Libraries Journal published by John Wiley & Sons Ltd on behalf of Health Libraries Group.
Full Text Check: https://libkey.io/libraries/1656/10.1111/hir.12444

Siri Gowda, Wei S. Leong and Ovie Edafe (2022) Day-case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms-A systematic review Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 47(5) p.553-560
Abstract: OBJECTIVES: Obstructive sleep apnoea (OSA) is a common indication for adenoidectomy and tonsillectomy in children. Traditional practice involves overnight admission to monitor for respiratory complications. However, there is a shift towards same-day discharge in selected patients. This systematic review aims to critically evaluate day-case criteria and safety in children with OSA undergoing adenotonsillectomy., DESIGN: We performed a systematic search of EMBASE, Medline and the Cochrane library. All data collected were independently validated for accuracy. Quality assessment of included articles was performed. The protocol was registered with PROSPERO., RESULTS: A total of 15 studies were included (10 731 patients). There was heterogeneity in methods used to ascertain OSA, day-case discharge criteria and lack of prospective discharge protocol. The proportion of children considered for planned day-case surgery ranged from 28.7%-100% based on individual criteria, with an average rate of successful same-day discharge of 96.1% in these patients. The reported rates of post-operative respiratory adverse events and need for airway intervention were 0%-27.3% and 0.4%-6.8%, respectively. There was no reported mortality. The studies were considered low to medium on quality assessment., CONCLUSION: There is a lack of prospective data on day-case criteria and systematic assessment of post-operative complications in children with OSA undergoing adenoidectomy and tonsillectomy. However, current literature suggests that day-case surgery is safe in carefully selected patients. Better characterisation of patient-specific risk factors is needed to develop an optimal criteria-based timeline for safe discharge. This has the potential to improve confidence and uptake across units. Copyright © 2022 John Wiley & Sons Ltd.
Full Text Check: https://libkey.io/libraries/2596/10.1111/coa.13946

R. Handagala, B. S. H. Indrasena, P. Subedi, M. S. Nizam and J. Aylott (2022) Implementing the HEART score in an NHS emergency department: can identity leadership combined with quality improvement promote racial equality? Leadership in Health Services Abstract: Purpose: The purpose of this paper is to report on the dynamics of "identity leadership" with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients. Design/methodology/approach: A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments' perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months. Finding(s): The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas. Research limitations/implications: More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity. Originality/value: This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS. Copyright © 2020, Emerald Publishing Limited.
Full Text Check: https://libkey.io/libraries/1656/10.1108/LHS-04-2022-0035

Sinan Khadhouri, Kevin M. Gallagher, Kenneth R. MacKenzie, Taimur T. Shah, Chuanyu Gao, Sacha Moore, Eleanor F. Zimmermann, Eric Edison, Matthew Jefferies, Arjun Nambiar, Thineskrishna Anbarasan, Miles P. Mannas, Taeweon Lee, Giancarlo Marra, Juan Gomez Rivas, Gautier Marcq, Mark A. Assmus, Taha Ucar, Francesco Claps, Matteo Boltri, Giuseppe La Montagna, Tara Burnhope, Nkwam Nkwam, Tomas Austin, Nicholas E. Boxall, Alison P. Downey, Troy A. Sukhu, Marta Anton-Juanilla, Sonpreet Rai, Yew-Fung Chin, Madeline Moore, Tamsin Drake, James S. A. Green, Beatriz Goulao, Graeme MacLennan, Matthew Nielsen, John S. McGrath, Veeru Kasivisvanathan and Identify Study Group (2022) Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study European urology focus Abstract: BACKGROUND: Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation., OBJECTIVE: To develop a prediction model for urinary tract cancer in patients referred with haematuria., DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged >=16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded., OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism., RESULTS AND LIMITATIONS: The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy., CONCLUSIONS: This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation., PATIENT SUMMARY: We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation. Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
Full Text Check: https://libkey.io/libraries/2596/10.1016/j.euf.2022.06.001

Wei Sheng Leong, Siri Gowda, Richard Jackson, Emilien Chabrillac and Ovie Edafe (2022) Superficial versus total parotidectomy for metastatic cutaneous SCC and melanoma of the head and neck: a systematic review The Journal of laryngology and otology p.1-22
Abstract: Full Text Check: https://libkey.io/libraries/1656/10.1017/S0022215122001724

L. Lewis, S. Borg, L. Alison, H. Hardisty, S. Parry-Okeden, D. Kerrin, L. Chadha, K. Roberts, K. Shabani, A. C. Offiah and N. J. Bishop (2022) Parathyroid hormone changes in infants investigated for inflicted injury; an observational retrospective single centre cohort study Child abuse & neglect 131(p.105775
Abstract: BACKGROUND: Biochemical and haematological testing is recommended in the United Kingdom when inflicted injury is suspected. We examined the associations of test results with radiologically-confirmed fracture(s), and between test results, in a large retrospective observational cohort., METHODS: Infants up to age two years presenting with suspected inflicted injury, without clinically or radiologically apparent bone disease, and where a skeletal survey was undertaken during the period 1st August 2013 to 31st December 2020, were included. Biochemical parameters: corrected calcium (cCa); phosphate (P); alkaline phosphatase (ALP); parathyroid hormone (PTH); 25-hydroxyvitamin D (25D); and haematological parameters: haemoglobin (Hb); mean corpuscular haemoglobin (MCH); mean corpuscular haemoglobin content (MCHC); mean corpuscular volume (MCV); platelet count were collated together with the results of the radiological assessments., FINDINGS: Of 332 eligible infants (190 male), 142 (84 male) had fracture(s) and/or intracranial injury. Mean PTH in the non-fracture group (n measured 50/190) was 27.3 ng/l; in those with intracranial injury alone (n measured 9/23) was 39.4 ng/l; in those with fracture alone (n measured 62/84) was 45.0 ng/l; and in those with fracture and intracranial injury (n measured 20/35) 51.8 ng/l. F-test of multiple means = 0.0369. There was no difference in 25D between the groups., INTERPRETATION: PTH was raised in infants who had fracture(s), intracranial injury or both. A single raised PTH may not necessarily be an indicator of prior disturbed skeletal health in these circumstances. The relevance of vitamin D status and interpretation of data from biochemical testing should be informed by the overall presentation in suspected inflicted injury cases. A single raised PTH may be a consequence of the child's injuries rather than prior disturbed bone health. Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Full Text Check: https://libkey.io/libraries/1656/10.1016/j.chiabu.2022.105775

Kelly Moore (2022) Lower leg improvements in secondary care: Implementing the National Wound Care Strategy Programme Wounds UK 18(2) p.48-57
Abstract: The National Wound Care Strategy Programme (NWCSP) seeks for improvement in the care of patients with wounds (The National Wound Care Strategy Programme -- Lower Limb Recommendations, 2020). The recommendations offer a clear framework for the development for local delivery in clinical care settings. The Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH) developed clinical pathways through collaboratively system leadership with the Doncaster Place Wound Care Alliance, ensuring secondary care was included and potential and historical barriers overcome, to implement the NWCSP recommendations. Here we describe the process of the translating national recommendations into clinical pathway and the issues that led to the development of a secondary care focused version.
Full Text Check: https://www.wounds-uk.com/journals/issue/660/article-details/lower-leg-improvements-secondary-care-implementing-national-wound-care-strategy-programme

Manu Nayar, Chris Varghese, Aditya Kanwar, Ajith K. Siriwardena, Ali Raza Haque, Altaf Awan, Anita Balakrishnan, Arab Rawashdeh, Bogdan Ivanov, Chetan Parmar, Christopher M. Halloran, Clifford Caruana, Cynthia-Michelle Borg, Dhanny Gomez, Dimitrios Damaskos, Dimitrios Karavias, Guy Finch, Husam Ebied, James K. Pine, James R. A. Skipworth, James Milburn, Javed Latif, Jeyakumar Apollos, Jihene El Kafsi, John A. Windsor, Keith Roberts, Kelvin Wang, Krish Ravi, Maria V. Coats, Marianne Hollyman, Mary Phillips, Michael Okocha, Michael Sj Wilson, Nadeem A. Ameer, Nagappan Kumar, Nehal Shah, Pierfrancesco Lapolla, Connor Magee, Bilal Al-Sarireh, Raimundas Lunevicius, Rami Benhmida, Rishi Singhal, Srinivasan Balachandra, Semra Demirli Atici, Shameen Jaunoo, Simon Dwerryhouse, Tamsin Boyce, Vasileios Charalampakis, Venkat Kanakala, Zaigham Abbas, Nilanjana Tewari, Sanjay Pandanaboyana, Covidpan Collborative Group and Covid Pain Collborative Group (2022) SARS-CoV-2 infection is associated with an increased risk of idiopathic acute pancreatitis but not pancreatic exocrine insufficiency or diabetes: long-term results of the COVIDPAN study Gut 71(7) p.1444-1447
Abstract: Full Text Check: https://libkey.io/libraries/2596/10.1136/gutjnl-2021-326218

U. Raghavan, M. Daoud, E. G. Heywood and G. Ullas (2022) Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose Aesthetic Surgery Journal 42(1) p.16-27
Abstract: Background: Many locations for the nasal valve have been suggested, and more recently the concept of the flow-limiting segment was introduced. Rather than being controlled by an internal and external valve, flow through the nose is regulated by the cartilaginous side wall, septum, and inferior turbinate. Objective(s): The aim of this study was to assess the balanced cantilever graft (BCLG) as a technique to support the lateral nasal wall. Method(s): Patients undergoing primary open septorhinoplasty over a 2-year period were studied. Follow-up period was a minimum of 6 months to a maximum of 24 months. Subjective improvement of function was measured with a visual analog scale (VAS) and aesthetic outcomes by FACE-Q score. Objective assessment of the airway was performed with a nasal peak inspiratory flow (NPIF) meter. Strips of septal cartilage of sufficient dimensions were placed in submucosal pockets created under the area of the lateral wall to be supported. Result(s): Sixty patients received BCLGs. The VAS score for nasal obstruction increased from 2.6 preoperatively to 8.1 postoperatively. FACE-Q increased from 16.7 preoperatively to 36.6 postoperatively. NPIF was 74.9 L/minute preoperatively, improving to 95 L/minute postoperatively. Statistically significant improvements were seen in these functional and aesthetic scores. Conclusion(s): BCLGs support the weakened part of lateral nasal wall by their elastance. Minimal cartilage is required and the graft can be altered to support various parts of the lateral nasal wall. This graft does not cause an aesthetic deficiency whilst providing adequate support. Level of Evidence: 4: Copyright © 2021 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.
Full Text Check: https://libkey.io/libraries/2596/10.1093/asj/sjab212

D. A. Schwartz, E. Avvad-Portari, P. Babal, M. Baldewijns, M. Blomberg, A. Bouachba, J. Camacho, S. Collardeau-Frachon, A. Colson, I. Dehaene, J. C. Ferreres, B. Fitzgerald, M. Garrido-Pontnou, H. Gergis, B. Hargitai, A. Cecilia Helguera-Repetto, S. Holmstrom, C. L. Irles, A. Leijonhfvud, S. Libbrecht, T. Marton, N. McEntagart, J. T. Molina, R. Morotti, A. Nadal, A. Navarro, M. Nelander, A. Oviedo, A. R. O. Otani, N. Papadogiannakis, A. C. Petersen, D. J. Roberts, A. G. Saad, A. Sand, S. Schoenmakers, J. K. Sehn, P. R. Simpson, K. Thomas, M. Yolotzin Valdespino-Vazquez, L. E. Van der Meeren, J. Van Dorpe, R. M. Verdijk, J. C. Watkins and M. Zaigham (2022) Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury: A Study of 68 Cases With SARS-CoV-2 Placentitis From 12 Countries Archives of Pathology and Laboratory Medicine 146(6) p.660-676
Abstract: Context.-Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. Objective.-To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design.-Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. Results.-Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. Conclusions.-The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths. Copyright © 2022 College of American Pathologists. All rights reserved.
Full Text Check: https://libkey.io/libraries/2596/10.5858/arpa.2022-0029-SA

James Shobha, Prakash Subedi, Indrasena Buddhike Sri Harsha and Jill Aylott (2022) Review DebrIeF: a collaborative distributed leadership approach to “hot debrief” after cardiac arrest in the emergency department – a quality improvement project Leadership in Health Services 35(3) p.390-408
Abstract: Purpose>The purpose of this paper is to re-conceptualise the hot debrief process after cardiac arrest as a collaborative and distributed process across the multi-disciplinary team. There are multiple benefits to hot debriefs but there are also barriers to its implementation. Facilitating the hot debrief discussion usually falls within the remit of the physician; however, the American Heart Association suggests “a facilitator, typically a health-care professional, leads a discussion focused on identifying ways to improve performance”. Empowering nurses through a distributed leadership approach supports the wider health-care team involvement and facilitation of the hot debrief process, while reducing the cognitive burden of the lead physician.Design/methodology/approach>A mixed-method approach was taken to evaluate the experiences of staff in the Emergency Department (ED) to identify their experiences of hot debrief after cardiac arrest. There had been some staff dissatisfaction with the process with reports of negative experiences of unresolved issues after cardiac arrest. An audit identified zero hot debriefs occurring in 2019. A quality Improvement project (Model for Healthcare Improvement) used four plan do study act cycles from March 2020 to September 2021, using two questionnaires and semi-structured interviews to engage the team in the design and implementation of a hot debrief tool, using a distributed leadership approach.Findings>The first survey (n = 78) provided a consensus to develop a hot debrief in the ED (84% in the ED; 85% in intensive care unit (ICU); and 92% from Acute Medicine). Three months after implementation of the hot debrief tool, 5 out of 12 cardiac arrests had a hot debrief, an increase of 42% in hot debriefs from a baseline of 0%. The hot debrief started to become embedded in the ED; however, six months on, there were still inconsistencies with implementation and barriers remained. Findings from the second survey (n = 58) suggest that doctors may not be convinced of the benefits of the hot debrief process, particularly its benefits to improve team performance and nurses appear more invested in hot debriefs when compared to doctors.Research limitations/implications>There are existing hot debrief tools; for example, STOP 5 and Take STOCK; however, creating a specific tool with QI methods, tailored to the specific ED context, is likely to produce higher levels of multi-disciplinary team engagement and result in distributed roles and responsibilities. Change is accepted when people are involved in the decisions that affect them and when they have the opportunity to influence that change. This approach is more likely to be achieved through distributed leadership rather than from more traditional top-down hierarchical leadership approaches.Originality/value>To the best of the authors’ knowledge, this study is the first of its kind to integrate Royal College Quality Improvement requirements with a collaborative and distributed medical leadership approach, to steer a change project in the implementation of a hot debrief in the ED. EDs need to create a continuous quality improvement culture to support this integration of leadership and QI methods combined, to drive and sustain successful change in distributed leadership to support the implementation of clinical protocols across the multi-disciplinary team in the ED.
Full Text Check: https://libkey.io/libraries/2596/10.1108/LHS-06-2021-0050

L. Southby, S. Harding, A. Davies, H. Lane, H. Chandler and Y. Wren (2022) Parent/Caregiver Views of the Effectiveness of Speech-Language Pathology for Children Born With Cleft Palate Delivered via Telemedicine During COVID-19 Language, Speech, and Hearing Services in Schools 53(2) p.307-316
Abstract: Purpose: The purpose of this study was to describe and examine parent views of speech-language pathology (SLP) for children born with cleft palate delivered via telemedicine during the COVID-19 pandemic in the United Kingdom (UK). Method(s): Parents were asked whether they found this method of delivery "very effective," "somewhat effective," or "not at all effective." Free text was then invited. There were 212 responses. Ordinal chi-square, Kruskal-Wallis, or Fisher's exact tests examined associations between parent views of effectiveness and biological variables and socioeconomic status. Free text responses were analyzed using qualitative content analysis. Result(s): One hundred and forty (66.0%) respondents reported that SLP delivered via telemedicine was "somewhat effective," 56 (26.4%) "very effective," and 16 (7.6%) "not at all effective." There was no evidence of an association between parent reported effectiveness and any of the explanatory variables. Parent-reported challenges impacting on effectiveness included technology issues and keeping their children engaged with sessions. Importantly, telemedicine was viewed as "better than nothing." Conclusion(s): Most parents reported that they felt SLP delivered via telemedicine during the first few months of the COVID-19 pandemic in the UK was at least "somewhat effective." It is important to interpret this in the context of there being no other method of service delivery during this time and that this study only represents families who were able to access SLP delivered via telemedicine. Further work is needed to identify which children with cleft palate might benefit from SLP delivered via telemedicine to inform postpandemic service provision. Copyright © 2022 American Speech-Language-Hearing Association.
Full Text Check: https://libkey.io/libraries/2596/10.1044/2021_LSHSS-21-00071

E. Tian Tan, Wei Sheng Leong, Ovie Edafe and Showkat Mirza (2022) A systematic review of the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with obstructive sleep apnoea Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Abstract: INTRODUCTION: Recent guidelines suggest obstructive sleep apnoea (OSA) is not an absolute contraindication for same day discharge following surgery. The aim of this systematic review was to examine the feasibility and safety of day case nasal and/or palatopharyngeal surgery in patients with OSA., METHODS: We performed a systematic search of PubMed, EMBASE and the Cochrane library. Quality assessment of included studies was done. The protocol of this systematic review was registered with PROSPERO (CRD42021273451)., RESULTS: A total of 1836 patients from ten observational studies were included. There were 268 (15.4%) nasal surgeries, 738 palatopharyngeal surgeries (42.4%) and 735 (42.2%) combined nasal and palatopharyngeal surgery. The majority of patients had moderate to severe OSA. A total of 860 patients (49.8%) were successfully discharged as day cases. There were no standard criteria for daycase surgery. Post-anaesthetic respiratory events were reported in 86/1750 (4.9%) patients. Oxygen desaturation was the most common respiratory event (83.7%, n = 72). There was no mortality reported., CONCLUSION: Current data suggests day surgery is feasible in carefully selected patients with OSA undergoing nasal and/or palatopharyngeal surgery. Further well-designed prospective studies with an emphasis on the systematic assessment of complications are required to establish safety and daycase criteria. Copyright This article is protected by copyright. All rights reserved.
Full Text Check: https://libkey.io/libraries/1656/10.1111/coa.13969

Lynda Wyld, Malcolm W. R. Reed, Karen Collins, Sue Ward, Geoff Holmes, Jenna Morgan, Mike Bradburn, Stephen Walters, Maria Burton, Kate Lifford, Adrian Edwards, Kate Brain, Alistair Ring, Esther Herbert, Thompson G. Robinson, Charlene Martin, Tim Chater, Kirsty Pemberton, Anne Shrestha and Anthony Nettleship (2022) Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT Programme Grants for Applied Research (PGfAR) 10(6) p.vii-113
Abstract: Full Text Check: https://libkey.io/libraries/1656/10.3310/XZOE2552

Chee-Seng Yee, Caroline Gordon, Mohammed Akil, Peter Lanyon, Christopher J. Edwards, David A. Isenberg, Anisur Rahman, Lee-Suan Teh, Sofia Tosounidou, Robert Stevens, Athiveeraramapandian Prabu, Bridget Griffiths, Neil McHugh, Ian N. Bruce, Yasmeen Ahmad, Munther A. Khamashta and Vernon T. Farewell (2022) The BILAG-2004 index is associated with development of new damage in SLE Rheumatology (Oxford, England) Abstract: OBJECTIVE: To determine whether BILAG-2004 index is associated with the development of damage in a cohort of SLE patients. Mortality and development of damage were examined., METHODS: This was a multicentre longitudinal study. Patients were recruited within 12 months of achieving 4th ACR classification criterion for SLE. Data were collected on disease activity, damage, SLE-specific drug exposure, cardiovascular risk factors, antiphospholipid syndrome status and death at every visit. This study ran from 1st January 2005 to 31st December 2017. Descriptive statistics were used to analyse mortality and development of new damage. Poisson regression was used to examine potential explanatory variables for development of new damage., RESULTS: 273 SLE patients were recruited with total follow-up of 1767 patient-years (median 73.4 months). There were 6348 assessments with disease activity scores available for analysis. During follow-up, 13 deaths and 114 new damage items (in 83 patients) occurred. The incidence rate for development of damage was higher in the first 3 years before stabilising at a lower rate. Overall rate for damage accrual was 61.1 per 1000 person-years (95% CI : 50.6, 73.8). Analysis showed that active disease scores according to BILAG-2004 index (systems scores of A or B, counts of systems with A and BILAG-2004 numerical score) were associated with development of new damage. Low disease activity (LDA) states (BILAG-2004 LDA and BILAG Systems Tally (BST) persistent LDA) were inversely associated with development of damage., CONCLUSIONS: BILAG-2004 index is associated with new damage. BILAG-2004 LDA and BST persistent LDA can be considered as treatment targets. Copyright © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Full Text Check: https://libkey.io/libraries/2596/10.1093/rheumatology/keac334

Louise Wan Yee-Loi, Gemma Cass, Anna Collins, Meera Adishesh, Susan Addley, Holly Baker-Rand, Rasiah Bharathan, Dominic Blake, James Beirne, Lisa Canavan, James Dilley, Gary Fitzgibbon, Kate Glennon, Narthana Ilenkovan, Eleanor Jones, Tabassum Khan, Kavitha Madhuri Thumuluru, Victoria McQueen, Alison Montgomery, Rachel Louise O'Donnell, Sven Watmore, Philip White and Gemma Louise Owens (2022) FARGO-360: a multi-disciplinary survey of practice and perspectives on provision of care for patients with frailty presenting with gynecological cancers in the UK and Ireland International Journal of Gynecological Cancer 32(7) p.924-930
Abstract: ObjectivesFrailty has been associated with worse cancer-related outcomes for people with gynecological cancers. However, the lack of clear guidance on how to assess and modify frailty prior to instigating active treatments has the potential to lead to large variations in practice and outcomes. This study aimed to evaluate current practice and perspectives of healthcare practitioners on the provision of care for patients with frailty and a gynecological cancer.MethodsData were collected via a questionnaire-based survey distributed by the Audit and Research in Gynecological Oncology (ARGO) collaborative to healthcare professionals who identified as working with patients with gynecological malignancies in the United Kingdom (UK) or Ireland. Study data were collected using REDCap software hosted at the University of Manchester. Responses were collected over a 16 week period between January and April 2021.ResultsA total of 206 healthcare professionals (30 anesthetists (14.6%), 30 pre-operative nurses (14.6%), 51 surgeons (24.8%), 34 cancer specialist nurses (16.5%), 21 medical/clinical oncologists (10.2%), 25 physiotherapists/occupational therapists (12.1%) and 15 dieticians (7.3%)) completed the survey. The respondents worked at 19 hospital trusts across the UK and Ireland. Frailty scoring was not routinely performed in 63% of care settings, yet the majority of practitioners reported modifying their practice when providing and deciding on care for patients with frailty. Only 16% of organizations surveyed had a dedicated pathway for assessment and management of patients with frailty. A total of 37% of respondents reported access to prehabilitation services, 79% to enhanced recovery, and 27% to community rehabilitation teams.ConclusionPractitioners from all groups surveyed considered that appropriate training, dedicated pathways for optimization, frailty specific performance indicators and evidence that frailty scoring had an impact on clinical outcomes and patient experience could all help to improve care for frail patients.
Full Text Check: https://libkey.io/libraries/2596/10.1136/ijgc-2022-003396