P59 How COVID-19 influenced UK Burns Services: a national multicentred audit

Abstract Introduction COVID-19 has affected national guidelines and availability of resources, resulting in different approaches to treating burns. This project aimed to identify changes to burns management in the UK during the “first wave” of COVID-19, and how the lessons learned can be applied to the current “second wave”. Methods Between 11th July-15th September, 18 burns services across the UK completed a MDT survey and contributed data on service evaluation. The MDT survey captured perspectives of multiple stakeholders and included changes to burns services, disruptions to supply chain, and service improvements resulting from COVID-19. Service evaluation data was collected retrospectively and prospectively on patients who received inpatient/outpatient treatment during COVID-19. Patients in the retrospective cohort were first seen by burns services between 6th-30th April (coinciding with the UK’s COVID-19 peak), and the prospective cohort were first seen between 30th April-15th September. Each cohort consisted of 10-20 patients per burns service. Service evaluation covered key areas of burns aetiology, referral pathway changes, patient presentation delays to tertiary services, patient management decisions, and outpatient dressing clinic management. Data from the MDT survey and the service evaluation were analysed by descriptive statistics and thematic analysis. Results The changes to burns services include delays in burn referrals, increase in conservative management, and increased use of telemedicine. Conclusion Across the UK, safe and effective burns care continued to be delivered despite difficulties from the pandemic. We hope the learning points identified in this study will be of use during the “second wave” of the pandemic.

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SP5.1.3 Analysis of National Bariatric Surgery Related Clinical Incidents: Lessons Learned and a Proposed Safety Checklist for Bariatric Surgery

British Journal of Surgery ◽

10.1093/bjs/znab361.113 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Islam Omar ◽

Brijesh Madhok ◽

Chetan Parmar ◽

Omar Khan ◽

Michael Wilson ◽

...

Keyword(s):

Bariatric Surgery ◽

Significant Proportion ◽

Lessons Learned ◽

Learning System ◽

Left Behind ◽

High Severity ◽

Nasogastric Tubes ◽

The Uk ◽

Bariatric Surgery Worldwide ◽

Learning Points

Abstract Background Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the UK every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents. Methods We analyzed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. The authors used their experience to identify learning themes and design a safety checklist. Results We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.3% (N = 164), intraoperative 38.1% (N = 206), and postoperative accounted for 31.6% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively. The most commonly reported high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most commonly reported high severity theme was improper management of diabetes mellitus (35;6.5%). Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively. Conclusion We identified 58 specific themes of bariatric surgery-related clinical incidents. We proposed specific recommendations for each incidents theme in addition to a bariatric safety checklist to help improve the safety of bariatric surgery worldwide.

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Institutional developments, standards and river quality: a UK history and some lessons for industrialising countries

Water Science & Technology ◽

10.2166/wst.1996.0072 ◽

1996 ◽

Vol 33 (3) ◽

pp. 211-222 ◽

Cited By ~ 10

Author(s):

D. W. M. Johnstone ◽

N. J. Horan

Keyword(s):

Middle Ages ◽

Aquatic Environment ◽

Industrial Revolution ◽

Integrated Management ◽

Sewage Treatment ◽

Lessons Learned ◽

Process Manufacturing ◽

Treatment And Disposal ◽

The Uk ◽

Developed World

From the middle ages until the early part of the nineteenth century the streets of European cities were foul with excrement and filth to the extent that aristocrats often held a clove-studded orange to their nostrils in order to tolerate the atmosphere. The introduction in about 1800 of water-carriage systems of sewage disposal merely transferred the filth from the streets to the rivers. The problem was intensified in Britain by the coming of the Industrial Revolution and establishment of factories on the banks of the rivers where water was freely available for power, process manufacturing and the disposal of effluents. As a consequence the quality of most rivers deteriorated to the extent that they were unable to support fish life and in many cases were little more than open sewers. This was followed by a period of slow recovery, such that today most of these rivers have been cleaned with many having good fish stocks and some even supporting salmon. This recovery has not been easy nor has it been cheap. It has been based on the application of good engineering supported by the passing and enforcement of necessary legislation and the development of suitable institutional capacity to finance, design, construct, maintain and operate the required sewerage and sewage treatment systems. Such institutional and technical systems not only include the disposal of domestic sewage but also provisions for the treatment and disposal of industrial wastewaters and for the integrated management of river systems. Over the years a number of institutional arrangements and models have been tried, some successful other less so. Although there is no universally applicable approach to improving the aquatic environment, many of the experiences encountered by the so-called developed world can be learned by developing nations currently attempting to rectify their own aquatic pollution problems. Some of these lessons have already been discussed by the authors including some dangers of copying standards from the developed world. The objective of this paper is to trace the steps taken over many years in the UK to develop methods and systems to protect and preserve the aquatic environment and from the lessons learned to highlight what is considered to be an appropriate and sustainable approach for industrialising nations. Such an approach involves setting of realistic and attainable standards, providing appropriate and affordable treatment to meet these standards, establishment of the necessary regulatory framework to ensure enforcement of the standards and provision of the necessary financial capabilities to guarantee successful and continued operation of treatment facilities.

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Survey of young people in one region of the UK on accessing COVID-19 information (SOCIAL)

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000942 ◽

2021 ◽

Vol 5 (1) ◽

pp. e000942

Author(s):

Oliver G P Lawton ◽

Sarah A Lawton ◽

Lisa Dikomitis ◽

Joanne Protheroe ◽

Joanne Smith ◽

...

Keyword(s):

Social Media ◽

Young People ◽

Significant Role ◽

Online Survey ◽

Descriptive Statistics ◽

Sources Of Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Education Gaps ◽

The Uk

COVID-19 has significantly impacted young people’s lives yet little is known about the COVID-19 related sources of information they access. We performed a cross-sectional survey of pupils (11–16 years) in North Staffordshire, UK. 408 (23%) pupils responded to an online survey emailed to them by their school. Descriptive statistics were used to summarise the data. Social media, accessed by 68%, played a significant role in the provision of information, despite it not being considered trustworthy. 89% felt that COVID-19 had negatively affected their education. Gaps in the provision of information on COVID-19 have been identified.

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Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: To compensate or not to compensate?

Journal of Orthodontics ◽

10.1177/1465312521991831 ◽

2021 ◽

pp. 146531252199183

Author(s):

Jed Lee ◽

Joanna Johnson ◽

Dirk Bister ◽

Mohsin Chaudhary ◽

Golfam Khoshkhounejad

Keyword(s):

Teaching Hospital ◽

Poor Prognosis ◽

Service Evaluation ◽

Good Prognosis ◽

Final Decision ◽

National Guidelines ◽

High Quality Research ◽

Permanent Molars ◽

First Permanent Molars

Objective: To observe whether paediatric dentists and orthodontists balance and compensate the extraction of first permanent molars (FPMs) in children aged 7–11 years. Design: Service evaluation. Setting: UK dental teaching hospital. Methods: Retrospective analysis of FPM extraction patterns in patients aged 7–11 years that attended for extraction of FPMs from 1 January 2019 to 31 January 2020 (13-month period). Results: A total of 194 patients were included and they collectively had 435 FPMs extracted. No balancing extractions to prevent dental centreline shifts and no lower FPM compensatory extractions were performed. Compensatory extraction of good prognosis upper FPMs were performed in 64% (94/146) of cases to avoid overeruption. Orthodontic input was sought for poor prognosis lower FPMs in 76% of cases compared to 51% for poor prognosis upper FPMs. Conclusion: Compensatory extraction of good prognosis upper FPMs to avoid overeruption appears to be a common practice at Guy’s and St Thomas’ Hospitals. There was also higher demand for orthodontic advice for cases presenting with poor prognosis lower FPMs compared to poor prognosis upper FPMs, which suggests that paediatric dentists may prefer for the final decision on upper FPM compensatory extractions to be made by an orthodontist, even with national guidelines available. More high-quality research on the topic is required to determine the necessity of this practice for achieving optimal long-term oral health in children.

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COVID-19 and its impact on the clinical specialty training recruitment process: lessons learned and the shape of future specialty recruitment in the UK

Journal of the Royal Society of Medicine ◽

10.1177/01410768211008860 ◽

2021 ◽

pp. 014107682110088

Author(s):

Sola Adeleke ◽

Chuanyu Gao

Keyword(s):

Lessons Learned ◽

Specialty Training ◽

Recruitment Process ◽

Clinical Specialty ◽

The Uk

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The potential dangers of not understanding COVID-19 public health restrictions in dementia: “It’s a groundhog day – every single day she does not understand why she can’t go out for a walk”

BMC Public Health ◽

10.1186/s12889-021-10815-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Clarissa Giebel ◽

Kerry Hanna ◽

Manoj Rajagopal ◽

Aravind Komuravelli ◽

Jacqueline Cannon ◽

...

Keyword(s):

Public Health ◽

Cognitive Deficits ◽

Third Sector ◽

Cognitive Capacity ◽

The Public ◽

Health Measures ◽

Third Sector Organisations ◽

The Uk ◽

Second Wave

Abstract Background Sudden public health restrictions can be difficult to comprehend for people with cognitive deficits. However, these are even more important for them to adhere to due to their increased levels of vulnerability, particularly to COVID-19. With a lack of previous evidence, we explored the understanding and changes in adherence to COVID-19 public health restrictions over time in people living with dementia (PLWD). Methods Unpaid carers and PLWD were interviewed over the phone in April 2020, shortly after the nationwide UK lockdown, with a proportion followed up from 24th June to 10th July. Participants were recruited via social care and third sector organisations across the UK, and via social media. Findings A total of 70 interviews (50 baseline, 20 follow-up) were completed with unpaid carers and PLWD. Five themes emerged: Confusion and limited comprehension; Frustration and burden; Putting oneself in danger; Adherence to restrictions in wider society; (Un) changed perceptions. Most carers reported limited to no understanding of the public health measures in PLWD, causing distress and frustration for both the carer and the PLWD. Due to the lack of understanding, some PLWD put themselves in dangerous situations without adhering to the restrictions. PLWD with cognitive capacity who participated understood the measures and adhered to these. Discussion In light of the new second wave of the pandemic, public health measures need to be simpler for PLWD to avoid unwilful non-adherence. Society also needs to be more adaptive to the needs of people with cognitive disabilities more widely, as blanket rules cause distress to the lives of those affected by dementia.

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“At Least until the Second Wave Comes…”: A Twitter Analysis of the NHS and COVID-19 between March and June 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083943 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3943

Author(s):

Kathy McKay ◽

Sarah Wayland ◽

David Ferguson ◽

Jane Petty ◽

Eilis Kennedy

Keyword(s):

Health Care ◽

Social Media ◽

Content Analysis ◽

Well Being ◽

Profound Impact ◽

Time Period ◽

Twitter Analysis ◽

The Uk ◽

Media Narratives ◽

Second Wave

In the UK, tweets around COVID-19 and health care have primarily focused on the NHS. Recent research has identified that the psychological well-being of NHS staff has been adversely impacted as a result of the COVID-19 pandemic. The aim of this study was to investigate narratives relating to the NHS and COVID-19 during the first lockdown (26 March–4 July 2020). A total of 123,880 tweets were collated and downloaded bound to the time period of the first lockdown in order to analyse the real-time discourse around COVID-19 and the NHS. Content analysis was undertaken and tweets were coded to positive and negative sentiments. Five main themes were identified: (1) the dichotomies of ‘clap for carers’; (2) problems with PPE and testing; (3) peaks of anger; (4) issues around hero worship; and (5) hints of a normality. Further research exploring and documenting social media narratives around COVID-19 and the NHS, in this and subsequent lockdowns, should help in tailoring suitable support for staff in the future and acknowledging the profound impact that the pandemic has had.

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An OSCE as part of the first-year SpR assessmentinent in ENT

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363506x124116 ◽

2006 ◽

Vol 88 (9) ◽

pp. 310-312 ◽

Cited By ~ 1

Author(s):

A Drake-Lee ◽

D Skinner ◽

A Reid

Keyword(s):

First Year ◽

European Law ◽

Senior Registrar ◽

The Uk ◽

Second Wave

The structure of postgraduate hospital training in the UK has changed in the last 20 years: the Calman report brought training in line with European law and the SpR post was created out of the registrar and senior registrar posts. Implementation of the new training was staggered across specialties. ENT was included in the second wave of implementation in October 1995. At the same time, consultant expansion was envisaged.

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Why Protect Ancient Woodland in the UK? Rethinking the Ecosystem Approach

Transnational Environmental Law ◽

10.1017/s2047102520000333 ◽

2020 ◽

pp. 1-24

Author(s):

Jona Razzaque ◽

Claire Lester

Keyword(s):

High Speed ◽

Biodiversity Loss ◽

Ecosystem Approach ◽

Lessons Learned ◽

Value Systems ◽

Ancient Woodland ◽

Forestry Practices ◽

Regulatory Frameworks ◽

Trade Offs ◽

The Uk

Abstract Sites of ancient woodland in the United Kingdom (UK) are diminishing rapidly and the multifunctional forest management system with its fragmented approach fails effectively to protect such woodland. In the face of reports on the destruction of ancient woodland, the HS2 High-Speed train project in the UK signifies the extent of trade-offs among the key stakeholders. Such large infrastructure projects typically come with high environmental and social costs, including deforestation, habitat fragmentation, biodiversity loss, and social disruption. This article examines the protection of ancient woodland in the UK and assesses the challenges in applying the ecosystem approach, an internationally recognized sustainability strategy, in the context of such protection. A better understanding of the ecosystem approach to manage ancient woodland is critical for promoting sustainable forestry practices in the UK and informs the discussion in this article of the importance of conserving ancient woodland globally. Lessons learned from UK woodland policies and certification schemes include the need to have in place strong regulatory frameworks, introduce clear indicators, and recognize pluralistic value systems alongside economic considerations. The article concludes that the protection of ancient woodland in the UK requires distinct and strong laws that reflect multiple values of this resource, acknowledge the trade-offs among stakeholders, and adopt an inclusive approach to reduce power asymmetries.

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