A UK national audit of the laboratory investigation of phaeochromocytoma and paraganglioma

2021 ◽  
pp. 000456322110467
Author(s):  
Christopher Boot ◽  
Barry Toole ◽  
Sharman Harris ◽  
Lisa Tetlow ◽  
Wassif S Wassif
Keyword(s):  
United Kingdom ◽  
Laboratory Investigation ◽  
Clinical Biochemistry ◽  
Good Practice ◽  
Reference Ranges ◽  
First Line ◽  
Endocrine Society ◽  
The United Kingdom ◽  
Plasma Metanephrines ◽  
Urine Metanephrines

Background Phaeochromocytomas and paragangliomas (PPGL) are catecholamine secreting tumours associated with significant morbidity and mortality. Timely diagnosis and management are essential. A range of laboratory tests can be utilised in the investigation of PPGL. There is scope for significant variation in practice between centres. We aimed to investigate how the laboratory investigation of PPGL is performed in laboratories across the United Kingdom. Methods A questionnaire consisting of 21 questions was circulated to Clinical Biochemistry laboratories in the United Kingdom via the Association for Clinical Biochemistry and Laboratory Medicine office. The survey was designed to allow audit against Endocrine Society Guidelines on the Investigation and Management of PPGL and to obtain information on other important aspects not included in these guidelines. Results Responses were received from 58 laboratories and the data were compiled. The majority of laboratories use either urine or plasma metanephrines in first-line testing for PPGL, although a number of different combinations of biochemistry tests are utilised in different centres. All laboratories measuring metanephrines or catecholamines in-house use LC or LC-MS/MS methods. There are some marked differences between laboratories in urine metanephrines reference ranges used and sample requirements. Conclusions There is evidence of good practice in UK laboratories (as assessed against Endocrine Society Guidelines) such as widespread use of urine/plasma metanephrines and appropriate analytical methodologies used. However, there is also evidence of variations in practice in some areas that should be addressed.

scholarly journals Young Parents’ Experiences of Pregnancy and Parenting During the COVID-19 Pandemic: A Qualitative Study in the United Kingdom

2021 ◽  
Author(s):  
Bettina Moltrecht ◽  
Louise J. Dalton ◽  
Jeffrey R. Hanna ◽  
Clare Law ◽  
Elizabeth Rapa
Keyword(s):  
Mental Health ◽  
United Kingdom ◽  
Perinatal Care ◽  
Good Practice ◽  
Poor Mental Health ◽  
Mental Wellbeing ◽  
Young Parents ◽  
The United Kingdom ◽  
Increased Risk ◽  
Parents Experiences

Abstract Young parents (aged 16-24 years) in the perinatal period are at an increased risk of poor mental health especially during the COVID-19 pandemic, due to multiple risk factors including social and economic instability. COVID-19 related restrictions had profound implications for the delivery of perinatal care services and other support structures for young parents. Investigating young parents’ experiences during the pandemic, including their perceived challenges and needs, is important to inform good practice and provide appropriate support for young parents. Qualitative interviews were conducted with young parents (n=21) during the COVID-19 pandemic in the United Kingdom from February – May 2021. Data were analysed using thematic analysis. Three key themes were identified to describe parents’ experiences during the COVID-19 pandemic. Parents reported specific COVID-19 related anxieties and stressors, including worries around contracting the virus and increased feelings of distress due to uncertainty created by the implications of the pandemic. Parents described feeling alone both at home and during antenatal appointments and highlighted the absence of social support as a major area of concern. Also, parents felt their perinatal care had been disrupted by the pandemic and experienced difficulties accessing care online or over the phone. This study highlights the potential impact of the COVID-19 pandemic on young parents, including their mental wellbeing and the perinatal support they were able to access. Insights from this study can inform the support and services offered to families going forward. Specifically, the findings emphasise the importance of (a) supporting both parents during perinatal appointments, (b) providing parents with mental health support early on and (c) finding ways to facilitate communication pathways between professionals and parents.

Code of Ethics and Professional Conduct for Occupational Therapists

1997 ◽  
Vol 60 (1) ◽  
pp. 33-37 ◽  
Keyword(s):  
United Kingdom ◽  
Occupational Therapy ◽  
Professional Practice ◽  
Code Of Ethics ◽  
Good Practice ◽  
Occupational Therapists ◽  
Professional Conduct ◽  
The United Kingdom ◽  
Statutory Requirement ◽  
The Status

The Professions Supplementary to Medicine Act 1960 bestows the status of a profession on occupational therapy which automatically carries the statutory requirement to regulate professional practice for the protection of clients. The Code of Ethics and Professional Conduct (hereinafter referred to as ‘the Code’) is produced by the College of Occupational Therapists (hereinafter referred to as ‘the College’) for, and on behalf of, the British Association of Occupational Therapists, the central organisation for occupational therapists throughout the United Kingdom. The College of Occupational Therapists is the subsidiary organisation, with delegated responsibility for the promotion of good practice and the prevention of malpractice.

scholarly journals ‘HOW WELL ARE WE DOING?’ THE UNITED KINGDOM AND ITS IMPLEMENTATION OF THE OECD ANTI-BRIBERY CONVENTION

2017 ◽  
Vol 29 (1) ◽  
pp. 109-130
Author(s):  
John Hatchard
Keyword(s):  
United Kingdom ◽  
International Business ◽  
Final Section ◽  
Good Practice ◽  
Public Officials ◽  
Business Transactions ◽  
The United Kingdom ◽  
Oecd Convention ◽  
The Uk

The Organisation for Economic Cooperation and Development (OECD) Convention on Combating Bribery of Foreign Public Officials in International Business Transactions (the OECD Convention) entered into force on 15 February 1999. As at 31 May 2017, there were 41 State Parties (the Parties) comprising the thirty-five OECD member countries and six non-member countries.The United Kingdom (UK) ratified the Convention in 1998. The OECD Convention is supplemented by the Revised Recommendations of the Council of the OECD on Combating Bribery in International Business Transactions (the 2009 Recommendations),Annex I of which contains “Good Practice Guidance on Implementing Specific Articles of the Convention.”In March 2017, the OECD Working Group on Bribery in International Business Transactions (the WGB) published its Phase 4 Report on the United Kingdom’s implementation of the OECD Convention (Phase 4 Report).Having provided a short background section on the scope of the OECD Convention and the role of the WGB, the following section will review some of the key recommendations contained in the Phase 4 Report. In the final section, an assessment is made as to how well the UK is doing with regard to the implementation of its OECD Convention obligations.   

scholarly journals Adrenal Mass Hemorrhage Clinically Mimicking a Pheochromocytoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A112-A112
Author(s):  
Panadeekarn Panjawatanan ◽  
Muhammad Daniyal ◽  
Juan Jose Delgado Hurtado
Keyword(s):  
Adrenal Mass ◽  
Reference Range ◽  
Case Reports ◽  
Adrenal Adenoma ◽  
Vital Signs ◽  
Healthy Woman ◽  
Reference Ranges ◽  
Mri Findings ◽  
Plasma Metanephrines ◽  
Urine Metanephrines

Abstract Background: A pheochromocytoma is diagnosed clinically using correlation of clinical, imaging, and laboratory studies. We report the case of an adrenal mass hemorrhage that presented with significantly elevated urine metanephrines mimicking a pheochromocytoma. Clinical Case: A 59-year-old healthy woman presented to the ED with chest pain, left flank and upper quadrant pain associated with diaphoresis and palpitations. Vital signs were significant for a pulse of 92 bpm, and a BP of 213/88 mm Hg. Physical exam revealed tenderness to palpation on the left upper quadrant and left costovertebral angle. Laboratory tests were significant for an elevated D-dimer (2,449 ng/mL, reference range 215–499 ng/mL). CT abdomen with IV contrast showed a 3.5 x 2.9 cm round mass abutting the lateral limb of the left adrenal gland with surrounding fat stranding with suspicion of inflammation or hemorrhage. 24-hour urine metanephrines showed elevated metanephrine (7,227 mcg/24hr; reference range <400 mcg/24 hr) and normetanephrine (1,209 mcg/24hr; reference range 900 mcg/24 hr). In the setting of up trending cardiac enzymes and inferior-lateral ST segment depression, a cardiac catheterization was performed which was unrevealing. She was discharged from the hospital and referred to endocrinology. On that visit, ~ 1 month after the patient was admitted to the hospital, plasma metanephrines were ordered which showed mildly elevated plasma metanephrine (0.83 nmol/L; reference range <0.5 nmol/L) and normetanephrine (1.2 nmol/L; reference ranges <0.9 nmol/L). An MRI abdomen with and without contrast revealed a 2.7 x 2.2 x 1.8 cm nodule arising from the lateral limb, with loss of signal on in-phase images suggestive of blood products. Plasma metanephrines and MRI findings ruled out the diagnosis of a pheochromocytoma. Conclusion: To our knowledge, few cases of an adrenal mass hemorrhage clinically mimicking a pheochromocytoma have been reported. Although the inpatient clinical presentation of our patient was consistent with this, the outpatient plasma metanephrines and MRI were not. An adrenal adenoma hemorrhage should be considered as a potential differential diagnosis for elevated metanephrines, which can clinically mimick a pheochromocytoma. References: (1)Sekos K, Short T, Ing SW. Adrenal hemorrhage due to hypercoagulable state mimicking pheochromocytoma. Journal of Clinical and Translational Endocrinology: Case Report. 8. 9–12. 2018.(2)Wordsworth S, Thomas B, Agarwal N, Hoddell K, Davies S. Elevated urinary cathecholamines and adrenal haemorrhage mimicking phaechromocytoma. BMJ Case Reports. 2010.

Guidelines for the Utilisation of Sewage Sludge on Land in the United Kingdom

1984 ◽  
Vol 16 (12) ◽  
pp. 461-471 ◽  
Author(s):  
M G Healey
Keyword(s):  
United Kingdom ◽  
Sewage Sludge ◽  
Crop Yield ◽  
Potential Risk ◽  
Good Practice ◽  
National Context ◽  
Resource Value ◽  
The United Kingdom ◽  
Sludge Disposal ◽  
The Uk

The paper outlines general policy on sludge disposal in the United Kingdom and administrative arrangements for water services. It indicates the legislative controls though good practice is achieved through observance of non-statutory guidelines. Statistics largely emanating from a recent survey are given. The resource value of sewage sludge is placed in national context and an appraisal is made of the potential risk to health, the environment and crop yield, though years of experience have shown little risk so long as good practice is followed. The UK guidelines are designed to encourage the utilisation of sewage sludge making recommendations on suitable uses and the precautions to be observed. General advice is given on good agricultural and sewage sludge disposal practice and on the monitoring of operations. The paper concludes with reference to research being undertaken for the purpose of confirming or refining the guidelines.

Accountability and Review in the Counter-Terrorist State

2019 ◽  
Author(s):  
Jessie Blackbourn ◽  
Fiona de Londras ◽  
Lydia Morgan
Keyword(s):  
United Kingdom ◽  
Empirical Analysis ◽  
Critical Analysis ◽  
Good Practice ◽  
State Building ◽  
Policy Discourse ◽  
Political Actors ◽  
Counter Terrorism ◽  
The United Kingdom ◽  
Law And Policy

The United Kingdom should now be understood as a counter-terrorist state, that is a state in which counter-terrorism law, policy, discourse, and operations are mainstreamed across the domains of law and government in forms that are conceptualised and designed as ‘permanent’ in at least some cases; in which non-state actors are responsibilised for counter-terrorism; and in which all persons are the subjects of counter-terrorism, although not to equal degrees. This book argues that counter-terrorism review—which it defines as the legal, political, and policy processes that consider the application and impacts of counter-terrorism law and policy in theory as well as in practice, with a view to assessing its merits and contributing towards its improvement—has the capacity to enhance accountability in the counter-terrorist state. Building on exclusive interviews with political actors and practitioners, as well as detailed empirical analysis of existing reviews—it presents the first comprehensive, critical analysis of counter-terrorism review in the United Kingdom. While this reveals substantial pockets of good practice, it also shows that the accountability enhancing potential of counter-terrorism review is limited in practice by executive domination, parliamentary limitations, persistent state secrecy, and the absence of trust in the counter-terrorist state.

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