scholarly journals Centralization of Cleft Lip and Palate Services in the United Kingdom

2018 ◽  
Vol 55 (5) ◽  
pp. 676-681 ◽  
Author(s):  
Nicola Marie Stock ◽  
Hamza Anwar ◽  
Jonathan R. Sandy ◽  
Nichola Rumsey
Keyword(s):  
United Kingdom ◽  
Large Scale ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Patient Centered ◽  
Delivery Of Care ◽  
Emotional Challenges ◽  
The United Kingdom ◽  
Specialist Services ◽  
The Impact

Background: Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult “returners” who have undergone treatment both pre- and postcentralization. Methods: Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. Results: The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients’ capacity to cope with the associated emotional challenges. Conclusions: The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.

scholarly journals Closing the Loop on Centralization of Cleft Care in the United Kingdom

2017 ◽  
Vol 55 (2) ◽  
pp. 248-251 ◽  
Author(s):  
Andrew R. Ness ◽  
Andrew R. Wills ◽  
Andrea Waylen ◽  
Jackie Smallridge ◽  
Amanda J. Hall ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Previous Survey ◽  
Main Outcome Measure ◽  
The United Kingdom ◽  
Closing The Loop ◽  
Clinical Measures ◽  
The Impact

Objective: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. Setting: Audit clinics held in Cleft Centers in the United Kingdom. Patients, Participants: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. Interventions: Centralization of cleft care. Main Outcome Measure(s): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. Results: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. Conclusions: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: Outcome Comparisons, Training, and Conclusions

2001 ◽  
Vol 38 (1) ◽  
pp. 38-43 ◽  
Author(s):  
David Bearn ◽  
Sue Mildinhall ◽  
Terrie Murphy ◽  
John J. Murray ◽  
Debbie Sell ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Health ◽  
Parent Satisfaction ◽  
Advisory Group ◽  
Dental Arch ◽  
The United Kingdom ◽  
Alveolar Bone Grafting

Objective A critical appraisal of cleft care in the United Kingdom. Design Retrospective comparative study. Setting All National Health Service cleft centers in the United Kingdom. Patients/Participants Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. Main Outcome Measures Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. Conclusions This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.

scholarly journals Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study

2019 ◽  
Vol 57 (1) ◽  
pp. 5-13
Author(s):  
Arthur S. Yang ◽  
Bruce M. Richard ◽  
Andrew K. Wills ◽  
Osama Mahmoud ◽  
Jonathan R. Sandy ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Palatal Fistula ◽  
The United Kingdom ◽  
Palate Repair

Objectives: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Design: Cross-sectional study. Setting: All 11 centralized regional cleft centers in the United Kingdom. Participants: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Main Outcome Measure: Nonperialveolar palatal fistula prevalence up to age 5. Results: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. Conclusion: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

scholarly journals The 23–26 September 2012 U.K. Floods: Using PV Surgery to Quantify Sensitivity to Upper-Level Forcing

2017 ◽  
Vol 145 (10) ◽  
pp. 4055-4079 ◽  
Author(s):  
Sam Hardy ◽  
David M. Schultz ◽  
Geraint Vaughan
Keyword(s):  
United Kingdom ◽  
Large Scale ◽  
Extreme Event ◽  
Initial Conditions ◽  
Initial Position ◽  
River Flooding ◽  
The United Kingdom ◽  
Accumulated Rainfall ◽  
Upper Level ◽  
The Impact

Major river flooding affected the United Kingdom in late September 2012 as a slow-moving extratropical cyclone brought over 150 mm of rain to parts of northern England and north Wales. The cyclone deepened over the United Kingdom on 24–26 September as a potential vorticity (PV) anomaly approached from the northwest, elongated into a PV streamer, and wrapped around the cyclone. The strength and position of the PV anomaly is modified in the initial conditions of Weather Research and Forecasting Model simulations, using PV surgery, to examine whether different upper-level forcing, or different phasing between the PV anomaly and cyclone, could have produced an even more extreme event. These simulations reveal that quasigeostrophic (QG) forcing for ascent ahead of the anomaly contributed to the persistence of the rainfall over the United Kingdom. Moreover, weakening the anomaly resulted in lower rainfall accumulations across the United Kingdom, suggesting that the impact of the event might be proportional to the strength of the upper-level QG forcing. However, when the anomaly was strengthened, it rotated cyclonically around a large-scale trough over Iceland rather than moving eastward as in the verifying analysis, with strongly reduced accumulated rainfall across the United Kingdom. A similar evolution developed when the anomaly was moved farther away from the cyclone. Conversely, moving the anomaly nearer to the cyclone produced a similar solution to the verifying analysis, with slightly increased rainfall totals. These counterintuitive results suggest that the verifying analysis represented almost the highest-impact scenario possible for this flooding event when accounting for sensitivity to the initial position and strength of the PV anomaly.

Communicating Public Health Advice After a Chemical Spill: Results From National Surveys in the United Kingdom and Poland

2013 ◽  
Vol 7 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Julia M. Pearce ◽  
G. James Rubin ◽  
Richard Amlôt ◽  
Simon Wessely ◽  
M. Brooke Rogers
Keyword(s):  
Public Health ◽  
United Kingdom ◽  
Large Scale ◽  
Hazardous Substance ◽  
Crisis Communications ◽  
Public Health Preparedness ◽  
The United Kingdom ◽  
The Cost ◽  
And Coping ◽  
The Impact

AbstractObjectiveThe aim of this study was to enhance public health preparedness for incidents that involve the large-scale release of a hazardous substance by examining factors likely to influence public responses to official guidance on how to limit their exposure.MethodsAn online demographically representative survey was conducted in the United Kingdom (n = 601) and Poland (n = 602) to test the strength of association of trust in authorities, anxiety, threat, and coping appraisals with the intention to comply with advice to shelter in place following a hypothetical chemical spill. The impact of ease of compliance and style of message presentation were also examined.ResultsParticipants were more likely to comply if at home when the incident happened, but message presentation had little impact. Coping appraisals and trust were key predictors of compliance, but threat appraisals were associated with noncompliance. Anxiety was seen to promote behavioral change. UK participants were more likely to comply than Polish participants.ConclusionsSuccessful crisis communications during an emergency should aim to influence perceptions regarding the efficacy of recommended behaviors, the difficulties people may have in following advice, and perceptions about the cost of following recommended behaviors. Generic principles of crisis communication may need adaptation for national contexts. (Disaster Med Public Health Preparedness. 2013;7:65-74)

scholarly journals The Cleft Multidisciplinary Collaborative: Establishing a Network to Support Cleft Lip and Palate Research in the United Kingdom

2018 ◽  
Vol 56 (4) ◽  
pp. 502-507 ◽  
Author(s):  
David C. G. Sainsbury ◽  
Amy Davies ◽  
Yvonne Wren ◽  
Lucy Southby ◽  
Ambika Chadha ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
The United Kingdom

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 3: Speech Outcomes

2001 ◽  
Vol 38 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Debbie Sell ◽  
Pamela Grunwell ◽  
Sue Mildinhall ◽  
Terrie Murphy ◽  
Tremaine A. O. Cornish ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Age Groups ◽  
Advisory Group ◽  
Cross Sectional ◽  
The United Kingdom ◽  
Severe Degree ◽  
Therapy Intervention

Objective To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. Design Prospective descriptive study on a cross-sectional sample of children. Patients/Participants Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP. Main Outcomes Ratings of intelligibility, nasality, “speech cleft type characteristics” and speech therapy intervention. Conclusions Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.

Maxillary Growth in Cleft Lip and Palate Patients, With and Without Vomerine Flap Closure of the Hard Palate at the Time of Lip Repair

2018 ◽  
Vol 55 (9) ◽  
pp. 1205-1210 ◽  
Author(s):  
Norman Hay ◽  
Brijesh Patel ◽  
Priya Haria ◽  
Brian Sommerlad
Keyword(s):  
United Kingdom ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
The United Kingdom ◽  
Study Support ◽  
Maxillary Growth ◽  
Flap Closure ◽  
Anterior Posterior

Objective: To assess the midterm effect on maxillary growth of vomerine flap (VF) closure of the hard palate, at the time of lip repair. Design: A retrospective analysis of prospectively collected nonrandomized data. Interventions: Consecutive participants with a unilateral cleft lip and palate (UCLP) were operated on, at 3 months of age, by the same surgeon. They were divided into 2 groups, those who had a VF and those who did not (non-VF). Setting: Participants were treated at 2 hospitals in the United Kingdom. Participants: Twenty-eight participants in the VF group and 24 participants in the non-VF group attended follow-up at 10 years of age. Main Outcome Measures: Standardized lateral cephalometric radiographs were taken at 10 years. Following tracing and digitization, parameters to assess the maxillary growth were analyzed. Results: No statistically significant differences were found in the anterior–posterior or vertical skeletal cephalometric parameters. Conclusions: The results of this study support the statement that VF repair does not significantly affect maxillary growth in patients with a UCLP, when assessed cephalometrically at 10 years of age. It should be noted that at this age, growth is not yet complete.

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