The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV

Download Full-text

Evaluation of outcomes following centralization of cystectomy services in the United Kingdom.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.286 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 286-286

Author(s):

Prashant Patel ◽

Felicity Evison ◽

Henry Goodfellow ◽

Richard Bryan ◽

Nicholas David James

Keyword(s):

Bladder Cancer ◽

High Volume ◽

Mortality Rates ◽

Outcome Data ◽

The United Kingdom ◽

Urological Cancers ◽

Co Morbidity ◽

Comorbidity Scores ◽

Comorbidity Index ◽

The Uk

286 Background: NICE-Improving Outcomes in Urological cancers (2002) recommended that providers in UK carry out a cumulative total of at least 50 radical cystectomies or prostatectomies per year. Surgeons should perform ≥5 cystectomies per year and 30-day mortality rates of 3.5% or less must be achieved. We evaluated this effect of centralisation on cystectomy outcomes over the past decade. Methods: The Health Episode Statistic (HES) database for cystectomies in England over a period of 2001 to 2012 for patients with bladder cancer was interrogated. Banded provider volumes (<10, ≥10 to < 16, ≥16) and surgeon volumes (<5, ≥5 to <8, ≥8) with respect to age, sex, Charlsons’ comorbidity index, deprivation index are presented with outcomes related to 30, 60, 90 day mortality; length of stay (LOS); re-admission; complications; operation specific re-intervention; and overall survival related outcome data is analysed. Results: 14,693 cystectomies for bladder cancer were performed over the study period. 85.5% providers (35% of all cystectomies) and 70.9% Surgeons (40% of all cystectomies) were performing less than the recommend standard prior to the NICE 2002 recommendations. A decade later 50% providers (3.5% of all cystectomies) and 42% surgeons continue to perform less than the recommended standard but only 12.5% of all cystectomes were carried in non-compliant centres/surgeons. The 30-day mortality rate fell from 3.7% to 2.4%. There was no difference in age, sex or deprivation scores amongst the bands for providers/surgeons. However, high volume providers and surgeons operated on patients with higher comorbidity scores but achieved shorter LOS. No difference in complications was seen amongst the bands, but re-intervention rates were higher amongst low volume surgeons. Mortality (early and overall) was lower in high volume provider and surgeons when compared to low bands. Conclusions: The UK data suggests 87.5% cystectomies are carried out in a compliant centre indicative of centralisation. The 30-day mortality rates have fallen. Overall mortality is lower in high volume providers and surgeons despite these groups with higher co-morbidity scores reflective of improved service provision through centralisation.

Download Full-text

Mela in the UK: A ‘travelled and habituated’ festival

Focus On Festivals ◽

10.23912/978-1-910158-15-9-2639 ◽

2015 ◽

Author(s):

Rakesh Kaushal ◽

Chris Newbold

Keyword(s):

United Kingdom ◽

South Asian ◽

Rural Culture ◽

Event Management ◽

Local Authorities ◽

The Core ◽

The United Kingdom ◽

Religious Festivals ◽

Definition Of ◽

The Uk

Mela in the United Kingdom has become, in its short thirty year history, one of the most popular forms of festival entertainment. The word ‘mela’ itself, is based on the Sanskrit, meaning a community gathering or meeting, and in its many forms mela in the UK has remained true to this broad sense of people, families and communities congregating together in an atmosphere of festivity. At its roots, mela in the UK has evolved out of South Asian religious rites and rituals, and can also be seen to be built on South Asian folk and rural culture and traditions. However, at the core of the definition of mela is the notion of a gathering. This is most appropriate here in that it does not necessarily refer to any mono-cultural or religious focus, and is important when we observe how mela has ‘travelled’ and become ‘habituated’ in the UK. Carnegie and Smith (2006) identify Edinburgh Mela as having travelled but in this chapter, whilst recognising the travelled nature of mela that they refer to, we indicate that it is the habituated nature of mela that more clearly identifies its nature and existence in the UK. Therefore, this chapter will document that, after 25 to 30 years, mela in the UK can be seen to be adopting its own traditions and connotations. Moreover, by the very nature of the modern diverse British population, mela is now largely urbanised and many continue to reflect South Asian religious festivals, be they Boishakhi Melas (Brick Lane London), Holi Hai Melas (Oxford) or Eid Melas (Birmingham), but others have lost touch with these roots as the demands of festival and cultural event management and venue availability have led to other requirements taking priority. The focus of the research presented here is concerned with the manifestation of mela in the UK and, in particular, how it has adapted to the various town and city locations in which it is now a fundamental part of the cultural events calendar. The importance of mela in terms of economic impact and tourism may be one reason why mela is popular with local authorities.

Download Full-text

Breeding objectives for red deer

Animal Science ◽

10.1017/s0003356100006735 ◽

1993 ◽

Vol 57 (1) ◽

pp. 161-167

Author(s):

C. McManus ◽

R. Thompson

Keyword(s):

Gene Flow ◽

Red Deer ◽

Economic Value ◽

Live Weight ◽

The United Kingdom ◽

Breeding Objective ◽

Breeding Objectives ◽

Antler Size ◽

Definition Of ◽

The Uk

AbstractThe definition of breeding objectives for farmed red deer in the United Kingdom (UK) was investigated. Options studied include the effects of discounting gene flow and the effect of altering variable costs/income (such as price of food or price received for sale animals). Three different herd structures were investigated. As the discount rate increased the importance of traits measured on the offspring also increased. Traits included in the economic breeding objective included number of calves weaned, carcass weights of stag calves and surplus hinds, hind calf live weight and food consumption for hinds and calves. The breeding objective derived does not include a measure of antler size, as antlers have little/no economic value in the UK market. Suggestions are made for further research.

Download Full-text

Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom

Cerebrovascular Diseases ◽

10.1159/000512603 ◽

2020 ◽

pp. 1-7

Author(s):

Joseph Kwan ◽

Madison Brown ◽

Paul Bentley ◽

Zoe Brown ◽

Lucio D’Anna ◽

...

Keyword(s):

Negative Impact ◽

Service Evaluation ◽

Outcome Data ◽

Term Outcome ◽

Neurological Outcomes ◽

Neurological Improvement ◽

Patient Demographics ◽

The United Kingdom ◽

The Uk ◽

The Impact

Introduction: We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. Methods: This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February (“pre-COVID,” n = 33) versus March and April (“during COVID,” n = 28). Results: Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes; (b) successful recanalization rate was maintained at 81%; (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different; (d) use of general anesthesia fell significantly from 85 to 32% as intended; and (e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals significantly improved for door-to-groin puncture (48 [interquartile range (IQR) 39–57] vs. 33 [IQR 27–44] minutes, p = 0.013) and door-to-recanalization (82.5 [IQR 61–110] vs. 60 [IQR 55–70] minutes, p = 0.018). Conclusion: The COVID-19 pandemic has had a negative impact on the stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or early neurological outcome. Internal delays actually improved during the COVID-19 pandemic. Further studies should examine the effects of the COVID-19 pandemic on longer term outcome.

Download Full-text

P-OGC04 Evaluation of post-operative surveillance strategies for oesophago-gastric cancers in the United Kingdom

British Journal of Surgery ◽

10.1093/bjs/znab430.132 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Swathikan Chidambaram ◽

Viknesh Sounderajah ◽

Nick Maynard ◽

Tim Underwood ◽

Sheraz Markar

Keyword(s):

United Kingdom ◽

Surgical Care ◽

High Volume ◽

High Recurrence Rate ◽

Allied Health Professionals ◽

Gastric Cancers ◽

The United Kingdom ◽

Major Factors ◽

Randomised Controlled ◽

The Uk

Abstract Background Oesophago-gastric malignancies are associated with a high recurrence rate, yet there is a lack of evidence to inform guidelines for the standardisation and structure of post-operative surveillance after curatively intended treatment. This study aimed to capture the variation in post-operative surveillance strategies across the United Kingdom and Ireland, and enquire the opinions and beliefs around surveillance from practicing clinicians. Methods A web based survey consisting of forty questions was sent to surgeons or allied health professionals performing or involved in surgical care for oesophago-gastric cancers at high volume centers in the United Kingdom (UK). Respondents from each centre completed the survey on what best represented their centre. The first section of the survey evaluated the timing and components of follow-ups, and their variation between centres. The second section evaluated respondents perspective on how surveillance can be structured. Results Thirty five surgeons from 25 centers consisting 28 consultants, 6 senior trainees and 1 specialist nurse had completed the questionnaire. 45.7% of responders arranged clinical follow-up at 2-4 weeks. Twenty responders had a specific post-operative surveillance protocol for their patients. Of these, 31.4% had a standardised protocol for all patients, while 25.7% tailored it to patient needs. Patient preference, comorbidities and chance of recurrence were considered as major factors for necessitating more intense surveillance than currently practised. Conclusions There is a significant variation in how patients are monitored after surgery between centers in the UK. Randomised controlled trials are necessary to link surveillance strategies to both survival outcomes and quality of life of patients and to evaluate the prognostic value of different post-operative surveillance strategies.

Download Full-text

Global deoffshorization and its impact on the national and regional economies of eastern european countries

Problems and Perspectives in Management ◽

10.21511/ppm.17(3).2019.24 ◽

2019 ◽

Vol 17 (3) ◽

pp. 293-305 ◽

Cited By ~ 1

Author(s):

Svitlana Khalatur ◽

Gediminas Radzevicius ◽

Liudmyla Velychko ◽

Valeriia Fesenko ◽

Lesia Kriuchko

Keyword(s):

Regional Economy ◽

Financial Control ◽

Eastern European ◽

Regional Economies ◽

The United Kingdom ◽

Macroeconomic Indicators ◽

Eastern European Countries ◽

Definition Of ◽

The Uk ◽

Theoretical Foundations

In recent years, deoffshorization is a trend and dozens of countries have already started an open fight against offshore accounts. Ukraine is moving to complete deoffshorization in accordance with the new rules for exchanging information on financial accounts and BEPS rules. The purpose of the study was to search for optimal solutions for further improvements in the field of deoffshorization of the national and regional economy of the Eastern European contries, in particular Ukraine. The following methods were used to solve the problems in the work: induction and deduction (in the study of offshore types, the definition of interconnection and interdependence between them), abstract-logical (in generalizing the theoretical foundations of economic deoffshorization ), econometric-statistical (in assessing the state and dynamics of export-import operations of Ukraine with offshore jurisdictions), statistical analysis.On the basis of theoretical and empirical conclusions, the main consequences, which are the result of the study of global deoffshorization in conditions of financial control and its influence on the national and regional economy of Ukraine, are presented. The article provides a correlation analysis of the dependence of the export index to the UK from Ukraine with export, import and balance of offshore countries. A study was conducted on the presence or absence of a relationship between the volume of balance, exports and imports from Ukraine to the United Kingdom with the macroeconomic indicators of the national economy of Ukraine.

Download Full-text

United Kingdom newsprint media reporting on sexual health and blood-borne viruses in 2010

Sexual Health ◽

10.1071/sh13093 ◽

2013 ◽

Vol 10 (6) ◽

pp. 546 ◽

Cited By ~ 3

Author(s):

Susan Martin ◽

Shona Hilton ◽

Lisa M. McDaid

Keyword(s):

United Kingdom ◽

Sexual Health ◽

Media Coverage ◽

Large Scale ◽

Risk Groups ◽

Media Representations ◽

Media Messages ◽

The United Kingdom ◽

The Media ◽

The Uk

Background Improving sexual health and blood-borne virus (BBV) outcomes continue to be of high priority within the United Kingdom (UK) and it is evident that the media can and do impact the public health agenda. This paper presents the first large-scale exploration of UK national newsprint media representations of sexual health and BBVs. Methods: Using keyword searches in electronic databases, 677 articles published during 2010 were identified from 12 national (UK-wide and Scottish) newspapers. Content analysis was used to identify manifest content and to examine the tone of articles. Results: Although there was a mixed picture overall in terms of tone, negatively toned articles, which focussed on failures or blame, were common, particularly within HIV/AIDS, hepatitis B and C, and other sexually transmissible infection coverage (41% were assessed as containing negative content; 46% had negative headlines). Differences were found by newspaper genre, with ‘serious’ newspaper articles appearing more positive and informative than ‘midmarket’ newspapers or ‘tabloids’. Across the sample, particular individuals, behaviours and risk groups were focussed on, not always accurately, and there was little mention of deprivation and inequalities (9%). A gender imbalance was evident, particularly within reproductive health articles (71% focussed on women; 23% on men), raising questions concerning gender stereotyping. Conclusions: There is a need to challenge the role that media messages have in the reinforcement of a negative culture around sexual health in the UK and for a strong collective advocacy voice to ensure that future media coverage is positively portrayed.

Download Full-text

14. Federalism

The Changing Constitution ◽

10.1093/he/9780198806363.003.0014 ◽

2019 ◽

pp. 391-420

Author(s):

John McEldowney

Keyword(s):

United Kingdom ◽

Northern Ireland ◽

Federal State ◽

Home Rule ◽

The United Kingdom ◽

Unitary State ◽

Uk Supreme Court ◽

Definition Of ◽

The Uk ◽

The Eu

Federalism, to date, has proved unattractive to the United Kingdom. The United Kingdom is commonly described as a unitary state, whereby governmental power is primarily exercised through a sovereign Parliament at Westminster. The UK may be distinguished from Federal countries, notably the United States or Germany. In federal systems, sovereign power is shared between the federal government and the states. However, the description of the United Kingdom as a unitary state is an oversimplification as there are many instances of devolved, shared and autonomous powers that do not easily fit under a centralized view of the state. These ‘quasi-federal’ elements of the constitution arise through the UK Parliament delegating to regional and local communities a variety of powers and responsibilities through elected local and municipal authorities as well as devolved ‘deals’. Since 1989, powers have been distributed to the four nations of the United Kingdom: England, Scotland, Wales and Northern Ireland through extensive, and increasing, devolved powers (devolution) including a variety of tax-raising powers. There is also a London Assembly with devolved powers. The future of the UK after Brexit is uncertain and there are deep divisions of opinion. England and Wales voted for Brexit while London, Northern Ireland and Scotland voted to remain within the EU. Different constitutional configurations were suggested for the four nations, during the nineteenth century, including federalism, Irish home rule and independence as well as strengthening local government. No exact definition of federalism emerged from the different variations supported at one time or another during this period. Consequently supporters of federalism have struggled to have a single configuration to make their case. Overall federalism was rejected as inconsistent with the orthodoxy of a unitary state formed from an incorporating union centred around a sovereign Parliament. Has the extent of substantial devolved and delegated powers reached a tipping point that places a form of divisible federalism as a way of addressing current concerns and controversies including Brexit? Any formal adoption of federalism would alter the role of the UK Supreme Court as well as future relations with the EU after Brexit. Federalism might provide a mechanism for a changing unitary state to address 21st-century challenges amidst a perceptible shift to a ‘quasi-federal’ state with devolved governments and many shared or delegated powers.

Download Full-text

Halal certification organizations in the United Kingdom

Journal of Islamic Marketing ◽

10.1108/jima-06-2015-0045 ◽

2017 ◽

Vol 8 (1) ◽

pp. 107-126 ◽

Cited By ~ 14

Author(s):

Carrie Amani Annabi ◽

Olufunbi Olajumoke Ibidapo-Obe

Keyword(s):

Quality Assurance ◽

Literature Review ◽

English Language ◽

Content Type ◽

The United Kingdom ◽

Certification Organizations ◽

Definition Of ◽

The Uk ◽

Practical Implications

Purpose The aim of this paper is to investigate the role that halal certification organisations (HCOs) play in the UK in assuring quality in halal cosmetics. Design/methodology/approach The study evaluates whether halal certification assures the quality of halal cosmetic products. This research evaluated the quality assurance systems of major UK HCOs, using a hypothetical product as a test vehicle. The investigation considered whether these organisations differ in their definition of “halal” and “halal cosmetics” and also considered how effectively their certification signals quality assurance. Findings The study indicated that there is a failure to adopt holistic halal terminology which implies that within the UK halal cosmetics industry, manufacturers may not be working within agreed standards for halal product integrity. Research limitations/implications This study focussed on UK certification for halal cosmetics by three HCOs and disregarded other forms of halal businesses. The literature review is based solely on literature available in the English language. The study lacks generalisability, as only one hypothetical product was tested; therefore, it was not possible to reach an understanding of all the costs involved in UK HCO certification. Practical implications This study undertook a comprehensive literature review on halal certification to produce a comparison of halal sanctioning laws, certification processes and the level of supply chain verification by UK HCOs. Originality/value This study adds value to the knowledge on UK halal certification.

Download Full-text

Brain death

10.1093/med/9780199568741.003.0154 ◽

2018 ◽

Author(s):

Matt Wise ◽

Paul Frost

Keyword(s):

Brain Death ◽

Brain Activity ◽

Irreversible Loss ◽

Cardiorespiratory Function ◽

The United Kingdom ◽

Brainstem Death ◽

Brainstem Function ◽

Definition Of ◽

The Uk ◽

The Brain

Mechanical ventilation has made it possible for the heart to continue to beat and perfuse other organs even when the brain is dead. This means that death can be diagnosed in two distinct ways: first, in the traditional manner, as permanent cessation of cardiorespiratory function; and, second, while the patient is ventilated, as brain death (BD). In 1976 the Conference of Medical Royal Colleges and their Faculties in the United Kingdom, in a statement on the diagnosis of BD, recognized the brainstem as the centre of brain activity, without which life was not possible. Brainstem death (BSD) occurs when there is complete, irreversible loss of brainstem function, that is, irreversible loss of the capacity for consciousness, coupled with irreversible loss of the capacity to breathe. In the UK, the terms BD and BSD are used interchangeably and are legally synonymous with somatic death. This chapter covers examination for BSD, complications, diagnosis, investigation, and actions arising after BSD, as well as a definition of BD.

Download Full-text