scholarly journals Bronchiolitis: treatment and management in an urgent out of hours care setting

2020 ◽  
Vol 31 (6) ◽  
pp. 246-253
Author(s):  
Justine Dexter ◽  
Gerri Mortimore
Keyword(s):  
Early Stage ◽  
Initial Assessment ◽  
Small Children ◽  
Out Of Hours ◽  
Ensure Patient Safety ◽  
Out Of Hours Care ◽  
The Common ◽  
Management Approaches ◽  
The Uk ◽  
Supportive Management

Justine Dexter and Gerri Mortimore explore ways to manage the common lung infection bronchiolitis in small children Bronchiolitis is an acute inflammation of the bronchioles that predominately affects children but is most common in the first 12 months of life. Viral bronchiolitis is the principal cause of admission in England and Wales, with numbers exceeding 30 000 annually. Occurrence is seasonal, in winter months incidence is typically at epidemic proportions for approximately six weeks. Bronchiolitis presents initially with coryza and a persistent cough; as the infection progresses, tachypnoea, chest recession, or both, may be present alongside wheeze or crackles. The assessment of an unwell child is challenging and as an advanced nurse practitioner, working in an out of hours service, the importance to prevent further deterioration should focus on spotting the sick child at an early stage. Therefore, an initial assessment should be undertaken, prior to taking a history and examination, to ensure patient safety. Bronchiolitis is usually a self-limiting illness, that requires supportive management only with treatment directed at fluid input. However, management approaches to bronchiolitis continue to be a subject of substantial debate with vast differences in practice exhibited in the UK, and beyond. with a lack of consensus regarding management. Therefore, the appropriate management of children presenting with bronchiolitis is challenging and can be overwhelming. Nurses must be aware of the pathophysiology, presentation, diagnosis, and management of children presenting to an out of hours service with bronchiolitis, to manage patients safely.

scholarly journals Correspondence. Out-of-hours care in the UK - generalizability of research findings

1999 ◽  
Vol 21 (4) ◽  
pp. 482-483
Author(s):  
C. O'Donnell ◽  
A McConnachie ◽  
K. Moffat ◽  
N Drummond ◽  
P Wilson ◽  
...  
Keyword(s):  
Out Of Hours ◽  
Out Of Hours Care ◽  
Research Findings ◽  
The Uk

Access: Office hours, shifts, or 24/7 availability?

2017 ◽  
Author(s):  
Tom Burns ◽  
Mike Firn
Keyword(s):  
Patient Safety ◽  
Crisis Intervention ◽  
Information Exchange ◽  
Community Outreach ◽  
Home Treatment ◽  
Crisis Resolution ◽  
Out Of Hours ◽  
Ensure Patient Safety ◽  
Timely Access ◽  
The Uk

Crisis intervention is an important component of community outreach, so the arrangements for flexible and timely access have always been important. The original ACT model stressed 24/7 availability, but this has proven difficult to sustain. This chapter critically examines the need for such availability, and describes a series of less resource-intense alternatives. These include shift working, flexible evening and weekend working, and shared access arrangements. With the development of crisis resolution/home treatment (CRHT) teams in the UK, outreach out of hours has increasingly been restricted to them. We examine the differences between reality and rhetoric in the benefits of extended working and note the costs, both in terms of manpower, but also of information exchange, in some of these over-elaborate systems. We a also examine effective contingency arrangements to ensure patient safety out of hours.

scholarly journals The Impact of the European Working Time Regulations and Modernising Medical Careers on Out-of-hours ENT Cover

2013 ◽  
Vol 95 (4) ◽  
pp. 1-5 ◽  
Author(s):  
ME Smith ◽  
R Lakhani ◽  
N Bhat
Keyword(s):  
Working Time ◽  
Junior Doctors ◽  
Surgical Specialty ◽  
Out Of Hours ◽  
Medical Careers ◽  
European Working ◽  
Out Of Hours Care ◽  
The Uk ◽  
The Impact ◽  
Insight Into

The implementation of the European Working Time Regulations (EWTR), coupled with the ongoing impact of Modernising Medical Careers (MMC), has necessitated a significant redevelopment of out-of-hours cover for surgical specialties in the UK. A review of the literature related to the provision of out-of-hours ENT cover gives an insight into the impact of these changes on a comparatively small surgical specialty. A 2008 survey revealed that three-quarters of junior doctors providing ENT out-of-hours care were crosscovering specialties other than ENT – a figure up from just over half of junior doctors in 2005, prior to stricter EWTR rules. Of all 'first-on-call' doctors for ENT, only 19–32% have prior ENT experience. Consequently, ENT services are provided frequently by inexperienced, non-enT doctors covering multiple other specialties, often as part of a 'hospital-at-night' team.

Punk as Folk: Continuities and Tensions in the UK and Beyond

2020 ◽  
Author(s):  
Pete Dale
Keyword(s):  
Folk Music ◽  
Music Making ◽  
Collective Creativity ◽  
Living Tradition ◽  
Wide Range ◽  
The Us ◽  
The Common ◽  
The Individual ◽  
The Uk

Numerous claims have been made by a wide range of commentators that punk is somehow “a folk music” of some kind. Doubtless there are several continuities. Indeed, both tend to encourage amateur music-making, both often have affiliations with the Left, and both emerge at least partly from a collective/anti-competitive approach to music-making. However, there are also significant tensions between punk and folk as ideas/ideals and as applied in practice. Most obviously, punk makes claims to a “year zero” creativity (despite inevitably offering re-presentation of at least some existing elements in every instance), whereas folk music is supposed to carry forward a tradition (which, thankfully, is more recognized in recent decades as a subject-to-change “living tradition” than was the case in folk’s more purist periods). Politically, meanwhile, postwar folk has tended more toward a socialist and/or Marxist orientation, both in the US and UK, whereas punk has at least rhetorically claimed to be in favor of “anarchy” (in the UK, in particular). Collective creativity and competitive tendencies also differ between the two (perceived) genre areas. Although the folk scene’s “floor singer” tradition offers a dispersal of expressive opportunity comparable in some ways to the “anyone can do it” idea that gets associated with punk, the creative expectation of the individual within the group differs between the two. Punk has some similarities to folk, then, but there are tensions, too, and these are well worth examining if one is serious about testing out the common claim, in both folk and punk, that “anyone can do it.”

scholarly journals AGILE: a seamless phase I/IIa platform for the rapid evaluation of candidates for COVID-19 treatment: an update to the structured summary of a study protocol for a randomised platform trial letter

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gareth O. Griffiths ◽  
Richard FitzGerald ◽  
Thomas Jaki ◽  
Andrea Corkhill ◽  
Helen Reynolds ◽  
...  
Keyword(s):  
Phase I ◽  
Early Stage ◽  
Late Phase ◽  
Optimum Dose ◽  
Open Label ◽  
Link Type ◽  
Hospitalised Patients ◽  
Volunteer Study ◽  
The Uk ◽  
Phase Trial

Abstract Background There is an urgent unmet clinical need for the identification of novel therapeutics for the treatment of COVID-19. A number of COVID-19 late phase trial platforms have been developed to investigate (often repurposed) drugs both in the UK and globally (e.g. RECOVERY led by the University of Oxford and SOLIDARITY led by WHO). There is a pressing need to investigate novel candidates within early phase trial platforms, from which promising candidates can feed into established later phase platforms. AGILE grew from a UK-wide collaboration to undertake early stage clinical evaluation of candidates for SARS-CoV-2 infection to accelerate national and global healthcare interventions. Methods/design AGILE is a seamless phase I/IIa platform study to establish the optimum dose, determine the activity and safety of each candidate and recommend whether it should be evaluated further. Each candidate is evaluated in its own trial, either as an open label single arm healthy volunteer study or in patients, randomising between candidate and control usually in a 2:1 allocation in favour of the candidate. Each dose is assessed sequentially for safety usually in cohorts of 6 patients. Once a phase II dose has been identified, efficacy is assessed by seamlessly expanding into a larger cohort. AGILE is completely flexible in that the core design in the master protocol can be adapted for each candidate based on prior knowledge of the candidate (i.e. population, primary endpoint and sample size can be amended). This information is detailed in each candidate specific trial protocol of the master protocol. Discussion Few approved treatments for COVID-19 are available such as dexamethasone, remdesivir and tocilizumab in hospitalised patients. The AGILE platform aims to rapidly identify new efficacious and safe treatments to help end the current global COVID-19 pandemic. We currently have three candidate specific trials within this platform study that are open to recruitment. Trial registration EudraCT Number: 2020-001860-27 14 March 2020 ClinicalTrials.gov Identifier: NCT04746183 19 February 2021 ISRCTN reference: 27106947

Contracts and the Implied Freedom of Political Communication

2020 ◽  
pp. 0067205X2097975
Author(s):  
Patrick McCabe
Keyword(s):  
Political Communication ◽  
Common Law ◽  
Employment Contracts ◽  
Out Of Hours ◽  
The Common

This article considers the phenomenon of contractually-imposed restraints on political communication. Such restraints often incidentally arise from broad limits on out-of-hours conduct imposed by employment contracts or from confidentiality or non-disparagement clauses in deeds of settlement. It is argued that the implied freedom of political communication has work to do in relation to at least some categories of such restraints. The various objections to that view are examined and it is argued those objections are not compelling. The article analyses the question of how the implied freedom would operate in respect of contracts that impermissibly burden freedom of political communication, and suggests that this may be achieved by developing the common law of contract to accomodate a doctrine similar to the doctrine governing unreasonable restraints of trade.

Eye emergencies in the deployed setting

2019 ◽  
Vol 105 (2) ◽  
pp. 125-132
Author(s):  
GMC Hunter ◽  
R Ward ◽  
DC Wright
Keyword(s):  
Healthcare Professional ◽  
Initial Assessment ◽  
The Common

AbstractEye emergencies are common on deployed operations. This article aims to describe the common eye presentations and to guide the initial assessment and management of ophthalmic emergencies for a healthcare professional remote from immediate specialist input. Emphasis is placed upon how urgently ophthalmic advice should be sought for certain eye conditions.

scholarly journals The Rising Frequency of IT Blackouts Indicates the Increasing Relevance of IT Emergency Concepts to Ensure Patient Safety

2016 ◽  
Vol 25 (01) ◽  
pp. 130-137 ◽  
Author(s):  
U. Sax ◽  
M. Lipprandt ◽  
R. Röhrig
Keyword(s):  
Risk Management ◽  
Worst Case ◽  
Counter Measures ◽  
It Systems ◽  
Healthcare It ◽  
Ensure Patient Safety ◽  
Total Data ◽  
It Support ◽  
Management Approaches ◽  
Clinical Systems

Summary Introduction: As many medical workflows depend vastly on IT support, great demands are placed on the availability and accuracy of the applications involved. The cases of IT failure through ransomware at the beginning of 2016 are impressive examples of the dependence of clinical processes on IT. Although IT risk management attempts to reduce the risk of IT blackouts, the probability of partial/total data loss, or even worse, data falsification, is not zero. The objective of this paper is to present the state of the art with respect to strategies, processes, and governance to deal with the failure of IT systems. Methods: This article is conducted as a narrative review. Results: Worst case scenarios are needed, dealing with methods as to how to survive the downtime of clinical systems, for example through alternative workflows. These workflows have to be trained regularly. We categorize the most important types of IT system failure, assess the usefulness of classic counter measures, and state that most risk management approaches fall short on exactly this matter. Conclusion: To ensure that continuous, evidence-based improvements to the recommendations for IT emergency concepts are made, it is essential that IT blackouts and IT disasters are reported, analyzed, and critically discussed. This requires changing from a culture of shame and blame to one of error and safety in healthcare IT. This change is finding its way into other disciplines in medicine. In addition, systematically planned and analyzed simulations of IT disaster may assist in IT emergency concept development.

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