An audit of amputation levels in patients referred for prosthetic rehabilitation

Most lower limb amputations in the United Kingdom (UK) are carried out within general surgical, orthopaedic and plastic surgical units of district hospitals. This study of patients referred for rehabilitation was undertaken to determine the number and specialty interests of surgeons referring amputees, the numbers referred by each and, as one of several possible measures of appropriateness for rehabilitation, the amputation levels in patients referred for the first time to one sub-regional Disablement Services (limb fitting) Centre (DSC) over a 14 month period. Thirty nine surgeons, referred 263 amputees. The majority (61%) of surgeons referred 5 or fewer: a nucleus of 11 vascular surgeons (28%) referred 64% of the patients. The underlying pathology, speciality interest of the surgeon or numbers referred by individual surgeons had no relation to final healed level which was below the knee in 55% of cases compared to national figures for all other DSC's ranging between 39% and 48% below-knee between 1981 and 1988. Since current practice in the UK is to refer all but the frailest patients for consideration of prosthetic rehabilitation, this study suggests that, nationally, more patients could be suited for the functionally superior below-knee level of amputation than are currently benefiting from it.

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To bee or not to beet with neonicotinoids

Environmental Law Review ◽

10.1177/14614529211021194 ◽

2021 ◽

Vol 23 (2) ◽

pp. 103-109

Author(s):

Lynda M. Warren

Keyword(s):

Sugar Beet ◽

Weather Conditions ◽

The European Union ◽

Environmental Standards ◽

Economic Interests ◽

Precautionary Approach ◽

The United Kingdom ◽

Commercial Sugar ◽

The Uk ◽

First Time

In January 2021 the UK government granted an application for authorisation to use thiamethoxam, a neonicotinoid pesticide, to protect commercial sugar beet crops from attack by viruses transmitted by aphids. This was the first time such an authorisation had been granted in the United Kingdom (UK) and there were concerns that it signalled a weakening of environmental standards now that the UK was no longer part of the European Union. In fact, similar authorisations had been granted by several European Member States in the last 2 years, despite the ban on the use of neonicotinoids introduced in 2018. Nevertheless, the reasons for granting the authorisation do suggest that the balance between adopting a precautionary approach to environmental protection and taking emergency action to protect economic interests may have shifted. It was acknowledged that the proposed mitigation to safeguard bees and other wildlife was not entirely satisfactory. In the end, due to unforeseen weather conditions it meant that the pesticide is not necessary, which in itself demonstrates that short-term emergency measures are unsuitable for dealing with the problem. If the sugar beet industry is to continue to prosper in the UK, it will need to be managed in a way that provides resistance to virus infection without the use of controversial chemicals.

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The duties of impartiality, disclosure, and confidentiality: lessons from a London-seated arbitration

Arbitration International ◽

10.1093/arbint/aiab013 ◽

2021 ◽

Author(s):

Samuel Yee Ching Leung ◽

Alex Chun Hei Chan

Keyword(s):

United Kingdom ◽

Important Case ◽

Careful Examination ◽

International Arbitration ◽

The United Kingdom ◽

Key Concepts ◽

The Uk ◽

First Time

Abstract Halliburton Company v Chubb Bermuda Insurance Ltd (formerly known as Ace Bermuda Insurance Ltd [2020] UKSC 48 is an important case not only to the UK but also to the international arbitration community for several reasons: first, it examines indispensable duties in international arbitration and for the first time recognises and explicates upon the duty of disclosure at the highest court of the United Kingdom; secondly, it addresses and clarifies key concepts in international arbitration; thirdly, it confirms the objective nature of the test of justifiable doubts which has wider implications for other arbitral forums; fourthly, it illustrates how the duties of impartiality, disclosure, and confidentiality interact with and affect each other and how the key concepts should be applied to this interaction; and finally, it lays down useful guidance for arbitrators. For these reasons, this case deserves close and careful examination. This article aims to explain the significance of the aforesaid and suggests that, in addition to what has been addressed, further judicial explanations are warranted in what other aspects.

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A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa

Prosthetics and Orthotics International ◽

10.1177/0309364617698520 ◽

2017 ◽

Vol 42 (2) ◽

pp. 179-186 ◽

Cited By ~ 5

Author(s):

Liezel Ennion ◽

Anton Johannesson

Keyword(s):

South Africa ◽

Lower Limb ◽

Rural Setting ◽

Limb Amputation ◽

Prosthetic Rehabilitation ◽

Rural South ◽

Physical Strength ◽

District Hospitals ◽

Fitting In ◽

Rural South Africa

Background: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. Objective: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Conclusion: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

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Using information graphics in health technology assessment: Toward a structured approach

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309990286 ◽

2009 ◽

Vol 25 (4) ◽

pp. 555-563 ◽

Cited By ~ 2

Author(s):

Martin Pitt ◽

Will Stahl-Timmins ◽

Rob Anderson ◽

Ken Stein

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Current Practice ◽

Health Technology ◽

Information Graphics ◽

The United Kingdom ◽

Classification Framework ◽

Key Stakeholders ◽

The Uk ◽

Structured Approach

Objectives: This study investigates the use of information graphics to display the outputs of health technology assessment (HTA) in the United Kingdom and proposes a more structured approach founded in an analysis of the decision-making requirements of the key stakeholders.Methods: A scoping review of HTA reports was conducted to investigate current practice in the use of information graphics in HTA literature. A classification framework using dimensions of report section, graphical type, and originating research center was devised and used for a full content analysis of the graphical figures in the fifty most recent reports produced for the UK National Health Service's HTA process.Results: Our survey shows that graphical tools are used extensively in HTA reports although less frequently than tables. Use of information graphics varies widely between different report sections and tends to follow conventional lines with little evidence of variance from established practice. The largest variance was found between the quantities of graphics used by different research centers responsible for authoring the reports.Conclusions: HTA makes extensive use of graphics; however, there is little evidence of a systematic or standardized approach, or of much innovation. Significant potential exists to explore the application of information graphics in this field, but there are many research challenges. A contextually based, structured approach to the design of effective information graphics in HTA is proposed as a basis both to investigate the application of existing graphical tools in HTA, and to explore the considerable scope for innovation.

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Confessions of a Hindu-Catholic Artist

Religion and the Arts ◽

10.1163/156852908x270999 ◽

2008 ◽

Vol 12 (1) ◽

pp. 164-185

Author(s):

Caroline Mackenzie

Keyword(s):

United Kingdom ◽

New Age ◽

The United Kingdom ◽

New Public ◽

Public Work ◽

Inner World ◽

The Uk ◽

The Right ◽

First Time ◽

The Church

AbstractDuring my first twelve years in India I studied Hindu art and philosophy, encountering "inculturated" Catholic Christianity for the first time. When I returned to the United Kingdom, I was struck by a manifest separation between the dry, orderly church, and the imaginative world of "New Age" networks such as Dances of Universal Peace. In 1999 I received a major commission to re-design a church in Wales. This opening allowed me to use art as a means to bring some of the insights gained in India into a Western Christian context. After this public work, I made a series of personal pictures that depicted the healing and empowering effect of the new public images (archetypes) on my inner world. I then tried to connect the work in the church to liturgy but found no opening in the UK. In 2003, I returned to India to the Fireflies Intercultural Centre in Bangalore. There I found a "laboratory of the spirit" that provided the right conditions for serious religious experimentation. In 2007, I found a way to express the vision of the artwork in the Welsh church via an embodied liturgy. Using masks representing the Elements, I worked with an Indian Catholic priest to create a cosmic Easter Triduum.

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"A gift from God": Anglo-Greek relations during the dictatorship of the Greek colonels

The Historical Review/La Revue Historique ◽

10.12681/hr.329 ◽

2014 ◽

Vol 11 ◽

pp. 67 ◽

Cited By ~ 1

Author(s):

Alexandros Nafpliotis

Keyword(s):

United Kingdom ◽

Military Regime ◽

Diplomatic Relations ◽

Military Leaders ◽

Good Working ◽

The United Kingdom ◽

The Uk ◽

The Military ◽

First Time

The focus of this article is an analysis of the Greek junta’s relations with the Wilson and Heath governments in the United Kingdom from 1967 to 1974. Emphasis is placed on diplomatic relations between the two traditional allies. The reactions of the military leaders of the regime in Athens and its representatives in Britain to policies pursued by London towards the establishment, consolidation and eventual demise of the colonels’ dictatorship are presented through the examination (for the first time) of official documents from both the UK and Greece. It is argued that the Greek military regime struggled to cultivate relations with Britain primarily for reasons of domestic and international prestige. Whereas Whitehall pursued a policy of “good working relations” with the junta in order to promote British interests vis-à-vis NATO, Cyprus and trade, the leadership in Athens was solely interested in using British support to gain legitimacy internationally and domestically.

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GRADE-ADOLOPMENT Process to Develop 24-Hour Movement Behavior Recommendations and Physical Activity Guidelines for the Under 5s in the United Kingdom, 2019

Journal of Physical Activity and Health ◽

10.1123/jpah.2019-0139 ◽

2020 ◽

Vol 17 (1) ◽

pp. 101-108 ◽

Cited By ~ 1

Author(s):

John J. Reilly ◽

Adrienne R. Hughes ◽

Xanne Janssen ◽

Kathryn R. Hesketh ◽

Sonia Livingstone ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behavior ◽

Sedentary Time ◽

De Novo ◽

Movement Behavior ◽

Physical Activity Guidelines ◽

Assessment Development ◽

The United Kingdom ◽

The Uk ◽

First Time

Background: This article summarizes the approach taken to develop UK Chief Medical Officers’ physical activity guidelines for the Under 5s, 2019. Methods: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)-Adaptation, Adoption, De Novo Development (ADOLOPMENT) approach was used, based on the guidelines from Canada and Australia, with evidence updated to February 2018. Recommendations were based on the associations between (1) time spent in sleep, sedentary time, physical activity, and 10 health outcomes and (2) time spent in physical activity and sedentary behavior on sleep outcomes (duration and latency). Results: For many outcomes, more time spent in physical activity and sleep (up to a point) was beneficial, as was less time spent in sedentary behavior. The authors present, for the first time, evidence in GRADE format on behavior type–outcome associations for infants, toddlers, and preschoolers. Stakeholders supported all recommendations, but recommendations on sleep and screen time were not accepted by the Chief Medical Officers; UK guidelines will refer only to physical activity. Conclusions: This is the first European use of GRADE-ADOLOPMENT to develop physical activity guidelines. The process is robust, rapid, and inexpensive, but the UK experience illustrates a number of challenges that should help development of physical activity guidelines in future.

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Future integrity of the United Kingdom is at risk

Emerald Expert Briefings ◽

10.1108/oxan-db264119 ◽

2021 ◽

Keyword(s):

At Risk ◽

United Kingdom ◽

Northern Ireland ◽

Economic Impact ◽

Content Type ◽

The United Kingdom ◽

The Uk ◽

First Time

Significance The Brexit process also has coincided with the rise of national over British identities in Scotland and Wales, as well as an increase in younger generations supporting independence. In Northern Ireland, Catholics are likely to outnumber Protestants for the first time when the census is released next year. Impacts The UK government’s hard-line opposition to another Scottish referendum vote could risk increasing support for independence. Resolving tensions over the Northern Ireland protocol will be crucial in making progress on other aspects of UK-EU relations. Concern over the economic impact of Brexit suggests that London will continue to take a lax approach to customs checks on EU imports.

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Owner and veterinary surgeon perspectives on the roles of veterinary nurses and receptionists in relation to small animal preventive healthcare consultations in the United Kingdom

Veterinary Record ◽

10.1136/vr.104773 ◽

2018 ◽

Vol 183 (9) ◽

pp. 296-296 ◽

Cited By ~ 9

Author(s):

Zoe Belshaw ◽

Natalie Jane Robinson ◽

Rachel Sarah Dean ◽

Marnie Louise Brennan

Keyword(s):

Small Animal ◽

Preventive Healthcare ◽

Telephone Interviews ◽

The United Kingdom ◽

Veterinary Surgeons ◽

Practice Based Research ◽

Rapport Building ◽

Veterinary Surgeon ◽

The Uk ◽

First Time

Veterinary receptionists and veterinary nurses rarely feature in published practice-based research, yet are integral to small animal veterinary practice in the UK. The aim of this study was to investigate the perspectives of UK-based owners and veterinary surgeons about veterinary nurses and receptionists in relation to their role in preventive healthcare. Semistructured telephone interviews were conducted with 15 dog and cat owners and 14 veterinary surgeons. Interview transcripts were thematically analysed. Reception staff were identified as having a range of important roles, from rapport building to providing healthcare information and advice. The perceived importance of those roles appeared to differ between owners and veterinary surgeons. Veterinary nurses were described as performing a diversity of roles in relation to preventive healthcare, both in the reception area and in the consulting room. Many owners, and some veterinary surgeons, expressed uncertainty about the remit and status of veterinary nurses in relation to providing veterinary advice. This study identifies for the first time the degree of responsibility for preventive healthcare given to veterinary receptionists and veterinary nurses in UK small animal practices. Further work is needed involving reception and nursing staff to fully appreciate and define their roles in small animal practice.

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