Description and evaluation of a pathway for unaccompanied asylum-seeking children

Objective(1) To describe a novel integrated pathway for unaccompanied asylum-seeking children (UASC).(2) To evaluate a population engaged with this service.DesignDescription of the integrated pathway (objective 1) and retrospective evaluation, using data from community paediatrics, infectious diseases (IDs) screening and a sexual health (SH) service (objective 2).SettingUnlinked data were collected from three services across three National Health Service (NHS) trusts in London.PatientsAll Camden UASC engaged with the service from 01 January 2016 to 30 March 2019.InterventionsA multidisciplinary approach prioritising the health needs of UASC including a childre and adolescent mental health service (CAMHS) clinican and a health improvement practitioner. There are low thresholds for onward referral and universal asymptomatic screening of UASC for ID.Main outcome measuresData on demographics, unmet health needs and known outcomes.ResultsData were available for 101 UASC, 16% female, median age 16 years (range 14–17). Physical assault/abuse was reported in 67% and 13% disclosed sexual assault/abuse, including 38% of female UASC. Mental health symptoms were documented in 77%. IDs warranting treatment were identified in 41% including latent tuberculosis (25%) and schistosomiasis (13%). Interpreters were required for 97% and initial non-attendance rates at follow-up were 40% (ID) and 49% (SH).ConclusionsThese data demonstrate high rates of historical physical and sexual assault/abuse, unmet physical, mental and emotional health needs among UASC and significant barriers to engaging with services. An integrated pathway has been successfully implemented and shown to deliver appropriate, joined-up care for UASC, consistent with current recommendations, with the potential to improve outcomes.

Perceptions of Training Pathways from Recent Cardiothoracic Surgery Graduates

Background: There are three cardiothoracic surgery (CTS) training pathways—general surgery residency followed by a CTS residency of 2-3 years (traditional), 4 years of general surgery and 3 years of CTS residency (4+3), and an integrated 6-year pathway (I-6). The goal of this study was to survey early career cardiothoracic surgeons regarding their training experiences. Methods: An email-based survey was sent to cardiothoracic surgeons, who graduated between 2012-2017. Data on training pathway specific variables and overall satisfaction were collected. The primary endpoints were career preparation and satisfaction, scored on a scale from 1-100, 100 being the most positive. Results: Four hundred seventy-seven emails were sent, with a response rate of 95/477 (20%). Seventy-six of the respondents (80%) were male; the mean age was 39. Seventy-seven (81.0%) completed a traditional training pathway, 7 (7.4%) completed a 4+3 pathway, and 11 (11.6%) completed an I-6 pathway. Participants felt prepared for practice with a mean response of 79.8 (range 31-100); mean career satisfaction was 87.6. When asked which pathway respondents would choose in the current era, 52 (54.7%) would choose a traditional pathway, 17 (17.9%) a 4+3 pathway, and 19 (20.0%) an I-6 program; 7 (7.4%) did not respond. Twenty of 72 (27.8%) traditional pathway trained and 18/18(100%) integrated pathway trained surgeons would choose an integrated pathway. Conclusions: This is the first survey addressing perceptions of training from early-career cardiothoracic surgeons across all training pathways. Data from this study provides insights to better understand how to improve CTS training for the next generation of surgeons.

184 30% Reduction in Time to Admission for Trauma Cases; An Integrated Multidisciplinary Model of Care Pathway in a Major Tertiary Hospital

Introduction Blue Book Guidelines recommend admitting hip fracture patients to an orthopaedic ward within 4 hours of presentation. BOAST guidelines advise early multidisciplinary team management. Since 2018, our Institution has utilised an integrated, multidisciplinary model for referrals of trauma patients in the Emergency Department. We hypothesised that this significantly reduces time to admission. Method We retrospectively reviewed data on all trauma cases admitted over a two-month period in 2017 and 2019 (before and after development of our Integrated Pathway). Our Integrated Pathway is facilitated by a mobile application which is accessed by all ED and Orthopaedic medical staff, including Consultants, allowing instantaneous communication. Results Sixty-six trauma patients were admitted to our Institution between December 2017 and January 2018. Average time taken from triage in ED to admission by the Orthopaedic team was 7hrs 10mins. Sixty-three patients were admitted over the same period in December 2019 and January 2020. Average time taken from triage in ED to admission by the Orthopaedic team was 4hrs 59mins. Conclusions Our Integrated Multidisciplinary mobile application system resulted in a 30.5% decrease in time to admission, which is a significant improvement. We would recommend the introduction of similar systems in other hospitals as part of their Model of Care Pathway.

Phospho-proteomic analysis of the effect of merecidin inhibiting the human lung adenocarcinoma A549 cells

Background: Merecidin induced A549 cells apoptosis. The present study aimed to assess the differentially phosphorylated proteins in lung cancer A549 cells treated with antibacterial peptide merecidin. Methods: TMT/iTRAQ labeling, LC-MS/MS analysis, HPLC grading, IMAC modification and enrichment, and liquid chromatography-mass spectrometry of peptide. The data of proteins were filtered according to the localization probability >0.75 standard. The phosphorylated proteomics data were analyzed using GO, KEGG, and STRING databases. Western blots examined the changes in phosphorylated protein expression. Results: Protein function enrichment showed significant changes in the phosphorylation level with respect to protein binding, metabolic activity, molecular function regulation, cell process, and biological function regulation. Integrated pathway bioinformatics results showed that differential proteins are associated with several pathways, including mTOR and AMPK etc. Screening of the COG database revealed differentiated phosphorylated proteins in cell signal transduction, RNA transcription, translation processing and modification, ribosome synthesis of proteins, cytoskeleton protein formation, intracellular material transport, secretion, and vesicle transport. Protein interaction level analysis identified an interaction network with HDAC1, RPL23A, SRSF3H, and NCBP1.etc. The phosphorylated proteomics data and showed that after merecidin treatment, ATG2B and ULK1s were significantly upregulated, while MAPK1 and AKT were significantly downregulated. In addition, Western blot also showed the upregulated level of ATG13,ULK1;MAPK1 downregulated. Conclusion: The results verified the feasibility of phosphorylated proteomics analysis, confirmed the signaling pathways, and suggested that merecidin may induce autophagy of lung adenocarcinoma A549 cells.

Phospho-Proteomic Analysis of The Effect of Merecidin Inhibiting the Human Lung Adenocarcinoma A549 Cells

Objectives: Merecidin induced A549 cells apoptosis. The present study aimed to assess the differentially phosphorylated proteins in lung cancer A549 cells treated with antibacterial peptide merecidin. Methods: TMT/iTRAQ labeling, LC-MS/MS analysis, HPLC grading, IMAC modification and enrichment, and liquid chromatography-mass spectrometry of peptide. The data of proteins were filtered according to the localization probability >0.75 standard. The phosphorylated proteomics data were analyzed using GO, KEGG, and STRING databases. Western blots examined the changes in phosphorylated protein expression. Results: Protein function enrichment showed significant changes in the phosphorylation level with respect to protein binding, metabolic activity, molecular function regulation, cell process, and biological function regulation. Integrated pathway bioinformatics results showed that differential proteins are associated with several pathways, including mTOR and AMPK etc. Screening of the COG database revealed differentiated phosphorylated proteins in cell signal transduction, RNA transcription, translation processing and modification, ribosome synthesis of proteins, cytoskeleton protein formation, intracellular material transport, secretion, and vesicle transport. Protein interaction level analysis identified an interaction network with HDAC1, RPL23A, SRSF3H, and NCBP1.etc. The phosphorylated proteomics data and showed that after merecidin treatment, ATG2B and ULK1s were significantly upregulated, while MAPK1 and AKT were significantly downregulated. In addition, Western blot also showed the upregulated level of ATG13,ULK1;MAPK1 downregulated. Conclusion: The results verified the feasibility of phosphorylated proteomics analysis, confirmed the signaling pathways, and suggested that merecidin may induce autophagy of lung adenocarcinoma A549 cells.

Spinal muscular atrophy: developing an integrated pathway in a new era for treatment

Spinal muscular atrophy is a rare neuromuscular condition that affects infants from birth, but which can also present later in life. The recent development of the drugs nusinersen, risdiplam and onasemnogene, has changed the treatment landscape and brought new hope. As a result of changes in treatment, an expert group is developing an overview pathway for care. Sue Thomas provides a brief overview of existing standards of care, the new treatments available and the policies that enable their administration.