scholarly journals A survey of the management of 16–18-year-olds presenting with diabetic ketoacidosis in the UK: a need for standardisation

2019 ◽  
Vol 19 (1) ◽  
pp. 29-33
Author(s):  
Ketan Dhatariya ◽  
Peter Winocour ◽  
Andrew Raffles
Keyword(s):  
Diabetic Ketoacidosis ◽  
Poor Response ◽  
Standard Of Care ◽  
British Society ◽  
Clinical Settings ◽  
Specialist Nurse ◽  
Mailing Lists ◽  
Paediatric Endocrinology ◽  
Medical Teams ◽  
The Uk

Background: The standard of care of 16–18-year-olds presenting with diabetic ketoacidosis (DKA) is uncertain. It is unknown who looks after them or what guidelines are used to manage their DKA.Methods: We carried out a survey using a standardised questionnaire sent to diabetes and emergency care teams across the UK using mailing lists from the Association of British Clinical Diabetologists, The Diabetes Specialist Nurse Group (UK) and the British Society of Paediatric Endocrinology and Diabetes.Results: There was a relatively poor response rate; only 32 completed questionnaires were received between May and November 2018. The data suggest that the care was highly variable across the UK. There were no consistencies on how ‘16–18 years old’ was defined; who looked after them either during the acute phase once they had been triaged through the emergency department or during the later stages of their admission; or what guideline was used to treat their DKA. Several other aspects of care were also varied.Conclusions: The care of 16–18-year-olds presenting with DKA needs to be standardised across the UK. Furthermore, because a large number are looked after by adult non- specialist general medical teams, there is a clear need to ensure a consistent straightforward joint guideline that can be readily applied in all acute clinical settings regardless of whether care takes place in a paediatric or an adult clinical setting.

Peer Review of Paediatric Endocrine Services in the UK: A Template for Quality and Service Improvement

2021 ◽  
pp. 1-6
Author(s):  
John Schulga ◽  
Heather Mitchell ◽  
S. Faisal Ahmed ◽  
Assunta Albanese ◽  
Justin Warner ◽  
...  
Keyword(s):  
Peer Review ◽  
National Level ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
British Society ◽  
Service Improvement ◽  
Paediatric Endocrinology ◽  
Test Feasibility ◽  
Specialist Nurses ◽  
The Uk

<b><i>Background:</i></b> Independent peer review of healthcare services can complement existing internal-, institutional-, and national-level regulatory mechanisms aimed at improving quality of healthcare. However, this has not been reported for paediatric endocrinology services in the UK. We aimed to test feasibility and acceptability through a first cycle of a national peer review of paediatric endocrine services. <b><i>Methods:</i></b> Tertiary centres in paediatric endocrinology across the UK were assessed against 54 quality standards, developed by the British Society for Paediatric Endocrinology and Diabetes (BSPED) in five domains of healthcare by a team comprising paediatric endocrinologists and specialist nurses. The evaluation was supported by a self-assessment. A post-peer-review questionnaire was used as feedback. <b><i>Results:</i></b> All 22 centres in the UK underwent independent peer review between 2011 and 2017. Each served a median population of 2.6 million (range 1–8 million) and offered 1,872 (range 779–6,738) outpatient consultations annually. A total of 43 (range 30–49) standards were met in combined evaluation of all centres. Variance of adherence for essential standards ranged from 52 to 97% at individual centres with 90% adherence demonstrated by 32% of centres. Post-review feedback showed 20/22 (95%) validating the utility of the peer review. <b><i>Conclusions:</i></b> The BSPED peer review of all UK centres providing paediatric endocrine services is shown to be feasible and provides a quality benchmark for replication by national services.

The short Synacthen test: a questionnaire survey of current usage

2012 ◽  
Vol 97 (10) ◽  
pp. 870-873 ◽  
Author(s):  
Charlotte Jane Elder ◽  
Pooja Sachdev ◽  
Neil Peter Wright
Keyword(s):  
Low Dose ◽  
Inhaled Corticosteroids ◽  
British Society ◽  
High Dose ◽  
Paediatric Endocrinology ◽  
Children With Asthma ◽  
Synacthen Test ◽  
The Uk ◽  
Meta Analyses ◽  
Short Synacthen Test

BackgroundSupported by meta-analyses, the low-dose Synacthen test (LDST) has gained in popularity, with many believing it to be more sensitive than the supraphysiological standard (250 µg) short ST (SSST), particularly when assessing children prescribed high-dose inhaled corticosteroids (HDICS). However, consensus is lacking about its specific clinical application, what is considered ‘low dose’ and how that dose is made up.MethodsTo ascertain current use of the short Synacthen test (SST), a questionnaire was emailed to members of the British Society of Paediatric Endocrinology and Diabetes in the UK and Ireland (N=257), requesting a response from each department (N=92). A reminder was sent a month later to members of departments which had not responded.ResultsThe authors received 39 replies, giving a response rate of 42%. All departments use the SST: 82% use an LDST, 87% use the SSST and 69% use both. The 1 µg dose was used by 44% of hospitals, with the other 56% using seven different doses based on age, weight and body surface area. There were 14 different methods of preparing the low dose test. Additionally, variations in the timings of cortisol sampling and the diagnostic cut-offs for adrenal insufficiency were found. Increased requests for SSTs in children with asthma prescribed HDICS were noted by 44% of respondents, with 67% reporting the detection of adrenal suppression in this group.ConclusionStandardisation of the SST is required to address the considerable variation in the methodology and application of this test in the UK and Ireland.

Increasing the heart failure nursing workforce: recommendations by the British Society for Heart Failure Nurse Forum

2019 ◽  
Vol 14 (11) ◽  
pp. 1-12 ◽  
Author(s):  
Jayne Masters ◽  
Carys Barton ◽  
Lynda Blue ◽  
Jenny Welstand
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Significant Proportion ◽  
British Society ◽  
Timely Manner ◽  
Specialist Nurse ◽  
Heart Failure Patients ◽  
Specialist Nurses ◽  
The Uk ◽  
Improve Patient

There are almost 1 million people diagnosed with heart failure in the UK, and this number continues to rise. It is a common cause of hospitalisation and costs associated with those hospitalisations account for a significant proportion of the NHS budget. Studies have demonstrated that community heart failure specialist nurses improve patient outcomes and reduce the costs associated with hospitalisation. Yet, despite increased prevalence, considerable advances in therapies, and new recommendations from the National Institute for Health and Care Excellence, the recommended number of heart failure specialist nurses per 100 000 has stayed the same. This article will describe the development of community heart failure nursing in the UK, and outline the challenges currently facing heart failure specialist nurses. It makes a number of recommendations that would ensure heart failure patients are able to be seen by a heart failure specialist nurse in a timely manner, help reduce inequalities of care, reduce costs associated with heart failure hospitalisations and help ensure sustainability of heart failure services over the longer term.

scholarly journals A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Mindfulness ◽  
2021 ◽  
Author(s):  
Kate Williams ◽  
Samantha Hartley ◽  
Peter Taylor
Keyword(s):  
Delphi Study ◽  
Good Practice ◽  
Evidence Base ◽  
Clinical Settings ◽  
Training Support ◽  
Decision Making Processes ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Uk ◽  
Clinical Populations

Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

scholarly journals Determinants of penetrance and variable expressivity in monogenic metabolic conditions across 77,184 exomes

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Julia K. Goodrich ◽  
Moriel Singer-Berk ◽  
Rachel Son ◽  
Abigail Sveden ◽  
Jordan Wood ◽  
...  
Keyword(s):  
Case Control Study ◽  
Rare Variants ◽  
Standard Of Care ◽  
Polygenic Scores ◽  
Monogenic Diseases ◽  
Metabolic Conditions ◽  
The Uk ◽  
Control Study ◽  
Polygenic Variation

AbstractHundreds of thousands of genetic variants have been reported to cause severe monogenic diseases, but the probability that a variant carrier develops the disease (termed penetrance) is unknown for virtually all of them. Additionally, the clinical utility of common polygenetic variation remains uncertain. Using exome sequencing from 77,184 adult individuals (38,618 multi-ancestral individuals from a type 2 diabetes case-control study and 38,566 participants from the UK Biobank, for whom genotype array data were also available), we apply clinical standard-of-care gene variant curation for eight monogenic metabolic conditions. Rare variants causing monogenic diabetes and dyslipidemias display effect sizes significantly larger than the top 1% of the corresponding polygenic scores. Nevertheless, penetrance estimates for monogenic variant carriers average 60% or lower for most conditions. We assess epidemiologic and genetic factors contributing to risk prediction in monogenic variant carriers, demonstrating that inclusion of polygenic variation significantly improves biomarker estimation for two monogenic dyslipidemias.

scholarly journals New Labour, New Policies: Constructing a Discourse of Citizenship

1998 ◽  
Vol 3 (2) ◽  
pp. 101-114
Author(s):  
Keith Crawford
Keyword(s):  
Citizenship Education ◽  
New Labour ◽  
Political Context ◽  
British Society ◽  
Contemporary Society ◽  
Legitimation Crisis ◽  
New Policies ◽  
The Uk ◽  
The Impact

The purpose of this paper is examine the development of citizenship education as a curriculum priority within the UK. Employing Habermas' theory of legitimation crisis, the paper places the contemporary enthusiasm for citizenship education within a socioeconomic, cultural and political context. The paper argues that current preoccupations with citizenship education contained in Education for Citizenship and the Teaching of Democracy in Schools (Dfee, 1999), stem from the impact of Neo-Liberal concerns with individualism, economic and technological globalisation and the potential fragmentation of contemporary society. The paper explores the principles of education for citizenship and the teaching of democracy in schools and suggests that, as part of New Labour's developing conception of British society, citizenship education asks some fundamental questions of that society.

Chronic post-amputation pain & blast injury: An analysis of British First World War Veterans’ pension records, 1914-85

2021 ◽  
Author(s):  
Sarah Dixon Smith ◽  
David Henson ◽  
George Hay ◽  
Andrew S.C. Rice
Keyword(s):  
Blast Injury ◽  
First World War ◽  
World War ◽  
The Public ◽  
The First World War ◽  
Future Care ◽  
Medical Teams ◽  
The Uk ◽  
First World

LAY SUMMARY The First World War created the largest group of amputees in history. There were over 41,000 amputee Veterans in the UK alone. Recent studies estimate that over two thirds of amputees will suffer long-term pain because of their injuries. Medical files for the First World War have recently been released to the public. Despite the century between the First World War and the recent Afghanistan conflict, treatments for injured soldiers and the most common types of injuries have not changed much. A team of historians, doctors, and amputee Veterans have collaborated to investigate what happened next for soldiers injured in the war and how their wounds affected their postwar lives, and hope that looking back at the First World War and seeing which treatments worked and what happened to the amputees as they got older (e.g., if having an amputation put them at risk of other illnesses or injuries) can assist today’s Veterans and medical teams in planning for their future care.

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