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Aim: This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics. Methods: The National Diabetes Foot Care Audit collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer‐free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment. Results: Of 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer‐free at 12 weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non‐specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer‐free at follow‐up. Conclusions/Interpretations: Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co‐morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment. [ABSTRACT FROM AUTHOR]

We estimated the frequency of non-specific influenza-associated clinical endpoints to inform the feasibility of pragmatic randomized controlled trials (RCT) assessing relative vaccine effectiveness (rVE). Hospitalization rates of respiratory, cardiovascular and diabetic events were estimated from Denmark and England's electronic databases and stratified by age, comorbidity and influenza vaccination status. We included a seasonal average of 4.5 million Danish and 7.2 million English individuals, 17 and 32% with comorbidities. Annually, approximately 1% of Danish and 0.5% of English individuals were hospitalized for selected events, ~50% of them respiratory. Hospitalization rates were 40–50-fold and 2–10-fold higher in those >50 years and with comorbidities, respectively. Our findings suggest that a pragmatic RCT using non-specific endpoints is feasible. However, for outcomes with rates <2.5%, it would require randomization of ~100,000 participants to have the power to detect a rVE difference of ~13%. Targeting selected groups (older adults, those with comorbidities) where frequency of events is high would improve trial efficiency. [ABSTRACT FROM AUTHOR]

Coastal communities and infrastructure need protection from flooding and wave overtopping events. Assessment of hazard prediction methods, used in sea defence design, defence performance inspections and forecasting services, requires observations at the land-sea interface but these are rarely collected. Here we show how a database of hindcast overtopping events, and the conditions that cause them, can be built using qualitative overtopping information obtained from social media. We develop a database for a case study site at Crosby in the Northwest of England, use it to test the standard methods applied in operational flood forecasting services and new defence design, and suggest improvements to these methods. This novel approach will become increasingly important to deliver long-term, cost-effective coastal management solutions as sea-levels rise and coastal populations grow. At sites with limited, or no, monitoring or forecasting services, this approach, especially if combined with citizen science initiatives, could underpin the development of simplified early warning systems. [ABSTRACT FROM AUTHOR]

The National Diabetes Footcare Audit (NDFA) in England and Wales was established in July 2014. Linked to the National Diabetes Audit, the NDFA aims to review data on all newly occurring diabetic foot ulcers, evaluating care processes and linking these with clinical outcomes. The 2014-2016 report has now been published and demonstrates that delays between presentation and first assessment in specialist care are significantly associated with worse outcomes. The audit can help to reduce both the human and the financial costs of diabetic foot disease. [ABSTRACT FROM AUTHOR]

Introduction Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved. Methods A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/ issues. Interviews were recorded, transcribed and thematically analysed. Results Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics. Conclusions Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties. [ABSTRACT FROM AUTHOR]

Introduction The National Lung Cancer Audit is run jointly by the Royal College of Physicians and The Information Centre for health and social care, and is commissioned by the Healthcare Quality Improvement Partnership (HQIP). Its development was driven by the realisation that lung cancer outcomes vary widely across the UK and are poor compared to other western countries. The aim of the audit is to facilitate service improvement by recording elements of process and outcomes in lung cancer on a large scale and, using case-mix adjustment, to explain the wide variations noted and improve standards of care. Although several other countries also submit data to the audit, this abstract presents provisional results for England only. Results In Year 6, participation has again increased and all trusts have now contributed data at some time. Completeness of data on individual cases remains high although it is noteworthy that 18% of cases are submitted without a disease stage and 16% without performance status. This year the results show that the histological confirmation rate has risen substantially to nearly 77%, and 96% of patients have been discussed in an MDT, although the surgical resection and anti-cancer treatment rates have not increased further. Conclusions Participation remains high and the audit continues to collect data on close to 100% of cases of lung cancer and mesothelioma that present to secondary care. Overall treatment rates seem to have stopped improving, although it is acknowledged that some of the earlier annual improvements reflected improvements in data quality. The rise in HCR is likely to reflect a real change in practice, possibly due to the new found importance of tissue (choice of chemotherapy, use of EGFR antagonists) and possibly due to the focus given to HCR by the audit itself. It is of concern that a significant minority of patients appear to be managed without information on disease stage and PS--key variables needed for appropriate management of patients. [ABSTRACT FROM AUTHOR]