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ENT is a consistently under-represented specialty in medical school curricula. With social distancing measures limiting face-to-face (FtF) teaching and clinical opportunities, we created an e-Learning platform to consolidate and improve knowledge on common ENT emergencies. Following invitation to medical students undergoing their rotation in ENT at University Hospital Wales (UHW) Cardiff, five focus groups were shown an e-Learning module and interviewed between June and July 2021. 13 medical students participated in total (9 female, 4 male, median age 22 years). These structured interviews were recorded and transcribed. Transcripts were analysed using the qualitative data analysis software NVivo (QSR International, UK). The modules were found to be concise, clinically relevant and beneficial to student confidence in recognising and managing ENT emergencies. While e-Learning will likely never replace face-to-face learning, it was perceived to be a beneficial resource both academically and practically- especially in the context of limited clinical opportunities. [ABSTRACT FROM AUTHOR]

Smart meters (SM) with wireless capabilities are one of the most meaningful applications of the Internet of Things. Standards like Zigbee have found a niche in transmitting data on energy usage to the user and the supplier wirelessly via these meters and communication hubs. There are still certain difficulties, notably in delivering wireless connectivity to meters situated in difficult-to-reach locations such as basements or deep indoors. To solve this issue, this paper investigates the usage of mesh networks at 868 MHz, particularly to increase coverage, and proposes an additional mounted antenna to significantly increase outside coverage while providing the necessary coverage extension for hard-to-reach indoor locations. Extensive measurements were made in Newbury in both suburban and open environments for validation and delivery of a simple statistical model for the 868 MHz band in United Kingdom conurbations. Results presented in this paper estimate that mesh networks at 868 MHz can accommodate large areas constituting several SMs with the proposed coverage extension method. With our findings and proposed methods on mesh connectivity, only 1% of UK premises will require mesh radios to achieve the desired coverage. [ABSTRACT FROM AUTHOR]

Undergraduate otolaryngology teaching in the UK is generally limited primarily due to curriculum time constraints with traditional face-to-face (FtF) teaching being restrained by the limitations of time and location. Advances in network technology have opened up new doors for the delivery of teaching in the form of online learning. This study compares a traditional instructor-led lecture with synchronous e-learning (SeL) using otolaryngological emergencies teaching as an educational intervention. A randomised controlled trial was designed involving two groups of medical students attending an otolaryngology emergencies management lecture: one present FtF and the other viewing the streamed lecture online. The primary outcome measure was improvement between pre-and post-lecture test scores. Secondary outcomes comprised the students' ratings of the lecture on a Likert-type scale. Students in both groups had improved test scores following the lecture ( p < 0.001 for both groups) and there was no difference in magnitude of improvement in test scores between the two groups ( p = 0.168). There was no difference in student ratings between the two groups for the usefulness of the lecture ( p = 0.484), interactivity ( p = 0.834) and meeting educational needs ( p = 0.968). The FtF group, however, was more satisfied overall ( p = 0.034). This study demonstrates that SeL may be as effective as FtF teaching in improving students' knowledge on the management of otolaryngological emergencies, and that it is generally positively perceived by medical undergraduates. This highlights the potential utility of e-learning technology in undergraduate otolaryngology training. [ABSTRACT FROM AUTHOR]

Background Around 150,000 people each year attend hospitals in England due to self-harm, many of them more than once. Over 5,000 people die by suicide each year in the UK, a quarter of them having attended hospital in the previous year because of self-harm. Self-harm is a major identifiable risk factor for suicide. People receive variable care at hospital; many are not assessed for their psychological needs and little psychological therapy is offered. Despite its frequent occurrence, we have no clear research evidence about how to reduce the repetition of self-harm. Some people who have self-harmed show less active ways of solving problems, and brief problem-solving therapies are considered the most promising psychological treatments. Methods/Design This is a pragmatic, individually randomised, controlled, feasibility study comparing interpersonal problem-solving therapy plus treatment-as-usual with treatment-as-usual alone, for adults attending a general hospital following self-harm. A total of 60 participants will be randomised equally between the treatment arms, which will be balanced with respect to the type of most recent self-harm event, number of previous self-harm events, gender and age. Feasibility objectives are as follows: a) To establish and field test procedures for implementing the problem-solving intervention; b) To determine the feasibility and best method of participant recruitment and follow up; c) To assess therapeutic delivery; d) To assess the feasibility of obtaining the definitive trial's primary and secondary outcomes; e) To assess the perceived burden and acceptability of obtaining the trial's self-reported outcome data; f) To inform the sample size calculation for the definitive trial. Discussion The results of this feasibility study will be used to determine the appropriateness of proceeding to a definitive trial and will allow us to design an achievable trial of interpersonal problem-solving therapy for adults who self-harm. Trial registration Current Controlled Trials (ISRCTN54036115) [ABSTRACT FROM AUTHOR]

The natural history of type 2 diabetes mellitus (T2DM) is a relentless progression of b-cell failure and dysregulation of b-cell function with increasing metabolic derangement. Insulin remains the only glucose-lowering therapy that is efficacious throughout this continuum. However, the timing of introduction and the choice of insulin therapy remain contentious because of the heterogeneity of T2DM and the well-recognized behavioral and therapeutic challenges associated with this mode of therapy. Nevertheless, the early initiation of basal insulin has been shown to improve glycemic control and affect long-term outcomes in people with T2DM and is a treatment strategy supported by international guidelines as part of an individualized approach to chronic disease management. The rationale for early initiation of insulin is based on evidence demonstrating multifaceted benefits, including overcoming the glucotoxic effects of hyperglycemia, thereby facilitating "bcell rest," and preserving β-cell mass and function, while also improving insulin sensitivity. Independent of its effects on glycemic control, insulin possesses anti-inflammatory and antioxidant properties that may help protect against endothelial dysfunction and damage resulting in vascular disease. Insulin therapy and the achievement of good glycemic control earlier in T2DM provide long-term protection to end organs via "metabolic memory" regardless of subsequent treatments and degree of glycemic control. This is evidenced from long-term observations continuing from trials such as the United Kingdom Prospective Diabetes Study. As such, early initiation of insulin therapy may not only help to avoid the effects of prolonged glycemic burden, but may also positively alter the course of disease progression. [ABSTRACT FROM AUTHOR]

Self-harm remains a serious public health concern, not least because of its strong link with suicide. Twenty-five years ago we lamented the deficits in UK services, research and policy. Since then, there has not been nearly enough effective action in any of these three domains. It is time for action. [ABSTRACT FROM AUTHOR]

Tonsillectomy is a common therapeutic option in the management of recurrent tonsillitis. In 1999, the Scottish Intercollegiate Guidelines Network (SIGN) introduced SIGN 34 outlining appropriate indications for tonsillectomy. Following concerns of increasing hospital admissions for tonsillitis, in 2009 ENT UK suggested that too few tonsillectomies were being undertaken. This study analyses the effect the SIGN guidelines have had on trends in population rates of tonsillectomy and hospital admissions for tonsillitis and peritonsillar abscess in England, Scotland and Wales. A retrospective study was undertaken using the health databases of England, Scotland and Wales between 1999 and 2010. Tonsillectomy, acute tonsillitis and peritonsillar abscess were identified using national classification codes. Changes in rate of tonsillectomy and hospital admissions for tonsillitis and peritonsillar abscess were assessed using a linear regression model. 699,898 tonsillectomies were undertaken in the three national cohorts over the study period. Linear regression analysis suggested that implementation of SIGN 34 significantly reduced the population rate of tonsillectomy in England ( p = 0.005) and Wales ( p = 0.003) but not in Scotland ( p = 0.24), and indicated there had been an increase in hospital admissions for acute tonsillitis in all cohorts (England p = 0.000008, Scotland p = 0.03, Wales p = 0.000005) and peritonsillar abscess in England ( p < 0.05) and Wales ( p = 0.03). SIGN 34 has reduced tonsillectomy rates in England and Wales but not in Scotland. This finding is associated with increasing hospital admissions for acute tonsillitis in all national cohorts, which may suggest that the current stipulated guidelines miss patients who would benefit from surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract: Effective intervention following self-harm is vital because of the strong link between self-harm and suicide. Unfortunately, services for people who self-harm have been poor in the UK and elsewhere. In 2004, the National Institute for Health and Clinical Excellence issued a guideline setting out clear standards for care following self-harm, many of which are included in this article. Whether this guideline has led to much needed improvements in care is not clear; there are few published experiences concerning implementation of the guidance but some studies suggest that care continues to be unsatisfactory. The barriers to implementation of self-harm guidelines are not clear, but the lack of definitive research evidence for effective treatments is a potential candidate. Several systematic reviews have failed to demonstrate a statistically significant reduction in fatal or non-fatal repetition following intervention after self-harm. Recent studies have, however, shown clear benefits for some psychological therapies – in particular for cognitive behavioural therapy with a problem-solving element. Promising results have also been demonstrated for some brief interventions designed to encourage uptake of aftercare following self-harm. This article sets out a little of the evidence for these potentially beneficial interventions, including recent developments in research evidence and implications for future research. [Copyright &y& Elsevier]

Abstract: There are uneven standards of care for people who attend hospital because of self-harm (self-poisoning and self-injury), in the UK and elsewhere. In the hope of improving the situation the UK Department of Health commissioned a National Institute for Health and Clinical Excellence (NICE) Guideline on self-harm, which sets out the standards of care for staff in the emergency department. They should, in the first instance, evaluate the patient''s physical and mental health to allow for more thorough psychosocial assessment before the person leaves the hospital. The psychosocial assessment should take account of the person''s mental health and social needs, as well as their levels of perceived risk, and there should be adequate levels of training, supervision, privacy and inter-professional communication. Effective intervention following an episode of self-harm, whether initiated by emergency department staff of by mental health professionals, is an uncertain business because the evidence base is scant and equivocal. Research evidence fails to show clear advantage to simple alterations in the structure of the services such as the handing out of cards that offer the person a telephone number to call if he or she is feeling like undertaking further self-harm, or the sending of postcards that suggest getting in touch with the hospital. The best current evidence of benefit comes from brief forms of psychological therapy based on problem-solving techniques derived from interpersonal therapy of from cognitive therapy. Benefits include reduced repetition of self-harm and improvements in mood, hopelessness and problems experienced. [Copyright &y& Elsevier]

Examines the concept of prandial glucose regulation in the management of type two diabetes in Great Britain. Clinical efficacy of glucose regulation; Factors in the development of diabetic complications; Value of combination therapy.

Reports developments on public health in Great Britain. Accuracy of non-mydriatic photography in detecting preproliferative and proliferative diabetic retinopathy; Inadequacy of government allocation for the training of future social workers; Significance of the biopsy cut procedure for ultrasound guided biopsy.

A cohort of 120 patients, comprising all those who met the St Louis criteria for a diagnosis of schizophrenia, discharged from a mental hospital over a five-year period, were followed-up in the community after an interval of five to nine years; 105 were traced and 94 were alive. Of those, 66 were living in UK, out of hospital, and willing to be seen. Their mental states, and social functioning and circumstances were assessed by interview with the patients and those with whom they lived; 18% had recovered to the extent that they had no significant symptoms and appeared to function satisfactorily. More than 50% had definite psychotic features. No patients and few relatives sought a return to hospital care, but severe emotional, social, and financial difficulties were commonplace; 27% of the sample had no contact with medical or social services, a further 14% saw only community nurses, and 24% only their general practitioners. The findings emphasise the limitations of community services in dealing with the chronicity and severity of the impairments resulting from schizophrenic illness. [ABSTRACT FROM AUTHOR]

Background: Non-fatal self-harm is one of the commonest reasons for adults' emergency hospital attendance. Although strongly associated with fatal and non-fatal repetition, there is weak evidence about effective interventions—and no clear NICE guidance or clinical consensus concerning aftercare. We examined the practicability of a definitive trial to evaluate problem-solving therapy (PST) to reduce repetition of self-harm; MIDSHIPS is a single-centre, parallel-group, individually randomised controlled feasibility trial comparing treatment-as-usual (TAU) alone to TAU plus up to six sessions of brief problem-solving therapy (PST) with adults who had recently attended hospital because of self-harm. Objectives were to adapt the intervention for a UK setting, train therapists, recruit and randomise patients, deliver PST under supervision, and establish comparative outcomes, assessed blindly. Methods: We adapted the problem-solving intervention from an earlier trial and trained a mental-health nurse to deliver it. Adult patients attending the general hospital for self-harm were recruited while undergoing psychosocial assessment by the mental health team, and 62 were randomly allocated (32 TAU, 30 PST). The primary outcome assessed repeat hospital attendance due to further self-harm 6 months post-randomisation. Secondary outcomes included participant-reported outcomes and service use at 3 and 6 months post-randomisation. Results: The recruitment period had to be extended and 710 patients screened in order to establish a trial sample of the planned size (N = 62). A quarter of participants allocated to PST did not undertake the therapy offered; those who received PST attended a median of three sessions. Secondary outcomes were established for 49 (79%) participants at 6 months; all participants' hospital records were retrieved. Repetition of self-harm leading to hospital presentation occurred in 19 of the 62 participants (30.6%, 95% CI 19.2%, 42.1%) within 6 months of randomisation. Promising differential rates of self-harm were observed with an event rate of 23.3% (95% CI 8.2%, 38.5%) in the PST arm; and 37.5% (95% CI 20.7%, 54.3%) in TAU. Economic findings were also encouraging, with a small QALY gain (0.0203) in the PST arm together with less reported use of the NHS in the PST arm (average £2120) than with TAU-only (£2878). Conclusions: The feasibility trial achieved its objectives despite considerable difficulties with recruitment—adapting the PST, training a therapist, recruiting patients who had recently self-harmed, delivering the therapy, and establishing primary and secondary outcomes. These data provide a robust platform for a definitive multicentre randomised controlled trial of brief problem-solving therapy after hospital attendance due to self-harm. Trial registration: Identification number and URL: ISRCTN54036115 http://www.isrctn.com/search?q=midships. Registered: 13 January 2012 [ABSTRACT FROM AUTHOR]

Examines the efficacy of serotonin reuptake inhibitors for depressive illness in Great Britain. Comparison between serotonin reuptake inhibitors and antidepressant drugs; Advantages of serotonin reuptake inhibitors; Estimation of cost per treatment episode. INSET: Commentary: new drugs increase doctors' choice.

Abstract: Background: Psychosocial assessment is central to the management of self-harm, but not all individuals receive an assessment following presentation to hospital. Research exploring the factors associated with assessment and non-assessment is sparse. It is unclear how assessment relates to subsequent outcome. Methods: We identified episodes of self-harm presenting to six hospitals in the UK cities of Oxford, Leeds, and Manchester over an 18-month period (1st March 2000 to 31st August 2001). We used established monitoring systems to investigate: the proportion of episodes resulting in a specialist assessment in each hospital; the factors associated with assessment and non-assessment; the relationship between assessment and repetition of self-harm. Results: A total of 7344 individuals presented with 10,498 episodes of self-harm during the study period. Overall, 60% of episodes resulted in a specialist psychosocial assessment. Factors associated with an increased likelihood of assessment included age over 55 years, current psychiatric treatment, admission to a medical ward, and ingestion of antidepressants. Factors associated with a decreased likelihood of assessment included unemployment, self-cutting, attending outside normal working hours, and self-discharge. We found no overall association between assessment and self-harm repetition, but there were differences between hospitals – assessments were protective in one hospital but associated with an increased risk of repetition in another. Limitations: Some data may have been more likely to be recorded if episodes resulted in a specialist assessment. This was a non-experimental study and so the findings relating specialist assessment to repetition should be interpreted cautiously. Conclusion: Many people who harm themselves, including potentially vulnerable individuals, do not receive an adequate assessment while at hospital. Staff should be aware of the organizational and clinical factors associated with non-assessment. Identifying the active components of psychosocial assessment may help to inform future interventions for self-harm. [Copyright &y& Elsevier]

These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.