What ‘incomparable Jewells Havens, and sure harbours are’: the remains of late 16th century Dover harbour and their wider significance

SUMMARY: During excavations undertaken for the Dover Western Dock Revival Scheme, Kent, UK, Archaeology South-East (ASE; UCL Institute of Archaeology) encountered substantial remains associated with the development of the port of Dover. Despite natural limitations, especially in the form of silting from the River Dour and longshore drift, Dover has historically been a strategic location in which to maintain a port. The remains presented here comprise a nationally significant waterfront revealed during the revival scheme; that is, the Tudor engineering commonly attributed to Sir Thomas Digges, overseen by the Privy Council and commissioned by Elizabeth I

Angina Management is Poor After Percutaneous Coronary Intervention

Self-management of coronary heart disease (CHD) is critical after elective percutaneous coronary intervention (PCI). While elective PCIs should reduce patients’ stable angina symptoms, recurring pain is a common problem post-procedure and effective self-management of this seemed poor. The aims of the study were to identify how patients self-managed their angina symptoms after undergoing PCI and to explore barriers to their effectiveness in this

Evaluation of nationwide referral pathways, investigation and treatment of suspected cauda equina syndrome in the United Kingdom.

Purpose: Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. Materials and Methods: A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 months between 1st October 2016 and 31st March 2017. Results: A total of 28 UK spinal units submitted data on 4441 referrals. Over half of referrals were made without any previous imaging (n = 2572, 57.9%). Of all referrals, 695 underwent surgical decompression (15.6%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%). Patient location and pre-referral imaging were not associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced longer time intervals from referral to undergoing the MRI scan. Conclusions: This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Adherence to guidelines would reduce the number of referrals to spinal services by 72% and reduce the number of patient transfers by 79%

Research priorities relating to the delivery of cardiovascular prevention and rehabilitation programmes: results of a modified Delphi process

Objective: The purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR). Methods: The PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative. Following a literature review to identify unanswered research questions, modified Delphi methods were used to engage CVPR-informed expert stakeholders, patients, partners and conference delegates in ranking the relevance of research questions during three rounds of an anonymous e-survey. In the first survey, unanswered questions from the literature review were ranked and respondents proposed additional questions. In the second survey, these new questions were ranked. Prioritised questions from surveys 1 and 2 were incorporated in a third/final e-survey used to identify the top 10 list. Results: From 459 responses across the global CVPR community, a final top 10 list of questions were distilled from an overall bank of 76 (61 from the current evidence base and a further 15 from respondents). These were grouped across five broad categories: access and remote delivery, exercise and physical activity, optimising programme outcomes, psychosocial health and impact of the pandemic. Conclusions: This PSP used a modified Delphi methodology to engage the international CVPR community to generate a top 10 list of research priorities within the field. These prioritised questions will directly inform future national and international CVPR research supported by the BACPR CSG

Cardiac Rehabilitation Availability and Density around the Globe

BackgroundDespite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.MethodsA survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.FindingsCR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N?=?1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p

Nature of Cardiac Rehabilitation Around the Globe

BackgroundCardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.MethodsIn this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.Findings111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p

Understanding Cardiac Rehabilitation Delivery During Covid-19; Lessons for Future Delivery; a Mixed Methods Study

Funding Acknowledgements: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Scottish Funding Council (additional research funding for universities 2020-21) Background/introduction: Cardiac rehabilitation (CR) services were disrupted during early COVID-19 due to limited interpersonal contacts, exercise facility closures, and clinical service reorganisation to meet COVID-19 patients’ needs. This necessitated urgent service reorganisation. Purpose: We aimed to understand CR delivery changes in Scotland, the impact on staff and participant experiences, and implications for future delivery. Methods: A concurrent mixed methods study with data collected between April-December 2021. A quantitative online survey compared CR service provision pre-COVID-19 (21 March 2019 – 20 November 2019) with provision during early COVID-19 (21 March 2020 – 20 November 2020). Quantitative data were analysed descriptively using SPSSv26. Qualitative semi-structured telephone interviews were conducted with CR professionals and CR participants. These were thematically analysed using the framework approach. Data were integrated during study design by aligning survey and interview questions, and at the discussion stage. Results: Eleven CR services completed the online survey, and 11 individual CR staff and 17 CR participants from six services completed qualitative interviews. Services reported staffing reductions, delayed initial patient contact, replacing face-to-face CR with web-based and telephone support, and a reduction in goal setting, functional capacity testing and exit assessments. Three main qualitative themes represented the challenges and opportunities of changing CR delivery during COVID-19: 1) Access to health professional support; 2) Disruption in continuity of care and 3) CR technology use (Figure 1). Conclusions: Initially, Covid-19 adversely affected CR delivery. Telephone support, the provision of web-based information and exercise options, wearables and mHealth apps can enhance future CR delivery. Technological resources must be accessible, and staff require training to ensure competency