Innovations in pay and grading in NHS trusts

This report examines innovations in pay and grading in 10 NHS trusts in England using data collected from March 2000 to January 2001, ie prior to the implementation of Agenda for Change. These 10 trusts, which varied in size, function, and location, were selected primarily to illustrate a variety of different approaches to pay and grading. The research utilised a qualitative methodology, with interviews of managers on a one to one basis, group interviews with lay union representatives, focus groups with staff and the inspection of documents. This study focused on four questions: • Did local pay resolve the problems associated with Whitley? • What were the consequences of local pay? • Were the trusts’ pay systems introduced in line with 'new pay' ideas and current trends in reward management? • What factors were critical to the success of developing and implementing local pay systems in NHS trusts

Greenhouse gas emissions of realistic dietary choices in Denmark: the carbon footprint and nutritional value of dairy products

Background: Dairy products are important in a healthy diet due to their high nutritional value; they are, however, associated with relatively large greenhouse gas emissions (GHGE) per kg product. When discussing the need to reduce the GHGE caused by the food system, it is crucial to consider the nutritional value of alternative food choices. Objective: The objective of this study was to elucidate the role of dairy products in overall nutrition and to clarify the effects of dietary choices on GHGE, and to combine nutritional value and GHGE data. Methods: We created eight dietary scenarios with different quantity of dairy products using data from the Danish National Dietary Survey (1995–2006). Nutrient composition and GHGE data for 71 highly consumed foods were used to estimate GHGE and nutritional status for each dietary scenario. An index was used to estimate nutrient density in relation to nutritional recommendation and climate impact for solid food items; high index values were those with the highest nutrient density scores in relation to the GHGE. Results: The high-dairy scenario resulted in 27% higher protein, 13% higher vitamin D; 55% higher calcium; 48% higher riboflavin; and 18% higher selenium than the non-dairy scenario. There was a significant correlation between changes in calcium and changes in vitamin D, selenium, and riboflavin content (P=0.0001) throughout all of the diets. The estimated GHGE for the dietary scenario with average-dairy consumption was 4,631 g CO2e/day. Conclusions: When optimizing a diet with regard to sustainability, it is crucial to account for the nutritional value and not solely focus on impact per kg product. Excluding dairy products from the diet does not necessarily mitigate climate change but in contrast may have nutritional consequences

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Attitudes towards alcoholics Staff patient relationships in the acute hospital setting

Available from British Library Document Supply Centre- DSC:DXN058726 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Drug use prevention among young people: a review of reviews.

This evidence briefing is a review of reviews about the effectiveness of public health interventions to prevent and/or reduce illicit drug use among young people. The research examined 15 systematic reviews, meta-analyses and other types of reviews between 1996 - 2001

Combined ipilimumab and nivolumab first-line and after BRAF-targeted therapy in advanced melanoma

The combination of ipilimumab and nivolumab is a highly active systemic therapy for metastatic melanoma but can cause significant toxicity. We explore the safety and efficacy of this treatment in routine clinical practice, particularly in the setting of serine/threonine-protein kinase B-Raf (BRAF)-targeted therapy. Consecutive patients with unresectable stage IIIC/IV melanoma commenced on ipilimumab and nivolumab across 10 tertiary melanoma institutions in Australia were identified retrospectively. Data collected included demographics, response and survival outcomes. A total of 152 patients were included for analysis, 39% were treatment-naïve and 22% failed first-line BRAF/MEK inhibitors. Treatment-related adverse events occurred in 67% of patients, grade 3–5 in 38%. The overall objective response rate was 41%, 57% in treatment-naïve and 21% in BRAF/MEK failure patients. Median progression-free survival was 4.0\ua0months (95% CI, 3.0–6.0) in the whole cohort, 11.0\ua0months (95% CI, 6.0-NR) in treatment-naïve and 2.0\ua0months (95% CI, 1.4–4.6) in BRAF/MEK failure patients. The combination of ipilimumab and nivolumab can be used safely and effectively in a real-world population. While first-line efficacy appears comparable to trial populations, BRAF-mutant patients failing prior BRAF/MEK inhibitors show less response