Southend University Hospital NHS Foundation Trust was an NHS foundation trust which ran Southend University Hospital. It merged with two other trusts to form Mid and South Essex NHS Foundation Trust on 1 April 2020.
BACKGROUND:In neonatal trials, verbal opt-out consent has been used to reduce burden on families and make recruitment more efficient and representative. It involves information provision through posters and leaflets before randomisation, and parents can verbally 'opt out' of their baby being randomised to the trial. There is limited understanding of how opt-out consent is operationalised in a multicentre neonatal trial, and its acceptability to staff and parents. OBJECTIVE:To explore views and experiences of verbal opt-out consent in neoGASTRIC, a neonatal randomised trial comparing routine and no routine measurements of gastric contents in preterm babies. METHODS:A mixed methods (questionnaires, interviews and focus groups) process evaluation within a trial. SETTING:Four UK neonatal units. PARTICIPANTS:253 participants: 167 staff (149 questionnaires; 18 across two focus groups), 86 parents (85 questionnaires; 15 interviews; 14 took part in both). RESULTS:Parents and staff supported opt-out consent in neoGASTRIC as interventions were viewed as low risk and non-invasive. Parents appreciated an appropriately timed research conversation; only 21% noticed study information banners/posters. Operationalisation of opt-out consent varied in terms of when information was provided and randomisation timing. Women approached during labour or within hours of birth reported feeling overwhelmed and lacking capacity to consider research. Some staff operationalised a modified opt-in approach. CONCLUSIONS:An appropriately timed verbal opt-out approach to consent was seen acceptable as proportionate in the neonatal context in a low-risk trial comparing different accepted clinical, non-pharmaceutical, practices. Findings informed neoGASTRIC and will guide approaches to consent in this setting.
Objective To describe the demographic characteristics, causes and temporal patterns of child deaths occurring in a paediatric emergency department (ED) over a 10-year period.Design Single-centre retrospective observational study.Setting A major trauma centre in the UK with a standalone paediatric ED.Patients 58 children aged 0-17 years who died in the ED or were brought in dead between January 2014 and December 2023.Interventions None.Main outcome measures Causes of death, demographics, seasonal and diurnal variation, parental presence and safeguarding concerns.Results Median age at death was 2 years. The highest proportion of deaths occurred among infants under 1 year (36%) and adolescents aged 13-17 years (31%). Leading causes of death included sudden unexpected deaths (26%), infections (24%) and acute medical or surgical conditions (16%). Overall mortality was highest during winter months (29%), notably due to infections (50% of infection-related deaths). Sudden unexpected deaths showed clear early morning peaks, with 40% occurring between 04:00 and 07:59. Adolescents (13-17 years) represented 31% of deaths, predominantly due to infections and suicide or self-harm. Parental presence during resuscitation was high (83%). Prior safeguarding concerns were documented in 28% of cases, rising to 100% in deaths due to inflicted injury or abuse.Conclusions Child deaths in the ED present distinct patterns differing from national childhood mortality statistics, emphasising sudden and acute conditions. Recognising these unique characteristics can guide improvements in clinical practice, ED-specific bereavement support, targeted staff training and resource allocation for periods of highest risk.
The management of hepatitis C virus (HCV) infection in patients requiring ongoing enzyme-inducing antiepileptic drugs (eiAEDs) presents a therapeutic challenge due to potential drug-drug interactions with direct-acting antivirals (DAAs). Evidence regarding DAA treatment efficacy in this context remains limited. This case series examined the outcomes of patients with HCV who continued their eiAED therapy while being treated with conventional regimens of DAAs. A total of 23 patients with HCV were treated with standard doses and durations of HCV DAAs in combination with eiAEDs. High treatment adherence was reported for 19 (82.6%) patients and 21 (91.3%) achieved sustained virological response; two were lost to follow-up. Despite potential for reduced DAA levels, no virological failures or serious adverse events were observed in patients attending follow-up. This represents the largest reported single case series involving concomitant use of eiAEDs and DAAs. The findings provide reassurance that standard-dose DAA treatment can be effective even when co-administered with eiAEDs.
Background/Aims: To identify pre-, intra-, and postoperative risk factors for developing IOL dislocation that required surgical intervention for IOL dislocation after an initial planned phacoemulsification cataract surgery. Methods: A retrospective multicenter clinical database study collected over 12 years from 8 clinical centers in the United Kingdom. We included all eyes that underwent planned phacoemulsification cataract surgery. We excluded eyes that underwent planned large incision cataract surgery, were left aphakic during initial surgery and those that underwent retina or other intraocular surgery between initial cataract surgery and development of IOL dislocation. We used the Poisson model with robust approximation of variance for multivariable estimations to calculate adjusted relative risk (ARR). Results: Of 176,572 eyes that underwent planned phacoemulsification cataract surgery, 145 (0.08%) developed IOL dislocation requiring surgery. Factors that increased the risk for developing IOL dislocation included age between 18 and 40 years (ARR = 4.5 [1.7- 12.0]), age between 40 and 60 years (ARR = 2.6 [1.6- 4.5]), male sex (ARR = 1.5 [1.1- 2.1]), pseudoexfoliation (ARR = 5.7 [3.1- 10.5]), zonular dialysis (ARR = 3.3 [1.5- 7.1]), posterior capsule rupture (PCR) (ARR = 16.4 [9.7- 27.1]), iris damage (ARR = 4.2 [1.5- 11.6]), combined phacoemulsification-pars plana vitrectomy (ARR = 3.2 [1.7- 6.2]), and YAG capsulotomy (ARR = 2.8 [1.5- 5.2]) (p < 0.05 for all). Conclusion: This large database study quantified the risk factors for IOL dislocation after cataract surgery. This information is clinically useful for surgeons for preoperative risk stratification and surgical planning.
BACKGROUND AND OBJECTIVE:The European Association of Urology urolithiasis guidelines provide evidence-based recommendations for the diagnosis and treatment of urinary stone disease. Given the complexity and variability of stone formation, individualised patient management is emphasised. METHODS:The guidelines incorporate evidence from the latest research and focus on risk assessment, imaging techniques, pharmacological management, and surgical interventions. A research librarian conducted literature searches for urolithiasis in the Cochrane Library, Medline, and Embase databases via Dialog-Datastar. The strength of recommendations is also rated. KEY FINDINGS AND LIMITATIONS:Diagnosis relies on a combination of clinical history, biochemical evaluation, and imaging, with ultrasound as the first-line modality and low-dose computed tomography as the gold standard for precise stone assessment. Stone composition and burden influence treatment decisions with algorithms primarily based on stone size, location, and composition. Nonsteroidal anti-inflammatory drugs are recommended for first-line pain management, with opioids reserved as a secondary option. Medical expulsive therapy with α-blockers may be considered for selected patients with ureteral stones. Extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy remain the primary intervention modalities, with selection based on stone characteristics and patient factors. Advances in multiplanar imaging have improved assessment of the stone burden, although further research is needed to refine predictive models. Genetic testing is recommended for high-risk patients to guide personalised treatment. CONCLUSIONS AND CLINICAL IMPLICATIONS:The guidelines provide a framework for clinical decision-making while acknowledging the need for continued advances in urolithiasis.
