Background/Aims Patient safety incidents are a major source of avoidable morbidity and mortality. National systems, such as the National Reporting and Learning System and the summary hospital-level mortality indicator, aim to improve patient safety in the NHS through the monitoring of incident rates and excess mortality. This study examined the relationship between patient safety incident reporting and hospital-level mortality. Methods This retrospective cohort study used two large publicly available datasets: quarterly National Reporting and Learning System reports; and summary hospital-level mortality indicator data. Data from the years 2016 and 2021 were analysed. Correlation and multivariate regression were used to explore associations between degrees and types of harm reported in patient safety incidents and hospital-level mortality, while accounting for hospital size. Results No association was found between patient safety incident reporting overall, for any year or at any degree of harm or type of harm, with hospital-level mortality. Further analyses accounting for hospital size or proportions of degrees of harm (low vs severe) also revealed no significant relationships. Conclusions Although patient safety incident reporting is intended to reduce preventable harm, these findings found no association with hospital-level mortality. This may reflect the complexity of measuring safety outcomes. The pattern of patient safety incident reporting highlights the need for open safety cultures and streamlined reporting for recurrent issues. Implications for practice Efforts to improve patient safety reporting should focus on improving the quality, consistency and utility of reported data. This includes repeatedly reporting recurrent incidents and developing psychologically safe working environments, with open reporting cultures. There is a need for more standardised national reporting guidance.

National Institute for Health and Care Excellence (NICE) and National Clinical Guideline for Stroke 2023 (NCGFS23) guidelines recommend specialist TIA clinic assessment within 24 hours of symptom onset of suspected TIA. There is limited evaluation of TIA clinic services in the United Kingdom (UK) and Republic of Ireland (ROI). This study aims to assess attendee characteristics, NICE/NCGFS23 adherence, and clinical outcomes across the UK and ROI.DelAys in TIA Evaluation and Service (DATES) is a prospective national audit and service evaluation delivered through an established collaborative (The Neurology and Neurosurgery Interest Group (NANSIG)). All UK and ROI outpatient rapid-access TIA clinics are eligible. All index suspected TIA presentations will be included, irrespective of final diagnosis. Centres will register as an audit/service evaluation without altering routine practice. Data will be collected electronically, with blinded independent validation. The primary outcome is adherence to the NICE/NCGFS23 recommended 24-hour target. Secondary outcomes include presenting symptoms, diagnosis, investigations, treatment, and onward referral.DATES is anticipated to be the largest prospective study presenting in-depth evaluation of UK/ROI TIA clinic attendances. Our results will provide real-world data on TIA pathways and potentially improve existing services.

BACKGROUND:Depression severity is a well-established risk factor for suicidal ideation, but the extent to which sociodemographic and employment-related factors contribute independently remains unclear. AIMS:Complete data from doctors (N = 4055) presenting to National Health Service Practitioner Health (NHS-PH) in 2022-2023 were used to test the hypothesis that depression severity is the largest determinant of suicide ideation risk (defined by Patient Health Questionnaire 9 (PHQ-9) question 9 score) among doctors. METHOD:Using PHQ-8 score (PHQ-9, excluding the item on suicide ideation) as a proxy for depression severity, the case-control discriminatory capacity of receiver operating characteristic curves (AUCs) were evaluated for (a) a univariable model studying modified PHQ-9 alone as the predictor of severe suicide ideation; and (b) a multivariable model integrating modified PHQ-9 and multiple sociodemographic and employment factors as the predictor of severe suicide ideation. Models were compared both descriptively and through a likelihood ratio test. RESULTS:The univariable model using depression severity alone as the predictor of severe suicide ideation yielded an AUC of 0.921. The addition of sociodemographic and employment factors improved the fit significantly (likelihood ratio test with (χ2(14) = 50.26, P < 0.001), amended AUC 0.930). Having both a disability and a relationship status of 'no partner' was significantly independently associated with suicide ideation in the multivariable model. CONCLUSIONS:In this national cohort of doctors, depression severity was strongly associated with suicidal ideation. However, disability and lack of a partner were also independently linked to increased risk, suggesting that suicidal ideation is not solely driven by symptom severity. Social and functional factors may help identify higher-risk individuals and inform targeted support.

INTRODUCTION:Given its proximity to the central nervous system, surgical site infections (SSIs) after craniotomy (SSI-CRAN) represent a serious adverse event. SSI-CRAN are associated with substantial patient morbidity and mortality. Despite the recognition of SSI in other surgical fields, there is a paucity of evidence in the neurosurgical literature devoted to skin closure, specifically in patients with brain tumors. The primary objective of this service evaluation is to ascertain the incidence and the risk factors associated with SSI-CRAN. The secondary objectives would be a) to ascertain the incidence of SSI-CRAN in sutured versus stapled wounds, after accounting for patient, surgical and hospital confounders of SSI-CRAN and b) to determine the percentage of patients with gliomas that begin adjuvant oncological treatment in patients with infection versus those without infection. METHODS:Surgical Site Infection after Craniotomy in Neuro-Oncology (SINO) is a international prospective multicentre service evaluation that will include patients with an intracranial neoplasm, both primary and secondary neoplasms, treated with cranial surgery (including biopsy). Consecutive paediatric (<18 years) and adult (≥18 years) patients diagnosed with a brain tumour, undergoing cranial surgery between 1st October 2024 and 1st December 2024 will be included. Prospective data will be collected with a follow-up of 90 days.

Background: The authors systematically appraise a large database of continuous professional development (CPD) and continuous medical education (CME) events against the European Accreditation Council for Continuous Medical Education (EACCME) framework. Methods: The authors performed a retrospective observational study of all CPD or CME events within the European Union of Medical Specialists (UEMS) database between 2017 and 2019, including 91 countries and 6034 events. Assessment of event design, quality and outcomes was evaluated against a validated, expert-derived accreditation framework, using thematic analysis to extract distinct themes, and subsequent quantitative analysis. Results: The authors included 5649 live educational events (LEEs) and 385 e-learning materials (ELMs). Three thousand seven hundred sixty-two [3762 (62.3%)] of the events did not report clear justification in their needs assessment process. Most accreditation applications claimed covering a single educational need [1603/2277 (70.3%)]. Needs assessments were reported to be similar across conferences, courses and other types of events (P<0.01); 5642/6034 events (93.5%) had clearly documented expected learning outcomes; only 978/6034 (16.2%) reported a single expected learning outcome while the rest report 2-10 outcomes. Providers who declared more than one educational need also declared multiple learning outcomes (rho=0.051, P<0.01). Conclusions: Despite EACCME providing a robust framework for the CPD/CME accreditation process, reporting quality can still be improved, as more than 1 in 2 events fail to provide a clear description of their needs assessment. To the authors' knowledge, this is the largest educational LEE/ELM database, which can be a starting to revisit the CME/CPD accreditation process.

Background Multiple sclerosis (MS) is a leading cause of non-traumatic disability in young adults. Accumulating evidence indicates early diagnosis and early treatment improves long-term outcomes. However, the MS diagnostic pathway is increasingly complex, and delays may occur at several stages. Factors causing delays remain understudied. We aim to quantify the time taken for MS to be diagnosed, and characterise the diagnostic pathway and initial care provided, in the United Kingdom (UK) and Republic of Ireland (ROI). Methods Delays In MultiplE Sclerosis diagnosis (DIMES) in the UK and ROI is a multicentre, observational, retrospective study that will be conducted via the Neurology and Neurosurgery Interest Group (NANSIG) collaborative network. Any hospital in the UK and ROI providing an MS diagnostic service is eligible to participate. Data on consecutive individuals newly diagnosed with MS between 1st July 2022 and 31st December 2022 will be collected. The primary outcomes are 1) time from symptoms/signs prompting referral to neurology, to MS diagnosis; and 2) time from referral to neurology for suspected MS, to MS diagnosis. Secondary outcomes include: MS symptoms, referring specialties, investigations performed, neurology appointments, functional status, use of disease modifying treatments, and support at diagnosis including physical activity, and follow up. Demographic characteristics of people newly diagnosed with MS will be summarised, adherence to quality standards summarised as percentages, and time-to-event variables presented with survival curves. Multivariable models will be used to investigate the association of demographic and clinical factors with time to MS diagnosis, as defined in our primary outcomes. Discussion DIMES aims to be the largest multicentre study of the MS diagnostic pathway in the UK and ROI. The proposed data collection provides insights that cannot be provided from contemporary registries, and the findings will inform approaches to MS services nationally in the future.

Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic review assesses the baseline characteristics of men and women presenting to secondary, tertiary, and quaternary centres with acute myocardial infarction (MI). Over 1.4 million participants from 18 studies, including primary prospective, cross sectional and retrospective observational studies, as well as secondary analysis of registry data are included in the study. The study showed that women were more likely than men to have a previous diagnosis of diabetes, hypertension, cerebrovascular disease, and heart failure. They also had lower odds of presenting with previous ischaemic heart disease and angina, dyslipidaemia, or a smoking history. Further work is necessary to understand the reasons for these differences, and the role that gender-specific risk factors may have in this context. Moreover, how these between-gender differences are implicated in management and outcomes also requires further work.

BACKGROUND:We sought to explore associations between trainee doctor perception and excess patient mortality.METHODS:Data from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated.RESULTS:All domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=-0.44; p<0.0001), teamwork (R=-0.36; p<0.0001) and clinical supervision at any time (R=-0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year.CONCLUSION:Trainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.

ObjectivesThis study aimed to investigate whether components of junior doctor satisfaction are associated with patient mortality within the United Kingdom.MethodsWe conducted a cross-sectional study of publicly available data (the General Medical Council [GMC] National Survey and the Summary Hospital-level Mortality Indicator [SHMI]) pertaining to subjective physician trainee satisfaction and patient mortality within 80 United Kingdom-based healthcare institutions. The direction and strength of correlation between components of the GMC National Survey and relative patient mortality as described by the SHMI were calculated. Additional outcomes included mean GMC survey scores for reported domains and mean SHMI by healthcare institution.ResultsSHMI for included healthcare institutions ranged from 0.69 to 1.21 (mean [SD], 1.01 [0.1]). Mean GMC domain scores ranged between 44.61 and 88.62 (mean [SD], 71.16 [10.84]). Statistically significant correlations were observed for clinical supervision, clinical supervision out of hours, rota design, overall satisfaction, and teamwork. After application of Bonferroni correction, statistically significant correlations remained for both clinical supervision and clinical supervision out of hours.ConclusionsThere is a significant association between components of subjective trainee satisfaction and patient mortality within the United Kingdom. Further investigation to examine these relationships, perhaps to target intervention, may prevent avoidable patient harm.

BackgroundThere is an urgent need for reliable methods to remotely monitor Multiple Sclerosis (MS). Existing assessments, such as Timed 25-Foot Walk (T25FW) and 9-Hole Peg Test (9HPT), are traditionally carried out in person by physicians. The use of self-administered, remote versions of these assessments could improve monitoring and hence care for people with MS (pwMS). This study evaluated the use of remote T25FW (rT25FW) and 9HPT (r9HPT) assessments.Methods pwMS were given comprehensive instructions and equipment for completing rT25FW/r9HPT. We assessed relationships between EDSS scores (through a previously-validated webEDSS) and contem- poraneous rT25FW/r9HPT using Spearman’s rank-order correlation, to evaluate consistency with previous in-person studies.ResultsSeventy-one pwMS completed the webEDSS and r9HPT, and 108 completed the webEDSS and rT25FW. There was a mild-moderate positive correlation between webEDSS and rT25FW (rho=0.40, p<0.0001, 95%CI=0.23–0.55), a finding consistent with previous in-person studies. There was a non-significant weak correlation between webEDSS and r9HPT. Distributions of rT25FW/r9HPT times were positively skewed. 100% of r9HPT times and 93.5% of rT25FW times were within specified limits used in clinical trials.ConclusionThese findings provide pilot evidence to indicate remote monitoring of MS is feasible. These assessments should be further developed to aid remote follow-up of pwMS.ashvin.kuri99@gmail.com

Low serum 25(OH)D3 (vD) is an environmental risk factor for multiple sclerosis (MS). Lower vD levels during early disease may be associated with long-term disability. Determinants of serum vD levels in healthy individuals include supplementation behaviour and genetic factors. These determinants have been less well studied in people with MS (pwMS). We developed a vD-weighted genetic risk score (GRS) and validated this in 373,357 UK Biobank participants without MS. We measured serum 25(OH)D3 and genotyped six vD-associated SNPs (rs12785878, rs10741657, rs17216707, rs10745742, rs8018720, rs2282679) in a cohort of pwMS (n = 315) with age and geographically matched controls (n = 232). We then assessed predictors of serum vD concentration in this cohort. The GRS was strongly associated with vD status in the Biobank cohort (p < 2 × 10–16). vD supplementation, having MS, lower BMI, increased age and supplementation dose were associated with higher vD levels (false discovery rate, FDR < 5%). In multivariable models adjusting for supplementation, BMI, age, sex, and MS status, the GRS was strongly associated with vD level (p = 0.004), but not in those who supplemented (p = 0.47). Our findings suggest that vD supplementation is the major determinant of vD level in pwMS, with genetic determinants playing a far smaller role.

BackgroundLow serum 25(OH)D3 (vD) in early disease may be associated with worse prognosis in multiple sclerosis (MS). Determinants of serum vD concentration are established in healthy individuals, but poorly studied in people with MS (pwMS). Unpicking the determinants of vD concentration in pwMS may have important preventative and therapeutic implications.MethodsWe recruited a study cohort of pwMS from the UK MS Register (n=315) and matched controls (n=232). We measured serum 25(OH)D3 and genotyped six vD-associated SNPs. We developed a weighted genetic risk score (GRS) using these SNPs and validated it in 373,357 UK Biobank participants. We then assessed predictors of vD levels in our cohort and constructed multivariable models to assess the influence of GRS.ResultsThe GRS was well-validated, being strongly associated with vD status in the Biobank cohort (p<2x10-16). In our study cohort, taking vD supplementation, having MS, lower BMI, increased age and supplementation dose were associated with higher vD levels (false discovery rate, FDR<5%). In multivariable models adjusting for these confounders, GRS was strongly associated with vD level in non-supplementers (p=0.004), but not in supplementers (p=0.47).ConclusionsOur findings suggest vD supplementation is the most important determinant of vD level in pwMS, and genetic determinants may play a relatively minor role.

Background: Glioblastoma multiforme is the most common and aggressive primary adult brain neoplasm. The current standard of care is maximal safe surgical resection, radiotherapy with concomitant temozolomide, followed by adjuvant temozolomide according to the Stupp protocol. Although the protocol is well adopted in high-income countries (HICs), little is known about its adoption in low- and middle-income countries (LMICs). The aim of this study is to describe a protocol design for a systematic review of published studies outlining the differences in GBM management between HICs and LMICs. Methods: A systematic review will be conducted. MedLine via Ovid, Embase and Global Index Medicus will be searched from inception to date in order to identify the relevant studies. Adult patients (>18 years) with histologically confirmed primary unifocal GBM will be included. Surgical and chemoradiation management of GBM tumours will be considered. Commentaries, original research, non-peer reviewed pieces, opinion pieces, editorials and case reports will be included. Results: Primary outcomes will include rates of complications, disability-adjusted life years (DALYs), prognosis, progression-free survival (PFS), overall survival (OS) as well as rate of care abandonment and delay. Secondary outcomes will include the presence of neuro-oncology subspecialty training programs. Discussion: This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets. Systematic Review Registration: The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020215843). Highlights Glioblastoma multiforme (GBM) remains the most common primary adult cerebral neoplasm, with an age-adjusted incidence rate of 3.22 per 100,000 population and a 5-year survival rate of 6.8% Despite the well-evidenced efficacy of Stupp protocol, the implementation of this approach bears an institutional and individual financial burden that is particularly notable in low- and middle-income countries (LMICs) This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets.

The Clinical TeacherVolume 18, Issue 5 p. 487-489 INSIGHTS Author gender bias in paediatric journals and FOAM Antonia Round, Corresponding Author Antonia Round [email protected] orcid.org/0000-0003-0204-9329 Leicester Medical School, University of Leicester, Leicester, UK Correspondence Antonia Round, Leicester Medical School, University of Leicester, Lancaster Rd, Leicester LE1 7HA. Email: [email protected]Search for more papers by this authorJack Barton, Jack Barton orcid.org/0000-0002-7376-4197 St George’s, University of London, London, UKSearch for more papers by this authorAshvin Kuri, Ashvin Kuri orcid.org/0000-0003-0125-4806 Barts and The London School of Medicine and Dentistry, London, UKSearch for more papers by this authorTien Tran, Tien Tran orcid.org/0000-0002-6601-3299 St George’s, University of London, London, UKSearch for more papers by this authorJonathan Round, Jonathan Round orcid.org/0000-0002-7404-2006 St George’s, University of London, London, UKSearch for more papers by this authorKatie Knight, Katie Knight orcid.org/0000-0001-9277-4916 North Middlesex Hospital, London, UKSearch for more papers by this author Antonia Round, Corresponding Author Antonia Round [email protected] orcid.org/0000-0003-0204-9329 Leicester Medical School, University of Leicester, Leicester, UK Correspondence Antonia Round, Leicester Medical School, University of Leicester, Lancaster Rd, Leicester LE1 7HA. Email: [email protected]Search for more papers by this authorJack Barton, Jack Barton orcid.org/0000-0002-7376-4197 St George’s, University of London, London, UKSearch for more papers by this authorAshvin Kuri, Ashvin Kuri orcid.org/0000-0003-0125-4806 Barts and The London School of Medicine and Dentistry, London, UKSearch for more papers by this authorTien Tran, Tien Tran orcid.org/0000-0002-6601-3299 St George’s, University of London, London, UKSearch for more papers by this authorJonathan Round, Jonathan Round orcid.org/0000-0002-7404-2006 St George’s, University of London, London, UKSearch for more papers by this authorKatie Knight, Katie Knight orcid.org/0000-0001-9277-4916 North Middlesex Hospital, London, UKSearch for more papers by this author First published: 06 May 2021 https://doi.org/10.1111/tct.13365Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume18, Issue5October 2021Pages 487-489 RelatedInformation

Background: There is an urgent clinical need for reliable remote monitoring methods in Multiple Sclerosis (MS). We evaluated the use of remotely patient-recorded timed 25-foot walk (rT25FW) and nine-hole peg test (r9HPT). Methods: Seventy-one people with MS completed a previously-validated online EDSS (webEDSS) and r9HPT, and 108 completed the webEDSS and rT25FW. Results: There was a mild-moderate positive correlation between webEDSS and rT25FW, and no significant correlation between webEDSS and r9HPT. Distributions of rT25FW and r9HPT times were positively skewed. Conclusions: Our results provide pilot evidence that remote monitoring of MS is potentially valid but requires refinement before wide-scale implementation. With a median EDSS of 4.5 and EDSS range of 0 - 8.0, at least some patients with ambulatory difficulty are able to complete the assessments.

Purpose Self-directed learning (SDL) has been increasingly emphasized within medical education. However, little is known about the SDL resources medical students use. This study aimed to identify patterns in medical students’ SDL behaviors, their SDL resource choices, factors motivating these choices, and the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on these variables. Methods An online cross-sectional survey comprising multiple-choice, ranked, and free-text response questions were disseminated to medical students across all 41 UK medical schools between April and July 2020. Independent study hours and sources of study materials prior to and during the COVID-19 pandemic were compared. Motivational factors guiding resource choices and awareness of Free Open Access Meducation were also investigated. Results The target sample was 75 students per medical school across a total of 41 medical schools within the United Kingdom (3,075 total students), and 1,564 responses were analyzed. University-provided information comprised the most commonly used component of independent study time, but a minority of total independent study time. Independent study time increased as a result of the COVID-19 pandemic (P<0.001). All sub-cohorts except males reported a significant increase in the use of resources such as free websites and question banks (P<0.05) and paid websites (P<0.05) as a result of the pandemic. Accessibility was the most influential factor guiding resource choice (Friedman’s μrank=3.97, P<0.001). Conclusion The use of learning resources independent of university provision is increasing. Educators must ensure equitable access to such materials while supporting students in making informed choices regarding their independent study behaviors.

Background Epstein-Barr Virus (EBV) is a ubiquitous gamma-herpesvirus with which ~ 95% of the healthy population is infected. EBV infection has been implicated in a range of haematological malignancies and autoimmune diseases. Delayed primary EBV infection increases the risk of subsequent complications. Contemporaneous seroepidemiological data is needed to establish best approaches for successful vaccination strategies in the future. Methods We conducted a sero-epidemiological survey using serum samples from 2325 individuals between 0 and 25 years old to assess prevalence of detectable anti-EBV antibodies. Second, we conducted a retrospective review of Hospital Episode Statistics to examine changes in Infectious Mononucleosis (IM) incidence over time. We then conducted a large case-control study of 6306 prevalent IM cases and 1,009,971 unmatched controls extracted from an East London GP database to determine exposures associated with IM. Results 1982/2325 individuals (85.3%) were EBV seropositive. EBV seropositivity increased more rapidly in females than males during adolescence (age 10–15). Between 2002 and 2013, the incidence of IM (derived from hospital admissions data) increased. Exposures associated with an increased risk of IM were lower BMI, White ethnicity, and not smoking. Conclusions We report that overall EBV seroprevalence in the UK appears to have increased, and that a sharp increase in EBV seropositivity is seen in adolescent females, but not males. The incidence of IM requiring hospitalisation is increasing. Exposures associated with prevalent IM in a diverse population include white ethnicity, lower BMI, and never-smoking, and these exposures interact with each other. Lastly, we provide pilot evidence suggesting that antibody responses to vaccine and commonly encountered pathogens do not appear to be diminished among EBV-seronegative individuals. Our findings could help to inform vaccine study designs in efforts to prevent IM and late complications of EBV infection, such as Multiple Sclerosis.