Jointly estimating epidemiological dynamics of Covid-19 from case and wastewater data in Aotearoa New Zealand.

Background: Timely and informed public health responses to infectious diseases such as COVID-19 necessitate reliable information about infection dynamics. The case ascertainment rate (CAR), the proportion of infections that are reported as cases, is typically much less than one and varies with testing practices and behaviours, making reported cases unreliable as the sole source of data. The concentration of viral RNA in wastewater samples provides an alternate measure of infection prevalence that is not affected by clinical testing, healthcare-seeking behaviour or access to care.

The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope.

Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies.

Testing methods to estimate population size for wastewater treatment plants using census data: Implications for wastewater-based epidemiology.

In wastewater-based epidemiology (WBE), wastewater loads are commonly reported as a per capita value. Census population counts are often used to obtain a population size to normalise wastewater loads. However, the methods used to calculate the population size of wastewater treatment plants (WWTPs) from census data are rarely reported in the WBE literature.

Nasal Septal Flaps for Repair of Large or Recurrent Palatal Fistula: Report of Technique and 4-Year Experience.

Summary: Large or multiply recurrent oronasal fistulas following cleft palate repair present a challenging problem. Nasal septal mucoperichondrial flaps have been widely used for repair of skull base defects; however, their use in the repair of oronasal cleft palate fistulas has not previously been described. In this pilot study, the authors describe anterior palatal fistula repair using a nasal septal flap and review their experience with this technique over 4 years.

Telephone Triage Toolkit for Children's cancer services: A quality initiative.

Purpose: Service development to improve patient safety and experience, and improve staff safety and confidence when managing telephone calls from parents or carers of children with cancer in the UK.

Method: A multi-layered mixed methods approach broadly based on sequential PDSA (plan, do, study, act) cycles, to a series of quality initiative projects spanning 14 years. Various project styles and methods are described.

Challenges and opportunities for conducting a vaccine trial during the COVID-19 pandemic in the United Kingdom.

The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom.

Fifteen-minute consultation: Fractures in non-ambulant children with cerebral palsy.

Objective: To describe a safeguarding decision pathway for the assessment of osteopenic fractures in non-ambulant children with cerebral palsy.

Method: Literature review and consensus practice of a child safeguarding team, including clinicians and social workers.

Conclusion: Low-energy fractures of the lower limb in non-ambulant children with cerebral palsy are relatively common and explained by the presence of reduced bone strength, in the absence of any other unexplained injuries or safeguarding concerns.

Contemporary challenges for specialist nursing in interstitial lung disease.

Unlabelled: The role of clinical nurse specialists (CNSs) in interstitial lung disease (ILD) is evolving in response to clinical guidelines and the growth of clinical research. The role is well established in the UK, although more ILD posts are needed to ensure supply meets clinical demand. This phenomenon is also happening across Europe.

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age.

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib.

Real World Experiences: Pirfenidone and Nintedanib are Effective and Well Tolerated Treatments for Idiopathic Pulmonary Fibrosis.

Idiopathic Pulmonary Fibrosis (IPF) now has two licensed treatments available. Pirfenidone was the first drug to be licensed and approved for use, followed by nintedanib. We set out our real world experience with these agents in terms of their adverse events profile outside the restrictions of a clinical trial.

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study.

Background: The objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis.

Methods: Prospective cohort study of participants referred for suspicion of CRC in two English regions. Data were collected using a patient questionnaire, primary care and hospital records.

Modification of T cell responses by stem cell mobilization requires direct signaling of the T cell by G-CSF and IL-10.

The majority of allogeneic stem cell transplants are currently undertaken using G-CSF mobilized peripheral blood stem cells. G-CSF has diverse biological effects on a broad range of cells and IL-10 is a key regulator of many of these effects. Using mixed radiation chimeras in which the hematopoietic or nonhematopoietic compartments were wild-type, IL-10(-/-), G-CSFR(-/-), or combinations thereof we demonstrated that the attenuation of alloreactive T cell responses after G-CSF mobilization required direct signaling of the T cell by both G-CSF and IL-10.

Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care.

Background: Family history is an important risk factor for many common chronic diseases, but it remains underutilised for diagnostic assessment and disease prevention in routine primary care.

Aim: To develop and validate a brief self-completed family history questionnaire (FHQ) for systematic primary care assessment for family history of diabetes, ischaemic heart disease, breast cancer, and colorectal cancer.

Design And Setting: Two-stage diagnostic validation study in 10 general practices in eastern England.

Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study.

Background: GPs need to recognise significant pigmented skin lesions, given rising UK incidence rates for malignant melanoma. The 7-point checklist (7PCL) has been recommended by NICE (2005) for routine use in UK general practice to identify clinically significant lesions which require urgent referral.

Aim: To validate the Original and Weighted versions of the 7PCL in the primary care setting.

The cost-effectiveness of a novel SIAscopic diagnostic aid for the management of pigmented skin lesions in primary care: a decision-analytic model.

Objectives: Pigmented skin lesions are commonly presented in primary care. Appropriate diagnosis and management is challenging because the vast majority are benign. The MoleMate system is a handheld SIAscopy scanner integrated with a primary care diagnostic algorithm aimed at improving the management of pigmented skin lesions in primary care.

The B4 school check behaviour measures: findings from the Hawke's Bay evaluation.

The Before (B4) School Check is a free health and development check delivered by specifically trained nurses to four year old children throughout New Zealand, aimed to identify and address any health, behavioural, social or developmental concerns that could affect a child's ability to get the most benefit from school. Reported here are the results of an evaluation of the B4 School Checks in Hawke's Bay, focusing specifically on children assessed at the 84 School Check with behaviour issues as determined by the Strengths and Difficulties Questionnaire (SDQ). Health Hawke's Bay (HHB) records were reviewed to understand the number and demographics of the children assessed with behaviour issues at the B4 School Checks up to 31 August 2011, and the interventions to which they were referred.

Ultraviolet-C irradiation in the management of pressure ulcers in people with spinal cord injury: a randomized, placebo-controlled trial.

Objective: To compare the effects of ultraviolet-C (UVC) with placebo-UVC on pressure ulcer healing in individuals with spinal cord injury (SCI).

Design: Double-blind randomized trial with stratification for ulcer location to buttock or lower extremity. Subjects were followed up for 1 year postintervention.

Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomised controlled trial.

Objectives: To assess whether adding a novel computerised diagnostic tool, the MoleMate system (SIAscopy with primary care scoring algorithm), to current best practice results in more appropriate referrals of suspicious pigmented lesions to secondary care, and to assess its impact on clinicians and patients.

Design: Randomised controlled trial.

Setting: 15 general practices in eastern England.

Improving school readiness with the Before School Check: early experience in Hawke's Bay.

Aim: The New Zealand Ministry of Health's Before-School Check (B4SC) aims to identify those 4-year-old children with health, developmental or behavioural problems likely to impact on their education so these can be remediated before school entry. This evaluation aims to demonstrate the outcomes of the first 10 months of the B4SC programme in Hawke's Bay and the lessons learnt.

Methods: The B4SC was implemented in Hawke's Bay using an intersectoral, collaborative approach including all major stakeholders, led by the Hawke's Bay Primary Health Organisation (HBPHO).

Acceptability and accuracy of a non-endoscopic screening test for Barrett's oesophagus in primary care: cohort study.

Objectives: To determine the accuracy and acceptability to patients of non-endoscopic screening for Barrett's oesophagus, using an ingestible oesophageal sampling device (Cytosponge) coupled with immunocytochemisty for trefoil factor 3.

Design: Prospective cohort study.

Setting: 12 UK general practices, with gastroscopies carried out in one hospital endoscopy unit.

Protocol for the MoleMate UK Trial: a randomised controlled trial of the MoleMate system in the management of pigmented skin lesions in primary care [ISRCTN 79932379].

Background: Suspicious pigmented lesions are a common presenting problem in general practice consultations; while the majority are benign a small minority are melanomas. Differentiating melanomas from other pigmented lesions in primary care is challenging: currently, 95% of all lesions referred to a UK specialist are benign. The MoleMate system is a new diagnostic aid, incorporating a hand-held SIAscopy scanner with a primary care diagnostic algorithm.

Learning a novel technique to identify possible melanomas: are Australian general practitioners better than their U.K. colleagues?

Background: Spectrophotometric intracutaneous analysis (SIAscopy) is a multispectral imaging technique that is used to identify 'suspicious' (i.e. potentially malignant) pigmented skin lesions for further investigation.