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Recurrent Morphoeic Basal Cell Carcinoma with Metastatic Progression in A 34-Year-Old Patient: A Case Report
No full textBest Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review
Get PDFBackground:
In the past decade, there has been a rise in the use of digital or electronic records in social care worldwide, capturing information key to service delivery. With the COVID-19 pandemic, the increased need for digital services further accelerated digitisation in health and social care. For example, the UK government created a fund specifically for adult social care providers to adopt digital social care records. These rapid developments offer valuable learning opportunities about digital care record implementation in adult social care settings.
Objective:
This rapid scoping review aimed to understand what is known about the implementation of digital social care records in adult social care and how implementation varies across use cases, settings, and broader contexts.
Methods:
The scoping review methodology was guided by Arksey and O’Malley and refined by Levac et al and the Joanna Briggs Institute. Following Tricco et al, some amendments were made to enable a rapid review. We conducted comprehensive searches based on the concepts of Digital Care Records, Social Care, and Interoperability in MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts. Studies were limited to those published between 2018 and 2023 in English. One reviewer screened titles and abstracts, while two reviewers extracted data. Qualitative content analysis was conducted on the included studies, mapping findings against Greenhalgh et al’s NASSS (Non-adoption, Abandonment, Scale-up, Spread, Sustainability) framework.
Results:
Our search identified 2499 references. After title and abstract screening, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries (including one multi-country), with the UK being the most represented (n=10). Studies were most often undertaken in nursing homes/facilities (n=7) with older people as the target population (n=6). Health records were the most investigated record type (n=12). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning six of the seven NASSS framework domains and aligning with five overarching themes that require greater active management with respect to implementation. Intended or actual implementation outcomes were reported in 17 studies.
Conclusions:
Findings suggest implementing digital care records is particularly complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should utilise robust frameworks and mixed methods or quantitative designs where appropriate. Future research should consider defining the target population, gathering data on carer/service user experiences, and focusing on digital care records specifically being used in social care
Relationships between knee and ankle strength and horizontal deceleration performance at different sprint distances in multi-directional sports athletes
No full textThe aim of this study was to investigate the relationships between knee and ankle strength and horizontal deceleration performance following different sprint distances. Fifty-seven (n = 41male, n = 16 female) youth team-sports athletes completed: a) 5-m and 10-m horizontal deceleration ability (HDA) tests; b) concentric (60°/s, 180°/s) and eccentric (30°/s) relative peak torque (PT) measurements of the knee extensor (KE) and flexor (KF) muscles and the ankle plantarflexion (APF) and dorsiflexion (ADF) muscles in an isokinetic dynamometer. Pearson’s correlation coefficients revealed that concentric at 60°/s and eccentric at 30°/s KE were mostly related to deceleration performance both in HDA5-m (r = −0.50 to −0.61, p < 0.05) and HDA10-m tests (r = −0.50 to −0.63, p < 0.05). Moreover, a significant correlation was observed between concentric APF and average deceleration (DECavg) measured from HDA5-m test in both the dominant leg (DL) and non-dominant leg (NDL) (r = −0.52 to −0.53, p < 0.05), but not to 10-m horizontal deceleration performance. The current results indicate that deceleration performance varies in its demands on knee and ankle strength across different sprint distances. Athletes who frequently decelerate over short distances should focus not only on strengthening their knee strength but also on prioritising ankle strength
Estimated cumulative incidence of intervention by children's social care services to age 18: a whole-of-England administrative data cohort study using the child in need census
Get PDFIntroduction
Each year, children's social care (CSC) recognises around 3% of all children as children in need (CiN) of intervention, including those who receive a child protection plan due to risks of substantial harm and those who become looked after in state care. A previous cumulative estimate of the incidence of becoming CiN of 14% to age 5 indicates that the childhood lifetime incidence is likely very high.
Objectives
We aimed to estimate the cumulative incidence of referrals, social work assessments, being recognised as a CiN or made subject to a child protection plan (CPP) before age 18 in England.
Methods
The annual CiN census contains all-of-England longitudinal records of CSC referrals. Data collection began in 2008, meaning there is no cohort that can be followed up from birth to age 17 (i.e., before 18th birthday). Analyses revealed data quality issues before 2011/12. We estimated the above cumulative incidences in three cohorts and combined them, adjusting numerators to account for left-censoring. The three cohorts were children born in: (a) 2012/13, followed to age 5; (b) 2005/06, followed from age 6 age to 12; and (c) 2000/01, followed from age 13 to 17. We carried out sensitivity analyses to address possible bias induced by linkage error using one of two encrypted identifiers in the dataset.
Results
Of all children living in England, before turning 18, 35.4% were referred, 32.3% were assessed, 25.3% were recorded as CiN and 6.9% were subject to a CPP (37.5%, 34.6%, 26.0% and 7.1%, respectively, in sensitivity analyses).
Conclusions
By age 18, an estimated 1 in 4 children are identified by CSC as needing support at some point. Government should monitor the cumulative incidence of ever receiving CSC support with a view to addressing upstream health and social determinants
Motivated by Compassion: Reviewing the Proposed Public Interest Guidance for Prosecuting Mercy Killings
Get PDFIn 2022, the Crown Prosecution Service started a public consultation on a proposed update to legal guidance on homicide. Among the objectives of this consultation was to guide prosecutors on the public interest factors relevant when deciding whether to prosecute a mercy killing. This article reviews this consultation, focusing on the role of compassion within the CPS's guidelines. The discussion examines the meaning of compassion, how some of the public interest factors relate to this and whether additional factors should be added within the guidelines to help prosecutors identify the suspects’ motives. The suggested adjustments to the prosecutorial guidance will help the prosecution assess whether the suspect indeed acted out of compassion and whether their actions were appropriate given the circumstances
Semi-invasive therapies for pain in knee osteoarthritis: a systematic review and network meta-analysis
Get PDFBackground: The increasing number of semi-invasive pain therapies in knee osteoarthritis poses challenges in decision making. This review aimed to simultaneously compare established intra-articular therapies with newer peri-articular therapies and explore effect modifiers.
Methods: Randomised controlled trials were searched from five electronic databases without date or language restrictions. Study selection and data extraction of reports, retrieved up to May 2024, were performed independently by paired assessors. The primary outcome was six-month pain score. Nine treatments were included. The effect size (ES) for each treatment, relative to placebo, was estimated using standardised means difference and expressed with 95% confidence intervals (CI). The rigour of results was evaluated with subgroup/sensitivity analyses.
Results: A total of 111 studies (14695 participants) were included, with intra-articular hyaluronic acid having the greatest number of participants. Neuro-ablation demonstrated the greatest ES (1.08, 95%CI: 0.07, 2.10). While platelet rich plasma (PRP) ranked second (ES: 0.75, 95% CI: 0.28, 1.22), it was the only intervention demonstrating statistically significant effect at 3, 6, and 12 months. However, this statistical significance was lost in some sensitivity analyses. Larger estimates for biologics and PRP compared to prolotherapy, steroid and hyaluronic acid injections were consistently observed across different time points and in multiple sensitivity analyses. Generally, no statistically significant difference was found between the nine types of therapies.
Conclusion: Although there is robust evidence suggesting greater efficacy of PRP, potentially including biologics, over other interventions, future research is needed to identify the phenotype or patient subgroup that would benefit most from PRP
Urban Metaverse Cyberthreats and Countermeasures Against These Threats
Get PDFCybersecurity and privacy protection are the two crucial challenges in making secure and reliable urban metaverse cyberspaces thrive, as cybercrime activities are expected to be rampant in this ecosystem with trillion dollars of economic value in the years to come. Ensuring seamless connectivity, data accuracy, and user privacy are critical aspects that need further attention for the efficacy of urban metaverse cyberspaces with Urban Twins (UTs), particularly, from technical, legislative, and ethical standpoints. A large number of transactions and immersive experiences shall be managed safely in an automated manner in urban metaverse cyberspaces. Cybersecurity measures in urban cyberspaces encounter a unique set of challenges due to the immersive nature of these spaces. In this direction, this study analyses cyberthreats within urban metaverse cyberspaces and basic countermeasures against these threats
Topical sirolimus in dermatology: a systematic review
No full textTopical sirolimus is increasingly utilized off-licence to manage various dermatological conditions while avoiding typical adverse effects associated with systemic sirolimus. However, widespread use is limited by a highly heterogeneous evidence base of mixed quality. Our aim was to evaluate the current evidence base for the indications, efficacy and safety profile of topical sirolimus in dermatology. A literature search was conducted from 2005 to 4 July 2023, of English-language studies, with the following databases consulted: MEDLINE, PubMed, Embase, CENTRAL and EBSCO. Key words included ‘topical’, ‘rapamycin’, ‘sirolimus’ and ‘dermatology’. Data on drug efficacy, concentration, side-effects, cointerventions and follow-up were extracted. The search identified 202 studies, 71 of which met the inclusion criteria. Efficacy of topical sirolimus was demonstrated in facial angiofibromas (799 patients) compared with placebo across multiple randomized controlled trials, with a predominant concentration of 0.1%. Evidence was mixed for use of sirolimus in port-wine stains (61 patients), with evidence of effectiveness for combined sirolimus and pulsed-dye laser. Multiple case reports demonstrated clinical improvement with topical sirolimus in cutaneous vascular abnormalities (33 patients) at a higher concentration of 1%. Other applications of topical sirolimus were predominantly case reports, demonstrating generally favourable outcomes. Topical sirolimus was generally well tolerated; most reported adverse effects were localized irritation and pruritus. Ointment-based preparations and once-daily dosing appeared to confer a better side-effect profile. Most high-quality data pertain to the efficacy of topical sirolimus in treating facial angiofibromas in tuberous sclerosis. Outcomes are generally promising in other indications, with good tolerability, but data quality is mixed
Is there a link between neurodiversity and stalking? a systematic review
Get PDFPurpose
The increasing conviction rates of stalking in the UK have prompted efforts to identify factors that may influence individuals to engage in such behaviour. Over two million people in England and Wales experience stalking every year, with estimated reoffending rates for stalking being between 25 and 55% (ONS, 2022; McEwan et al., 2017). Research has identified risk factors that may contribute towards stalking behaviours, which has included obsessive relational pursuit and online impulsivity (Post et al., 2014a; Rocheleau, 2019). This has resulted in researchers postulating a link between facets of neurodiversity and stalking behaviour (Freckelton, 2013). The purpose of this study was to examine the evidence base for any link between neurodiversity and stalking.
Design/methodology/approach
The Systematic Review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers were screened for quality appraisal and risk of bias. The initial search yielded 3,880 articles. A total of 10 papers were deemed as meeting the inclusion criteria.
Findings
There is insufficient research quality regarding neurodiversity and stalking perpetration due to poor diagnostic reliability of neurodiversity and a lack of reliable tools being used in the research which do not meet the definitions of stalking. As such, the existing research about neurodiversity and stalking perpetration is inconclusive and predominantly unreliable. Tentative evidence indicated that people with neurodiversity were at greater risk of being victims of stalking and that for the minority of people with neurodiversity who engage in stalking the factors that contribute towards this mirror those of neurotypical individuals.
Practical implications
Overall, the factors contributing to stalking highlighted by the included studies, such as difficulties with communication, empathy, insight into social functioning, interpersonal competence and ways of forming relationships with others, seem to map onto the deficits of neurotypical stalking perpetrators (Canter and Youngs, 2012; Lewis et al., 2001; Mullen et al., 2006). However, tools that contextualise neurodiversity in the context of risk assessments for stalking may be helpful (Al-Attar, 2019, 2021).
Originality/value
Recommendations for further research are made to gain a robust understanding of any potential relationship between neurodiversity and stalking and in particular a risk of stalking victimisation
Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors
Get PDFObjective: To compare costs and consequences of Early Stroke Specialist Vocational Rehabilitation (ESSVR) with usual care in working age, stroke survivors over 12 months.
Design: an economic evaluation nested within the pragmatic, multi-centre, randomised, controlled RETurn to work After stroKE (RETAKE) study.
Setting: Twenty-one English and Welsh NHS hospital-based stroke units. A UK NHS and Personal Social Services perspective was taken in the base-case and a wider perspective (participant, family, employer and other public services) in a secondary analysis.
Participants: 583 stroke survivors age ≥18 years (mean 54.0 years, 69% male).
Interventions: Participants were randomised to ESSVR, an early, individually tailored (in content, dose, intensity and duration) intervention, plus usual care or usual care alone.
Main measures: Disease-specific resource-use data and EQ-5D-5L (health-related quality of life) collected at baseline, three, six and 12 months. Resource-use items were valued using unit costs in UK£ 2021/22. EQ-5D-5L was used to estimate Quality-adjusted life-years (QALYs). If ESSVR was found effective, an incremental cost-utility analysis was planned, otherwise a cost-consequence analysis.
Results: The clinical study found no evidence of a between-group difference in the proportion of participants returning to work at 12 months. This, and the level of missing data, means a cost-consequence analysis is reported. Using imputed data, ESSVR plus usual care is estimated to be more expensive with slightly higher QALYs compared with usual
care.
Conclusions: ESSVR is unlikely to be considered cost-effective over 12 months, which fits with the clinical finding of no between-group difference in return-to-work rates post-stroke.
Clinical trial registration information:
The ISRCTN registry: ISRCTN12464275
https://doi.org/10.1186/ISRCTN1246427