Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance).

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.

Airway and alveolar nitric oxide production, lung function, and pulmonary blood flow in sickle cell disease.

BACKGROUND: Children with sickle cell disease (SCD) often have obstructive lung function abnormalities which could be due to asthma or increased pulmonary blood volume; it is important to determine the underlying mechanism to direct appropriate treatment. In asthmatics, exhaled nitric oxide (FeNO) is elevated. FeNO, however, can also be raised due to increased alveolar production. Our aim, therefore, was to determine if airway or alveolar NO production differed between SCD children and ethnic and age-matched controls. METHODS: Lung function, airway NO flux and alveolar NO production, and effective pulmonary blood flow were assessed in 18 SCD children and 18 ethnic and age-matched controls. RESULTS: The SCD children compared to the controls had a higher respiratory system resistance (P = 0.0008), alveolar NO production (P = 0.0224), and pulmonary blood flow (P < 0.0001), but not airway NO flux. There was no significant correlation between FeNO and respiratory system resistance in either group, but in the SCD children, there were correlations between alveolar NO production (P = 0.0006) and concentration (P < 0.0001) and pulmonary blood flow. CONCLUSION: Airway NO flux was not elevated in the SCD children nor correlated with airways obstruction, suggesting that airways obstruction, at least in some SCD children, is not due to asthma.

Perinatal prevention of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD), defined as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children require frequent readmissions to hospital in the fi rst 2 years, and although lung growth and remodelling results in progressive improvement in lung function, airflow abnormalities may remain. Indeed, the most severely affected experience troublesome respiratory symptoms as adolescents and young adults. As a consequence, many potential preventative strategies have been investigated, and some have resulted in a reduction in BPD but with a negative risk/benefit ratio, for example, postnatal corticosteroids. Others therapies, namely antenatal corticosteroids and postnatal surfactant, have resulted in significant benefits to infants, including reductions in respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and neonatal death, but have not impacted favourably on the incidence of BPD, perhaps due to the increased survival of very immature infants. In one major trial, it has been shown that BPD can be reduced without adverse effects by caffeine administration. Avoidance of high oxygen concentrations at resuscitation is also a promising approach to reduce BPD.

Making workplace wellbeing a priority for the NHS.

Happiness and wellbeing of NHS staff is critical to the quality of care they can provide for patients and communities. It is important for healthcare leaders and local policy makers to continue to foster a nurturing and supportive work culture to enable staff to practice to the best of their abilities and provide safe, sustainable and patient-centred care. This article outlines strategies to improve the NHS as a place of work.

Radiology department preparedness for COVID-19 - experience of a central-London hospital.

The COVID-19 pandemic has placed significant strain on healthcare systems across the world, requiring rapid adaptation and a change in approach to the delivery of healthcare services. Although not always immediately at the frontline, radiology has a key role in the effort against the SARS-CoV-2 virus. Radiology preparedness, including the development of a set of policies and procedures designed to acquire and maintain enough capacity to support the ongoing care needs of patients both with and without COVID-19, is essential in this modern-day healthcare crisis of unprecedented magnitude.

Image guided injection therapies in athletes-Do they work and what should we be using?

In the modern management of the injured elite athlete, the goals of guided injection therapies have extended beyond simple reduction of pain to enhancement of tissue healing and accelerated return to competition, faster than natural healing can allow. This article will review the injection therapies which are frequently used in elite sports injury management and describe other less commonly used injection therapies that are available to the treating clinician and athlete. The evidence base, where available, for each treatment option will be summarised.

A self-measurement device suitable for hospital use: validation of the Spengler Pro M according to the International Protocol of the European Society of Hypertension.

OBJECTIVE: Hypertension affects the global population. The effective management of hypertension requires accurate measurement and monitoring of blood pressure. We evaluated the accuracy of a self-measurement device, with features suitable for hospital practice, in an adult population according to the International Protocol of the European Society of Hypertension. METHODS: After ethical approval, trained observers using a double-headed stethoscope took nine sequential same arm measurements from 33 participants, alternating between mercury sphygmomanometry and the test device. Anyone with an arrhythmia or unclear Korotkoff sounds was excluded. Data was analyzed according to the protocol guidelines. RESULTS: The device passed all the criteria of the International Protocol with 79/94/97 and 72/92/97 of systolic and diastolic differences, respectively within 5/10/15 mmHg of the mercury standard. It also achieved the Association for the Advancement of Medical Instrumentation criteria with a mean difference (standard deviation) of -0.3 (5.8) mmHg for systolic and -0.4 (6.4) mmHg for diastolic pressure. CONCLUSION: The Spengler Pro M device can be recommended for clinical use in an adult population, according to the International Protocol of the European Society of Hypertension. Accuracy in special populations such as those with an arrhythmia or diabetes should be investigated separately.

Surgical volunteerism or voluntourism - Are we doing more harm than good?

The significant rise in the number of international health electives undertaken by medical students and doctors in the US, Canada and UK reflects acknowledgement of the inter-connected nature of these challenges to health systems and the drive to help solve them. However, the next generation of international volunteers often operate under a conflicting duality: whilst many of their role models have devoted their lives to global health following a similar volunteering experience, there are pervasive ethical problems associated with transient global health work that must be identified and addressed to ensure positive outcomes for all parties involved. The majority of populations served by shortterm surgical volunteer trips are vulnerable communities; this raises ethical questions such as the lack of informed consent, use of unauthorised photos for marketing, and practicing new procedural techniques. 2 Whilst there exist various models that can be used to facilitate effective international health electives, there is a lack of stringent monitoring and enforcement both on the part of healthcare institutions deploying volunteers as well as recipient bodies in LMICS. Well-organised programmes prevent cases of 'poor care given to poor people' as medical students and doctors are expected to act in their patients' best interests as they would do in their home country. As clinician interest in global health projects continue to rise, too-common trainee naivety - while rooted in goodwill - must be supplanted by adequate training, ethical coherence, and cultural fluency. The onus lies on medical schools and healthcare bodies endorsing international electives to ensure that individuals are appropriately prepared and only travel through programmes that are able to demonstrate that they meet the necessary requirements and follow guidelines to avoid doing more harm than good.

Student-led leadership training for undergraduate healthcare students.

Purpose Effective clinical leadership is crucial to avoid failings in the delivery of safe health care, particularly during a period of increasing scrutiny and cost-constraints for the National Health Service (NHS). However, there is a paucity of leadership training for health-care students, the future leaders of the NHS, which is due in part to overfilled curricula. The purpose of this study was to assess the impact of student-led leadership training for the benefit of fellow students. Design/methodology/approach To address this training gap, a group of multiprofessional students organised a series of large-group seminars and small-group workshops given by notable health-care leaders at a London university over the course of two consecutive years. Findings The majority of students had not previously received any formal exposure to leadership training. Feedback post-events were almost universally positive, though students expressed a preference for experiential teaching of leadership. Working with university faculty, an inaugural essay prize was founded and student members were given the opportunity to complete internships in real-life quality improvement projects. Originality/value Student-led teaching interventions in leadership can help to fill an unmet teaching need and help to better equip the next generation of health-care workers for future roles as leaders within the NHS.

Exploring the potential impact of health promotion videos as a low cost intervention to reduce health inequalities: a pilot before and after study on Bangladeshis in inner-city London.

BACKGROUND: Coronary artery disease is the single most common cause of death in the UK. For those born in Bangladesh but dying in England and Wales, coronary artery disease causes 25% of all deaths. Cost-effective solutions are required to address this burden. Several studies have demonstrated the effectiveness of educational video intervention in informing patients in various settings. SETTING: A Bangladeshi women's group in South London. QUESTIONS: The effectiveness of a health educational video in influencing the knowledge and attitudes towards a preventable illness amongst Bangladeshis in London? The scope of videos for health promotion? METHODS: An educational video on the signs, symptoms and prevention of coronary artery disease was played to a Bangladeshi women's group in South London in the Bengali language. Participants (n = 18, mean age = 53.7) completed a fifteen-question survey to assess their baseline knowledge prior to viewing (pre-test). The group then viewed the video and repeated the initial questionnaire, with additional questions to solicit their attitudes and perceptions (post-test). RESULTS: The intervention significantly improved the basic knowledge of coronary artery disease. There was a statistically significant improvement in the number of correct responses amongst participants with p = 0.0002 (mean change 2.28, 95% CI 1.29-3.27) and in the number of unsure responses p = 0.0042 (mean change 1.83, 95% CI 0.01-3.01). Upon viewing the video, all participants agreed that they wanted to implement the advice from the video into their current lifestyles. CONCLUSION/DISCUSSION: The educational video significantly improved the knowledge and attitudes pertaining to coronary artery disease amongst British-Bangladeshi individuals in the UK community setting. This project illustrated how commissioners may effectively utilise third-sector organisations through partnerships to implement innovative methods of health screening and promotion. Videos are a novel approach of providing culturally sensitive health education to ethnic minority groups, through screening in clinics and in local media.