NHS 111 Clinical Assessment Services: paediatric consultations.

Around the UK, commissioners have different models for delivering NHS 111, General Practice (GP) out-of-hours and urgent care services, focusing on telephony to help deliver urgent and emergency care. During the (early phases of the) COVID-19 pandemic, NHS 111 experienced an unprecedented volume of calls. At any time, 25%-30% of calls relate to children and young people (CYP). In response, the CYP's Transformation and Integrated Urgent Care teams at NHS England and NHS Improvement (NHSE/I) assisted in redeploying volunteer paediatricians into the integrated urgent care NHS 111 Clinical Assessment Services (CAS), taking calls about CYP. From this work, key stakeholders developed a paediatric 111 consultation framework, as well as learning outcomes, key capabilities and illustrations mapped against the Royal College of Paediatrics and Child Health (RCPCH) Progress curriculum domains, to aid paediatricians in training to undertake NHS 111 activities. These learning outcomes and key capabilities have been endorsed by the RCPCH Curriculum Review Group and are recommended to form part of the integrated urgent care service specification and workforce blueprint to improve outcomes for CYP.

The mass-specific energy cost of human walking is set by stature.

The metabolic and mechanical requirements of walking are considered to be of fundamental importance to the health, physiological function and even the evolution of modern humans. Although walking energy expenditure and gait mechanics are clearly linked, a direct quantitative relationship has not emerged in more than a century of formal investigation. Here, on the basis of previous observations that children and smaller adult walkers expend more energy on a per kilogram basis than larger ones do, and the theory of dynamic similarity, we hypothesized that body length (or stature, L(b)) explains the apparent body-size dependency of human walking economy. We measured metabolic rates and gait mechanics at six speeds from 0.4 to 1.9 m s(-1) in 48 human subjects who varied by a factor of 1.5 in stature and approximately six in both age and body mass. In accordance with theoretical expectation, we found the most economical walking speeds measured (J kg(-1) m(-1)) to be dynamically equivalent (i.e. similar U, where U=velocity(2)/gravity · leg length) among smaller and larger individuals. At these speeds, stride lengths were directly proportional to stature whereas the metabolic cost per stride was largely invariant (2.74±0.12 J kg(-1) stride(-1)). The tight coupling of stature, gait mechanics and metabolic energy expenditure resulted in an inverse relationship between mass-specific transport costs and stature (E(trans)/M(b)∝L(b)(-0.95), J kg(-1) m(-1)). We conclude that humans spanning a broad range of ages, statures and masses incur the same mass-specific metabolic cost to walk a horizontal distance equal to their stature.

Assessing the metabolic cost of walking: the influence of baseline subtractions.

Partitioning locomotor metabolic rates into resting and locomotor components is a common practice that has both basic and applied value. Here, we evaluated the quantitative influence of the specific baseline value subtracted (quiet standing vs. resting metabolic rates) from the gross metabolic rates measured during walking. We quantified resting, standing and gross metabolic rates during horizontal treadmill walking at six speeds from 0.2 through 1.9 m*s(-1) in 6 healthy, adult subjects. We found that standing metabolic rates were significantly greater than resting values (1.25 +/- 0.03 vs. 1.08 +/- 0.02 W*kg(-1)) and that both constituted large fractions of the gross metabolic rate while walking at all speeds examined (range 16-58%). Differences in the respective net metabolic rates obtained by subtracting standing vs. resting values differed most at the slowest speed measured (16.0% at 0.2 m*s(-1)) and least at the fastest one (2.9% at 1.9 m*s(-1)). Standing metabolic rates, like walking metabolic rates, include the metabolic cost of muscular activation for balance and maintaining an upright posture. Therefore, the net metabolic rates determined by subtracting standing from gross rates underestimate the total muscular costs that walking requires. We suggest that the net walking metabolic rates obtained by subtracting resting metabolic rate values are more representative of the total metabolic energy that walking requires.

Quality of life and cholinesterase inhibitors: a qualitative study of patients with Alzheimer's disease and their carers.

OBJECTIVES: Cholinesterase inhibitors' (ChEIs) impact on cognitive functioning in Alzheimer's disease has been extensively researched. The effect of ChEIs on improving day-to-day living and quality of life in conjunction with level of functioning for patients or their carers has not been investigated. METHOD: Five spouse dyads (patient and carer) and one additional carer were interviewed about their perceptions of ChEIs in relation to their influence on daily life for both parties. Interviews were transcribed and thematic analysis conducted. RESULTS: Themes identified were forgetfulness, differences in long-term versus short-term memory, independence/dependence, negative emotion, no appreciable benefit, sense of hopelessness, carer as motivator, stabilization of the patient, and never regain what has been lost. CONCLUSIONS: This study suggests that ChEI medication does not enhance life for the patient or their primary caregiver. Further qualitative and quantitative research is required into the impact of ChEIs upon both the patient and their caregivers.