Patient partnership in cardiovascular clinical trials.

Patients are ultimately the end-users of medical therapies and need to be actively integrated as contributors and decision-makers in the process of product development throughout product lifecycles. This is increasingly being recognized by patients, investigators, regulators, payers, sponsors, and medical journals. However, cardiovascular research remains behind other fields in terms of the extent of patient involvement and awareness of clinical trials in cardiovascular research. True patient partnerships in cardiovascular therapeutic development may permit more rapid recognition of unmet needs, ensure alignment of product development priorities with patient priorities, improve efficiency of trials (e.g. recruitment), and ensure outcomes of value to patients are being measured in trials (e.g. quality of life). This paper reviews ongoing initiatives and remaining opportunities to accomplish contributive patient involvement in cardiovascular clinical research.

Gauge/Gravity Dynamics for Composite Higgs Models and the Top Mass.

We provide gauge/gravity dual descriptions of explicit realizations of the strong coupling sector of composite Higgs models using insights from nonconformal examples of the AdS/CFT correspondence. We calculate particle masses and pion decay constants for proposed Sp(4) and SU(4) gauge theories, where there is the best lattice data for comparison. Our results compare favorably to lattice studies and go beyond those due to a greater flexibility in choosing the fermion content. That content changes the running dynamics and its choice can lead to sizable changes in the bound state masses. We describe top partners by a dual fermionic field in the bulk. Including suitable higher dimension operators can ensure a top mass consistent with the standard model.

Use of clinician-performed ultrasound in the assessment of safe umbilical venous catheter tip placement.

AIM: Safe tip placement of umbilical venous catheters (UVCs) in sick neonates is critical in minimising risk. We aimed to demonstrate the utility of clinician-performed ultrasound (CPU) in identifying UVCs that are placed within small intrahepatic portal vessels or within the heart despite the appearance of being well placed on X-ray. METHODS: This was a retrospective observational study of preterm and term neonates who had a UVC placed and the position assessed by X-ray and/or CPU according to the Royal Prince Alfred Hospital level 3 neonatal intensive care unit (NICU) guideline. Cases were identified by exporting the records of all admissions between 1 April 2015 and 30 June 2016 from the NICU's data collection database. Paper-based medical records, NICU's data collection database records and the ultrasound reporting system were reviewed to determine X-ray and CPU findings. RESULTS: A total of 157 neonates had 169 UVCs placed. CPU was performed in 77% (111). In 15 cases (14%), UVC placement on X-ray appeared appropriate based on estimated vertebral level; however, CPU demonstrated the line to be in an unsafe position (small intrahepatic portal vessel (3); right atrium (9); left atrium (3)). CONCLUSIONS: Assessment of safe UVC placement by estimations according to vertebral level on X-ray alone is inadequate. CPU offers confident localisation of the UVC tip and enables corrective manipulation of intracardiac or intrahepatic UVCs in real time. We recommend CPU as an adjunct to X-ray to ensure safe UVC placement.

Feasibility and utility of portable ultrasound during retrieval of sick preterm infants.

AIM: Document the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport. METHOD: A transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤30 weeks gestation. RESULTS: Forty-four newborns were studied in 2008-2015; of them, 21 were transported by road, 19, by helicopter and four, by fixed wing: median birthweight, 1130 g (680-1960 g) and median gestation, 27 weeks (23-30); 30 of 44 were male babies. Antenatal steroid course was complete in two babies. Ultrasound in the referring hospital was at a mean of two hours: 47 minutes (00:15-7:00) of age. Low systemic blood flow was common: 50% had right ventricular output <150mL/kg/min and 23%, a superior vena cava flow <50mL/kg/min. at stabilisation. Cranial US: 10 Grade I IVH, 2 Grade II IVH, 1 Grade IV IVH and 32 normal scans pretransport. After transport, three further Grade I IVH were reported. Mortality was higher in the babies with low systemic blood flow: 4 of 12 (33%) died vs 1 of 31 (6%) in the normal flow group (OR = 7.2, 95% CI: 1.1 to 47, p = 0.022). CONCLUSION: Point-of-care ultrasound during the retrieval of preterm infants confirms a high incidence of haemodynamic pathology. The use of ultrasound during transport may provide an opportunity for earlier targeted circulatory support.

Pressures force hospitals to declare major incidents.

More than 40% of hospitals in England were forced to declare major incidents during the first week of January, as bed shortages led to delays in emergency departments (EDs), thousands of trolley waits for beds and long queues of ambulances outside units. Even cancer operations, normally protected, were cancelled.

NHS England promises to prioritise emergency care.

Emergency care has been identified as one of four priorities by NHS England chief executive Simon Stevens. The others are cancer care, general practice and mental health care.

Clock ticking again on four-hour target.

Emergency departments (EDs) in England have been told they need to start hitting the four-hour target again by March 2018. Health secretary Jeremy Hunt has set the deadline following the announcement of extra money in the Budget.

There's more to staff recruitment than pay: NHS Improvement.

Retaining staff remains a major problem for the NHS. Over the past six years the proportion of nurses leaving the health service has risen by one quarter, to top 10% in 2016.

Number crunching: are there enough nurses?

Throughout the election campaign, the Conservatives have been keen to point out how it has increased the number of nurses in hospitals.

What the election means for the NHS.

In many ways it is curious that the NHS did not feature more prominently in the election campaign. Polling consistently showed it was the most important issue for the electorate after Brexit.

How care homes are being short-changed.

In England, four in ten care home residents pay the full cost of their care. But new research from analysts LaingBuisson suggests they may also be paying for the care of those who get help from the state.

International experts call for atrial fibrillation screening programme.

Screening programmes need to be introduced to detect irregular heart rates among older patients, according to an international collaboration of experts.

Advancing care of residents in care homes.

There are more than twice as many people living in care homes in the UK than there are inpatients in NHS hospitals, yet there is much less research about how to provide the best care for these 416,000 residents.

MPs demand urgent review of social care funding.

The timing was uncanny. First came the upbeat tone of NHS England's progress report on its 2014 Five Year Forward View.

Prospective Surveillance of Extreme Neonatal Hyperbilirubinemia in Australia.

OBJECTIVES: To determine the incidence, causes, associated factors, and short-term outcomes of extreme neonatal hyperbilirubinemia in Australia in order to identify opportunities for prevention. STUDY DESIGN: This was a prospective population-based surveillance study in collaboration with the Australian Pediatric Surveillance Unit between April 1, 2010, and March 31, 2013. Case definition was: infants >34 weeks gestation with a peak total serum bilirubin ≥450 µmol/L and or clinical evidence of bilirubin encephalopathy. Clinicians completed questionnaires detailing demographic and clinical data including: peak serum bilirubin, signs of bilirubin encephalopathy, etiology, associated pathology, management, and short-term outcomes. RESULTS: The questionnaire return rate was 95%, and 87 infants met the case definition. The Australian incidence of extreme neonatal hyperbilirubinemia is estimated to be 9.4/100,000 live births. Main etiologies were: idiopathic ABO blood group incompatibility, glucose-6-phosphate dehydrogenase deficiency, and Rhesus isoimmunization. There were no significant differences in short-term outcomes between inpatient and outpatient cases. Cases with a hemolytic etiology were significantly more likely to have extremely high levels of hyperbilirubinemia (P < .002). CONCLUSION: The incidence of extreme neonatal hyperbilirubinemia in Australia is comparable with previous studies. Robust pre- and post-discharge assessment and management strategies of neonatal hyperbilirubinemia are essential to prevent neurodisability. Universal glucose-6-phosphate dehydrogenase screening and serial bilirubin monitoring may optimize preventative strategies.

Feasibility and utility of portable ultrasound during retrieval of sick term and late preterm infants.

AIM: To determine the role of clinician performed ultrasound (CPU) during the retrieval and transport of critically ill term and near term newborns. METHODS: A neonatologist with portable ultrasound accompanied a sample of newborn retrievals to perform cardiac and cerebral ultrasound before and after transportation. RESULTS: A total of fifty-five babies were studied. Median birthweight: 3350 g (2220-5030 g). CPU led to a change in the planned receiving hospital in ten babies. Eleven babies were suspected congenital heart disease (CHD) prior to retrieval: eight confirmed CHD by CPU and three normal structure. One transported to a children's hospital for cardiology review was confirmed as having normal structure; one to a perinatal hospital where normal structure was confirmed and one baby died at the referring hospital and postmortem confirmed normal structure. In five babies with clinical pulmonary hypertension, CPU revealed unsuspected CHD. The destination was changed to a paediatric cardiology centre, avoiding a second retrieval. Eleven babies had evidence of haemodynamic compromise allowing targeting of inotropes. CONCLUSION: This is the first study of CPU during retrieval of high-risk infants. Ultrasound in retrieval is feasible, allows accurate triage of babies to cardiac centres and may allow more accurate targeting of fluid and inotrope support.

Close to the tipping point.

Rising attendances at emergency departments (EDs), lengthening waiting times and increasing numbers of admissions are well documented.

Relieving pressure on struggling emergency departments.

January 2016 was one of the most difficult months for emergency departments since the four-hour waiting time standard was introduced by the government in 2004. Patient demand was high and the percentages of people admitted or discharged within four hours fell to some of its lowest levels in all UK countries. This article gives an overview of the situation across the four nations and explores the reasons behind the statistics. It also outlines what hospitals and local authorities are doing to relieve pressures and cope with unprecedented demand.

Surviving out-of-hospital cardiac arrest.

Emergency care nurses have been urged to play their part in Scotland's push to revolutionise care for cardiac arrest patients - by teaching others how to save a life. This article discusses the Scottish out-of-hospital cardiac arrest strategy, with particular focus on the drive to increase bystander cardiopulmonary resuscitation (CPR) rates, and on how emergency nurses are being enlisted to help promote the training of members of the public.

Leading Change, Adding Value.

Essential facts Leading Change, Adding Value is NHS England's new nursing and midwifery framework. It builds on Compassion in Practice (CiP), which set out the 6Cs. While CiP established the values of nursing and midwifery, the new framework explains how staff can help transform the health and care sectors to meet the aims of the NHS England's Five Year Forward View.