Showing papers by "Nigel Davies published in 2022"

Intestinal Absorption of FITC-Dextrans and Macromolecular Model Drugs in the Rat Intestinal Instillation Model

Abstract: In this work, we studied the intestinal absorption of a peptide with a molecular weight of 4353 Da (MEDI7219) and a protein having a molecular weight of 11 740 Da (PEP12210) in the rat intestinal instillation model and compared their absorption to fluorescein isothiocyanate (FITC)-labeled dextrans of similar molecular weights (4 and 10 kDa). To increase the absorption of the compounds, the permeation enhancer sodium caprate (C10) was included in the liquid formulations at concentrations of 50 and 300 mM. All studied compounds displayed an increased absorption rate and extent when delivered together with 50 mM C10 as compared to control formulations not containing C10. The time period during which the macromolecules maintained an increased permeability through the intestinal epithelium was approximately 20 min for all studied compounds at 50 mM C10. For the formulations containing 300 mM C10, it was noted that the dextrans displayed an increased absorption rate (compared to 50 mM C10), and their absorption continued for at least 60 min. The absorption rate of MEDI7219, on the other hand, was similar at both studied C10 concentrations, but the duration of absorption was extended at the higher enhancer concentration, leading to an increase in the overall extent of absorption. The absorption of PEP12210 was similar in terms of the rate and duration at both studied C10 concentrations. This is likely caused by the instability of this molecule in the intestinal lumen. The degradation decreases the luminal concentrations over time, which in turn limits absorption at time points beyond 20 min. The results from this study show that permeation enhancement effects cannot be extrapolated between different types of macromolecules. Furthermore, to maximize the absorption of a macromolecule delivered together with C10, prolonging the duration of absorption appears to be important. In addition, the macromolecule needs to be stable enough in the intestinal lumen to take advantage of the prolonged absorption time window enabled by the permeation enhancer.

Non-Fungible Tokens as a Mechanism for Representing Patient Consent

Abstract: In recent years we have seen the adoption of distributed ledger technology (DLT), originally the mechanism underpinning the operation of the Bitcoin crypto currency, across a wider range of technology sectors including healthcare. DLT allows for the design of informatics systems with the properties of immutability, security, and decentralization. One recent innovation in the space has been the specification and development of Non-Fungible Tokens (NFTs). NFTs are decentralized DLT-based records that represent ownership of a unique digital asset. The predominant current use case for NFTs has been in the representation and sale of digital artwork, however the features offered by NFTs, unique-ness, immutability, transferability, and verifiability, are directly applicable to the design of health informatics systems. In this paper we explore these properties and describe a reference architecture for using NFTs as a means of representing and transferring records of patient's consent for medical data use.

“Raising the curtain on the equality theatre”: a study of recruitment to first healthcare job post-qualification in the UK National Health Service

Abstract: Abstract Background UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations. Aim To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups. Methods The study was informed by critical theory and the authors’ interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers. Results Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches. Conclusion These accounts from 12 recruiting managers give a ‘backstage’ view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to ‘raise the curtain on the equality theatre’ and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.

The evidence base for interprofessional education within health professions education: A protocol for an update review

Abstract: ABSTRACT Interprofessional education (IPE) interventions aiming to promote collaborative competence and improve the delivery of health and social care processes and outcomes continue to evolve. This paper reports on a protocol for an update review that we will conduct to identify and describe how the IPE evidence base has evolved in the last 7 years. We will identify literature through a systematic search of the following electronic databases: Medline, Embase, CINAHL, Education Source, ERIC, and BEI. We will consider all IPE interventions delivered to health professions students and accredited professionals. Peer-reviewed empirical research studies published in any language from June 2014 onwards will be eligible for inclusion. The outcomes of interest are changes in the reaction, attitudes/perceptions, knowledge/skills acquisition, behaviors, organizational practice, and/or benefits to patients. We will perform each task of screening, critical appraisal, data abstraction, and synthesis using at least two members of the review team. The review will enable an update and comprehensive understanding of the IPE evidence base to inform future IPE developments, delivery and evaluation across education and clinical settings.

668 Should we formally verify the tetanus and MMR vaccination status of all those < 2 years of age attending the paediatric emergency department?

Abstract:

Aims

Vaccines are a great global health success. However, in the UK, populations remain vulnerable to vaccine-preventable diseases due to variable coverage. Recent data for Lancashire and Greater Manchester showed 93.5% of children had completed a primary course of tetanus vaccination and 90.2% had received a first dose of MMR (MMR1) by their second birthday. Every year in England, millions of children and young people (CYP) attend Paediatric Emergency Departments (PED), with under-twos relatively over-represented. Many may have additional unmet health need (e.g. be under-immunised). The PED attendance therefore offers an opportunity to improve health beyond the reason for presentation and a pilot suggests that parents/carers are amenable to this. This work is part of a larger project assessing sources of vaccination data and levels of unmet vaccination-related need in PED attendees. The aim of the component presented here was to explore the vaccination status of children under the age of two, with a focus on tetanus-containing vaccines and MMR1. Vaccination is important in the PED management of a tetanus-prone wound and MMR1 protects against measles and mumps, both of which cause outbreaks where vaccination is part of the control strategy.

Methods

This cross-sectional observational study had a single data point for each participant attending the PED of a large district general in Greater Manchester in October 2021. Ethics approval was obtained to use an ‘opt-out’ approach. A power calculation showed 577 participants were needed to detect a five percent difference between PED attendees and their peers. Vaccination data were extracted from individual electronic summary care records (SCR) (part of the primary care record visible to those in secondary care).

Results

In the study period, 724 children under the age of two attended the PED. As first routine immunisations are offered at the age of two months, all those under this age were excluded (n = 116). SCRs were not available for a further 58 children, meaning 550 sets of data were included in the analysis. At the time of attendance, 86.5% of children were up-to-date with tetanus-containing and MMR vaccination (where age-appropriate), when compared to the national schedule (tetanus at 2, 3,and 4 months; MMR around 12-13 months). However, amongst those eligible to receive an MMR (over the age of 13 months; n = 284), this dropped to 81.7%. In this older age group, there were 17 children who had incomplete tetanus and no MMR1.

Conclusion

Children under the age of two attending the PED appear to be no better vaccinated than their local peers and may have even lower coverage rates for MMR1. Ongoing work will look at coverage in older age groups. An earlier part of this work demonstrated that parent/care recall of vaccination status should not be the only source of vaccination data during a consultation (due to its low specificity), suggesting vaccination status should be formally checked where possible e.g. via SCRs. This population might benefit from an intervention to improve vaccination uptake, delivered in the PED and future work will seek to co-design one or more interventions.