Showing papers by "Leicester Royal Infirmary published in 2022"

General Oncology Care in Syria

Abstract: Abstract The first entity dedicated to cancer was established named “Nuclear Medical Center” with a single radiotherapy unit in 1969. Since then, the concept of oncology has rapidly progressed with the establishment of a division of oncology in the University of Damascus, School of Medicine with six staff members at that time. In 2001, a National Cancer Registry was established with the help of the World Health Organization. Many civil societies related to cancer awareness, early detection, and care of patients bloomed, first being the Syrian Cancer Society. Now cancer diagnosis and treatment facilities are spread all over the county but mainly concentrated in Damascus, Lattakia, and Aleppo. All three main government related medical entities that are the Ministry of Higher Education, Ministry of Health, and the Medical Corps are involved in the process with the help of the private sector also. This progress of course was slowed due to the bloody aggression that engulfed Syria for 10 years of conflict. However, it did not halt the country’s goals and achievements. In 2006, Nuclear Medicine Centre was developed into a comprehensive institution for cancer, Al Bairouni University Hospital (ABUH) to provide free standard of care treatment for all citizens. The Syrian National Committee for cancer control (SNCCC) was established in June 2019 with a mission of strategic planning for better cancer management in collaboration with all stakeholders aiming to raise cancer services to the best possible standard in the post-war era. The chapters’ focus is to discuss cancer care services being provided in the country and future challenges that need to be addressed for high quality oncology care services in Syria.

African Forest-Fringe Farmers Benefit from Modern Farming Practices despite High Environmental Impacts

Abstract: Agricultural expansion has led to a significant loss of habitat and biodiversity in Ghana and throughout West Africa and the tropics generally. Most farmers adopt both organic and inorganic inputs to boost production, with the potential to slow agricultural expansion, but with relatively little consideration of related environmental impacts. In Ghana, where high-input modern farming is rapidly overtaking traditional organic agricultural practices, we examined five stakeholder groups in regard to their perceptions of the environmental, economic, and social costs and benefits of modern, mixed-input, and traditional farming systems. The stakeholder groups included farmers adopting different agricultural practices, as well as governmental and non-governmental natural resource managers. Our findings indicate that the overall perceived costs of modern farming, attributable to large quantities of inorganic inputs, are higher than the overall perceived benefits. Farmers are, however, still motivated to practice modern farming because of perceived higher returns on investment, regardless of environmental impacts, which they tend to discount. Traditional farmers do not use inorganic inputs and instead rely on swidden ‘slash-and-burn’ practices, resulting in declining productivity and soil fertility over time. Since traditional farmers are ultimately forced to encroach into nearby forests to maintain productivity, the perceived environmental sustainability of such farming systems is also limited. Mixed-input farming is not significantly different from modern farming with respect to its perceived environmental and economic traits, because it incorporates agro-chemicals alongside organic practices. Stakeholders’ perceptions and the apparent environmental outcomes of different farming systems suggest that reducing the use of inorganic inputs and promoting the adoption of organic inputs could minimise the negative impacts of agro-chemicals on the forest environment without necessarily compromising productivity. Campaigns to promote low-input or organic agriculture on environmental grounds in West Africa may falter if they fail to recognise farmers’ relatively favourable perceptions of the environmental implications of modern farming practices.

A Gallery Model for Affine Flag Varieties via Chimney Retractions

Abstract: Abstract This paper provides a unified combinatorial framework to study orbits in certain affine flag varieties via the associated Bruhat–Tits buildings. We first formulate, for arbitrary affine buildings, the notion of a chimney retraction. This simultaneously generalizes the two well-known notions of retractions in affine buildings: retractions from chambers at infinity and retractions from alcoves. We then present a recursive formula for computing the images of certain minimal galleries in the building under chimney retractions, using purely combinatorial tools associated to the underlying affine Weyl group. Finally, for Bruhat–Tits buildings in the function field case, we relate these retractions and their effect on minimal galleries to double coset intersections in the corresponding affine flag variety.

Peer Review Report For: Mixed-methods evaluation of the NHS Genomic Medicine Service for paediatric rare diseases: study protocol [version 2; peer review: 3 approved, 1 approved with reservations]

Abstract: Background: A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently established to deliver genomic testing with equity of access for patients affected by rare diseases and cancer. The overarching aim of this research is to evaluate the implementation of the GMS during its early years, identify barriers and enablers to successful implementation, and provide recommendations for practice. The focus will be on the use of genomic testing for paediatric rare diseases. Methods: This will be a four-year mixed-methods research programme using clinic observations, interviews and surveys. Study 1 consists of qualitative interviews with designers/implementers of the GMS in Year 1 of the research programme, along with documentary analysis to understand the intended outcomes for the Service. These will be revisited in Year 4 to compare intended outcomes with what happened in practice, and to identify barriers and facilitators that were encountered along the way. Study 2 consists of clinic observations (pre-test counselling and results disclosure) to examine the interaction between health professionals and parents, along with follow-up interviews with both after each observation. Study 3 consists of a longitudinal survey with parents at two timepoints (time of testing and 12 months post-results) along with follow-up interviews, to examine parent-reported experiences and outcomes. Study 4 consists of qualitative interviews and a cross-sectional survey with medical specialists to identify preparedness, facilitators and challenges to mainstreaming genomic testing. The use of theory-based and pre-specified constructs will help generalise the findings and enable integration across the various sub-studies. Dissemination: We will disseminate our results to policymakers as findings emerge, so any suggested changes to service provision can be considered in a timely manner. A workshop with key stakeholders will be held in Year 4 to develop and agree a set of recommendations for practice.

The Impact of COVID-19 on the Choice of Treatment for Hand Fractures: A Single-Centre Concordance Study

Abstract: Background: Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a 'one-stop' clinic on initial presentation. Our aim was to evaluate the effect of coronavirus disease 2019 (COVID-19) on the choice of treatment for hand fractures using inter-rater agreement between surgeons. Methods: All patients with hand fractures during the COVID-19 lockdown from March to May 2020 were included in the study. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and relevant clinical history to provide their opinion on optimal treatment. Weighted kappa analysis was performed to determine concordance and inter-rater agreement between the two surgeons and actual management. Results: The study included 82 patients (62 men and 20 women) with a mean age of 40.3 (SD 19.7). The injuries occurred most often at home following an accident (34%) or a fall (28%). Fractures involved the metacarpals in 29 patients and the distal phalanx in 22 patients. Thirty-five patients underwent surgery, whereas 47 were managed conservatively. Overall agreement between actual management and consultant A and consultant B was moderate (κ = 0.55, p < 0.0001 and κ = 0.63, p < 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and consultant A and consultant B (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p < 0.0001), but weak for distal phalanx fractures (κ = 0.29, p = 0.03). Conclusion: Our study has shown that overall management of hand fractures remained optimised throughout the pandemic. However, a lack of concordance was observed in the management of metacarpals. Level of Evidence: Level IV (Therapeutic).

Covid-19 and its implications for the provision of gynecological services globally

Abstract: Covid-19 took the world by surprise and has completely changed the way humans live and work. There is hardly an aspect of life that has not been affected. Whether social, economic, physical, psychological, cultural or religious, this pandemic has revolutionized every aspect of our lives and some of these changes are here to stay for the unforeseeable time. Although much has been written about the negative effects of Covid-19 on our social lives, some technological advances on COVID-19 have profoundly affected various aspects of our lives. These are mostly to do with how we communicate, deliver health services, innovate and investigate new preventative measures and treatments, travel and indeed influenced the carbon footprint of the planet. Although most of gynaecology is elective and was therefore not considered a priority in the early phases of COVI-19, there are considerable consequences of delaying treatment for some of these elective conditions. Of particular importance are infertility, pre-malignant conditions, chronic pelvic pain, sexual disorders and those affecting the psychological and social aspects of women and families. The pandemic forced a rethink of how healthcare is delivered with wide adoption of remote/virtual consultation and triaging of clinical presentations. The rapid development of immunization and drugs against the virus was met with doubts by a large proportion of the population with reluctance to accept these. Consequently, there remains unvaccinated portions of both low and high-risk populations, some of whom may be denied access to gynaecological care. On the other hand, some pregnant women who are frightened of the impact of vaccination on pregnancy put their own lives at risk. While significant progress has been made to combat the pandemic, lessons about healthcare delivery (face-to-face versus virtual), education of the end users and introduction of new technologies into the development of drugs and vaccines must be evaluated and improved moving forward not only during the ongoing epidemic but with future outbreaks.

Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups

Abstract: More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.