Aims & Objectives: To establish trends in HCAI in children admitted to PICU with time and the impact of an ongoing surveillance and analysis programme. Methods Review of all HCAI cases in children admitted to PICU between January 2013-December 2017 and the impact of ongoing quality improvement measures. HCAI considered included central line associated blood stream infections (CLABSI), ventilator associated pneumonia (VAP), surgical site infections (SSI), hospital acquired blood stream infections (HA BSI), catheter associated urinary tract infections (CA UTI) and mucosal barrier injury blood stream infections (MBI BSI). Cases were notified clinically and by analysis of microbiology data and validated at a monthly multidisciplinary HCAI meeting with thematic analysis. Results There were 7062 admissions over the 5 years with 56 623 patient days analysed. Overall PIC mortality was 5.5% There were 184 confirmed HCAI in 165 children (2.4%). 16 children had >/=2 during their PIC stay. 86/184 (47%) were considered preventable. 35 (21%) died but in only one was the HCAI the cause of death. CA UTI's were most common, followed by CLABSI's. There were significant changes with time and QI interventions. The rate of CLABSI's fell from 1/1000 CVC days in 2013 to 0.25 in 2017. Significant reductions in VAP and SSI were also achieved but conversely CA UTI rates rose. Overall HCAI rates fell from 3.5/1000 patient days to 2.3. Conclusions HCAI rates are lower than previously published in this 5 year study but up to half may be prevented with significant impacts on antibiotic exposure and morbidity.
ABSTRACT OF THESISA metacognitive perspective on somatic symptom reporting.Philip Benedict MilnerDoctor of Clinical Psychology, The University of ManchesterJune 2012 The first part of this thesis explores the potential role of metacognitive beliefs and strategies in functional somatic symptoms. Current models (for example, Brown, 2004; Deary, Chalder and Sharpe, 2007) and treatments of functional somatic symptoms focus on cognitive models and cognitive behavioural treatments which show modest treatment effects. A metacognitive account is discussed based upon supervisory regulatory executive function theory (SREF; Wells and Matthews, 1994) and research is systematically reviewed which may support such an account. Current research offers limited indirect support for metacognitive factors playing a role in the difficulties of people suffering from functional somatic symptoms. This paper concludes that further research is needed in this promising area. The second part of the thesis describes a cross-sectional correlational study which examines the relationship of somatic symptom reporting in primary care with metacognitive beliefs, finding a significant association for the first time. Fifty patients were recruited from general practice surgeries took part in the study. Support for the novel Metacognitive Health Questionnaire measure was also found. This measure showed significant associations between health specific metacognitive beliefs and body focussed attention, health preoccupation and distress. This measure also showed significant associations with illness behaviours and thought control strategies. Each of these findings is in line with SREF theory. This study provides preliminary support for the role of metacognition in symptom reporting. The third part of the thesis critically evaluated issues salient to the study including methodologically, supervisory, ethical and clinical issues. The interpretations of the literature review and findings of the research paper are limited by the lack of direct findings to support a metacognitive account, and the cross sectional nature of this study. It is hoped that the prospective study which the research study reported forms part, will offer more robust insights into the role of metacognition in symptom reporting, and that future studies will examine this area further.
To ensure delivery of public health, research is needed on the impact of social, economic, environmental and service-related influences on population health and well-being. This paper reports on a study of the current level of medical and non-medical academic public health R&D capacity, capability and concerns in England. A web-based quantitative survey ascertained details of staff, postgraduate students and research activity in university departments of public health and a sample of wider public health academic and non-academic institutions. In addition, a qualitative survey of selected institutions used focus groups and semi-structured telephone interviews. Although there had been an increase in staffing over the previous decade, the academic workforce was predominantly female and young. Several major deficits in capabilities were uncovered including: lack of secure funding and critical mass to build programmes of work; lack of depth and expertise in academic departments; lack of career pathways; lack of structured training funding; and a need to improve CPD. Concerns were: teaching and research balance; recruitment and retention; identity; conflict between RAE, NHS and multidisciplinary working; medical versus non-medical differentials; and sustainability. A number of recommendations are made but it is recognized that a paradigm shift is required to change the current situation of Public Health research, and that this is unlikely to be initiated from within the current academic structure.
Group B streptococci (GBS) have been recognized as a leading cause of serious early-onset neonatal sepsis for 30 years. Introduction of intrapartum antibiotic prophylaxis (IAP) has led to a decrease in neonatal early-onset GBS (EOGBS) disease and in early neonatal sepsis-related mortality in many countries. At present decisions concerning the administration of IAP are usually based on either the presence of risk factors at the time of labor, or on screening of women at 35–37 weeks gestation. A new generation of rapid test for GBS suitable for point of care use offer the prospect of accurately detecting GBS during labor, which might improve targeting of IAP. Looking further ahead, active immunization of women before or during pregnancy may become the mainstay of prevention of neonatal EOGBS disease. In this article the role of GBS as a neonatal pathogen, and current and possible future strategies for prevention of neonatal EOGBS disease, are reviewed.
The relation between age at registration, socioeconomic status, and survival from cervical cancer for women resident in Sheffield was examined using the 556 such cases registered with the Trent Cancer Registry from 1971 to 1984. The address and electoral ward at registration were used to categorize the socioeconomic status of 99% of the women. Five year survival for all cases was 49%, increasing age having a predictable deleterious effect. Socioeconomic status seemed to have little effect on survival, especially when the covarying effect of age had been taken into account. It is hypothesised that the survival inequalities for cervical cancer demonstrated elsewhere have largely been prevented in Sheffield by good access to effective treatment from the National Health Service.
This paper reports an analysis by small areas of various measures of disease and the use of cervical smear services in the city of Sheffield. The correlation of these with social class and the Jarman underprivileged area score were compared. Wide variations in mortality rates between electoral wards in Sheffield were demonstrated, particularly for deaths from diseases with a large preventable component. Social class correlated more strongly with all-cause mortality (r = 0.69) and preventable mortality (r = 0.91) than did the Jarman score. There was no significant correlation between routine cervical smear rate and either social class or the Jarman score among women under the age of 35 years. Among older women, however, there was a high degree of correlation with fewest smears being taken in the most deprived wards. Social class was more strongly correlated with the invasive cervical cancer rate in electoral wards than was the Jarman score, and was thus a better indicator of the need for cervical screening. However, the Jarman score showed a greater degree of (negative) correlation with the uptake of cervical screening than did social class with disproportionately fewer smears being taken by general practitioners in areas of highest need. Social class may be better than the Jarman score as an indicator of both ill-health and the need for preventive health services in Sheffield. Information is routinely collected decenially on social class and needs little further computation, unlike the Jarman score. Furthermore, much is already known about the relationships between social class and both ill-health and the need for preventive services.
In a district where cytology services were severely stressed, small area variations in cervical cancer and cervical screening activity showed the same lack of concordance as in other studies of larger areas. In electoral wards with high indices of socio-economic deprivation, where the incidence of and deaths from cervical cancer were high, screening uptake was low in women aged 35 years and over, and the number of smears taken by general practitioners disproportionately low. Moreover, there was evidence of a high case fatality rate in the most deprived areas. Whilst there was a strong negative correlation between smear rate in older women and indicators of socio-economic deprivation (rs−0.7l,p<0.001), this was not the case for younger women amongst whom smears were taken with particularly high frequency by health authority and family planning clinics. Eighty-three per cent of deaths from cervical cancer in Sheffield occurred in those aged 50 years or over, but only 12 per cent of smears come from this group. Sufficient resources are currently deployed to allow each woman in the district aged between 15 and 64 years to have a smear every four years. A high proportion however are having smears more frequently and approximately 50 per cent of smear resources are being used by 19 per cent of women.
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