Appropriateness of two-week wait head and neck cancer referrals to a district general hospital.

Objectives The NHS advise urgent referral of patients with suspected head and neck cancers to secondary care to be seen via a two-week wait pathway. The objective of this review was to analyse the two-week wait head and neck cancer referrals to a district general hospital and to identify the prevalence of oral cancer.Materials and methods Patients referred via an urgent two-week wait cancer pathway during the period of 12 October 2020 to 19 January 2022 were identified. Data were extracted and analysed for referral source, patient sex, whether or not a biopsy was undertaken, and the number of patients with a final positive cancer diagnosis.Results Overall, 883 two-week wait referrals were received. Most referrals came from general medical practitioners (50%) followed by general dental practitioners (37%). A total of 379 patients (46%) underwent a biopsy, special investigations, or internal referral to another speciality. The overall prevalence of cancer was 6.2%. Most referrals received were for commonly occurring benign conditions.Conclusion Despite many two-week wait suspected cancer referrals, only a small percentage of patients go on to be diagnosed with head and neck cancer. These results highlight the number of avoidable referrals, which ultimately impact patient waiting lists and clinician time.

Evolutions in undirected travel (satisfaction) during the COVID-19 pandemic.

The COVID-19 pandemic illustrated that undirected travel (UT), or trips taken for their own sake, can partly compensate for a reduction in destination-based trips due to governmental regulations. Consequently, UT (in general, but particularly during the pandemic) may be especially satisfying and therefore important to subjective well-being. However, through the course of the pandemic, changes in UT were anticipated as individuals adapted to a 'new normal'. This research - conducted in Flanders, Belgium - first investigates whether the characteristics of and satisfaction with UT persisted after one year into the pandemic (April 2020 to May 2021) using longitudinal panel data from two waves (n = 332). Results of paired sample t-tests indicate that UT satisfaction increased though duration of trips decreased, and results of the Sign test indicate that the frequency of UT generally decreased. Second, this research investigates characteristics of individuals with different UT behavior. Six profiles of UT behavior were identified based on starting or stopping UT, increasing or decreasing UT, maintaining UT frequency, or not participating in UT. Chi2 tests identified differences among profiles based on wave 1 UT frequency, most recent trip mode, socio-demographic, and household characteristics. Results indicate that participation in UT might motivate future UT, one to three UT trips per week is a maintainable frequency, UT might be important to those with smaller living spaces and those living with children or other adults, and suggest that attention should be paid to mobility equity, including how and for whom systems are planned. These findings are important to understanding the effects of long-term governmental regulations in response to the COVID-19 pandemic on travel behavior, and how investigating UT might help to challenge and reimagine traditional mobility systems post-pandemic.

City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities.

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Assessing the Quality and Performance of Institutional Review Boards: Impact of the Revised Common Rule.

The Common Rule, revised extensively to enhance human subjects protections and to reduce burdens to investigators and institutional review boards (IRBs), was implemented on January 19, 2019. We analyzed IRB performance metric data from 2016 through 2021 to evaluate the potential impact of the revised Common Rule on the quality and performance of IRBs. From 2016 to 2021, exempt protocols increased by 159% and protocols requiring IRB continuing reviews decreased by 28%. As only 48% of all protocols in 2021 were subjected to the revised Common Rule requirements, numbers of exempt protocols and protocols requiring IRB continuing reviews will continue to increase and decrease, respectively, in the next few years. Among a total of 16 IRB performance metrics studied, 4 improved, 4 deteriorated, and 8 remained unchanged from 2016 through 2021. This study represents the first effort to evaluate the impact of revised Common rule on IRB quality and performance.

A Consideration of Professionalism for Dental Professionals.

Professionalism is an ubiquitous word in dentistry. Whilst we often feel we have an innate understanding of it, there is no single clear definition as to what professionalism in dentistry really means. Therefore, how can we truly comprehend what is expected of us? This article aims to explore current literature regarding professionalism and provide some clarity as to what this means with regards to dentistry in the United Kingdom. Guidance from the General Dental Council's (GDC) document Preparing for Practice1 breaks professionalism into four categories: (1) patients and the public, (2) ethical and legal, (3) teamwork, and (4) development of self and others. Investigation into each of these categories alongside the GDC's most recent study Professionalism: A Mixed-Methods Research Study2 enables an unambiguous view of professionalism in dentistry from the GDC's perspective. Whilst the GDC's Preparing for Practice and Professionalism: A Mixed-Methods Research Study are good starting points in improving our understanding of professionalism, it is still very much open to interpretation by the individual, owing to lack of a clear-cut definition. Overall, professionalism remains a vague and poorly defined concept in dentistry.

Inferior alveolar nerve block: is articaine better than lidocaine?

This opinion article seeks to analyse current literature surrounding the question: is articaine better than lidocaine for inferior alveolar nerve blocks? It does so with regards to efficacy and risk of paraesthesia associated with administration.

Infants of human immunodeficiency virus type 1-infected women in rural south India: feeding patterns and risk of mother-to-child transmission.

BACKGROUND: We assessed the infant feeding choices of HIV-1-infected women in rural Tamil Nadu, India, and risk factors for mother-to-child transmission of HIV-1. METHODS: The study population comprised live born infants of HIV-1-infected women from the antenatal clinics of 2 public hospitals in rural Tamil Nadu, India who were enrolled in a prospective cohort study. All women enrolled in the cohort were offered antiretroviral prophylaxis and infant feeding counseling based on WHO/UNAIDS/UNICEF training materials. Infant study visits were scheduled at birth (within the first 24 hours of life), at 1 week, 1 month, and 2 months after birth, and then every 2 months between 4 and 12 months of age. RESULTS: One-third of women did not breast-feed their infants. Of those who initiated breast-feeding, the median duration of breast-feeding was approximately 3 months. Among those infants who initiated breast-feeding, the proportion exclusively breast-feeding declined from approximately 70% during the first week of life to 0% by the 8 month visit. The observed rate of mother-to-child transmission of HIV-1 in the entire cohort was 6.5% (95% CI: 1.4%-17.9%). The observed HIV-1 incidence among breast-fed infants was 0% (95% CI: 0%-8.9%). CONCLUSION: The overall transmission rate was relatively low, suggesting effectiveness of antiretroviral transmission prophylaxis. The infant feeding choices made may reflect knowledge gained through the educational program and infant feeding counseling provided. Ensuring HIV-1-infected women receive appropriate HIV-1 treatment (for those who meet criteria for treatment) and access to known efficacious interventions to prevent mother-to-child transmission of HIV-1, are essential.

Safety of HIV-1 Perinatal Transmission Prophylaxis With Zidovudine and Nevirapine in Rural South India.

BACKGROUND: The authors assessed acceptance and safety of, and adherence to, perinatal HIV-1 transmission prophylaxis at 2 public hospitals in rural Tamil Nadu, India. METHODS: Eligible HIV-1-infected women were offered zidovudine (ZDV) beginning at 28-weeks gestation until delivery. Their infants received ZDV for 6 weeks. A subsequent revision to the protocol added 1 dose of nevirapine (NVP) for mother and infant. RESULTS: Sixty of 67 women (90%) met inclusion criteria for the cohort study. Thirty-four of 36 eligible women and all 19 eligible live born infants received prophylaxis on study. Infant, but not maternal, adherence to ZDV varied by antiretroviral prophylaxis group (those receiving combined prophylaxis with ZDV and NVP had lower median adherence) (P = .02). Neutropenia (usually transient) was the most common severe adverse event. Only 1 of 5 women with neutropenia possibly related to ZDV permanently discontinued ZDV. ZDV was not discontinued for any infant. CONCLUSION: With the exception of neutropenia, usually transient and always without clinical consequences, long-term ZDV (with or without NVP prophylaxis) is well tolerated.