'Do I, don't I?' A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic.

BACKGROUND: Paediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care. METHODS: Semistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach. RESULTS: From interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them. CONCLUSION: A pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.

Pathogenesis of follicular lymphoma: genetics to the microenvironment to clinical translation.

Follicular lymphoma (FL) represents a heterogeneous disease both clinically and biologically. The pathognomonic t(14;18) translocation can no longer be thought of as the primary genetic driver, with increasing recognition of the biological relevance of recurrent genetic alterations in epigenetic regulators that now feature as a pivotal hallmark of this lymphoma subtype. Furthermore, sequencing studies have provided a near complete catalogue of additional genetic aberrations. Longitudinal and spatial genetic studies add an additional layer to the biological heterogeneity, providing preliminary molecular insights into high-risk phenotypes such as early progressors and transformation, and also supporting evidence for the existence of persisting re-populating cells that act as lymphoma reservoirs and harbingers for FL recurrence. Simultaneously, understanding of the tumour microenvironmental cues promoting lymphomagenesis and disease progression continue to broaden. More recently, studies are beginning to unravel the convergence and co-operation between the genetics, epigenetics and microenvironment. There is a pressing need to marry biology with therapeutics, especially with the burgeoning treatment landscape in FL, to aid in optimising patient selection and guiding the 'right drug to the right patient'.

Follicular lymphoma genomics.

Although outcomes for follicular lymphoma (FL) continue to improve, it remains incurable for the majority of patients. Through next generation sequencing (NGS) studies, we now recognize that the genomic landscape of FL is skewed toward highly recurrent mutations in genes that encode epigenetic regulators co-occurring with the pathognomonic t(14;18) translocation. Adopting these technologies to study longitudinal and spatially-derived lymphomas has provided unique insights into the tumoral heterogeneity, clonal evolution of the disease and supports the existence of a tumor-repopulating population, considered the Achilles' heel of this lymphoma. An in-depth understanding of the genomics and its contribution to the disease pathogenesis is identifying new biomarkers and therapeutic targets that can be translated into clinical practice and, in the not too distant future, enable us to start considering precision-based approaches to the management of FL.

The Villa Park experience: crowd consultations at an English Premiership football stadium, season 2007-8.

OBJECTIVES: The Football Licensing Authority has expressed concern that crowd injury rates in British football stadiums may be increasing. This study aims to provide modern data regarding crowd consultation patterns from an English Premiership football stadium. DESIGN: Retrospective case mix analysis. SETTING: 21 matches played by Aston Villa FC at Villa Park (season 2007-8; capacity 42 640 spectators). PATIENTS: 78 patients produced a median consultation rate of four per match (incidence of 1.0 per 10 000 spectators). RESULTS: New conditions on match day formed 67% of contacts, including minor trauma (41%) and new general medical conditions (27%). The remaining 33% of presentations were unrelated to new injury or illness in spectators on match day, including exacerbations of pre-existing illness (17%), opportunistic presentations of existing stable problems (10%) and stadium staff injuries (6%). There were no critical illnesses or major incidents. Seven injuries were attributed to stadium infrastructure. Alcohol was deemed to be the causative factor in just two cases. CONCLUSION: Crowd consultation rates at a large modern sports stadium are low. Many spectators use medical services for conditions unrelated to new injury or illness on match day. More data are needed from British football stadiums to be able to plan event cover safely and efficiently.

Adequacy of immediate care documentation at a major United Kingdom endurance event.

The objective of this study was to determine the rate of major omissions from documentation in a prehospital environment. Analysis of 251 competitor records, documented over 2 years from four consecutive UK outdoor endurance events (2006-2007), was performed. Eighty-two percent of case notes were found to be of adequate quality (n = 206), with 15% containing minor omissions (n = 37, i.e. omissions of some patient details) and 3% containing major omissions (n = 8, i.e. no details of diagnosis/treatment). Of the major omissions, first aiders and health-care professionals (doctors and nurses) made the same number of errors (n = 4 each, P = 0.7), but first aiders made significantly more minor omissions (n = 31 vs. 6, P<0.001). From 25 patients who needed medication, only one prescription error occured. In conclusion, accurate documentation is achievable at prehospital mass gathering events. First aiders made no more major documentation omissions than health-care professionals, but made more minor omissions. Standardized proformas may help reduce this rate and improve efficiency.