Explore the vast range of titles available.

ObjectiveScreening for critical congenital heart disease (CHD) with prenatal ultrasound or postnatal pulse oximetry has the potential to improve outcome. To guide screening recommendations, this study aimed to identify the proportion and outcome of major CHD diagnosed before (early) or after (late) postnatal discharge prior to the introduction of postnatal oximetry screening.DesignA retrospective, population-based review of all major CHD in New Zealand from 2006 to 2010. The timing of diagnosis relative to discharge and to intervention in critical and non-critical cases with intention to treat was determined, as was the relationship of diagnostic timing to mortality at 1 year of age.ResultsLate diagnosis occurred in 20% of critical and 51% of non-critical cases. Mortality occurred in 18% of critical vs 8% of non-critical cases. Mortality was lower with an early diagnosis of critical CHD (early diagnosis 16% vs late diagnosis 27%, p=0.04). Isolated critical CHD benefited most from early diagnosis (mortality, early diagnosis 12% vs late diagnosis 29%, p=0.002). Early diagnosis occurred in >90% critical complex CHD and hypoplastic left heart syndrome, 85% d-transposition of the great arteries (d-TGA) and 53% critical left ventricular outflow tract obstruction (LVOTO). Deaths in d-TGA and LVOTO primarily occurred prior to intervention and for d-TGA most often when birth was distant from the cardiac centre.ConclusionsExcess mortality occurs following late diagnosis of critical CHD, and for d-TGA even with early diagnosis if intervention is not immediately available. Antenatal detection retains an important role in reducing mortality related to critical CHD.

ObjectiveTo identify and critically synthesise definitions of acute flares in knee osteoarthritis (OA) reported in the medical literature.DesignSystematic review and narrative synthesis. We searched Medline, EMBASE, Web of science and six other electronic databases (inception to July 2017) for original articles and conference abstracts reporting a definition of acute flare (or synonym) in humans with knee OA. There were no restrictions by language or study design (apart from iatrogenic-induced flare-ups, eg, injection-induced). Data extraction comprised: definition, pain scale used, flare duration or withdrawal period, associated symptoms, definition rationale, terminology (eg, exacerbation or flare), baseline OA severity, age, gender, sample size and study design.ResultsSixty-nine articles were included (46 flare design trials, 17 observational studies, 6 other designs; sample sizes: 15–6085). Domains used to define flares included: worsening of signs and symptoms (61 studies, 27 different measurement tools), specifically increased pain intensity; minimum pain threshold at baseline (44 studies); minimum duration (7 studies, range 8–48 hours); speed of onset (2 studies, defined as ‘sudden’ or ‘quick’); requirement for increased medication (2 studies). No definitions included activity interference.ConclusionsThe concept of OA flare appears in the medical literature but most often in the context of flare design trials (pain increases observed after stopping usual treatment). Key domains, used to define acute events in other chronic conditions, appear relevant to OA flare and could provide the basis for consensus on a single, agreed definition of ‘naturally occurring’ OA flares for research and clinical application.PROSPERO registration numberCRD42014010169.

Determining the accuracy of a method calculating the Gold Standards Framework Surprise Question (GSFSQ) equivalent end-of-life prognosis amongst hospital inpatients. A prospective cohort study with regression calculated 1-year mortality probability. Probability cut points triaged unknown prognosis into the GSFSQ equivalent ‘Yes’ or ‘No’ survival categories (> or < 1-year respectively), with subsidiary classification of ‘No’. Prediction was tested against prospective mortality. An acute NHS hospital. 18,838 acute medical admissions. Allocation of mortality probability by binary logistic regression model (X2=6,650.2, p<0.001, r2 = 0.43) and stepwise algorithmic risk-stratification. Prospective mortality at 1-year. End-of-life prognosis was unknown in 67.9%. The algorithm’s prognosis allocation (100% vs baseline 32.1%) yielded cohorts of GSFSQ-Yes 15,264 (81%), GSFSQ-No Green 1,771 (9.4%) and GSFSQ-No Amber or Red 1,803 (9.6%). There were 5,043 (26.8%) deaths at 1-year. In Cox’s survival, model allocated cohorts were discrete for mortality (GSFSQ-Yes 16.4% v GSFSQ-No 71.0% (p<0.001). For the GSFSQ-No classification, the mortality odds ratio was 12.4 (11.4–13.5) (p<0.001) vs GSFSQ-Yes (c-statistic 0.72 (0.70–0.73), p<0.001; accuracy, positive and negative predictive values 81.2%, 83.6%, 83.6%, respectively). Had the tool been utilised at the time of admission, the potential to reduce possibly avoidable subsequent hospital admissions, death-in-hospital and bed days was significant (p<0.001). This study is unique in methodology with prospectively evidenced outcomes. The model algorithm allocated GSFSQ equivalent EOL prognosis universally to a cohort of acutely admitted patients with statistical accuracy validated against prospective mortality outcomes.

Multinational companies must understand the influences on responsibility for managing people so that they can manage talent consistently thus ensuring that it is transferable across locations. We examine the impact of firm and national level characteristics on the devolution of HRM decision making to line managers. Our analysis draws on data from 2335 indigenous organizations in 21 countries. At the firm level, we found that where the HR function has higher power, devolution is less likely. At the national level, devolution of decision making to line management is more likely in societies with more stringent employment laws and lower power distance.

Background Numerous tools based on electronic health record (EHR) data that predict risk of unscheduled care and mortality exist. These are often criticised due to lack of external validation, potential for low predictive ability and the use of thresholds that can lead to large numbers being escalated for assessment that would not have an adverse outcome leading to unsuccessful active case management. Evidence supports the importance of clinical judgement in risk prediction particularly when ruling out disease. The aim of this pilot study was to explore performance analysis of a digitally driven risk stratification model combined with GP clinical judgement to identify patients with escalating urgent care and mortality events. Methods Clinically risk stratified cohort study of 6 GP practices in a deprived, multi-ethnic UK city. Initial digital driven risk stratification into Escalated and Non-escalated groups used 7 risk factors. The Escalated group underwent stratification using GP global clinical judgement (GCJ) into Concern and No concern groupings. Results 3968 out of 31,392 patients were data stratified into the Escalated group and further categorised into No concern ( n  = 3450 (10.9%)) or Concern ( n  = 518 (1.7%)) by GPs. The 30-day combined event rate (unscheduled care or death) per 1,000 was 19.0 in the whole population, 67.8 in the Escalated group and 168.0 in the Concern group ( p  < 0.001). The de-escalation effect of GP assessment into No Concern versus Concern was strongly negatively predictive (OR 0.25 (95%CI 0.19–0.33; p  < 0.001)). The whole population ROC for the global approach (Non-escalated, GP No Concern, GP Concern) was 0.614 (0.592—0.637), p  < 0.001, and the increase in the ROC area under the curve for 30-day events was all focused here (+ 0.4% (0.3–0.6%, p  < 0.001), translating into a specific ROC c-statistic for GP GCJ of 0.603 ((0.565—0.642), p  < 0.001). Conclusions The digital only component of the model performed well but adding GP clinical judgement significantly improved risk prediction, particularly by adding negative predictive value.

ObjectivesTo estimate the direction and magnitude of socioeconomic inequalities in outcome, experience and care among adults consulting for a musculoskeletal pain condition.DesignMulticentre, prospective observational cohort with repeated measures at three waves (baseline, 3 months and 6 months after index consultation).Setting30 general practices in North Staffordshire and Stoke-on-Trent, England.Participants1875 consecutive, eligible, consenting patients, aged 18 years and over, presenting with a relevant SNOMED CT-coded musculoskeletal pain condition between September 2021 and July 2022.InterventionsStandard care.Primary and secondary outcome measuresPrimary outcome was patient-reported pain and function using the Musculoskeletal Health Questionnaire (MSK-HQ score, 0–56). Secondary outcomes were patient experience (overall dissatisfaction with consultation experience, dichotomised) and an indicator of care received (opioid prescription within 14 days of index consultation). Using multilevel models, we examined inequalities in primary and secondary outcomes by area deprivation (Index of Multiple Deprivation derived from patient residential postcode), before and after adjusting for sociodemographic and survey administration variables, clinical case-mix and selected practice-level covariates.ResultsCompared with patients from the least deprived neighbourhoods, patients from the most deprived neighbourhoods had significantly poorer MSK-HQ scores at baseline (mean 22.6 (SD 10.4) vs 27.6 (10.1)). At 6 months, the inequality gap in MSK-HQ score widened (difference in mean score after adjustment for all covariates: 1.94; 95% CI: −0.70 to 4.58). Opioid prescription was more common for patients living in the most deprived neighbourhoods (30% vs 19%; fully adjusted OR: 0.69; 95% CI: 0.44 to 1.08). Only 6% of patients overall reported being dissatisfied with their consultation. Analysis of multiply imputed data produced a similar pattern of findings to complete-case analysis.ConclusionsSubstantial inequalities in the chronicity, severity and complexity of musculoskeletal pain problems are already present at the time of accessing care. Inequalities in pain and function do not reduce after accessing care and may even widen slightly.Trial registration numberISRCTN18132064; Results.

ObjectivesThe association between impaired digital provision, access and health outcomes has not been systematically studied. The Wolverhampton Digital ENablement programme (WODEN) is a multiagency collaborative approach to determine and address digital factors that may impact on health and social care in a single deprived multiethnic health economy. The objective of this study is to determine the association between measurable broadband provision and demographic and health outcomes in a defined population.DesignAn observational cross-sectional whole local population-level study with cohorts defined according to broadband provision.Setting/participantsData for all residents of the City of Wolverhampton, totalling 269 785 residents.Primary outcomesPoor broadband provision is associated with variation in demographics and with increased comorbidity and urgent care needs.ResultsBroadband provision was measured using the Broadband Infrastructure Index (BII) in 158 City localities housing a total of 269 785 residents. Lower broadband provision as determined by BII was associated with younger age (p<0.001), white ethnic status (p<0.001), lesser deprivation as measured by Index of Multiple Deprivation (p<0.001), a higher number of health comorbidities (p<0.001) and more non-elective urgent events over 12 months (p<0.001).ConclusionLocal municipal and health authorities are advised to consider the variations in broadband provision within their locality and determine equal distribution both on a geographical basis but also against demographic, health and social data to determine equitable distribution as a platform for equitable access to digital resources for their residents.

This Handbook incorporates a variety of disciplines and approaches in order to provide a comprehensive and authoritative examination of the issues that result from increasing age diversity at work. Despite interest in this area exploding over the past few years amongst academics, practitioners and policy makers, the analysis of age diversity has remained primarily within disciplinary 'silos' such as Psychology or Sociology with a focus on ageing or generational differences, rather than a combination of approaches to understanding age diversity. Unique in its coverage of multiple perspectives, it considers not only generational and ageing perspectives to age diversity, but also highlights the importance of context in driving both the impact and response to this issue. The Palgrave Handbook of Age Diversity and Work includes contributions from leading scholars in age and generational diversity from across the world, discussing cutting-edge research findings about the nature and impact of age diversity and presenting approaches to managing this phenomenon.