St George’s Archives – View of the Dissecting Room of St George’s Hospital

Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Natasha Shillingford, Project Archivist.

View of the Dissecting Room of St George’s Hospital, Archives and Special Collections, St George’s, University of London

“At the time of which I am writing, between the years 1858 and 1860, Mr Pollock and Mr Gray were Lecturers on Anatomy, Mr Athol Johnstone was Lecturer on Physiology, and Dr Noad, Lecturer on Chemistry; whilst Dr Dickinson and Dr Hastings were Demonstrators of Anatomy. All these appear in the photograph.”

‘The Men of my Time’, St George’s Hospital and Medical School Gazette, No. 3, Vol 1

George Pollock

Painting of George Pollock
Photo credit: St George’s, University of London

George David Pollock was born in India in 1817, the son of Field-Marshall Sir George Pollock and his wife Frances Webbe. Pollock was sent to England as a child and later apprenticed to a country practitioner. He then entered St George’s Hospital and became House Surgeon to Sir Benjamin Brodie. Due to Brodie’s influence, Pollock in 1843 gained the post of Resident Physician to Lord Metcalfe, Governor-General of Canada. Following Lord Metcalfe’s death, Pollock returned to England and in 1846 he was elected Assistant Surgeon to St George’s Hospital, where he served for thirty four years until his retirement in 1880

In 1869, the Swiss surgeon Jacques-Louis Reverdin developed a successful method for the allograft of human skin. Based upon Reverdin’s work, Pollock performed the first such successful operation in England in May 1870. This technique was known as the Pollock Graft and was adopted by many surgeons.

Pollock took over the care of ophthalmic cases at St George’s. He was also Demonstrator of Anatomy under Prescott Gardner Hewett, and succeeded him as Lecturer on Anatomy. In the Ophthalmic Department at St George’s Hospital, he was known for his cataract operations which led to his private practice in eye diseases. He was also appointed Surgeon on the founding of the Hospital for Sick Children in Great Ormond Street and took great interest in cleft palate operations.

Pollock also served as Examiner in Surgery to the Indian Medical Service where he was said to be a popular member of the teaching staff. He was also President of the Association of Fellows and headed a reform party at the Royal College of Surgeons. He was President of the Royal Medico-Chirurgical Society in 1886, and of the Pathological Society in 1875, and also Surgeon in Ordinary to the Prince of Wales.

He practiced at 36 Grosvenor Street until the last year of his life, when he moved to 35 Chester Square. He married Marianne, daughter of Robert Saunders, in 1850 by whom he had five children, three surviving him. He died on 14th February 1897 after a short illness of pneumonia.

Henry Gray

Image of Henry Gray
Copyright expired. CC BY 4.0

Henry Gray was born in 1827, the son of a Private Messenger to George IV and William IV. He entered St George’s Hospital on 6th May 1845 and he soon focussed his attention on the study of anatomy. In 1848, at the age of 21, he was awarded the Triennial Prize of the Royal College of Surgeons for his essay on ‘The Origin, Connection and Distribution of the Nerves of the Human Eye and its Appendages, illustrated by Comparative Dissections of the Eye in other Vertebrate Animals’. As a student he was described as a painstaking and methodical worker who learned anatomy by undertaking dissections himself.

In 1850 Gray was appointed House Surgeon under Robert Keate, Caesar Hawkins, Edward Cutler and Thomas Turner. On 3rd June 1852 he was elected a Fellow of the Royal Society, a rare distinction at the age of 25. Gray devoted himself to the study of anatomy and the first edition of his ‘Anatomy, Descriptive and Surgical’ was published in 1858, with engravings by Dr Henry Vandyke Carter. The book, known as ‘Gray’s Anatomy’, had reached the 23rd edition by 1928.

In 1861, Gray became a candidate for the post of Assistant Surgeon at St George’s Hospital. His election was viewed to be certain, but he contracted smallpox while looking after a nephew with the disease, and died after a short illness on 13th June 1861. Upon his death, Sir Benjamin Brodie wrote ‘I am most grieved about poor Gray. His death, just as he was on the point of realizing the reward of his labours, is a sad event indeed…Gray is a great loss to the Hospital and the School. Who is there to take his place?’

Athol Archibald Wood Johnstone

Post Mortem examination book 1844 (Anne Thompson, PM/1844/64) Archive and Special Collections, St George’s, University of London

Athol Archibald Wood Johnstone was born in 1820, the youngest son of Dr James Johnson, Physician to King William IV, whose name was accidentally spelt Johnson instead of Johnstone. Athol Johnstone reverted to the original family name on the death of his father.

He studied at St George’s Hospital, where he became House Surgeon, Demonstrator of Anatomy and Lecturer on Physiology. He later succeeded George Pollock as Surgeon to the Hospital for Sick Children, Great Ormond Street. Johnstone was also Surgeon to the Royal Alexandra Hospital for Children with Hip Disease, and to St George’s and St James’s Dispensary. In 1861 he declined to stand for the vacancy of Assistant Surgeon to St George’s Hospital following the death of Henry Gray. In 1862 he moved to Brighton where he practiced as Surgeon to the Brighton and Sussex Throat and Ear Hospital, the Invalid Gentlewomen’s Home, and the Brighton Battery of the old Royal Naval Artillery.

He was twice married, his second wife surviving him. Johnstone died on 16th March 1902 in Brighton.

Henry Minchin Noad

Henry Minchin Noad was born in 22nd June 1815 at Shawford, Somerset, the son of Humprey Noad. He was educated at Frome Grammar School. He began the study of chemistry and electricity, and about 1836 he delivered lectures on both subjects at the literary and scientific institutions of Bath and Bristol. He joined the London Electrical Society in 1837.

In 1845 he began his studies under August Wilhelm Hofmann at the Royal College of Chemistry. He joined the medical school of St George’s Hospital in 1847 when he was appointed to the chair of Chemistry. He remained in this role until his death.

In 1849 Noad obtained his degree of doctor of Physics from the University of Giessen. In 1850-51 he conducted an inquiry into the composition and functions of the spleen with Henry Gray. In 1856 he was elected a Fellow of the Royal Society. He was appointed Consulting Chemist to the Ebbw Vale Iron Company, the Cwm Celyn, and Blaenau, the Aberdar and Plymouth, and other iron works in South Wales. In 1866 he became an examiner of malt liquors at the India Office. In 1872 he became an examiner in Chemistry and Physics at the Royal Military Academy in Woolwich.

Noad died at his home in Lower Norwood, London on 23rd July 1877, survived by his wife Charlotte Jane.

William Howship Dickinson

Image of William Howship Dickinson
Image in public domain

William Howship Dickinson was born on 9th June 1832 in Brighton, the son of William Dickinson of Brockenhurst. He was educated at Caius College, Cambridge and at St George’s Hospital. After graduating in 1859, he became Curator of the Museum, Assistant Physician in 1866 and Physician in 1874. He was also Assistant Physician from 1861 to 1869 at the Hospital for Sick Children, and later physician from 1869 to 1874. He held the offices of Censor and Curator of the Museum at the Royal College of Physicians, delivered the Croonian Lectures in 1883 and the Harveian Oration in 1891. Dickinson was Examiner in medicine to the Royal College of Surgeons and to the Universities of Cambridge, London and Durham.

Thomas Pickering Pick recalled attending an anatomy demonstration by William Howship Dickinson. He said that ‘The first of these which I attended was on the kidney, and a specimen from the dead-house was exhibited. I ventured to ask, no doubt with all diffidence as a beginner, whether it was not a very large one, and was met by the remark: “By no means; perhaps you are thinking of the kidneys you have eaten for breakfast this morning.” At this there was a universal titter, and I felt extremely small. But undoubtedly the suggestion was a perfectly true one. It was the first time I had seen a human kidney, and my knowledge of that particular organ was entirely derived from the sheep’s kidney on the breakfast table.’ (‘The Men of my Time’, St George’s Hospital and Medical School Gazette, No. 3, Vol 1)

Dickinson was a general physician but he was known as an authority on diseases of the kidney and children’s diseases. He was known to be a meticulously careful observer who visited the wards of St George’s Hospital every day to observe his patients and take their medical histories. Dickinson was said to have ‘worshipped St George’s Hospital almost to the point of idolatry and received in return, during his long life, no small measure of its homage.’

In 1861 he married Laura, daughter of James Arthur Wilson, physician to St George’s Hospital. They had four daughters and two sons. Dickinson died on 9th January 1913.

Cecil Hastings

Unfortunately not much is known about Dr Cecil William Hastings, Demonstrator of Anatomy at St George’s Hospital. The student registers of the medical school reveal that he was educated at the University of Oxford and became a Member of the Royal College of Physicians. He took the post of House Surgeon in 1853 and was also Physician at the Royal Pimlico Dispensary.

Search the Authority Records on the Archives and Special Collections catalogue to find out more about the Surgeons and Physicians of St. George’s Hospital (https://archives.sgul.ac.uk/).

Screenshot of a search in the Authority Records on the Archives and Special Collection catalogue.

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Health e-news Friday 19 June

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

Updated guidance on AGPs and the need for PPE

The government has updated its guidance on the use of personal protective equipment in relation to COVID-19, clarifying the list of aerosol generating procedures (AGPs) considered to be potentially infectious. The update comes following review by the committee of an evidence summary by Health Protection Scotland which set out to establish an evidence base for which AGPs should be considered to pose a high risk of infection transmission.

JCVI issue advice on priority groups for COVID-19 vaccination

The Joint Committee on Vaccination and Immunisation (JCVI) has published interim advice on the priority groups for COVID-19 vaccination, as part of the planning for deployment of any safe and effective vaccine. The committee considered health and social care workers to be the highest priority group, based on their increased exposure and the risks of their transmitting the virus to patients. The next priority for vaccination would be those at increased risk of serious disease and death from COVID-19 infection. The advice will be updated as more information becomes available.

COVID-19 related news

PHE publish stakeholder insights on COVID-19 impact on BAME communities

Following claims of its being withheld from publication in a recent report, Public Health England (PHE) have released a summary of stakeholder insights into the factors potentially influencing the disproportionate impact of COVID-19 on BAME communities. The publication summarises the views elicited from over 4,000 people, during a total of 17 hosted sessions, and make a series of requests for action and recommendations to tackle the issue. The Health Foundation response to the publication questions the absence of any recommendation on tackling entrenched discrimination, while the Chartered Society of Physiotherapists and the Royal College of Paediatrics and Child Health are amongst the professional bodies to have called for real change, noting the failure of previous reports and inquiries on racism to deliver it.

Human trials of coronavirus candidate vaccine set to begin

Researchers are set to being human trials of the COVAC1 coronavirus candidate vaccine, following the completion of pre-clinical safety tests and animal studies. The trial is seeking approximately 120 healthy volunteers for phase I, with results expected around the end of August. The first phase will evaluate three different doses of the vaccine for safety and the ability to induce an immune response.

Trial identifies positive results of dexamethasone in reducing COVID-19 mortality

The RECOVERY trial, which last week suspended investigation of hydroxychloroquine as a treatment for COVID-19, has reported positive findings from the arm examining use of the steroid dexamethasone. Amongst ventilated patients the steroid reduced the risk of dying by one-third, in patients receiving oxygen only the risk was reduced by one-fifth, while no benefit was found for patients not requiring respiratory intervention. Following announcement of the results, the government has approved this use of dexamethasone across the NHS, and is taking steps to ensure and protect UK supply of the steroid which is typically used to reduce inflammation.

Research findings suggests complex relationship between COVID-19 and ethnicity

Research published today suggests that socioeconomic or behavioural factors, cardiovascular disease risk, or vitamin D status do not wholly explain the higher rates of severe COVID-19 infections amongst BAME populations. The results confirm that BAME ethnicity, male sex, higher body mass index, greater material deprivation, and household overcrowding are independent risk factors for COVID-19, but suggest that more research is required to understand the complex relationship between COVID-19 and ethnicity.

RCN set out priorities for resumption of NHS services

The Royal College of Nursing (RCN) has set out eight priorities which they consider to be vital for the safety of health care staff and the public, as the resumption of services is planned for. The priorities include providing counselling and psychological support, ensuring full and proper risk assessments for staff, and tackling the underlying causes which have contributed to increased risks for BAME staff.

RCP priorities for resetting NHS services

The Royal College of Physicians (RCP) has set out its key priorities for the resetting and rebuilding of NHS services. To ensure effective services, the priorities include introducing improved ways of integrated working, encouraging protected time for quality improvement and research, and supporting education and development for all staff.  

Online psychological first aid course available to NHS staff and volunteers

A psychological first aid course developed by Public Health England with support from NHS England and Health Education England, is available to all NHS staff and volunteers. The course is accessible through Future Learn, and is intended to support staff and volunteers in providing psychological support to people affected by COVID-19. The course takes approximately 90 minutes to complete, and is offered in three sections.

King’s Fund on resilience in the health and care system

The King’s Fund offers thoughts on what a resilient health and care system would look like, as part of the consideration of restarting and recovering services. Acknowledging the relevance of stockpiles, supply chains and hospital beds as factors contributing to a resilient system, the author argues for additional issues such as flexibility in the workforce, better integrated care, and capacity in community organisations to be accounted for when thinking about a resilient system.

Nuffield Trust examines use of emergency care during pandemic

The Nuffield Trust considers the extent of the reduction in emergency department attendances during the height of the COVID-19 pandemic, some of the factors which might have contributed to the reduced numbers, and whether some of these reductions might be sustained as lockdown measures continue to be eased. The 29% reduction of A&E visits in March and the 57% reduction in April stand in contrast to the average yearly increases of 2-5% during the last two decades, and while concerns that patients with serious health conditions may have been avoiding hospital are undoubtedly part of the cause, the complete picture is likely to be more complex.

Other news

RCN to host series of events on race inequalities

A series of online events hosted by the Royal College of Nursing will attempt to start the conversation about the nature of race, racism, structural discrimination and inequality in the nursing profession. The first event took place today, and details of future events will be available on the RCN website and Twitter account. The events will be open to non-members. The organisation has also created a new online resource drawing together information, advice and resources on diversity and inclusion in nursing.

NHS Virtual Pride to take place Friday 26 June

NHS England and NHS Improvement’s LGBTQ+ Staff Network has announced it will be holding an NHS Virtual Pride on Friday 26 June, the day before Global Pride 2020. As an alternative to the celebrations that would typically be taking place, Virtual Pride will take be hosted on Teams from 6pm. NHS organisations and individual staff are encouraged to participate; for more information, follow @VirtualNHSPride on Twitter. Use the #proudatstgeorges hashtag if you want to get involved, or to share stories or experiences more locally.

FSRH update Service Standards for Consultations

The Faculty of Sexual & Reproductive Health have published an update to their Service Standards for Consultations in Sexual and Reproductive Health. The revised guidance includes standards for online and remote consultations, additional standards supporting patients where English is a second language, and updated standards for confidentiality, amongst statements on other aspects of consultations.

NHS Confederation suggests CQC should not rush back to old inspection regime

Responding to the CQC announcement that it intends to resume some routine inspections this autumn, the Chief Executive of the NHS Confederation, Niall Dickson, has suggested that the current moment offers an opportunity for rethinking the inspection, regulation and governance of the health and care sectors. Acknowledging the important role of regulation, Dickson has called for lessons to be learnt from this period, “…before than jumping back into the old inspection regime.”

 
NICE guidance

Diagnostics guidance

DG39 Tests to help assess risk of acute kidney injury for people being considered for critical care admission (ARCHITECT and Alinity i Urine NGAL assays, BioPorto NGAL test and NephroCheck test)

Medtech innovation briefing

MIB 212 MolecuLight i:X for wound imaging

MIB216 FibroScan for assessing liver fibrosis and cirrhosis in primary care

MIB218 Actim Pancreatitis for diagnosing acute pancreatitis

NICE guideline

NG178 COVID 19 rapid guideline: renal transplantation

Quality standard

QS161 Sepsis Updated

Technology appraisal

TA633 Ustekinumab for treating moderately to severely active ulcerative colitis


NIHR alerts 


Statistics

Health e-news Friday 12 June

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

Latest COVID-19 guidance updates from NHS Employers

The most recent COVID-19 updates from NHS Employers include guidance on infection control and RIDDOR reporting, the addition of a staff risk assessment proforma tool, updates on shielding, and a guide to overtime interpretation.

Updated guide to surgical prioritisation during COVID-19

Guidance on surgical prioritisation during the COVID-19 pandemic has been updated to include material on spinal surgery and paediatric cardiac surgery. The guidance outlines levels of surgical priority for patients, covering the majority of specialties. The categorisation is intended to help plan the allocation of resources, and to facilitate the development regional networks for the delivery of surgery.

RCPCH update guidance on shielded patients

The Royal College of Paediatrics and Child Health (RCPCH) updates its guidance for clinicians on the shielding of clinically vulnerable children and young people. The new guidance identifies two groups of vulnerable individuals and categorises these groups according to a recommendation for continued shielding, or consideration on a case by case basis.

FSRH guidance on restoration of services during COVID-19

The Faculty of Sexual and Reproductive Health (FSRH) have published guidance and a policy position providing recommendations on prioritisation as services are restored. The guidance includes general principles for the restoration of services, offers suggestions for essential services and recovery phases, and identifies priority and vulnerable groups. Also included in the guidance is an outline of positive changes that have been made to accommodate the lockdown, and which should remain in place. The guidance can be read here, and the policy position is available here.

COVID-19 related news

Preliminary results from RECOVERY trial of potential COVID-19 treatments

Preliminary results from the RECOVERY trial, a large randomised controlled trial of possible treatments for COVID-19, show no effect on mortality from the use of hydroxychloroquine in patients admitted to hospital with the virus. The trial, which has enrolled over 11,000 patients from 175 NHS hospitals, is testing treatments including Lopinavir-Ritonavir, Tocilizumab, convalescent plasma, and Hydroxychloroquine. Preliminary results from the arm of the trial testing Hydroxychloroquine have revealed no beneficial effect of treatment with the drug, and enrolment has been stopped.

NHS Confederation report addresses planning for next stage of COVID-19

A report from the NHS Confederation, ‘Getting the NHS back on track; planning for the next phase of COVID-19’, outlines some of the key challenges that organisations are likely to face over the coming months, and offers some practical solutions for phase three guidance and beyond. The recommendations include extending emergency funding across all NHS sectors, implementing ongoing arrangements with private sector providers, delaying CQC inspections, and a review of the impact of COVID-19 on the NHS and social care workforce. The report also make a clear call for appropriate supplies of PPE as services resume, and seeks assurances that the planned test, track and trace system will be both fully operational and robust.

BMA survey results highlight ongoing PPE issues

The results from the latest in a series of BMA surveys suggest that shortages of personal protective equipment (PPE) remains an issue in hospitals and GP surgeries. Around one in five of the respondents report either shortages, or no supply at all of FFP3 masks when working in areas where aerosol-generating procedures (AGP) are carried out, while shortages of gowns and aprons have worsened in non-AGP areas. Issues around female doctors finding masks that fit appropriately have been drawn to the attention of the DHSC.

NICE and NIHR produce advice for developers of COVID-19 medicines

NICE and NIHR have collaborated to produce advice for those developing medicinal products aimed at preventing or treating COVID-19. The guide offers support and recommendations on numerous aspects of proposed trials, including trial design, intended study population, duration, and the reporting of results.

Other news

NHS Employers highlight resources to support WDES reporting

NHS Employers have highlighted some resources on supporting staff with disabilities working within the NHS, in order to help managers and senior leaders address some of the challenges faced. The resources have been made available to help with the preparation and submission of Workforce Disability Equality Standard (WDES) reports, which organisations will be required to submit between 6 July and 31 August.

HSJ announce sponsorship of workplace race equality award

The HSJ has announced its sponsorship of a new workplace race equality award, in an effort to recognise initiatives promoting race equality and inclusion within HNS workplaces. The announcement notes that the Workforce Race Equality Standard (WRES) has helped to bring about some positive changes, and its data has helped evidence the positive outcomes of embracing workforce diversity. Nevertheless, the award entry page acknowledges the continued discrimination and disparity of experience that BME staff can face, and along with inviting submissions of initiatives that have improved workplace equality, offers suggestions to support these necessary changes.

AOMRC publish changing specialties guides for doctors in training

The Academy of Medical Royal Colleges (AOMRC) have published a series of guides offering support for flexibility in postgraduate training, and for doctors in training who wish to change specialties. The guides are accompanied by a set of FAQs which offer answers for doctors in training, as well as for Local Education and Training Boards and medical Royal Colleges.

Kings Fund on learning from staff experiences

The Kings Fund offer some thoughts on the learning that might come from staff experiences during the COVID-19 pandemic, and the potential gains that can be made. The piece argues that, “…staff must have autonomy and control, feel a greater sense of belonging and be supported in order to have a sense of competence, rather than simply being overwhelmed by excessive workload.” It also highlights the importance of reflection, reviews and learning, and calls for compassionate and collective leadership.

 
NICE guidance

Evidence summary

ES27 COVID 19 rapid evidence summary: Remdesivir for treating hospitalised patients with suspected or confirmed COVID-19

Medtech innovation briefing

MIB211 Archimedes for biopsy of suspected lung cancer

NICE guideline

NG29 Intravenous fluid therapy in children and young people in hospital Updated

Technology appraisal

TA632 Trastuzumab emtansine for adjuvant treatment of HER2-positive early breast cancer


NIHR alerts 

Decision aids quickly and accurately rule out heart attack for almost half of all patients tested

Therapists and patients have good quality interactions during telephone sessions

A simple test may predict the risk of hospitalisation for flare-up in patients with COPD, a common lung disease


Statistics

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Health e-news Friday 5 June

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

CSP publish Covid-19 palliative care standards

The Chartered Society of Physiotherapists (CSP) has launched a new set of Covid-19 rehabilitation standards, specifically for use in palliative care. The standards, available in full on the CSP website are relevant for all settings, and provide a framework for those providing rehabilitation and physiotherapy for those with Covid-19 who are approaching the end of their life.

BPS publish guidance for psychologists working in palliative care

New guidance from the British Psychological Society (BPS) offers considerations and recommendations for psychologists working in palliative care. The guidance highlights some of the impacts that Covid-19 might have upon end of life care, and the modifications or adaptations that may be necessary to manage these. The guide notes the importance of adhering to the existing relevant NICE Quality Standards, and also stresses the importance of communication and how best to enable this.

Intercollegiate general surgery guidance on Covid-19

Updated intercollegiate guidance on general surgery and Covid-19 has been published, to reflect the information on re-starting surgery available from various organisations, and the emerging data and evidence available. The guidance specifically highlights two separate streams of surgical patients: elective patients known to be free from Covid-19; and acute patients whose status is unknown, and offers considerations for these.

COVID-19 related news

Research bodies boost support for mental health research on COVID-19

The National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) are seeking research proposals on the identification and mitigation of the mental health effects of the Covid-19 pandemic. Immediate priorities for research that have been identified include the effects of the pandemic on mental health in the whole population and in vulnerable groups; brain function and cognition; and the mental health of patients with COVID-19. The aim of the appeal for proposals is to reduce the emergence of new mental health problems, and to improve outcomes for those whose mental health has already been affected by the pandemic.

Public Health England review of disparities in Covid-19 risks

Public Health England (PHE) have published a review of surveillance data on the disparities in risks and outcomes of Covid-19 infection. Disparities were identified for those of older age, living in deprived areas, and male sex, which replicate the existing inequalities present in UK mortality rates. As broadly reported and discussed, a disparity for those from BAME groups also exists, which deviates from typical data. Many healthcare organisations have responded to the publication, including the NMC, the CSP, the RCP, the RCN, and the AOMRC.  The Health Foundation commented, the  BMA called for action to tackle the issues highlighted, while a report in the HSJ suggests that a section of the report was removed by the government before its publication.

NHS Employers highlight resources to support diversity and equality in the NHS

NHS Employers have highlighted a series of resources that can offer support, recommendations and guidance on implementing positive change on diversity, inclusion and equality within healthcare workplaces. Noting the diversity of the NHS workforce, the organisation points out the need to ensure that the working environment in health and social care is one where all staff feel supported and valued in their work, and are safe.        

Other news

Evidently Cochrane on the absence of evidence

The Evidently Cochrane blog, from the Cochrane Library, considers what the absence of evidence might or might not mean when it comes to research, using examples from recent Cochrane reviews, and newspaper reports of studies to illustrate the matter. The piece highlights some reasons why evidence may not exist, or might be unreliable, including small study sizes, insufficient data, or poorly designed studies, but goes on to impress that the lack of evidence for a treatment does not equate to proof of no effect.

 
NICE guidance

Nice guideline

NG157 Joint replacement (primary): hip, knee and shoulder

Technology appraisal

TA631 Fremanezumab for preventing migraine


NIHR alerts 

Apps to help patients take medication on time need to be evaluated in a consistent way


Statistics

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St George’s Archives – Morbid appearances

Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Juulia AhvensalmiArchivist.

We have now catalogued a good chunk of St George’s historical post mortem records, and are preparing to make them available on our catalogue soon. In our blog posts, we’ve been exploring various themes and aspects emerging from the records, from examining cases of leprosy and hysteria, to delving into the social backgrounds and occupations of the patients.

But let’s take a closer look at the records themselves. Do they always contain the same information? How are they structured? What do they actually say? The format doesn’t vary very much: the records we are now cataloguing stretch from 1841 to 1920, and tend to follow the same template, as shown in these images from 1845 and from 1920.

Post mortem examination book 1845 (Sarah Leigh, PM/1845/126) and Post mortem examination book 1920 (John Welburn, PM/1920/182). Archives and Special Collections, St George’s, University of London.
Post mortem examination book 1845 (Sarah Leigh, PM/1845/126) and Post mortem examination book 1920 (John Welburn, PM/1920/182). Archives and Special Collections, St George’s, University of London.

Apart from the two earliest volumes, in which each case occupies only a single page, all the volumes reserve a two-page spread for each individual patient. The labelled boxes across the top of the pages record the patient’s case number, name (sometimes also occupation is noted here), age, date of their admission to the hospital, date of death, the name of the doctor admitting them, the length of time between death and the post mortem examination, references in medical and surgical registers and the ‘Nature of disease’.

This last box details the cause of death, based on the examination. Sometimes the cause is determined to be straightforward, and the box only lists a single ailment (‘Fracture of skull’, ‘Pneumonia’), but more often multiple diseases or other ailments are listed – there is not always a single cause of death, but multiple contributing factors. In the catalogue we are including a transcription of this field, as well as a standardised form of the disease(s), using Medical Subject Headings (MeSH). Treatments (in particular operations) as well as post-mortem changes and features of the body sometimes also appear in this list, and can vary from brief and vague (‘Disease of the heart’) to very long and specific:

‘Renal sarcoma (removed by operation). Accidental inclusion of small gut in abdominal saturation. Volvulus of small gut. Small gut obstruction. Commencing peritonitis’, or

‘Phthisis. Old adhesions of the pleurae. Lymph in pericardium. Atheroma in aorta & mitral valve. Tubercular spots in various parts of the intestines with ulceration of the mucous membrane. Mesenteric glands enlarged’

Post mortem case notes for Elizabeth Burnett in PM/1849/20, signed by Henry Gray; and Alice McDonald, PM/1918/290, signed by H.I. (Helen Ingleby). Archives and Special Collections, St George’s, University of London.
Post mortem case notes for Elizabeth Burnett in PM/1849/20, signed by Henry Gray; and Alice McDonald, PM/1918/290, signed by H.I. (Helen Ingleby). Archives and Special Collections, St George’s, University of London.

The left-hand page, labelled ‘Morbid appearances’, is reserved for the details of the post mortem examination in which, following a general description of the appearance of the body (‘Body well-formed and in good condition…’), each examined part of the body is listed. This is sometimes presented as larger wholes (cranium, thorax, abdomen) or simply as list of organs and body parts that were examined (left hip, skull, lungs, heart, uterus and so on). The bottom of the page is usually signed by the doctor who performed the examination; this tended to be a fairly junior doctor. Sometimes there is more than one name.

Any preparations or samples taken are also listed here, with references to the catalogues of the Pathology Museum of St George’s – as a part of the Post Mortem Project, we are listing these references and attempting to locate them in the museum – the referencing systems have, however, been changed multiple times over the years, so the task is not always that easy.

Medical case notes for James Cronin, PM/1864/233, signed by Octavius Sturges; and John Welburn, PM/1920/182, signed by Wathen Ernest Waller. Archives and Special Collections, St George’s, University of London
Medical case notes for James Cronin, PM/1864/233, signed by Octavius Sturges; and John Welburn, PM/1920/182, signed by Wathen Ernest Waller. Archives and Special Collections, St George’s, University of London

The right-hand page is for details of the medical case before the patient’s death. This, too, is usually signed by the doctor examining the patient, and is similarly formulaic: first, the history of the case is rehearsed, detailing symptoms and other details, followed by a description of the patient on their admission and details of the treatment(s) received prior to their death. If there is no post mortem examination, no medical notes are included either.

There are of course some differences in the way the case notes are presented during this time – we are, after all, talking of a period of 79 years. Some, although by means not all, of the 20th century volumes contain a carbon copy of typewritten medical notes instead of the more usual handwritten ones (a blessing for the cataloguers, who have to decipher the often rushed handwriting – the later volumes also tend to be more difficult to read!). These notes were copied from the medical and surgical registers recording all admissions to the hospital. Unfortunately, however, we no longer have these registers, so it is impossible to tell whether the notes were copied exactly or changed in the transmission.

Wordcloud of adjectives in the post mortem volumes. Archives and Special Collections, St George’s, University of London.
Adjectives in the post mortem volumes. Archives and Special Collections, St George’s, University of London.

Perhaps, however, typing your notes rather than writing them down by hand affected the way the cases were recorded: the later volumes certainly tend to be briefer, focusing on the medical facts only, where many of the earlier case notes contain more colourful descriptions and often personal observations by the doctors: the patients are often described in terms which strike the modern reader as distinctly subjective in a medical context, even unprofessional and offensive. Some of the language used in the descriptions can come as quite a shock to the 21st century reader, such as descriptions of patients as ‘idiot’ (which remained as part of the medical vocabulary until the 1970s), ‘stupid’ or ‘half-witted’:

‘[He] was never more than half-witted and could follow no occupation. The [epileptic] fits increased in frequency and the man became more nearly idiotic’ [Alfred Dolman, PM/1891/376]

Racial and ethnic prejudices similarly appear in the medical case notes. John Lusila (PM/1854/384), a waiter who died of tuberculosis, is described as ‘this poor black’. Of Michael Fitzgibbon (PM/1864/127), a cooper who died aged 32, it is simply noted: ‘Of this illness no accurate account could be obtained (the patient was Irish)’; it is unclear whether the reason for the trouble in communication was linguistic (perhaps Michael did not speak English?) or something else. Jane Caldecourt (PM/1887/283), a kitchen maid who died aged only 17, is described as ‘a well-nourished, healthy-looking girl of very dark complexion, mother was a coloured woman’.

From the case notes made by Octavius Sturges in the Post mortem volumes. Archives and Special Collections, St George’s, University of London
From the case notes made by Octavius Sturges in the Post mortem volumes. Archives and Special Collections, St George’s, University of London

One of the doctors, Octavius Sturges (1833-1894), who was a medical registrar at St George’s Hospital in the 1860s, was particularly fond of sketching evocative and occasionally even poetic images of the patients with his words. One patient is described as ‘an anxious, delicate girl with an anxious, sad expression’, another as ‘a dark, spare person of melancholy aspect, a needlewoman’; another as ‘stout and well-built with the countenance of a drunkard’ or ‘a miserable, emaciated old man having the withered and wrinkled face of a mummy’. The reader gets a very immediate sense of the people in front of Sturges (and of Sturges himself in the process): perhaps he had unrealised ambitions as a novelist? A rather disparaging description of Sturges by a colleague after his death describes Sturges as ‘A man of ordinary size with his head rather sunk down between his shoulders. The colour of his face was high and purplish, for he was a victim of nitral stenosis. Not one of our great physicians, he was a thoroughly practical children’s doctor’ – the truthfulness or kindness of the statement can be debated, but it does seem like a description Sturges might have approved of.


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Health e-news Friday 29 May

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

NHS Employers update guidance on carrying out staff risk assessments

Guidance from NHS Employers on risk assessments for staff has been updated. The updates have added additional context on COVID-19 and the staff groups that are more vulnerable to serious illness and death, and offer recommendations for ongoing actions that can be taken to mitigate the level of risk to staff. The update also provides guidance on how employers can support colleagues to raise concerns, and offers good practice examples of responses from NHS trusts.

Guidance from WHO/Europe on long-term care and COVID-19

In light of the high numbers of COVID-19 related infections and deaths in care facilities and other long-term care, the World Health Organization (WHO) Europe has produced guidance on how to prevent and manage infections in these settings going forward. The guidance also calls for integrated, person-centred long-term care systems, working in collaboration with health services in order to improve outcomes for residents and staff in care settings, while also minimising pressure on health care systems.

Latest updates to COVID-19 guidance from NHS Employers

The most recent set of updates to COVID-19 related guidance from NHS Employers includes information on: deploying nursing, midwifery and allied health professional students; visa extensions and application process; support resources available for NHS staff; and tips on carrying out interviews via video conferencing.

Guidance on NHS test and trace service

Various guidance on the government’s test and trace programme has been published. This includes an overview of the system, including what happens if you test positive, or have had close contact with someone who has tested positive. Separate guidance has been published for workplaces, offering advice for employers, workplaces and employees, and also for individuals who have had contact with possible or confirmed cases.

Discussion paper from IZA considers design of safe COVID-19 exit strategy

Non-profit research institute, the Institute of Labor Economics, (IZA) has published a paper on the design of strategy for exiting COVID-19 lockdown. The paper argues against a general release strategy, suggesting that this ignores the fatality risks this may pose for citizens in midlife and older. Presenting data from China, Italy and the UK which highlights the strong age pattern in the risk of death from COVID-19, the authors recommend a rolling age-release strategy, combined with continued social distancing measures. The paper also discusses the benefits of releasing lockdown according to the age gradient of risk, including the decreased likelihood of having to introduce further rounds of lockdown.

COVID-19 related news

MHRA offers support for use of remdesivir in COVID-19 treatment

The Medicines and Healthcare products Regulatory Agency (MHRA) has given support for use of remdesivir through the UK’s Early Access to Medicines Scheme (EAMS). This step will enable the drug, which was originally developed as an ebola treatment, to be used in the treatment of adults and adolescents hospitalised with severe coronavirus (COVID-19) infection who meet additional clinical criteria.

Results of RCN survey suggests BAME staff more likely to be left without PPE

A recent RCN member-wide survey suggests disparities in access to personal protective equipment (PPE), and the offer of PPE training, between respondents from BAME backgrounds and those from white British backgrounds. In light of the results, both the RCN and the NMC have reiterated the need for all health and care professionals to have access to the necessary PPE and training to protect themselves and those they care for.

Research highlights value of lung ultrasound in COVID-19 management

A paper in the journal, Anaesthesia, reviews the early evidence and guidance on the use of lung ultrasound in COVID-19 patients. The research considers the diagnostic advantages of ultrasound over alternatives such as CT scans, stethoscopes and chest X-rays, including the high diagnostic accuracy, the portability of ultrasound machines, and the low infection control implications. The article also explores the practical issues around implementing lung ultrasound into routine clinical practice.

Other news

Government research maps current provision of occupational health and work-related MSK services

Research commissioned by the government’s Work and Health Unit to inform the ongoing development of policy relating to occupational health has published its findings. The research aimed to examine the available models of private and NHS service provision; how these are commissioned, resourced and accessed; examine the workforce of private and NHS providers; and investigate the commissioning of MSK and work-related NHS services.

 
NICE guidance

Technology appraisal

TA630 Larotrectinib for treating NTRK fusion-positive solid tumours


NIHR alerts 

Loneliness, but not social isolation, predicts development of dementia in older people

Largest ever trial into a rare cancer of the urinary system shows clear benefits of chemotherapy after surgery


Statistics

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Health e-news Friday 22 May

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

Guidance on government antibody testing programme

In support of the announcement of an antibody testing programme intended to begin from next week, the government has published guidance explaining the aims of the programme. The guidance details who will currently be eligible for testing, what antibody testing is, and what the test will tell you. In conjunction with the guidance, there is also an infographic to explain the different coronavirus tests; the swab test to identify whether an individual has the virus, and the new antibody test to identify if someone has had it.

New advice for cancer patients undergoing radiotherapy

The Royal College of Radiologists (RCR) have worked with other professional bodies, and leading cancer care charities to created tailored coronavirus guidance for radiotherapy patients. The advice stresses the importance of continuing with treatment, and aims to reassure patients of the precautions being taken by cancer centres to prevent the transmission of the virus, and to keep patients and staff as safe as possible.

FICM guidance addresses delivery of critical care during transition

New guidance from the Faculty of Intensive Care Medicine (FICM) reflects upon the changes in provision that were made to accommodate COVID-19 patients, and addresses the considerations that will have to be faced in the transition back to restoring more routine services. These include issues relating to capacity, staffing levels and the availability of drugs, consumables and PPE, as well as the need to manage infection control, potentially by adapting the site of service delivery.

CPOC advice for patients going for surgery

The Centre for Perioperative Care (CPOC) has published FAQs to address some of the concerns that patients may have about going to hospital during the ongoing pandemic, and to offer advice on how best to prepare for an operation. The series of FAQs take patients through measures being taken to protect patients and staff, and questions to ask the hospital, as well as providing an idea of the surgery journey.

COVID-19 related news

NHS Confederation stress importance of testing, tracking and tracing strategy

In an open letter to the Secretary of State for Health and Social Care, Chief Executive of the NHS Confederation, Niall Dickson, highlighted the crucial nature of implementing a coherent test, track and trace strategy, involving local agencies and public health professionals, in order to limit the risk of unleashing another wave of infections when lockdown measures are further eased.

Government announces antibody testing programme

A new antibody testing programme, intended to start from next week, will offer tests to NHS and care staff and eligible patients and care residents. The test will aim to identify whether someone has already had the virus, and to provide data on the antibodies they have developed. While there is no current evidence that the presence of antibodies means a person is immune to COVID-19, or that they cannot be re-infected or pass the virus along to others, data from the testing will help to answer questions relating to immunity that are currently under examination, and will offer additional information on the prevalence of the virus.

New trial to look at whether dogs can help with detection of COVID-19

Trials to explore whether specially trained ‘detection dogs’ may be able to detect coronavirus in humans are set to begin. The research will bring together researchers from the London School of Hygiene and Tropical Medicine (LSHTM) and Durham University, with the charity Medical Detection Dogs. Dogs have already been successfully trained to detect the odour of diseases such as cancer, malaria and Parkinson’s in humans, and the new research will see if dogs could detect COVID-19 even before symptoms appear.

Research to examine re-purposing of existing immune response drugs

A new trial, led by Cambridge and King’s College London, will set out to test whether existing drugs which target the body’s immune response, can be re-purposed for use in the treatment of COVID-19. For those patients who develop a severe case of the virus, the most serious symptoms appear to be caused by the immune system response, which results in the destruction of healthy cells as well as those infected by the virus. The two drugs to be trialled are Ravulizumab and Baricitinib, and have been chosen by doctors and scientists with expertise in immune-response diseases.

Other news

Mental Health Awareness week centres upon theme of kindness

Hosted by charity the Mental Health Foundation, Mental Health Awareness week this year is centred upon the theme of kindness. On the website supporting the week, there are resources discussing why kindness matters, and the links between kindness and good mental health, a look at some of the research on kindness, and some thoughts on the importance of kindness in public policy.

FICM guidance on enhanced care in the acute setting

The Faculty of Intensive Care Medicine (FICM), in collaboration with the Royal College of Physicians (RCP) have produced guidance for the development of enhanced care in the acute hospital setting. The guidance addresses those patients whose needs fall into the gap between critical care and the provision available on a normal ward, and outlines a framework to be considered in developing a service to meet these needs.

Royal College of Surgeons offer five tips for Mental Health Awareness Week

The Royal College of Surgeons have highlighted five things that can be done to support good mental health. While some of the advice is more specifically aimed at surgeons, the list includes advice on taking time for self-care, making use of support networks or trusted colleagues, and being kind to others.

 
NICE guidance

Evidence summary

ES24 COVID-19 rapid evidence summary: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19

ES25 COVID-19 rapid evidence summary: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19

ES26 COVID 19 rapid evidence summary: Anakinra for COVID-19 associated secondary haemophagocytic lymphohistiocytosis

Medtech innovation briefing

MIB217 Cytokine adsorption devices for treating respiratory failure in people with COVID-19

Nice guideline

NG160 COVID-19 rapid guideline: dialysis service delivery Updated

NG167 COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders Updated

NG174 COVID-19 rapid guideline: children and young people who are immunocompromised Updated


NIHR alerts


Statistics

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Preparing for online assessment

In this post, the Learning Development team, who run the Academic Success Centre and Study+ on Canvas, offer advice on preparing for assessments which have been moved online. We cover pre-exam preparation, planning for the assessment period and what to do during the exams itself, as well as who you can speak to if you’d like to talk to someone about preparing for assessments.  

Pre-exam preparation

Even though the format of your assessment will have changed, it’s still important that you prepare for the exam period in the usual way. Aim to revise the course content well in advance, so that you can go into exams feeling confident that you know what material might come up. Even if you are not doing time-constrained exams, and may be allowed to consult resources during the assessment window itself, you won’t have enough time to learn new information, apply it, and write a convincing assessment answer within the exam period itself. Make sure you revise as fully for these exams as you would for any others.

Most people find it helpful to prepare a revision plan some weeks before the exams themselves. Make sure you know what topics each exam might cover, and then think about how confident you feel about each topic, and how much time you have available to revise each one. Create a schedule for each week in which you plan which topics you’re going to study and when – doing so now can help manage anxiety around how much content you need to cover, as you break it down into manageable chunks. This resource from the University of Liverpool has lots of advice on preparing for online assessment, and in particular the section on creating a study plan may be useful to you at this point.

When creating a revision schedule, always remember to schedule ‘downtime’, including exercise, self-care and family/ social time. These are all vital for staying healthy during the exam period. Try not to block out every hour and day in your calendar with planned revision activities, but instead leave some free space each week to catch up on things you haven’t finished, reflect on what’s worked well, and ‘re-revise’ any topics that have proved more difficult than expected.

During the assessment period

It’s worth taking some time to think through your schedule during the assessment period itself, particularly if it’s going to be unlike any assessments you’ve done before.

You will have at least a 24-hour window during which to choose when to take your assessment. This is to accommodate the varying time zones, technological resources, and home-study set ups of all the students on your course. Depending on the format of your exam, it may be that you choose your start time within the 24-hour window and then have a fixed period (e.g. 2.5hours) immediately following this start time in which to complete your work. For other types of assessment, you may be able to read the questions at the start of the 24-hour window and then be free to work on them at any time during the window, provided your answers are submitted on time. However, this doesn’t mean you should spend 24 hours doing the work! For long answer or essay-style questions your programme team will give you a word count to indicate how much detail they expect in your answers, which will help you figure out how long to spend on them. This shouldn’t be significantly longer than you would spend in a more conventional exam, and certainly shouldn’t take longer than a normal working day.

Try thinking through the following questions in order to feel prepared for the assessment period:

  • When in the window will you access the assessment? Is there a time of day when you work best, and/ or when your home life is most conducive to unbroken concentration?
  • What exactly are you being asked to do in the exam? Check that you’re fully aware of the instructions (i.e. how long you have to submit your response, and how long it should be) in advance.
  • How does the online system work? You should be given the opportunity to do a ‘practice run’, possibly completing a general knowledge quiz or similar, before the assessment itself. Ask your programme team if you have any doubts about this process.
  • Who will you contact if you have any difficulties during the assessment period? Have the contact details for IT support on hand, as well as your programme team.
  • What can you be doing to make sure you’re in the best possible frame of mind when you complete the exam? Think about how you’ll plan your day to make sure you’ve eaten well, rested well, and feel physically fit to concentrate.

During the exam

During the exam, be ready to apply the usual time management strategies and exam techniques you would in an in-person exam. For example, know how many questions you need to answer, how many marks are available for each, and how you plan to divide up your time to ensure you don’t spend too long on any one section. If there are different sections covering different topics, will you prefer to start on those you’re most confident on, to build momentum, or those which are trickiest, and may be freshest in your mind from last-minute revision? Do you have time to read through all of the questions before you start answering, or will you be up against the clock, and needing to keep a very strict eye on time?

If you’re not sure of an answer, or if you have a choice of questions and don’t know which one to go with, you may find it useful to jot down some ideas next to each question to help you decide. Be careful with how long you spend on this, but do allow yourself some time to plan answers as this will save you from waffling and mean more efficient use of your time overall.

If you are doing any work outside of the main submission portal (e.g. in a Microsoft Word document) remember to save this regularly or make sure auto-save is turned on. Alternatively, have some note paper next to your device so that you can jot thoughts down separately from the assessment itself.

Try to leave at least 10% of the exam time free at the end, for you to review your answers. This is important for proofreading of long answers, and checking you’ve followed all the correct procedures for shorter questions, i.e. that you haven’t missed out any questions or ticked any wrong boxes along the way. This is where you can get easy marks from rectifying simple mistakes, so it’s definitely worth saving time for!

If you’d like to speak to somebody outside of your programme about preparing for assessment, one-to-one appointments with the learning development team are available via Microsoft Teams. Click here to book, or visit Study+ on Canvas for more information.

Health E-news Friday 15 May

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

NHS Employers highlight recent guidance updates

NHS Employers highlight the most recent updates to COVID-19 guidance for NHS workforce leaders. The updates include new information on registering staff for COVID-19 testing, FAQs on the extension to visas for international healthcare professionals, and details of the professions covered by the extension scheme.

Risk reduction framework for healthcare staff published

A new framework produced by the Faculty of Occupational Medicine, and backed by NHS England, offers recommendations on how to reduce the risks of COVID-19 to healthcare staff. Based upon the current evidence available on the heightened risks linked with characteristics including age, gender, ethnicity and long term health conditions, the framework offers recommendations on how to approach risk assessments incorporating the workplace, workforce and the individual. One potential consideration is for the redeployment of staff to lower risk environments.

Guidance supporting compassionate visiting arrangements

NHS England have produced guidance on supporting compassionate visiting arrangements for those receiving end of life care. The guidance highlights general practical considerations, and provides advice on how to facilitate visiting in inpatient, hospice, care home settings, as well as at home. All recommendations are consistent with the existing advice on suspension of visiting and palliative care in hospitals, and general advice from the government.

Resources to support staff in difficult conversations

Health Education England (HEE) have produced a set of resources aimed at supporting staff to manage difficult conversations with patients and families during the Covid-19 outbreak. A series of films have been produced, alongside some print resources aimed to guide the process of communicating unwelcome news.

RCN course supporting delivery of end of life care

The Royal College of Nursing (RCN) has developed a learning resource to support the delivery of dignified end of life care. The programme is intended to equip staff with some of the resources necessary to support dying people and their family and carers, and to ensure the provision of dignified end of life care, and also offers support for the wellbeing and self-care of nursing and midwifery staff. The online programme has been designed to be flexible, allowing staff to access and revisit individual resources as necessary.

Multidisciplinary guidance for safe tracheostomy during Covid-19

Multidisciplinary guidance published in the journal Anaesthesia, brings together the work of surgeons, anaesthetists, intensive care staff, nurses, physiotherapists, speech & language therapists and importantly, from patient groups, offering consensus on how to improve safety in tracheostomy of patients with Covid-19. Topics covered by the guidance include: the infectivity of patients with respect to tracheostomy indications and timing; aerosol‐generating procedures and risks to staff; insertion procedures; and management following tracheostomy.

Rehabilitation of Covid-19 patients

Two new sets of guidance provide recommendations for the rehabilitation needs of patients surviving COVID-19 related critical illness. The Faculty of Intensive Care Medicine (FICM) have produced provisional guidance on the recovery and rehabilitation of patients, considering the necessarily multidisciplinary nature of the services and professionals involved, and providing an example hospital care pathway.

Meanwhile, the Chartered Society of Physiotherapists (CSP) have launched a set of standards aimed at physiotherapists and service leads, and outlining the need for continuation of rehabilitation from critical and acute care  through to hospital or community-based rehabilitation services.

Reintroducing healthcare services

A series of resources have been produced, outlining key principles for reintroducing routine aspects of the healthcare services in the UK that have taken a backseat during the first peak of COVID-19:

NHS England have produced a road map, noting the requirement for patients to isloate for 14 days prior to attending planned procedures, and to be symptom free in order to be admitted. It also mentions testing and social distancing requirements relating to both elective and emergency treatment.

NHS Providers have produced a briefing on balancing the needs of managing the ongoing demands and risks of COVID-19 treatment, alongside restarting care for other healthcare needs.

 A joint piece from the Health Foundation, The King’s Fund and Nuffield Trust identifies five immediate challenges they believe the NHS face, including reassuring the public about using the services they need, looking after the workforce, and using the changes that have been made to services as the basis for future innovation and improvement.

The Academy of Medical Royal Colleges (AOMRC) have published principles for reintroducing healthcare services, again addressing the use of remote or virtual care where appropriate, the need for the public to seek necessary medical help, and staff support. Their guidance also provides further links to key specialty specific and individual College guidance.

Intercollegiate guidance on the pre-operative COVID-19 testing for elective cancer surgery has been updated. The guidance, from organisations including the Royal College of Surgeons of Edinburgh (RCSED), the Royal College of Surgeons of England (RCS) and the Royal College of Radiologists (RCR), clearly outlines the necessary process for screening before surgery.

The British Orthopaedic Association (BAO) have issued new guidance on restarting non-urgent trauma and orthopaedic care. The guidance comprises three sections: capacity issues for resuming surgery; infection prevention and control measures for planned surgery and prioritising patients for surgery.

A number of NHS unions have jointly produced a blueprint for return, focussed on keeping staff and patients safe.

COVID-19 related news

New study will attempt to identify genetics that may influence COVID-19 reaction

A new study will attempt to explore how genetics might influence individual reactions to COVID-19, offering explanations as to why some patients experience a mild infection, while others’ response of the virus is much more severe. In setting out to identify which genes cause particular people to be susceptible to specific infections, the study aims to determine which existing treatments may be effective, and to support the development of new treatments.

Cochrane Rapid Review on convalescent plasma for COVID-19 treatment

A Cochrane Rapid Review published yesterday, examines the evidence for convalescent plasma in the treatment of patients with COVID-19. While the existing evidence consists of 8 very small studies, meaning the effectiveness and safety of this treatment is uncertain, the authors identified 48 ongoing studies into the use of convalescent plasms in COVID-19 patients. The review will be updated based on monthly searches.

RCN urges better tracking of data on COVID-19 infection in healthcare workers

The Royal College of Nursing (RCN) has called for the collection of accurate data on health and care staff who contract COVID-19 in an open letter sent to the UK’s health secretaries and ministers. The letter states that a failure to properly collect data on workers testing positive, those admitted to hospital or having died as a result of the virus, means that decisions are being made without sufficient information.

HEE announce medical rotations will take place in August

Trainee rotations in August will take place as planned, Health Education England (HEE) have announced, following the cancellation of all planned rotations in May, June and July. Trainees in Foundation and Core posts will rotate at the beginning of August, though these will take account of local requirements and COVID-19 pressures. A webinar for trainees will take place at 7pm on Tuesday 26 May, and further information and up to date guidance for trainees can be found on the HEE website.

RCP urges ‘new deal’ for international health and social care staff

The Royal College of Physicians (RCP) has called on the government to make changes for international health and social care staff, in recognition of their vital frontline role, which has been highlighted during the management of the current pandemic. Changes proposed by the RCP would see staff exempted from the International Health Surcharge, extension of the proposed NHS Visa to social care staff, and indefinite leave to remain offered to all NHS and social care staff who have worked during the pandemic, along with their spouses and dependents.

RCOG and RCM respond to study on pregnant women and COVID-19

The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have published a joint statement in response to a study on the outcomes of pregnant women and their babies during the pandemic. Findings from the UK study support the existing clinical guidance that pregnant women are at no greater risk of severe illness, but did show that older pregnant women, or those who were obese or overweight, had pre-existing conditions including diabetes, or were of BAME background were more likely to be hospitalised if infected. In addition, the majority of women hospitalised were in the third trimester of their pregnancy.

POST briefings examine expert concerns over COVID-19

The Parliamentary Office of Science and Technology (POST) have produced a series of briefings based on the concerns that experts have relating to COVID-19 and various aspects of short, medium and long-term management and treatment. The briefings address concerns about the health and social care system, future preparedness for public health crises, research into testing, treatment and therapies, and the virology, immunology and epidemiology of COVID-19.

Centre for Mental Health forecast increased mental ill health

The Centre for Mental Health has used international evidence from previous epidemics and the aftermath of the 2008 banking crisis, to estimate the potential effects of COVID-19 on the mental health of the UK population. The briefing highlights groups who are at especially high risk of mental health difficulties, and offers recommendations for action that the government and the NHS can take in order to protect and support the mental health of the population.

Other news

Nurses Day celebrated amidst changed circumstances

International Nurses Day took place on the 12 May, and while planned celebrations had to be put on hold, or much adapted in light of the current pandemic, the always vital contribution of nursing staff to the healthcare system was still marked, locally, nationally and internationally. The RCN created a video to mark the day, and also urged nursing staff to ensure their own self-care and wellbeing.

 
NICE guidance

Medtech innovation briefing

MIB215 Space from Depression for treating adults with depression

Nice guideline

NG176 COVID-19 rapid guideline: chronic kidney disease

NG177 COVID-19 rapid guideline: interstitial lung disease

Technology appraisal

TA628 Lorlatinib for previously treated ALK-positive advanced non-small-cell lung cancer

TA629 Obinutuzumab with bendamustine for treating follicular lymphoma after rituximab


NIHR alerts 

Functional braces are effective alternatives to plaster casts for ruptured Achilles tendons

Eplerenone does not improve vision in people with central serous chorioretinopathy


Statistics

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Ebooks for SGUL Library users

As we are sitting at desks in bedrooms and kitchen tables around the UK and indeed the world, electronic resources have become increasingly important to our learning and teaching. The immediate chaos of rethinking a Library service without a physical library space has died down and your Librarians are busy developing new online learning resources to prepare for an uncertain future and continue to develop existing ones. While that work is going on, we are highlighting a range of electronic resources that are available to you at the moment.

Online resources available to SGUL students

Our own e-book collection has expanded dramatically and we continue to work to make the textbooks you need available electronically. As a little reminder, you can find these by searching Hunter, our Library catalogue, and filtering resources to “online resources” only.

In this blogpost, we are presenting electronic resources by a range of publishers which are temporarily available to SGUL library users during the coronavirus crisis. Please note the dates of when access ends.

EBSCO e-book collections

EBSCO have made three e-book collections available to St George’s Library users. St George’s University students and staff need to login with their username and password. NHS staff at St George’s Trust use their OpenAthens details to access the textbooks.

The collections cover clinical, nursing and psychology topics and all three are available until 30 June 2020.

You can find the links for the collections on our Databases A-Z list. Make sure to use the appropriate one, based on whether you are with the University or the Trust.

The clinical collection includes topic areas such as dermatology, gynaecology and obstetrics, internal medicine, medicine (general), nursing, ophthalmology, otorhinolaryngology, pathology, paediatrics, pharmacology and surgery.

The nursing collection includes over 700 e-books, from clinical guides, and evidence-based practice manuals, to practical handbooks and professional growth titles. You can find textbooks on subjects like nursing research & theory, pharmacology, nursing management, evidence-based nursing, home care nursing and leadership.

Topics such as in psychoanalysis, psychotherapy, counselling, social psychology, evolutionary psychology and developmental psychology are included in the psychology collection, which has over 500 popular textbooks.

To make the most of these textbooks, think about a topic that interests you and condense it into one or two keywords. As the example below shows, it is a good idea to keep search strategies in mind when searching the EBSCO e-book collection, but don’t be intimidated by the interface! Our Libguide on effective searching offers further guidance.

Example keyword search in EBSCO clinical e-book collection
Example keyword search in EBSCO clinical e-book collection

If you are unsure of how to search for e-books, email us at liaison@sgul.ac.uk and we will be happy to help.

AccessMedicine

AccessMedicine is available to SGUL staff and students and can be accessed until 30 June 2020. You need your username and password to log in.

The website includes over 130 e-books covering basic sciences, clinical medicine and healthcare systems. It also includes cases, videos and Q&As making it an all-around great learning resource. You can even create multiple-choice revision examples for yourself.

For example, you can look at Harrison’s pathophysiology animations, which are short, animated presentations. Short lectures on various topics are available too.

AccessMedicine lectures screenshot
AccessMedicine lectures

There also videos and lectures on human anatomy. If you are revising anatomy at the moment, have a look at Acland’s Video Atlas of Human Anatomy too. You have permanent access to it with your SGUL username and password.

Until 22 June 2020, you also have access to LWW Health Library, which includes videos, cases and textbooks, much like AccessMedicine, but for a broader range of courses, including physiotherapy and radiography.

Sage Nursing Support

Twelve chapters from key nursing textbooks are available from Sage for anyone to download, meaning it is available to both NHS staff and SGUL students. They are available for the duration of the Covid-19 crisis.

Sage Nursing chapter examples
Sage Nursing chapter examples

Topics covered include biological and pathological chapters, caring for adults with respiratory diseases, infection control, and managing the transition to professional practice – with reference to working under pressure and mindfulness.


For more help available, to get information on resources available or to book a 1:1 appointment with your Liaison Library, please contact liaison@sgul.ac.uk.

Careers and Employability Service still open for business!

In these are extraordinary times, the Career Services team continue to be available, albeit remotely, throughout the summer. You can book an appointment here and you can find a wide range of helpful resources on our Canvas module. Our pages include links to guide sheets and videos to cover many of your career planning queries.  Everything is organised into the three career planning stages: EXPLORE, PLAN, APPLY. And some programme areas, like Medicine and BMS, have their own section with resources organised by year group.

If you are feeling isolated or frustrated by lockdown and wondering what you can do, here are three key ways you can build your careers confidence:

  1. Review what you can do already and what skills you want to build. Check out Exploring your Skills and Strengths on Canvas for some exercises to start you off. Look for opportunities you might want to apply for and see which skills they are looking for.  Do you have those skills? Could you build them online?
  2. Review your CV and application writing skills.  Could you update your CV or improve the layout so it is easier to read quickly to find the key points?  What about cover letters or personal statements?  Do you feel confident about drafting these? You are welcome to send your CV or personal statement draft to careers@sgul.ac.uk for review. It helps us if you book a slot then choose ’by email’ for the final question. Or check out how to build a successful CV or application.
  3. Cultivate your online network. Are you on LinkedIn?  Does your profile need a review?  We can help with that. Then you could try searching for alumni who are working in the roles that interest you and check their skills and career path. You can do that by clicking the alumni button on this page.  If you want to work for a particular employer or NHS Trust, are you following them? Putting a notification of a job opportunity is often placed on LinkedIn now and would appear in your feed, so you could be one of the first to know.  Plus, you will see what the organisation posts about current developments and plans which will help you with your application.

A few more suggestions:

  • Go to InsideSherpa and enrol (for free) on one of their virtual work experience programmes with leading companies. This will give you something for your CV if you have no physical work experience planned.
  • Volunteer!  St George’s has many opportunities, especially now. These include tasks (like telephoning isolated people) which do not involve leaving home.
  • To help you deal with the uncertainty, here is a great video on growth mindset and here is an article which includes 15 ways you can adopt a growth mindset. With this, as in all other material here, do get in touch via careers@sgul.ac.uk if you would like to chat about it or find out more.

The Library has e-resources available for you look at, covering topics such as getting into particular medical specialties, writing great medical CVs and developing your career as a healthcare professional. For example, you can search for “medical career” in Hunter – our library catalogue. Remember to filter the results to “online resources” only (left-hand side menu).

Health E-News Friday 8 May

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

Joint statement addresses death certification during COVID-19 pandemic

A joint statement from the Care Quality Commission, the General Medical Council and Healthcare Improvement Scotland addresses questions raised by changes to the legislation relating to completion of the medical certificate cause of death (MCCD). The statement provides clarity over certification of death in cases where a positive swab diagnosis of COVID-19 is not available, advising practitioners to apply clinical judgement in stating the cause of death. The statement also makes it clear that the inclusion of COVID-19 in any part of the MCCD should be a matter solely for the doctor completing the form.

Government guidance on verifying deaths outside of hospitals

The government has published guidance clarifying practice for verifying deaths outside of hospitals and providing a framework for safe verification of death during the coronavirus emergency. The guidance applies to all cases outside of hospital, and supports verification of death by registered professionals, including paramedics, medical practitioners and registered nurses.

AOMRC statement on CPR and personal protective equipment (PPE)

The Academy of Medical Royal Colleges (AOMRC) have released a statement on the use of PPE when carrying out chest compressions and defibrillation as part of resuscitation, addressing divergent recommendations. Revised guidance from Public Health England does not include CPR on the list of aerosol generating procedures, and advises that first responders can begin CPR and defibrillation without the need for PPE. In contrast, guidance from the Resuscitation Council (UK) considers chest compressions to be an aerosol generating procedure and that PPE should be used where available, while they advise use of a cloth or towel in community settings if there is a perceived risk of infection. The statement also includes links to College specific guidance on CPR and PPE.

COVID-19 related news

IFS report examines evidence of disproportionate effect of COVID-19 on BAME groups

The Institute for Fiscal Studies (IFS) have published a report examining the evidence that the impact of COVID-19 is not uniform across ethnic groups, including the stark reality that in the UK, per-capita deaths amongst the black Caribbean population have occurred at three times those of the white British population. The report also explores the broader socio-economic impacts on BAME groups of the pandemic more generally. Meanwhile, a study from Imperial College looking at the characteristics and outcomes of hospitalised COVID-19 patients, also found an increased risk of mortality amongst people in BAME groups, and figures from the Office of National Statistics (ONS) suggest that black males are 4.2 times more likely to die from COVID-19 than white males. A recent piece from the King’s Fund considers what can be done to tackle these issues from the perspective of those working in health care.

Chief Medical Officers urge recruitment of more COVID-19 patients

The UK’s four Chief Medical Officers and NHS England and Improvement’s’ National Medical Director have written a joint letter to every NHS Trust, emphasising the importance of enrolling more patients into nationally prioritised COVID-19 clinical trials. In the absence of any proven existing treatment, the need for evidence from trials is especially important in guiding future treatment options.

RCEM set out recommendations for ‘resetting’ emergency department care

In a position statement published this week, the Royal College of Emergency Medicine (RCEM) have set out five fundamental aims that they believe to be necessary for emergency department care in the aftermath of the peak of the COVID-19 pandemic. The aims and associated recommendations in the statement call for emergency department care to be reset, and urge wholesale change to improve patient safety and the wellbeing of staff in emergency departments.

RCOT call on members to join the ‘Big Rehab Conversation’

The Royal College of Occupational Therapists (RCOT) are calling on members to join the ‘Big Rehab Conversation’ – a series of one hour virtual sessions held over Zoom every other Thursday evening. The first meeting will take place on Thursday 14 May. The discussions are intended to help set best practice for rehabilitation, and to identify challenges that might arise in the rehabilitation of people recovering from COVID-19. Interested members can sign up here.

Other news

RCN make preparations to mark Nurses’ Day on May 12

Next Tuesday, the 12 May marks Nurses’ Day, on the 200th anniversary of the birth of Florence Nightingale. In light of the COVID-19 pandemic, many plans to recognise and celebrate this day will have to be adapted, but the Royal College of Nursing (RCN) highlight the added importance of shining a light on the remarkable work done by nurses, and ask the public and patients to use the day to thank nurses around the world. The RCN website will be updated to note the day.

 
NICE guidance

Nice guideline

NG175 COVID-19 rapid guideline: acute kidney injury in hospital


Statistics

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Presenting: (new) Pubmed interface

PubMed users will have noticed a new version of Pubmed, which will become the default after 18 May 2020.

How to access the new Pubmed

Customised versions of PubMed make it easier to access the full-text of articles where they are available.

NHS users should use the following link, to access content available through OpenAthens: https://www.ncbi.nlm.nih.gov/pubmed/?otool=igbsgnhslib

Staff and students of St George’s, University of London should use the following link to access content available through your university login: https://www.ncbi.nlm.nih.gov/pubmed?otool=igbsgulllib

What’s new?

Changes to the site have primarily been made in order to offer an updated and more responsive PubMed, that provides the same experience and tools for users across all types of devices, from laptops to tablets and phones. Find out more about the transition from old to new here.

Some of the key changes to how results are presented include:

  • A new and improved best match, which is now the default sorting
  • A new summary view for results, which includes snippets from the abstract of each article

A new user guide and FAQs are available on the PubMed home page, or can be accessed directly here, and any questions, comments or other feedback can be shared using the Feedback button at the bottom of the new site. For those wishing to keep up to date with enhancements and changes to PubMed as they happen, follow the New and Noteworthy page.

There is lots of online training available for Pubmed. Their tutorials and on-demand course for the new interface are particularly useful.

How to find articles in Pubmed

Best search practices in the new PubMed remain the same as the legacy system:

  • To find articles by topic, enter your keywords or phrases into the search box and let PubMed’s term mapping do the work for you. Remember to be specific, don’t use quotation marks, search tags, or boolean operators, and avoid truncation (*)
  • To find articles by citation, enter the citation elements you have (author, title words, journal, volume, year, etc.) and let the citation sensor find the article for you
  • To find articles by author, search the author’s last name and initial(s)
  • To find articles by journal, use the complete journal title, ISSN or title abbreviation

During these uncertain times, we continue to provide support to all at St George’s. Whether you are NHS staff, a student or a researcher, don’t hesitate to get in touch and we will be able to advise. Email us at liaison@sgul.ac.uk.

Health E-News, Friday 1 May

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

NHS Employers highlight COVID-19 guidance updates for workforce leaders

The most recent updates to COVID-19 guidance for workforce leaders are highlighted on the NHS Employers website. Updates include guidance on deploying medical students, deploying returning doctors, overseas recruitment, and death in service benefits. The complete collection of workforce guidance can be found here.

Government guidance on supporting adults with autism or learning disabilities

The Department of Health and Social have published guidance for care workers and personal assistants supporting adults with learning disabilities and adults with autism. The guidance aims to help staff keep those they work with safe, and to protect their own wellbeing. It offers recommendations for communication of the changes that might be required under the current circumstances, and how to continue to maximise independence as far as possible. The guidance also links to further helpful resources for carers, and easy read resources that might be helpful.

COVID-19 related news

Report considers how to approach coronavirus exit strategy

The Institute for Government have published a report detailing the key issues of facing a long-term exit strategy for the current coronavirus lockdown. Acknowledging the inevitable trade-offs to be faced, the report stresses the need for the government to explain how it will balance economic concerns with the health concerns of lifting restrictions. It discusses the objectives of the government and the steps that might be taken to exit lockdown, and considers the various ways in which these two might interact. Some necessities for a successful exit, the report argues, is having adequate testing and tracing capacity in place, and transparency and a readiness to explain choices.

RCSLT report on dysphagia assessment

An expert advisory group within the Royal College of Speech and Language Therapists (RCSLT), set up in response to concerns from members on the government’s personal protective equipment (PPE) guidance, has published their report on dysphagia assessment. The report finds that dysphagia assessment should be considered an aerosol generating procedure, and should therefore be included in the list of such procedures within guidance on PPE. The report is backed by the Intensive Care Society, the National Tracheostomy Safety Project, the British Thoracic Society, ENT UK, the UK Swallow Research Group, the European Society for Swallowing Disorders, the British Association of Parenteral and Enteral Nutrition, and the British Association of Stroke Physicians, and has been sent to the government.

CSP resources to help with remote service delivery

The Chartered Society of Physiotherapists (CSP) have developed a series of resources to help physiotherapy staff support patients to remain active and to self-manage existing conditions during the COIVD-19 restrictions. The resources include support for general activity and strength and balance, alongside collections specifically for cancer and pain management, arthritis and osteoporosis, and respiratory illnesses, amongst others.

Visa extension scheme to be applied to allied health professionals

The government has announced that all regulated professions in the health and care sector will be covered by the visa extension scheme, meaning allied health professionals will now be covered. The Royal College of Occupational Therapists welcomed the announcement, who, alongside the CSP had called on the government to take this step to protect allied health professionals in addition to the medical staff originally covered by the extension.

Considering the second phase of the NHS response to COVID-19

Following correspondence on the second phase NHS response to COVID-19, a number of responses have urged a cautious approach to reintroducing normal NHS activity. A joint statement from the Faculty of Intensive Care Medicine and the British Association of Critical Care Nurses highlights the need to consider the potential impact on critical care and its capacity; while Niall Dickson, chief executive of the NHS Confederation called for local clinicians and managers to lead on the redesign of services as the situation unfolds.

Other news

Shorter course of radiotherapy could benefit early stage breast cancer treatment

Results from a pioneering study suggest that women with early stage breast cancer can be treated with fewer but larger daily doses of radiotherapy, delivered in a shorter overall duration compared with the current standard. The trial involved more than 4,000 patients and evaluated two different radiotherapy programmes, and offers findings which could reduce treatment times for early stage breast cancer patients. The full findings have been published, and are available online in The Lancet.

 
NICE guidance

Nice guideline

NG159 COVID-19 rapid guideline: critical care in adults Updated

NG160 COVID-19 rapid guideline: dialysis service delivery Updated

NG161 COVID-19 rapid guideline: delivery of systemic anticancer treatments Updated

NG163 COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community Updated

NG167 COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders Updated

NG169 COVID-19 rapid guideline: dermatological conditions treated with drugs affecting the immune response Updated

NG173 COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital

NG174 COVID-19 rapid guideline: children and young people who are immunocompromised


Statistics

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The Founder of Post Mortem Examinations at St George’s, University of London

Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Natasha ShillingfordProject Archivist.

Photograph of portrait of Sir Prescott Gardner Hewitt, Archives & Special Collections, St George’s, University of London
Photograph of portrait of Sir Prescott Gardner Hewitt, Archives & Special Collections, St George’s, University of London

‘It is not the oil-painting which adorns the walls our board-rooms…which will cause him so vividly to abide in our memories as, perhaps the unrivalled collection of pathological experience which this Hospital possesses, and which we owe to the initiation of Sir Prescott Hewett. For it is to him we are indebted for the inauguration of the system of recording the post-mortem records of the Hospital, which had now remained in force for over fifty years, and which has endowed us with a collection of pathological experience perhaps unrivalled in the medical world. This is a monument which will ever remain and will be ever associated with the name of Hewett.’ (‘Distinguished St George’s Men’, St George’s Hospital and Medical School Gazette, Vol III, Issue 25)

Post mortem examination signed by Prescott Hewett, PM/1842/104. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London
Post mortem examination signed by Prescott Hewett, PM/1842/104. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

Prescott Gardner Hewett was born on 3rd July 1812, the son of William N W Hewett of Bilham House, near Doncaster, by his second wife. His father was a country gentleman whose fortune was said to have suffered from his love of horse racing. Hewett received a good education and spent some years in Paris where he trained in the studios, having first decided to become a professional artist. However he became acquainted with the son of an eminent French surgeon and he became inspired to joint the surgical profession himself. He studied anatomy in Paris before returning to England.

Upon his return he entered St George’s Hospital where his half-brother Dr Cornwallis Hewett had been Physician to the hospital from 1825-1833. The excellence of his dissections caught the attention of Sir Benjamin Brodie, and he was appointed Demonstrator of Anatomy and Curator of the St George’s Hospital Museum around 1840. The first record in his handwriting was dated 2st January 1841. It was said that his ‘lucidity of expression, his clear and graphic exposition of his subject, his apt illustrations, and above all his facile and ready pencil, which served to demonstrate the most complicated anatomical point, soon gained him recognition and esteem of his class.’ (‘Distinguished St George’s Men’, St George’s Hospital and Medical School Gazette, Vol III, Issue 25)

It was during his time as Curator of the Museum that the post mortem records that are currently being catalogued as part of the Opening up the Body project were first commenced by Hewett. Also, many of Sir Benjamin Brodie’s preparation in the Museum were put up by Hewett.

He was appointed Lecturer on Anatomy in 1845 and Assistant Surgeon on 4th February 1848. He became full surgeon on 21st June 1861, in succession to Caesar Hawkins, and Consulting Surgeon on 12th February 1875.

He was also elected President of the Pathological Society of London in 1863, and ten years later he occupied the Presidential Chair of the Clinical Society. Amongst his other positions, he was appointed Surgeon Extraordinary to Queen Victoria in 1867, Sergeant-Surgeon Extraordinary in 1877, and Sergeant-Surgeon in 1884 in succession to Caesar Hawkins. From 1867 he also held the appointment of Surgeon to the Prince of Wales, and afterwards King Edward VII. On August 6th 1883 he was created a baronet.

Hewett was also Arris and Gale Professor of Human Anatomy and Physiology at the Royal College of Surgeons from 1854 to 1859, a Member of the Council from 1867 to 1883, Chairman of the Board of Examiners in Midwifery in 1875, Vice-President in 1874 and 1875, and President in 1876.

On 13th September 1849 Prescott Hewett married Sarah Todmorden, eldest daughter of the Rev. Joseph Cowell, of Todmorden, Lancashire, by whom he had one son and two daughters. He died on 19th June 1891 at Horsham, where he had retired after being created a baronet.

Few men have ever left the world with a more stainless record of duty honestly done and of success won by no ignoble means.

(‘Distinguished St George’s Men’, St George’s Hospital and Medical School Gazette, Vol III, Issue 25)


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Health E-News 24 April

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

Report from Imperial College on strengthening hospital capacity during COVID-19

A report from Imperial College presents a pandemic planner tool to inform the calculation of capacity of beds, staff and ventilators on the basis of implementing various interventions relating to the provision of healthcare services. The planner is interactive and adaptable to changing circumstances and evidence. The interventions were informed by a rapid review of policy decisions that have been implemented, or are under consideration, across 12 European countries, and additional means detailed in the report.

Supplementary RCP guidance on managing patients with PDOC

The Royal College of Practitioners (RCP) have published supplementary guidance to support clinicians managing tracheotomised patients with prolonged disorders of consciousness (PDOC), in order to take account of the requirements to protect patients and staff from COVID-19 infection risks. The guidance offers specific recommendations for PPE use, alongside considerations for units on staff and equipment levels.

NHS Employers highlight recent updates to COVID-19 guidance

Key recent updates to the NHS Employers COVID-19 guidance for workforce leaders are highlighted here. Amongst the changes are updates on visa extensions and applications, workforce supply and deployment, and provision of support for the mental wellbeing of staff during the ongoing pandemic.

COVID-19 related news

Updated Cochrane Review on personal protective equipment

A 2019 Cochrane Systematic Review on personal protective equipment (PPE) has been updated to include new studies and to take into consideration developments around COVID-19. The review evaluates different types of PPE, and issues around training and donning and doffing PPE. Amongst the conclusions, and because of uncertain evidence, the authors recommend that hospitals register and record the types of PPE being used by healthcare staff, in order to provide real-life information on the degree of protection offered.

RCoA publish results of membership survey

The Royal College of Anaesthetists (RCoA) have published results from a membership survey on experiences during the COVID-19 pandemic, which drew over 2,00 responses. The findings include that one quarter of respondents feel pressurised to treat COVID-19 patients when they feel they do not have adequate levels of protection, while over two thirds feel concerned for their own health and welfare due to inadequate supplies of PPE. 38% of respondents have been unable to access testing, and concerns were also reported in relation to supplies of anaesthetic drugs, mental distress and burnout.

NHS Confederation briefing considers evidence of COID-19 impact on BME staff

A briefing from the NHS Confederation’s BME Leadership Network explores potential underlying factors for the impact on black and minority ethnic (BME) healthcare staff and communities, and recommends practical advice on how to mitigate risks. The briefing points to evidence of the disproportionate effect of COVID-19 on people from BME backgrounds, considers the risks faced by different groups, and the potential links with socio-economic status and existing co-morbidities.

RCPsych warn of possible COVID-19 crisis in mental health units

The Royal College of Psychiatrists (RCPsych) has warned that mental health units across the country are at risk of a crisis similar to that sweeping through care homes. The warning comes after a survey of College members found that around half of the psychiatrists who responded confirmed the ability to access tests for themselves (51%), or for their patients (54%). Shortages of PPE and access to testing puts staff and patients of inpatient or community mental health services at increased risks of exposure to COVID-19.

RCN amongst unoins calling for minute’s silence for key workers who have died from COVID-19

The Royal College of Nursing (RCN) has joined with the Royal College of Midwives and UNISON, in calling for a minute’s silence to honour the UK key workers who have died as a result of coronavirus. The silence is to take place on International Workers’ Memorial Day, Tuesday 28 April, at 11am.

CSP calls for visa extension scheme to be applied to AHPs

The Chartered Society of Physiotherapy (CSP) has called on the government to add NHS physiotherapy staff, other allied health professionals (AHPs) and their families, to the automatic visa extension scheme that was recently launched. The government scheme currently provides overseas nurses, doctors and paramedics who are working in the UK with an automatic one-year visa extension in light of the current situation. The same request to extend the scheme to AHPs has also been made by the Royal College of Occupational Therapists.

RCP highlight available support for NHS video consultations

A blogpost on the RCP website highlights some of the resources available to NHS and foundation trusts to support the implementation of video outpatient consultations. Of particular note is the availability of Attend Anywhere, a video consultation platform, which has been fully funded for all trusts for 12 months; and the availability of up to £20,000 in funding for hardware to enable video consultations.

POST publish briefing on vaccines for COVID-19

The Parliamentary Office of Science and Technology (POST) have published a briefing on vaccines for COVID-19. The briefing offers some background on the typical processes of development and manufacturing of vaccines, followed by an overview of current candidate vaccines that have been developed both in the UK and internationally.

Other news

Medical organisations launch recommendations for contraception access

The Faculty of Sexual and Reproductive Healthcare, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have launched recommendations on access to contraception in maternity units. In the face of reduced access to contraception resulting from the impact of COVID-19 on GP practices and contraceptive clinics, maternity units offer an alternative site to discuss and provide contraceptive needs, for those attending.

Deal for new cancer drug agreed

The NHS in England has finalised a deal to provide a new cancer treatment, the drug larotrectinib, which is the first in a new generation of ‘tumour agnostic’ drugs to be made available. These drugs target tumours according to their genetic make-up, rather than their site of origin in the body. The new treatment will initially be used for children, young people and some adults, and could offer hope to patients with rare forms of cancer, some of which were previously untreatable.

 
NICE guidance

Nice guideline

NG163 COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community Updated

NG165 COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community Updated

NG167 COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders Updated

NG171 COVID-19 rapid guideline: acute myocardial injury

NG172 COVID-19 rapid guideline: gastrointestinal and liver conditions treated with drugs affecting the immune response


National Institute for Health Research (NIHR) Signals


Statistics


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Ten tips for adjusting to remote learning

In this post, the Learning Development team, who run the Academic Success Centre and Study+ on Canvas, offer advice on adjusting to remote learning and continuing to engage with your course in the era of social distancing.

The last five weeks have seen unprecedented changes to life as we know it, with inevitable disruption to your studies and daily routine. Teaching, learning and assessment are now continuing remotely, and as we all shift to this new way of working, it is necessary to reflect on and adapt our study practices to fit with the new environment.

This post is adapted from the Study+ resource on Tips for Distance Learning. Log into Canvas for more information, or contact Rosie MacLachlan at rmaclach@sgul.ac.uk with any queries

1. Get organised, within reason 

It’s easy to think that, with restrictions on socialising and being outdoors, we’ll now all have lots of extra time on our hands and you’ll find it easy to smash through all your work. Maybe you will, but don’t fall into the trap of expecting too much of yourself and then getting demoralised and demotivated if you can’t meet unreasonable expectations. Be gentle with yourself, and acknowledge the impact anxiety and disruption can have on your work rate. Now more than, ever it is important to get organised, prioritise tasks, and ensure a healthy approach to study.

2. Plan your days 

It’s difficult when working from home but try to emulate your daily routine from before the lockdown. Treat studying as you would a job, getting up and going to sleep at your usual time on weekdays. It may be tempting to study in your pajamas, but getting washed and dressed every day will help you feel more engaged and connected to reality. In terms of what to study and when, it is important to break tasks up into manageable chunks, and set yourself achievable tasks for each (short) study session.  See the Study+ page on Organisation and Time Management for help with this. 

3. Find a dedicated study space

As far as possible, try to set up a dedicated study space in your home, and use that space only when you’re studying. This will help get you into professional mode, and create a separation between your home and study life. If this isn’t possible for you, can you follow a schedule where a space (e.g. the kitchen table) is used only for study between certain hours of the day, after which you’ll put your materials away and return the space to its usual purpose?

If you’re asked to attend an online seminar, try to do so from a private space without those you live with passing through. Try too to work from a table and chair as much as possible rather than a sofa or your bed – following the usual habits of professional life will help you engage better in these unusual circumstances, and help to prevent stiffness and backache.

Photo of person studying at a desk.
Find a dedicated study space

4. Don’t try to study through your mobile!

As more of your learning moves online, it will be important to ensure you have access to the best computer set up you can manage. A good internet connection and up-to-date computer/laptop/ tablet are essential – speak to St George’s Learning Technology Services (LTS@sgul.ac.uk) if you have any concerns about this. Although it may be tempting to access Canvas etc. through your phone, such a small device is not conducive to good learning or healthy posture, so please try to avoid this. If possible, it’s also worth investing in a USB headphones and microphone set, as these make the online experience more immersive, removing distractions and thereby improving concentration.

5. Take regular breaks

Most people can’t concentrate on one task uninterruptedly for more than about half an hour. Don’t expect yourself to be able to work non-stop from 9 to 5, it’s important to take regular breaks. The Pomodoro Technique utilises principles from educational psychology to recommend concentrated study period of 25 minutes at a time, followed by a 5 minute break, with a longer break every two hours. See if this works for you – we’ve found it really helpful, particularly when struggling to get started. It’s easier to tell yourself you’re going to read a textbook for a 25-minute-stint than to sit down thinking you’ll get through the whole thing before you stand up again.

6. Aim for variety

You may find that the majority of your learning will necessarily be coming through your computer. However, staring into a screen all day every day isn’t good for anyone, and is unlikely to promote effective retention of information. Aim every day for some variety in what you’re physically doing. If you’re watching lectures or reading online, can you break this up with times of physically making notes on paper, or talking through your learning with somebody else? Many people find it easiest to synthesise their learning in a visual form, creating a mindmap or diagram of large concepts. See the ‘After’ section of our Learning From Lectures resource for examples of visual notes you could produce on scrap paper. If you haven’t already, it’s also worth reading through the Effective Study and Revision page, for ideas on how to be ‘active’ in your independent study.

Blank example of a mindmap
Try to do a mind map to consolidate your learning.

7. Talk to whoever’s around you

Learning is an inherently social activity. We learn most effectively when we’re discussing ideas with other people, asking and answering questions, and confirming understanding through debate. If there’s somebody at home who can help you with your study, ask if you can talk things through with them (they don’t need to have any prior understanding of what you’re studying) for five minutes at a time. If you can explain something clearly to somebody with no prior knowledge, that’s a sign you’ve fully understood it yourself.

8. Stay connected to your classmates

Try to stay engaged with peers on your course. It can be really helpful to impose some ‘accountability’ on yourself through agreeing targets or deadlines with peers, and then checking in regularly. For example, you could text a friend to tell them what you’re planning to study on a particular morning, and then video chat with them at lunchtime to compare notes on how the morning went (as well as having some important social downtime) – all the better if they’re working on the same topic as you. You might like to think about setting up a study group using one of the many options for online videoconferencing or chat software. Everyone should be able to access Microsoft Teams through their St George’s email address, or you could use your existing social media channels. Within any new group, it’s useful to discuss the purpose for meeting – what are your priorities and aims, and does everyone agree on these? Set small targets for each session, rather than a vague ambition to ‘do’ a whole topic. 

Stay connected

9. Be active when you study

In a face-to-face lecture, there is a time pressure for the lecturer to convey as much content as possible in only 50 minutes. When studying remotely, this time pressure doesn’t need to apply. Just as when reading an academic paper, it’s useful to pause and reflect on what you’ve read at regular intervals. When following a lecture on Panopto, aim to stop it every 10 minutes or so to ask yourself what you’ve understood from it. This is more productive than aiming to take notes as you listen, and encourages more genuine engagement. Try watching short blocks of the video, and then intersperse this with something more active: writing a summary paragraph or series of bullet points on what you’ve just learnt. Better still, write questions about what you’re still curious on – taking ownership and determining your priorities, rather than passively receiving information. If you’re using this approach, you may find there’s no need to take lecture notes at the same time as listening. Although it may take longer to keep pausing the video, you can be more confident that you’re retaining the information if you’re actively engaged with it. 

10. And finally… we’re still here for you!

While the university campus may be shut down, remember that most of your learning resources, and particularly St George’s Library, are available via remote access. You can use Hunter to access thousands of learning resources from home, or contact the library for one-to-one support from a Liaison Librarian. The Academic Success Centre, which provides one-to-one advice on study strategies, has moved to remote appointments. Click here if you’d like to book one of these. 

There is still lots of support available.

Now available: BMJ Learning

St George’s University students

Great news – the University has decided to get access to all BMJ Learning modules for students. You can now work your way through hundreds of accredited, peer-reviewed modules in text, video and audio formats.

To access BMJ Learning you will need to sign in with or register for a BMJ personal account. Once you are logged in, select ‘Shibboleth access’ on the drop down list from the ‘My Account’ menu. You will have full access to the BMJ Learning resources with your university username and password. Returning users who have completed the step above to link their account with the SGUL subscription can login with their personal account directly. If you have any questions around this, don’t hesitate to email liaison@sgul.ac.uk.

The courses include a range of modules, covering different topics. There are specific courses for fast-tracked students to get training on clinical skills and Covid-19 treatment. Learn for example about basic life support, basic practical skills and fluid management in acutely ill patients.

Examples of modules included in the fast-tracked students course

The regular courses on offer are divided into specialties such as diabetes and endocrinology, gastroenterology, neurology, oncology, paediatrics, practical skills, respiratory and ENT, rheumatology, sexual and reproductive health.

BMJ Learning specialties

NHS staff

In light of the current ongoing Coronavirus Covid-19 crisis, BMJ Learning have made some of their online courses available for free temporarily to NHS staff. Access them here – https://new-learning.bmj.com/covid-19

NHS staff will find the following courses particularly useful:

  • Covid-19 treatment
  • Return to Practice
  • Well being

NHS staff who are returning to work or working on the frontline with Covid-19 patients will find the modules on treatment and clinical skills refreshers useful.

Example of a module within the Return to Practice course

The Well being course covers a range of topics around your professional practice, such as emotional intelligence and dealing with conflict, but also focuses on understanding patient consent and treatment risk calculations.

All you need to access the content is sign up for a free account, which you can do here.

Three resources for students to check out

In response to the current Coronavirus Covid-19 pandemic, many academic publishers and providers of educational content have made all or parts of their collections temporarily, freely available for you to use via your George’s login.

You can find a list of all current databases available to support you in your learning here. We have highlighted the educational resources we think you might find particularly useful by putting them together under the tag “Online Learning and Teaching Resources”.

In this blog post, we highlight three of those and show you how to make the most of them.

JoVE (Journal of Visualised Experiments)

We subscribed to JoVE (Journal of Visualised Experiments) at the beginning of the current academic year. JoVE includes biology, immunology and infection, medicine and neuroscience. Our subscription also includes access to some parts of Science Education.

Currently, however, JoVE has made its entire collection of Science Education available to subscribers. In addition to clinical skills, JoVE has modules on biology, psychology and chemistry for example.

Access JoVE via the following link: https://www.jove.com/science-education-library. Please you note that you still need to sign in with your St George’s username and password.

Screenshot of JoVE homepage
Homepage of JoVE

LWW Health Library

As a St George’s student, you have free access to the LWW Health Library until June 22 2020. You can access the library here with your St George’s username and password.

It includes key textbooks, thousands of videos, cases and questions for the following subjects:

  • Medical education
  • Occupational therapy
  • Pharmacy
  • Physical therapy
  • Physician Associate (core education and rotations)

LWW Health Library includes key textbooks for all of the above subjects, divided into the different topics important to you, for instance medical students might want to have a look at Grant’s Atlas of Anatomy or relevant introductions to clinical medicine.

Screenshot of the medical education page on LWW Health Library
Example of medical education in LWW Health Library

Considering the wide range of subjects covered, we are sure LWW Health Library is a great resource for most students at St George’s to check out. If you create a personal account, you can also take the quizzes for each of these topics and bookmark useful content.

E-book collections

In addition to the 5,000 e-books that you have access to normally, numerous publishers have made their collections temporarily available for free. You are able to find and access those via Hunter, as you would any other e-book.

ScienceDirect

You can access 256 titles in the ScienceDirect e-book collections here. Again, you need your username and password to access this collection.

Screenshot of how to filter for appropriate content in ScienceDirect
Filter for appropriate textbooks in ScienceDirect

To find the most appropriate textbooks for your course, you can filter the collection. Make sure to choose to select “books”. As a “domain”, you can choose for example:

  • Biochemistry, genetics and molecular biology
  • Immunology and microbiology
  • Medicine 
  • Nursing and health professions
  • Pharmacology, toxicology and pharmaceutical science

Please have a look at the ScienceDirect entry on our Databases A-Z list to find a list of all the titles you have access to.

Other e-book collections

Cambridge Core textbooks are also currently available for free for students (login required). You can find it on the Databases A-Z list, under the “Online Learning and Teaching resources” tab. Cambridge Core includes a small collection of healthcare related books, which you can find by selecting “Medicine” among the subjects and then filtering to see only books under content type. They have a good selection of nursing and mental health textbooks in particular.

Screenshot of example of nursing textbook in Cambridge Core
Example of nursing textbook in Cambridge Core

Also available through the Databases A-Z list is SpringerLink, another collection of e-books with many healthcare related content. You need to filter for books and English language. They include sub-disciplines for oncology, cardiology, neurology, internal medicine and imagine/radiology for example. So, this is one to check out for radiology students as well as MBBS students.

Person with long hair sitting at a table and writing

Our regular providers of e-books, Dawsonera and Ebook Central are currently allowing multiple concurrent users, so you will always be able to access the content you need when you need it.


Any more questions? As a little reminder, you also currently have access to some CPD courses on BMJ Learning for free. The courses cover Covid-19 treatment, Well being and clinical skills for fast-tracked students. All you need to do is create a personal account with them. You can do that here.

Have you got any questions around e-resources or how to make the most of them? Please email us at liaison@sgul.ac.uk.

Holiday Library Update

In less unusual times, we know that many of our students would be heading away from SGUL right now to enjoy a few weeks’ holiday; and while it’s easy lately for the days and weeks to blend into one, we hope that everyone does get a chance to take some time off over the coming weeks (even if our entertainment options these days are a little different than in the past).

That said, we know that many of you will also be working to stay on top of your studies. With that in mind, here are three quick reminders of some of the ways your library can help.

1. Access online resources with your SGUL password

Hunter allows you to search a huge collection of online journal articles that you can access with your SGUL login. For tips on finding articles in Hunter, check the Hunter FAQs.

Or browse a list of learning resources – including HSTalks for lecture videos, Cite them Right for referencing help, our most popular online resource BMJ Best Practice, and many more – that can also be accessed with your SGUL login.

Help with offsite access

Our quick video shows you the easiest way to log in to journals and other online resources when you’re offsite. There’s also a PDF helpsheet to guide you through the process.

If you’re having problems logging in to any of our journals or online resources, let us know at journals@sgul.ac.uk. We’ll get back to you as soon as possible between 9am and 5pm, Monday to Friday.

Resetting your SGUL password

You can reset your SGUL password here, as long as you’ve registered an alternate email address; if you haven’t done this yet, contact the Student Life Centre to set one up.

If you have problems resetting you password, email ITAV@sgul.ac.uk.

2. Explore e-books

There are now over 3000 e-books available in Hunter – so whatever your topic, it’s quite likely there’s an e-book that can help. To find out, search in Hunter for Books and more; then select Online Resources in the filter at the left to see which titles you can access straight away using your SGUL login.

See our short video on finding and accessing e-books in Hunter.

Use the Online Resources filter to see e-books only

Temporary access to extra e-books

A number of publishers are making their e-book collections freely available during the Covid-19 health crisis – so you may be able to view e-books now that you wouldn’t usually be able to access.

From Monday 13th April you’ll be able to access all of these through Hunter while free access lasts. For now, you can log in to publishers’ websites to see what’s available and start reading. Try:

For a full list of these offers – as well as a growing collection of free resources on Covid-19 – check the new list in our Databases A-Z. We’re updating this list as new resources become available.

Borrowed books?

We’ve suspended holds for now, so you won’t be asked to return any books you’ve borrowed until further notice. Books will continue to renew automatically.

3. Get 1-2-1 help from a librarian

Working from home set up, lapatop and flowers on kitchen table.
Working from home

The library team may now be working from kitchens, bedrooms, sitting-rooms and a few other places besides – but we’re as committed as always to getting you the information, research and referencing help you need.

We continue to provide 1:1 support for everyone at St George’s. To make an appointment, please email us at liaison@sgul.ac.uk. In these unusual circumstances, we use Microsoft Teams to guide you through the databases and answer any questions you might have.

We are focusing our efforts on developing online material on Canvas and helping you make the most of our e-resources. For any queries or help needed email us at liaison@sgul.ac.uk. We are happy to help!

From servants to soldiers, from agriculture to administration: occupations in St George’s Hospital Post Mortem casebooks, 1841-1918

Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Dr Juulia AhvensalmiProject Archivist.

Post mortems? Surely they’re all about death and misery? In this blog post I hope to show that is not the (only!) truth. I want to examine what else historical post mortems can tell us, and illustrate how they contain a wealth of information about not just the deaths, but also the lives of the patients. The post mortem volumes held in the archives of St George’s, University of London provide a fascinating glimpse to the social structures of 19th and early 20th century central London. So let’s see what the collection can tell us about the patients of St George’s Hospital in the 19th and early 20th centuries. What did they do for living? How did big changes in the society such as the industrial revolution and the First World War show in the lives of Londoners at this time? I’ll use visualisations to give an overall picture, and zoom in to look at the people behind the statistics, so sit back – get your cup of tea ready – let’s go to Hyde Park Corner.

Engraving of St George's Hospital and Constitution Arch
St George’s Hospital and the Constitution Arch, Hyde Park Corner. Engraving. Credit: Wellcome CollectionAttribution 4.0 International (CC BY 4.0)

Most of the post mortem cases record the occupation of the patient, and this is one of the details we have been keeping a track on whilst cataloguing the volumes. The image below shows an overview of occupations from the volumes finished so far, ranging from 1841 to 1918; the data has been visualised using Flourish, and you can explore the graph in more detail by zooming in, and filtering the data by year to take a closer look.

Flourish data visualisation
Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

The largest categories are in the building and construction trade (general labourers, painters, carpenters), and in domestic service (servants, cooks, housemaids). Other categories include food and accommodation services (people working in public houses, hotels and restaurants), food industries and sellers of food (grocers, bakers, butchers), people working in occupations relating to agriculture (largely stablemen, grooms as well as gardeners and farm labourers) and industries and manufacture (from smiths to window blind makers) and transport (drivers, railway workers and so on). The classification is a simplified version of ‘The occupational structure of Britain 1379-1911’ by the Cambridge Group for the History of Population and Social Structure.

It’s not always clear what category is most appropriate – unless the record explicitly states that someone works for instance as a servant at a hotel, rather than at a private house, it is impossible to know. ‘Servant’ has therefore been classified as ‘domestic service’, with the caveat that this might not exclusively be the case. The category ‘miscellaneous services and occupations’ include what it says on the tin – a selection of occupations that do not fit neatly the other categories, often because they were rare within the data, or because it is not clear which category they should belong in. The latter category includes things like apprentices (who were they apprenticed to?) and collectors (what exactly were they collecting?). Amongst them there is a wonderful array of occupations: there’s a mosaic worker from 1870, an assistant secretary of the Conservative Club from 1918, a piano forte maker from 1877, a keeper of urinal from 1858, a sword polisher from 1888 and a cats’ meat man from 1858. The latter would have sold meat for cats, probably walking around the streets with a cart (one can only imagine the cats trailing after him!). Rosa Blacker in 1858 is ‘Clergyman’s daughter’, and Louisa Lee in 1887 is just described as ‘gypsey’ (there would also be a lot to say about the use of language in the records, often startling and offensive to the modern reader).

The hospital at this period was located at Hyde Park Corner: the site was not closed until 1980. The building still stands, but instead of a hospital it now houses a luxury hotel. Knightsbridge, Kensington, Chelsea, St James’s, Mayfair, Soho – these days that part of London doesn’t suggest the working class population that the occupational data highlights here. But although Hyde Park Corner, then as now, had an abundance of large, wealthy households, these houses required servants, as well as people working in the local shops and factories. Some of the areas which we may now connect with wealth and opulence were not always like that; the notorious slum around Westminster, for instance, was dubbed the ‘Devil’s Acre’ by Charles Dickens. The so-called poverty map by Charles Booth, a businessman and social reformer, published 1886-1903, shows the area around Hyde Park to be largely wealthy and middle class, but towards Westminster and Chelsea there are areas in which the population is classed from ‘poor’ to ‘very poor, casual. Chronic want’ and ‘lowest class. Vicious, semi-criminal’.

Charles Booth's Poverty Map
Charles Booth’s poverty map of the area around Hyde Park Corner. Source: Charles Booth, © 2016 London School of Economics and Political Science. Map data © OpenStreetMap contributors

Accidents and diseases are frequently a direct consequence of people’s occupations, and the post mortems enable the tracking of occupational diseases. Painters often suffered from colic, or lead poisoning, and paper stainers also frequently dealt with toxic substances: John Hyland, 48, is noted as having handled during his working life ‘much lead, arsenic, copper & mercury’ – a paper stainer would have worked with wallpaper, which, due to its vivid colours, was notoriously deadly in the Victorian era. Falling off scaffolding or ladders is a frequent cause of death for builders, and in 1888 we find the case of Aaron Gatheridge, 53, who, as a carpet layer, had ‘swallowed many nails and tacks’ (he died of cancer of the pylorus).

Preconceptions and prejudices about certain occupations as well as classes can also be seen in the post mortems. Those working in the hospitality industry in particular were often assumed to be heavy drinkers, and the doctor treating David Ferguson, 45, in 1888 notes that ‘He was a butler but claimed to be considered temperate’, whilst George Carter’s, 45, medical record in 1860 states that ‘This man was an omnibus driver of drunken habits, like most of his class’. Some positions also came with certain benefits, as we learn from the case of George Courtenay, 38, in 1860: ‘He was a very sober man, though he partook freely of the beer which was allowed in unlimited quantity to the servants’ (sobriety is also a relative concept).

Post Mortem record of Mary Fitzgerald 2 Mar 1905 PM/1905/57
Post Mortem record of Mary Fitzgerald, 2 Mar 1905 PM/1905/57. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

Of Mary Fitzgerald, aged 35 in 1905 it is noted that ‘Her life had always been sedentary – that of a needlewoman’. Another aspect of 19th century life the post mortems reveal is social and geographical mobility. Sarah Black was only 15 years old when she died of tuberculosis. She is described as being a kitchen maid, and her medical case notes tell us that she had come to London from Argyleshire two years previously, presumably to find work in the city. The doctor notes that ‘She was a dark-haired Highland girl with a fair skin’.

Not everyone was, however employed: unemployment was also a problem, and with no social security available apart from poor houses and charity hospitals, unemployment often meant destitution. The case notes of Samuel Brooks, 24, tell us that at the time of his admission to the hospital suffering from tuberculosis, ‘he had been out of work a long time, & starving, that he had recently found employment, and it was supposed he had been unequal to his task. He had been ailing for a fortnight, and had been entirely laid up for a week’. William Chant committed suicide in 1887, aged 57, after a period of unemployment; his notes tell us that ‘in consequence [he] had got very depressed’.

The class divide

The class divisions were stark: if you were wealthy enough, you would pay for a doctor to visit you at home, or attend their private practices. Only those who could not afford it went to the hospitals, which were often filthy and unhygienic.

Post Mortem record of Agneta Le Strange, 3 Oct 1918, PM/1918/207
Post Mortem record of Agneta Le Strange, 3 Oct 1918, PM/1918/207. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

There are occasional exceptions to this rule in the post mortem records: among the occupations of the hospital patients we find some gentlemen, a couple of ladies, an admiral and a naval commander, for instance. But looking further into these cases, they all turn out to be accidents or a sudden disease. The evocatively named Agneta le Strange was brought to the hospital unconscious by the police in 1918 after suffering a sudden brain haemorrhage; not a heroine in a gothic novel or a wizard as her name might suggest, Agneta was presumably visiting the family’s London townhouse in Eaton Square (the family also had a mansion in Norfolk). In the majority cases, the bodies, though recorded in the post mortem volumes, were not autopsied, as that was another marker of social status: the choice to not have a post mortem. H.J. Blagrove, a ‘gentleman’, was ‘flung from his horse near the hospital’ in 1854, but his relatives asked that his body would not be examined, apart from his skull, which had been injured in the accident.

Occupations in SGUL post mortem examination books, 1858. Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

The earliest of the post mortems from the 1840s only record patients’ occupations sporadically, often when it has some bearing to their disease. As we proceed further in time, the registrars start recording the occupations more methodically. Decades before cars filled the streets of London, horses were an important feature in everyday life, as the presence of grooms and stablemen shows; cab drivers, carmen and coachmen were employed in driving the horse-driven carts or cars around the capital. A gardener might have worked somewhere like the Vauxhall Pleasure Gardens, Chiswick Garden or Hyde Park, for instance, or in any number of plant nurseries providing plants to aspiring gardeners in the capital – there are even occasional farm labourers among the patients. Many people are employed in the building and construction: London was rapidly growing and these skills were in demand. There are fruiterers, bakers, butchers, distillers; people work in hotels, restaurants,  coffee houses, pubs (‘potman’ collected and washed dirty pots and glasses in a public house); they cook and serve; sew dresses, make cabinets and wigs and saddles; the charwomen and street sweepers clean and take care of public places as well as private houses.

The gender divide

Women’s occupations in SGUL post mortem examination books, 1841-1918. Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

Women did not have many occupations open to them on their own right. When in employment, they were, by and large, working with textiles as dressmakers, needlewomen and milliners, and in domestic service, as servants, housemaids, cooks, laundresses and cleaners. Towards the late 19th century industrialisation means some other occupations become available for women, such as working in factories, and in particular during the First World War we start seeing clerks, secretaries and typists among the women. Lilly Grundy, 19, is recorded as having been a ‘machinist’, probably in a shoe factory. For unmarried women with children, the options were even fewer, and for most of the 19th century limited to dressmaking and cleaning. The post mortem records usually note the occupation of the father for the children; recording the occupation of the mother instead signals to the reader that the mother was unmarried. The mother of Edwin Cannon, aged 4 in 1887, was a charwoman (or cleaner), and the mother of Pat Gurney, aged 5 in 1917, was a flower seller, indicated in the post mortem records by ‘M’ for ‘mother’.

Index to the post mortem volume 1887, showing the entry for Edwin Cannon, PM/1887/120, and index to the post mortem volume 1917, showing the entry for Pat Gurney, PM/1917/266. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

This was also the time when St George’s Medical School allowed its first female students, several of whom went on to work at the hospitals, including on the post mortems. Mostly, however, women’s status was defined by that of their husband or father; they are designated as ‘wife of labourer’, ‘wife of coachman’, or simply ‘married’, ‘wife’ or ‘widow’. And looking more closely into the cases it is soon obvious why this would be. Lack of (knowledge of) contraception as well as the social unacceptability of it meant that many women spent much of their lives pregnant, breastfeeding and caring for their children – they simply did not have the chance to even consider working outside the home. Emma Rickets, 50, is recorded as having had 22 children in 1888 – and having been one of 22 herself. That is of course an extreme example – but 10 children is not uncommon, and surely much fewer would have been stressful enough. Maria Cooper was 27 when she died in 1860; she is noted to have been married at 15 and borne nine children before her untimely death.

War and bureaucracy

Soldiers and sailors make occasional appearances in the records, often in the form of men who had perhaps gone ‘to sea’, often in East India Company’s employ, and latterly returned to Britain from the colonies. James Scott, for instance, died aged 44 in 1881. His occupation is listed as a confectioner, but his medical case notes tell us that he had gone to sea aged 17 in East India Company’s service, and had suffered from dysentery whilst in India. Life at sea is laid bare in the description of Scott as ‘a very heavy drinker of spirits, especially 1858-1870 when he had much morning vomiting & depression’. Far fewer are references to people who made the journey in the other direction: John Lusila was only 23 when he died in 1854 of tuberculosis. His medical record notes that ‘This poor black, who was a native of Angola, and had been in the West Indies, had been 10 years in England, & was a waiter in an eating house’.

Post mortem record of John Lusila, 17 Dec 1854, PM/1854/384. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

From the Napoleonic wars in the early 19th century to the First World War, the post mortems record soldiers, their wives and their children. In the visualisation of the occupations in 1918, the armed forces has become the largest category: there are soldiers, privates, riflemen, sergeants, a captain, a naval commander and an admiral – and in particular their wives and children, who of course were the ones remaining in London.

Occupations in SGUL post mortem examination books, 1917. Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

The visualisation also shows a huge increase in the types of occupations, compared to the earlier chart of 1858. In addition to the categories seen earlier – domestic service, occupations relating to the food industries and hospitality, building and construction – the industrial revolution, as well as the war, is apparent in all the jobs in factories: machinists, munition workers, aeroplane makers, electric fitters. There are also more white-collar type jobs in administration (clerks, secretaries, typists); there are engineers, a barrister, an architect, a bank manager and so on. The biggest change, however, is in the ‘other’ category, which earlier was filled with married women; in 1918, this category only includes two widows and one housewife.

Hélène Crosmond-Turner in Various musical celebrities by and after Elliott & Fry bromide print, 1890s. NPG Ax139913 © National Portrait Gallery, London

One of the interesting categories are those working in arts and entertainment. There are not many, but they include Percy Vaughan, a comedian, who died of tuberculosis aged 29 in 1887. His medical case records laconically that ‘he had been a pantomimic actor & had lived hard and fast’. Another tragic story is that of an opera singer, Hélène Crosmond-Turner. Born Rosa Levison or Leverson, she shot herself in a cab on Piccadilly in 1888 after failing to renew her contract as a lead in Aïda. She had for some time been worried about her financial situation and her career, and had tried some days previously to overdose on painkillers. The papers made much of this dramatic suicide, including describing her dress in detail – red and brown stripes, with a black and brown checked ulster, trimmed with imitation beaver (‘not one of her best outfits, as her landlady Mrs Godbold later observed’). Part of the attention lavished at poor Hélène following her death was due to her famous mother, Madame Rachel, whose tagline was ‘beautiful forever’. From selling rabbit skins and used clothes in London’s East End, Rachel proceeded to be the owner of a very profitable beauty salon in Mayfair. Her famous cosmetics, however, contained a multitude of toxic chemicals, including prussic acid, lead and arsenic. This, alongside with allegations of blackmailing her clients, led her to being prosecuted for fraud. She died in Woking jail in 1880, aged 60, eight years before her daughter.

What other stories would you like to hear from the post mortem project? We’re lucky in that we have all the volumes digitised, so we’re able to continue cataloguing the cases, and are eager to hear your views!

Careers Week: round up

It was great to see so many at the Careers Week stand outside the library last Wednesday.  We had a range of very interesting queries. Here’s a flavour: 

  • Where do I find vacancies and careers information? 
  • What are my options now I have decided to leave MBBS? 
  • How do I get onto the UK Foundation Programme? 
  • What can I do to get onto a surgery specialty? 

We checked some CVs and really enjoyed answering all your questions. Don’t worry if you missed us, you can still book to see us for any careers advice or application/CV help on Canvas or email one of St George’s Career Consultants (Karen Deadfield – kdeadfie@sgul.ac.uk).

Students with laptops sitting in Curve Lecture Theatre.

In addition to the Careers pages you can find on Canvas (some through your course pages), here are our Top 5 websites to explore: 

  1. Prospects.ac.uk – comprehensive information on all things careers from helping weigh up career options to career salaries, postgrad study to going for interviews.  
  1. Target Jobs – great on application advice and video interviews but another great general website 
  1. Oxford University’s Anatomy of a Personal Statement – for an annotated example of an application for Medicine 
  1. Health Careers – explore the range of careers and progression in healthcare. 
  1. LinkedIn – start setting up a profile and seeing how to develop areas of interest, check career routes of others and grow a professional network. Connect with St George’s students and staff as a starting point.   

Don’t forget: Explore, Plan, Apply! 


The Library has resources available for you to browse and borrow, covering topics such as getting into particular medical specialities, writing great medical CVs and developing your career as a healthcare professional. For example, you can search for “medical career” in Hunter – our library catalogue. We have also collected books around Careers and Professional Development and Women in Leadership on our Wakelet.

St George’s first Careers Week has landed

Banner for St George's careers service

Do you want to know how to succeed and develop in your chosen career path?

Do you want more ideas on where your degree can take you? The obvious and the not so obvious?

Are you looking for career inspiration beyond your specialism?

St George's, University of London medical students

What is happening this week?

Monday 2 March to Wednesday 4 March

Look out for the Careers-themed posts on social media and the odd blog post or two giving hints, tips and links on managing your career – think Explore, Plan, Apply!

Check Canvas to see if your course of study has its own career pages – there is a wealth of information to give you the full picture and a huge advantage in your career planning.

Wednesday 4 March

Meet the Careers Consultants – Social Learning Space, Hunter Wing, 1st floor 11am-2.30pm

Thursday 5 March

Humans in Healthcare – Curve Lecture Theatre, 4pm to 6pm. Please book here.

  • St George’s welcomes people from a range of healthcare specialties to share their lived experiences about staying well in the workplace, coping with their careers and highlighting the issues relating to mental health and the importance of seeking help.  
  • The focus is on workplace well being.
  • Keynote speaker is renowned speaker, Dr Ahmed Hankir, presenting the keynote on The Wounded Healer, bringing his personal story of mental health challenges in the medical profession.
  • It will be a great opportunity to network as well as manage your workplace well being.  
  • Event requires you to book here.
St George's, University of London paramedic science students

The Library is also celebrating Careers Week by having a themed book display around well being at work, mindfulness and stress and career development. Have a look at our curated collections of books around Health and Wellbeing, Careers and Professional Development and Women in Leadership. If you have got any recommendations for us to include, let us know by emailing liaison@sgul.ac.uk

A Case of Leprosy in the Archives

Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Natasha Shillingford, Project Archivist.

The post mortem record of Amy Bradshaw, Archives & Special Collections, St George’s, University of London, PM/1884/9

Amy Bradshaw, a seven-year-old girl, was admitted to St George’s Hospital on 24th July 1883 and she later died on 10th January 1884. She was suffering from Leprosy.

The medical case notes record that ‘Her mother was a native of Oxfordshire, her father of Barbados, where his family had lived for three generations since leaving Scotland.’ Amy was one of six children, one of whom died in infancy of dysentery, and two had Leprosy. The sister next above her in age was four and a half years older, and she developed symptoms of Leprosy in 1875. Amy was said to have first developed symptoms herself in 1879, when her mother noticed raised spots ‘like blind boils’ on her back and thighs, which after a time turned brown and were succeeded by a fresh crop.

On admission she was described as ‘a dark intelligent child of characteristically leprous aspect. Over the face and hand the flattened tubercles, in parts red, in parts brown, are abundantly scattered: the nose enlarged, flattened at the tip, red and pigmented; the lower lip the same.’ On her arms, legs and feet were depressed cicatrices and scattered dark brown pigment.

On examination the larynx and epiglottis were found to be thickened and unnaturally white and a lumpy deposit was found. ‘The timbre of the voice is somewhat nasal and the vowel sounds slightly continental.’

Amy was treated with Chaulmoogra Oil in the form of an emulsion which was seen as a success and the child was happy as a rule, although she occasionally complained of soreness and aching in the leprous tubercles. On 17th December her temperature rose rapidly ‘when an acute invasion of the new growth set in with much pain and suppuration.’ The medical case notes report that Amy’s elder sister who was suffering from the same symptoms, was allowed to leave the hospital on 23rd December to spend Christmas at home. However, she developed pneumonia shortly after and died on 6th January. Amy also gradually developed pneumonia in the hospital and ‘sank with great pain, and high fever, dying in Jan 10 1884.’ The post mortem report states ‘Face disfigured by leprosy cicatrices.’

Leprosy affects the nerves, respiratory tract, skin and eyes. It can cause loss of fingers and toes, gangrene, ulcerations, skin lesions and weakening of the skeleton. If left untreated, it can lead to a loss of sensation in the hands and feet. This lack of ability to feel pain can lead to the loss of extremities from repeated injuries or infection due to unnoticed wounds. Leprosy can also damage the nerves in the face which causes problems with blinking and eventual blindness. Other symptoms, which can be seen in the case of Amy Bradshaw, include flattening of the nose due to destruction of nasal cartilage, and phonation and resonation of sound during speech.

Credit: Elephantiasis graecorum, True Leprosy. Chromolithograph.
Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The disease takes its name from the Greek word λέπρᾱ (léprā), from λεπῐ́ς (lepís; “scale”). Leprosy has a long and complicated history and for centuries has been associated with social stigma, which even in the modern day continues to be a barrier to self-reporting and early treatment.

The earliest possible account of a disease which is believed to be Leprosy appears in an Egyptian papyrus document written around 1500 BC. Indian texts from 600 BC also describe a disease that resembles Leprosy. The first account of the disease in Europe occurs in the records of Ancient Greece after the army of Alexander the Great came back from India, and then in Rome in 62BC which coincided with the return of troops from Asia Minor.

Leprosy had entered England by the 4th century AD and was a common feature of life by 1050, although throughout its history it has been feared and misunderstood. It was often believed to be a hereditary disease, or some believed that it was a punishment or curse from God. Pope Gregory the Great (540-604) considered people with Leprosy to be heretics.

Others thought that the suffering of lepers echoed the suffering of Christ and they were enduring purgatory on earth and would go straight to heaven when they died. Therefore, they were considered closer to God than other people.

Leprosy patients were often stigmatised and shunned by the rest of society. During the middle ages people suffering from Leprosy were made to wear special clothing, ring bells to warn others of their presence, and walk on a different side of the road.

Credit: Manuscript showing leper. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

A passage from Leviticus 13: 44-46 shows the biblical perception that people with leprosy were unclean and should be ostracised from society:

the man is diseased and is unclean. The priest shall pronounce him unclean because of the sore on his head.

Anyone with such a defiling disease must wear torn clothes, let their hair be unkempt, cover the lower part of their face and cry out, ‘Unclean! Unclean!’ As long as they have the disease they remain unclean. They must live alone; they must live outside the camp.

Credit: Two lepers receiving food through a wall. Etching by Gaitt after A. Decamps. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Even in more modern times, patients with Leprosy were often confined to colonies called Leprosariums because of the stigma of the disease. Some of these colonies were situated in remote lands or islands, such as the island of Spinalonga off the coast of Crete which was used as a leper colony from 1903 to 1957. The novel ‘The Island’ by Victoria Hislop tells the story of the leper colony on Spinalonga and its inhabitants.

In 1873 Dr Gerhard Henrik Armauer from Norway identified the germ that causes Leprosy. The discovery of Mycobacterium Leprae proved that leprosy was not a hereditary disease, or a punishment by God, but an infection caused by bacteria.

Patients with Leprosy were often treated, as can be seen in the case of Amy Bradshaw, with oil from the chaulmoogra nut. The treatment was said to be painful and its success was questionable, although some patients appeared to benefit. Leprosy is now curable with multidrug therapy (MDT) which was developed in the early 1980s

The last case of indigenous leprosy in the UK was diagnosed in 1798. Leprosy can no longer be contracted in this country, but there are around 12 new cases diagnosed each year. The World Health Organisation (WHO) (https://www.who.int/news-room/fact-sheets/detail/leprosy) figures state that in 2018 there were 208,619 new cases of leprosy diagnosed. This is approximately one every two minutes.


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LGBT History Month 2020 – more LGBT book reviews

This is the second installment of our book reviews of LGBT books that we have in our collection at St George’s.

Every February we celebrate LGBT History Month! It is about celebrating the richness of queer people’s contributions to society, to make LGBT+ people visible in all their diversity and to educate out prejudice.

At St George’s we have a growing Reading for Pleasure collection and as part of that we have been expanding our range of LGBT titles. You can browse the whole collection on our Wakelet.

Rainbow heart that is lighting up.

Orlando – Virginia Woolf

Liz (Diversity and Inclusion Adviser)

Virginia Woolf’s Orlando, written in 1928, is a progressive, fun and vibrant novel that plays with gender and identity but carries an underlying important questioning of the restrictive nature of gender placed on individuals by society. This novel is very ahead of its time, like much of Woolf’s other works. It challenges the status quo, making it as important a comment on gender today, as it was when it was first published. 

Orlando is a beautifully written book with vivid and rich descriptions of societies and landscapes and tales of love and passion spanning over 300 years. Orlando is a love story, arguably based on Vita Sackville-West, Woolf’s close friend and lover. Woolf uses the novel to explore this relationship free of the boundaries of society, exploring sexuality and gender that is fluid.

Woolf creates Orlando as a playful, intense and humorous character through which she is able to explore, critique and question the role of gender in society and how this has changed over time. Woolf considered Orlando to be a “holiday” or “joke”, suggesting it is less serious and intellectual than her other works. Despite this, the novel has a serious and interrogative undertone which makes for interesting reading.

In Orlando, gender is fluid. For the protagonist, Orlando, gender changes as the novel moves through time. Half way through the novel Orlando changes from man to woman. This is not remarkable for Orlando or for Woolf, but entirely plausible. Woolf writes

‘Orlando had become a woman – there is no denying it. But in every other respect, Orlando remained precisely as he had been. The change of sex, though it altered their future, did nothing whatever to alter their identity’

In this, Woolf argues that gender is merely costume and expression, and is interchangeable. Orlando has autonomy over their identity, and this remains separate from the sex and gender.

Woolf highlights the complex relationship between gender and identity and how this is impacted by societal expectations and norms. Orlando pushes boundaries and questions why our roles and identities are so shaped and prescribed by our sex. Orlando is able to break free of this, exploring different roles and learning the penalties and privileges of each of these. Gender is performative and fluctuating, demonstrating a wonderful freedom. As the novel progresses Woolf explores a hopeful and changed world for women.

Orlando is a hugely progressive and daring novel; it is widely viewed as the first trans novel. It is fast-paced and immensely enjoyable to read. Whilst it was published 1928 it still feels relevant and challenging today. Woolf asks important and brave questions of her reader through a charming and playful love story I’d recommend everyone to read. 

Book cover of Orlando by Virginia Woolf.
Orlando

The Night Watch – Sarah Waters

Anne (Liaison Support Librarian)

Sarah Waters is a contemporary novelist known for weaving together themes of gender, sexuality and identity with characters that live on the margins of their respective societies. Night Watch (2006) is no exception to this. As readers we follow four characters through London before, during and after WWII. The author expertly plays with time and chronology, slowing revealing secrets and hidden traumas. At first, I found it difficult to engage with the characters and due to the chronology of the novel it is not fast-paced. However, some scenes stood out as highlights to me. Without wanting to give too much away, all I can say is that the characters’ personal development connects in imaginative, sometimes horrifying, ways to wartime events and post-wartime malaise. The female characters struggle to readjust to the more stereotypical gender roles they are expected to fall back into after the war. The sexual freedom they experienced during the war has receded and turned some characters’ romances into flat routine in which they seemed trapped. Their sexuality and the consequences thereof are something all four protagonists struggle with, either because of social stigma or personal shame and often because of a combination of both. Waters’ language does justice to the dramatic, (in)tense scenes as well as the more mundane, everyday elements of people’s lives and I always enjoy a good description. 

While I am not painting a very rosy picture of The Night Watch, and it definitely is a dark novel at times, I enjoyed reading it. As always, I really liked Sarah Waters’ gender-bending, sexually adventurous and at times confused protagonists as they navigate their historical contexts.  

Book cover of The Night Watch by Sarah Waters.
The Night Watch

We published another blog post a few weeks with more book reviews of LGBT titles. You can find it here. Any recommendations for our LGBT book collection? Email us at liaison@sgul.ac.uk.

LGBT History Month 2020 – LGBT book reviews

Every February we celebrate LGBT History Month! It is about celebrating the richness of queer people’s contributions to society, to make LGBT+ people visible in all their diversity and to educate out prejudice.

At St George’s we have a growing Reading for Pleasure collection and as part of that we have been expanding our range of LGBT titles. You can browse the whole collection on our Wakelet.

We have asked staff to share their thoughts with us!

Poster on brick wall with a rainbow and the text "Love is Love".

Maurice – EM Forster

Andy (Information Assistant)

When I first read Maurice by E M Forster, I was fourteen years old. Reading it proved to be the first time that I recognised myself in print. My interests, my desires and my hopes. Quite a feat for a novel published in 1971 and written in 1914! The novel centres on the relationship between two university students and their struggles to find a way of accepting and constructing a homosexual life in Edwardian England. As with Forster’s other novels, class and social mores are at the forefront of the novel. Even in the 90s as a gay teenager, the availability of gay representation within the mainstream was almost non-existent. Portrayals of gay life were often negative, and skewed. Reading Maurice and Forster’s superb character construction gave me a chance to see other gay men who were relatable and aspirational in their search for an accepted existence.

The novel was inspired by Forster’s visit to the gay socialist Edward Carpenter. When visiting Carpenter, Forster observed for the first time, a gay relationship between Edward Carpenter and his lover George Merrill being lived openly. Indeed many of Carpenter socialist politics are evident in the novel. Especially his interest in breaking down class distinctions.

Maurice is a must read for anyone who wants to see the power of the novel to effect real political and social change. It’s just so good. 

Book cover of Maurice
Maurice

Aristotle and Dante Discover the Secrets of the Universe – Benjamin Alire Sáenz

Jenni (Research Publications Assistant)

Aristotle and Dante Discover the Secrets of the Universe revolves round the friendship and eventual romance between two Mexican teenage boys, Ari and Dante. It’s written in a lyrical style that took me a while to get into, but once I did I just kept loving it more and more.

Ari’s gradual journey towards learning how to deal with his own emotions is beautifully and delicately handled, as is the (unresolved, and I think this is a strength) thread about what it means to be Mexican, and how it feels to be treated as not Mexican enough. The author makes all the secondary characters feel rounded and true without breaking out of Ari’s point of view, and portrays the adults in particular as being good people trying their best (and not always getting it right) in a way that I found refreshing.

My enjoyment was unfortunately a little marred towards the end by a backstory reveal that edged uncomfortably close to some lazy transphobic and homophobic tropes, and a slightly unsatisfying resolution to the otherwise captivating romance plot (involving a trope that I personally am not fond of), but other than that this is a wonderful, mesmerising book that is very much worth reading.

Book cover of Aristotle and Dante Discover the Secrets of the Universe
Aristotle and Dante Discover the Secrets of the Universe

Yes, You are Trans Enough – Mia Violet

Beth (Liaison Support Librarian)

I picked up Mia’s book because in my quest to be a better trans ally, I felt I needed a stronger grasp not only on trans issues but the lived experiences of those questioning their gender. Luckily, this memoir delivers on both fronts: it draws deeply on Mia’s burgeoning awareness of her true gender identity through to her decision to transition and she links the myriad of hurdles she faced (and continues to face) along the way to the wider issues facing the trans community. While there are regular reminders that there is no one ‘universal trans experience’, I suspect that many of the themes she discusses in her book will resonate with anyone who has ever felt bullied, excluded or marginalised.

I did feel the book could have used some more judicious editing – Mia’s writing style is honest but often offers exhaustive detail. This isn’t necessarily a criticism though: her attention to detail also provided me with several learning opportunities, particularly her struggle to access the healthcare services she needed. I was also struck by the difficulties she faces with her mental health, having become a beacon of support for other trans people online. It was a stark reminder of the emotional labour demanded of individuals who are fighting for basic rights (like appropriate healthcare) that most of us would take for granted.

I think Yes, you are trans enough is a great starting point for anyone wanting an introduction to trans issues. And even if Mia’s experiences are very different to your own, at the heart of the book is a story of personal acceptance and finding confidence in your identity which is a real pleasure to read, especially if you’ve ever felt a bit lost.

Book cover for Yes, You are Trans Enough
Yes, You are Trans Enough

We will be publishing another blogpost in a few weeks with more book reviews of LGBT titles. We would love to hear from you! Have you read any of these books or one from our LGBT collection (found on our Wakelet)? Let us know your thoughts in a couple of paragraphs and we’ll publish your review as part of our next blogpost. Email us at liaison@sgul.ac.uk.

Coronavirus (Covid-19) Resources

Bottles in research lab at St George's, University of London

Last updated: 08/04/2020

**This blog post is now closed due to the growing number of these resources. All of the resources listed here, and many more, are now organized within two filtered lists on the Library’s Databases A-Z. See below for details.**

Online Teaching and Learning Resources – contains quick links to the Library’s existing offsite resources for students, as well as new educational materials made available by publishers for a limited period during the Covid-19 crisis.

Coronavirus (Covid-19)a full list of research, clinical and educational Covid-19 resources, including preset Covid-19 search strings from PubMed.

Focused links to Covid-19 clinical and clinical education resources for NHS staff will also be found on our NHS LibGuides in due course.

In response to the Coronavirus (Covid-19) outbreak, some publishers have opened up access to articles and tools to support healthcare professionals and the public.

Here’s a quick round up of links to keep you up to date with this global medical emergency. Most of the content listed on this page is free to access.

American Medical Association: JAMA Network COVID-19 information collection

BMJ: Coronavirus special issue & BMJ Best Practice’s Coronavirus topic

Cambridge University Press has made 80 relevant book chapters and journal articles freely available on Cambridge Core during the Covid-19 crisis.

Clarivate Analytics: Comprehensive overview of different types of Coronavirus, including the current outbreak: Diseases Briefing – Coronaviruses.

The Cochrane Library has established a special collection on Coronavirus (COVID-19): evidence relevant to critical care. See also its companion special collection on  COVID-19: infection and control https://www.cochranelibrary.com/collections/doi/SC000040/full

Dimensions has collated a regularly updated export of publications, data sets and clinical trials relevant to COVID-19 accessible here.

DUKE University Press: Navigating Pandemic syllabus. Information on how we navigate the spread of communicable diseases. Listed e-books freely available until 1 June 2020 and journal articles until 1 October 2020.

DynaMed: Novel Coronavirus (2019-nCoV)

Elsevier: Novel coronavirus information center

Emerald: free access to research on Covid-19 and related topics, including expert briefings, journal articles and book chapters (until the end of 2020)

EPPI Centre: a living, up to date, systematic map of the evidence on COVID-19

European Centre for Disease Prevention and Control: dashboard featuring updated data on the pandemic, alongside reports, risk assessments and other publications.

Google scholar: search string Created by Wichor M. Bramer, Biomedical information specialist, Erasmus MC

Lancet: Coronavirus hub

MAG: articles on Covid-19 available for free on MA Healthcare.

Microbiology Society: List of articles freely available.

NEJM: 2019 Novel coronavirus (2019-nCoV) Links to the first article published on the virus and other resources.

The New England Journal of Medicine: Collection of articles and other resources on the Coronavirus (Covid-19) outbreak.

NICE have put together rapid guidelines and evidence reviews around COVID-19.

Ovid and Uptodate: Coronavirus resources and tools Includes access to Uptodate’s coronavirus topic and expert searches that can be run on the Ovid Medline search platform and Journals@Ovid (Normal OpenAthens or Institutional logins required for expert searches).

Ovid have also provided temporary access to GIDEON (Global Infectious Diseases and Epidemiology Online Network) which covers all infectious diseases in every country. It is updated daily with information on the latest outbreaks, helping with diagnosing diseases and identifying organisms.

To access it, login to Ovid (with your NHS OpenAthens account or university login), and you should see the link to GIDEON on the top tool bar.

Oxford Centre for Evidence Based Medicine: The CEBM has committed its skills and expertise in evidence synthesis and dissemination to the effort against the current COVID-19 pandemic. This page will be updated regularly.

Oxford University Press: content from OUP journals and online resources on COVID-19, other coronaviruses, and related topics

Public Health England Coronavirus Information: https://phelibrary.koha-ptfs.co.uk/coronavirusinformation/.

Royal College of Physicians: Links to specialty specific guidance on COVID-19

The Royal Society: Sharing research data and findings relevant to the novel Coronavirus outbreak.

SCIE (Social Care Institute for Excellence): Covid-19 advice for social care

Springer/Nature: Novel coronavirus (Covid-19)

St George’s, University of London on FutureLearn: Free online courses on how to manage Covid-19 in General Practice and how to understand and manage Covid-19 critical care.

UpToDate: COVID-19 topic from UpToDate

WHO: Novel coronavirus 2019 nCoV  and their database on global research on Covid-19 (please note this database may contain publications which are not freely available)

Wiley: Coronavirus research from Wiley

Finally, Keith Nockles, an academic librarian from the University of Leicester, is regularly updating a coronavirus blog featuring many of the above links as well as sections on news, epidemiology & genetics and information for patients.