The library working environment: study break passes and texting service

Maintaining a pleasant working environment for everyone who uses the library is one of our main concerns. To ensure that it continues to be a great place to study, we have introduced, or rather reintroduced for those of you  who have used the library for a few years, two new schemes.

Study break scheme

We are still operating at reduced capacity and we’d like to make sure everyone has access to the study space they need. A study break pass allows you to take a break of up to 30 minutes during which time you can leave your belongings unattended. While we don’t take any responsibility for unattended personal stuff, with our study break scheme you can make sure that we don’t move your things to make space for other library users during the 30 minutes. After that time or if you choose not to use a study break card and you are away from the desk, other library users or staff are able to move your belongings to the side to make space. Find out more here or email library@sgul.ac.uk with any comments you might have.

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Noise in the library

We have also introduced a texting service, so you are easily able to alert us to noise in the library or other issues affecting your study space. Text us, with your location, on 07562901543 and we will ensure you can study in peace and quiet. This service is available between 9am and 9pm Monday through to Sunday. Again, if you have any comments about this, please email library@sgul.ac.uk.

Poster for texting service.

We hope that these schemes allow us to continue keeping the library a pleasant working environment for all library users.

Tips and tricks for longer research projects

The focus of this blogpost is literature searching, specifically for longer research projects such as dissertations, and it is aimed at St George’s students.

Your expert Liaison Librarians are able to support you with every step of the way so don’t hesitate to get in touch by emailing liaison@sgul.ac.uk. We are able to advise on how to plan and carry out a complex literature search in a variety of databases. We can also recommend which databases are most suitable for your topic.

You can email us for an individual appointment or come to one of our online drop-ins. Monday to Friday between 12-1pm you can chat to a Liaison Librarian directly. Click on the relevant link on the day you want to drop by.

Here we provide tips and tricks, no matter which stage of the process you are currently at.

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If you are…

…just getting started

Do a scoping search in Hunter. Even if you already use Hunter to locate books and journal articles in our collection, our Hunter video might teach you another thing or two about how to really make the most of its search functions.

If you aren’t familiar with the planning stage of literature searching or you usually skip this bit to get stuck in straight away, now is a good time to change that. When it comes to dissertations and research projects, you need to be much more systematic in your work, including when you formulate your research question. Have a look at our Canvas unit on this topic. It gives you more information and by the end, you will have a research question ready to start searching with.

If you are worried about how to structure your dissertation or academic writing, you can make an appointment with the Academic Success Centre team. Their details are found on the Study+ section in Canvas. We also have a number of books in our collection which can help with academic writing, including how to approach a literature review, dissertation or research paper. They are listed on our Writing for Assessment Wakelet.

If you need specific software to do your research, such as SPSS, have a look at what is available to you through St George’s University and request it here.

And finally, a little tip on how to get started. If you know of a paper which covers the area you are interested in already, have a look at which articles they reference and perhaps you find some relevant papers in their reference list for your project. While this is not a systematic method, it can help you get started and add to your search strategy (e.g. which alternative terms to use).

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…ready for an in-depth literature search

If you are a little overwhelmed by the prospect of doing a complex search in multiple databases (and who can blame you), you need to start by familiarising yourself with how to build a complex search, what alternative terms are and how to include them and how to use advanced search strategies. We have a libguide that takes you through the whole literature searching process. For those of you who are working on a systematic literature review, have a look at our relevant libguide, which highlights what you need to consider to turn your literature review into a systematic literature review. Watch the following videos to find out more about identifying keywords and alternative terms.

We have introductory videos on Ovid (Medline), Ebsco (Cinahl) and Internurse to get you started. Once you have familiarised yourself with the basics, watch our detailed video tutorial on how to search in Ovid/Medline using advanced search techniques.

Have a look at our Databases A-Z list to see which databases are available to you. Your subject guide will tell you which databases are most relevant to your course.

Don’t forget – you can also ask a Liaison Librarian for help by emailing us at liaison@sgul.ac.uk or coming to one of our daily online drop-ins. We can recommend which databases are most suitable for your topic.

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…finishing up and sorting out your references

To cite correctly at St George’s, most of you need to use Harvard Cite Them Right. While we have a number of physical copies of this in the library, you will probably be using the Cite Them Right website (login required). In case you need a refresher on how to navigate Cite Them Right, we also have a detailed walkthrough video on our YouTube channel and in our Referencing Essentials unit in Canvas.

We strongly recommend you don’t use reference generators such as Cite This for Me as we find that generally the references produced by such tools are wrong. You end up spending longer correcting and double-checking your references than you would have done writing them from scratch. If you find the resource in Hunter, you will notice a “citation” option for each record. This has been formatted to match the requirements of Harvard Cite Them Right but it is not always correct. Make sure you compare it to Cite Them Right and correct it if necessary.

For a longer project, we encourage you to use reference management software as it helps you to deduplicate your search results, manage your references and create in-text citations and references. At St George’s, we support RefWorks, which is a web-based software. You need your St George’s login to access it and create an account. To get started, have a look at our RefWorks libguide. Additionally, our detailed video tutorial covers everything from how to get started to how to create references and in-text citations from within Microsoft Word.

We can also help you with your references, so if you are unsure about anything please email liaison@sgul.ac.uk or come to our drop-ins.

A Railway Mystery

Opening Up the Body’ is a Wellcome-funded 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 1841-1921. This post was written by Project Archivist Natasha Shillingford.

Following on from the discovery of a post mortem case of a monkey on the railway we decided to explore other cases of railway mysteries in the post mortem collection of St George’s Hospital. We soon came across a case worthy of the great Hercule Poirot.

On 23rd September 1886 Moritz Fischer was admitted to St George’s Hospital with a compound depressed fracture of the skull, with laceration of the dura mater and brain with meningitis.

PM/1886/292. Archives and Special Collections, St George’s, University of London

The case notes said that ‘The man was found in a 1st class compartment of the Metrop[olitan] Railway with a fractured skull.’ He was conscious but did not speak. There was a scalp wound about eight inches in length which extended from the centre of the forehead. The external table of the skull was fractured and the internal table was driven through the dura mater into the brain, with the brain substance protruding. The fragments of the bone were picked out with forceps and the scalp was brought together with sutures. He went on well without any special symptoms for nine days when he passed his urine into the bed and became drowsy. His temperature slowly rose from 99 degrees to 106 degrees on the evening of the 3rd October and he died on the 4th.

The post mortem examination states that there was a wound 3 ¼ inches long over the frontal region. It started from a point 1 inch to the right of the middle line and passed obliquely forwards and to the left. The angles of the wound were infiltrated. Beneath it, part of the temporal bone was absent. Some soft greyish substance protruded which was examined microscopically and found to consist almost entirely of nerve fibres, blood and granular matter.

PM/1886/292. Archives and Special Collections, St George’s, University of London

What happened to Mr Fischer in the first-class compartment to cause such brutal and deadly injuries?

Lloyds Weekly London Newspaper reported on September 26th 1886 that on the arrival of the train at Bayswater, ‘the attention of the newspaper boy attached to the bookstall on the platform was attracted to the last compartment by one of the first-class carriage fourth from the engine, there being a stream of blood on the outside of the carriage door, the window of which was open. On looking through into the compartment the lad observed a gentleman lying prostate on the floor, alone, and with his feet towards the door, there being a small quantity of blood on the carpet, and a much larger quantity on the cushion of the seat nearest the engine.’ The acting-inspector on duty opened the door and ‘saw that the unfortunate man was quite insensible, and that blood was flowing from a terrible wound on the forehead.’ The gentleman was ‘attired in a grey overcoat, the coat underneath being of black diagonal cloth, and his trousers were light-striped. His gold watch and chain were safe, as were also his rings, but not much money was found in his possession. A few papers were discovered, and they were all in German. A visiting card was found bearing the inscription, “Mr. Moritz Fischer,” and the police, as the result of subsequent inquiries, ascertained on Friday that the injured gentleman was Mr. Moritz Fischer, head of the firm of Mr. A. Fischer and Co., general foreign agents of 35 Carter-lane, and having residence in Westbourne-terrace.’ Thus it appears that none of Mr Fischer’s belongings were stolen so theft was unlikely to be a motive for an attack. However, ‘It was reported that despite the carriage being empty, they could not be quite certain on the point, owing to the confusion which prevailed.’ Therefore it is entirely possible that another individual was in the carriage with Mr Fischer and escaped during the turmoil.

The police, however, were of the opinion that Mr Fischer sustained his injuries by accident, and the following anecdote appeared to confirm this hypothesis:

‘A friend of the injured man says that about twelve months ago Mr. Fischer met with a curiously similar but by no means so serious an accident while travelling on the railway. He had put his head out of the carriage window when he was struck by some projection in the tunnel. He was severely cut, and had to wear a bandage for some time. The injury then sustained was just over the forehead, as now, but the skull was not fractured. The old accident subsequently formed a standing joke among his friends, and he was often rallied about putting his head out of carriage window and advised not to be of so inquisitive a turn of mind. Only a few nights ago the old joke was repeated to him, along with the question whether he had lately been putting his head out of the window. This may be an explanation of the mystery, or it may be only a striking coincidence; but it is a singular fact that most of the known facts appear to lend themselves to such an explanation of what at first appeared to be a very tragic crime.’

The newspaper paper continues by saying that ‘It is conjectured that Mr. Fischer had a propensity for watching the people who occupied the adjoining compartments, and while indulging in this habit he must have placed his feet on the carriage seat, and in his endeavour to place his body as far outside the window as possible, his head must have come in contact with the projection in the spring of the arch.’

However, at the inquest into the death of Moritz Fischer (reported in the London Evening Standard 08 October 1886), a friend of the deceased, Fritz Mercier, said that despite being aware of Mr Fischer previously having injured his head during a journey from Manchester, he refuted the claim that he was well known to have put his head out a carriage window. Despite this, the inquest further confirmed that there was no sign of a struggle, there was no derangement of the carriage and ‘On the night of the accident when the traffic had ceased, Witness went in a carriage and found at the very spot where it was supposed the gentleman met with his injury, that it was quite possible by leaning about 18 to 20 inches out of the window, to meet with a similar accident. At the same spot there was a continuous trail of blood on the wall.’ Furthermore, a witness spoke to picking up a pair of spectacles about twenty yards from where the blood was found on the wall, and another witness testified that Mr Fischer had never been known to be without his spectacles.

Based on the evidence, and despite conflicting testimonies from the friends of Mr Fischer, the jury returned a verdict of Accidental Death. Foul play or a case of curiosity killed the cat, either way please refrain from putting your head outside a carriage window on a moving train.


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New Read and Publish deals for 2021

Since last year’s announcements, SGUL Library has expanded our number of “Read and Publish” deals, giving SGUL researchers even more opportunities to publish open access – this year we have new arrangements with publishers such as Oxford University Press, BMJ Publishing and Cambridge University Press, in addition to others such as Springer and Wiley.

Under these Read and Publish deals, open access fees for publishing original research in many journals from participating publishers are waived.

The deals are called read and publish because the institution has paid for SGUL staff and students to have access to read articles in the subscription journals covered, PLUS, where the SGUL researcher is the corresponding author, research articles can be published under a Creative Commons licence at no extra cost. This is visualised below:

Image shows a large green circle containing a smaller blue circle, containing an even smaller yellow circle. The largest circle is labelled 'university subscription', the middle circle is labelled 'Read articles' and the smallest 'Publish open access'.

To be eligible to publish open access, you’ll need to be the corresponding author on the paper, and either a member of St George’s, University of London staff, or a student at St George’s, University of London. You’ll be expected to use your SGUL affiliation on any articles where the fee is waived under this scheme. Guidance on acknowledging affiliation is contained in SGUL’s Research Publications Policy.

Corresponding authors who are members of St George’s University Hospitals NHS Foundation Trust staff with honorary status at SGUL won’t normally qualify for these deals, although if the paper acknowledges a UK funder and a co-author with a relevant grant is based at SGUL, the paper may still qualify – please contact us for further advice.

As well as increasing the opportunities for SGUL researchers to make their research openly available, these deals will also help researchers to comply with funder mandates to publish open access (a CC-BY licence will usually be the one to select for funded research papers).

Which publishers are included in these new deals?

  • BMJ Publishing, including titles such as Archives of Disease in Childhood, Gut, Heart and Sexually Transmitted Infections (your research must be acknowledging one or more specific UK funders to qualify). Note: This deal does not include open access waivers for publishing in the BMJ, or wholly open access titles.
  • Cambridge University Press, including titles such as British Journal of Psychiatry, Cardiology in the Young, Epidemiology & Infection and Twin Research and Human Genetics.
  • Oxford University Press, including titles such as Brain, Clinical Infectious Diseases, European Heart Journal, Human Molecular Genetics, Journal of Infectious Diseases and Virus Evolution.
  • The American Physiological Society, including titles such as American Journal of Physiology – Cell Physiology and American Journal of Physiology – Lung Cellular and Molecular Physiology. Researchers will also be eligible for a one year APS membership.

See our webpages for further information on the publishers and journals included in these deals, and information on how to apply.

Open Research Platforms

As well as these opportunities to publish open access, a growing number of funders are providing open research platforms for researchers to publish the results of their research rapidly. These include:

Are you funded by the Wellcome Trust?

If you are funded by the Wellcome Trust, remember that their open access policy has changed for journal articles submitted from 1st January 2021. All original, peer reviewed research articles funded by the Wellcome Trust and submitted from this date must be made freely available via PubMed Central (PMC) and Europe PMC by the final publication date, and must be published under a CC BY license (unless Wellcome has agreed to the use of a CC BY-ND license).

The following statement must be included on original, peer reviewed research articles funded by Wellcome and submitted from 1st January 2021:

“This research was funded in whole, or in part, by the Wellcome Trust [Grant number]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.”

This rights retention strategy, developed by cOAlition S, will allow Wellcome funded authors to publish in their choice of journal, while also complying with the Wellcome Trust’s new open access policy.

COAlition S have also produced this graphic to explain the rights retention strategy.

For more information on Wellcome’s open access policy, have a look at our Library web page setting out the key points you need to know.

Questions?

Contact us at openaccess@sgul.ac.uk

Or see our Open Access FAQs webpage

Jenni Hughes, Research Publications Assistant

Jennifer Smith, Research Publications Librarian

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Big Read 2021: ‘Airhead’ reviews by the St George’s community

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This year, Emily Maitlis’s book Airhead : the imperfect art of making news was chosen as St George’s University’s Big Read book. The Big Read is a shared reading project to foster a sense of belonging among staff and students. It is not too late to claim your free e-book copy. Visit our website to find out more.

Since the beginning of the academic year we have had a number of engaging events around the Big Read. We have met for book clubs (there’s another one on the 28th April). People from across the institution organised discussions around some of the themes covered by the book such as the environment, grief, meditation and movement. We also had the pleasure of welcoming Emily Maitlis to St George’s and hearing from her directly as she was interviewed by two St George’s students. You can find the recording of that session here.

Airhead is a collection of Emily Maitlis’s accounts of meeting world-famous people, reporting on significant world events and investigating important topics of the day. As such, the book lends itself perfectly to reviews as each of us will have chapters that resonate more than others.

Book cover for Airhead by Emily Maitlis

Below you can read a selection of chapter reviews from members across the St George’s community.

Dan Jeffcote (Information Assistant) – David Attenborough: One hour in a hot-air balloon

The interview took place just after the BBC released “Planet Earth II”.  The programme features incredible camera-work and increasingly there is a sense of urgency about the effects of climate change on the planet in his work.

In the interview he discusses issues such as the ozone layer, plastic, building in wildlife habitats and population growth. He is clearly passionate about using scientific evidence to explain climate change. He is well known for his gift for narration and as an adventurer but its his calmness, thoughtfulness and wisdom that come across in this chapter.

His message appears to be we have at this moment in time a choice to either “destroy” or “cherish” our heritage.  Emily Maitlis describes her one hour with him as an interview that calms her soul.

Alina Apostu (Student Experience Officer) – A few words on Jon Stewart and the creature of the news

I suppose one question is ‘What is it like? What is it like to meet all those people in person?’

She, Emily Maitlis, does a good job at giving you a sense of how that might be … but it’s a different feeling that she makes real for the reader …

While all the names in Airhead are big names, my first chapter to read was the one about Jon Steward. I like Jon Stewart. A lot. I like his work, his humour, his voice (both metaphorically and literally). So I echoed Maitlis’ hopes that ‘I do not want to find out he’s a complete muppet in real life. That his thoughts are all tightly scripted, his jokes pre-prepped. I am desperate, in other words, not to be disappointed.’ (p.60).

In the chapter, Maitlis moves so swiftly from mention of his film, Rosewater, and the story behind it of the incarcerated Iranian journalist Maziar Bahari, to the different implications of writing news and writing satire, to his political convictions, to the relationship to his father, to his retirement from the Daily Show, to his view of Islamism, to the effects news have on people’s actual lives, to how he thinks (or doesn’t) about the audience. Eight topics in what feels like a glimpse of a meeting.

As I read, the feeling that became real was of that rush, that rush of the news, of the need to ‘get it’, of the clock-ticking… the book doesn’t lie, it is about the imperfect art of making news, and it felt that whom I met was not so much Jon Stewart but something else … an entity, a creature of the news that takes hold of everything, that brings interviewer and interviewee together in a quick exchange, moving oh so swiftly between philosophical questions, practical implications in real life and personal, intimate histories. Not sure how I feel about that creature …

Sue David (Associate Director of Information Services (Library & Learning Services)) – Rachel Dolezal: the black human activist who turned out to be white

I have enjoyed Emily Maitlis’s book Airhead, with its broad range of issues and personalities and its insight into the frantic life of a journalist – her emotional rollercoaster and personal struggles and juggles.

I found this chapter particularly thought provoking in the context of my own journey towards an understanding of issues associated with racism which have recently been brought to the fore, but which have been part of the British narrative for centuries.

Rachel is a complicated character with a host of interwoven complexities following her abusive upbringing and the negligence and despair she suffered as a child.  That she finds solace in a role as a substitute mother to four adopted black siblings in whose culture she become immersed is a fascinating insight into someone who is looking for a sense of belonging and a need to escape from her own reality.

Emily Maitlis treats Rachel with empathy and compassion.  She does not try to sensationalise her story and has split loyalties, understanding what others will be expecting from the interview – and they are disappointed.  The vitriolic responses to Rachel and the interview are deeply upsetting and have a personal impact on Maitlis who feels an inner need to protect the person behind the story.

This is an example of a hugely complex story which cannot be tackled from a single perspective.  Here the issues “had overtaken the person at the centre”, but the focus of the interview was Rachel and Emily Maitlis treats her subject with sensitivity despite the expectations of her audience.

James Calvert (Liaison Support Librarian (Faculty of Health, Social Care and Education))

Airhead: The Imperfect Art of Making News examines the nature of broadcast news journalism, capturing a vivid snapshot of what happens in front of the camera as well as behind the scenes. As an anecdotal tale of her journalistic adventures, and seemingly fuelled on a diet of chocolate, alcohol and very little sleep, Emily Maitlis takes us swiftly from one famous encounter to the next, her book presented as a collection of compelling vignettes. The short, episodical chapters that make up this easy-reading, but not always comfortable-reading book offers an insider’s perspective on the news-making process. For myself, this never felt more real than with the chapter, ‘Meeting a Prince’, an account of the build-up of the weeks and days to that now infamous Newsnight interview, an important event that may still have the power to help Epstein’s victims later down the line.

Anne Binsfeld (Liaison Support Librarian (IMBE)) – Russell Brand: How Addiction Starts with a Penguin Bar

While I don’t necessarily like Russell Brand, his way of branding himself or even most of his opinions, I really enjoyed the chapter on Maitlis’s interview with Brand around addiction and his book Recovery. Emily Maitlis’s honesty is disarming and I am intrigued by her claim that his book is ‘a sort of AA programme without the pomposity’ considering Russell Brand comes across as pompous and over the top quite often. In this interview however, or rather in Emily’s account of this interview, he comes across as insightful and honest – perhaps because I can see the importance of acknowledging addiction as incredibly common, be it to online shopping sprees (in Maitlis’s case) or drinks, drugs and Penguin bars (in Brand’s case). I would imagine after a year of Covid-19 and three lockdowns down the line, most of us have developed unhealthy coping mechanisms to, as Brand says, supplement ‘our experience of being’. Addiction is a distraction from worries and fears that just feel too large for us to face head on. Despite Brand’s charm, Maitlis doesn’t let him off the hook easily and I have also enjoyed reading about that. Although she might not get any ‘tears of repentance’, she does know how to ask those questions that touch on something true and important in Brand’s experience. In return, Brand comes across as an engaged and engaging interviewee. The final scene highlights poignantly that the art of making news is a game of give and take, like a dance in which interviewer and interviewee are in communication with each other. Great interviews are not one-directional and as Emily Maitlis is happy to admit, put the interviewer on the spot time and time again.

Women in Leadership at St George’s

This blogpost was written by Sue David, Associate Director of Information Services (Library & Learning Services) at St George’s, for International Women’s Day 2021.

Sue David, Associate Director of Information Services (Library & Learning Services) at St George’s

St George’s is lucky to have many inspirational women leaders who act as role models to the whole institution.  Our Principal Jenny Higham, gives us an example of a woman who has made a mark in her field; a practicing clinician, leading a complex institution, with an amazing CV.  She inspires confidence and trust, but remains approachable and compassionate.  Alongside her in the Senior Leadership Team, Jane Saffell heads up Education with tireless energy, creativity and vision.  Other women leaders at St George’s are many and bring their own skills and personalities to their roles.

In the field of librarianship I can look to colleagues who have truly inspired me and have had an impact on how I fulfil my role on a day to day basis.  Liz Jolly, currently heading up the British Library is a loud advocate for services which genuinely meet users’ needs.  Stella Butler (Leeds) and Chris Banks (Imperial) are strong voices for change in accessibility and access to resources.  Within the University of London colleagues at some of the biggest institutions (King’s, City, LSE) work tirelessly to support their staff and deliver the best services they can within the budgets available to them.

What I hope I have gleaned from my encounters with these colleagues is that there is a huge range of skills and attributes that make a strong leader.  There are plenty of important texts and articles, development programmes (the Aurora leadership programme was a particular highlight for me) and training opportunities (I would point to “Manager as Coach” which I attended this year), but I believe it is my networking with inspirational colleagues both within St George’s and in the wider community that has shaped my approach.

From my experience I have come to realise that a cornerstone for me is authenticity.  I try to remain true to my values and to also encompass the St George’s CORE values (Commitment, Openness, Respect, Engagement) in how I lead my team.  People are at the heart of everything I do and my greatest inspiration is my team.  I value their enormous commitment, creativity and hard work. They inspire me to do the best job I can, represent them and our services fairly across the institution and raise the profile of our services wherever possible. 

The key skills I have tried to develop to help me do this are emotional intelligence, empathy and an ability to listen.  Enthusiasm and energy are also important to me and I hope to lead from the front, showing that I am willing to be on the front line when I am needed and not shy away from tasks which are difficult or outside my comfort zone.  My door is always open and I hope that I welcome suggestions, innovation and change from wherever in the institution it may come.

Covid has really emphasised the need to be flexible – to be willing to take on new challenges and contribute to the whole institution’s response.  This has involved engaging with colleagues I wouldn’t normally have the opportunity to work with, learning from them and collaborating in our response, keeping our students’ and staffs’ best interests at heart.

Taking a leadership role can be daunting.  Overcoming the feelings of inadequacy and developing confidence in your ability to do the best job you can in your own way takes time.  Seeking support from both inside and outside the organisation, getting involved in activities which are challenging (chairing committees, involvement in external networks) and trusting your instincts go a long way to help.  I think it is really important not to be afraid to make mistakes and to own those mistakes and learn from them.  We are none of us perfect and can only do our best. 

For me it is important that what I do enables others.  I aim to help my team grow and develop their own skills and qualities, to help our students get the service they need and to help St George’s continue to be a caring, compassionate “family” that strives to do the best it can for everyone.

Careers Week 2021: 1-6 March Careers Inspiration in Challenging Times

It has never been so important to manage your career to achieve your ambitions. The next St George’s Careers Week (our second ever!) will be taking place over the week 1-6 March, coinciding with the same national themed week.

Register here.

We hope the programme will help you make the right choices, inspire you with real life stories, re-energise your job hunt, and ultimately, boost your career.

Open to students of all year groups and pathways, as well as recent graduates, our programme of events will address themes like Resilience, Workplace Wellbeing and Planning your Career in a Pandemic. The programme will include Q&A sessions in which alumni and students from a range of disciplines and courses share their own careers and wellbeing insight, as well as advice on how to manage your own future and job hunt successfully in these unpredictable times.

We will be revealing other useful careers and well-being resources during Careers Week and beyond to help our current students and newest alumni on their career path.

Details of the virtual programme is Canvas Careers Pages, Sgul.ac.uk and other St George’s social media.

You can view profiles, stories and advice from our alumni, tips on resilience, and well-being resources.

We hope you will be able to join us! REGISTER HERE (to keep up to date with latest news and activities)

The Post Mortem Examinations and Case Books as a Source for Genealogical Research

Opening Up the Body’ is a Wellcome-funded 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 1841-1921. This post was written by Project Archivist Natasha Shillingford.

Previous blog posts have highlighted the value of the Post Mortem collection for contributing to our understanding of medical education, death practices, and the history of London’s hospitals and infectious diseases. However, it is also a valuable and rich resource for genealogy and tracing your family history. The collection consists of 76 volumes, and an estimated total of 36,000 cases which is a lot of names! The majority of the patients admitted to St George’s Hospital were from the lower classes as wealthier individuals were able to pay physicians to attend to them in their homes. Therefore, the Post Mortem Examinations and Case Books provide information about working class patients who may not be represented in many other records and can provide additional or missing information about your ancestors.

PM/1890/349. Archives and Special Collections, St George’s, University of London

The right-hand page is reserved for details of the medical case before the patient’s death. It records the patient’s medical history, current symptoms which caused them to attend the hospital, a description of the patient on admission and details of the treatments prescribed and changes in condition prior to their death. On first glance the medical case history appears to be rather formulaic but on closer inspection they provide fascinating insights into the patients and provide a glimpse into their life before death.

From 1st July 1837 all births and deaths had to be reported to a local registrar, who in turn reported them to the superintendent registrar of the registration district where the birth or death occurred. Since 1874 doctors’ certificates were also required by a registrar before a death certificate could be issued. A death certificate records where and when the individual died, name and surname, sex, age, occupation, cause of death, the signature, description and residence of the informant, when the death was registered and the signature of the registrar.

The death certificate of George Danbury will undoubtedly list his death simply as Tetanus. However, the medical notes expand on this diagnosis and tell us that ‘A fortnight before his admission George Danbury ran a nail into the ball of his right great toe. He felt no pain but later felt stiffness of the jaw and pain in the back. On admission he could not open his jaw and there was stiffness and pain in the back of the neck. He began to experience spasms, had a good deal of sweating and the head became retracted and fixed.’ (PM/1870/258)

The case notes often include the medical history of other family members to determine if the patient could be suffering from an inheritable disease. This is invaluable for tracing other family members of the deceased.  Fifty-three-year-old Henry Moon died in 1889 from ‘Carcinomatous stricture of Oesophagus’. The case notes begin ‘The patient was a clerk. He gave a family history of carcinoma. One aunt had died of cancer of the throat, another of cancer of the stomach, a cousin of cancer of the eye.’ (PM/1889/285). The medical case notes will also record if they came from a phthisical (tuberculous) family, and if their parents lived to an old age. If the patient is female, it will often be noted how long they had been married, how many children they had given birth to, how many children were living at the time of her admission, and how many miscarriages the woman had suffered. The case notes for Sarah Harris records ‘Pregnancies = 9. Children = 8. Miscarriage = 1, in Dec last at 5 months. Says that during this last pregnancy had ‘fits’ when about 4 ½ months gone, from which time till she aborted she did not feel the child. A doubtful abortion in Feb last.’ (PM/1881/388). Ellen Pointon, a thirty-nine-year-old Widow ‘had been married for 9 years. She had had 1 miscarriage and four children, 3 of whom were alive when she came into the hospital.’ (PM/1888/301)

The case notes often track a patient’s travel both within the UK and abroad to determine the origin of the disease, particularly if the disease is highly infectious. 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 (PM/1884/9). Charles Dilloway was a footman who had just returned from a foreign tour. Twenty days before his admission he was in Rome. He returned via San Remo, Cannes and Boulogne. ‘He was back in England a fortnight before he came to the hospital. After his return he lived at 35 Chesham Place Belgrave Square’ where he slept below ground. Not only is each city he travelled through recorded in the case notes, the physician has also recorded the name of each hotel that he stayed at during his travel back to England.

Furthermore, the physicians often record the address of the patient along with living conditions if they believe it is relevant to the disease, such as in the case of a four-year-old boy called Albert Pratt. His ‘Parents lived at Brighton but the child had been staying at 1A Bulmer Place Notting Hill Gate. In this house the floor of the W.C. [Water Closet] was in a very bad state, having all crumbled away. The Landlord refusing to do anything. Within the last 6 weeks 6 persons living in the house, 4 children and 2 young women had had sore throats but all recovered.’ Young Albert, was diagnosed with Diphtheria and ultimately succumbed to the illness. (PM/1889/22)

Diet is often commented on in the medical case notes, such as in this case of 15 year old John Landeg who died of Scurvy in 1882.  ‘When admitted the boy stated that he had been feeling weak and ill for four or five months previously. That he had a dislike to [non] salt meat and consequently had for the last four or five weeks been eating only salted meat. He was an office boy, in the habit of taking away from home meat for the whole day, and consequently rarely eat vegetables. Got potatoes on Sundays only.’ (PM/1882/366)

Alcohol consumption is also often recorded, such as in the case of 25 year old Alfred Balcombe who was described as ‘A coachman of intemperate habits, a beer drinker, reported to be generally in a fuddled state, refusing his food and supplying its place with beer, ’ (PM/1866/18) or Frederick Osborne, a forty five year old labourer, who had ‘always been accustomed to drink beer, avoiding the weaker kinds and drinking chiefly ‘six ale,’ and some spirits. The average quantity of beer was five or six pints daily.’ (PM/1888/95)

Occupations are listed where known, and the medical case notes often expand on simple terms such as ‘Groom’ or ‘Soldier’. Elbra Appleby died in 1881, aged fifty-one. In his work as a painter he had been exposed to so much lead that, despite precautions, he developed colic and wrist drop, losing strength in both hands and becoming irritable and depressed (PM/1881/392). John Lewicki was ‘An old soldier, formerly on Napoleon’s Polish lancers. He had fought in nearly all the wars of the empire. He had been frost-bitten at Beresina, and again at Moscow. He was wounded at Austerlitz, recovered a sabre cut at Vittoria. Altogether he shewed seven scars. He escaped from Waterloo unhurt. Latterly he enjoyed a pension for a few years, but lost it on account of his republican views. He was expelled from Paris and contrived to get his living by selling pencils about the streets of London. He attributed his illness to eating sprats.’ (PM/1860/36)

Sometimes the comments of the physicians can be extremely evocative and paint a picture of the patient on their admission. For example, the doctor Octavius Sturges (1883-1894) describes various patients 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 case notes sometimes include anatomical sketches and drawings, and occasionally portraits of the patient, such as in the case of Thomas Roles, a 49-year-old Shopkeeper, who was admitted to St George’s with a tumour of the face which was removed by operation.

PM/1880/236. Archives and Special Collections, St George’s, University of London

The left-hand page, labelled ‘Morbid appearances’, is used to record the details in the post mortem examination, with each part of the body examined in depth. The morbid appearances also include a general description of the body, recording information such as height, weight and hair colour. At a time when photography was unusual for many working-class Londoners such as those attending St George’s Hospital, the general description at least provides a hint as to their appearance. Thomas Roles was described as ‘Well nourished. Obese. 5’6” high. Hair dark.’

In conclusion, the Post Mortem Examinations and Case Books are a unique and fantastic resource for tracing the lives of working-class individuals in London, and the information provided in the volumes almost serves to bring the patients back to life.


If you are interested receiving updates from the Library and the St George’s Archives project, you can subscribe to the Library Blog using the Follow button or click here for further posts from the Archives.

Kortext ebooks NHS collection

Health Education England (HEE) has invested in a collection of ebooks for NHS staff, now available through Kortext.

The collection of ebooks covers subject areas including key clinical topics, nursing and healthcare management, alongside titles on critical appraisal, mentoring and revision resources for medical exams.

To access the books, go directly to the Kortext website: https://app.kortext.com, select St George’s University Hospitals NHS Trust from the list of institutions and enter your OpenAthens details. You will also find a link to Kortext in ‘My Resources‘ when you log into your OpenAthens account.

On the landing page of the site, click on Collections to view the full list of ebooks. Selecting an available title will add it to Books, which is your personal bookshelf. Books that you open will remain on your bookshelf for the duration of their loan period.

Kortext offers accessiblity options which allow you to change the formatting of a book, including options for the background colour, the font and the size of the text. When reading a book, make use of the options to take notes, highlight content, bookmark pages or print – all notes, highlights and bookmarks are saved in your account.

If you wish to read offline, create a personal Kortext account and download the app; Kortext apps are available for Mac, Windows, iOS and Android.

Example titles:

Bailey & Love’s Essential Clinical Anatomy

Care of the Cancer Patient

Children and Young People’s Nursing Skills at a Glance

Essentials of Management for Healthcare Professionals

Essential knowledge and skills for healthcare assistants

Medical Statistics at a Glance

Patient-Centred Ethics and Communication at the End of Life

Research Methodologies for Beginners

Supervision in Clinical Practice : A Practitioner’s Guide

The doctor’s guide to critical appraisal

The Foundation Programme for Doctors

The textbook of non-medical prescribing

This collection is an addition to those ebooks which are already available from St George’s Library, and which can be accessed through Hunter.

If you need to create an OpenAthens account, or have forgotten your password, visit: https://openathens.nice.org.uk/. Contact liaison@sgul.ac.uk with any questions.

#MorbidAdvent: What Did We Learn?

Opening Up the Body’ is a Wellcome-funded 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 1841-1921. This post was written by Project Archivist Alexandra Foulds, with contributions from Project Archivist Natasha Shillingford and Archivist Juulia Ahvensalmi.

St George’s University of London Museum and Archives Instagram post on smallpox as part of #MorbidAdvent
St George’s University of London Museum and Archives Instagram post on smallpox as part of #MorbidAdvent

In December 2020 we decided to do an advent calendar on social media in which we would use every day to highlight a disease or condition that could be found in our post mortem casebooks. Calling it #MorbidAdvent, throughout the month we covered:

When we started, we assumed that these were conditions that had been relegated to history but the morbid nature of all these diseases was brought into stark relief with the realisation that none of the diseases apart from smallpox (thanks to the efforts of Edward Jenner) have actually been eradicated.

Vaccinations are, of course, of particular interest and relevance at the moment, and there are vaccines for many of the diseases we examined, including tuberculosis, rabies, influenza, whooping cough, tetanus, diphtheria, measles and smallpox. Others, such as malaria or leprosy can be treated with various medications.

Despite this, many of the diseases remain common outside of the Western world. 10 million people were diagnosed with tuberculosis in 2019, predominantly in South-East Asia, Africa, and the Western Pacific, resulting in 1.5 million deaths. There were an estimated 229 million cases of malaria in 2019, the majority of them in sub-Saharan Africa: children are particularly vulnerable to the disease. Diphtheria, despite mass immunisations in the UK in the 1940s, is still common in Africa, India and Indonesia, with a 5-10% death rate affecting mainly children. Measles, which has an alarmingly high R number of 12 to 18, similarly caused over 140,000 deaths in 2018, mostly in children under 5 years old. Cholera outbreaks remain common in Africa, South America and Asia. In 2008-2009 an outbreak in Zimbabwe killed 4200 people and in 2010-2011 another in Haiti caused 6631 deaths. In all of these places, a lack of access to health care, poor water quality and poor sanitation allow for contagious diseases to take hold and spread.

As these diseases have not been eradicated they frequently resurface in the United Kingdom. There are still around 12 new cases of leprosy diagnosed each year in the UK and the World Health Organisation states that in 2018 there were 208, with 619 new cases of leprosy diagnosed worldwide. This is approximately one every two minutes. In 2019 the notification rate for TB in the UK was 8.4 per 100,000 of the population. Even smallpox has the potential to return, as it did in 1978, as it is retained in laboratories.

It is not only contagious diseases that can have resurgences. Rickets, for example, which is caused by a vitamin D deficiency, despite mostly disappearing in the UK in the 1950s with mass programs of cod liver oil for children, has recently experienced a comeback that has been attributed to children spending more time indoors and the use of sun creams whenever they are outside.

Photo of the post mortem record of Ethel Almond who had rickets and then contracted tubercular meningitis (PM/1888/314). Archives and Special Collections, St George’s, University of London.

The post mortem record of Ethel Almond who had rickets and then contracted tubercular meningitis (PM/1888/314). Archives and Special Collections, St George’s, University of London

Patients at St George’s Hospital

Visualisation of the causes of death found in the post mortem casebooks of St George’s Hospital 1841-1887 created using Flourish. Archives and Special Collections, St George’s, University of London.
Visualisation of the causes of death found in the post mortem casebooks of St George’s Hospital 1841-1887 created using Flourish. Archives and Special Collections, St George’s, University of London.

When we started the advent calendar we knew that the period covered by our post mortem casebooks (1841-1946) was punctuated by numerous outbreaks, epidemics and global pandemics of various contagious diseases. The most notable of these that affected the UK included:

Cholera: 1831-1832, 1838-1839, 1848-1849, 1853-1854, 1866-1867

Influenza: 1830-1831, 1833, 1836-1837, 1847-1848, 1857-1858, 1889-1890 (Russian/Asiatic Flu), 1918-1920 (Spanish Flu)

Smallpox: Large epidemics in 1837-1838 and 1870-1874 (after the Franco-Prussian War). 1901-1902 was the last outbreak in London. (England was declared rid of smallpox in 1939).

Scarlet fever: 1892-1893. Particularly common at the beginning and ends of the nineteenth century.

Diphtheria: 1850-1860

While trying to find cases of these diseases in the post mortem casebooks, however, we were struck by the fact that there were far fewer cases than we had expected, even in years when there were epidemics. This was despite many contagious diseases being more easily caught by people with malnourishment, a condition from which it is likely that many of the patients at St George’s would have suffered. St George’s Hospital’s nineteenth-century position at Hyde Park Corner meant that many of its patients came from Westminster and Pimlico, both of which were very impoverished, working-class areas of London at this time. Wealthier patients in nearby St James’s, Belgravia and Mayfair would have been more likely to have been treated by visiting physicians (some of whom would have also worked at St George’s) in their own homes. Hospitals had been created in the UK in the eighteenth century to serve the ‘deserving’ working class poor and were considered, at least until the late nineteenth century, to be dirty and sources of contagion, so people tended to stay away if they could. The extremely poor who were unable to support themselves, considered to be ‘undeserving’, would have been treated in workhouse hospitals.

Fever hospitals

Trying to account for this low number of contagious diseases in our post mortem casebooks led us to find out about fever hospitals, or hospitals set up in the nineteenth century specifically to treat contagious diseases. Prior to this only a small amount of hospitals were willing to take contagious patients. A smallpox hospital had been created in Windmill Street off Tottenham Court Road in 1746, and patients with other contagious diseases could be sent to one of the Royal Hospitals or to Guy’s Hospital. As part of the nineteenth-century public health movement, 12 fever hospitals were created in London, starting with the Institution for the Care and Prevention of Contagious Fevers (later called the London Fever Hospital) at Grays Inn Lane in 1801. While the majority of these were on land, between 1883 and the end of the nineteenth century three of them were converted ships (the wooden warships the Atlas and the Endymion, and the iron paddle steamer Castalia), which were moored on the River Thames and used to treat smallpox patients. Patients who needed to be treated in a hospital were sent to one of these fever hospitals after being referred by a doctor, and were only treated in hospitals such as St George’s if their condition was not apparent when they were admitted. Once their condition was diagnosed, we can see from the medical notes in our post mortem casebooks that they were moved to separate wards. One of the fever hospitals, however, the Grove Fever Hospital which opened in 1899, was sited where St George’s Hospital is now in Tooting. Two of the ward blocks survive to this day.

Photograph of Grove Fever Hospital. Archives and Special Collections, St George’s, University of London.
Photograph of Grove Fever Hospital. Archives and Special Collections, St George’s, University of London.

Highlights of the advent calendar

A few of the conditions covered in the advent calendar proved to be particularly interesting and unusual, such as glanders, leprosy, and malaria.

Glanders

Glanders is an unusual disease in the Morbid Advent Calendar as it is a zoonotic disease. In other words, Glanders primarily occurs in horses, mules and donkeys but can be transmitted to humans by direct contact with an infected animal’s body fluid and tissues, and can enter the body through skin abrasions. The majority of patient’s in the post mortem volumes who contracted Glanders, were stablemen, horse keepers and grooms.

Despite the fact that the last confirmed case in Great Britain was in 1928, it still remains a very real threat, particularly as a biological weapon during war and has long been a threat to armies. It is believed that Glanders may have affected the horses of Marshall Tallard’s cavalry prior to the Battle of Blenheim in 1704 which helped the Duke of Marlborough to win the battle. It is also believed that during World War I, Russian horses on the Eastern Front were deliberately infected with Glanders by German agents. More recently, the Soviet Union allegedly used the germ that causes Glanders during the Soviet-Afghan War.

Unlike many of the diseases featured in the calendar, there is currently no vaccine for Glanders. The lack of a vaccine, the fact that the disease is not widely known and is therefore difficult to diagnose, the ability for the germs to be released into the air, water or food supply, and the germ’s resistance to common antibiotics makes the bacteria a significant bioterrorism threat.

Leprosy

Photo of manuscript showing a leper. Wellcome Collection. Attribution 4.0 International (CC BY 4.0)
Manuscript showing a leper. Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The earliest possible account of a disease which is believed to be leprosy appears in an Egyptian papyrus document written around 1500 BC. The first account of the disease in Europe occurs in the records of Ancient Greece after the army of Alexander the Great returned from India.

Leprosy had entered England by the 4th century AD and was a common feature of life by 1050. However, it seemed unusual to find a case of leprosy in London in 1884, particularly as the last case of indigenous leprosy in the United Kingdom was diagnosed in 1798.

Further research uncovered that it wasn’t until 1873 that Dr Gerhard Henrik Armauer from Norway identified the germ that causes leprosy and proved that it was not a hereditary disease or a punishment by God, but an infection caused by bacteria. It is now curable with a multidrug therapy which was developed in the early 1980s.

Malaria

The post mortem record of John Lee who is described as having ‘lived in an aguish district near Eastbourne’ (PM/1891/87). Archives and Special Collections, St George’s, University of London.
The post mortem record of John Lee who is described as having ‘lived in an aguish district near Eastbourne’ (PM/1891/87). Archives and Special Collections, St George’s, University of London.

From ‘mal’aria’, or bad air, malaria was so named as it was thought to be caused by miasma. The connection between mosquitoes and malaria was not established until the 1890s; Patrick Manson, the first lecturer in tropical diseases at St George’s Hospital Medical School and the founder of the London School of Hygiene and Tropical Medicine, was instrumental in developing the so-called mosquito-malaria theory.

Far from being confined to hot, faraway countries (though the postmortems show that the majority of the cases were contracted by soldiers, seamen and colonial officers in India, the West Indies, China or the United States), the postmortem books reveal cases in places like Deptford, Hampshire and Eastbourne: it turns out that malaria was, in fact, a significant cause of death in Britain. In these cases, the diagnosis is often given as ‘ague’ or ‘marsh fever’. Decrease of marsh wetlands and increase in cattle as well as improvements in housing, drainage and ventilation (factors which affect also many other causes of death during this period) and water chlorination led to malaria gradually disappearing as an endemic disease in Britain (the last cases occurred in Stockwell in 1953).

Quinine, derived from the bark of cinchona tree, has been used to treat malaria since the 1600s, and the origins of gin & tonic is often said to be as an anti-malarial drug, though this is not strictly true. Quinine is still used to treat malaria, although there are now various other medications too.

What did we take away?

Finding out more about these diseases put the current Covid-19 pandemic in a new light. While it is easy to think of our current situation as exceptional, what our advent calendar made clear was that it is something that humans have experienced many times before and continue to endure in many parts of the world. While it might be easy to find this thought quite bleak, it helped us to feel more positive. Like all outbreaks of contagious disease, this too shall pass, and as our history and our experience over the last year shows, we have the ability to band together to make great medical advancements when we have the drive to do so. Current technology has enabled us to experience this pandemic in a global way that has never been seen before and hopefully this unity will continue as we try to vaccinate the world’s population. Perhaps this will carry forward and enable us tackle other diseases together, giving new impetus to strategies such as the World Health Organisation’s plan to cut new cases of TB by 90% and reduce deaths by 95% by 2035.


If you are interested receiving updates from the Library and the St George’s Archives project, you can subscribe to the Library Blog using the Follow button or click here for further posts from the Archives.

What can you do to help your job hunt despite being in a pandemic?

This is a guest post by the Careers team at St George’s.

Decorative Career Services banner

Whether you are soon to graduate or perhaps you are a student considering your future, applying for placements or simply looking for part-time work, the pandemic has had an enormous impact on recruitment. Nevertheless, the global spotlight on healthcare and scientific research offers career opportunities for students studying and graduating at St George’s. The importance of what you know and do has never been so critical to all our lives. Undeniably, these are challenging times for job searching as uncertainty is the theme of the day. Rest assured that whatever struggle you are going through now, your career goals and ambitions are still attainable. There are plenty of constructive things you can do to give yourself the best chance now and for the longer term, when we hope the current situation will be part of history, gone but not forgotten.

Decorative image: a person smiling at the camera wearing a mortarboard hat, which they are holding with their right hand.

Here are some of our top tips on how to handle your career planning in this current situation and turn some negatives into positives.

Set a schedule – allocate time in your schedule for career management. This can be a neglected area in our lives. In fact in normal times, people spend more time planning holidays than their careers. With no concrete travel plans on the horizon, much more time can be given to this life-changing preparation. It also means that you can feel reassured that you have given thought and time to your future, and you are in control. Use the Careers pages on Canvas where I guarantee you will find something that will change your life, even in a small way! 

Take a step back and be kind to yourself – take time to Explore, Plan, Apply. At St George’s, ‘Explore, Plan and Apply’ is the approach and mantra for career planning and management. This means starting from the beginning to ‘explore’ what different possibilities exist, what do you enjoy, what are you good at? What are your values? There are lots of online tools to help you analyse yourself and the options available to direct your research –  options that inspire, and motivate you, or at least provide the stepping stone to your preferred career areas (you may have several!). 

Don’t limit yourself to local options – look more broadly than your immediate area or London. You can always return to our beautiful metropolis in future once you have some solid experience under your belt and the cost of housing can be less in other areas too.

Stand out from the Crowd…tailor your CV and application. Students have said when the pressure is on to find a job, there can be a tendency to send off as many duplicate CVs or applications as possible, some quoting 20, 50 or even more, hoping that one will stick. Time and time again, employers have said how this approach does not work. To help you stand out from the crowd, read the job description and person specification, research what the company do, their values and reflect this in your application. Every employer and job will be different so one size does not fit all. There is more advice here in the Apply section on the Careers Canvas module  and do book an appointment with the Careers Service if you want to talk through your approach or get your application checked.

Decorative image. Person sitting at a table looking at a CV.

Build your network of professionals – Your career will develop and evolve. Develop your network of people working in sectors you are interested in. Check the St George’s Alumni pages on LinkedIn or the SGUL alumni bios to find inspiration, make like-minded contacts with similar interests and gain knowledge

Develop your skills – As you explore different career paths or expand your network, you may feel there are skills that you would like to improve or develop. Perhaps there is an area that you have been curious to try. There are a large number of free (and otherwise) online courses, and what better way to show your motivation to a new employer, while developing your own confidence in yourself, really feeling like you are managing your own development – it is certainly a win/win. Don’t forget too that you can keep track of the skills you are developing through the St George’s Skills and Recognition Award.

Look after your mental health – You are not alone if you are feeling gloomy and struggling. So many are under strain in these uncertain times. Do get help. Here are some organisations you can contact to support you through this time.

Think longer term – In 2030 what will you be glad you did in 2020/21? Developed your research skills and specialisms? Improved your digital skills? Extended your network of professional and scientific contacts? Improved your health/stress management? Experimented with something different?

There are lots more tips here on making the most of this time.

For further support, refer to the Canvas Careers pages, the website or contact us careers@sgul.ac.uk.


Look out for details about St George’s Uni Careers Week 1-6 March 2021, coming soon on all St George’s social media accounts and platforms.

Introducing: RefWorks video series

Getting all your citations and bibliography right can be a daunting prospect – especially if is for a longer research project, an article or your dissertation. In moments like that, it can be helpful to make use of reference management software, which eliminates some of the stress and hassle of referencing correctly.

At St George’s, we support RefWorks, a web-based application which supports you in collecting, storing and managing your references. As part of RefWorks, you can also make use of RefWorks Citation Manager (RCM) which is a Microsoft Word Add-in. With RCM you can create citations and bibliographies within your documents.

While RefWorks is a really useful tool for students and staff at St George’s, it requires learning how to use it before tempting to get started on your references. This is where our new RefWorks video series comes in handy.

RefWorks video series

We have created 9 short videos that guide you through the process of using RefWorks. You can find the entire series on our YouTube channel and on Canvas, as part of our RefWorks unit. If you want to get a quick overview, check out this video.

RefWorks can be a big help in getting your references done quickly, but you will find that there are mistakes in your references. You are responsible for making sure that when you submit your assignment all your citations and your bibliography are correct, so do double-check each reference in line with Cite Them Right, the correct version of Harvard to use at St George’s.

If you are new to referencing, work your way through our referencing unit on Canvas before you start using RefWorks.

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Further help

Don’t hesitate to get in touch with us by emailing liaison@sgul.ac.uk with any questions about RefWorks that you might have. While RefWorks is generally straight-forward to use, at times users experiences issues for example with creating an account. We can help with you with that.

If you prefer getting a proper training session on RefWorks, please visit our website to sign up for a session that suits you. Our RefWorks training is part of a number of generic training sessions, including literature searching for your dissertation.

We also have a Libguide on RefWorks and reference management, which gives you a quick overview of what you need to know to sign up and add references to RefWorks. Our Libguide also includes helpful screenshots if you get stuck and information on Legacy RefWorks.

Access to BNF and BNFC

The BNF and BNFC are key resources for all medical and pharmacology students.

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This is particularly important for Clinical Pharmacology students and those of you in your final year studying medicine, as you will have your PSA (Prescribing Safety Assessment) coming up soon and we know you need BNF and BNFC to do well.

Recently, we have made some changes to how you access these resources, so we wanted to keep you updated.

Access to BNF and BNFC

You no longer have to go via BMJ Best Practice to access BNF and BNFC. Instead you can go straight via MedicinesComplete. We hope this will make things a little more straight-forward for you. If you go to our website, you find the Databases A-Z link on the right-hand side. From there, all you need to do is search for BNF or find it under ‘B’.

Even easier, you can access both via Hunter. Click here for the BNF and here for the BNFC.

If you have any questions or issues around accessing e-resources, please email journals@sgul.ac.uk.

Information Skills Training: January – March

We are restarting our information skills training for university and NHS library users from January. While the sessions were on hold over the past months as we shifted all our training and support services online, we are now in the position to start offering these sessions again. All our sessions are online.

We have specific training for St George’s staff and students, as well as for NHS library users. These generic training sessions are open to everyone and are available in addition to any course-specific training you might have.

Don’t forget, we also continue to run our online drop-in, Monday to Friday 12-1pm. At our drop-ins we can help you with getting started, doing in-depth literature searching projects and referencing enquiries.

Below you can find out more about the different online training sessions we offer and the dates for these sessions. To book, please visit LibCal and register for the session you would like to attend.

Visit our website to find out more or email liaison@sgul.ac.uk.

Training sessions on offer

My Learning Essentials: Hunter & Harvard

Wednesday 27 January 1-2pm
Monday 22 March 12-1pm

This session is suitable for SGUL or FHSCE undergraduate or postgraduate students who have specific referencing or literature searching enquiries relating to their assignments.  You will be able to discuss your query with the librarian, and receive guidance on how to effectively use Hunter to find academic books and articles and how to use CiteThemRight to ensure your referencing complies with SGUL’s specific Harvard Referencing Style.

Book here.

Students sitting in lecture theatre.

Literature searching for your dissertation

Thursday 14 January 11.30-1pm
Monday 15 February 11.30-1pm
Tuesday 15 March 11-12.30pm

We know databases, like Medline (aka PubMed) and CINAHL, can be daunting, but with a little help and guidance, we are short you will get to grips with them in no time. If you have a longer research project, like a dissertation, or you just want to impress in your assignments, this session is for you. You will learn how to effectively run a literature search in a database relevant to your subject. The sessions are suitable for St George’s and FHSCE staff and students.

Sign up here.

RefWorks

Thursday 28 January 12-1pm
Tuesday 23 February 12-1pm
Wednesday 24 March 1-2pm

In this session, we will introduce you to the reference management software RefWorks. We will show you up to set up an account, add references, manage them and how to use RefWorks Citation Manager (RCM), a Microsoft Word Add-in.

Book here.

Book shelf in the library.

Training sessions for NHS staff

NHS Library induction

Friday 22 January 12-1pm
Wednesday 17 February 12-1pm
Monday 22 March 1-2pm

Library induction for NHS staff, introducing you to the range of services and resources on offer to those working for St George’s Hospital, Queen Mary’s Hospital and other community-based sites.

Sign up here.

Finding the Evidence

Monday 11 January 11am-12pm
Wednesday 27 January 2pm-3pm

Tuesday 9 February 10am-11am
Thursday 25 February 3pm-4pm

Friday 12 March 1pm-2pm
Wednesday 31 March 12pm-1pm

Finding top-quality evidence is a priority for health care practitioners. This session will introduce the high-quality resources available to you, as well as provide training in how to use them effectively to support evidence-based clinical practice or decision-making.

The session will cover: The range of evidence-based healthcare resources available, including: NICE Evidence, the Cochrane Library and BMJ Best Practice.

How to use the NHS databases effectively and identify the most appropriate database for your need. This includes how to create and plan a search strategy using subject headings and keywords and how to combine searches and apply limits to focus your results; how to access full-text articles where available or locate articles through St George’s journals page; and how to save your searches and set up alerts.

You can book your slot here.

Systematic Reviews: finding and managing the evidence

This course will focus on in-depth literature searching for systematic reviewers and how to manage your results. It will provide you with an overview of the systematic review process, the know-how of creating effective search strategies, systematic searching of the literature, managing your results and documenting the search process.

You can book this session here.

At the end of this session you will be able to:

  • plan robust search strategies for literature searches in support of systematic reviews
  • carry out systematic, advanced searches on the Ovid platform
  • save searches strategies and create alerts
  • plan how you will manage your search results and report on your search methodology.

If you have any questions about these training sessions, don’t hesitate to get in touch by emailing liaison@sgul.ac.uk.

Holiday Library Update

Wherever you’re planning to spend the next few weeks, we hope you’ll have as peaceful and relaxing a time as possible. We know that lots of you will also be thinking about revision and assignments at some point over the break, and with that in mind we wanted to remind you of some of the help and resources that are always available from the library, no matter where you are.

1. Find useful tips in our How-to videos

Over the past few months, we’ve been busy adding to our collection of How-to videos. We hope these short videos will give quick, clear answers to a range of questions, so you can get help whenever you need it.

A few of our recent videos focus on referencing. If you’re new to referencing, then our How to use Cite Them Right video can get you started. Or if you’re ready to start using reference management software, we have a series of videos on RefWorks, starting with a RefWorks Overview. Other videos include:

…and lots more. See the full collection on our YouTube channel here.

2. Explore e-books in Hunter

This year we’ve also been rapidly expanding our e-book collection, which now includes over 3000 titles. This means that even if you’re not able to come into the library in person, it’s now more likely that you’ll be able to find the books you need to support your study online.

There are two ways to find e-book material in Hunter:

  • You can search for whole e-books by selecting Books and more in the dropdown menu, then choosing Online Resources from the filter options on the left.
  • You can also search for individual chapters – a useful option if your topic is a bit more specific. Search under All Resources, then choose Book Chapters from the options on the left.

Read online

When you first sign in to view an e-book, you’ll usually be offered options to read online or download the book. Opting to read online will allow more SGUL users to view the e-book simultaneously.

3. Study resources

We have many resources available to students to help you prepare for exams and do your assignments. You can find out more about what resources we recommend for your subject by checking your Libguide. Whatever your subject, we have got you covered; medicine, biomedical science, paramedic science, radiography and many more. Access all our learning resources via the Databases A-Z list. JoVE Science Education is popular among our visual learners and suitable for different subjects. Long-standing favourites are Acland’s Video Atlas of Human Anatomy and BMJ Learning. New this year are LWW Health Library, for medicine and Occupational Therapy students and AccessMedicine for medicine students. As mentioned above, we have produced a range of how-to videos on Youtube. If you have any questions about these resources or if you are looking for personalised recommendations, email us at liaison@sgul.ac.uk

4. Literature searching

If you are spending the holidays preparing an essay or another written assignment such as a dissertation, have a look at our literature searching guide and our video series on how to use Ovid (Medline). We also have a collection of books around doing systematic literature reviews, dissertations and report writing. Get in touch via liaison@sgul.ac.uk to get help from your liaison librarian.

5. Christmas closure

Decorative Merry Christmas image.

The library closes at 11pm, Tuesday 22nd December and reopens at 8am, Monday 4th January. The computer rooms will also close during this period, but you can still return books via the the return slot. Please note that the library team will be on holiday and will respond to your queries on their return in January. Should you have any questions about opening hours or book loans, email library@sgul.ac.uk. In January, our opening hours will be 8am to 11pm Monday to Friday, 9am to 9pm Saturday and Sunday.

From everyone at St George’s Library, we wish you a Merry Christmas and a Happy New Year!

‘Digits: For Good’: Vaccinating Harrods and Selfridges, or, (Digital) preservation of COVID-19 and influenza records

Digital Preservation Day 2020 celebrates the positive impact of digital preservation. The theme ‘Digits: For Good’ focuses this year on the creation and preservation of research and development data used in finding a vaccine for COVID-19. In this post we’ll look into the work we’ve been doing to preserve these records, and also what the archives can tell us of past pandemics. This blogpost has been written by St George’s Archivist Juulia Ahvensalmi, Records Manager Kirsten Hylan and Research Data Support Manager Michelle Harricharan. You can engage with the day and find out more about our work on Twitter at @CollectionsSgul and @sgullibrary and using the hashtags #WDPD2020 and #SGULWDPD2020.

Our COVID-19 story 

At St George’s, University of London (SGUL), a specialist health and medical sciences university in South-West London, the Archivist, Research Data Support Manager, and Records Manager have joined forces to advocate for digital preservation.   

When it comes to meeting the challenge of preserving our digital materials, we have found that by bringing together staff members from different areas of the University we can utilise different skills and internal networks to achieve our goals.   

As part of the work we are undertaking around digital preservation, the team aims to collect all Covid-19 related material produced by SGUL. This includes a variety of documents in a variety of formats, produced by different parts of the university, including 

  • Communications, such as emails, web pages, FAQs, video recordings and social media. These provide evidence of our response to the crisis and our management of it – something that will be both interesting and important to keep for the future. Communications sent out to students, staff, alumni as well as those externally available will tell the story of how St George’s reacted to the pandemic 
  • Governance records, including minutes of meetings. These provide evidence of the conversations and decision-making about the responses and management of the pandemic 
  • Research, including recording the range of Covid-19 research St George’s researchers have been involved in throughout the pandemic as well as our researchers’ incredible work in the national and international media. Research data from these studies are also important to collect and preserve for the long term.

To date we are curating and preserving the items that we aware of, and we have started conversations with departments such as External Relations, Communications and Marketing to identify material we may have missed.   

We are conscious of the need to collect the full complement of Covid-19 material as ultimately this material will be an important part of our Archive in years to come and support future research.   

Looking back 

The majority of the material related to COVID-19 is digital, but that is not the case for most of the material held in the archives (although in the future that is of course likely to change!). The one pandemic most often compared to COVID-19 is the 1918-1919 influenza pandemic, known most commonly (and misleadingly) as the ‘Spanish’ flu, or ‘the Grippe’. Estimates of the number of deaths caused by it vary anywhere from 17 to 100 million people worldwide

In order to understand more about the current pandemic, and our responses to it, and to learn from our past mistakes, we need to look into the past. How did St George’s, then, respond to this pandemic? Well – the answer is that we don’t really know. The minutes of the Medical School (later SGUL) committee and council make no reference to the pandemic. St George’s Hospital and Medical School Gazette, journal produced by St George’s staff and students between 1892 and 1974, notes in February 1919 that the out-patient department and many wards at the hospital had to be closed as so many nurses were off sick, but the medical school records don’t reveal much more (although St George’s Hospital records, which are held at the London Metropolitan Archives, may hold more information). 

A photo of a paragraph in the St George’s Hospital and Medical School Gazette, Feb 1919. Archives and Special Collections, St George’s, University of London.
St George’s Hospital and Medical School Gazette, Feb 1919. Archives and Special Collections, St George’s, University of London.

What we do have is historical post mortem examination records, which we are currently cataloguing and making available online. These records provide an incredible source for studying death and disease in 19th and early 20th century London. They chart, among other things, the 1854 cholera epidemic, show how prevalent tuberculosis was, and contain numerous fascinating and illuminating cases, such as that of the pastry chef murderer in 1908. 

Photo of book cover: Post mortem and case book 1846, PM/1846. Archives and Special Collections, St George’s, University of London.
Post mortem and case book 1846, PM/1846. Archives and Special Collections, St George’s, University of London.

When we started cataloguing the volumes for 1918 and 1919, we were expecting to find plenty of examples of influenza, and were surprised when, well, there just weren’t that many.  

There were, of course, some cases, and many that sound troubling, such as the case of Ada Bell, a soldier’s wife aged 32, who died at St George’s 31 Oct 1918. Her illness was initially diagnosed as pneumonia, but she was brought to the hospital delirious, coughing and suffering from diarrhoea, deafness and shortness of breath. Her cause of death was deemed to be typhoid fever and influenzal bronchopneumonia. 

Scan of Post mortem case of Ada Bell, [Wife of] Soldier, 32, PM/1918/240. Archives and Special Collections, St George’s, University of London.
Post mortem case of Ada Bell, [Wife of] Soldier, 32, PM/1918/240. Archives and Special Collections, St George’s, University of London.

As the symptoms were varied, cases were sometimes misdiagnosed as dengue, cholera or typhoid, for instance. Of the overall deaths in those two years at St George’s, influenza cases account for 5.5% of all the cases: the yellow line in the graph below shows cases where influenza was reported to be the cause of death (or, to be more specific, cases in which influenza is mentioned in the post mortem report). We don’t, however, have the admissions registers for the hospitals, so we cannot tell the number of cases overall, only the number of deaths. 

There is a relatively large number of ‘unknown’ causes of death during these years as well (shown in turquoise in the graph below) – these are cases for which the records enter no cause of death and no details on the medical case, and they may or may not include some further influenza cases. The graph also shows other respiratory tract diseases (in green) and digestive system diseases (in purple).  

Graph showing deaths at St George's hospital 1918-1919. Showing overall deaths, influenza, other respiratory tract diseases, digestive system diseases and unknown causes deaths.
Deaths at St George’s Hospital 1918-1919. Source: Post mortem examinations and casebooks, PM, Archives and Special Collections, St George’s, University of London.

The 1889 influenza 

Influenza was of course not confined to these years only. Every so often influenza cases would flare up, and the previous time this happened on a large scale in 1889-90. With our propensity for blaming single countries for viruses, this pandemic is sometimes referred to as Russian flu and, according to some theories, it may have played a part in immunising those who had it against the 1918 flu, which appeared to disproportionately strike the younger population. 

There were attempts at finding medicines to cure the disease, and there was a minor scandal when the name of the teacher of materia medica (the study of drugs to treat diseases) at St George’s was found printed on an advertisement for an influenza cure: despite denying his involvement, he had to resign. The advertisement does not actually tell us what the medication consisted of, but we can only assume it did not work. 

‘Woodland affaire’, 1890. Archives and Special Collections, St George’s, University of London.

Influenza also continued to be a concern even after the 1918-1919 pandemic had abated, and in the 1926 St George’s decided to get involved in researching vaccines for influenza. There was a public funding campaign for the project, and in February 1927, St George’s published a letter in The Times

‘following on the traditions established here by Jenner and Hunter in their historical work, we are […] engaged in special research with the object of ascertaining what causes influenza, how it can be controlled, how it can be prevented from spreading and, finally, whether a really effective treatment can be found for it’. 

Scan of article in newspaper about influenza epidemic, research at St George's Hospital. ‘Influenza epidemic: Research at St George’s Hospital’. The Times, 15 Feb 1927.
‘Influenza epidemic: Research at St George’s Hospital’. The Times, 15 Feb 1927.

The arguments found in the plea for funding sound familiar: the ‘heavy burden which this scourge places on the community by the dislocation of business and loss of working power’. Because the project was widely publicised, the public was eager to take part, and we have some wonderful letters from people writing in and suggesting their own cures and theories of the causes of influenza: we will be tweeting these, so look out for them on our Twitter feed! 

Records relating to influenza research. Archives and Special Collections, St George’s, University of London.

The money for the research was found, and the subject of the vaccinations was chosen to be the staff of Harrods and Selfridges on Oxford Street, as well as the staff at Quin & Axtens and Bon Marché in Brixton, department stores which had recently been acquired by Selfridges. Altogether 345 people were vaccinated.  

Photo of table 1, ‘Report on anti-catarrh inoculations (catarrh of respiratory mucous membranes)’, 1928. Archives and Special Collections, St George’s, University of London.
Table 1, ‘Report on anti-catarrh inoculations (catarrh of respiratory mucous membranes)’, 1928. Archives and Special Collections, St George’s, University of London.

The various reports, meetings minutes and correspondence held in the archives tell us how the research subject was decided on, issues to do with the research, space and equipment (including the building of a spiral staircase in the laboratory – obviously an essential architectural refinement) and, most importantly, how the research was conducted and what the results were. 

The report of the findings in 1928 shows the research was conducted using attenuated vaccine ‘obtained from pathological fluids or secretions or from a mucous surface of persons who exhibited clinical evidence of disease’, with the assumption that the disease was called by a bacterium called Pfeiffer’s bacillus, or Haemophilus influenzae (also known as h-flu). It was not until a few years later, in 1933, that it was definitely established that influenza was actually viral, and not bacterial.  

And the results? Well, it appears that 1927 was a disappointing year when it comes to influenza, at least from the researchers’ point of view. The vaccination campaign was, however, declared a success, and there were plans to repeat it the following winter (although if that did happen, the records have not survived). 

Photo of response to ‘Report on the work carried out in the Research Laboratory’, 11 Jul 1928. Archives and Special Collections, St George’s, University of London.
Response to ‘Report on the work carried out in the Research Laboratory’, 11 Jul 1928. Archives and Special Collections, St George’s, University of London.

The preserved documents reveal an on-going preoccupation with and interest in influenza, even though (given what we are currently going through) there does not appear to be much sense of urgency, certainly not at the time of the 1918 influenza. 

Although the research was not successful in finding a vaccine that worked, it was an important step on the way: you won’t know what works until you try it. Our knowledge is cumulative, and dead-ends are part of research – not everything can work out, but it all adds up. The first influenza vaccine was developed in the 1940s, and (soon, hopefully) we will see a COVID-19 vaccine. 

Looking forward

What does this all have to do with digital preservation, then? Compared to the 1918 and 1889 flu pandemics the records we are creating today are largely digital. The technology supporting these records change rapidly and may one day become obsolete. If this happens, we could lose access to valuable records, including our covid-19 records. St George’s has recognised this and is actively engaged in looking after our digital information for the long term. We’ve recently purchased a digital preservation system, Preservica, to help us to preserve our digital records. We are working to develop methods and processes that will allow us to preserve the records that are currently being created, and to do so in a meaningful way that will work for colleagues across the organisation. 

Rather than thinking of digital and physical something entirely separate, we should consider them as part of a continuum, as it were. Preserving digital material can be challenging, and we can’t always replicate the processes used for paper with digital material, but the gaps in the past records show the need to preserve evidence of the current pandemic, not only for historical interest but to provide evidence of what happened and how we dealt with it. 

If you are interested in learning more about digital preservation at St George’s, or would like to get involved, please contact archives@sgul.ac.uk.

A recipe for success: studying with your peers

This contribution from the Learning Development team at St George’s comes from Hauwa.

Hauwa Muhammad is a 2nd year Biomedical Sciences Student and Learning Development Assistant at CIDE (as part of her Placement Training Year).

There are many benefits to getting together with your peers to revise difficult content in your programme of study. A key one is being able to use each other as a learning resource, having those extra thinking heads to resolve problems and clarify doubts. Studying with your peers also allows for a less pressured environment, since you are all in the same boat and, probably, at the same level. Outside the more formal context of the classroom/ lecture, and without the presence of an expert (the teacher), you feel more comfortable asking questions and less worried about making mistakes. Another advantage of forming or joining an existing study group relates to accountability. Being accountable to others and not just to yourself, provides an incentive for studying as you won’t want to feel behind when meeting with your peers. 

You must now be wondering how relevant this post is to you, since all or most of the interactions on your course continue to happen online. Colleagues from CIDE (the Centre for the Innovation and Development in Education) have launched a peer-assisted learning initiative precisely to help with the possible negative impact of not being able to meet face-to-face to discuss the content of your programme. One of the key aspects of this initiative is the involvement of a second-year student in the organisation and facilitation of study groups. I was hired for this purpose and since mid-September I have been piloting online study groups for year 1 students from two of St George’s programs: Biomedical Sciences and Therapeutic Radiography. These study groups are attached to specific modules where students are required to learn vast amounts of new information. I have been using the Big Blue Button (BBB) platform in Canvas to hold the study groups. BBB allows the creation of breakout rooms so students can join others in small groups to engage with the module’s content.  

A group of three students talking and smiling.

Peer Assisted Learning (PAL) has existed since the beginning of education. It occurs all around you. It happens in schools between kids while they are painting, colouring, or learning rhymes together. It takes place during group work or when friends are teaching each other. However, the introduction of PAL into universities was developed by researchers at Vanderbilt University in 1973 (Tariq, 2005). They developed theories that conceptualised learning through participation in social interactions and activities (Chan et al., 2016). Since the official integration of PAL into the university curriculum, 55 universities have adopted it into their curriculum in the UK (Keenan, 2014). This is more than 50% of the universities in the UK and the prevalence of peer-led learning schemes is increasing across institutions in the UK and internationally (Keenan, 2014).

When I enrolled at university, the first advice I was given was to make friends on my course. As a social and outgoing person, it was easy for me to make acquaintances by attending almost every lecture and meeting different sets of people in the lecture hall. Out of the many acquaintances, I made two good friends during my second semester and we have studied together ever since. However, I didn’t really know about the importance of making friends on your course until, during the lockdown in semester 4 when I went back to Nigeria to stay with my family. Suddenly, my schedule was a disaster. I had daily revision sessions on WhatsApp with my two peers and subsequently, I was able to study 70% of the content. My average increased by 10% from my first year to my second year because I studied with these two strangers I met in the lecture theatre.

Decorative image

The importance of student engagement in the organisation of PAL can’t be emphasized enough, especially in a pandemic. You can’t form relationships with people easily because there are no face-to-face interactions. Now, this is where this initiative is of massive help to students. Every session allows you to meet random strangers that you’re in this struggle with. Every session gives you the opportunity to meet your course mates informally using Big Blue Button and revise the content together. These are the replacement for the group calls I had when I was in Nigeria during lockdown. Some of the session strategies we use to revise the content are peer lessons and informal quizzes. During an informal quiz, students are split into groups of 5 using the breakout rooms and asked to create multiple choice questions from the lectures allocated to each group. This is to create an informal environment to be able to discuss the content and increase individual confidence in learning. Questions are then shared with everyone in the main conference where answers are discussed as a group. Volunteers explain why the chosen answers are right. If there’s a disagreement in answers chosen, everyone provides a reason for why he/she chose a specific answer. These sessions are fun and depend on the engagement of everyone. The sessions are open to all and non-compulsory, although attendance is encouraged.

We’ve had mostly positive feedback from the piloted sessions although we’re still working on improving the PAL sessions.  Students have mentioned that these sessions have enabled them to clarify complex concepts and become more aware of course expectations. We hope reading this blog will encourage you to also form or join a study group with your peers.

References

  1. Chan, N., Phan, C., Aniyah Salihan, N. and Dipolog-Ubanan, G., (2016). (PDF) ‘Peer Assisted Learning In Higher Education: Roles, Perceptions And Efficacy’. Social Sciences & Humanities 24 (4): pp 1811 – 1822.
  2. Keenan, C., (2014). ‘Mapping Student-Led Peer Learning In The UK’. The Higher Education Academy.
  3. Tariq, V., (2005). ‘Introduction And Evaluation Of Peer-Assisted Learning In First-Year Undergraduate Bioscience’. Bioscience Education 6(1).

If you’d like to speak to somebody outside of your programme about preparing for writing assignments and preparing for exams, 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.

Now is the time – Careers Service at St George’s

Banner for St George's Careers Service with the motto: explore / plan / apply

Whether you are just starting out at St George’s, about to complete your course this year, or anything in between; it is always the right time to work on your career management. For those graduating this year, the urgency is even greater to find the right next step, so do take advantage of the support on offer.

Here are some simple starting tips.

Explore, Plan and Apply are the stages to work through. We have a section on the Careers Canvas pages dedicated to each step, supporting you along the way.

Explore

Exploring is finding the direction that is right for you and inspires you! Take the time to identify your skills and strengths, see what graduate job opportunities and careers sectors interest you, and network to meet the right people that share your career interest.

Two students. one medical and one allied health, walking and talking in a university corridor

You may find that the St George’s alumni stories inspire you and open up a range of possibilities to explore. Alumni from different courses offered at St George’s give you an introduction to what their current role involves and how they got there. Get career advice from people who have been in your situation just a few years ago.

Plan

Planning is taking the time to plot your approach to reach your goal. For example, organising work experience to upskill and test out ideas, deciding where to apply for a placement, researching your next course of study. Perhaps you want to explore the Student Ambassador programme (opens October 2020) to work within St George’s and boost your CV. There are many ideas for CV boosting experience on the Careers Canvas pages. Don’t forget to give yourself the best advantage by completing the St George’s Skill and Recognition Award, an online skills portfolio to take you through from your current stage, all the way through your career.

Apply

Applying making a successful application, CV and pass recruitment processes. If you are looking for your next move now, and of course closing dates for many graduate schemes are coming to an end in November,  we have recently added some resources to help you at this particular time. Have a look at our Canvas page on job hunting in a Global Pandemic.


We hope you can find all you need. Contact us with any queries, worries or feedback at careers@sgul.ac.uk

Black History Month 2020

October is Black History Month and in the Library, we celebrate that with books of course. We have been promoting relevant events on our Twitter account throughout the month, but we also have our own contribution to make.

On Wakelet, we have put together a collection of fiction and non-fiction books for Black History Month, which includes physical books and e-books. You can access the list here. There is a range of classics, recent publications and texts around the Black Lives Matter movement. Recently, we added White privilege – The myth of a post-racial society by Kalwant Bhopal and Akala’s Natives – Race and class in the ruins of empire to our Black History Month Wakelet for example. We also have a Wakelet on Ethnic Diversity and Inclusion, which includes podcasts.

We are always looking for recommendations for what to add, so don’t hesitate to get in touch by emailing liaison@sgul.ac.uk.

In this blogpost, Library staff are sharing their thoughts on some of the books in the collection and their book recommendations for Black History Month.

Book reviews

Natives by Akala

Jenni Hughes (Research Publications Assistant)

This is an enlightening, powerful read on how race and class intersect and operate in today’s Britain. Akala’s choice to examine these in tandem deepens and enhances his analysis of both: his early observation that “we are trained to recognise the kinds of racism that tend to be engaged in by poorer people” rather than the larger, more damaging kinds perpetuated by the rich and powerful, for example, clarified a great deal for me about mainstream discourse around race and racism in this country.

Akala’s accounts of his personal experiences of classism and racism support and are supported by his deep knowledge of the history and sociology of race, and his prose slides easily between different registers (academic, vernacular etc), enabling him to communicate his points clearly and incisively. Overall, this is a compelling and very readable analysis drawing on a rich well of knowledge, research, experience and scholarship.

Book cover for Akala's Natives

Giovanni’s Room by James Baldwin

Andy Lacey (Information Assistant)

Reading James Baldwins Giovanni’s Room felt like a whole new world opening up when I first read it as a 17-year-old. A whole world filled with adult gay men, with complicated, messy but joyous lives.

The novel centres on David, an American in France who travels to Paris. He meets Giovanni, a bartender and the two become friends. We are then taken on a journey with them, but also their social sphere. We explore their experiences of social alienation, but also their passions, and attempts to construct a unique space for themselves in the world. This novel is so good at describing homosocial spaces, and exploring how gay men often had to construct new, alternate families. It is also great at examining modern ideas of masculinity, and spotlighting the problems with it. Having been written by a gay black man in 1956, this novel still seems powerful and contemporary even all these years later. Which maybe shows there is still a way to go. Brave, important and completely brilliant.

Book cover for Baldwin's Giovanni's Room

Brit(ish) by Afua Hirsch

Georgina Coles (Information Assistant)

I would highly recommend Brit(ish) by Afua Hirsch. It’s both a personal account of the author’s struggle with her identity as a British Ghanaian woman and an exploration of the place of racism in British history and identity, and how British society can’t claim to be ‘post-racial’ or ‘colour-blind’ until it confronts the racism inherent in both its imperial past and its present. A fascinating and important book.

Book cover for Brit(ish) by Afua Hirsch

A Small Island by Andrea Levy

Karen John-Pierre (NHS and Liaison Manager)

On June 22nd, 1948 the first wave of immigrants from Jamaica arrived at Tilbury Docks on the Empress Windrush. Dressed in their Sunday best and full of hope and pride at finally arriving in the ‘Mother country’, they, and other commonwealth immigrants who followed them, encountered a much more hostile and colder environment than they were expecting.

This is the real-life backdrop to the late Andrea Levy’s award-winning and popular novel, ‘A Small Island’, which charts the incohesive interplay between Hortense and Gilbert, originally from Jamaica, their English landlady, Queenie and her husband, Bernard. Levy gives voice to the different internal journeys they make in this new landscape at the birth of modern multicultural Britain, letting each main character in turn take the reins of the story to reveal different perspectives, hopping between past and present.

In this honest and important book, Levy exams themes such as the effects of Britain’s colonial rule in the Caribbean and India, post-war migration and racism, the framing of interracial relationships, the sadness and heartache of immigrant life as well as the universal themes of love, marriage and hope. As the daughter of a Windrush child, this book struck a huge chord with me: I revelled in the telling of stories largely untold and would urge you to do the same.

Book cover for Small Island by Andrea Levy.

Wide Sargasso Sea by Jean Rhys

Anne Binsfeld – Liaison Support Librarian (IMBE)

Wide Sargasso Sea by Jean Rhys is a poetic, raw and magical reading. The author highlights class and race issues, with a strong feminist and anti-colonial twist. Rhys uses the Victorian classic Jane Eyre by Charlotte Brontë and retells it from the point of view of Bertha, the “madwoman in the attic”. Set in Jamaica, Antoinette/Bertha’s story focuses on her youth as the heiress of a crumbling Creole family dynasty. She is married off to a stranger, Jane Eyre’s Mr. Rochester, who takes her to England and locks her away. As well as addressing patriarchal abuse, Antoinette’s story looks at the intersectionality of mental health issues and racism. A haunting, but beautiful book.

Book cover for Wide Sargasso Sea.

More recommendations

If you are looking for further recommendations for your Black History Month reading, Lawrence Jones (Content and Digital Infrastructure Manager) recommends Passing by Nella Larsen, a book about mixed race women in the US in the 1920s ‘passing’ as white & the stresses they suffer whilst trying to avoid being found out. Louise Davies (Circulation Desk Supervisor) recommends Half of a Yellow sun by Chimamanda Ngozi Adichie, which is also on our Black History Month Wakelet.

Brenda Cluffer (Information Assistant) really liked Andrea Levy’s Long Song. She says the following about the author’s latest book: “The Long Song talks about the months leading up to the abolition of Slavery in the Island of Jamaica. Andrea Levy manages to bring humour to a rather brutal and tragic time in British history. It tells the story of  a young girl called July and her son who through various events are torn apart by the horrors of this system and the journeys they take in order to survive. The book covers topics of colourism, class, race, landlord and tenant, slave uprisings, abolition of slavery, the role of clergy and rape. A very serious topic but Andrea has the knack of drawing you into the subject and providing the Caribbean old saying ‘take bad something and mek laugh’ into a compelling read.”


Don’t forget to email liaison@sgul.ac.uk with any recommendations around Black History Month you might have. Also, be sure to have a look at our Wakelet where you can find collections around mental wellbeing, LGBTQ+, women in leadership and many more.

Open Access Week 2020: Open with Purpose

This week, October 19th-25th, is Open Access Week, an annual, international event dedicated to celebrating and promoting Open Research.

This year’s theme is Open with Purpose: Taking Action to Build Structural Equity and Inclusion, acknowledging that current systems are often built on a past of historic injustices and that in building new systems, we need to be mindful of who we are and aren’t including, who we are prioritising and whether we are perpetuating a legacy of injustice.

To find out more, visit www.openaccessweek.org, or follow the official twitter hashtag, #OAWeek. We’ll also be tweeting and retweeting from the library account, @sgullibrary, and, if you’re in the library, look out for our poster on how to find open access material.

You can also find posts we’ve made in previous years under the Open Access Week tag on this blog.

Here at SGUL we support open research via our Research Publications Repository (SORA) and our Research Data Repository. We currently have over 4870 full text papers available via SORA, with an average 4180 downloads a month, and these numbers are rising every day. And, since its launch three years ago, we’ve had 17,163 downloads of public content in our Research Data Repository.

As well as supporting SGUL researchers to make their publications openly available via SORA, the Library is also signing up to Read and Publish deals, several of which are new in 2020. These deals work by giving SGUL patrons access to read journals, and giving SGUL corresponding authors the opportunity to publish original research articles on open access, as visualised below:

(from our blogpost on our Read and Publish deals)

Research outputs that aren’t traditional publications, such as research data, source code, poster presentations and so on, can be uploaded to our Research Data Repository, where they will be preserved and, where appropriate, made available for other researchers to explore and re-use. The Research Data Repository has been updated recently – have a look at our blog post from last week to find out more.

If you’d like to know more about SORA or about our Research Data Repository, please get in touch at sora@sgul.ac.uk (for SORA) or researchdata@sgul.ac.uk (for the Research Data Repository, or for general help managing your data throughout the research lifecycle).

Want to get involved?

Here are some ways to consider making your research practices more open:

  • Upload your author’s accepted manuscripts to a repository such as SORA: this means that, publisher copyright permitting, we will be able to make them available to people who might not otherwise have been able to access them. You can do this via your CRIS profile at http://cris.sgul.ac.uk/ – if you have any questions, you can contact us at sora@sgul.ac.uk
  • Get in touch with researchdata@sgul.ac.uk about making your other research outputs openly accessible via our Research Data Repository, or for ideas on where to find open data and other outputs you can use in your own research.
  • Think about uploading a preprint of your research to a preprint server. Posting papers to preprint platforms has increased greatly since the start of the pandemic – you can find out more about preprints, such as what they are and what to consider before posting, by reading our blogpost from last year on preprints in the medical, biological and health sciences.
  • Follow the conversation via the twitter hashtag #OAWeek – and add your own thoughts and reflections!

Any questions? Get in touch with us:

We look forward to hearing from you.

Michelle Harricharan, Research Data Support Manager

Jenni Hughes, Research Publications Assistant

Jennifer Smith, Research Publications Librarian

Health E-news Friday 9 October

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

Announcement of forthcoming guideline on persistent effects of COVID-19

NICE, and the Scottish Intercollegiate Guidelines Network (SIGN) have announced that they will work with the Royal College of General Practitioners (RCGP) to develop a guideline for the persistent effects of COVID-19, or long covid. The guideline will address, among other things, a formal definition of the disease, and how to identify on-going symptoms, which can include on-going shortness of breath, fatigue, heart, lung, kidney, neurological and musculoskeletal problems. It will also provide a definition of best practice investigation and treatment options to support the management of the condition. Publication is expected before the end of the year.

COVID-19 related news

Cochrane review on anticoagulants for people hospitalised with COVID-19

A recently published Cochrane review explores the use of prophylactic anticoagulants for those who are hospitalised with COVID-19, to see whether preventive use of anticoagulants reduced mortality or the need for respiratory support, compared with placebo or no anticoagulant treatment. The studies found for inclusion in the review were retrospective studies from hospitals in China, Italy, Spain and the USA, and the variance in reporting of results, along with incomplete reporting, means the review authors have low confidence in the current evidence. 22 ongoing studies on the topic, including 20 RCTs, were identified, and the review will be updated when results of these are published.

Other news

Cochrane brings together recent reviews relevant to nursing, midwifery and allied health

On the Evidently Cochrane blog this week, collections of recent Cochrane reviews have been brought together for several staff groups. The individual collections offer an overview of recent evidence relating to nursing, reviews relevant for allied health professionals, and for midwives. Each collection offers several different topics, provides a summary of the findings, and links to the full reviews.

Cancer Research UK publication on the early detection and diagnosis of cancer

Cancer Research UK have published the ‘Early Detection and Diagnosis of Cancer Roadmap’, a report which aims to help bring together the UK efforts in early detection and diagnosis of cancer. The document aims to define a shared vision amongst healthcare professionals, healthcare service commissioners, academia, research funders, patients and other stakeholder sectors, and makes recommendations for overcoming the existing challenges to progress in this area.

NHS Employers resources for World Mental Health Day

Ahead of World Mental Health Day on Saturday 10 October, NHS Employers have rounded up a range of resources relevant to mental health and wellbeing amongst the healthcare workforce. The resources include a toolkit developed in partnership with Mind, and a variety of resources relating to mental wellbeing throughout the ongoing pandemic, including some specific advice on mental health for those working from home.

International consensus statement on preventing opioid-related harm

An international multi-disciplinary consensus statement on the prevention of opioid-related harm in surgical patients has been published in Anaesthesia. The authors of the statement include anaesthetists, pain specialists, surgeons, a primary care physician, nurse and pharmacist from Australia, India, Italy, the Netherlands, the UK and the USA, selected on the basis of clinical or academic expertise. The statement offers guidance on the safe peri-operative use of opioids in adult surgical patients, and includes recommended strategies to reduce the potential harms of postoperative use of opioids.

Nuffield Trust report considers mental health nurse education

A report from the Nuffield Trust, commissioned by NHS Employers and the Mental Health Network, looks at ways more people might be attracted to apply to study mental health nursing, and considers the reasons why numbers are currently limited. ‘Laying foundations: Attitudes and access to mental health nurse education’, identifies five broad areas where efforts can be made to encourage and support an increased number of students in mental health nursing education. These include improving understanding of mental health nursing roles and mental health patients, and enabling access to courses across the country, from across the breadth of the population.

NICE guidance

Medtech innovation briefing

MIB229 AnaConDa-S for sedation with volatile anaesthetics in intensive care

NICE guideline

NG170 COVID-19 rapid guideline: cystic fibrosis Updated

NG183 Behaviour change: digital and mobile health interventions

Technology appraisal

TA652 Alpelisib with fulvestrant for treating hormone-receptor positive, HER2-negative, PIK3CA-positive advanced breast cancer (terminated appraisal)

NIHR alerts 

Working may improve quality of life for carers of people with dementia

A decision aid may help people with newly-diagnosed multiple sclerosis consider their options for treatment

People with anorectal melanoma may not benefit from radical surgery


Statistics

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Health E-news Friday 2 October

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 related news

Cochrane Review examines the accuracy of chest imaging for COVID-19 diagnosis

A recent Cochrane Review considers the evidence for thoracic imaging tests in the diagnosis of COVID-19. Noting the continuing challenges of accurate diagnosis by reverse transcriptase polymerase chain reaction (RT‐PCR) testing, the review assessed studies on the use of chest imaging tests, including CT, X-ray and ultrasound, to see how accurate these tests are in diagnosing cases of suspected or confirmed COVID-19. On the basis of the included studies, the review suggests that chest CT and chest X-ray may be useful for confirming COVID-19 diagnosis, but that CT scans may be less accurate in suspected cases.

Study findings show high prevalence of infection, but suggest growth rate may be slowing

Interim findings from the Real-time Assessment of Community Transmission (REACT) study have been published, offering a view of the levels of infection in the general population in England. The study, led by Imperial College Healthcare NHS Trust, tests over 150,000 participants each month over a 2-week period, and the published findings shows prevalence of infection increased across all age groups and regions. Infection was highest in those aged 18 to 24 with 1 in 100 people infected, and cases increased seven-fold in those aged over 65. The North West had the highest levels of infection and the number of infections in London increased five-fold. The current prevalence of infection is the highest recorded to date by the study team.

Other news

GMC publish updated guidance on Decision making and consent

The General Medical Council have published new guidance on Decision making and consent, effective from Monday 9 November. The guidance is intended to help doctors have meaningful conversations with patients about their treatment and care options, and is designed to be easy to follow, taking account of the work pressures faced by doctors. A single page summary with key principles doctors need to know, a focus on the importance of taking a proportionate approach, tailored to individual patients, and information on how healthcare colleagues can support decision making.

Professional bodies for radiology and cancer radiotherapy call for dedicated investment

The Royal College of Radiologists (RCR), Society and College of Radiographers (SCoR) and the Institute of Physics and Engineering in Medicine (IPEM) have each submitted cases to the Treasury, ahead of the forthcoming Comprehensive Spending Review. The organisations are united in their calls to the Government to combat staff shortages and inadequate and outdated equipment and IT, the primary obstacles that slow down care for cancer and imaging patients. The full submissions of each organisation can be accessed from this page.

RCoA and Association of Anaesthetists publish guidance on safe drug management

The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists have published guidance on the Safe Drug Management in Anaesthetic Practice. This guidance has been endorsed by the Royal Pharmaceutical Society (RPS), the Faculty of Intensive Care Medicine and the College of Operating Department Practitioners. The guidance builds upon 2016 guidance, ‘Storage of drugs in anaesthetic rooms’, extending its scope to include other areas where anaesthesia is routinely administered, such as emergency departments and labour wards.

King’s Fund considers the trade-offs between digital and face-to-face care

With the move from face-to-face to digital provision of some health care services during the first stages of the pandemic, there is a need to consider the gains, the losses and the balance between the two options, ahead of lasting decisions being made, suggests the King’s Fund. Noting some of the benefits that digital solutions offer patients and staff, and highlighting some of the obstacles preventing access to digital solutions, the argument is made for a balance which draws on the strengths of both face-to-face and digital, taking proper account of the needs and preferences of patients and healthcare professionals.

Resources, events and celebrations for Black History Month

As Black History Month begins, with restrictions limiting face-to-face events, NHS Employers is keen for staff to engage with celebrations, and share stories and resources online. Their website lists some events that NHS trusts have planned throughout the month, links to further information and resources on Black History Month specifically, as well as resources on inclusion and diversity more broadly. They also offer some key facts, figures and information about the current NHS workforce.

NHS Confederation report calls for ‘re-imagining’ of the NHS

Bringing together NHS Confederation members and partners, the NHS Reset campaign has convened the health and care system to reflect on the learning from the last six months and what it means for the future. The report reflects the views of the NHS Confederation, and highlights five factors which are central to helping reset the way health and care is planned, commissioned and delivered.


NICE guidance

Technology appraisal

TA650 Pembrolizumab with axitinib for untreated advanced renal cell carcinoma

TA651 Naldemedine for treating opioid-induced constipation


NIHR alerts 

Tackling fear and misinformation may help increase hepatitis C testing in prison

Tranexamic acid should not be used for patients with severe gastrointestinal bleeding


Statistics

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Health E-News Friday 25 September

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

New guidance on preparing anaesthesia and critical care for a second COVID-19 surge

New joint guidance produced by the Faculty of Intensive Care Medicine, the Intensive Care Society, the Association of Anaesthetists and the Royal College of Anaesthetists, outlines key principles for clinical directors to consider when planning service changes. The guidance aims to enable services to increase the availability of critical care facilities for COVID-19, while also protecting planned surgery, preserving training, and protecting the health and wellbeing of healthcare staff.

COVID-19 related news

New discovery in structure of Coronavirus could offer way of stopping virus

A new discovery in the structure of the SARS-CoV-2 Spike protein could offer a potentially significant means of eliminating the COVID-19 virus. An international team led by the University of Bristol, who have been examining the molecular composition of the virus, have made a finding that suggests that it might be possible to develop anti-viral drugs to target a particular part of the virus spike, thereby stopping its infectivity. The full findings are available in an article published in Science.

Cochrane blog offers summary of existing evidence on COVID-19

A piece on the Cochrane blog offers a summary of the existing Cochrane Reviews and Special Collections on various aspects of the virus. These include reviews on detecting COVID-19, testing and screening options, measures for controlling the spread – which include PPE, quarantine and travel-based measures – and treatment options for patients with COVID-19. The piece also considers the impact of the pandemic on other areas of health and wellbeing, and links to relevant reviews. Keep up to date with Cochrane news and reviews on COVID-19 at their page dedicated to Coronavirus resources.

Other news

Healthcare regulators publish annual joint report on whistleblowing disclosures

The GMC, NMC and the six other UK healthcare regulators have published their joint ‘Whistleblowing disclosures report 2020’. The report covers any disclosures made between 1 April 2019 and 31 March 2020, and outlines the number of disclosures received by each of the regulating bodies, as well as summarising the actions taken as a result of these disclosures.

Latest evidence from Cochrane on psychological therapies for chronic pain

A recently published Cochrane review investigates the use of three common psychological therapies for chronic pain in adults: cognitive behavioural therapy (CBT), behavioural therapy (BT) and acceptance and commitment therapy (ACT). The review is based upon studies of face to face treatment delivered by trained psychological therapists, and found that CBT offers small benefits on pain, disability and distress, while the evidence for ACT and BT was uncertain.

King’s Fund report examines the workplace needs of nurses and midwives

A report from the King’s Fund, ‘The courage of compassion: Supporting nurses and midwives to deliver high-quality care’, examines the pressures faced by nursing and midwifery staff, and investigates the workplace transformations that could contribute to improved health and wellbeing, decreased stress, and increased motivation. The report suggests that three core needs of autonomy, belonging and contribution must be met, and provides recommendations for how these can be achieved.

Flu vaccination programme aiming to reach 30 million people

This year’s flu vaccination programme will be expanded in an attempt to provide the vaccine to 30 million people, as findings from Public Health England (PHE) research earlier this year suggests that the risk of death more than doubled for people who tested positive for both flu and COVID-19, compared to those with COVID-19 alone. The vaccine will first be offered to all primary school children, two and three year olds, and the most at-risk groups, including adults over 65 and those with long term health conditions, before being rolled out to others later in the season. All staff at St George’s can, of course get their flu jab from the daily flu clinic.

Evidence review on the influences of improvement processes in healthcare

An evidence review commissioned by The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, and carried out by the RAND Corporation, explores the key influences affecting the implementation of improvement processes in healthcare. Based upon a review of publications covering a range of improvement approaches, six factors were found to be key influences on the successful implementation of improvement. These include leadership, patient and public involvement, and the use of data. The review is intended to highlight the issues that need to be considered when designing improvement initiatives.

NICE guidance

Clinical guideline

CG173 Neuropathic pain in adults: pharmacological management in non-specialist settings Updated

Interventional procedures guidance

IPG680 Transcranial magnetic stimulation for auditory hallucinations

Medtech innovation briefing

MIB227 t:slim X2 insulin pump for managing blood glucose levels in type 1 diabetes

MIB228 Novii Wireless Patch System for maternal and fetal monitoring

NICE guideline

NG59 Low back pain and sciatica in over 16s: assessment and management Updated

NG182 Insect bites and stings: antimicrobial prescribing

Technology appraisal

TA649 Polatuzumab vedotin with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma


NIHR alerts 

New research provides insights into the distress experienced by transgender adults

More precise classification of risk in prostate cancer reveals a huge variation in treatment

Terminally ill patients and their families often need more help to manage their medicines

More health research should take place in the areas and populations with most disease

Cultural and language barriers need to be addressed for British-Pakistani women to benefit fully from breast screening

Community-based medicine collection improves access to lifesaving HIV treatment in South Africa

Statistics

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Health E-news Friday 4 September

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 related news

Further evidence for benefits of corticosteroids in COVID-19 treatment

Findings in papers published this week in Journal of the American Medical Association (JAMA), have reinforced evidence that outcomes for patients severely affected by COVID-19 can be significantly improved by corticosteroids. The first of the papers examines the effect of hydrocortisone on mortality and organ support, finding more rapid recovery and better survival rates in treatment with the steroid. The second paper looked at mortality over a 28-day period after the start of treatment with corticosteroids, estimating a 20 percent reduction in risk of death.

Government announce funding of increased testing capacity

The government has announced funding for increasing the current capacity for existing polymerase chain reaction (PCR) COVID-19 testing, with the aim of enabling large-scale repeat population testing. In addition, funds will go to expanding pilot trials of new testing techniques and technology, including a rapid test that could provide results in as little as 20 minutes.

New findings add to picture of COVID-19 risks in pregnancy

A systematic review published in the BMJ offers further detail to the known risk factors, clinical manifestations, and outcomes in pregnant and recently pregnant women with COVID-19. The key findings of the review are: that increasing maternal age, existing co-morbidities or high BMI are risk factors for severe COVID-19 in pregnancy; that women with the virus are more likely to experience preterm birth; and pregnant women are less likely to manifest symptoms of fever and myalgia than non-pregnant women with COVID-19.

Nuffield Trust briefing on impact of COVID-19 on use of technology in NHS

A briefing from the Nuffield Trust explores how the pandemic has pushed the adoption of technology in the delivery of NHS services and notes the increased usage of digital health services by patients. The report examines what has enabled these changes, considers possible risks of the move to remote service delivery alongside the positive outcomes, and calls for the balancing of change with evidence of its benefit. Finally, the funding, infrastructure and workforce requirements of sustaining any lasting technological adoptions is highlighted.

Other news

RCPCH statement on paediatrician role in supporting mental health

The Royal College of Paediatrics and Child Health (RCPCH) has published a statement on the role of paediatricians in supporting the mental health of children and young people. Noting the increasing incidence of mental health issues among children and young people, the heightened risks for those in vulnerable groups, and the anticipated increase in support needs resulting from COVID-19, the statement makes a series of recommendations relating to training for paediatricians, and also for service developments.

NICE guidance

Diagnostics guidance

DG41 Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke

Medtech innovation briefing

MIB225 Helge for detecting haemolysis

Medical technologies guidance

MTG50 Axonics sacral neuromodulation system for treating refractory overactive bladder

NICE guideline

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

Technology appraisal

TA645 Avelumab with axitinib for untreated advanced renal cell carcinoma

TA646 Glasdegib with chemotherapy for untreated acute myeloid leukaemia (terminated appraisal)

TA647 Eculizumab for treating relapsing neuromyelitis optica (terminated appraisal)


NIHR alerts 

Male prisoners develop unhealthy hearts at younger ages than people on the outside

Teams of healthcare professionals from a wide range of disciplines and pay grades are most effective at delivering improvements in patients’ experiences

Psychiatric drugs given to children and adolescents have been ranked in order of safety

Anti-inflammatory drugs do not lift depression in bipolar disorder


Statistics

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St George’s Archives – The Pastry Chef Murderer

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.

On 27th July 1908 a patient called Ferdinand Alletrie was admitted to St George’s Hospital with a stab wound in the left chest which was penetrating the heart. The medical case notes say that ‘He was a waiter at the Bath Club. He had quarrelled with a colleague who waited for him outside and stabbed him in the chest.’ On admission he was observed to be in articulo mortis, or at the point of death. There was a stab wound in the third left intercostal space just to the left of the sternum. His clothes were noted to be soaked in blood. Ferdinand died five minutes after his admission.

Post Mortem Case Book 1908 (Ferdinand Alletrie, PM/1908/221)

The morbid appearances listed during the post mortem examination note that on the left side of the chest in the third interspace was a ‘punctured wound pointed at either end and gaping in the middle. It measured 1” long and ½” wide in the middle.’ The Post Mortem includes an illustration of the murder weapon as shown below.

Post Mortem Case Book 1908 (Ferdinand Alletrie, PM/1908/221)

But what led to the death of Ferdinand at St George’s Hospital? A search through historic newspapers uncovered an article called ‘Foreigners’ Fight at the Bath Club’ in the Leicester Daily Post dated 1st August 1908. The article details the tragic events that took place at the Bath Club that evening as well as the resulting inquest at Westminster Coroner’s Court ‘on the body of a cook named Pierre Auguste Ferdinand Alletree, employed at the Bath Club, who died from the effects of a wound said to have been inflicted by another employee of the club, who was in consequences arrested.’ The accused man was named as Georges Backenstrass.

Pierre Souleyne, chef at the Bath Club, said that he had engaged Alletree as sauce cook at the beginning of June, and later employed Backenstrass as a pastry chef at the club. One evening Backenstrass approached the chef and said ‘Chef. I am very sorry. I want to leave at the end of the week.’ When asked why he wanted to leave, he said that he was not friendly with the sauce chef. Souleyne said to him, ‘You have nothing to do with the sauce cook, and he has nothing to do with you. You must work friendly together.’ The chef also spoke to the sauce cook, no doubt to diffuse the situation, and Alletree responded, ‘You know me. He is silly. Don’t take any notice of him.’ No doubt the chef thought the issue was resolved, but he soon received news that the two chefs were fighting.

Louis Ayrand, another sauce cook, gave evidence as to the relationship between the two chefs. He said that Backenstrass ‘was a quiet and reserved man. He had some malady, and for that reason he was avoided by the other men.’ He said that ‘we never ate any of his pastry’, because of this unnamed illness. Continuing, the witness said that Backenstrass and Alletree did not agree about their work, and they had previously quarrelled when Backenstrass would not send up the sauce. On the night of the murder Ayrand heard the two chefs quarrelling in the vegetable pantry, and they decided to settle matters outside in Berkeley Street. Soon another chef by the name of Griffin called out ‘The pastry cook has stabbed your chef.’ Soon after Alletree ran back to the club, his hand over his heart, pointed to the pastry chef and said ‘Arrest him, he has stabbed me with a knife.’

Griffin, a vegetable cook at the Bath Club, said that he had quarrelled with Backenstrass the same night, when he took a biscuit off the pastry chef’s plate and Backenstrass objected. Alletree then began arguing with Backenstrass, and the latter said ‘I will wait for you outside.’ Griffin followed the two men outside and saw Alletree put his hand to Backenstrass’ neck and push him back. Backenstrass retaliated by hitting Alletree in the chest with something, after which the sauce chef exclaimed ‘he has stabbed me.’

Another chef stated that he saw the cook with a knife after the quarrel and said to him ‘You ought not to use a knife when you have quarrelled.’ Backenstrass replied ‘Well, there are two waiting for me downstairs.’

When Backenstrass was taken to Marlborough Street Police Station he made a statement in which he said that the sauce cook had called him a sneak for talking to the chef about him, and that the sauce chef and Griffin had approached him in the pantry, the latter threatening to break his nose. Describing the affair in the street, Backenstrass said ‘I took my knife out of my right trousers pocket and struck him in the chest. The knife is very sharp. It is the one I used for pastry. I never carried it before that night. I took it because of the pastry cook and the vegetable cook. If they had left me alone this would not have happened. The sauce cook told me I had too many pans in the fire. He told me I ate too much and he would come and watch me out. I asked him several times to leave me alone, and he would not.’

Backenstrass was held at Brixton Prison prior to the inquest. However the Governor of the prison informed the Coroner that Backenstrass had committed suicide in prison by hanging himself in his cell. The Coroner pointed out to the Jury that although Alletree had started the quarrel, if Backenstrass was still alive they would have to commit him on the capital charge. The jury returned a verdict of wilful murder against Backenstrass.

A further search of the historic newspapers revealed the article ‘The Bath Club Tragedy. The Brixton Prison Suicide’ in the Faringdon Advertiser and Vale of the White Horse, 8th August 1908. The article discusses the inquest into the death of Backenstrass. A medical officer testified that the prisoner, apparently a German, had suffered from a nervous affection. There were marks of two wounds of an operation in the abdomen, ‘but the man was in fairly good health, and behaved himself quite rationally, though he shewed that he was naturally worried about the crime.’ On the prisoner’s slate was found words written to the effect that ‘he had not been in good health, that he felt the disgrace, that his conscience was quite clear, and that he was guiltless of the offence with which he was charged.’ The jury returned a verdict of suicide whilst of unsound mind.


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Health e-news Friday 28 August

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 vision for eye care services during and beyond COVID-19

The College of Optometrists and The Royal College of Ophthalmologists (RCOphth) have developed a joint vision for the two professions to continue to work together to support the delivery of safe and sustainable eye care services in England. The vision sets out three key principles and recommendations for the development and governance of high quality eye care service. The three principles are: balancing visual loss due to delays against the risk of acquiring COVID-19; decisions about the most effective patient care being made by the appropriate clinician, and; all pathways to be underpinned by the highest standards of joint optometry and ophthalmology clinical governance.

COVID-19 related news

Study offers more detailed picture of COVID-19 risk factors and outcomes in children

Findings, published in the BMJ, of an observational study of 651 children and young people (aged less than 19 years) with COVID-19 admitted to hospitals across England, Wales and Scotland between 17 January and 3 July 2020, offer further details of the symptoms, risks and outcomes of the virus in children. The nationwide study highlights that a very small number of children (six) died, and that those children most at risk of requiring intensive care are babies under one month old, and children aged 10 to 14 years. In common with adults, the study found that obesity, and black ethnicity were factors that increased the risk of requiring intensive care.

New measures to support development and rollout of COVID-19 vaccines announced

The government has outlined a number of measures that will allow the safe future mass rollout of a COVID-19 vaccine. These include an expansion of the trained workforce that can administer vaccines, in order to increase access; and giving the Medicines and Healthcare products Regulatory Agency (MHRA) powers to consider approving use of a vaccine ahead of a full product licence; providing that robust clinical trials demonstrate its safety and effectiveness. Linked with these proposals, a consultation is seeking views on the safe distribution of potential COVID-19 vaccines and treatments.

Other news

RCN launches fresh campaign for nursing pay rise

The Royal College of Nursing (RCN) has launched a new ‘Fair pay for nursing’ campaign, seeking an immediate pay rise of 12.5% for all NHS nursing staff. The RCN highlight that the pay rise is needed to: provide safe and effective patient care for all people of the UK by addressing the staffing crisis within nursing; recognise the skill, accountability and expertise of a safety critical profession; and recognise that the salaries of nursing staff have not kept pace with increases in the cost of living. The campaign page also notes the political nature of health care funding in its call for action to address the years of inadequate support for nurses.

RCPCH on declining vaccination rates in the UK

The Royal College of Paediatrics and Child Health (RCPCH) considers some of the factors that are contributing to the ongoing trend of declining vaccination rates in the UK. The piece highlights some of the potential barriers that prevent access to vaccines; considers the significant role of misconceptions, misinformation and belief; and in light of the pandemic, also discusses the impact of disruption to routines and the development and distribution of new vaccines.

NHS Confederation calls for inspections to be paused until after winter

The NHS Confederation has written to the Secretary of State for Health and Social Care, calling for the routine inspections of hospitals and other health care providers to be put on hold until after winter. Pausing inspections, the organisation says, will enable hospitals and other providers to focus on the backlog of treatment that has built up, as well as address issues like staff exhaustion, while also managing the ongoing threat from coronavirus. A recent report by the NHS Confederation makes the case for learning from the present moment, and asks questions of what governance and regulation of healthcare could look like if bureaucracy were reduced.

NHS Providers report on meeting the needs of everyone

A report from NHS Providers, ‘Getting it right for everyone: Meeting the needs of people with a learning disability and autistic people in NHS services’ looks at the longstanding structural inequities faced by people with a learning disability and autistic people, and the further  impact of the pandemic upon these inequalities. Drawing upon interviews with leaders in trusts providing good and outstanding learning disabilities and autism services, the report sets out in detail the common themes behind high quality care, offering detailed case studies of how they have succeeded.

NICE guidance

Clinical guideline

CG134 Anaphylaxis: assessment and referral after emergency treatment Updated

Diagnostics guidance

DG40 High-sensitivity troponin tests for the early rule out of NSTEMI

Medtech innovation briefing

MIB224 FebriDx for C-reactive protein and myxovirus resistance protein A testing

Quality standard

QS196 Community pharmacies: promoting health and wellbeing

QS197 Faltering growth

NIHR alerts

Screening for lymphoedema after breast cancer surgery could identify women likely to benefit from compression sleeves

The weekly break from dialysis is harmful to patients with kidney failure

Statistics

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Health E-news 21 August

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 related news

Joint letter urges recruitment of COVID-19 patients onto RECOVERY trial

In a joint letter sent to every NHS trust in the country, the UK’s four Chief Medical Officers and NHS England and Improvements’ National Medical Director have urged continued recruitment of high numbers of patients onto the RECOVERY trial, which is exploring potential treatments for the virus. The letter also discusses the next phase of the research response, which includes preparation to support a number of large-scale COVID-19 vaccine studies and driving forward the studies on convalescent plasma.

Considering the evidence on the efficacy of masks

Researchers at the University of Edinburgh, exploring the effectiveness of surgical and single-layer cotton masks on mitigating dispersion of large respiratory droplets (i.e. non aerosol), have made their findings available as a pre-print, non peer reviewed paper on medRxiv. The authors estimate that wearing even a basic, single layer mask decreases the number of projected droplets by over 1000 times in comparison to not wearing any face covering. The authors note that their research explores respiratory droplets, warning that any emerging evidence on aerosol transmission could impact the findings. Related to this, a separate paper in the BMJ calls for further research on the airborne transmission of COVID-19, and the measurement of viral aerosol outputs during respiratory activity and medical procedures. The authors in this case suggest that the infection risk associated with deep breathing, talking, and singing indoors is underappreciated and urgently needs attention.

Other news

Government announces creation of new public health protection organisation

The government announced the creation of a new organisation, with a primary focus on public health protection and infectious disease capability. The National Institute for Health Protection (NIHP), which will bring together Public Health England (PHE) and NHS Test and Trace, as well as the analytical capability of the Joint Biosecurity Centre (JBC) under a single leadership team, will start work immediately. Responses from a range of organisations, including the BMA, the AOMRC, the Academy of Medical Sciences, the Health Foundation and The King’s Fund raise a number of concerns. Primary amongst these are the timing of the reorganisation, the degree of independence that the body will have from government, and what will happen to the broader, prevention focused elements of PHE’s work.

Draft guidance makes new recommendation for lymphoma treatment

In new draft guidance, NICE has recommended use of combination treatment involving polatuzumab vedotin for adults with diffuse large B-cell lymphoma (DLBCL). The combination treatment will be available from today for patients whose cancer has relapsed or not responded to primary treatment, and who cannot have a haematopoietic stem cell transplant.

Findings from international study suggest efficacy of single-dose radiotherapy for breast cancer treatment

A study involving 32 centres in 10 countries, including the UK, has published findings in the BMJ. The TARGIT-A study examined the effectiveness of Targeted Intraoperative Radiotherapy (TARGIT-IORT), which uses just one shot of radiotherapy, compared to conventional external beam radiotherapy (EBRT), which requires daily treatment sessions over three to six weeks. The trial showed TARGIT-IORT  had comparable long-term efficacy for cancer control and lower non-breast cancer mortality.


NICE guidance

NICE guideline

NG125 Surgical site infections: prevention and treatment Updated

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

NG178 COVID 19 rapid guideline: renal transplantation Updated

NG180 Perioperative care in adults

NG181 Rehabilitation for adults with complex psychosis


NIHR alerts 


Statistics

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Former students of St George’s: Assaad Y. Kayat (1843-1846)

To welcome new and old students to St George’s, our Archive team will be exploring the stories of some of our alumni. Today’s post comes from Archivist Juulia Ahvensalmi.

Image of Assaad Y. Kayat
Image of Assaad Y. Kayat. Source: ‘A Voice from Lebanon with the Life and Travels of Assaad Y. Kayat’ (1847).

Going through student records recently in the archives, I came across the name Assaad y Kayat in the list of students enrolled at St George’s in 1843. There was not much information in this list: his student number was 4093, he had attended the medical school for three seasons and he ‘appears not to have paid his fees’. His name stood out from the list of predominantly British names (the students at St George’s were until relatively recently primarily white, middle or upper class and male – you can read about our first female students in 1915 here), but the brief description was also intriguing. Who was Assaad, where did he come from and what happened to him?

As luck would have it, it turns out that Assaad, helpfully for us, published a book with his life story. He spelled his name As’ad Yakub Khayyat or Assaad Y. Kayat, and the book he wrote was called ‘A Voice from Lebanon, with the Life and Travels of Assaad Y. Kayat’. It was originally published by Madden & Co on Leadenhall Street, London, in 1847, and the front page includes a (rather dashing) portrait of him (see above).

The book appears to have been written specifically for a British audience. He had spent time in England on three occasions: it was on his third trip that he became a student at St George’s. At the age of 32 when he began his studies, he would have been considerably older than most of his fellow students – Henry Gray, for instance, was only 16 when he began his studies the previous year. Assaad was also married and had two small children, and had to earn money to cover his studies, so he presumably did not have much time for student activities. In his book, however, he only has words of praise for his time as a student:

‘I … entered as a medical student at St George’s Hospital … I shall be for ever indebted to them for the instruction I have received from their high skill. It is indeed a glorious hospital, an exalted medical school; it is an honour to be taught at it’

Signature of Assaad Y. Kayat in the St George’s Hospital Medical School Register 1836-1902.
Signature of Assaad Y. Kayat in the St George’s Hospital Medical School Register 1836-1902. Archives and Special Collections of St George’s, University of London

Life and travels of Assaad Y. Kayat

Born in 1811 in Beirut, Assaad describes in vivid detail his childhood and upbringing, through epidemics, wars and revolutions. He learns to read and write at the age of four, first in Arabic, his mother tongue, as his father wants to give him a good education (‘from the fear of my growing to manhood in a state of wretchedness and oppression’). Showing great promise and inclination for learning languages (he subsequently learns both ancient and modern Greek, Italian, English and Persian) as well as an astute business sense, Assaad soon progresses from selling rag papers to interpreting for sailors and merchants and is eventually employed as an interpreter by the British consul and representative of the East India Company in Syria. He travels widely around Middle East and Europe. Keeping in mind his audience, there is a lot of name-dropping of British dignitaries, officials and other people he meets on the way – his skills at networking are clearly second to none.

Although his focus is on Christian missionary activities, his account comes across as strikingly liberal for its time: he talks of ‘native agency’ and the importance of having native teachers and preachers, as well as of learning local languages and customs. He is a keen advocate of education, and in particular women’s education and equality.

Medical education

Throughout the account, he emphasises his journey to become a doctor ‘in order to benefit my fellow creatures’. On his second visit to England in the later 1830s, he attends some medical lectures at Cambridge, as well as at St George’s, where his first connection appears to have been the hospital chaplain, Rev William Niven. He regards medical education as an essential:

‘It requires no miracle to heal, but only to attend a medical course for a diploma or degree. A dose or two of sulphate of quinine often cures your patient of ague; vaccination prevents his taking the small-pox; the use of certain precautions prevents your catching the plague.’

In 1843 he returns to England, accompanied by his wife and toddler, as well as a group of young men with the view of obtaining an education for them, and to study medicine at St George’s. It is not all plain sailing, however, His wife Martha struggles to settle in; she has a toddler and a small baby to care for, she is sick herself, cannot get used to the miserable weather and the famous London fogs (or smogs caused by pollution in the dirty and overcrowded city), she doesn’t speak English and is largely confined to their small rented rooms, instead of their lovely house and garden and the company of her family and friends in Beirut (so despite his advocacy for women’s education, his own wife is stuck with a very traditional role at home). They are struggling with money; the committee (‘Committee of the Syrian Society’) Assaad had set up to enable the education for his ‘Syrian youths’ is slow to help, and Assaad attempts to raise money by giving public lectures on Syria and Christianity and by setting up a small importing and exporting business.

He is also keenly aware of his status as an immigrant in Britain and encounters prejudices and racism. He cites a journalist, who ‘came to my lectures twice, and all she could observe was my handsome appearance – her ears tickled by my foreign accent’ and talks at length about the difficulties in trying to expel these prejudices:

‘Some take me for a prince, or at least a chief; others, for a Chinese ambassador, a merchant, or an interpreter. Some think I am a Jew; others, a Turk, a missionary, a philosopher, or a lecturer; Christians of every denomination appointing to me a station or an office according to their own preconceived notions.’

Entry for Assaad Y Kayat (student number 4093). St George’s student records Vol 5. SGHMS/4/1/7.
Entry for Assaad Y Kayat (student number 4093). St George’s student records Vol 5. SGHMS/4/1/7. Archives and Special Collections of St George’s, University of London.

The student records show that Assaad studied for three seasons. One of the records notes that he ‘appears not to have paid his fees’, but according to his own account he finishes his studies in 1846, obtains his diploma and is admitted as a member of the Royal College of Surgeons, before returning to Beirut. It is unclear which account is true; maybe some more research in the archives will shed more light on the matter.


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Health E-news Friday 14 August

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 publishes guidance for phase three response to COVID-19

The NHS has published a guidance document offering recommended actions across several key areas, including: addressing inequalities in provision and outcomes; mental health planning; and the restoration of community health services. Responding to the publication of the guidance, the NHS Confederation welcomed the emphasis on tackling the health equalities exposed by the pandemic.

COVID-19 related news

Briefing from NHS Providers explores trusts’ experiences of COVID testing regime

A new report from NHS Providers, drawing on the responses from 112 trusts to a survey conducted during June and July, explores the experiences that trusts have had with the national testing strategy so far. The report examines levels of confidence in the government’s approach and strategy, and trust leaders’ confidence in being able to meet testing requirements; considers issues relating to variable turnaround time for test results, and the implications of these; and calls for greater local involvement and control in testing in order to manage routine testing of staff and patients as services resume.

REACT study publishes first findings

The REACT (REal Time Assessment of Community Transmission) study, which has been using antibody finger-prick tests to track past infections and monitor the progress of the pandemic, has published pre-print findings on antibody prevalence based on 100,000 study participants. The findings indicate that 3.4 million people – 6% of the population – had been infected by COVID-19 by 13 July 2020. People living in London were most likely to have been infected, as were those working in care homes and health care, and people from Black, Asian and other minority ethnic groups and people living in larger households. All findings from the study can be found on the group’s page on the Imperial website.

COVID-19 pay protection FAQs

The NHS Staff Council Executive has published FAQs on pay protection relating to workforce issues arising from COVID-19. The document is an addition to existing guidance from the Department of Health and Social Care, and answers questions relating to staff who are redeployed to help service and patient needs, or in cases of redeployment following a risk assessment.

Study reveals extent of symptoms or infection of healthcare staff resulting from intubation

A new study published in Anaesthesia, explores the extent to which healthcare staff involved in procedures such as intubation might be exposed to elevated risk of acquiring COVID-19. The study of 1,718 healthcare workers from 503 hospitals in 17 countries shows that overall, 1 in 10 healthcare workers involved in intubating seriously ill patients with COVID-19 later reported symptoms, or had lab-confirmed COVID-19 themselves. The study authors recommend use of the findings to inform service planning, and suggest future work should aim at identifying interventions to reduce risks to healthcare professionals.

Other news

Research finds breast screening women aged 40-49 reduces cancer mortality

Research published in The Lancet Oncology, from a trial involving 23 breast screening units across Great Britain, suggests that yearly mammography commencing at age 40 or 41 years could lead to reductions in breast cancer mortality. The trial involved over 160 thousand women, recruited between October 1990 and September 1997, and the publication offers analysis of the data at 23 years of follow-up.

BMA report on disability in the medical profession

A new report from the BMA examines the experiences of disabled people studying, training and working in medicine, and offers recommendations for improving the support on offer. The report, based upon responses to a BMA survey, shows that just over half of respondents receive adjustments that they need, and which are a legal duty to provide. Over three quarters of respondents also expressed concerns over being treated unfavourably if disclosing a disability or long-term health condition.

NICE guidance

Interventional procedures guidance

IPG678 Deep brain stimulation for refractory epilepsy in adults

IPG679 Implanted vagus nerve stimulation for treatment-resistant depression

Medtech innovation briefing

MIB221 Healthy.io test for home testing of urine albumin to creatinine ratio

MIB222 pCONUS2 Bifurcation Aneurysm Implant for complex intracranial aneurysms

MIB223 Spartan RX point-of-care CYP2C19 test to guide treatment in acute coronary syndrome

Quality standard

QS194 Decision making and mental capacity

NICE Guideline

NG160 COVID-19 rapid guideline: dialysis service delivery Updated

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

Technology appraisal

TA641 Brentuximab vedotin in combination for untreated systemic anaplastic large cell lymphoma

TA642 Gilteritinib for treating relapsed or refractory acute myeloid leukaemia

TA643 Entrectinib for treating ROS1-positive advanced non-small-cell lung cancer

TA644 Entrectinib for treating NTRK fusion-positive solid tumours

NIHR alerts 

Early warning scores used in hospitals must be based on sound science

High rates of delirium, persistent fatigue and post-traumatic stress disorder were common after severe infection in previous coronavirus outbreaks

Fluoxetine does not improve outcomes after stroke

Statistics

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Welcome to St George’s

We would like to welcome all new doctors who have recently joined us at St George’s. Below are some key things to help get you started.

Register with the library

To register with the library, simply complete the online registration form here.

Self-register for an OpenAthens account

If you need to set up a new OpenAthens account, use the self-registration form; if you already have an existing account with another organisation, you can transfer it to St George’s. If you have any questions, or need any help, contact our OpenAthens administrator, Stephen Reid.

Key resources

BMJ Best Practice

BMJ BestPractice is an online point of care tool that gives healthcare professionals fast and easy access to the latest information when making diagnosis and treatment decisions. Access via your OpenAthens account.

UpToDate

UpToDate is an online evidence-based medicine resource providing point-of-care clinical information. Access via your OpenAthens account, or from the trust intranet.

Databases

The library website has a list of databases available to all NHS staff. This inlcudes a version of PubMed which links to OpenAthens full-text content, Medline, Embase and additional resources including Aclands Video Atlas of Anatomy.

BMJ OnExamination

Designed to assist doctors in training to prepare for membership examinations with current and relevant online revision courses. Voucher codes providing 2 months access to the site are available from the library. Contact liaison@sgul.ac.uk for further information, or to request a voucher.

Journals

OpenAthens journals A-Z

To see which journals are available to access with your OpenAthens account, visit the NICE journals A-Z. Login to see full details.

University journals A-Z

Further titles are available from the St George’s, University of London collections; see the searchable A-Z list. All university journals are accessible from the computer rooms adjacent to the library; visit the library helpdesk to obtain a login.

Article request service

Articles from the university collections can also be requested online, using the form on the library website.

E-books

Our e-book collection can be found using Hunter, the library search tool. Filter results to ‘Online Resources’ for e-books, and login with your OpenAthens account.

Library guides

The library has produced a range of guides, designed to support clinical practice, research, and professional and service development. These include a guide to COVID-19 resources and research, quality improvement, and a guide on carrying out systematic reviews. The full list of guides can be found here.

Literature searching service

CARES is our literature searching service, available to all NHS staff. The service supports clinical practice, service development, research and teaching by providing librarian-run literature and evidence searches on your behalf.

Contact

For help, or for further information on library services, support and training, and the resources that are available to you, contact us on liaison@sgul.ac.uk

Health E-news, 31 July

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 guidance updates from NHS Employers

NHS Employers have information on the latest COVID-19 guidance updates. Updates include: details on the government announcement confirming that registered health and care professionals travelling to the UK from high-risk countries will be required to self-isolate for 14 days; revised guidance on quarantine, including leave and pay options for staff required to quarantine; and guidance relating to the pausing of shielding, which is effective 1 August.

COVID-19 related news

NHS Confederation on ONS excess mortality statistics and test and trace figures

In a response to the publication of Office for National Statistics (ONS) comparison of all-cause mortality between European countries, and the latest figures for the test and trace programme, Dr Layla McCay, a director at NHS Confederation, expressed concerns over the week-on-week decreases in the percentage of close contacts being reached by tracing system, and stressed the importance of this system to the ability to identify and manage any surges in infections.

Chief executives of NHS trusts voice concerns over staff wellbeing

In a report published by the NHS Confederation this week, chief executives from NHS trusts across England revealed concerns about the impacts of COVID-19 on their staff. Executives voiced serious concerns over: the increasing levels of anxiety and fatigue reported by staff during the pandemic; the safety of BME staff, in light of the disparities of COVID-19 impacts; and protecting the safety of patients and staff as routine services are resumed.

NIHR announce funding of projects to investigate higher COVID-19 risk among certain ethnic groups

The National Institute for Health Research (NIHR) has announced joint funding with UK Research and Innovation (UKRI) of six new research projects to eek to explain and mitigate the disproportionate death rate from COVID-19 among people from Black, Asian and minority ethnic (BAME) backgrounds. One of the studies, UK-REACH, led by the University of Leicester, will establish a unique partnership between national healthcare organisations to specifically address the prevalence of COVID-19 amongst BAME healthcare workers.

NHS England launch online portal to support COVID-19 rehabilitation

A new website from NHS England has been launched, offering an ‘online portal’ to help the rehabilitation of patients discharged from hospital post COVID-19 and those managing their illness at home. The site has been developed with the support and input of several royal colleges, professional bodies and charities. The site offers support for managing a variety of common physical effects those recovering from the virus may experience, as well as for supporting mental health and wellbeing.

PHE report confirms increased COVID-19 risks of being obese or excessively overweight

A report from Public Health England (PHE), which summaries findings from recent publications examining he effects of excess weight and obesity on COVID-19, confirms that the data show that obese people are significantly more likely to become seriously ill and be admitted to intensive care with COVID-19 compared to those with a healthy BMI. The report also summarises evidence regarding the nation’s eating and exercise habits during the COVID-19 pandemic. While some data suggests that more people have exercised during lockdown, evidence indicates that the nation’s exercise levels have not increased overall since before the pandemic.

Other news

NHS England sets out plan to roll out new A&E standards before winter

NHS England is planning to roll out new emergency care standards, designed to replace the four-hour A&E target, before this winter. The new standards have not been published or consulted on and do not have official sign-off from ministers, though the plans have the backing of the Royal College of Emergency Medicine and other royal colleges. Details of the proposed changes are outlined in a paper discussed at an NHSE and NHS Improvement board meeting.

Induction of labour: if, and when, to induce

Evidently Cochrane discusses a recently updated Cochrane review, ‘Induction of labour at or beyond 37 weeks’ gestation, looking at the effects for women and their babies of inducing labour towards the end of pregnancy. The review found evidence that induction later in pregnancy, when compared to waiting for birth to happen, reduced the number of perinatal deaths, led to fewer babies requiring intensive care, and a probable reduction in the number of caesareans required. The review does highlight the variation in values and preferences, and reiterates the need for collaborative discussion and shared decision-making.

New e-learning resource for those working with people with dysphagia

A new Dysphagia Guide, developed in conjunction between Health Education England (HEE), Sheffield Teaching Hospitals NHS Foundation Trust, and the Royal College of Speech and Language Therapists has been made available to access without registration on the HEE e-Learning for Healthcare website. The guide is intended as a resource for health and care professionals working with people with dysphagia, as well as carers and those living with dysphagia themselves.

NHS People Plan published

The NHS People Plan has today (30 July) been published, outlining actions that organisations, employers and staff will need to take in the coming months.
We are the NHS: People Plan 2020/21 sets out guidelines for employers and systems within the NHS, as well as actions for NHS England and NHS Improvement and Health Education England throughout the coming months and year. While welcomed by royal colleges and professional bodies representing health professionals, there was widespread comment on the need for action on staff shortages and a commitment to funding. This was echoed by the Health Foundation in it’s response.


NICE guidance

Medtech innovation briefing

MIB220 Prontosan for acute and chronic wounds

NICE Guideline

NG164 COVID-19 rapid guideline: haematopoietic stem cell transplantation Updated

NG179 COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services

Quality standard

QS195 Renal and ureteric stones


NIHR alerts


Statistics

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Health e-news Friday 24 July

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 related news

Resuming health services during COVID-19 – learning from other countries

The Nuffield Trust have published a briefing examining how other countries are handling issues relating to health service resources and capacity, and the resumption of services as lockdown measures are eased. The report, drawing upon data from the WHO, the European Commission, the European Observatory on Health Systems and Policies, and the OECD, also considers what lessons the NHS might learn from the experiences of other countries.

ONS bulletin examines COVID-19 mortality rates by area and deprivation

The Office for National Statistics (ONS) have published a bulletin on deaths involving COVID-19 by local area and socioeconomic deprivation. Presenting figures at national, regional and local authority level, the bulletin offers provisional analysis of deaths between March 1 and 30 June, focusing on differences between local areas. The analysis also shows the differences between proportion of COVID-19 related deaths as they relate to an area’s level of deprivation. Mortality rates in the most deprived areas of both England and Wales were around twice those of the least deprived areas.

UKRI funded vaccine trial publishes results from early trial stages

The team of scientists at Oxford University’s Jenner Institute and Oxford Vaccine Group have published results from Phase I/II trials in The Lancet this week. The study, which involves researchers from St George’s, has found that the vaccine candidate produces both T-cell and antibody responses against the SARS-CoV-2 virus, including robust neutralising antibody responses. No safety concerns were noted.

Other news

Pay rise for doctors and dentists in England announced

The government has accepted the recommendations in the latest Review Body on Doctors’ and Dentists’ Remuneration (DDRB) report, which will see pay for NHS doctors and dentists in England rise by 2.8%. The rise will be backdated to April 2020.

Partial update to back pain and sciatica guidelines out for consultation

A draft partial update of the National Institute for Health and Care Excellence (NICE) 2016 guideline on the assessment of low back pain and sciatica has been published for consultation. The draft guideline says that people with acute or chronic sciatica should not be offered gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines. It also recommends that people with chronic sciatica should not be offered opioids, and states that no evidence recommends the use of antidepressants for sciatica. The Chartered Society of Physiotherapy intends to respond to the consultation, and recommends that individual members also contribute.

 
NICE guidance

Evidence summary

ES29 Remsima (infliximab biosimilar) for subcutaneous injection for managing rheumatoid arthritis

Interventional procedures guidance

IPG674 Artificial iris insertion for acquired aniridia

IPG675 Artificial iris insertion for congenital aniridia


NIHR alerts 

Drug users who lack access to clean water use dangerous alternatives to prepare injections

Most patients leaving hospital in India are given inadequate medical information

Loneliness in people with dementia is linked to social isolation and depression

Most people caring for relatives with dementia experience loneliness


Statistics

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Summer Holiday Library Update

While this summer is certainly different from any we have experienced before, we still hope you are making the most of the nice weather and enjoying a well-deserved break. For those of you who are continuing with university work, catching up on last year’s content or preparing for what’s to come, we have put together a short blog post around how to make the most of the Library resources. Our online services mean you can get the information and help you need, no matter where you currently find yourself.

1. Discover e-books in Hunter

We’ve added a large number of titles to our e-book collection in the last few months, so it’s now more likely than ever that you’ll find a range of online books to help with your topic.

You can find all our e-books in Hunter. Search under Books and more, then select Online Resources in the menu on the left. To access a book, use the SGUL users log in here link and enter your SGUL username and password.

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

The Oxford Medical Handbooks have been some of our most popular e-books. You can find them by searching in Hunter, or view the full collection at Oxford Medicine Online – along with over 1000 other Oxford Medicine books available in full text and searchable by specialty and series.

Oxford Medical Handbooks

Please note we’ll be transferring part of our e-book collection to a new platform in the coming months due to the closure of DawsonERA. We hope disruption will be minimal, but if you’re unable to view an e-book you previously used, email us at library@sgul.ac.uk and we’ll try to restore access.

2. Explore online learning resources

As well as e-books and e-journals, your SGUL login gives you access to online teaching and learning resources, many featuring multimedia and quiz elements to help keep your study interactive. We’ve highlighted two popular resources below, but you can browse a full list here.

BMJ Learning offers hundreds of text and multimedia learning modules across 70+ medical specialties.

Access BMJ Learning here. On your first visit you’ll need to sign in with Shibboleth (use your SGUL login), then create a BMJ personal account with a unique password. On your next visit, just sign in with Shibboleth; your BMJ Learning homepage will now be personalised to your interests and previous learning

Sign in to BMJ Learning with Shibboleth then create your personal account. After this, just sign in with Shibboleth each time.

JoVE (Journal of Visualised Experiment) is an extensive collection of videos illustrating scientific concepts and laboratory techniques. SGUL students can view all content in the Biology, Immunology and Infection, Medicine and Neuroscience sections. Click here to sign in to JoVE.

Until 30th Sept 2020 we also have access to key sections in JoVE Science Education – so you have time to review topics in Basic and Advanced Biology, Clinical Skills and other areas over the summer. Click here for more information.

3. Contact the Library for help

The Library team remain available throughout summer to answer any questions you might have. For general enquiries, for example about loans and opening hours, please email library@sgul.ac.uk.

Your Liaison team is busy this summer preparing for next academic year as we transition all of our teaching and 1-2-1 support online. We have already delivered some online training sessions which went well. Additionally, we are working on some Canvas tutorials and are expanding our video collection. We remain available for help via email (liaison@sgul.ac.uk) and can set up an appointment with you if you need help with your research or referencing.

Health e-news Friday 17 July

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

AOMRC recommendations for COVID-19 winter surges

The Academy of Medical Royal Colleges (AOMRC) have published a statement, further to a report by the Academy of Medical Sciences warning of the potential for a higher winter peak of coronavirus infections. Acknowledging the risks highlighted, the AOMRC make a series of recommendations for preparatory action across key areas, including: system capacity; workforce requirements; infection control and PPE; and testing, amongst others. In each area, they outline actions that need to be taken at a national level, together with necessary local and regional actions.

 

Joint statement on improving medical pathways for acute care

The Royal College of Emergency Medicine (RCEM), Royal College of General Practitioners (RCGP), Royal College of Physicians (RCP) and the Society for Acute Medicine (SAM) have published joint recommendations for transformation of the urgent and emergency care pathway, in light of the continuing COVID-19 pandemic. The statement includes a number of recommendations which they hope can enable organisations to provide care in such a way that appropriately manages risks of crowding of emergency services, and infection prevention and control.

FSRH update guidance to patients of sexual and reproductive health services

The Faculty of Sexual & Reproductive Health (FSRH) have published an update to their advice for patients who need to access contraception, abortion care and other sexual and reproductive health services. The update contains information on which services are likely to be available, along with contact information for relevant services in all countries of the United Kingdom. The guidance is designed for use and distribution by any healthcare workers supporting women with their sexual and reproductive health needs.

Government publishes guidance on managing local COVID-19 outbreaks

New guidance from the government has been published, setting out how national and local organisations should work together in order to contain and manage local COVID-19 outbreaks. The guidance outlines local authority plans and powers, and the roles and responsibilities of both local authorities and national organisations including NHS Test and Trace and the Joint Biosecurity Centre (JBC), and Public Health England (PHE).

COVID-19 related news

Research questions the effectiveness of aerosol boxes

A recently published study in Anaesthesia, suggests that aerosol boxes that have been manufactured in order to protect healthcare workers from COVID-19 might actually be increasing the risks of exposure to airborne particles carrying the virus. The devices are intended for use during tracheal intubation in patients requiring ventilation, but the paper builds on concerns from the medical community that the devices may either not work, or could be causing unforeseen harm to medical staff. The paper notes the untested nature of such devices and their absence from recommendations or endorsement in any existing guidelines, and calls for appropriate testing and regulation.

Transparent face masks for health and care professionals

The Royal College of Speech and Language Therapists (RCSLT) have been lobbying for the introduction of transparent face masks for use in health and social care settings over the past few months, in light of the communication barriers caused by opaque face coverings. In an update to these efforts, the government has accepted the importance of transparent face masks, and have placed an order with the one supplier whose offerings meet the necessary standards. The masks on order are single use, will not require FIT testing, and will not be suitable for use in high-risk environments.

Other news

PHSO report paints stark picture of NHS complaint handling

A report from the Parliamentary and Health Service Ombudsman (PHSO), paints a stark picture of the state of NHS complaint handling, drawn from evidence taken from interviews with a wide range of individuals and organisations who have first-hand experience of how the NHS and UK Government departments approach complaints. The report highlights three areas of particular concern: a lack of consistency in how staff are expected to handle and resolve complaints; inconsistent training on handling complaints; and a negative view of complaints at the organisational level. The report recommends establishment of a complaints standards framework, similar to that pioneered by the Scottish Public Services Ombudsman, which would provide better consistency in the handling of complaints across public services.

RCN survey results reveal increase in numbers considering leaving profession

Initial results of a survey of Royal College of Nursing (RCN) members have been revealed in the first published report. The survey received 42,000 responses, and offers a view of how nursing staff feel about their professional lives. Across both NHS and independent sectors, the percentage of those considering leaving the profession has risen to 36%, up from 27% last year. A high percentage of those considering leaving cited pay as a factor (61%), along with the way nursing staff have been treated during the pandemic (44%), low staffing levels (43%) and lack of management support (42%). The report also notes that while 74% of those responding felt more valued by the public throughout the recent months of COVID-19, only 18% felt more valued by the government.

SOM report on mental health and wellbeing of nurses and midwives

A report from the Society of Occupational Medicine (SOM) offers a summary of the research evidence on the mental health and wellbeing of UK nurses and midwives. The report considers a variety of questions relating to the topic, highlights key findings from the relevant studies found, and makes a series of recommendations for improving current working conditions. The report identifies considerable risk of stress, burnout and mental health problems related to work amongst nurses and midwives; low satisfaction with job demands, control and support; a high risk of bullying and harassment; and a variety of other working conditions that not only threaten the health of nurses and midwives, but also impact on their ability to deliver high quality care to patients.

NHS Employers guidance on supporting staff with childcare responsibilities

NHS Employers have published updated guidance on how NHS organisations can support staff with childcare responsibilities. The guidance covers issues relating to childcare through the summer, the beginning of the new school term in September, and on providing flexibility as an employer.

King’s Fund on obesity and the need for significant government action

The King’s Fund here consider the potential forms of government action to tackle rising rates of obesity in the UK, and the evidence for their likely success or failure. Obesity is a well-established risk factor for diabetes and a range of other diseases and chronic health conditions, to which list can now be added COVID-19, and the piece argues for a strategy that goes beyond public information campaigns, and which makes use of existing evidence demonstrating the need for fiscal and structural actions.

 
NICE guidance

Quality standard

QS193 Specialist neonatal respiratory care for babies born preterm


NIHR alerts 

Some antidepressants can help people quit smoking, but other medications may offer greater benefits

Most patients undergoing planned surgery do not need compression stockings

Asthma patients with a history of opioid use have worse outcomes


Statistics

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Important announcement on ebook access via the Library

13 July 2020

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Preview(opens in a new tab)Add titleImportant announcement on ebook access via the Library

On 19 June 2020 Dawson Books announced that it had entered into administration. This means that the company will no longer continue to operate.

In recent years, the Library has purchased approximately 1400 ebooks via Dawson Books and end-users (e.g. SGUL students/staff; NHS staff etc) access this content through the Library via the DawsonERA platform. The administrators have recently announced that they are only committing to keeping this platform operational through to 31 July.

The Library is currently in negotiations with alternative ebook suppliers to transfer to them as many of its Dawson ebook titles as possible so that we can secure ongoing access. However, as you can imagine, every other UK university library is also organising to transfer its ebook titles from Dawson and, due to the sheer scale of the work required, alternative suppliers may not be in a position to transfer St George’s titles by the 31 July deadline. This means that during August and beyond you may find that you are unable to access some ebooks which you may have used up until now.

The Library will work towards making as many of our Dawson ebooks available via a new supplier throughout the remainder of July and into August. However, setting up this access via a new supplier may continue into September and beyond.

If you therefore find in the coming weeks that there is an ebook title you previously accessed via the library but which is now no longer available, please email the Library at library@sgul.ac.uk and we will investigate what we can do. 

We apologise for any inconvenience caused.

Health e-news Friday 10 July

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

BSG issue two further guidance updates

The British Society of Gastroenterology (BSG), with input from organisations including the British Liver Trust and NHS Blood & Transplant, have provided guidance on patient groups who should be considered highly vulnerable, or advised to shield. In addition to this, guidelines for triage of patients referred for upper gastrointestinal (UGI) physiology investigations have also been made available. These latter guidelines apply to new referrals and referrals from prior to the pandemic.

Government adopts RCPCH guidance on children and shielding

Recent guidance from the Royal College of Paediatrics and Child Health (RCPCH), on COVID-19 shielding in children and young people, has now been adopted by the government. The guidance gives recommendations on which patients should continue to shield, and notes that patients should only be removed from the shielding patient list by their GP or specialist doctor, following consultation. The recommendations have been incorporated into Public Health England guidance on shielding.

COVID-19 related news

Cochrane Review on signs and symptoms of COVID-19

A new Cochrane Review explores the available evidence on the signs and symptoms of COVID-19, in an effort to inform timely and accurate diagnosis of the virus. The review considered studies published between January and April 2020, addressing the accuracy of any signs and symptoms, either alone or in combination, for the diagnosis of COVID-19. The 16 studies included, covering 27 signs and symptoms, so far provide little in the way of reliable evidence for diagnosis, and the authors conclude that “neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease.” As with all COVID-19 related Cochrane Reviews, this one will be updated as new evidence becomes available.

Independent SAGE report on COVID-19 and ethnicity

Independent SAGE have released a report examining the question of why more people from black and ethnic minority (BME) backgrounds appear to be at greater risk of hospitalisation and deaths with COVID-19. As with previous reports on the topic, the evidence considered appears to point to a complicated picture involving interplay between socio-economic disadvantage in BME populations, high prevalence of chronic diseases and the impact of long-standing racial inequalities being key explanations.

Oxford CEBM examine ONS figures on COVID-19 mortality

Here, the Oxford based Centre for Evidence Based Medicine (CEBM) examine the latest Office for National Statistics (ONS) data on deaths. Looking at figures for the week ending 26 June (Week 26), as well as comparing data for this year so far against five year averages, they consider what the numbers of ‘excess deaths’ can tell us about the impact of COVID-19.

UKRI and NIHR announce funding for study of long-term impacts of COVID-19

UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR) have announced funding of a study into the long term health impacts of COVID-19. The PHOSP-COVID study will aim to recruit patients who have been discharged from hospital after having COVID-19, and will set out to determine the short to long terms health issues experienced and to explore the effectiveness of medicines, treatments and care pathways for particular disease characteristics.

Report on divergent mental health experiences during pandemic

The Mental Health Foundation have shared further findings from their ongoing Coronavirus: Mental Health in the Pandemic study. Exploring the divergent mental health experiences of different population groups, the report highlights those groups identified as being at high-risk from mental health problems, and the impact that the pandemic and the measures to manage it has had on these groups.

Other news

IMMDR publishes ‘First Do No Harm’ report

The Independent Medicines and Medical Devices Safety Review (IMMDR) has published its report, ‘First Do No Harm’, following a two year long examination of how the English healthcare system responds to reports from patients on the harmful side effects of medical devices and medicines. The report focuses on three interventions: Primodos, sodium valproate and pelvic mesh, setting out a series of recommendations for the support of those who suffered as a result of these, and to reduce the future risk of avoidable harms from medical interventions. The report also highlights some of the themes to come from patient evidence, relating to a lack of information enabling informed choices, and a struggle to be properly listened to by healthcare professionals, amongst others.

FSRH amongst signatories of letter calling for reversal of cuts to PrEP funding

Charities and health organisations including the Faculty of Sexual & Reproductive Healthcare (FSRH), have written to the Secretary of State for Health and Social Care, Matt Hancock, to express concerns over the announcement that the budget for local authority implementation of HIV Pre-Exposure Prophylaxis (PrEP) is to be cut by £5 million this year, and to request that the decision be reconsidered. The cut represents a reduction of almost a third of the promised budget of £16 million. PrEP has proven to be highly effective in preventing HIV transmission, and signatories of the letter fear that the budget cut will hamper the delivery of equitable access of PrEP to all communities that might benefit.

King’s Fund on interventions to improve inclusion in NHS providers

The King’s Fund have published research, carried out before the pandemic, on three NHS case studies seeking to address workforce race inequalities and develop positive and inclusive working environments. The three trusts included in the research were selected on the basis of showing promising signs of positive change on inclusion and addressing race inequalities. Work in each of the three organisations included interventions such as establishing staff networks, ensuring safe routes for staff to raise concerns, and enabling staff development and career progression.

 


NICE guidance

Medtech innovation briefing

MIB219 CFHealthHub for managing cystic fibrosis during the COVID-19 pandemic


Statistics

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DawsonERA ebook access

DawsonERA ebook access is at risk due to the company going into administration. If you use DawsonERA ebooks via Hunter & you have saved notes, highlights etc. within any titles, make sure you download these annotations ASAP. The Library is working to try to ensure ongoing access.

Health e-news Friday 3 July

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

RCR and SCoR produce guidance for radiology patients

The Royal College of Radiologists (RCR) and the Society and College of Radiographers (SCoR) have produced guidance for patients who are attending hospital for imaging and interventional radiology procedures. The guidance details arrangements that hospitals are putting into place to protect visiting patients from coronavirus. It also reminds patients of the guidance around wearing a face covering or mask while on hospital sites.

CSP video offers easy to follow advice for COVID-19 recovery

A short video recently produced by the Chartered Society of Physiotherapists (CSP), offers practical and easy to follow advice for those recovering from COVID-19. The video shows people what to expect, offering reassurance that it may take time for a return to normal energy and fitness levels, while highlighting the need for a gradual approach. The video is supported by a series of resources to support recovery, including specific advice on breathlessness, and useful strengthening exercises.

BSG publish guidance on reconfiguring services

The British Society of Gastroenterology (BSG) has published guidance on reconfiguring outpatient gastroenterology and hepatology services in the wake of the first peak of COVID-19. The guide is a first step towards restarting services, which will be updated as the situation evolves. It makes a series of recommendations at this stage, including the importance of signposting patients to the correct pathway; the necessity of face to face consultations in some circumstances; and the need for appropriate IT and support to enable successful remote consultations.

COVID-19 related news

Preliminary results suggest no mortality benefits to lopinavir/ritonavir in COVID-19 patients

Further preliminary results from the RECOVERY trial, which is investigating several potential treatments fro COVID-19, have been made available. The new findings suggest that the antiviral drug lopinavir/ritonavir has no significant mortality benefit in hospitalised COVID-19 patients. Noting the need to provide information quickly as effective treatments for the virus are sought, UKRI stressed in its announcement that these results, as with previous findings have not been subjected to peer review.

Evidence from Cochrane on antibody tests for COVID-19

Evidently Cochrane discusses the existing evidence relating to antibody testing and COVID-19, in the light of publication of a rapid review on the topic. The review set out to examine the accuracy of antibody testing, which appears to be heavily reliant upon the timing of when a test is administered. Tests done at 1 to 7 days from onset of symptoms correctly identified only 30% of people known to have COVID-19, rising to 70% between 8 and 14 days and 90% at 15 to 35 days. Other questions remain regarding the usefulness of antibody testing, including the uncertainty as to whether the presence of antibodies provides protection against further infection. The review is a living review, and will be updated on the basis of frequent searches for new relevant studies.

Insufficient evidence to support role for vitamin D in reducing COVID-19 risk

Two new rapid reviews, from the Scientific Advisory Commission on Nutrition (SACN) and the National Institute for Health and Care Excellence (NICE), have found there to be insufficient evidence on the role of vitamin D in reducing the risks of acute respiratory tract infections (ARTIs) or COVID-19. The SACN review did not specifically assess the effect of vitamin D supplementation on COVID-19 risk, but did conclude that the available evidence does not support a role in the prevention of ARTIs. The evidence summary from NICE evaluating vitamin D and COVID-19, meanwhile, pointed to low quality evidence. Both organisations noted that trials on vitamin D and COVID-19 are ongoing, and will assess new evidence as it becomes available.

RCS survey on elective surgery and recommendations

The Royal College of Surgeons of England (RCS) have published results of their survey of elective surgery which was carried out between 8 June and 15 June, along with a series of recommendations aimed at mitigating the challenges currently being faced by surgical teams. Of the 1,741 respondents, 33% reported being unable to undertake elective procedures in the last four weeks; 62% reported being able to access COVID-light facilities for their patients; and 91% of those who had resumed planned procedures reported that patients were receiving pre-operative COVID-19 tests. Recommendations include twice weekly testing for surgical staff; and work to speed up access to patient test results.

Research describes range of complications with potential link to COVID-19

Research published in The Lancet Psychiatry investigates the breadth of COVID-19 complications which affect the brain, including findings of stroke, encephalitis, and altered mental states such as psychosis and catatonia. The study of 153 patients during three weeks at the peak of the virus found that the majority of cerebrovascular  events occurred in those over 60 years of age, while half of the cases with altered mental states were under 60. These complications may not be a direct result of the virus itself, but the findings offer a first view of some of the mental health support that may be required following illness with the virus.

NHS Providers report on recovery of NHS services

NHS Providers have published a report based upon a survey of all NHS trust leaders, which explores the challenges to be faced as the NHS recovers from the initial peak of COVID-19. Drawing on the responses provided by nearly 60% of providers (representing 126 trusts), the report highlights four key findings, including the significantly increased demand for urgent or crisis care; the constraints and uncertainties around restarting services; and the particularly large challenges faced by acute hospitals. The report concludes that ‘sustained realism’ is required from government and national bodies on the return to full services. The report comes in the same week that the Royal College of Physicians (RCP) reported on a survey indicating that almost half of medical specialties expect to be working at less than pre-COVID levels for at least 12 months.

Open letter from medical Royal Colleges call for urgent rapid review on COVID-19

An open letter recently published in the BMJ, signed by the presidents of the UK’s medical Royal Colleges, and others, calls for the government to carry out a rapid review of the current situation with regards to the COVID-19 pandemic, and the actions that are required to prevent, and/or prevent a second wave of infections. The letter calls for specific attention to be paid to the overall governance of the situation, and scrutiny of this; procurement of supplies; the disproportionate burden on black, Asian and minority ethnic communities; and the need for international collaboration.

Other news

King’s Fund discuss forthcoming report on race inequalities and inclusion in the NHS

The King’s Fund discusses the forthcoming publication of its report on workforce race inequalities and inclusion in NHS providers. The report draws upon research carried out with three NHS organisations, and the experiences of ethnic minority staff, and is expected to be published in full later this month. Here, some initial thoughts on the scale of the problem, and the extent of the efforts required to bring about significant change are shared.

NHS Confederation launches Health and Care LGBTQ+ Leaders Network

NHS Confederation recently launched the Health and Care LGBTQ+ Leaders Network, with the aim of promoting and ensuring the equal treatment of members of the LGBTQ+ community, both as patients and members of the health care workforce.  The network will also work collaboratively to engage with the LGBTQ+ community, allies, wider NHS leadership and other organisations, with a view to increasing the LGBTQ+ membership of boards and the representation of the community amongst senior leadership.

RCN joins 13 other health unions in calling for NHS pay rise

The Royal College of Nursing (RCN) has joined unions including the CSP, UNISON, and the Royal College of Midwives (RCM), in writing to the Prime Minister and Chancellor to call for a start to NHS pay discussions. Alongside calls for a fair pay rise, the unions have asked the government to act upon the significant staffing shortages across the NHS, and to work towards a long-term pay deal that will help to attract people to join the NHS.

Londoners set out expectations for appropriate use of health data

In a London-wide Citizen’s Summit, representatives have set out expectations on the appropriate use of individual and aggregated health and social care data. The summit involved 100 individuals, with representation from each London borough, a range of attitudes towards data sharing, and a diversity intended to reflect the broader population. The summit offered almost unanimous support of the joined up use of identifiable data for the provision of health care, and also discussed the benefits – with conditions and appropriate governance and oversight – of using de-personalised data to inform service planning, and for research and development. A report of the findings can be found here.

 
NICE guidance

Evidence summary

ES28 COVID-19 rapid evidence summary: vitamin D for COVID-19

Interventional procedures guidance

IPG673 Intravascular lithotripsy for calcified coronary arteries during percutaneous coronary intervention

Medical technologies guidance

MTG49 Rezum for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia

Nice guideline

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

Technology appraisal

TA626 Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure

TA634 Daratumumab with lenalidomide and dexamethasone for untreated multiple myeloma (terminated appraisal)

TA635 Ramucirumab with erlotinib for untreated EGFR-positive metastatic non-small-cell lung cancer (terminated appraisal)

TA636 Eculizumab for treating refractory myasthenia gravis (terminated appraisal)

TA637 Ranibizumab for treating diabetic retinopathy (terminated appraisal)

TA638 Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer

TA639 Atezolizumab with nab-paclitaxel for untreated PD-L1-positive, locally advanced or metastatic, triple-negative breast cancer


NIHR alerts 

Ambulance staff who respond to suicides need more support

Interactive dashboard identifies patients at risk of unsafe prescribing in a flexible and sustainable way

Public health messages on alcohol need to consider how and why people drink, not just how much


Statistics

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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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Nothing new under the sun: 1870s style contact tracing and smallpox vaccinations

Opening Up the Body’ is a Wellcome-funded 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 1841-1921.This blogpost was written by Archivist Juulia Ahvensalmi.

 ‘It is difficult to imagine a more favourable opportunity than the one recently afforded us here, of investigating the laws of an epidemic disease such as the one we have just experienced’

Thomas Jones, ‘On the Recent Outbreak of Smallpox at St George’s Hospital’ (1870)

‘Contact tracing’ has in the past year become a phrase that is surely now familiar to us all. As a concept, however, it’s nothing new. In this blogpost, we’ll take a look at how St George’s reacted to a smallpox epidemic at the hospital.

In November 1870, smallpox cases started spreading within St George’s hospital. The infected patients had all been admitted for other causes, and had all been in the hospital for a long time – somewhere between two weeks and four months. It seemed clear the disease was being somehow transmitted among the patients, but as the cases occurred in different wards and floors with no direct contact between the patients, the route of transmission was a mystery.

Photo of St George's Hospital at Hyde Park Corner
Image 1. St George’s Hospital at Hyde Park Corner, London. Archives and Special Collections, St George’s, University of London.

Generally, patients with infectious diseases were sent to specialised hospitals to prevent the spread in more general hospitals. Two of these so-called fever hospitals were the Fountain Hospital and the Grove Hospital, which stood side by side on the site now occupied by St George’s in Tooting. The Fountain Hospital was established by the Metropolitan Asylums Board (MAB) in 1893 in response to a scarlet fever epidemic, and later became a mental hospital for children. The Grove Fever Hospital opened in 1899; in 1954 it became the Tooting branch of St George’s. The last remaining buildings are now being demolished.

Photo of architectural drawing showing Fountain Grove Fever Hospital, Tooting Graveney
Image 2. Architectural drawing showing ‘The Fountain Grove Fever Hospital, Tooting Graveney’. Archives and Special Collections, St George’s, University of London.
Left-hand side: aerial photo of St George's site with Fountain and Grove Hospitals in 1930s
Right-hand side: view of final buildings being demolished March 2021.
Image 3. An aerial view of St George’s site with Fountain and Grove Hospitals in the 1930s, and a view of the final buildings being demolished on a grey day in March 2021. Archives and Special Collections, St George’s, University of London.

Tracing the epidemic

Sarah M., 23, was admitted into St George’s hospital on 28 Sep 1870 for ‘syphilitic laryngitis’. For several weeks, she was given potassium iodide. The first smallpox eruptions appeared nearly two months after her initial admission, and were first thought to be a side effect of her medication. When her condition became apparent, she was quarantined in a separate room in the basement of the hospital, her bed and bedlinen were disinfected, and she was moved back to the workhouse she had come from only a few days later (which sounds like not very effective quarantine practice, but we’ll come back to that later).

Thomas Jones, MD, wrote an article on the outbreak in St George’s Hospital and Medical School Annual Reports, which consisted not only of reports of specifically relating to St George’s (despite the name), but also of articles by the staff of St George’s and external contributors. These were printed and widely distributed, and have been digitised by HathiTrust from copies held at Harvard University and University of Michigan: we are very grateful for this, especially now when our access to our own physical archives remains sporadic! Jones had only gained his MD earlier that year from St George’s, and was working at the hospital  as resident medical officer and anaesthetist.

Photo of text of St George's Hospital reports.
Image 4. Thomas Jones, ‘On the Recent Outbreak of Smallpox at St George’s Hospital’ (1870). St George’s Hospital reports, vol. 5 (1870). Full text available via HathiTrust and SGHMS/6/1/5, Archives and Special Collections, St George’s, University of London.

The article details the cases of the infected patients, with remarks on whether the patient in question had been vaccinated:

‘CASE XV. Mary H., æt. 12, admitted December 12, Drummond Ward. Suffering from knocked-knees. Smallpox eruption, very modified, appeared on January 9th. Discharged convalescent, January 31st. Vaccinated in infancy; vaccine cicatrices of excelled quality.’

‘Case XIX. Florence B., æt.19, admitted December 14th, Crayle Ward. Eczema. Smallpox eruption, which was distinct, appeared on January 14th. Was re-vaccinated on the same day. The attack was rather severe. There was no trace of the re-vaccination on the seventh day. Was vaccinated in infancy; one vaccine mark of bad quality. Has made a good recovery.’

There were altogether 27 cases, of which 20 were cases of transmission within the hospital, whose symptoms appeared between 25 Nov and 15 Jan. In addition, there were three patients who were admitted with smallpox between 12 Jan and 8 Feb, and four who showed symptoms only after having been discharged from the hospital initially.

Post mortems

Of these 27, six died. They were all said to have been suffering from various underlying conditions, including softening of the spinal cord, heart disease, pyelitis and congested lungs; one was recovering from an operation and one, a 23-year old probationer nurse at St George’s called Christiana S. in the article, was said to be ‘of a delicate constitution’ and in ‘a weak state of health’. Three of these six had been vaccinated.

The death of Christiana S., or Christina Stewart, was recorded in the St George’s post mortem books, although there are no case notes as no post mortem was performed – not uncommon when it came to hospital staff. Her cause of death is recorded as ‘Variola’, another name for smallpox.

Photo of post mortem case notes of James Jennings.
Image 5. Post mortem case notes of James Jennings, 37, Pork butcher, PM/1871/12. Archives and Special Collections, St George’s, University of London.

One of the unfortunate people who died was James Jennings. His occupation in his post mortem notes was recorded as ‘pork butcher’, and he had been suffering from a feeling of tightness around his abdomen and increasing weakness in his legs for some time; he was also partially paralysed on his hands and legs:

‘He walked to the train on day of admission but says that while in the carriage he felt a sudden sensation of coldness all over, & on reaching London found that he had entirely lost power in the legs’

His treatment included potassium iodide and belladonna. The rash appearing on his skin was initially attributed to the belladonna he had been receiving, rather than smallpox. He died 8 Jan 1871, a couple of days after the appearance of the pustules signifying a smallpox infection, ‘in spite of wine, which was freely administered’. The post mortem found no evidence that he had been vaccinated against smallpox.

The other deaths recorded include that of Ellen Collier, a milliner (whose body was not examined) and David Edwards, a groom, who became delirious and died after being moved to the temporary smallpox ward which had been set up on the top floor of the hospital.

The two other deaths occurred outside the hospital, and are not recorded in the post mortems. Michael S., 48, had been discharged from the hospital 28 Dec; he had spent the following night at Vauxhall-bridge-road, before returning home to Fellday, Dorking. He died 12 Jan 1871, and was examined by a local doctor in Dorking. John T. was only three years old, and had had lithotomy performed on him. Whilst at the hospital, he developed a sore throat, which was assumed to be due to ‘hospital air’ and was sent home, where he died less than a week after the appearance of the smallpox pustules. He had not been vaccinated.

Prevention and tracing the origins of the epidemic

The measures taken at the hospital to mitigate the spread of the disease included isolation of the infected patients: after the first three cases, a convalescent ward on the top floor was set up as a smallpox unit. The ward had dedicated nurses, and no visitors were allowed: the medical officer in charge visited this ward after all his other rounds. Particular attention was also paid to disinfecting the hospital:

‘For the atmosphere of the whole Hospital has been so thoroughly impregnated with carbolic acid, from sheets steeped in it and hung before the door of each ward, and from the floors being washed with a weak solution of the acid, that it has positively been painful to some with very sensitive organs of smell.’

The initial assumption was that the disease had been brought in by visitors, as it was known that smallpox was circulating in the neighbourhood, having, according to the Medical Officer of Health report, been introduced by a governess returning from Paris. Visitors were therefore banned from the wards, unless there were special reasons, i.e. the patient they were visiting was very ill.

Jones set up to detect the origin of the disease. Assuming the incubation period to be 13×24 hours (or 14 days), from the infection to the appearance of an eruption, he managed to trace patient zero, or Case I, Sarah M., who had spent 11 weeks at the hospital.

On 10 Nov, however, she had been allowed to leave the hospital for a few hours to visit a friend, who was later ascertained to have smallpox. Sarah had, however, since been moved back to the workhouse (there is no note in the article of whether the workhouse also suffered from an outbreak, but it is hard to imagine it did not), and Cases II and III did not appear until three weeks later, on a different floor – so how was it possible that the disease continued to spread at the hospital? Moreover, the cases continued to spread even after the visitor ban and the ‘rigidly observed’ quarantine measures.

Did it spread through the air? This theory was dismissed as unlikely, since the cases were so spread over different floors and wards. All other theories were similarly dismissed, and after careful investigation, the only common factor between the cases appeared to be the days when bed-linen was changed.

The linen was changed on Mondays and Thursdays: the dirty linen was sent out to be washed on Thursdays and returned, clean, the following Thursday. One sheet was used on that day, and another clean sheet on the following Monday. This theory seemed to account for the majority of the cases, with a few exceptions, one of which included the hospital carpenter, who may instead have caught the disease through contact with one of the patients.

This led to Jones concluding that the disease was infectious even before any eruptions appeared, and thus any cases of fever during an epidemic should be closely monitored to enable early isolation and disinfection.

Linen was supposed to be washed in boiling water, but, whether or not that actually happened (and washing the linen for the hospital was not an easy or light task!) this, it was concluded, was ‘not sufficient to destroy the fever-poison’. Carbolic acid, however, appears to have worked, as the sheets of the patients known to be infected were steeped in carbolic acid before being sent to the laundry.

Picture of nurses in the laundry of a hospital from 191?
Image 7. Nurses in the laundry of a hospital. Photograph, 191-.. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Vaccination

The main conclusion, however, was to do with vaccination, and in particular re-vaccination:

‘This outbreak … supplies us with farther evidence, if any were required, of the protective power of re-vaccination against smallpox’

Indeed, as the disease spread, it was decided that all the nurses and patients at the hospital should immediately be vaccinated. The vaccination programme was commenced on 13 January 1871, and by March, the measures taken appeared to have stopped the spread of the epidemic.

A follow-up article by obstetric assistant Richard Wilson examines how the vaccination programme was conducted. Three methods were used:

  • Puncturing: ‘by grasping the arm (usually the left) with the left hand, drawing the skin tense, and then making from four to five punctures down to the cutis-vera with an arrow-headed lancet’;
  • Abrasion or scratching, using an ‘ordinary bleeding-lancet’: ‘two or three small parallel scratches were made …. the lymph, if liquid, was then rubbed well in with the point of the lancet; if points were used, these were first moistened by the breath, and rubbed into the different scratches’; and
  • Vesication, using ‘blistering fluid’ the night before the vaccination to make small blisters: ‘on the following day they were priced to allow the serum to exude, and then the lymph was applied to the raw surface’.

The scratching method appeared to be most effective, although it was prone to produce severe inflammation in the elderly or those with other health conditions.

Photo of book page with text and a drawing of the effect of inoculation against smallpox from 1789.
Image 8. Edward Jenner, ‘Causes and Effects of Variolae Vaccinae’ (1798), showing the effect of inoculation against smallpox. RB/285, Archives and Special Collections, St George’s, University of London.

The quality of the ‘vaccine marks’ or ‘cicatrices’ appears of particular interest, with ‘good marks’ equating, it was speculated, to stronger protection and increasing the likelihood of a mild form of the disease. ‘Bad’ marks were smooth and shiny, or hardly visible at all: the stronger and more visible the mark, it was thought, the stronger the protection. The vast majority of the staff and patients had already been vaccinated at some point in their lives, most of them in infancy.

Photos of two pages of books with text from St George's Archives.
Image 9. Montagu, Mary Wortley. ‘The Works of the Right Honourable Lady Mary Wortley Montagu’ (1805 [1785]), with a description of a ‘smallpox party’ in Istanbul. RB/317, Archives and Special Collections, St George’s, University of London.

Smallpox epidemics were common throughout the 19th century, despite Edward Jenner, a St George’s alumnus, having developed smallpox vaccination in 1796. He was not the first one to attempt to treat the disease, one of the deadliest in history. Mary Montagu introduced the idea of inoculation from Turkey to Britain in the early 1700s. Smallpox was not eradicated until 1973, and to date remains the only human disease to have been eradicated by vaccination.


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Easter Holiday Library Update

The Easter holidays are just around the corner, but whether you’re planning to spend the next few weeks close to St George’s or a little further afield, we hope that our online services and support will make you feel that help with your studies is never too far away. Below we’ve put together some quick reminders of just some of the help and resources you can access no matter where you are.

Online books and articles

Our search tool, Hunter, is the best starting point for discovering e-books and journal articles that you can access from anywhere using your St George’s login and password.

  • to find articles, select Articles and more from the dropdown menu
  • to find e-books, select Books and more from the dropdown menu. Then use the filter options to limit your results to Online Resources.

E-learning tools

Your St George’s login also gives you access to our collection of online learning tools, many of them using video, quizzes and other interactive features to help you master topics. Try out some of our new and popular resources from the links below, or view a full list here.

  • *New* Complete Anatomy – a powerful 3D anatomy platform that also features lectures, quizzes and more. Install the app from the app store on your device, then use our activation code to set up your free account.
  • LWW Health Library – a large, searchable collection of key texts, videos, cases and self-assessment questions. We have access to all content in the Medical Education and Occupational Therapy collections.
  • BMJ Learning – hundreds of accredited and peer-reviewed learning modules.
  • JoVE Science Education – video tutorials in biology, chemistry and clinical skills.
Complete Anatomy is our newest online learning tool. Find instructions to install it on your device here.

Having trouble logging in to view an e-book, article or online resource? Our PDF guide or short video on offsite access may be able to help. Otherwise, email us at journals@sgul.ac.uk and we’ll try to resolve the issue.

Help with writing assignments and referencing

We have a large collection of books that can help with planning and writing assignments, both on the shelves and as e-books – this search in Hunter brings together lots of these titles. (Use the Online Resources filter on the left to show just e-books that you can access straight away). Our Writing for Assessment collection brings together resources on academic writing, study skills and dissertations and much more.

For a refresher on referencing, have a look at the Referencing Essentials unit in the Library Module on Canvas (login required). This includes a helpful guide to using Cite Them Right, the book and website that show you how to reference in the style used at St George’s. You can access the online version of Cite Them Right here.

If you’re working on a longer project or dissertation, you might be thinking about using a reference management tool to help organise your sources. St George’s supports RefWorks, and you can learn more about this web-based software and how use it in our blog post, RefWorks LibGuide or series of RefWorks videos.

Don’t forget your Liaison Librarians can answer any research or referencing enquiries you might have. Get in touch by emailing liaison@sgul.ac.uk or coming to one of our daily online drop-ins.

Easter weekend opening hours


Over the long Easter weekend from 2nd April to 5th April, the library and computer rooms will be open 9am to 9pm. There will be self-service only with security staff on hand. The helpdesk will not be staffed during this time. We will reopen on 6th April at 8 am.
After Easter, we resume normal opening hours, 8am to 11pm Monday to Friday, 9am to 9pm Saturday and Sunday. The helpdesk will be staffed 8am to 6pm Monday to Friday. Should you have any questions about opening hours or our service, please email library@sgul.ac.uk. Don’t forget to check our website about our current capacity on our Covid-19 response page.