Christie's

Bowties are a common hazard analysis tool used within aerospace and other safety critical industries, where they have the advantage of clearly depicting relationships between causes, hazards, consequences, and barriers (hazard controls). For a given bowtie, it is useful to understand how these barriers are performing, which is where occurrence reports provide an insight—describing incidents and how effective the barriers were. This paper presents a Natural Language Processing method—Aspect Sentiment Triplet Extraction, adapted to extract barriers from free-text occurrence reports alongside their effectivity and sentiment—a distinct advantage over pure entity extraction methods. The development of a bespoke labelled dataset to train a Bidirectional Encoder Representations from Transformers (BERT) model required extensive safety expertise, where the resulting model output was then qualitatively assessed. The model was ultimately applied to occurrence reports pertaining to lithium battery issues, proving useful in demonstrating key areas where the associated bowtie barriers were operating effectively, ineffectively, or in situations where no barriers were seemingly present. This was especially evident when the output was processed using an unsupervised k-means algorithm to display generalized themes. The method forms a useful tool for safety professionals who are concerned with extracting bowtie barrier information from high quantities of occurrence or incident data while addressing a critical gap in the body of knowledge by going beyond present entity extraction methods.

<h3>Background</h3> Patient safety is the avoidance of unintended or unexpected harm to people during the provision of health care (NHS England. The NHS patient safety strategy. [internet] 2019). Reporting incidents allows staff to learn from mistakes and change practice where needed (NHS England. Learning from patient safety events. [internet]). <h3>Aims</h3> To identify an effective way in externally sharing serious safety issues identified by patients admitted to the hospice from the community or another organisation, including any Care Quality Commission reportable incident plus safeguarding concerns, extensive pressure damage and medication incidents (Care Quality Commission. Regulations for service providers and managers: Regulation 18: Notification of other incidents. 2023 [internet]). To provide feedback, identify poor practice and enable learning in a more thorough, robust way. <h3>Methods</h3> A working group was formed consisting of, In-Patient Unit and Community leads, Pharmacy and admin. Incidents are reported via our hospice reporting system (Vantage) and serious clinical incidents result in an investigation (NHS England). An escalation form has been developed in addition and shared with the relevant organisation. All incidents are discussed at our governance meetings and learning is disseminated via our newly developed hospice learning log. The Patient Safety Incident Response Framework (PSIRF) (NHS England. Patient Safety Incident Response Framework [internet]) recommends an emphasis on involving those involved in incidents, to understand their experience, so initially we liaised with Community and Acute Hospital patient safety leads, to identify our intentions and establish engagement. A ‘learning from incidents’ escalation form was developed, reviewed, agreed to be used and is currently in use for escalating any serious incidents externally. <h3>Results</h3> The form is now being widely used and feedback has shown that further investigation is being done by the organisations that we share this information with. <h3>Conclusion</h3> As PSIRF is becoming more familiar and emphasis is on learning and improving practice after an incident has occurred, the ‘learning from incidents’ form and learning log complements this. We are now focussing on SWARM huddles and early identification of learning from incidents specifically in our In-Patient unit.

Abstract Background: Screen failures (SFs) in early-phase oncology trials (EPOTs) compromise trial efficiency, resource allocation, and patient experience. During the COVID-19 pandemic, our center adopted decentralized strategies—including telehealth consultations and remote investigations—to maintain recruitment. This shift has enabled broader access for patients beyond our immediate catchment area. We aimed to review our recent SF patterns, assess the impact of remote processes on SF rates, and identify modifiable factors to optimize future decentralized recruitment. Methods: We retrospectively reviewed electronic medical records to identify patients consented to EPOTs at a specialist UK center between January 2023 and December 2024. Data collected included patient demographics, consultation type (in-person or remote), EPOT type, and specific reasons for screen failure. Statistical comparisons were performed in RStudio using Fisher’s exact test, chi-squared test, and Mann–Whitney U test. Results: Among 202 patient consents (median age 62 years [IQR 54–68], 55.4% male, median performance status 1, median clinical frailty score 2), 38% of pre-screen visits were conducted by telephone. Overall median residential distance from the hospital was 48 km, with patients assessed remotely living farther away than those seen in person (median 78 km vs. 35 km; p &amp;lt; 0.001). The median interval from first contact to consent was 94 days. SF occurred in 21% (42/202) of patients, at a median of 12 days post-consent. SF rates were unaffected by consultation type, travel distance, or deprivation index. By investigational medicinal product (IMP) class, SF was highest for immunotherapy EPOTs (33%) and lowest for chemotherapy EPOTs (10%) (p = 0.03). Central nervous system (CNS) (50%), hepatobiliary (40%), and urological cancers (28%) had the highest SF rate, whereas lung (14%), upper gastrointestinal (14%), and colorectal cancers (12%) had the lowest. Leading SF causes were patient-related at 27% (comorbidities and increasing symptom burden), laboratory-related at 23% (deranged liver function tests and anemia), and imaging-related at 21% (rapidly progressive disease and new CNS metastases). Retrospective adjudication found that 11.9% of SF events were potentially preventable where the cause predated but was not identified before consent. Despite this, absence of recent (&amp;lt;28 days) pre-consent blood tests or physical examination did not increase SF rates (p = 0.64 and 0.18 respectively). Evaluation of strategies to reduce SF is ongoing. Conclusion: Decentralized recruitment methods, including remote consultations, are a feasible and effective approach for EPOTs, with no observed increase in SF rates. These findings support expanding hybrid and remote recruitment models to improve trial accessibility without compromising screening efficiency. Targeted operational refinements—such as timely pre-consent assessments and IMP-specific triage—can further reduce preventable SFs. Citation Format: Francis P. Young, Gemma Wickert, Heather Parry, Matthew Krebs, Louise Carter, Fiona Thistlethwaite, Donna Graham, Natalie Cook. Screen failures in early-phase oncology trials: A single-center UK analysis of decentralized recruitment methods [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2025 Oct 22-26; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2025;24(10 Suppl):Abstract nr C067.

This report focuses on the case of a woman in her 80s struggling with pruritus of a likely multifactorial cause within an inpatient unit at a hospice. Subcutaneous chlorphenamine 10mg twice daily, was used when the oral route was unavailable. Pruritus and associated rash resolved within 6 days of treatment being commenced. There was no further rash or pruritus after this. There is little literature about the use of subcutaneous chlorphenamine and this case report highlights its use can be effective for treatment of pruritus in palliative care and broaden therapeutic options. Further research is needed to support its use when administered subcutaneously.

BackgroundEmergency departments (E.D.) are described as suboptimal places to die due to their busy and often crowded nature, lack of time, space or privacy and focus on rapid assessment and recovery (Cooper, Hutchinson, Sheikh, et al. Palliat Med. 2018:32(9):1443–1454; Krebs, Hill, Kirkland, et al. Int Emerg Nurs. 2023;69:101294). E.D. staff report varying skills and confidence to deliver palliative care (Heufel, Kourouche, Wing Shan, et al. Int Emerg Nurs. 2022; 61:101153). Despite the challenges, dying patients present in E.D. for numerous reasons including; life-threatening acute emergencies, crises during terminal illness, uncontrolled symptoms, lack of community services and lack of advance care planning (Cooper, et al.; Krebs, et al.; Heufel, et al.).AimsWe aimed to develop an efficient, safe pathway to enable direct transfer of dying patients from two large emergency departments within our local acute NHS trust to the hospice in-patient unit.MethodsFormation of steering group including hospice staff, hospital palliative care team, Consultant in Emergency Medicine.Eligibility criteria agreed ensuring safe transfer of appropriate patients.Transfer process agreed by steering group and palliative medicine consultants across city.Pathway flowchart and telephone triage form developed and agreed by all parties.Documents shared electronically with all partners.Teaching delivered within E.D. and hospices.ResultsSince 2022, 32 patients have been transferred directly from ED to the hospice in-patient unit. Of these patients;12 were already known to the hospice service, 20 had no previous referral.Cancer/non cancer split = 50/50%.13 patients transferred in hours (Mon–Fri 09:00–17:00), 19 patients transferred out of hours.15 patients died within 24 hours of transfer. Seven died within three days of transfer. Five died within a week. Five were discharged after assessment and symptom management.11 patients were referred but not transferred:• 8 no available hospice bed.• 2 patients chose admission to hospital.• 1 too unstable to move.ConclusionCollaborative working and innovative thinking enables timely transfer of dying patients from E.D. to a peaceful hospice environment conducive to dignified, expert end of life care.

SummaryBackgroundSupportive care to ensure optimal quality of life is an essential component of cancer care and symptom control across the lifespan. Ongoing advances in cancer treatment, increasing toxicity from many novel treatment regimes, and variations in access to care and cancer outcomes across the globe and resource settings present significant challenges for supportive care delivery. To date, no overarching framework has been developed to guide supportive care development worldwide. As an initial step of the Multinational Association of Supportive Care in Cancer (MASCC) Supportive Care 2030 Movement, we developed a targeted, unifying set of ambition statements to envision the future of supportive cancer care.MethodsFrom September 2022 until June 2023, we used a modified Delphi methodology to develop and attain consensus about ambition statements related to supportive cancer care. Leaders of MASCC Study Groups were invited to participate in an Expert Panel for the first two Delphi rounds (and a preliminary round to suggest potential ambition statements). Patient Advocates then examined and provided input regarding the ambition statements.FindingsTwenty-seven Expert Panelists and 11 Patient Advocates participated. Consensus was attained on 13 ambition statements, with two sub-statements. The ambition statements addressed global standards for guideline development and implementation, coordinated and individualized care, dedicated supportive oncology services, self-management, needs for screening and actions, patient education, behavioral support, financial impact minimization, comprehensive survivorship care, and timely palliative care, reflecting collaboration, coordination and team-based approach across all levels.InterpretationThis study is the first to develop shared ambitions for the future of supportive cancer care on a global level. These ambition statements can facilitate a coordinated, resource-stratified, and person-centered approach and inform research, education, clinical services, and policy efforts.FundingThis project received funding support from Prof Raymond Chan’s NHMRC Investigator Grant (APP1194051).

To investigate the effect of web-assisted education on the pressure injury knowledge levels of nursing students. The study was conducted with 106 first-year students in the Nursing Department. Those who received both web-assisted education and conventional education were assigned to the experimental group, and those who received only conventional education were assigned to the control group. The authors used arithmetic mean, percentages, Student t test, and χ2 test to analyze the data. The rate of the correct responses given to the questions by the students was 97.55% in the experimental group and 85.15% in the control group. The comparison of the mean number of correct answers revealed a statistically significant difference between the two groups. The authors conclude that the web-supported education given to nursing students in addition to the conventional education positively contributed to their learning level.

Chronic venous disease is a circulatory system dysfunction that has the potential to lead to venous leg ulceration. Although research on the influence of specific gene variants on chronic venous disease has been limited, a few studies have reported an association between hemochromatosis and chronic venous disease. However, no studies have looked at the prevalence of lower-limb venous disease and leg ulcers in people with hemochromatosis. This study aimed to review the existing literature for any association between venous disease and hemochromatosis and investigate the prevalence of venous disease and leg ulcers in people with hemochromatosis. Scoping systematic literature review and cross-sectional study surveying people with hemochromatosis. This scoping systematic literature review included nine articles and indicated a link between hemochromatosis and venous disease/leg ulcers, although further studies are needed to support this link. Analysis of survey results from people with hemochromatosis found a 9.2% prevalence of leg ulcers in those with self-reported hemochromatosis, considerably higher than the 1% to 3% expected, suggesting that hemochromatosis gene variants may be associated with the pathogenesis of chronic venous disease and leg ulcers. This is the first known study to complete a review of the literature regarding hemochromatosis and venous leg ulcers and document the association between hemochromatosis and venous disease/leg ulcers. There is a lack of research in this area and hence limited evidence to guide practice.

Abstract Introduction: Chest computed tomography (CT) scans have a significant role in the identification and treatment of COVID-19 disease. In earlier studies, the introduction of chest CT has been a highly sensitive method in testing COVID-19 pneumonia. With a radiation dose comparable to a chest X-ray, ultra-low-dose CT has been promised to be a successful method for lowering radiation dose and motion artifact. Materials and Methods: The research was carried out at a tertiary care facility’s radiology department between August 1 and August 31, 2020. A sum of 109 individuals aged over 18 years old and been called for a noncontrast CT scan chest and received were included. Results: The minimum age was 18 and the maximum was 87, where 14.67% of them are between 21 and 40 years, 40.37% of them are between 41 and 60 years and 44.96% of them are between 61 and 87 years. Male’s mean age is 55.89 years and female’s mean age is 60.14 years. The overall mean age is 57.02 years and standard deviation is 13.49 years. The average body mass index was 26.51 ± 3.5 kg/m2. In the standard dose and ultra-low-dose groups, the mean effective dose values were 6.70 ± 0.85 and 0.33 ± 0.09 mSv, respectively (P &lt; 0.001). Conclusion: When identifying lung infiltrations among the patients admitted for elective or moderately urgent surgical or medical operations at the time of the COVID-19 pandemic, ultra-low-dose chest CT is an effective method that exposes patients to less radiation than standard dose CT.

Abstract Objective: The study’s objectives were to learn about the impact of serum amylase levels on morbidity and mortality of diabetic ketoacidosis (DKA) patients. Methodology: This is a single-center cross-sectional study of 100 patients admitted to the Medicine Intensive Care Unit at Shyam Shah Medical College and SGM Hospital Rewa between January 2021 and June 2022. Results: Mean duration of hospital stay in DKA patients with serum amylase level &lt;140 U/L was 10.56± 5.04 days while DKA patients with serum amylase level ≥140 U/L was 23.75 + 1.66 Days. The mean amylase level in death cases of DKA was 198.32 IU/L and in recovered cases of DKA was 87.22 IU/L. Conclusion: In our study, we discovered that as serum amylase levels rise so does the length of hospital stay. Amylase levels were extremely high in death cases.