tag:blogger.com,1999:blog-45006104889441591792024-03-13T00:40:36.344+00:00The ScHARR Student e-JournalThe ScHARR Student e-Journal is an online departmental journal where Masters and PhD students at the School of Health and Related Research (ScHARR), University of Sheffield, can publish their work.Danhttp://www.blogger.com/profile/00801851727216482389noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-4500610488944159179.post-60616413355850358262021-07-08T17:33:00.005+01:002021-07-08T17:34:54.246+01:00Diarrhoea among Children Aged under Five Years and Risk Factors in Informal Settlements: A Cross-Sectional Study in Cape Town, South Africa<p>ScHARR European Public Health student Thi Yen Chi Nguyen (Chi), published the following article in the International Journal of Environmental Research and Public Health (2021).</p><p><em style="background-color: white; box-sizing: border-box; color: #222222; font-family: Arial, Arial, Helvetica, sans-serif; font-size: 13.2px; line-height: inherit; max-height: 1e+06px;">Int. J. Environ. Res. Public Health</em><span face="Arial, Arial, Helvetica, sans-serif" style="background-color: white; color: #222222; font-size: 13.2px;"> </span><span face="Arial, Arial, Helvetica, sans-serif" style="background-color: white; box-sizing: border-box; color: #222222; font-size: 13.2px; font-weight: 700; line-height: inherit; max-height: 1e+06px;">2021</span><span face="Arial, Arial, Helvetica, sans-serif" style="background-color: white; color: #222222; font-size: 13.2px;">, </span><em style="background-color: white; box-sizing: border-box; color: #222222; font-family: Arial, Arial, Helvetica, sans-serif; font-size: 13.2px; line-height: inherit; max-height: 1e+06px;">18</em><span face="Arial, Arial, Helvetica, sans-serif" style="background-color: white; color: #222222; font-size: 13.2px;">(11), 6043; </span><a href="https://doi.org/10.3390/ijerph18116043" style="background-color: white; box-sizing: border-box; color: #3156a2; font-family: Arial, Arial, Helvetica, sans-serif; font-size: 13.2px; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">https://doi.org/10.3390/ijerph18116043</a></p><p><span style="text-align: justify;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhfb_BXAeAJKg3EbM9Hm6JKSX_PwOV4DF1p-GvKL-VrMx7sfqpKW1pmlLUYO7_TwXP8xXZQ-csh5hh5MYNLoe-LVZ1odslspXlNbPSE2h3GB-A2Vk15VpKaGrgVKVVgOp__yDZzI0RLh4/s899/Chi+Nguyen+Thi+Yen.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="899" data-original-width="898" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhfb_BXAeAJKg3EbM9Hm6JKSX_PwOV4DF1p-GvKL-VrMx7sfqpKW1pmlLUYO7_TwXP8xXZQ-csh5hh5MYNLoe-LVZ1odslspXlNbPSE2h3GB-A2Vk15VpKaGrgVKVVgOp__yDZzI0RLh4/w200-h200/Chi+Nguyen+Thi+Yen.jpg" width="200" /></a></div>Previously
trained in Public Health (BSc) and Epidemiology (MSc) at the University of
Basel, Switzerland, Chi has 5 years of work experience in public health
preventive programs, public engagement projects, and clinical research with
underprivileged communities across low-middle income countries in Africa and
Asia. Her main research interests are infectious diseases, antimicrobial
resistance, and applied health data science. <p></p><p>Chi's full profile can be seen in the article <b><a href="https://scharr-ejournal.blogspot.com/2021/07/vietnams-success-story-against-covid-19.html" rel="nofollow">Vietnam's success story against COVID-19</a></b>, also featured in the ejournal.</p><div class="html-abstract-title" style="background-color: white; box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><h3 style="box-sizing: border-box; color: black; font-size: 13.2px; line-height: 1.5; margin: 30px 0px 10px; max-height: 1e+06px; padding: 0.5em 0px; text-align: left; text-rendering: optimizelegibility;">Authors and Affiliations</h3><div><div><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">Thi Yen Chi Nguyen (1,2), Bamidele Oladapo Fagbayigbo (3,4), Guéladio Cissé </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">(1,2)</span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">, Nesre Redi </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">(1,2)</span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">, Samuel Fuhrimann </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">(1,2)</span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">, John Okedi (4), Christian Schindler </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">(1,2)</span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">, Martin Röösli </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">(1,2)</span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">, Neil Philip Armitage (4), Kirsty Carden (4), and Mohamed Aqiel Dalvie (3,4)</span></span></div><div><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;"><br /></span></span></div><div><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">1 </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland</span></div><div><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">2 </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">University of Basel, CH-4003 Basel, Switzerland</span></div><div><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">3 </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa</span></div><div><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222;"><span style="font-size: 13.2px;">4 </span></span><span face="Arial, Arial, Helvetica, sans-serif" style="color: #222222; font-size: 13.2px;">Future Water Institute, University of Cape Town, Cape Town 7700, South Africa</span></div></div><h3 style="box-sizing: border-box; color: black; font-size: 13.2px; line-height: 1.5; margin: 30px 0px 10px; max-height: 1e+06px; padding: 0.5em 0px; text-align: left; text-rendering: optimizelegibility;">Abstract</h3></div><div class="art-abstract in-tab hypothesis_container" style="background-color: white; box-sizing: border-box; color: #222222; display: inline-block; font-family: Arial, Arial, Helvetica, sans-serif; font-size: 13.2px; margin: 0px; max-height: 1e+06px; padding: 0px;"><b>Background</b>: There is limited data on the association between diarrhoea among children aged under five years (U5D) and water use, sanitation, hygiene, and socio-economics factors in low-income communities. The study investigated U5D and the associated risk factors in the Zeekoe catchment in Cape Town, South Africa. <b>Methods</b>: A cross-sectional study was conducted in 707 households in six informal settlements (IS) two formal settlements (FS) (March–June 2017). <b>Results</b>: Most IS households used public taps (74.4%) and shared toilets (93.0%), while FS households used piped water on premises (89.6%) and private toilets (98.3%). IS respondents had higher average hand-washing scores than those of FS (0.04 vs. −0.14, <span class="html-italic" style="box-sizing: border-box; display: inline; font-style: italic; max-height: 1e+06px;">p</span> = 0.02). The overall U5D prevalence was 15.3% (range: 8.6%–24.2%) and was higher in FS than in IS (21.2% vs. 13.4%, respectively, <span class="html-italic" style="box-sizing: border-box; display: inline; font-style: italic; max-height: 1e+06px;">p</span> = 0.01). Water storage >12 h was associated with increasing U5D (OR = 1.88, 95% CI 1.00–3.55, <span class="html-italic" style="box-sizing: border-box; display: inline; font-style: italic; max-height: 1e+06px;">p</span> = 0.05). Water treatment (OR = 0.57, 95%CI 0.34–0.97, <span class="html-italic" style="box-sizing: border-box; display: inline; font-style: italic; max-height: 1e+06px;">p</span> = 0.04), good hand-washing practices (OR = 0.59, 95%CI 0.42–0.82, <span class="html-italic" style="box-sizing: border-box; display: inline; font-style: italic; max-height: 1e+06px;">p</span> = 0.002) and Hepatitis A vaccination (OR = 0.51, 95%CI 0.28–0.9, <span class="html-italic" style="box-sizing: border-box; display: inline; font-style: italic; max-height: 1e+06px;">p</span> = 0.02) had significant preventing effects on U5D. <b>Conclusions</b>: The study highlights that good hygiene practice is a key intervention against U5D in informal settlements. The promotion of hand-washing, proper water storage, and hygienic breastfeeding is highly recommended.</div><p><span face="Arial, Arial, Helvetica, sans-serif" style="background-color: white; color: #222222; font-size: 13.2px;"></span></p><div class="art-keywords in-tab hypothesis_container" style="background-color: white; box-sizing: border-box; color: #222222; font-family: Arial, Arial, Helvetica, sans-serif; font-size: 13.2px; margin: 5px 0px 0px; max-height: 1e+06px; padding: 0px;"><em style="box-sizing: border-box; line-height: inherit; max-height: 1e+06px;">Keywords: </em><span style="box-sizing: border-box; max-height: 1e+06px;"><a href="https://www.mdpi.com/search?q=children" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">children</a>; <a href="https://www.mdpi.com/search?q=diarrhoea" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">diarrhoea</a>; <a href="https://www.mdpi.com/search?q=formal%20settlement" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">formal settlement</a>; <a href="https://www.mdpi.com/search?q=hygiene" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">hygiene</a>; <a href="https://www.mdpi.com/search?q=informal%20settlement" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">informal settlement</a>; <a href="https://www.mdpi.com/search?q=sanitation" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">sanitation</a>; <a href="https://www.mdpi.com/search?q=water%20quality" style="box-sizing: border-box; color: #3156a2; font-weight: 700; line-height: inherit; max-height: 1e+06px; text-decoration-line: none;">water quality</a></span></div>e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-75530779198530260972021-07-08T17:07:00.001+01:002021-07-08T17:08:27.366+01:00 Vietnam's success story against COVID-19<p style="text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigMKnb2OnnBixdtof8iGSvf1jKzTOL8AyEHZ8nZ0mB5E3qnmQVtStH_F_qzDSMoOcs7CApv30k2zPaVlHOs9T6IVashmy70ETtRAu3zctqRyAeY2KkMu-4lLmdw5lgK1pW1vpiU6aYfCU/s899/Chi+Nguyen+Thi+Yen.jpg" style="clear: left; display: inline; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img border="0" data-original-height="899" data-original-width="898" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigMKnb2OnnBixdtof8iGSvf1jKzTOL8AyEHZ8nZ0mB5E3qnmQVtStH_F_qzDSMoOcs7CApv30k2zPaVlHOs9T6IVashmy70ETtRAu3zctqRyAeY2KkMu-4lLmdw5lgK1pW1vpiU6aYfCU/w200-h200/Chi+Nguyen+Thi+Yen.jpg" width="200" /></a><b>Thi Yen Chi
Nguyen</b> (called Chi in her language) is a current student (2021) in MPH European Public
Health at ScHARR, under the Erasmus Mundus Excellent Scholarship. Previously
trained in Public Health (BSc) and Epidemiology (MSc) at the University of
Basel, Switzerland, Chi has five years of work experience in public health
preventive programs, public engagement projects, and clinical research with
underprivileged communities across low-middle income countries in Africa and
Asia. </p><p></p><p><span style="text-align: justify;">Her main research interests are infectious diseases, antimicrobial
resistance, and applied health data science.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span lang="EN-US">With an
enthusiasm for community development and the goal of developing into a global
health expert, Chi’s current work has two foci. One is using an evidence-based
approach to understand and mitigate the biological and behavioural risk of
disease transmission. The other is on health technology, and how it can be
utilized to provide accessible, affordable, cost-effective healthcare to all.<o:p></o:p></span></p>
<p><span style="text-align: justify;">Outside of
research activities, Chi is actively involved in several taskforces to promote
voices and contributions of young public health professionals: SheffWHO 2020
as Theme Guide Director, Erasmus Mundus Association as Vietnam Country
Representative, the Global Burden of Diseases Network as National Collaborator,
and the Oxford COVID-19 Government Response Tracker as Data Contributor.</span></p><p>Chi, along with fellow European Public Health student <b>Mashkur Abdulhamid Isa</b>, has published work on Vietnam's COVID 19 response in the journal <b>Public Health In Practice, </b><a aria-label="Persistent link using digital object identifier" class="doi" href="https://doi.org/10.1016/j.puhip.2021.100132" rel="noreferrer noopener" style="box-sizing: border-box; color: #0c7dbb; font-family: NexusSans, Arial, Helvetica, "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", STIXGeneral, "Cambria Math", "Arial Unicode MS", sans-serif; font-size: 14px; margin: 0px; padding: 0px; text-decoration-line: none; word-break: break-word;" target="_blank" title="Persistent link using digital object identifier"><b>https://doi.org/10.1016/j.puhip.2021.100132</b></a></p><div style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px; text-align: left;"><h3 style="text-align: left;"><b>Authors and affiliations</b></h3><div><div>Chi Nguyen Thi Yen (a,b) Catherine Hermoso (c), Elaine May Laguilles (c), Louise Elaine De Castro (c), Shera Marie Camposano (c) Noel Jalmasco (c), Kim Aira Cua (c), Mashkur Abdulhami Isa (b), Edikan Friday Akpan (d), Tuan Phong Ly (e), Shyam Sundar Budhathoki (f), Attaullah Ahmadi (g,h), Don Eliseo Lucero-Prisno III (i,j)</div><div><br /></div><div>a Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland</div><div>b School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom</div><div>c College of Medicine, Bicol University, Daraga, Albay, Philippines</div><div>d Faculty of Pharmaceutical Science, University of Port Harcourt, Port Harcourt, Nigeria</div><div>e School of Tourism Management, Macao Institute for Tourism Studies, Macao, SAR, China</div><div>f Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom</div><div>g Medical Research Center, Kateb University, Kabul, Afghanistan</div><div>h Global Health Focus Asia, Kabul, Afghanistan</div><div>i Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom</div><div>j Faculty of Management and Development Studies, University of the Philippines (Open University), Los Baños, Laguna, Philippines</div></div><div><br /></div><h3 style="text-align: left;"><b>Abstract</b></h3><p style="text-align: left;">Vietnam's close proximity to China where the COVID-19 outbreak started made it one of the countries expected to have widespread transmission of the virus. However, the country opposed this expectation and attained low spread of COVID-19 infection due to its proactive approaches in containing the disease. As of March 11, 2021, Vietnam has a total of 2529 confirmed cases, equivalent to 26 cases per one million population-compared to the global rate of 15,223 cases. The low-cost model approach used by Vietnam in dealing with previous public health issues, tackle the importance of a strategic public health system, good governance, and citizen cooperation in the fight against <a class="topic-link" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/covid-19" style="box-sizing: border-box; color: #2e2e2e; margin: 0px; padding: 0px; text-decoration-color: rgb(46, 46, 46); text-decoration-thickness: 1px; text-underline-offset: 1px; word-break: break-word;" title="Learn more about COVID 19 from ScienceDirect's AI-generated Topic Pages">COVID 19</a> pandemic. This paper aims to analyze Vietnam's achievement in its early and continued success in combating COVID-19 by taking into account various aspects of its health system and experience on outbreaks that have previously occurred and how these can be applied to current COVID-19 responses.</p></div>e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-27799867232526751522021-06-22T14:06:00.006+01:002021-06-23T08:58:09.478+01:00<br /><h3 style="text-align: left;">Levels of Physical Activity, Patterns, and Perceived Barriers, Among University Students in Oman: A cross-Sectional Study</h3><br />Amal Al Siyabi graduated as a medical doctor from Sultan Qaboos University (2007) and is now a specialist in Public Health, having graduated from the ScHARR MPH in 2020. Amal currently works as the head of Community and Health Partnership in the Ministry of Health, Oman. She focuses on healthy cities and villages, and physical activity as a focal point in Oman. She is also a member of the national committee of narcotic drugs and psychotropic substances prevention.<div><br /></div><div>Her Masters' dissertation project looked at the patterns of physical activity and perceived barriers to physical activity among University students in Oman, drawing on networks of students and using snowball sampling methods to achieve high levels of coverage of her target population. She was supervised by Dr Hannah Jordan.<br /><br />Amal went on to publish her findings in the International Journal of Science and Economics.</div><div><br /><h3 style="text-align: left;">Authors</h3>Amal Al Siyabi, Ozayr Mahomed, Huda Al Siyabi, Sitwat Usman Langrial, Salah T. Al Awaidy<br /><br /><h3 style="text-align: left;">Abstract</h3><b>Objective</b>: To investigate the prevalence, pattern, and the perceived barriers, of physical activity among Omani university students studying in Oman.<br /><br /><b>Methodology</b>: A self-administered questionnaire using the short-form of the International Physical Activity Questionnaire (IPAQ) was disseminated to a selected sample of university students, from their second academic year onwards through Whats AppTM. Descriptive, Bivariate and multivariate analysis was conducted to measure patterns, levels and associated factors.<br /><br /><b>Results</b>: Overall 44% were classified as highly active, 30% as moderately active, and 26% as lowly active or inactive. Younger students (< 22 years), male students, respondents with a positive perception of weight (normal or below), and self-perceived physically active (moderate to high) were more likely to engage in moderate to high physical activity. Students in university for < 4 years (OR: 2.69) and students were members of sports youth clubs (OR: 2.76) were significantly more likely to engage in moderate or high physical activity. Lack of motivation was the top barrier of physical activity.<br /><br /><b>Conclusions</b>: More than a quarter of surveyed Omani university students were physically inactive which has the potential to have a detrimental effect on their health and well-being. Therefore, creating a conducive environment is essential for improving short and long-term health outcomes.<div><br /><h3 style="text-align: left;">Link</h3><a href="https://doi.org/10.22158/ijsse.v1n1p49" id="pub-id::doi" style="background-color: white; color: grey; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 11.2px;">https://doi.org/10.22158/ijsse.v1n1p49</a></div></div>e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-80565617055987924702019-09-26T14:24:00.000+01:002019-09-26T14:24:01.638+01:00<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
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SheffWHO 2019: Winning Position Paper: NONCOMMUNICABLE DISEASES</h3>
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<span style="font-family: Arial, Helvetica, sans-serif;">Building on the hugely successful 2018 debut, SheffWHO explored the theme “Non-Communicable Diseases: A Crisis in Slow Motion” from 8-10 March 2019. As before, delegates represented WHO Member States, as well as Non-Governmental Organizations (NGOs), pharmaceutical companies and the media.<br /><br />Contributing to interdisciplinary and experiential learning in global health, delegates from all disciplines (not just science/health) were encouraged to participate in this event. They discussed, co-operated, and negotiated with other stakeholders to produce resolution papers addressing the simulation theme, as an important global health priority.<br /><br />The winning position paper was by Jowi Kryz Guillen.<br /> <br />For the SheffWHO 2019 simulation, Jowi was tasked to prepare a position paper for Pakistan as a delegate of the Eastern Mediterranean Regional Office (EMRO). This position paper addressed the conference theme of Non-Communicable Diseases (NDCs), which included details of mortality and morbidity due to NCDs and potential causal factors, such as diet, air quality and lifestyle. The main goal of the position paper was to propose alternative solutions to overcome prevalent NCDs in Pakistan, which are cost-effective and right-impact interventions that respects the political and cultural factors unique to Pakistan. Furthermore, the recommended actions enhances present healthcare platforms and complements the WHO agenda for combatting NCDs.<br /><br />Jowi has just finished her MSc in Biomaterial and Regenerative Medicine at the University of Sheffield, where she is expected to graduate this January 2020 with distinction. She is currently taking a sabbatical and volunteering with the British Council (Generation UK - InternChina) in Chengdu, to teach English and work for a local orphanage. Her next goal is to start a PGCE in Biology/Chemistry at University College London in 2020.</span><div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Name: Jowi Kryz Guillen <br />Role: Member State Representative of Pakistan <br />Region: Eastern Mediterranean (EMRO) <br />Twitter: @jowikryz </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: large;">Noncommunicable Diseases </span></h2>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">National Position Paper Pakistan </span></h3>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"></span></h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br />Pakistan has been named to be the 6th most populated country in the world, with over 200 million inhabitants contributing to 2.65% of the total world population</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6bcfa44b-7fff-c60a-02b8-9689d0106bc1" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">1</span></b>. Noncommunicable diseases, NCDs, and their shared risk factors (tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity, as well as air pollution) represent an unacceptable blind spot in our collective path to sustainable development, causing far more deaths and disability than any other group of diseases</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-223a4a58-7fff-fc4a-725d-2d530fa15422" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">2</span></b>. NCDs and injuries are amongst the top ten causes of mortality and morbidity in Pakistan</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-1e2c242b-7fff-d05c-3a6b-2126cc3bf164" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">3</span></b>; estimates indicate that they account for approximately 25% of the total deaths within the country</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-29a5bfef-7fff-e74e-b005-98278829392e" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">4</span></b>. NCDs contribute significantly to the premature mortality and morbidity, and impose a heavy economic burden on individuals, societies and health system</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-97892da2-7fff-d477-4ac7-f83bfa4f9418" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">5</span></b>. In most cases, it is the economically productive workforce (age 30 to 70 years old), which bears the brunt of these diseases</span><b id="docs-internal-guid-d66a4f2b-7fff-1f6d-5f14-5d6dfe7d6809" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">3,4,5</span></b><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-97892da2-7fff-d477-4ac7-f83bfa4f9418" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;"></span></b>. <br /><br /> NCDs currently share over a fifth of the disease burden in Pakistan, and 2.5% are disabled. The majority of such mortalities were caused by the four main NCDs, namely: cardiovascular disease, CVD (44% of all NCD deaths); cancer (22%); chronic respiratory disease (9%); and diabetes. Over the past 5 years, the proportion of underweight women has decreased (14% to 9%)</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-164dcc64-7fff-57d0-5830-a13b3d4822aa" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">6</span></b></span>, yet the proportion of overweight or obesity women has increased by 12%</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-164dcc64-7fff-57d0-5830-a13b3d4822aa" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">6</span></b></span>, where the rates are significantly higher than men, regardless of residence</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-12691199-7fff-8b16-ff43-a9e0ff7815a8" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">7</span></b>. The coexistence of underweight in early life with obesity in adults presages both a higher prevalence and incidence for NCDs such as CVD and diabetes. Existing population-based morbidity data on NCDs in Pakistan show that 1 in 3 adult, over the age of 45 years, suffers from high blood pressure</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-164dcc64-7fff-57d0-5830-a13b3d4822aa" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">6</span></b>, and the prevalence of diabetes is reported at 10%. The major contributing factors to these diseases are the combination of increasing urbanisation, changing lifestyles, reduced physical activity and higher energy density of diets with Pakistani cooking. <br /><br /> Pakistan is the only country to have been created in the name of Islam, therefore tobacco use and alcohol consumption would innately be at low incidences (0.3 litre consumption per capita and 36.7 prevalence of tobacco smoking; persons aged 15 and older),</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-f32e8503-7fff-dba3-37fe-d2d4c8ce7436" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">8</span></b> relative to other countries. However in 2016, the environmental issue of air pollution became apparent, where the mortality rate attributed to household and ambient air pollution was at 173.6 (per 100 000 population), inflicting 3.8 million deaths from chronic respiratory disease and 9.0 million deaths from cancer.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-f32e8503-7fff-dba3-37fe-d2d4c8ce7436" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">8</span></b> Yet again women are at greater risk of suffering from cancer, namely ovarian and breast cancer, taking the lives of 40 000 women per year</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-70772549-7fff-2041-b457-d27b38094b09" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">9,10</span></b>. According to multiple studies, breast cancer occurs to 1 in every 9 Pakistani woman, which is one of highest incidence rates in Asia</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-70772549-7fff-2041-b457-d27b38094b09" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">10</span></b></span> and is not sparing even the younger age groups </span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-70772549-7fff-2041-b457-d27b38094b09" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">9,10</span></b>. <br /><br />Despite the magnitude of the threat posed by NCDs, the current health expenditure (CHE) of Pakistan is 2.7% (GDP, 2015; US $38 per capita); the total expenditure on health is US $18 per head</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-70772549-7fff-2041-b457-d27b38094b09" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">10</span></b></span>. The World Health Organisation (WHO) has criticized the country’s reluctant investment (inadequate by 0.4%, according to United Nations human development index) towards health</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-df3c3871-7fff-d7c6-a7d9-384029250b11" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">11</span></b>, and recommended the allocation of US $34 per head to fund a package of essential health service</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-f32e8503-7fff-dba3-37fe-d2d4c8ce7436" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">8</span></b></span>. Furthermore, Pakistan was notoriously condemned for the vaccine-preventable diseases that caused half of all the deaths in 2008, based on the ‘Western sterilisation plot’</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-b9e14996-7fff-3797-30e0-a9150ec8b75b" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">12</span></b>. Thereafter, Pakistan became the first country in the WHO Eastern Mediterranean Region to conduct joint external evaluation in 2016, impetus to the tripartite alliance between the Ministry of Health, Government of Pakistan, the WHO, Pakistan office and the NGO Heartfile</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-5177d5a8-7fff-8e43-064f-2d4b4965e059" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.9600000381469735pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre;">13</span></b>. A national action plan for the International Health Regulation (IHR) Global Health Security Agenda was developed, with the aim to fulfil the IHR requirements to prevent, detect and mound a comprehensive public health response to health threats.<br /><br /> Addressing NCDs in developing country such as Pakistan is a multidimensional challenge with implication at different levels that requires the implementation of cost-effective and right-impact interventions. These include institutional, community and public policy levels changes set within a long-term and life-course perspective. Therefore in congruent to the WHO Global Coordination Mechanism (GCM) for the prevention and control of NCDs, the following actions could aid Pakistan to fight against NCDs and, promote mental health and well-being: <b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-78c74682-7fff-9e5b-ea58-62c7f2a5521e" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"> </span></b></span></b></b></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-78c74682-7fff-9e5b-ea58-62c7f2a5521e" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;">1. Government to prioritise prevention and treatment of NCDs for the </span></b></span></b></b></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-78c74682-7fff-9e5b-ea58-62c7f2a5521e" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;">next expenditure</span></b></span></b></b></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Increase the CHE % GDP and total expenditure on heath per person</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Establish a mandate to identify key stakeholders and experts in policy making, assess the existing status of NCDs, prepare a policy document and provide recommendations in response to NCDs </span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-78c74682-7fff-9e5b-ea58-62c7f2a5521e" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;">2. Strengthen knowledge and evidence via surveillance and research </span></b></b></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"> </b>Enhance the monitoring systems in rural areas, to identify the gaps in health care, reduce unreported cases and obtain reliable epidemiology of diseases</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Allocate domestic resources towards peer-review literature research on health, nutrition, education and disease progression</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-3e392eb0-7fff-e012-3a6d-ffeccec3e196" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"> </span></b></b></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-3e392eb0-7fff-e012-3a6d-ffeccec3e196" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;">3. Implement awareness and improve understand of NCDs </span></b></b></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Train doctors and community health workers to use techniques under the WHO guidelines for diagnosing diseases </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Rational use of drugs to prevent the overuse of antibiotics and curb microbial resistance</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Reduced inequality to healthcare delivery between private and public sectors</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-3e392eb0-7fff-e012-3a6d-ffeccec3e196" style="font-weight: normal;"><b id="docs-internal-guid-8454ac2c-7fff-f467-0598-50dcc47d6f6c" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"> </span></b></b></b></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-3e392eb0-7fff-e012-3a6d-ffeccec3e196" style="font-weight: normal;"><b id="docs-internal-guid-8454ac2c-7fff-f467-0598-50dcc47d6f6c" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;">4. Government to prioritise education for the next expenditure </span></b></b></b></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-3e392eb0-7fff-e012-3a6d-ffeccec3e196" style="font-weight: normal;">
</b></b></span>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Full and universal access to health programmes and actions to tackle physical inactivity and promote mental health </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Funded education and access to higher learning for healthcare professions to increase the rate of doctor-to-population ratio</span><span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-7f647fe6-7fff-2785-67a7-6232191d0792" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"> </span></b></b></span></li>
</ul>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b id="docs-internal-guid-6c7cf1cc-7fff-5234-0ae5-73079cc5edd5" style="font-weight: normal;"><b id="docs-internal-guid-7f647fe6-7fff-2785-67a7-6232191d0792" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-size: 10.800000190734863pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;">5. Exploit digital healthcare platforms and existing partnerships </span></b></b></span><br />
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Efficient service delivery to locating appropriate healthcare information, booking appointment with doctors and ordering the correct medication </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Maintain transparent communication and collaboration between government, NGO, manufactures, general public and private sector </span></li>
</ul>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>References</b></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b> </b><span style="font-size: xx-small;"><br /></span></span></div>
<ol>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Department of Economic and Social Affairs, Population Division: Pakistan Population (LIVE) [Internet]. World Population Prospects: 2019 [cited 2019 Mar 5]. Available from:<a href="http://www.worldometers.info/world-population/pakistan-population" target="_blank"> http://www.worldometers.info/world-population/pakistan-population/ </a></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Schweizerische Eidgenossenschaft. General Meeting of the WHO Global Coordination Mechanism for the prevention and control of noncommunicable diseases (GCM/NCD). Co-chairs Statement. Geneva, Switzerland: Swiss Confederation, 2018. </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Hyder AA, Morrow RH. Lost Healthy Life Years in Pakistan in 1990. Am J Public Health 2000;90(8):1235–40. </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Federal Bureau of Statistics, Statistics Division. Pakistan Demographic Survey 2001. Islamabad, Pakistan: Government of Pakistan, 2003. [cited 2019 Mar 5]. Available from: <a href="http://www.pbs.gov.pk/content/pakistan-demographic-survey-2001">http://www.pbs.gov.pk/content/pakistan-demographic-survey-2001</a></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">World Health Organization. World Health Report 2000 - Health Systems: Improving Performance. Geneva, Switzerland: WHO, 2000.</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF. </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Nanan DJ. The obesity pandemic – Implications for Pakistan. J Pakistan Med Assoc. 2002 Aug; 58(8). </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">World Health Statistics 2018: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva: WHO; 2018. </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Jardoon Z, Shah SP, Bourne R, Dineen B, Khan MA, Gilbert CE, Foster A, Khan MD. Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey. Br J Opthalmol. 2007 Oct 9; 91(10): 1269–73. [Online, cited 2019 Mar 5] Available at: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001008/" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001008/ </a></span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">World Health Organization – Cancer Country Profiles. Pakistan: World Health Organization, 2014. </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">WHO Global Health Expenditure Atlas: September 2014. Switzerland: World Health Organization; 2014. </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Janjua H. Afghan clerics in talks with Isis to break polio vaccine myths. The Guardian, Global Health, 2018, Mar 27 </span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. Islamabad, Pakistan: tripartite collaboration of the Ministry of Health, Government of Pakistan; WHO, Pakistan office, and Heartfile; 2004. </span></span></li>
</ol>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-31711498512519241042018-05-09T13:27:00.000+01:002018-05-09T13:43:24.525+01:00SheffWHO 2018: Winning Position Paper. OUTBREAKS AND PANDEMICS: ADDRESSING THE NEXT CRISISThe first of its kind in Sheffield, SheffWHO explored the theme “Outbreaks and Pandemics: Addressing the Next Crisis” from April 27th-29th, 2018. Delegates represented WHO Member States, as well as Non-Governmental Organizations (NGOs), pharmaceutical companies and the media.<br />
<br />
Contributing to interdisciplinary and experiential learning in global health, delegates from all disciplines (not just science/health) were encouraged to participate in this event. They discussed, co-operated, and negotiated with other stakeholders to produce resolution papers addressing the simulation theme, as an important global health priority.<br />
<br />
The winning position paper, competing with 70 attendees, was by Dr Shukrat O. Salisu-Olatunji. Shukrat completed her Masters in Clinical Research in ScHARR in 2017.<br />
<br />
<h2>
Delegate name: Dr Shukrat O. Salisu-Olatunji </h2>
<h2>
Region: AFRO (Country: Nigeria) </h2>
<h2>
Role: Member state delegate </h2>
<h2>
Twitter handle: @jumisal25 </h2>
<h3>
INTRODUCTION </h3>
Nigeria is known as the most populous nation in Africa with an estimated population of 196 million in April 2018 and a population growth rate of 2.67%[1]. With globalization, international trade and travel across borders, Nigeria is vulnerable to epidemics and outbreaks of infectious diseases from within and without. It is therefore critical to ensure optimal preparedness and response to this global threat and to empower the health system and its stakeholders appropriately with the goal of preventing pandemics and minimising casualties from such occurrences.<br />
Health funding is key in achieving optimal preparedness and response to outbreaks and epidemics, and Nigeria’s health allocation of 4.17% of its annual spending in 2017 is a far cry from the WHO recommendation of 13% [2,3]. The effects of poor health funding are felt across the three tiers of health care and most especially in primary care which is the foundation of health delivery closest to the people. The majority of patients (71.7%) must pay for health care out-of-pocket at the point of service even as the country puts in efforts to achieve Universal Health Coverage. There is high reliance on foreign aid and NGOs as a source of funding for public health initiatives like childhood immunization, HIV treatment, TB treatment among others.<br />
<h3>
NIGERIAN EXPERIENCE OF OUTBREAKS/EPIDEMICS </h3>
In recent times, Nigeria has experienced outbreaks of public health importance, including the Ebola outbreak in 2014. The strength of local response and collaborations between levels of government greatly influences the outcomes of such outbreaks with respect to acute response and control measures put in place to manage the situation. With the Ebola outbreak which involved several West African countries, the response was highly commendable as Nigeria succeeded in controlling the outbreak within three months and was declared Ebola free by the WHO[4]. The success of the country’s response has been attributed to the Incident management/ Emergency Operation Centre approach which facilitated resource and fund mobilization and coordination of response involving government health facilities, international aid organizations, NGOs and the private sector[5]. This success has however not been replicated with other outbreaks like Lassa fever, cerebrospinal meningitis, cholera and yellow fever which persist in the country. In the country’s experiences, the importance of strengthening health system’s preparedness in terms of personnel, co-ordination of stakeholders and mobilization of resources, provision of needed medications, vaccines and consumables and education of the populace has stood out.<br />
<h3>
CHALLENGES WITH OUTBREAK PREVENTION AND CONTROL </h3>
The health system’s preparedness and response to outbreaks is dependent on coordination of multiple stakeholders and the public. Poor political commitment especially with regards to funding, weak primary health care system, lack of ownership and community involvement are some of the challenges which negatively impact on outbreak/epidemic response. Political crisis and instability especially in Northern Nigeria also further reduce access to healthcare and jeopardises the chances of effective response to an outbreak. Distrust of the authorities and stigma associated with some communicable diseases like Lassa fever, as well as lack of funds to pay for healthcare services may discourage early reporting and identification of cases, thus increasing the likelihood of spread and epidemic potential of such a condition.<br />
<h3>
PROPOSED SOLUTIONS</h3>
<ul>
<li>Strengthen the foundation of the healthcare system by improving primary health care. Focus on disease prevention, health promotion and notifiable disease surveillance would provide a better defence against outbreaks at all levels of health care. Public health personnel must be aware of minimum standard operating procedures for potential epidemic prone diseases; e.g. case identification, contact tracing and isolation where required. </li>
<li>Create regional laboratories to facilitate rapid diagnosis and enhance surveillance and tracking of outbreaks. </li>
<li>Empower, educate and inform the populace through an effective communication system that enables early identification and reporting of suspected cases at times of outbreaks and minimises anxiety, stigma and harmful practices in the event of an outbreak. </li>
<li>Train healthcare personnel to enhance case management and optimal infection prevention and control in health facilities and the community. </li>
<li>Build capacity of Disease Surveillance and Notification Officers in each state. Strengthen Local governments in training DSNOs to use IDSR guidelines and facilitate timely reporting. </li>
<li>Engage private sector in a focused and coordinated manner. </li>
<li>Key into global initiatives for outbreak control like the recently launched “Eliminate Yellow fever in Africa by 2026”. </li>
</ul>
<h3>
CONCLUSIONS </h3>
Policies and interventions to build capacity of personnel, mobilise funds and needed resources and establish a preparedness and response strategy are essential in addressing the threats of outbreaks/epidemics. Improvements in the health system achieved through foreign aid and support must be sustained to empower the healthcare system at primary, secondary and tertiary levels.<br />
<h3>
REFERENCES </h3>
<ol>
<li>Country meters. Live Nigeria population (2018). Current population of Nigeria — Countrymeters [Internet]. 2018 [cited 2018 Apr 17]. Available from: http://countrymeters.info/en/Nigeria/ </li>
<li>World Health Organization. WHO | Nigeria [Internet]. WHO. World Health Organization; 2018 [cited 2018 Apr 22]. Available from: http://www.who.int/countries/nga/en/ </li>
<li>Nigeria’s Grossly Inadequate 2017 Health Budget [Internet]. THIS DAY. 2017 [cited 2018 Apr 22]. Available from: https://www.thisdaylive.com/index.php/2017/02/09/nigerias-grosslyinadequate-2017-health-budget/ </li>
<li>Centers for Disease Control and Prevention. Ebola Virus Disease Outbreak — Nigeria, July– September 2014 [Internet]. Morbidity and Mortality Weekly Report. 2014 [cited 2018 Apr 22]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm </li>
<li>Courage KH. How Did Nigeria Quash Its Ebola Outbreak So Quickly? - Scientific American [Internet]. Scientific American. 2014 [cited 2018 Apr 22]. Available from: https://www.scientificamerican.com/article/how-did-nigeria-quash-its-ebola-outbreak-soquickly/</li>
</ol>
e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-24184054149871979292018-04-26T14:45:00.001+01:002019-09-26T14:12:28.437+01:00Why A&E? A study into patient factors in low-acuity attendance in an urban district general hospital<div class="tr_bq">
Seth White graduated from ScHARR MSc in Clinical Research in 2016. His Masters' dissertation project was supported by Rotherham Emergency Department, and looked into reasons underlying increasing demand on the Emergency Department, particularly for less severe and urgent health problems.</div>
<br />
In collaboration with his supervisor Jo Coster, and Jeremy Reynard from Rotherham District General Hospital, Seth's research adresses problems facing Emergency Departments throughout the UK and beyond.<br />
<br />
<h3>
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<br />
Seth White MB ChB 1,3; Joanne Coster BSc 1; Jeremy Reynard MBBS FCEM 2 <br />
<br />
1 School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA<br />
2 Emergency Department, Rotherham District General Hospital, Rotherham, S60 2UD <br />
3 Corresponding author: <a href="mailto:seth.t.white@gmail.com">seth.t.white@gmail.com</a>, MD Anderson Cancer Center, 1515 Holcombe, Houston TX, USA 77030, T: +17137455253 <br />
<br />
KEYWORDS: Emergency demand, qualitative, interview study, non-urgent attenders, inappropriate attenders, ambulatory attendance, Accident and Emergency, managing demand<br />
<br />
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<span style="mso-bidi-font-style: normal;"><span lang="EN-US"></span></span><span style="mso-bidi-font-style: normal;"><span lang="EN-US">Abstract</span></span></h3>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US"><i style="mso-bidi-font-style: normal;"><span lang="EN-US"></span></i><span style="font-weight: normal;"><b>Introduction</b>: A&E demand is rising inexorably across developed countries. Demographic factors and population health do not fully account for this rapid rise. Considerable demand comes from relatively low-urgency patients, who are likely to be discharged without investigation or treatment. Understanding why such patients choose A&E is important when configuring current and future services. <br /><br /><b>Methods</b>: Semi-structured interviews undertaken at a local district A&E department situated in an urban deprived area. We included A&E attenders triaged to category 4 or 5 on the Manchester Triage Scale that did not present with an acute traumatic injury or were identified as vulnerable. Transcripts were analysed using framework analysis. <br /><br /><b>Results</b>: Fifteen patients were recruited and all were interviewed. None described their health problem as an emergency. Patients responded along three main themes. 1) Access to and confidence in primary care; participants lacked confidence in their GP and had difficulty getting appointments. There was a belief that GP consultations were futile as they would inevitably be referred to A&E. 2) Pull factors to A&E; relates to how perceptions of need and positive views of A&E (availability of facilities for investigation, speed and perceived quality) influence health seeking behaviour. 3) Individual and external factors; many patients were referred to A&E and NHS 111 was a common source of referral. Individual factors mostly related to anxiety and pain or using A&E as an informed decision.<br /><br /><b>Conclusion</b>: These findings demonstrate that patients will select A&E in lieu of other available options due to perceived benefits of A&E care and perceived barriers and limitations to primary care. Previous health care experiences (positive and negative) have a strong influence on future health care choices. The NHS 111 number appears to routinely refer low-urgency patients to A&E and this warrants further investigation. </span></span></b></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
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</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
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<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 478.8pt;" valign="top" width="638"><div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">What
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<span lang="EN-US">What is already known on this subject:</span></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-US">A&E demand is rising rapidly.<span style="mso-spacerun: yes;"> </span>Some of this demand is from patients who
may not require emergency or urgent care. Why such patients choose A&E is
unclear.</span></i></div>
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<span lang="EN-US">What this paper adds:</span></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-US">Patients attend A&E because they believe it is a
superior service with better access to investigations, better clinicians and
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<br />
<h3 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Introduction</span></b><span lang="EN-US"></span></h3>
<div class="MsoNormal">
<span lang="EN-US">Rising demand for Accident and Emergency
(A&E) care is a well-known and much politicized issue.<span style="mso-spacerun: yes;"> </span>Demand has risen 32% over the past ten years
alone </span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_1" title="Center, 2001-2015 #3"><span style="color: black; text-decoration: none;">1</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> and
is a common problem across developed countries.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_2" title="Pines, 2011 #1"><span style="color: black; text-decoration: none;">2</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> <span style="mso-spacerun: yes;"> </span>The factors driving this
increase are not fully understood – population increase and ageing alone do not
account for the magnitude of rises seen. <span style="mso-spacerun: yes;"> </span>Several interrelated factors have been <span style="mso-spacerun: yes;"> </span>suggested to explain this increase;
increasingly litigation-averse practices, organizational changes within healthcare
systems and increased community expectations are often cited.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_3" title="Lowthian, 2010 #4"><span style="color: black; text-decoration: none;">3</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">One significant factor, which may be
difficult to assess, is a shift in patient behavior.<span style="mso-spacerun: yes;"> </span>There is a view that an increasing number of
patients bypass primary care and attend A&E ‘inappropriately’.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_4" title="Benger, 2008 #17"><span style="color: black; text-decoration: none;">4</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> <span style="mso-spacerun: yes;"> </span>Many studies have assessed
the ‘appropriateness’ of patient attendance in A&E, asking whether patients
may have been more appropriately treated elsewhere.<span style="mso-spacerun: yes;"> </span>Such studies (using the judgement of physicians)
have estimated various inappropriate or avoidable attendance rates of between
6-80%.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_5" title="Murphy, 1998 #5"><span style="color: black; text-decoration: none;">5</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">The concept itself is poorly
defined in the literature, with individual studies often using independently
crafted definitions with little agreement between emergency physicians
themselves.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_6" title="Richardson, 2006 #6"><span style="color: black; text-decoration: none;">6</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>Although </span><span style="mso-ansi-language: EN-GB;">the term “inappropriate attender” is difficult
to systematically operationalise and may be unhelpful, it is clear that a
significant subpopulation present with low-acuity problems to A&E departments.<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US">Such patients may
contribute to overcrowding and increase strain on health services.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_3" title="Lowthian, 2010 #4"><span style="color: black; text-decoration: none;">3</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>Attempts to divert such
patients to other urgent or immediate healthcare services , such as walk-in
centers or other services, have not been shown to reduce A&E demand or influence
patients’ health seeking behaviour.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_4" title="Benger, 2008 #17"><span style="color: black; text-decoration: none;">4</span></a><span style="mso-no-proof: yes;"> </span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_7" title="Ismail, 2013 #7"><span style="color: black; text-decoration: none;">7</span></a><span style="mso-no-proof: yes;">]</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">This research was therefore undertaken to
identify and understand motivating factors in health care decision making for low-acuity
patients who choose to attend A&E.<span style="mso-spacerun: yes;"> </span>We
sought to explore the underlying reasons behind patient decision making and how
previous health care experiences and patient views of health services impact
and shape future decision making.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<h3 class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Methods</span></b><span lang="EN-US"></span></h3>
<h4 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Setting</span></b></h4>
<div class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<span lang="EN-US">The
research was undertaken at Rotherham District General A&E department
located in England.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>This A&E department serves the local area
of Rotherham (population: 257,000), which is a relatively ethnically homogenous
area </span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_8" title="Statistics, 2011 #2"><span style="color: black; text-decoration: none;">8</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> with a high index of social deprivation, being ranked in the bottom
quintile of local authorities nationally.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_9" title="Government, 2015 #8"><span style="color: black; text-decoration: none;">9</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>The A&E department is currently
undergoing refurbishment with plans to integrate a primary care service with
the emergency department to form the ‘Emergency Centre’,</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_10" title="Trust, 2016 #9"><span style="color: black; text-decoration: none;">10</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> expected to be completed in 2017.</span></div>
<h4 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Participant
Selection</span></b></h4>
<div class="MsoNormal">
<span lang="EN-US">Ambulatory adult patients who were triaged
to category four or five on the Manchester Triage Scale (the two lowest
acuities) were eligible for the study.<span style="mso-spacerun: yes;">
</span>Patients with recent onset of trauma (<24 hours), were in vulnerable
patient groups or acutely distressed were excluded from the study.<span style="mso-spacerun: yes;"> </span>These criteria were designed to capture a
less urgent population able to participate in an interview who could feasibly have
accessed treatment elsewhere.<span style="mso-spacerun: yes;"> </span>Formal prospective
assessment of suitability was not made as this was felt to be too subjective to
be useful.<span style="mso-spacerun: yes;"> </span>Ethical approval was gained
from Leicester Central research ethics committee, and study site approval was
obtained from NHS Rotherham and HRA prior to the commencement of the study (REC
reference: 16/EM/0205).</span></div>
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<br />
<h4>
Exclusion Criteria</h4>
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<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span dir="LTR"></span><span lang="EN-US">Pregnancy</span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
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distressed</span></div>
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<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span dir="LTR"></span><span lang="EN-US">Mental
health issue</span></div>
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<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span dir="LTR"></span><span lang="EN-US">Trauma (if
<24hrs or injury visible)</span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span dir="LTR"></span><span lang="EN-US">Formal
referral (with letter)</span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span dir="LTR"></span><span lang="EN-US">Inadequate
English</span></div>
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<span lang="EN-US"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span dir="LTR"></span><span lang="EN-US">Cognitive
impairment</span></div>
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<br /></div>
<span lang="EN-US"></span><br />
<h4 class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Data Collection</span></b></h4>
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<span lang="EN-US">All
data and information was collected within the A&E department. Patients were
screened during triage by the triage nurse, who held a copy of the study eligibility
criteria.<span style="mso-spacerun: yes;"> </span>Potential participants were
then identified to the principle investigator, and were provided with
participant information. After having time to read the information, participants
were given the opportunity to participate and if they consented, were invited
to a quiet side room where consent was taken in writing.<span style="mso-spacerun: yes;"> </span>Interviews were semi-structured in nature and
recorded on digital Dictaphone.<span style="mso-spacerun: yes;"> </span>A topic guide
was used to inform the interview and this was further developed and added to as
the research progressed.<span style="mso-spacerun: yes;"> </span>Initial topics were
derived from previous research in the UK and abroad and included a brief
chronology of events, perceptions of A&E and primary healthcare services,
past experiences and perceived health needs for this care problem.<span style="mso-spacerun: yes;"> </span></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<span lang="EN-US">A
second stage exclusion criteria was applied as recruitment only occurred when
the wait between triage and being seen was at least one hour, so as not to delay
care to participants.<span style="mso-spacerun: yes;"> </span>The study was restricted
to regular office hours (9-5 Mon-Fri) to avoid factors around out-of-hours
access, as the study was primary concerned with patients who could feasibly
have chosen to<i style="mso-bidi-font-style: normal;"> </i>attend a primary care
service.<span style="mso-spacerun: yes;"> </span>Interviews were carried out during
summer 2016.</span></div>
<h4 class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Analysis </span></b></h4>
<div class="MsoNormal">
<span lang="EN-US">Interviews were transcribed verbatim by the
lead researcher (SW). Transcripts were analyzed within NVIVO 11 software </span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_11" title="International, 2016 #10"><span style="color: black; text-decoration: none;">11</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> using
the method of framework analysis, which involves a series of clearly defined,
systematic and sequential steps.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_12" title="Ritchie, 2002 #11"><span style="color: black; text-decoration: none;">12</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> <span style="mso-spacerun: yes;"> </span>Following familiarization
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from interview responses such as “anxiety” or “perceived clinician quality” to
develop a working analytic framework.<span style="mso-spacerun: yes;">
</span>These were then discussed and revised with a second researcher (JC) and
applied to subsequent interview transcripts.<span style="mso-spacerun: yes;">
</span>Revisions were undertaken over several meetings.<span style="mso-spacerun: yes;"> </span>Continuing the same process, interview data
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to and confidence in primary care”, “pull factors to A&E”, and a third,
looser superordinate theme “individual and external factors”.<span style="mso-spacerun: yes;"> </span></span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Results</span></b></h3>
<h4 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Participant
characteristics</span></b></h4>
Fifteen participants were recruited; participants ranged in age from 18 to 63 and included seven women and eight men with a broad variety of presenting complaints (see Table 1). Six participants gave home addresses outside of the catchment area of Rotherham A&E. Disposal outcome was only available for thirteen participants – one participant’s outcomes could not be traced and another was recorded only as ‘seen by GP’. Four participants brought a relative into the interview (no carers were interviewed) but only three contributed to the interviews. <br />
<br />
Out of the thirteen participants with disposal outcomes available, five received advice only, and three received advice and a prescription. Only one participant received a specialty referral and no participants were admitted. One participant did not wait to be seen by a clinician after the interview. Two received wound care in the department, both judged to be candidates for wound care in general practice by the researcher. Participants came from a geographically diverse area and nearly all participants resided in areas with high levels of deprivation. Six participants had home addresses listed with an A&E in closer geographical proximity (although location of incident/onset of illness was not recorded). Three participants reported travelling to Rotherham in preference of another A&E during the interview (with one being advised to go to specifically Rotherham via 111 due to presence of maxillofacial surgeons – though they were not seen by the maxillofacial surgeons).<br />
<br />
<h4>
Table 1 - participant characteristics </h4>
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<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
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<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
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<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
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<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
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<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
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<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
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<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 6"/>
</w:LatentStyles>
</xml><![endif]--><!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin-top:0cm;
mso-para-margin-right:0cm;
mso-para-margin-bottom:8.0pt;
mso-para-margin-left:0cm;
line-height:107%;
mso-pagination:widow-orphan;
font-size:11.0pt;
font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:Arial;
mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;
mso-fareast-language:EN-US;}
table.TableGridLight1
{mso-style-name:"Table Grid Light1";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-priority:40;
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border:solid #BFBFBF 1.0pt;
mso-border-themecolor:background1;
mso-border-themeshade:191;
mso-border-alt:solid #BFBFBF .5pt;
mso-border-themecolor:background1;
mso-border-themeshade:191;
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-border-insideh:.5pt solid #BFBFBF;
mso-border-insideh-themecolor:background1;
mso-border-insideh-themeshade:191;
mso-border-insidev:.5pt solid #BFBFBF;
mso-border-insidev-themecolor:background1;
mso-border-insidev-themeshade:191;
mso-para-margin:0cm;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
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font-family:"Calibri",sans-serif;
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
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mso-bidi-theme-font:minor-bidi;
mso-ansi-language:EN-US;
mso-fareast-language:EN-US;}
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<![endif]-->
<br />
<table align="left" border="1" cellpadding="0" cellspacing="0" class="TableGridLight1" style="border-collapse: collapse; border: none; margin-left: 6.75pt; margin-right: 6.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-anchor-horizontal: margin; mso-table-anchor-vertical: paragraph; mso-table-left: center; mso-table-lspace: 9.0pt; mso-table-rspace: 9.0pt; mso-table-top: -3.2pt;">
<tbody>
<tr style="height: 36.8pt; mso-height-rule: exactly; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">ID#</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></b></div>
</td>
<td style="border-left: none; border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Age</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></b></div>
</td>
<td style="border-left: none; border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Sex</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></b></div>
</td>
<td style="border-left: none; border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Complaint</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></b></div>
</td>
<td style="border-left: none; border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Outcome</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-font-size: 12.0pt; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></b></div>
</td>
<td style="border-left: none; border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-font-size: 12.0pt; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Deprivation quintile</span></b></div>
</td>
<td style="border-left: none; border: solid #BFBFBF 1.0pt; height: 36.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Closest ED</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></b></div>
</td>
</tr>
<tr style="height: 34.35pt; mso-height-rule: exactly; mso-yfti-irow: 1;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">1</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">63</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Growth on nose</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Seen by GP</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">5</span><sup><span lang="EN-US">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.35pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 35.6pt; mso-height-rule: exactly; mso-yfti-irow: 2;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">2</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">57</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">R leg problem</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">5</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 35.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Mexborough (MIC)</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 32.8pt; mso-height-rule: exactly; mso-yfti-irow: 3;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">3</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">41</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">L side numbness</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Advice, prescription</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">4</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 32.8pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 37.25pt; mso-height-rule: exactly; mso-yfti-irow: 4;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">4</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">18</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Injury to R foot</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Dressing, local anaesthetic, advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">3</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">rd</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 18.6pt; mso-height-rule: exactly; mso-yfti-irow: 5;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">5</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">54</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Pain L knee</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Prescription, advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">4<sup>th</sup></span><span lang="EN-US" style="font-family: "times new roman" , serif;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.6pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 34.25pt; mso-height-rule: exactly; mso-yfti-irow: 6;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">6</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">27</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Dental problem</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Prescription, advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">5</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 34.25pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Barnsley</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 18.75pt; mso-height-rule: exactly; mso-yfti-irow: 7;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">7</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">41</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Knee prob</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<i><span lang="EN-US">Outcome unavailable</span></i><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<br /></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<br /></div>
</td>
</tr>
<tr style="height: 28.65pt; mso-height-rule: exactly; mso-yfti-irow: 8;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">8</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">52</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Left leg pain</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Did not wait</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<br /></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 28.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Sheffield</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 31.05pt; mso-height-rule: exactly; mso-yfti-irow: 9;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">9</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">32</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">R foot injury</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">5</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 31.05pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 18.9pt; mso-height-rule: exactly; mso-yfti-irow: 10;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">10</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">32</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">R leg injury</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">5</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.9pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 37.2pt; mso-height-rule: exactly; mso-yfti-irow: 11;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">11</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">21</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Left knee injury</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Observation, specialty referral, advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">3</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">rd</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 37.2pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Mexborough (MIC)</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 18.75pt; mso-height-rule: exactly; mso-yfti-irow: 12;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">12</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">30</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Groin pain</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Observation, advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">3</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">rd</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 18.75pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Doncaster</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 43.7pt; mso-height-rule: exactly; mso-yfti-irow: 13;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">13</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">26</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">R foot wound prob</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Wound cleaning, advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">3</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">rd</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 43.7pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">Bassetlaw</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
</tr>
<tr style="height: 27.65pt; mso-height-rule: exactly; mso-yfti-irow: 14;">
<td style="border-top: none; border: solid #BFBFBF 1.0pt; height: 27.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-themecolor: background1; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">14</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 27.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">51</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
</td>
<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 27.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">M</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<td style="border-bottom: solid #BFBFBF 1.0pt; border-left: none; border-right: solid #BFBFBF 1.0pt; border-top: none; height: 27.65pt; mso-border-alt: solid #BFBFBF .5pt; mso-border-bottom-themecolor: background1; mso-border-bottom-themeshade: 191; mso-border-left-alt: solid #BFBFBF .5pt; mso-border-left-themecolor: background1; mso-border-left-themeshade: 191; mso-border-right-themecolor: background1; mso-border-right-themeshade: 191; mso-border-themecolor: background1; mso-border-themeshade: 191; mso-border-top-alt: solid #BFBFBF .5pt; mso-border-top-themecolor: background1; mso-border-top-themeshade: 191; mso-height-rule: exactly; padding: 0cm 5.4pt 0cm 5.4pt;" valign="top"><div class="MsoNoSpacing" style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: -3.2pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span lang="EN-US">RTC/neck pain</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">Advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">2</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">nd</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">15</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">55</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">F</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">R wrist injury</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">Advice</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US" style="mso-text-raise: -5.5pt; position: relative; top: 5.5pt;">5</span><sup><span lang="EN-US" style="mso-bidi-font-size: 9.5pt;">th</span></sup><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<span lang="EN-US">Rotherham</span><span lang="EN-US" style="font-family: "times new roman" , serif; mso-bidi-font-size: 12.0pt;"></span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
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<h4 class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Thematic analysis</span></b></h4>
<div class="MsoNormal">
<span lang="EN-US">After applying several revisions to the
coding structure, a definitive thematic framework emerged describing the
factors behind A&E attendance.<span style="mso-spacerun: yes;"> </span>Twenty-one
individual subthemes were identified during the initial coding and many of
these were closely related or interlinked. All respondents contributed to at
least one main theme and often more. Three overarching themes were identified
and each contained subthemes: access to and confidence in primary care, pull
factors to A&E, and individual and external factors.</span></div>
<h4 class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Bypassing Primary Care</span></b></h4>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;"><span lang="EN-US">Access
to and confidence in primary care</span></i><span lang="EN-US"> related very
closely to <i style="mso-bidi-font-style: normal;">pull factors to A&E</i>.
A&E was almost universally better regarded than primary care, even in
participants who voiced positive opinions of their general practitioner. <span style="mso-spacerun: yes;"> </span>Many participants dismissed the idea of
attending primary care as ‘futile’ and were attracted to A&E as able to
provide more definitive care.<span style="mso-spacerun: yes;"> </span>Many
participants also believed that if they attended their GP it was merely
delaying the inevitable A&E attendance and referred to ‘cutting out the
middle man’ when describing their reasoning behind this.</span></div>
<blockquote>
<i>“Just because it was something that I didn’t know what it was, I thought I’d cut the middle man out and go straight to A&E” </i>– <b>Participant 2</b></blockquote>
<blockquote class="tr_bq">
<i>“I just thought that I'd just cut the middle man out by coming here for X-ray because I thought I would need one”</i> – <b>Participant 5</b></blockquote>
<blockquote class="tr_bq">
<i>"Whenever I've gone to the walk in or phoned 111 they tell me A&E straight away, or that you need to be seen within the next 4 hours…….so now when I get the pains I jump in a taxi and I come here.”</i> – <b>Participant 3</b></blockquote>
<blockquote class="tr_bq">
<i>“It’s just that every time we’ve been to see the GP it’s that they’ve more or less told him that they don’t specialize in that kind of thing so we go to A&E and you’ll get better treatment.”</i> – <b>Participant 1</b></blockquote>
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</div>
<div class="MsoNormal">
<span lang="EN-US">This closely related to three subthemes: 1)
Perceived need for diagnostic equipment, 2) Difficulty in accessing timely
primary care, and 3) Lack of confidence in primary care.</span></div>
<div class="MsoNormal">
<span lang="EN-US">Perceived need for diagnostic services was
an important factor in many decisions and a very prominent theme throughout the
interviews.<span style="mso-spacerun: yes;"> </span>Radiographs were commonly
thought to be required. <span style="mso-spacerun: yes;"> </span>No other
specific investigations were listed.</span><i> </i></div>
<blockquote class="tr_bq">
<div class="MsoNormal">
<i>“So I was going to ring the doctor and then I thought they might have to do an x-ray so I thought I’d come here and get it checked out as soon as possible” </i>– <b>Participant 9</b></div>
</blockquote>
<blockquote class="tr_bq">
<i>“I just thought that by coming here I'd get an X-ray” </i>– <b>Participant 5</b></blockquote>
<div class="MsoNormal" style="line-height: 100%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 11.0pt; margin-right: 8.85pt; margin-top: 0cm; mso-layout-grid-align: none; mso-line-break-override: restrictions; punctuation-wrap: simple; text-autospace: none; text-indent: 0cm;">
</div>
<div class="MsoNormal">
<span lang="EN-US">Difficulty in accessing the general
practitioner was also very common theme in the research – some participants
spoke of long waits, and first-come-first-serve telephone appointments as
barriers to GP attendance.<span style="mso-spacerun: yes;"> </span>It is worth
noting that this was still a prominent theme despite all the research being
conducted during normal weekday working hours.</span></div>
<blockquote>
<i>“The thing is that it’s really hard to get an appointment with them they’ve got a system where you need to ring at bang on eight in the morning and it’s either one or half one in the afternoon to get an afternoon appointment. But if you try to ring at eight… I’ve had it before where I’ve tried to get an appointment and it’s three [minutes] past eight and they’ve all gone” </i>–<b> Participant 11</b></blockquote>
<br />
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</div>
<div class="MsoNormal">
<span lang="EN-US">Confidence in general practice was mixed
overall, with several participants speaking of previous issues or disagreements
that led them to seek alternate care in A&E.</span></div>
<blockquote>
<i>“I’ll tell you when I got there I couldn’t breathe, I’ve got COPD, and the thing he said to me that the best thing to do was to go up to the moors, park car, and take a few deep breaths. And that night, ended up in hospital with a blood clot on the lung and pneumonia. That’s how good he [GP] were.”</i> – <b>Participant 1</b></blockquote>
<br />
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</div>
<div class="MsoNormal" style="line-height: 115%;">
<span lang="EN-US">Although opinions
of GP ability were mixed, there was generally a greater confidence in emergency
physicians.</span></div>
<blockquote>
<i> “I do like hospital because of all the equipment they have, everything right here. But when you come here it's like they know what they're doing more than other places” – </i><b>Participant 4</b></blockquote>
<br />
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</div>
<h4 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Choice
and External Influences on Agency</span></b></h4>
<div class="MsoNormal" style="text-indent: 0cm;">
<i style="mso-bidi-font-style: normal;"><span lang="EN-US">Individual
and external factors</span></i><span lang="EN-US"> is a looser association of
themes. This represents factors in the more immediate decision making process.
Anxiety and perceived severity of illness was cited by several participants,
and was an expected finding based on previous research. <span style="mso-spacerun: yes;"> </span>It was however, less prominent than
expected.<span style="mso-spacerun: yes;"> </span>Some patients expressed
uncertainty.<span style="mso-tab-count: 1;"> </span></span></div>
<blockquote>
<i>“I’m a little bit worried – do I need seeing to straight away?”</i> –<b> Participant 2</b><br />
<br />
<i>“Well I’m not quite sure… I don’t know 100% whether or not I should be in A&E. I don’t know if I qualify to be in A&E with my injury. Well I don’t know it’s not really an emergency. It is an accident though! But not an emergency. So I don’t know whether it was right to come to A&E” </i>– <b>Participant 13</b></blockquote>
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</div>
<div class="MsoNormal">
<span lang="EN-US">A number had been referred to go to A&E
by 111 and a similar number by friends, colleagues or informally by other
medical professionals. Interestingly a small but significant minority made an
informed choice based on convenience related factors, resulting in travelling not
insignificant distances past other A&E departments to reach their preferred
A&E department. </span></div>
<blockquote class="tr_bq">
<i>“Well yeah, I do actually live in Sheffield. I don't like the northern general it's always too busy… and it's a nightmare parking at the northern general isn't it?”</i> –<b> Participant 7</b></blockquote>
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</div>
<div class="MsoNormal">
<span lang="EN-US">One participant stated that Rotherham
A&E was their usual place of medical care. Participants were aware of
pressure on A&E departments and often had relatively detailed knowledge of locally
available services.</span></div>
<div class="MsoNormal">
<br /></div>
<h3 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Discussion </span></b><span lang="EN-US"></span></h3>
<h4 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Implications
for service delivery</span></b></h4>
<div class="MsoNormal">
<span lang="EN-US">This research builds on previous research
into patient decision-making in seeking A&E care and explores why patients in
a deprived population setting attend A&E in lieu of other health care
services for low urgency problems in-hours.<span style="mso-spacerun: yes;">
</span>Patients were unanimous in their perception that A&E is the best
place to attend for ease of access and availability of diagnostic
equipment.<span style="mso-spacerun: yes;"> </span>Patients perceived A&E as
a more ‘definitive’ option for care, implying that general practice was unable
to decisively attend to their complaints.<span style="mso-spacerun: yes;">
</span>This relates to the concept of convenience, which has strongly occurred
throughout the literature.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_3" title="Lowthian, 2010 #4"><span style="color: black; text-decoration: none;">3</span></a><span style="mso-no-proof: yes;"> </span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_13" title="Agarwal, 2012 #12"><span style="color: black; text-decoration: none;">13</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>What was distinct in this
research was the concept of <i style="mso-bidi-font-style: normal;">futility</i>
associated with GP attendance; many patients believed that they would have
ultimately been referred to hospital to either A&E or for investigations
available in A&E.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Anxiety and perceived severity were less
frequent complaints than expected; participants did not believe their problems were
emergencies.<span style="mso-spacerun: yes;"> </span>External sources of advice
appear to have played a part; some patients cited discussions with healthcare
professionals informally, or the 111 service.</span></div>
<div class="MsoNormal">
<span lang="EN-US">It is clear from the responses within the
study that A&E attendance in low-urgency patients is largely a logical and
considered choice, as it meets their perceived health needs with convenience. <span style="mso-spacerun: yes;"> </span>Although reasons for attending A&E varied
between participants, it was evident that most respondents had considered their
options before attending.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">In this sense A&E may be perceived to
be ‘a victim of its own success’.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_14" title="Khaldi, 2014 #15"><span style="color: black; text-decoration: none;">14</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> <span style="mso-spacerun: yes;"> </span>Confidence and positive
perceptions of the service may be increasing footfall through the service and
inadvertently decreasing use of other, more conventional means of non-urgent
healthcare for reasons that go beyond simple indecision/anxiety and access
issues.<span style="mso-spacerun: yes;"> </span>Public satisfaction with General
Practice, although high, has been on a downward trend for several years.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_15" title="Fund, 2015 #14"><span style="color: black; text-decoration: none;">15</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>It is possible that changing
perceptions between services are playing a role in demand. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Given that, from a patient perspective,
A&E is a logical and convenient choice, the very concept of “appropriateness”
around attendance is unhelpful <span style="mso-spacerun: yes;"> </span>as it suggests
patients are expected to make a decision on their care which physicians themselves
sometimes find difficult to explain, as discussed previously.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_6" title="Richardson, 2006 #6"><span style="color: black; text-decoration: none;">6</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>Furthermore, the very logic
of approaching the problem as one of “appropriateness” is fundamentally flawed.<span style="mso-spacerun: yes;"> </span>It is unreasonable to place the burden of
decision of choice on patients with no medical expertise and can lead to inequity
within the healthcare system.<span style="mso-spacerun: yes;"> </span>Such
opinions have been raised before,</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_14" title="Khaldi, 2014 #15"><span style="color: black; text-decoration: none;">14</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"> emphasizing the need for a patient-centered approach to health
service design.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">This research also helps explain why the extension
of primary care options has not demonstrably impacted demand.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_7" title="Ismail, 2013 #7"><span style="color: black; text-decoration: none;">7</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>Availability of primary care
may have some influence, but a majority appear to be deliberately seeking
A&E care for the clear benefits it brings.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">The role of 111 in referring patients unnecessarily
may need to be investigated further as 111 was a common source of referral of
low urgency patients to A&E.<span style="mso-spacerun: yes;"> </span>As 111
was introduced to provide advice to self-care and encourage alternatives to
A&E, this is a counterproductive outcome.<span style="mso-spacerun: yes;">
</span>This is consistent with available evidence which does not demonstrate
any reduction in A&E demand with 111 rollout.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_16" title="Turner, 2013 #13"><span style="color: black; text-decoration: none;">16</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">As many A&E departments integrate
primary care services into emergency departments this research demonstrates the
logic of this, from a patient perspective.<span style="mso-spacerun: yes;">
</span>A unified triage service between primary and emergency services may be necessary
as patients may, for various reasons, select emergency care in preference if
offered a choice.<span style="mso-spacerun: yes;"> </span>Future research into the
integration of primary care and emergency care services and research exploring
the organizational responsibilities and remit of each service within a shared
system is required.</span></div>
<div class="MsoNormal">
<br /></div>
<h4 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Limitations</span></b><span lang="EN-US"></span></h4>
<div class="MsoNormal">
<span lang="EN-US">Though the study appears to have captured a
largely low-urgency group of patients, it is not certain how generalizable
these answers may be to the broader population.<span style="mso-spacerun: yes;">
</span>Certain populations, specifically vulnerable groups such as pregnant
women and children, were excluded on ethical grounds and may have important
differences in their presentation factors which were not assessed here.<span style="mso-spacerun: yes;"> </span>Children may be an especially important source
of low-urgency demand, as has been suggested by others.</span><span lang="EN-US"><span style="mso-no-proof: yes;">[</span><a href="https://www.blogger.com/blogger.g?rinli=1&pli=1&blogID=4500610488944159179#_ENREF_17" title="Prince, 1992 #16"><span style="color: black; text-decoration: none;">17</span></a><span style="mso-no-proof: yes;">]</span></span><span lang="EN-US"><span style="mso-spacerun: yes;"> </span>Furthermore, this is a
single-centre study and the population captured here may not be generalizable
to the wider population, given the particular demographic features of this setting.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Finally, the findings must be interpreted
in the context where they were taken.<span style="mso-spacerun: yes;">
</span>The principle investigator is a physician who has previously worked in
the department.<span style="mso-spacerun: yes;"> </span>Participants were made
aware of this fact and may have spoken of A&E in a more positive light than
they would have otherwise.<span style="mso-spacerun: yes;"> </span>The authority
of the investigator may also have placed additional pressure on participants to
give socially desirable answers.</span></div>
<div class="MsoNormal">
<br /></div>
<h3 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Conclusion</span></b><span lang="EN-US"></span></h3>
<div class="MsoNormal">
<span lang="EN-US">Low urgency patients often choose A&E
due to perceived benefits in clinician quality, access and available diagnostic
equipment as well as other external influences and patient factors.<span style="mso-spacerun: yes;"> </span>Such patients may actively be choosing to
come to A&E for its perceived benefits and may not be dissuaded by the
offer of parallel services.<span style="mso-spacerun: yes;"> </span>This
research supports the logic of shared triage in the context of a joint primary
care-emergency service.<span style="mso-spacerun: yes;"> </span>The research
also implies difficulty in applying the Keogh report, as low urgency patients
may be less likely to seek care outside of an A&E setting. </span></div>
<div class="MsoNormal">
<br /></div>
<h3 class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Disclaimer</span></b><span lang="EN-US"></span></h3>
<div class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
<span lang="EN-US">This
study has received no funding and was undertaken in the context of a master’s
dissertation by Seth White supervised by Jo</span><span style="mso-ansi-language: EN-GB;"> Coster</span><span lang="EN-US"> at the University of Sheffield.<span style="mso-spacerun: yes;"> </span>There are no conflicts of interest.</span></div>
<div class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;">
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<h3>
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<h3>
<span lang="EN-US">References</span></h3>
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<br />
1. HSCIC. Accident and Emergency Attendances in England. 2001-2015 <br />
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2. Pines JM, Hilton JA, Weber EJ, et al. International perspectives on emergency department crowding. Academic Emergency Medicine 2011;18(12):1358-70 <br />
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3. Lowthian JA, Curtis AJ, Cameron PA, Stoelwinder JU, Cooke MW, McNeil JJ. Systematic review of trends in emergency department attendances: an Australian perspective. Emergency Medicine Journal 2010:emj. 2010.099226 <br />
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4. Benger J, Jones V. Why are we here? A study of patient actions prior to emergency hospital admission. Emergency Medicine Journal 2008;25(7):424-27 <br />
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5. Murphy AW. 'Inappropriate'attenders at accident and emergency departments I: definition, incidence and reasons for attendance. Family Practice 1998;15(1):23-32 <br />
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6. Richardson S, Ardagh M, Hider P. New Zealand health professionals do not agree about what defines appropriate attendance at an emergency department. The New Zealand Medical Journal (Online) 2006;119(1232) <br />
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7. Ismail SA, Gibbons DC, Gnani S. Reducing inappropriate accident and emergency department attendances. Br J Gen Pract 2013;63(617):e813-e20 <br />
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8. ONS. National Census, 2011.<br />
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9. Department for Communities and Local Government. Indicies of Multiple Deprivation, 2015.<br />
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10. Rotherham NHS Foundation Trust. Rotherham Emergency Centre - About Us. Secondary Rotherham Emergency Centre - About Us 2016.<br />
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11. NVIVO 11 for Windows [program], 2016.<br />
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12. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. The qualitative researcher’s companion 2002;573:305-29 <br />
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13. Agarwal S, Banerjee J, Baker R, et al. Potentially avoidable emergency department attendance: interview study of patients' reasons for attendance. Emergency Medicine Journal 2012;29(12):e3-e3 <br />
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14. Khaldi AWA. The NHS gets the A&E demand it deserves. Secondary The NHS gets the A&E demand it deserves 2014. https://www.hsj.co.uk/sectors/commissioning/the-nhs-gets-the-ae-demand-it-deserves/5070615.article.<br />
<br />
15. Fund TKs. Public Satisfaction with the NHS in 2015: Results and trends from the British Social Attitudes survey: The King's fund, 2015.<br />
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16. Turner J, O'Cathain A, Knowles E, Nicholl J. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study. BMJ open 2013;3(11):e003451 <br />
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17. Prince M, Worth C. A study of ‘inappropriate’attendances to a paediatric accident and emergency department. Journal of Public Health 1992;14(2):177-82 <br />
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e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comRotherham, UK53.4326035 -1.363500899999962753.356925 -1.5248623999999626 53.508282 -1.2021393999999628tag:blogger.com,1999:blog-4500610488944159179.post-4360660610411915182018-03-05T10:57:00.000+00:002018-03-05T15:52:16.866+00:00Implications for Health and Environmental Sustainability of Urbanisation and the Nutrition Transition: Perspectives from Rural and Urban Uganda<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOvDPGXu3JIHP_xDQJsneTqTm80lRGGUwupXKpgf2gB0lZTiNSHOrMyFgxMsbfPk6z_vWWErVodq8cr_TwBzeQl1Vpj0lQ_kXMDKWB1KNRei7KsdEXF8tcTbSYKrewqxHc9irrl2j0uZY/s1600/Auma+crop+photo.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="546" data-original-width="448" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOvDPGXu3JIHP_xDQJsneTqTm80lRGGUwupXKpgf2gB0lZTiNSHOrMyFgxMsbfPk6z_vWWErVodq8cr_TwBzeQl1Vpj0lQ_kXMDKWB1KNRei7KsdEXF8tcTbSYKrewqxHc9irrl2j0uZY/s200/Auma+crop+photo.jpg" width="163" /></a></div>
<span style="font-family: "verdana" , sans-serif;">Carolyn Imelda Auma began her studies at the University of Sheffield in September 2015 as a PhD student. Just before she commenced her studies at the University of Sheffield, she worked as part of a team of consultants that was involved in a multi-stakeholder review of the Uganda Development Strategy Investment Plan 2010/11-2014/15. Prior to this, she worked at the Food and Agricultural Organisation (FAO) Somalia in Nairobi, Kenya as an International Nutrition Analyst Intern for 6 months. Carolyn also previously worked as a Graduate Research Assistant at the School of Food Technology, Nutrition and Bio-engineering at Makerere University for about two years, upon the completion of her undergraduate degree. Aside from this, she has volunteered as a researcher at the School of Food Technology, Nutrition and Bio-engineering at Makerere University, National Crops Resources Research Institute (NaCRRI) and National Agricultural Research Institute (NARI), Biosciences Department, all in Uganda. She holds a BSc. in Food Science and Technology (First Class Hons.) from Makerere University, Uganda and MSc. International Public Health Nutrition (Distinction) from the University of Westminster. <br /><br /><b>Abstract</b><br /><br /><b>Introduction</b><br />As urbanisation increases in sub-Saharan Africa, dietary changes consonant with the nutrition transition are likely to occur. These may have implications for both health and environmental sustainability. Some authors have suggested that younger women, particularly low-income women in sub-Saharan Africa, are more vulnerable to dietary changes compared with men of a similar age. <br /><br /><b>Aim</b><br />To explore the dietary practices among rural and urban women of reproductive age in Uganda; the social, cultural and physical influences behind them and the implications thereof for environmental sustainability in order to propose an acceptable, affordable, healthy and environmentally sustainable diet adaptable to the Ugandan context. <br /><br /><b>Methods</b></span><br />
<span style="font-family: "verdana" , sans-serif;">To explore dietary practices and the healthiness and environmental sustainability of these dietary practices, principal component analysis of secondary data from the 2008 Uganda Food Consumption Survey will be used. This will be coupled with primary data collected via qualitative 24-hour recall interviews and Photovoice interviews among rural and urban Uganda women (n=54) of reproductive age. To explore the influences behind the dietary practices of Ugandan women of reproductive age, Photovoice will be used. Lastly, to propose an acceptable, affordable healthy and an environmentally sustainable Ugandan diet, OptiFood a software programme that uses mathematical modelling, will be used.<br /><br /><b>Expected outcomes</b><br />It is anticipated that this research will shed light on dietary practices of Ugandan women and the influences behind them, and so encourage discourse among public health practitioners and policy makers towards more healthy and environmentally sustainable dietary patterns.</span><br />
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A copy of Carolyn's poster for the Grantham Symposium can be seen here:<br />
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<a href="https://drive.google.com/open?id=0B_M7McCAtGVteDNBZ0h0eEdNNE9OVlVYUU5KakhwdTFaT2kw">Poster: Implications for Environmental Sustainabilty of Urbanisation and the Nutrition Transition: Perspectives from Rural and Urban Uganda</a></div>
</span>e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-18973675500858016482018-03-05T10:30:00.000+00:002018-03-05T14:43:06.588+00:00Qualitative Investigation of the Wellness Recovery Action Plan in a UK NHS Crisis Care Setting<div>
The following article was published in the Journal Issues In Mental Health Nursing and can be reached via the following link.</div>
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<b>Publisher weblink</b>: http://www.tandfonline.com/doi/full/10.1080/01612840.2017.1300840</div>
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Since studying at ScHaRR Michael has been promoted within the NHS, is working part time in research for The University of Birmingham, and is also working as a visiting lecturer at Sheffield Hallam University.</div>
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<b>Abstract</b><br />
Crisis theory suggests that in addition to presenting a threat to mental well-being, crises are also opportunities where successful interventions can lead to successful outcomes. UK mental health crisis teams aim to reduce hospital admission by treating people at home and by building resilience and supporting learning from crisis, yet data on repeat crisis episodes suggest this could be improved. This qualitative study sought to explore the Wellness Recovery Action Plan (WRAP) as a means of supporting resilience-building and maximising the opportunity potential of crisis. The following themes emerged: The meaning of crisis; Engaging with the WRAP process; WRAP and self-management; and Changes and transformations. This research suggests that WRAP has potential in supporting recovery from crisis, revealing insights into the nature of crisis which can inform the further development of crisis services.<br />
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<b>Author details</b><br />
Michael Ashman, Lived Experience Development Worker, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust; former Master of Public Health student, The School of Health and Related Research, the University of Sheffield.</div>
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Vanessa Halliday, Senior Lecturer, The School of Health and Related Research, The University of Sheffield, Sheffield. <br />
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Joseph Cunnane, Consultant Psychiatrist, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust. </div>
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<b>Citation</b><br />
Ashman, M., Halliday, V., & Cunnane, J.G., (2017). Qualitative Investigation of the Wellness Recovery Action Plan in a UK NHS Crisis Care Setting. Issues In Mental Health Nursing. 2017, VOL. 38, NO. 7, 570–577. <br />
<b>doi</b>: 10.1080/01612840.2017.1300840. Published online: 18 Jul 2017<br />
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e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-72449020190752946522017-03-06T11:53:00.000+00:002018-03-05T14:40:24.313+00:00A systematic review of barriers to and facilitators of physical activity for people with autism spectrum disorder<b style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"></span><span style="background-color: white; clear: left; color: black; float: left; font-family: "arial"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; margin-bottom: 1em; margin-right: 1em; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="176" src="https://lh5.googleusercontent.com/C924Rj8ER5_f7TZnzgF0Xq1fJ3r-pwAvC4US9Hk7NNCYMrtoFPoAUW5673kJJffB74yILL4VhJKXC5OHG0M0iSL3jy660T4DFBZ2FG5E5fGOA_RFHGreg9MO8hLf1uftFlyXcr6n6jXK5LCfDQ" style="border-image: none; border: medium; transform: rotate(0rad);" width="176" /></span></b><span style="font-family: "verdana" , sans-serif;">Liam graduated from the Master of Public Health (MPH) programme at ScHARR in 2016 with Distinction. He decided to study for an MPH because he wanted to develop the skills he had learnt in his undergraduate psychology degree in public health research, a field of study that combined his interests in biology, sociology and medicine at a population level. Throughout the programme, Liam was able to advance his knowledge of statistics and health psychology, while learning completely new skills in epidemiology, disease control and systematic reviewing. He also worked outside the taught modules as Vice-President of the Public Health Society, where he was primarily responsible for planning activities and events for students on the programme. Liam is currently working as a Research Assistant at the University College London Research Department of Primary Care and Population Health. He is working on a project exploring factors influencing STI testing behaviour of young people in the UK, using a theory-based online questionnaire.</span><br />
<span style="font-family: "verdana" , sans-serif;"><b><br />Abstract </b><br /> <br /><b>Background</b></span><br />
<span style="font-family: "verdana" , sans-serif;">Autism spectrum disorder is a lifelong neurodevelopmental disorder that affects people of all ages and across cultures. It is believed that autism spectrum disorder can contribute to lower levels of physical activity in people with the condition. Interest in the factors mediating this relationship has increased in recent years.<br /><br /><b>Aim</b></span><br />
<span style="font-family: "verdana" , sans-serif;">To identify the barriers to and facilitators of physical activity for people with autism spectrum disorder.<br /><br /><b>Design</b></span><br />
<span style="font-family: "verdana" , sans-serif;">Systematic review.<br /><br /><b>Data Sources</b></span><br />
<span style="font-family: "verdana" , sans-serif;">ASSIA, ERIC, MEDLINE, PsycINFO, Social Care Online, Web of Science, IBSS, LISA PEI, Social Services Abstracts, Sociological Abstracts and NAS Library Catalogue. Hand searching of reference lists of identified articles was also conducted.<br /><br /><b>Eligibility Criteria</b></span><br />
<span style="font-family: "verdana" , sans-serif;">Journal articles published in the English language from 1943 to March 2016. Journal articles were required to contain qualitative data relating to physical activity in people with autism spectrum disorder.<br /><br /><b>Results</b></span><br />
<span style="font-family: "verdana" , sans-serif;">Seventeen studies were included in the data synthesis. Most of the barriers and facilitators were labelled as either personal, social, environmental or policy and programme related. Using physical activity to reduce social stress was also a facilitator of physical activity.<br /><br /><b>Conclusions</b></span><br />
<span style="font-family: "verdana" , sans-serif;">Results from this synthesis can inform interventions and policies to encourage people with autism spectrum disorder to engage in physical activity. Further qualitative research would be beneficial to developing a more accurate picture of barriers and facilitators relevant to adults with autism spectrum disorder.<br /><br /><br /><br /><br /><br /><br /> </span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />e journal editorhttp://www.blogger.com/profile/12944376088910559347noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-22063280960093999892016-11-30T13:58:00.001+00:002016-11-30T14:00:06.568+00:00The role of information and communication technologies in health system resilience after the 2015 Nepal earthquake<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjda8dqbjPuzvZ2LLE5JeVaTU6NorOS_S6Tp8kMUkIu-LZXdsryml1st8IygAHIQFMBTMkCJ95xSG4Y2FQkZcl0JDUOgqeyOBhI-KZZnlvFQ1LtG7TR6sv9DV4BRCcbPtPM9ELIfrw2-DA/s1600/photo1+%25282%2529.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjda8dqbjPuzvZ2LLE5JeVaTU6NorOS_S6Tp8kMUkIu-LZXdsryml1st8IygAHIQFMBTMkCJ95xSG4Y2FQkZcl0JDUOgqeyOBhI-KZZnlvFQ1LtG7TR6sv9DV4BRCcbPtPM9ELIfrw2-DA/s200/photo1+%25282%2529.jpg" width="140" /></a></div>
Olivia Crane graduated from the Master of Public Health (MPH) programme at ScHARR in 2016. She applied for the programme after deciding on a career change away from Communications in the private sector, towards Public Health. The Masters programme built on her background in anthropology and gave huge new insight into the links between health systems and the ways people live and organise themselves socially.<br />
Since graduating from the MPH programme, Olivia has started working with the Public Health Guidelines department at the National Institute of Health and Care Excellence (NICE) as an Assistant Technical Analyst. The skills she learnt during the programme were invaluable in opening up this opportunity!<br />
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The title of Olivia's dissertation project was '<b>The Role of Information and Communication Technologies in Health System Resilience after the 2015 Nepal Earthquake' </b></div>
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The project was offered through a research attachment to staff from ScHARR and the Department of Politics, Dr. Julie Balen and Dr. Simon Ruston respectively. The time Olivia spent living in Nepal as a child for 6 years gave her both a passionate interest in the country, and some useful background understanding of language and culture.</div>
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<b>Background: </b>Information and Communication Technologies (ICTs) are increasingly recognised for their important role, and even greater potential in mitigating, preparing for, responding to, and recovering from natural disasters. However, to date, the vast majority of research into their use in disasters has been conducted in high-income country settings. This research should be expanded into low- and middle-income countries, particularly as vulnerability to natural disasters increases with poverty. Here the role of ICTs during a series of earthquakes that occurred in Nepal in April 2015 is explored.</div>
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<b>Methods: </b>In depth semi-structured interviews (n=24) and focus groups (n=4) were conducted in March and April 2016, almost one year post-earthquake. Data collection took place in three settings, namely (i) at village level in Barpak, the epicentre of the earthquake; (ii) at district level in Gorkha, the capital of the district in which Barpak is situated; and (iii) at central level in Kathmandu, the capital city of Nepal. Participants were individuals affected by the earthquake, and those in formal health system roles as well as informal grassroots responders. Data was recorded, professionally translated and transcribed, and underwent thematic analysis using NVIVO 11.</div>
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<b>Results: </b>Perceptions of the role of ICTs and their value varied greatly between groups. While access and capability were found to be key barriers to use rurally, ICTs formed a greater part of the response in urban settings. This was particularly true for the informal response, which relied on ICTs for networking and coordination. The response of the formal health system lagged behind in terms of ICTs, generally relying more upon traditional methods of disaster management. Preparation was severely lacking in all areas, including communication planning.</div>
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<b>Conclusions: </b>The findings of this study indicate that the complex problems of access and capability remain key barriers to ICT use in Nepal, as seen in other low-income country literature. It demonstrates the potential of ICTs for giving people voice, and in developing community intelligence for the benefit of affected groups as well as for the information of decision makers within the formal system. It also reveals the scope for increased connectedness between the formal health system and the informal health system response, which currently operate separately but with many of the same aims.</div>
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-17343364928724218782016-11-17T11:21:00.002+00:002016-11-17T11:21:12.072+00:00Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3KdLYih5fEb0-XbZ2V1maw9z8nnK1N2iaDBXo0a0oR7cHgbi-QAHwl286PNfgleI8b9yUxU_fYUXA9egyP4Hy5JmftFHENGGYg_ZC-p2WcAw0MFQLJyFbcB2yIRxgbB6XG82p3aUmZ-U/s1600/IMG_20160405_161036.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3KdLYih5fEb0-XbZ2V1maw9z8nnK1N2iaDBXo0a0oR7cHgbi-QAHwl286PNfgleI8b9yUxU_fYUXA9egyP4Hy5JmftFHENGGYg_ZC-p2WcAw0MFQLJyFbcB2yIRxgbB6XG82p3aUmZ-U/s200/IMG_20160405_161036.jpg" width="200" /></a></div>
Simbiat Olayinka Lawal recently completed the Master of Public Health (MPH) programme at ScHARR. Simbiat chose to study the MPH to gain more knowledge on the role of healthcare policy and management and also to develop her research skills, especially in health services research. In particular, the course developed Simbiat's knowledge of healthcare financing systems and enabled her to develop and refine her research skills. Taking part in the MPH program at ScHARR also equipped Simbiat with several other skills such as team work, time management and an ability to strive. Simbiat believes that the new skills she has obtained from studying the MPH will enable her to work in a role that will help Africa, and particularly her home country, Nigeria, to achieve universal health coverage and health equality as well as working towards sustainable development goals. In the future, Simbiat plans to pursue a doctorate degree in public health policy and management, alongside conducting research into the Nigerian healthcare system.<br />
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The title of Simbiat's dissertation project was: <b>Universal health coverage in developing countries and its impact on improving access to antenatal care and maternal health outcomes: A systematic review.</b><br />
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<b>Abstract</b><br />
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<b>Background:</b> Universal health coverage (UHC) refers to equal access to healthcare services across all socio-economic quintiles and reduction in financial risk incurred from the utilisation of health services. It is an important goal which would help reduce maternal mortality rates. However, the effectiveness of different healthcare financing (UHC) schemes on improving access and utilisation of maternal health services and on selected pregnancy outcomes amongst women of different socio-economic, educational and residential (rural or urban) backgrounds in developing countries, is not well understood.<br />
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<b>Aim:</b> This study aimed to examine the utility of UHC in improving access, utilization and pregnancy outcomes in women in developing countries.<br />
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<b>Method:</b> A systematic literature review was performed to answer the research question. Electronic databases; Medline, ASSIA, Cochrane library, TRIP, PubMed REMINER, CINAHL and Google scholar were used to retrieve all relevant studies on universal health coverage. Also, references of included studies and online resources of organisations such as WHO, UN and WORLD BANK were also searched to avoid omission of important literature. The inclusion and exclusion criteria were developed using the PICO (population, intervention, comparator and outcome) framework.<br />
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<b>Result:</b> A total of 13 studies were included in the review; of which 2 studies were from Bangladesh, 6 from Ghana, 1 from Uganda, 1 from Congo and 3 studies from two or more of the following countries: - (Ghana, Rwanda, Philippines, Senegal and Mali). There was a positive association between UHC and improved access, utility of antenatal health services and better increased access to emergency obstetric care (e.g. C-sections) despite women socioeconomic status, educational and residential (rural and urban) backgrounds: Antenatal health care (three to four or more ANC visits); NHIS (OR=1.182, p=0.05, OR=1.09, p=<0.01), other insurance (OR=2.37, p=<0.05 and OR=2.41, p=<0.05), voucher (OR=2.787, p=<0.001, OR=1.913, p= ≤0.001, (OR=0.2855, p=<0.001). Delivery at a healthcare facility; free delivery policy increased facility delivery by 2.3%, p=0.015, CI 0.50-4.05, NHIS policy increased facility delivery by 7.5%, p= ≤0.001, CI 4.97-9.92, other insurance coverage (e.g. CBHI) (OR=4.74, p= <0.10), and vouchers (OR=2.539, p= ≤0.001). Births attended by a skilled birth attendant; free delivery policy (OR=1.67, p= <0.01), NHIS policy (OR=1.65, p =<0.01 and OR=1.375, p=0.05), other insurance policy (free ANC policy) (OR=1.17, p= <0.01) and voucher scheme (OR=3.582, p= ≤0.001) and (OR=0.2119, p= <0.001). Emergency obstetric care (e.g. C-section); Fee exemption (OR=0.329, p= <0.0001), other insurance OR=1.13 vs. OR=1.26, p=<0.001, vouchers (OR=1.536, p= <0.01).<br />
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<b>Conclusion:</b> Universal health coverage through various strategies, if implemented adequately, sufficiently increases the utilization of maternal health care services. More women on UHC received emergency obstetric care such as C-section than those without. Future studies should endeavour to examine whether these benefits spill over to reducing maternal mortality. There should also be efforts to find out the barriers to universal adoption of UHC policies by developing countries, such as sources of funding, suitability of different policies in different developing economies.<br />
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-12800078664499267202016-10-20T15:10:00.000+01:002016-10-20T15:10:15.500+01:00Food insecurity and social support among Ghanaians living in Greater Manchester, UK: A qualitative study<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUhBJpyjGhZdlZJ7IhkJbj4jugUVGkopI2YVvf2DETjA9gWwc5tPc8qegasCsUgdPoT4pxRbjZKWPvn8ATjsNhouMzu72MP-94kZx2B1DxoIaRO0EG4Rpp-PO5ZX359hnl8WqWntJ7FBk/s1600/Hibbah.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUhBJpyjGhZdlZJ7IhkJbj4jugUVGkopI2YVvf2DETjA9gWwc5tPc8qegasCsUgdPoT4pxRbjZKWPvn8ATjsNhouMzu72MP-94kZx2B1DxoIaRO0EG4Rpp-PO5ZX359hnl8WqWntJ7FBk/s200/Hibbah.png" width="164" /></a></div>
Hibbah Araba Saeed joined the University of Sheffield in October 2013, as a PhD student at the School of Health and Related Research, Section of Public Health. Prior to starting her PhD, Hibbah worked as a Research Assistant at the Noguchi Memorial Institute for Medical Research, Ghana.<br />
Hibbah's PhD research is on Determinants of Dietary Behaviour among Ghanaians living in the United Kingdom. The research adopts a mixed method research approach to explore the determinants of dietary behaviour, dietary change following migration and household food insecurity among Ghanaians living in the United Kingdom. This article presents the findings from the qualitative aspect of the study.<br />
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<b>Food insecurity and social support among Ghanaians living in Greater Manchester, UK: A qualitative study</b><br />
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<b>Abstract</b><br />
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<b>Background: </b>In the UK, minority ethnic groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored perceptions of three main components of food insecurity (availability, accessibility, utilization) among Ghanaians. The role of social support in enhancing food security was explored to identify potential coping mechanisms for food insecure households.<br />
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<b>Methods:</b> We conducted 29 in-depth interviews using purposive sampling among Ghanaians aged ≥25yrs living in Manchester. Participants varied in socioeconomic status, gender and migration status. Utilizing a framework analysis approach, we analysed themes using the three main components of food security and also generated new themes from the data.<br />
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<b>Findings:</b> Overall, participants did not describe their personal experiences of food insecurity but some identified that food insecurity existed among Ghanaians in the community. Participants reported that food insecure household may be reluctant to make use of food banks because of pride/perceived social stigma. Also the type of foods served were considered culturally unappealing. This reluctance does not extend to close and trusted networks including the church. Within the church, people have trusted allies that they engage with for specific needs including financial support when needed.<br />
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<b>Conclusion</b>: Our analysis suggests that the church context forms a trusted base in which people operate. We recommend that to be able to reach the most deprived among the Ghanaian community, churches could be used as a channel for interventions.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilfh3hB65nACOVXJD3u12yn98dYonsveIt0lt2i6nBkl2YVFEIs8I7DUiNvVR7db-ZQ5K8_roA-iubFxmigmb-skxBhN2_NbBH_cnhJ5APGDutKUiBw-M9qQ2rfxiLXmrKXW-HuM0DqdQ/s1600/Hibbah+poster.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilfh3hB65nACOVXJD3u12yn98dYonsveIt0lt2i6nBkl2YVFEIs8I7DUiNvVR7db-ZQ5K8_roA-iubFxmigmb-skxBhN2_NbBH_cnhJ5APGDutKUiBw-M9qQ2rfxiLXmrKXW-HuM0DqdQ/s320/Hibbah+poster.PNG" width="224" /></a></div>
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<a href="https://drive.google.com/file/d/0B_syg_iyYpBkb2ZHS1BpQy02Qnc/view?usp=sharing" target="_blank">Click here</a> to view a poster about Hibbah's qualitative research studyAnonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-23226485496244861142016-10-05T11:24:00.001+01:002016-10-05T11:26:26.825+01:00Reasons for Variation in the Effectiveness of Cognitive Behavioural Therapy in Physiotherapy Management for Chronic Low Back Pain <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitzzv4q-AbynufE-cCvu0VUKckul1E73739TMB5IGtQyVTM0SLaIPvjwulATwE3A20YaJ87zA_pmJPSAMCzsMD7wW668_CRe7GKXU9Dee4lukVh6IxC5QMJvl2qNtiQdHHArPY52hzapI/s1600/LAlenezi.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitzzv4q-AbynufE-cCvu0VUKckul1E73739TMB5IGtQyVTM0SLaIPvjwulATwE3A20YaJ87zA_pmJPSAMCzsMD7wW668_CRe7GKXU9Dee4lukVh6IxC5QMJvl2qNtiQdHHArPY52hzapI/s200/LAlenezi.PNG" width="174" /></a></div>
Latifa AlEnezi qualified as a physiotherapist in 2007 at the Kuwait University, following which she worked as a clinical physiotherapist. In 2011 she was awarded a scholarship from the Kuwait Government to study for a MSc in Applied Physiotherapy at Sheffield Hallam University. Latifa is now studying for a PhD at ScHARR, University of Sheffield. Her main research interests are in musculoskeletal physiotherapy, pain management and self-care. The subject of Latifa's PhD is the use of cognitive strategies in supporting the management of chronic musculoskeletal pain.<br />
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<b>Reasons for Variation in the Effectiveness of Cognitive Behavioural Therapy (CBT) in </b><b>Physiotherapy Management for Chronic Low Back Pain (CLBP): </b><b>Mixed Methods Systematic Review</b><br />
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<b>Abstract</b><br />
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<b>Background:</b> Chronic Low Back Pain (CLBP) is one of the most common and recurrent musculoskeletal problems that causes patients to frequently access healthcare services. The Bio-psychosocial model emphasizes that psychological, behavioural and social factors contribute to the development and persistence of CLBP. Cognitive behavioural therapy (CBT) is a psychological pain management strategy that can be used by physiotherapists treating CLBP. However, the effectiveness of CBT for CLBP varies between different studies.<br />
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<b>Objectives</b><br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>To identify studies exploring or explaining the process of implementing CBT in physiotherapy management for CLBP.<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>To explore the reasons of variation in the effectiveness of CBT.<br />
•<span class="Apple-tab-span" style="white-space: pre;"> </span>To identify knowledge gaps in this area.<br />
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<b>Methods:</b> Quantitative, qualitative or mixed methods studies using CBT to manage CLBP patients were searched systematically until May 2014. The electronic search was done using the following databases CINAHL plus full text, MEDLINE via Ovid, Cochrane library, Scopus, Pub Med, Web of science, ASSIA and Psych info. All full text studies published in peer review journals were assessed for eligibility. Data extraction was based on population, intervention, comparison and outcome (PICO). Methodological quality and clinical relevance of included studies were assessed.<br />
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<b>Results:</b> Thirty- seven studies were included. There were 36 quantitative studies, and one qualitative study as part of a mixed methods study. A qualitative (narrative) analysis was considered due to lack of homogeneity among studies. The majority of studies (24 of 37 studies) had high methodological quality and were considered of moderate -to- high clinically relevance.<br />
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<b>Conclusion:</b> Studies were so heterogeneous it was not possible to account for differences in treatment effect. Key differences between studies were study design, setting, and outcome measures. There were no qualitative studies exploring how CBT is effective for CLBP or explaining the reasons for variation in CBT effectiveness. Further research is required to explore perceptions of CBT in physiotherapy.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiecRV-Cn89LrvuS3A2p9IEPpcp3s4WequBo7OXPq18eJafAZ4mLMBJkNqXtU8hYcL3XsTNIEEUibmTKWkW7iEn_gLFWaPEksSH0AyN_SvEDRdivvXlts-B9HEy4AgCwlTDveJ_68IToO8/s1600/poster_Latifa.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiecRV-Cn89LrvuS3A2p9IEPpcp3s4WequBo7OXPq18eJafAZ4mLMBJkNqXtU8hYcL3XsTNIEEUibmTKWkW7iEn_gLFWaPEksSH0AyN_SvEDRdivvXlts-B9HEy4AgCwlTDveJ_68IToO8/s200/poster_Latifa.PNG" width="200" /></a></div>
<a href="https://drive.google.com/file/d/0B_syg_iyYpBkcWxWdVRwQlRwUGs/view?usp=sharing" target="_blank">Click here</a> to view a poster about Latifa's research<br />
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-25248791764004800322016-07-19T14:57:00.001+01:002016-07-19T14:57:54.457+01:00A Mixed Method Investigation of Knowledge Sharing in Cross-Professional Teams in Healthcare-Research Methodology Review<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGArBZ2snA2h1oQfMbrWdmSz5ztcV9mlur6limvHEpXR7Yk70XM4xW-C4j0TtkhFLXd87O4IHUU790BfCB9Up4tkS6IimtS2OnbsZMvlHgj0Z7lJuYuyXMJHwGHNsgeg5apJq5bEqdLIw/s1600/579364_474705209274158_2096196481_n%25281%2529.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGArBZ2snA2h1oQfMbrWdmSz5ztcV9mlur6limvHEpXR7Yk70XM4xW-C4j0TtkhFLXd87O4IHUU790BfCB9Up4tkS6IimtS2OnbsZMvlHgj0Z7lJuYuyXMJHwGHNsgeg5apJq5bEqdLIw/s200/579364_474705209274158_2096196481_n%25281%2529.jpg" width="150" /></a></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;">Affra Al Shamsi graduated with distinction from her MSc in Information Management
at Sheffield University, and started her PhD studies at Sheffield’s School of
Health and Related Research (ScHARR) in March 2014. She was award her
Postgraduate Higher Diploma in Medical Librarianship with distinction from
Sultan Qaboos University (Oman), and holds a BSc in Chemistry from UAE
University. Affra is an interdisciplinary scholar both professionally and
academically, and her particular areas of interest include interdisciplinary
research, learning and teaching, knowledge sharing patterns and behaviour,
individual behaviour within teams, EBP (evidence based practice), mixed methods
research, multimodal approaches in research and teaching, systematic reviews,
public engagement, and research for impact.<o:p></o:p></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;">Affra is passionate about finding innovative and creative ways to bring
research and learning closer to the public. She is working in collaboration
with several public engagement groups, aiming to raise awareness of research
for impact, public involvement and engagement to PGR students. She also has special interest in teamwork and
improving individual team working skills, with an emphasis on healthcare. She
has developed a Masterclass for 4th year medical students designed to help
integrate their theoretical learning with clinical practice on ‘Communication
and Collaboration among Cross Professional Teams’ (MBChB Masterclass Integrated
Learning Activity (ILA)) which she will deliver in August. Affra was the 2009
Yale University International Associate, where she identified approximately
$60,000 in medical library cost savings for 2010.</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif; font-size: 10.5pt;"><o:p></o:p></span></div>
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<span style="background-color: transparent;"><span style="font-family: Verdana, sans-serif;">The title of Affra's PhD project is <b>'Incorporating a Knowledge Management Paradigm into Healthcare: A Mixed Method Investigation of Knowledge Sharing in Cross-Professional Teams in Healthcare' </b> </span></span></div>
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<span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;"><b>Abstract</b></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;"><br /></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;">This investigation maps the intersections
between teamwork and knowledge sharing (KS) within healthcare, aiming to
reconcile practice and evidence. <o:p></o:p></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;">It employs a pragmatic epistemology along with
mixed methods (MM), as the research focuses on the human factor in tacit KS
(communication, perceived ideas, practices, etc.,) on an individual and group
level within healthcare teams, to deepen our understanding of factors that
increase or lessen healthcare professionals’ tendencies to engage in KS
behaviours. <o:p></o:p></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;">This inductive-driven investigation is built on
predominantly qualitative research approaches involving a quantitative
component. Qualitative methods are best to identify an ‘unknown’ phenomenon
(tacit KS behaviours within healthcare cross-professional teams) and consider
potentially influencing factors. The research will offer a holistic
understanding through a literature review and document analysis (both
qualitative and quantitative), followed by a mixed method systematic review
(MMSR), interviews and focus groups, to explore participant views and identify
variables associated with KS in healthcare teams. The quantitative component,
primarily the questionnaire, will examine the relationships among the variables
identified during the previous phases, and the statistical data will allow for
replication and generalisation of data. The MMSR framework will be used to
analyse qualitative data, with emerging themes used to enhance, develop or
group questions in the survey. This holistic approach will bring together all
qualitative and quantitative data collected to develop the final instrument of
the survey. <o:p></o:p></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #333333; font-family: Arial, sans-serif;">This research methodology is innovative in its
scope and complexity. A review of current literature on MM highlights that
different types of data collected are usually triangulated rather than mixed or
integrated. Importantly, this MM research uses a combined approach throughout
the research methodology. It builds a solid framework to assist in combining
qualitative and quantitative methodologies, and adds rigor through integrating
MM in both data collection and analysis, adding unique and new knowledge in
this field. </span></div>
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<a href="https://drive.google.com/file/d/0B_syg_iyYpBkb1pSWmVrRFFpMmM/view?usp=sharing" target="_blank">To view a poster about Affra's research click here</a></div>
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<a href="http://www.sheffield.ac.uk/scharr/sections/heds/staff/shamsi_a" style="font-family: Arial, sans-serif;" target="_blank">To read Affra's student profile click here</a></div>
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-56301239651108739452016-06-20T15:08:00.000+01:002016-06-20T15:08:01.279+01:00Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity<div class="separator" style="clear: both; text-align: center;">
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In January 2014, Emma Howard-Drake graduated with distinction from the Master of Public Health (MPH) Management and Leadership. Alongside academic study, Emma has worked since 2011 as a public health specialist in a local authority.Both professionally and academically, Emma’s particular areas of interest and specialism include obesity, diet and physical activity in children and young people. In October 2014, Emma was awarded a Faculty Scholarship to undertake a mixed methods PhD in ScHARR, enabling her to build on the research undertaken during the MPH. In August 2016 she is planning to join the East Midlands Public Health training programme.<br />
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Emma’s MPH dissertation focused on exploring the perspectives of primary school headteachers on the barriers and facilitators of preventing childhood obesity. Along with her co-author, Emma's research has been published in the Journal of Public Health.<br />
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<a href="http://jpubhealth.oxfordjournals.org/content/38/1/44" target="_blank">Citation: Howard-Drake, E and Halliday, V (2015) Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity (1): 44-52.</a><a href="http://jpubhealth.oxfordjournals.org/content/38/1/44" target="_blank">doi: 10.1093/pubmed/fdv021</a><br />
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<b>Abstract</b><br />
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<b>Background:</b> Headteachers of primary schools in England are a crucial partner for childhood obesity prevention. Understanding how this works in practice is limited by their views being underrepresented or missing from the evidence base. The aim of this study was to explore primary school headteachers' perspectives on childhood obesity and the perceived barriers and facilitators of prevention.<br />
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<b>Methods:</b> A qualitative study with a purposive sample of 14 primary school headteachers from the Yorkshire and Humber region of England was conducted. Semi-structured interviews were audio-taped, transcribed and analysed using an inductive thematic approach.<br />
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<b>Results: </b>An extensive range of barriers and facilitators emerged within four key themes; understanding childhood obesity, primary school setting, the role of parents and external partners. A lack of knowledge, awareness and skills to deal with the sensitivity and complexity of childhood obesity across all school stakeholders presents the most significant barrier to effective action.<br />
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<b>Conclusions:</b> Headteachers recognize primary schools are a crucial setting for childhood obesity prevention; however their school's often do not have the capability, capacity and confidence to make a meaningful and sustainable impact. To increase headteachers' ability and desire to prevent childhood obesity, schools require specialist and tailored training, resources and support from external partners such as public health teams and school nursing services.<br />
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<br />Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-74587507316266003082016-05-18T15:42:00.000+01:002016-05-18T15:44:04.129+01:00The Support Needs of People Following Bariatric Surgery in the UK<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBsoFl_rG_kbM9ixUajmYFp0b3jYglC1R8EUNz5p3BixPUP9-qO6DPZCqOwEnaX60d8WeF50bQOsFdjoiPmi3jkD8AMuXTv9zP0RQdMmhcXKGibpBbodKd44EYLLWkZ-efL01pScHHtUE/s1600/NWalker.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBsoFl_rG_kbM9ixUajmYFp0b3jYglC1R8EUNz5p3BixPUP9-qO6DPZCqOwEnaX60d8WeF50bQOsFdjoiPmi3jkD8AMuXTv9zP0RQdMmhcXKGibpBbodKd44EYLLWkZ-efL01pScHHtUE/s200/NWalker.png" width="163" /></a></div>
Nerissa Walker graduated from the MSc in Clinical Research at the School of Health and Related Research (ScHARR) in January 2016 with merit. Nerissa qualified as a dietitian in 1999, her current role for the past 15 years has been at Sheffield Teaching Hospitals NHS Foundation Trust as a Specialist Dietitian for Bariatric Surgery & Complex Obesity. Nerissa decided to do the MSc in Clinical research to further her research career opportunities within bariatric and dietetic clinical research, locally and nationally. Since graduating she hopes to use the knowledge and skills that she developed to undertake local and national research projects in bariatric surgery and obesity which will benefit patient care and clinical services.<br />
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The title of Nerissa's dissertation project was <b>'The Support Needs of People Following Bariatric Surgery in the UK'</b>.</div>
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<b>Background </b>Previous studies have shown how<b> </b>support following bariatric surgery (BS) may influence outcomes such as weight loss. <b> </b>UK bariatric policies and guidance recognise the need and requirement of bariatric clinical services (BCS) to provide multidisciplinary team support and patient support groups following BS. <span lang="EN-US">It is currently unknown if people who have had BS and live in the UK feel their support needs are being met following BS or what types of support people need. This study aimed to investigate the support needs of people living in the UK and who have had BS.<b> </b></span></div>
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<b>Methods </b><span lang="EN-US">The study had a cross-sectional, non-experimental survey design. The target population was adults who lived in the UK and who had a BS procedure. The survey was distributed via bariatric patient and professional networks throughout the UK and self-completed online. Descriptive and inferential statistics were used to analyse the data<i>.</i><b> </b></span></div>
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<b>Results </b><span lang="EN-US">283 participants completed the survey. Time since surgery varied with just over half (54%) being > 2 years. The majority were NHS funded (80%) and had undergone gastric bypass surgery. 70% of participants felt that overall, their support needs had not been fully met following BS and given the opportunity, most (68%) would choose to continue with formal support from their BCS after 2 years. Those who were > 2 years following BS were less likely to have their support needs met compared to those < 2 years (<i>p</i> = <0.001). They were also increasingly likely to use informal types of support such as online forums. Having a gastric band was also associated with being less satisfied with support received compared to those who had a gastric bypass (<i>p</i> = 0.03). Eating behaviours such as cravings, binge eating and avoiding eating was reported to require the most support (26%), followed by diet and nutrition (17%) and excess skin (17%). </span></div>
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<b>Conclusion</b> <span lang="EN-US">Results of this survey suggest that the majority of people in the UK who have had BS do not feel that their support needs have been met. Given our understanding of how support can positively impact on longer term health, particularly for those 2 years post procedure or with a gastric band, outcomes and patient experience could be improved. A review of the support that is currently provided in the UK to patients that had BS is warranted. </span></div>
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<a href="https://drive.google.com/file/d/0B_syg_iyYpBkSDNyMHdZWXFJcUU/view?usp=sharing" target="_blank">To view a poster about Nerissa's research click here.</a></div>
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-29424056697321107352016-04-14T09:32:00.001+01:002016-04-14T09:32:32.198+01:00Polio Eradication: What are the final steps required to eradicate polio by 2018? <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS6xxd8ABFVW1Ol52jo8Yhnv5ZlZBh8NPDBHn9frYtBkzRv819AqPUCXF-3xwE0HhZRTQ2LK54dLtDn9PdT2XFk9Qtn4uOBuWymhma_nxaaAW5Zn_Zmor63UByM-K-yeOCbTP2jmeYt2s/s1600/RVis.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS6xxd8ABFVW1Ol52jo8Yhnv5ZlZBh8NPDBHn9frYtBkzRv819AqPUCXF-3xwE0HhZRTQ2LK54dLtDn9PdT2XFk9Qtn4uOBuWymhma_nxaaAW5Zn_Zmor63UByM-K-yeOCbTP2jmeYt2s/s200/RVis.PNG" width="185" /></a></div>
Richard Vis graduated from the MPH (online) at the School of Health and Related Research at the University of Sheffield in January 2016. Richard chose the programme as it has an excellent reputation with the medical profession with a national and international focus to the course. The distance learning route enabled him to continue in his job at Sanofi Pasteur MSD, a<span style="font-family: "arial"; font-size: 14.6667px; white-space: pre-wrap;"> </span>pharmaceutical company, alongside learning about the many different aspects of public health.<br />
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For his MPH dissertation project Richard chose to explore the eradication of polio because he was interested to see how achievable this goal is, and to explore how key initiatives, as well as vaccines, are being used to eradicate the disease. He found that many of the topics explored in his dissertation were covered in the MPH syllabus and became more relevant when conducting his research.<br />
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The title of Richard's dissertation project was '<a href="https://drive.google.com/file/d/0B_syg_iyYpBkUE0tMVJSVmN5WTg/view?usp=sharing" target="_blank">Polio Eradication: What are the final steps required to eradicate polio by 2018?</a>'<br />
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<b>Abstract</b><br />
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<b>Introduction: </b>In 1988 the World Assembly first set the goal of polio
eradication for the year 2000. It was revised
to 2005, then again to 2012. The current date set for polio eradication
and certification is by 2018 but wild polio virus still continues to circulate
in Pakistan and Afghanistan. Nigeria has been free from polio for just over a
year now but remains at risk of re-infection. Unless effective measures are
taken this latest deadline will also be missed and the momentum towards
eradication will be cause further disability and cost lives.<br />
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<b>Aim:</b> This dissertation sought to identify and highlight what the current barriers are to the completion of the eradication of polio, and to outline what final steps are needed to finally eliminate polio from Afghanistan and Pakistan, as well as Nigeria, that only recently become polio free. </div>
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<b>Methods:</b> A narrative literature review was undertaken that identified key interventions that have made significant impact on the reduction in the number of cases of polio and also identified recommendations of interventions required for each country to eradicate polio over the next three years. </div>
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<b>Results: </b>Five main interventions<b> </b>were identified: political, diplomatic stakeholder solutions; improvements in polio surveillance; strengthening of polio immunisation programme delivery; improvement in the management of programmes; improvements in social engagement and community advocacy. Specific recommendations were made for each country which need to be implemented effectively and rapidly to maintain the progress and momentum towards eradication. </div>
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<b>Conclusion: </b>Each of these three key countries, Afghanistan, Nigeria and Pakistan have specific challenges that are unique to them. Implementation of the standard polio eradication programme interventions more effectively should ensure that polio is finally eradicated from their countries, and globally. When this is finally achieved it will be the second major infectious disease to be eradicated after smallpox due to vaccination. This should drive forward the elimination of the next vaccine preventable disease targeted by the WHO, namely measles, by 2020. <br />
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<a href="https://drive.google.com/file/d/0B_syg_iyYpBkUE0tMVJSVmN5WTg/view?usp=sharing" target="_blank">Click on this link to read more about Richard's research.</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-86933152149909399822016-02-26T09:12:00.002+00:002016-02-26T09:13:31.819+00:00Light-emitting diode fluorescence microscopy for tuberculosis diagnosis: a meta-analysis<div>
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Eva Chang is a graduate of the Europubhealth (EPH) program and studied at ScHARR in 2012-2013. Prior to pursuing her MPH degrees, Eva had years of industry experience in monitoring clinical trials. Long interested in the multidrug-resistant tuberculosis (MDR-TB) crisis in Central Asia, Eva started the EPH program to study epidemiology and operational research methods.<br />
Eva is currently working as a Trial Manager at the Harvard Medical School for a clinical trial that aims to test for shorter and simpler treatment regimens for MDR-TB patients.<br />
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The focus of Eva's project work was light-emitting diode fluorescence microscopy for tuberculosis diagnosis. Along with her co-authors Eva has recently published her work in the European Respiratory Journal.</div>
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<a href="http://erj.ersjournals.com/content/early/2015/12/02/13993003.00978-2015" target="_blank">Citation: Chang EW, Page A-L and Bonnet M. Light-emitting diode fluorescence microscopy for tuberculosis diagnosis: a meta-analysis Dec 2015 DOI: 10.1183/13993003.00978-2015 s</a></div>
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Light-emitting diode fluorescence microscopy (LED-FM) is recommended by the World Health Organization to replace conventional Ziehl–Neelsen microscopy for pulmonary tuberculosis diagnosis. Uptake of LED-FM has been slow. One reason is its reported loss of specificity compared with Ziehl–Neelsen microscopy. We aimed to determine the diagnostic accuracy of LED-FM for tuberculosis detection and explore potential factors that might affect its performance.</div>
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A comprehensive search strategy based on pre-specified criteria was employed to identify eligible studies between January 1, 2000 and April 1, 2014 in 11 databases. Standardised study selection, data extraction and quality assessment were conducted. Pooled sensitivity and specificity of LED-FM using culture as the reference standard were estimated through meta-analyses using a bivariate random-effects model. Investigation of heterogeneity was performed by subgroup analyses.<br />
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We identified 12 unique studies, half of which were from peripheral healthcare facilities. LED-FM achieved a pooled sensitivity of 66.9% (95% CI 60.5–72.7) and pooled specificity of 96.8% (95% CI 93.1–98.6). A pooled sensitivity of 53.0% (95% CI 42.8–63.0) and pooled specificity of 96.1% (95% CI 86.0–99.0) were obtained by LED-FM among HIV-infected patients. Study methodology factors and differences in the LED-FM procedure or device could also affect the performance.<br />
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LED-FM specificity is high and should not be a barrier to device introduction, particularly among peripheral healthcare settings where this technology is meant to be used. Sensitivity is reduced in HIV-infected patients.<br />
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<span style="font-size: xx-small;"><a href="http://erj.ersjournals.com/content/early/2015/12/02/13993003.00978-2015" target="_blank">Reproduced with permission of the European Respiratory Society ©: European Respiratory Journal Dec 2015, DOI: 10.1183/13993003.00978-2015 </a></span>Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-33493772852254890572016-01-15T11:51:00.000+00:002016-01-15T11:51:24.160+00:00Exploring the barriers and facilitators of evidence based practice in clinical physiotherapy education: A qualitative studyMorgan West graduated from the MSc in Clinical Research at ScHARR in January 2016 with a distinction. Morgan qualified as a physiotherapist in 2006 and has been working in the NHS since.<br />
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In the second of two podcasts listen to Morgan talking to Chris Littlewood about her dissertation project 'Exploring the barriers and facilitators of evidence based practice in clinical physiotherapy education: A qualitative study'. <a href="https://youtu.be/bepnYskS544" target="_blank">In this podcast Morgan focusses on how her research project progressed and what she found.</a><span id="goog_1431122329"></span><br />
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<a href="https://youtu.be/fI8ucD3L4K0" target="_blank">Click here to listen to the first podcast in the series.</a><br />
<br />Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-83265225083359717442015-12-18T09:48:00.003+00:002016-01-15T15:32:50.074+00:00Assessment of the Perceptions of Local Sexual Health Stakeholders, Surrounding the Sexual and Associated Health Needs of ‘Men who have Sex with Men’ in North Lincolnshire.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXkiv7uhoUzkUcunJRQzUsEeRPAwoPE4oW0vkog-eH_mD3Rwd41tPJui3Q2hgLnbCHZVLw5RPNVT1JPF1kkJZeYpkapOJO57HV-PRNoaBZ8BJJRGOn5z7kTrpL8trqzfZkPC99kQKl75I/s1600/DSC_0542-133.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXkiv7uhoUzkUcunJRQzUsEeRPAwoPE4oW0vkog-eH_mD3Rwd41tPJui3Q2hgLnbCHZVLw5RPNVT1JPF1kkJZeYpkapOJO57HV-PRNoaBZ8BJJRGOn5z7kTrpL8trqzfZkPC99kQKl75I/s200/DSC_0542-133.jpg" width="192" /></a></div>
Meigan Oxley recently completed her Master of Public Health (MPH) Management and Leadership at ScHARR and will be graduating in January 2016 with a Distinction. Following her graduation Meigan will be starting her career working for NHS England in their Wider Systems Change team.<br />
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As part of the MPH programme Meigan completed a placement based dissertation project alongside North Lincolnshire Council, undertaking a piece of qualitative research at a local level.<br />
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<b>Project title: Assessment of the Perceptions of Local Sexual Health Stakeholders, Surrounding the Sexual and Associated Health Needs of ‘Men who have Sex with Men’ in North Lincolnshire.</b><br />
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The aims of the project were:<br />
1. To assess the perceptions of the stakeholders regarding the sexual and associated health needs of Men who have Sex with Men (MSM) living in the North Lincolnshire. <br />
2. To evaluate the extent to which the stakeholders perceive that the services in place adequately address the sexual and associated health needs of MSM. <br />
3. To assess if the stakeholders feel adequately knowledgeable, trained and have access to the resources needed to address the needs of MSM in the local area. <br />
4. To gain an insight into the views of the stakeholders and how the services could be improved to adequately address the perceived sexual health needs of MSM.<br />
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Conclusion: This study is the first to address the needs of MSM in North Lincolnshire. Inmet needs have been identified and services and commissioning improvements have been highlighted. <br />
Although this study was small, it has provided a unique insight which could be used to help shape future services and commissioning locally. Due to the complexed nature of MSM, further research with the MSM population is suggested to further local understanding.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEik5bU1tnJuwk4zGiAqsksL8b51mA1JPXN5F9rJhd7pHtLevHL7IQPEDHKs4kK7R6qoqdzbsshMKKxF4VxPJpysN3-tIZNk0Q6fE8N2SD5WctsmXNmuQYoPPx23sIjuKZNHCZXr6WHwAZk/s1600/Capture.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="282" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEik5bU1tnJuwk4zGiAqsksL8b51mA1JPXN5F9rJhd7pHtLevHL7IQPEDHKs4kK7R6qoqdzbsshMKKxF4VxPJpysN3-tIZNk0Q6fE8N2SD5WctsmXNmuQYoPPx23sIjuKZNHCZXr6WHwAZk/s400/Capture.PNG" width="400" /></a></div>
<a href="https://drive.google.com/file/d/0B_syg_iyYpBkbFJUcDhqSWk3Z2c/view?usp=sharing" target="_blank">To view a poster about Meigan's research click here.</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-56590958434914205582015-11-11T09:05:00.003+00:002015-11-11T09:05:46.823+00:00Effectiveness of limiting the time of alcohol sales as a means of preventing alcohol-related violence or crime<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaZTPxMljadPDz8g8GcC5vKHeicdCUi8VE4_ZFgC-wg_gLFO5HY-jfgMhE1AWotHrNb7gjGSTAyHR_ruD44suoQoQhWcS9ucVZvSQYSM8imXYzzygQE4lHIgL5N3ElhM56Rdro5HrhVFY/s1600/20151027_125846_resized_3.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaZTPxMljadPDz8g8GcC5vKHeicdCUi8VE4_ZFgC-wg_gLFO5HY-jfgMhE1AWotHrNb7gjGSTAyHR_ruD44suoQoQhWcS9ucVZvSQYSM8imXYzzygQE4lHIgL5N3ElhM56Rdro5HrhVFY/s200/20151027_125846_resized_3.png" width="130" /></a></div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Olubusayo Abegunde completed the Master of Public Health programme at ScHARR in September 2015 and will graduate with merit in January. Her passion for public health was ignited during her undergraduate studies where </span><span style="font-family: "arial" , "helvetica" , sans-serif;">she took a course in community health and epidemiology, which eventually led her to pursue the MPH programme. With the knowledge and skills gained from studying the MPH modules such as Health Promotion, Disaster and Emergency Management and Communicable Disease Control, Olubusayo wishes to return to her home country, Nigeria, to pursue a career with a Governmental or Non-Governmental Organisation so that she can help combat the public health challenges that the country faces. She is also interested in further postgraduate, study either in Communicable Disease Control or Disaster and Emergency Management.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The title of Olubusayo's dissertation project was '<b>Effectiveness of limiting the time of alcohol sales as a means of preventing alcohol-related violence or crime</b>'.</span><br />
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<b><span style="font-family: "arial" , "helvetica" , sans-serif;">Abstract</span></b><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Introduction:</b> Alcohol-related violence is a major global public health challenge, ranging from mere nuisance inconveniences to debilitating injuries and even death in people other than the drinker. Apart from the physical and emotional harm suffered by victims of alcohol-related violence, there is also pressure on the health and criminal justice services resulting in huge financial cost to the society. Previous reviews have reported that limiting the time of alcohol sales is an effective means of reducing alcohol-related harms, however, no review has been conducted to assess the effectiveness of this intervention specifically on alcohol related-violence or crime.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Objective: </b>To systematically review existing literature on the effectiveness of limiting the time of alcohol sales as a means of preventing alcohol-related violence or crime.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Search strategy:</b> Six electronic databases (Medline, PsycINFO, ETOH, EMBASE, Sociological abstracts and Econlit) were searched using pre-specified search terms. Reference and citation lists of relevant articles were also searched.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Selection criteria: </b>Quasi-experimental studies (before and after, interrupted time series designs) evaluating the effect of change (increase or decrease or both) in time of alcohol sales in relation to violence or crime were included in this review.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Data collection and analysis:</b> Forms adapted from “Data Collection Instrument and Procedure for Systematic Reviews in the Guide to Community Preventive Services” were used for data extraction and quality assessment of included studies. Narrative synthesis was employed to explore the findings of this review.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Results:</b> Fifteen studies were included in this review and were divided into three groups: Findings from increased time of alcohol sales; Findings from decreased time of alcohol sales and Findings from increased and decreased time of alcohol sales. Findings from ten studies where the time of alcohol sales was increased were inconsistent. Four studies where the time of alcohol sales was decreased showed a corresponding decrease in violence, this was corroborated by the finding from the study that assessed the effect of both increased and decreased time of alcohol sales.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Conclusion:</b> This review suggests that limiting the time of alcohol sales is an effective means of preventing alcohol-related violence or crime. More rigorous studies are needed to provide stronger evidence.</span></div>
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-84352273818747746232015-10-20T13:58:00.000+01:002015-10-20T13:58:29.895+01:00Identification, development and valuation of bolt-on dimensions for the EQ-5D-5L for use in health care decision-making. <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgu_ORD_Mmq4U6z5RaiJQS8pIt3vEhjj3U_2VPrUCjm5jyIqbQPFe_vOTPo83ZXgtrPqNPwHbE4PZCIkPUM4p9f6g8G1pWhXg9XfNSwGq5wzmKkg3fnjNPR8GHEanXT_U73Wd3G49CjOuI/s1600/IMG_5203.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgu_ORD_Mmq4U6z5RaiJQS8pIt3vEhjj3U_2VPrUCjm5jyIqbQPFe_vOTPo83ZXgtrPqNPwHbE4PZCIkPUM4p9f6g8G1pWhXg9XfNSwGq5wzmKkg3fnjNPR8GHEanXT_U73Wd3G49CjOuI/s200/IMG_5203.JPG" width="200" /></a></div>
Aureliano Paolo Finch is a first year PhD student in Health Economics and Decision Science at the School of Health and Related Research. Prior to moving to Sheffield, Aureliano graduated from the London School of Economics and the London School of Hygiene and Tropical Medicine joint programme "Health Policy, Planning and Financing". Aureliano has worked for one year as a White Helmet for the Caritas Brasileira Regional do Piaui, Parnaiba, Brazil, and for two years as a research fellow at Cergas - Bocconi University, Milan, Italy. Aureliano is a regular reviewer for Value in Health and Health Policy, and from the latter he was awarded the Outstanding Contribution in Reviewing, a prize given to the top 10th percentile of reviewers in terms of number of reviews completed for the journal. Aureliano is also a member of ISPOR and has published three peer-reviewed papers.<br />
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The title of Aureliano's PhD project, supervised by John E Brazier and Clara Mukuria, is: <b>Identification, development and valuation of bolt-on dimensions for the EQ-5D-5L for use in health care decision-making.</b><br />
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The project aims to explore and develop methods for bolt on research of generic preference based measures of health as a means of improving the instruments validity and responsiveness. This will involve several stages beginning with a comparison of different methods for identifying potentially relevant dimensions or potentially relevant areas of the EQ-5D-5L descriptive system where the addition of dimensions might be of interest. The project will go on to develop a group of bolt-ons, testing their impact on preferences for health states taken from the EQ-5D-5L and evaluating their effect on patients’ health states utility values.<br />
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<a href="https://drive.google.com/open?id=0B_syg_iyYpBkQjRoZ1BHV3pSdFE" target="_blank">Click this link to view a poster about Aureliano's research to date</a>.<br />
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In this poster Aureliano presents the results of his critical overview of systematic reviews on the validity and responsiveness of preference based measures. The overview shows that the reviews found few studies with complete psychometric results and/or comparative evidence between generic preference based measures. Most of the known groups and responsiveness tests were considered weak (e.g. patients vs. general population) and there was poor reporting of psychometric criteria (e.g. validity cut-offs) and results. However, on the basis of what was found there is some evidence to support EQ-5D validity and responsiveness in some conditions within respiratory, endocrine and skin diseases, but not in hearing and vision, with mixed results in mental health and in diseases of the nervous system. Limited evidence on SF-6D supported validity in visual disorders but found problems in cardiovascular diseases. HUI3 was valid in some conditions of nervous system and mental health, but not in some neoplasms. There was support for 15D in some genitourinary and metabolic diseases, while the AQoL had good psychometric characteristics in nervous system diseases. However, there were many condition/instrument pairs where there was scarce or no evidence. This highlights that the large amount of evidence produced to date provides only limited answers about generic preference based measures performance in different conditions. Consequently, this evidence give health technology assessment bodies little basis for selecting instruments and more comparative research is required using stronger tests of validity and responsiveness.<br />
<br />Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-65613760756643702642015-09-24T09:07:00.000+01:002015-09-24T09:07:37.170+01:00Youth violence prevention in Mexico: A complicated context for policy-making based on evidence synthesis<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJU-npY-4-f9lGY2NJPEEF-d6heDz-ljOUZFoLv-oBZ03ZlbOyzaHAvUcsHgzJUv39_vNQ34Gon34igNM8yQUEa1BD670AxNVwXjZcZLMB8gep-66QNpG8-VcsbixSmtTlh4xHfrdDc4k/s1600/IMG_5199.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="141" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJU-npY-4-f9lGY2NJPEEF-d6heDz-ljOUZFoLv-oBZ03ZlbOyzaHAvUcsHgzJUv39_vNQ34Gon34igNM8yQUEa1BD670AxNVwXjZcZLMB8gep-66QNpG8-VcsbixSmtTlh4xHfrdDc4k/s200/IMG_5199.JPG" width="200" /></a></div>
Erika E. Atienzo is a second year PhD student at the School of Health and Related Research. Before arriving to ScHARR, Erika worked for six years as a researcher in the Reproductive Health Department at the Mexican National Institute of Public Health where she collaborated on several research projects and was also involved in teaching. She is currently a member of the National System of Researchers in Mexico.<br />
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The title of Erika's PhD project is: <b>Youth violence prevention in Mexico: A complicated context for policy-making based on evidence synthesis.</b><br />
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The research is focused on the use of evidence synthesis for policy-making in a developing country, using a case study of the prevention of youth violence in Mexico. It will explore the evidence base in this area in Latin America and assess their utility when aiming to incorporate research into policy-making to prevent youth violence in Mexico. Her research will involve methods for evidence synthesis and a primary qualitative study with policy-makers and decision-takers.<br />
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<a href="https://drive.google.com/file/d/0B_syg_iyYpBkaG91NldNRWxWUjA/view?usp=sharing" target="_blank">Click this link to view a poster about Erika's research to date.</a><br />
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In this poster Erika presents some preliminary findings of two systematic reviews that form the basis of her PhD research. After a comprehensive search of manuscripts, this research shows that evidence on interventions to prevent youth violence for Latin America is limited and relies on non-rigorously designed studies. This scenario presents a challenge for the process of decision making in Mexico based on the use of conventional methods for evidence synthesis.<br />
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A profile of Erika’s PhD research aim and some of her previous publications can be found <a href="http://www.sheffield.ac.uk/scharr/sections/heds/staff/erika_atienzo" target="_blank">here</a>.<br />
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-3495089835926316862015-08-18T13:24:00.002+01:002015-08-18T13:24:53.918+01:00Competencies required from public health professionals by health based organisations and the role of academia<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbkTgsUdN1k4MvQNls2W6AZPR78PDPdA0-UrUDsFLoSm8O3JWy6zpsOwbkLMohn_ENeQlvimO6xX2bS3cIDPAb4f53TeheNsGhafh4ThZqs9rppOPA-urWyRutN9pYWMb0EPZ8TzDOZmw/s1600/my+picture.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbkTgsUdN1k4MvQNls2W6AZPR78PDPdA0-UrUDsFLoSm8O3JWy6zpsOwbkLMohn_ENeQlvimO6xX2bS3cIDPAb4f53TeheNsGhafh4ThZqs9rppOPA-urWyRutN9pYWMb0EPZ8TzDOZmw/s200/my+picture.jpg" width="200" /></a></div>
Syed Abbas graduated from ScHARR with a Master of Public Health with merit in 2012. Following his time in Sheffield Syed completed a contract with the University of York as a Research Fellow, during which he worked on a project to estimate the global burden of disease due to smokeless tobacco. Syed is currently working as an Assistant Professor in Community Health Sciences at Fatima Memorial Hospital College of Medicine and Dentistry in Pakistan. He is also a regular reviewer for the journal, Public Health<br />
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The focus of Syed's dissertation project was 'Competencies required from public health professionals by health based organisations and the role of academia'. Along with his co-authors, Andrew Lee and Hafsa Mubashir, Syed has recently published his work in the Journal of Pakistan Medical Association.<br />
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<a href="http://jpma.org.pk/full_article_text.php?article_id=5742" target="_blank">Citation: Abbas S M, Lee A, Mubashir H (2014) Competencies required from public health professionals by health based organisations and the role of academia. J Pak Med Assoc 64 (1):57-63.</a><br />
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<b>Abstract</b><br />
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<b>Objective:</b> To examine the complementarity between what is taught in Masters of Public Health courses and real world expectations of practitioner organisations.<br />
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<b>Methods:</b> The online survey of academic institutions and health-related organisations from high- and low-/middle-income countries was conducted between May 16 and August 1, 2011. A combination of snowballing and purposive sampling was used to recruit the respondents. The survey questionnaire was devised using a validated competencies framework.<br />
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<b>Results:</b> A total of 45 organisations responded to the survey. They were evenly distributed between academic institutions and practitioner organisations, high-income countries and low/middle income ones. There was marked disparity in rating for 14 (22%) of the 63 competencies examined. Practitioner organisations valued practical competencies such as contracting and negotiation skills, whereas academic institutions favoured research-based elements such as critical thinking and data-collection skills. Practitioner organisations also rated less highly course modules such as the dissertation component and research methods.<br />
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<b>Conclusions:</b> The lack of congruence between what is taught and what is required could result in public health practitioners being ill-prepared for the demands of the real world. Greater engagement between academic institutions and practitioner organisations is necessary to ensure that Masters of Public Health courses are appropriate and up-to-date.<br />
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Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.comtag:blogger.com,1999:blog-4500610488944159179.post-12653012957754304362015-07-13T10:22:00.000+01:002015-07-13T10:22:22.018+01:00Focusing events that shape the research process: A reflection by Henock B. Taddese<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIE9gdWeknrC1cI2eCuJUFloMnoyOG5MK4isnIoA4SHZU7pxjonBufiZa4jTHZvRziohjjkPkOl5uIORHT32o_v-9IqmciAsuNELqyYKaLF3S_E0DpIO_71eld8yvV5qxiGO52Sa2F_g0/s1600/HTaddese.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIE9gdWeknrC1cI2eCuJUFloMnoyOG5MK4isnIoA4SHZU7pxjonBufiZa4jTHZvRziohjjkPkOl5uIORHT32o_v-9IqmciAsuNELqyYKaLF3S_E0DpIO_71eld8yvV5qxiGO52Sa2F_g0/s200/HTaddese.jpg" width="150" /></a></div>
Henock B. Taddese recently completed his PhD at ScHARR. His PhD, entitled, ‘Cross-Sectoral Interactions in Real-Life: A Case Study of the Global Fund’s Country Coordinating Mechanism in Ethiopia’, focuses on understanding the complex real-life interactions between policy actors in developing country settings, as they participate in globally initiated public-private partnership mechanisms. Henock is also a graduate of the Europubhealth programme, a Masters in Public Health course delivered by a consortium of European and American Universities. Henock’s chosen pathway in the programme brought him to ScHARR in the UK, the University of Copenhagen in Denmark and the Ecoles des Hautes Etudes en Santé Publique (EHESP) in France. His research interests lie in the area of global health governance, especially on understanding the linkages and interfaces between global health governance structures and processes on the one hand, and national health policy actors and processes, on the other.<br />
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<a href="https://drive.google.com/file/d/0B_syg_iyYpBkd29NOFYxcWNJRE0/view?usp=sharing" target="_blank">To read a reflective account of Henock's PhD journey click here.</a></div>
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This reflective article highlights how particular instances and experiences, called ‘focusing events’
in the article, shape critical choices that are made in the research process, ultimately
influencing the focus of the study and the way it is conducted. The article thereby
argues that the distance between the finish line and the start of a research
endeavour is seldom a straight line but one where choices, preferences, and
methods have to be adapted in view of evolving theoretical and practical considerations.
By way of reflecting on the research process, the article also calls for increased
attention to neglected concepts in health systems research, such as the power
relationships between actors. Specifically, the article joins increasing calls
for in-depth analysis of power that moves beyond traditional stakeholder
analysis approaches; one that involves an inquiry of how stakeholders mobilise the
differential power resources available to them in order to safeguard their
stake in particular policies and programmes. The article emphasises the need to
increasingly pose questions such as ‘whose ‘should’ is that?’ in global health
research. <o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/04870718259985689908noreply@blogger.com