HERALD is a growing repository of research and organisational information generated by people working and volunteering in London's Integrated Care Systems.
Please see below for the full list of HERALD organisations. To engage with us as we develop the repository - including submitting items for adding to the collection and becoming a HERALD organisation - contact us via email: heraldrepository@gmail.com
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Recent Submissions
Item type:Item, King’s College Hospital Cancer Improvement Collaborative : Addressing Healthcare Inequalities(2024-09)Aim: To improve the understanding of diagnostic test results for our ethnically diverse population, referred to the one stop clinic for suspected breast cancer, as measured by the NCPES Q7. Method: Data from August 2020 – November 2021 was analysed and validated against the trust reported demographics for all new breast cancer diagnoses, for patients from an ethnically diverse background. This data was then used to draw a sample. The eligible population for the cycle of interviews was 54 patients, from an ethnically diverse background. The most representative groups from this cohort were from a Black African and from an Asian background, who numbered 27 patients.Item type:Item, Acute Medical Consultant Led Malignancy of Unknown Origin (MUO) service set up in a busy tertiary NHS Trust(2024-09)In 2021 an acute medicine consultant was recruited at King's College Hospital to work with AO CNSs and an administrator to provide a weekly MUO clinic and patient tracking. The aims: * Avoid admission of patients with an Eastern European Oncology Group performance status <3 and radiological findings of MUO during their acute presentation to hospital or on incidental radiological findings during radiology reporting. Referrals from specialist clinics and cancer diagnostic teams were also included. * Avoid duplication of referrals, investigations and MDT reviews through an electronic MUO referral pathway for ambulatory patients. * Implement national cancer diagnostic standards to triage, clinic review and tracking process till handover of care to appropriate cancer or non‐cancer teams. * Establish links with radiology, cancer MDTs and Palliative care to achieve diagnosis. * Initial work in a 6‐month pilot would focus on setting up processes for rapid triage, review of referrals, communication and collaborative working with MDTs and supportive services.Item type:Item, Expansion of Acute Oncology Services at an Acute Tertiary Care Trust without inpatients oncology beds(2024-09-12)The Acute Oncology Service (AOS) has utilised the acute medical team in the provision of cancer care at the front door as well as setting up a malignancy of Unknown Origin (MUO) service and a Same Day Emergency Care (SDEC) pathway. This has been achieved by recruitment of an acute medical consultant as an AOS lead and a review and restructure of the nursing workforce. This has resulted in an increase in AOS Clinical Nurse Specialists (CNS) and Advanced Clinical Practitioners (ACP) to support local care and facilitate ward rounds with visiting oncology consultants from cancer centre. Expansion of AOS service has allowed to improve documentation and communication to parent oncology teams. Early discharge and reduction in length of stay for patient on MUO pathway from March 2024 to June 2024. That allowed the AOS-specific SDEC pathway from March 2024. The AOS project group was set-up with main stakeholder Emergency Department (ED) and Acute Medicine (AM) and met every 2 weeks. The aims of the project were: A) To establish a new 7-day referral service with ED B) Agree working Standard Operating Procedure with Acute Medicine and AOS C) Agree patient identification criteria for ambulatory care assessment at ED D) Assess patients' experience. A substantial majority of cancer patients delayed reporting symptoms for more than three days. Despite the relatively low number of oncology patients attending the Emergency Department (ED), a significant proportion required inpatient admission. Furthermore, findings indicate that these patients often present in a more acutely unwell state, highlighting the need for encouraging patients to seek early advice to prevent symptom exacerbation and facilitate referral to alternative assessment pathways outside of the ED. Reinforcing the use of the Acute Oncology Service (AOS) alert card is recommended to expedite assessments and treatment processes.Item type:Item, Black flashes (dysphotopsia) as a symptom of vitreo-papillary traction in evolving posterior vitreous detachment - an optical coherence tomography case series.(04/06/2025)Purpose We present three cases of evolving posterior vitreous detachment (PVD) in which patients experienced black flashes, known as negative dysphotopsia (ND), and were found to have vitreo-papillary adhesion at the optic nerve head. Observations A 53-year-old female with a history of right rhegmatogenous retinal detachment (RRD) described initial symptoms of black flashes. Seven years later, she developed similar symptoms in the left eye and was diagnosed with PVD. OCT demonstrated vitreo-papillary adhesion. A 47-year-old male with a history of pseudophakic RRD in the left eye 5 years previously presented with black flashes in the right eye on eye movements. He was found to have PVD and RRD after 5 months of these symptoms. OCT revealed separation of the vitreous from the macula with attachment on the optic disc. A 51-year-old male developed ND which were replaced by white flashes after 3 weeks. A week later he was diagnosed with PVD and a retinal tear with OCT evidence of vitreo-papillary traction. Conclusions and importance Evolving PVD may present with ND before classical symptoms such as positive dysphotopsia and floaters, particularly in cases with vitreo-papillary adhesion/traction.Item type:Item, Detection of high risk human papillomavirus in bladder cancer: An exploratory study from a UK based population(25/06/2025)Background/Objectives: Human papillomavirus (HPV) is a prevalent sexually transmitted infection globally and is linked to the development of various cancers. While several international studies have investigated the incidence of high-risk HPV (HR-HPV) in bladder cancers, no such research has been conducted within the UK. Conflicting results in previous studies leave uncertainty regarding the role of HR-HPV in bladder cancer. This study aimed to assess the presence of HR-HPV DNA in bladder cancer specimens from the UK. Methods: A total of 55 fresh bladder specimens, including 4 benign and 51 malignant samples, were analysed using polymerase chain reaction (PCR) and Sanger sequencing to detect 12 HR-HPV types. Immunohistochemistry (IHC) was used to confirm the expression of the HPV E7 protein in HR-HPV-positive samples. Results: HR-HPV DNA was detected in 33% of bladder cancer specimens, with HPV16, HPV35, and HPV52 being the most prevalent types. None of the benign samples tested positive for HR-HPV. IHC confirmed HPV E7 protein expression in 81% of HR-HPV DNA-positive cancer samples. Conclusions: The findings suggest that HR-HPV may play a role in a subset of bladder cancers in the UK. The absence of HR-HPV in benign bladder specimens supports its potential involvement in cancer progression. Further research is needed to clarify the mechanistic role of HR-HPV in bladder cancer development.
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