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Why you should read this article: • To understand the challenges of providing inpatient care for people with dementia • To familiarise yourself with the differences between organic inpatient wards and mixed inpatient wards • To learn about the optimal inpatient environment for people with dementia Dementia presents a major public health challenge to healthcare providers globally. When older people with dementia need inpatient mental healthcare, they can be cared for in one of two different types of older adult ward. These patients can either be admitted to an organic inpatient ward for people with dementia or the subtypes of dementia, or they can be admitted to a mixed inpatient ward for older people who have either functional or organic conditions. Using a quality assurance pilot study, the authors aimed to investigate whether the quality of care for patients with dementia differed between mixed and organic inpatient wards in units exclusively serving older people. The quality of care on both types of ward was compared by analysing observed interactions between patients and staff, patient well-being and patient environment and mealtimes. The quality of care was measured with a specially developed instrument and against evidence-based standards of care. The ratings of both types of ward showed high levels of quality interactions between patients and staff. There were minimal differences in the quality of patient and staff interactions, patient well-being, and patient environment and mealtimes between the two types of ward. Further work on outcomes and carer experiences needs to be undertaken to establish the optimal care environment for people with dementia. [ABSTRACT FROM AUTHOR]

Background: Gall stones are the most common biliary pathology. It is estimated that gall stones affect 10-15 per cent of the population in western societies. They are symptomatic in the majority of cases (>80%) in the UK, the prevalence of gallstones at the time of death is estimated to be 17 per cent and may be increasing. Objectives: To study the preoperative factors (by clinical assessment and ultrasound study) and intraoperative factors to assess the difficulty level in laparoscopic cholecystectomy, to predict the level of difficulty in laparoscopic cholecystectomy based on pre-operative factors and score, to correlate the pre-operative score to the outcome of surgery. Results: The present study included 70 patients who underwent laparoscopic cholecystectomy in Government general hospital, Nizamabad, from November 2017 to October 2018. Out of 70 cases in the present study, 29 cases (41.4%) were in the age group of 41-50 years, 20 cases (28.6%) were in the age group of 31-40 years, 14 cases (20%) were in the 51-60 years age group. Conclusion: In patients with these risk factors, management can be improved by identifying patients who may require open approach, preoperative counseling and informed consent from the patient, assisting the surgery with appropriate arrangement of resources in the operation theatre, early conversion to open cholecystectomy. [ABSTRACT FROM AUTHOR]

The article focuses on the preferred modality of teaching for General Practice specialty trainees, and how the COVID-19 pandemic has affected the format of their formal teaching. Topics include shift in teaching sessions structure with increased mixed teaching, the preference of some trainees for online teaching; and the trainers feel that trainees may miss out on peer-to-peer learning, pastoral support, and informal curriculum development that face-to-face teaching provides.

Objective. To review the likelihood of very long-term remission in patients with biopsy-proven LN attempting to identify good prognostic features. Methods. We reviewed patients with LN whose renal biopsies showed World Health Organization (WHO) classes III, IV and V and who had a follow-up of at least 5 years between 1973 and 2008. We analysed demographic, clinical, laboratory and therapeutic parameters comparing those patients with (group A) and without (group B) 5 year remission. Results. Of 191 LN patients followed, 105 patients met the strict inclusion criteria. Ninety-five patients were female. Mean age at diagnosis of lupus was 24.1 years (S.D. 10.7). ean age at diagnosis of LN was 28.4 years (S.D. 11.3). The mean duration of follow-up was 13.7 years (S.D. 14.1). Forty (38%) patients achieved 5 year remission, of whom 17 (16.2%) had remission for ≥15 years. The incidence of flares per year from 5 to 15 years was 7.9%; however, no flares were observed after 15 years of remission. The only distinguishing feature found in this study was the association of WHO class IV on kidney biopsy with LN progression (P=0.03). Conclusion. Renal histology with WHO class IV predicted a poor long-term remission rate. Age, sex, ethnicity, serological parameters and treatment received did not predict long-term remission. Renal flares can occur up to 15 years after a patient has gone into remission. [ABSTRACT FROM AUTHOR]

Purpose: This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. Methods: We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). Results: Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. Conclusion: Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Focuses on the health information of developing countries like Africa. Availability of information in the developed countries; Difficulty of transporting information like food or medicines; Lack of access of health workers on up to date information in health. INSETS: Sending appropriate information;Barriers faced by publishers in developing countries;Donation and distribution schemes.

Examines the argument focusing on the smokers' rights to health care. Opposition based on the principles founded by the British National Health Service; Difficulties created by advocating smokers' health.

Whereas genetic variants influencing total amygdala volume have been identified, the genetic architecture of its distinct nuclei has yet to be explored. We aimed to investigate whether increased phenotypic specificity through nuclei segmentation aids genetic discoverability and elucidates the extent of shared genetic architecture and biological pathways with related disorders. T1-weighted brain magnetic resonance imaging scans (N = 36,352, 52% female) from the UK Biobank were segmented into 9 amygdala nuclei with FreeSurfer (version 6.1). Genome-wide association analyses were performed on the entire sample, a European-only subset (n = 31,690), and a generalization (transancestry) subset (n = 4662). We estimated single nucleotide polymorphism–based heritability; derived polygenicity, discoverability, and power estimates; and investigated genetic correlations and shared loci with psychiatric disorders. The heritability of the nuclei ranged from 0.17 to 0.33. Across the whole amygdala and the nuclei volumes, we identified 28 novel genome-wide significant (p adj < 5 × 10−9) loci in the European analysis, with significant en masse replication for the whole amygdala and central nucleus volumes in the generalization analysis, and we identified 10 additional candidate loci in the combined analysis. The central nucleus had the highest statistical power for discovery. The significantly associated genes and pathways showed unique and shared effects across the nuclei, including immune-related pathways. Shared variants were identified between specific nuclei and autism spectrum disorder, Alzheimer's disease, Parkinson's disease, bipolar disorder, and schizophrenia. Through investigation of amygdala nuclei volumes, we have identified novel candidate loci in the neurobiology of amygdala volume. These nuclei volumes have unique associations with biological pathways and genetic overlap with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Introduction:  The U.K. National Institute for Health and Clinical Excellence (NICE) specify the following indications for performing rectal biopsy to rule out Hirschsprung's disease (HSD): (1) passage of meconium > 48 hours; (2) constipation since first few weeks of life; (3) chronic abdominal distension with vomiting; (4) family history of HSD; and (5) faltering growth in addition to any other indication. The aim of this study was to assess the compliance of a tertiary referral center with the current U.K. NICE guidelines for performing rectal biopsies to rule out HSD. Secondary aims included assessing alternative indications and complication rates.Materials and Methods:  Retrospective analysis of patients undergoing open or suction rectal biopsies to investigate HSD, from 2009 to 2014.Results:  A total of 188 patients underwent 214 biopsies (suction: n = 154, open: n = 60). Note that 128 patients (68.1%) had biopsies indicated by NICE. A total of 84.4% of indicated biopsies were ganglionic versus 91.7% of unindicated biopsies (p = 0.17). Twenty-five patients were diagnosed with HSD (mean age: 13.2 weeks, range: 3 days-3.2 years). Only 80% of HSD patients had NICE-indicated biopsies. Presentations for patients with biopsies not indicated by NICE included constipation, distension, and vomiting that did not strictly meet the guidelines. The majority of biopsies were uncomplicated (suction 82.5% vs. open 95.0%)-inadequate/indeterminate histology was the most common complication (16.2% suction vs. 5% open).Conclusion:  A significant number of unindicated biopsies were performed, the majority of which were ganglionic. Rectal biopsies are generally safe and strict adherence to the NICE guidelines could have led to missed HSD diagnoses with potential significant morbidity and mortality. [ABSTRACT FROM AUTHOR]

Describes a new way to treat patients with fulminant hepatic failure in Great Britain. Performance of a clinical programme of subtotal hepatectomy and auxiliary orthotopic liver transplantation for toxic injury; Confirmation of native hepatic regeneration with transplant atrophy.

Focuses on the use of media as medium in broadcasting the issue of homelessness among mentally ill in Great Britain. Obstacle of reception staffs to access to the physicians; Negligence on the use of participant observation as investigative technique by academic physicians; Failure to identify the real reason for the refusal to provide medical care.

Posttraumatic stress disorder (PTSD) is heritable and a potential consequence of exposure to traumatic stress. Evidence suggests that a quantitative approach to PTSD phenotype measurement and incorporation of lifetime trauma exposure (LTE) information could enhance the discovery power of PTSD genome-wide association studies (GWASs). A GWAS on PTSD symptoms was performed in 51 cohorts followed by a fixed-effects meta-analysis (N = 182,199 European ancestry participants). A GWAS of LTE burden was performed in the UK Biobank cohort (N = 132,988). Genetic correlations were evaluated with linkage disequilibrium score regression. Multivariate analysis was performed using Multi-Trait Analysis of GWAS. Functional mapping and annotation of leading loci was performed with FUMA. Replication was evaluated using the Million Veteran Program GWAS of PTSD total symptoms. GWASs of PTSD symptoms and LTE burden identified 5 and 6 independent genome-wide significant loci, respectively. There was a 72% genetic correlation between PTSD and LTE. PTSD and LTE showed largely similar patterns of genetic correlation with other traits, albeit with some distinctions. Adjusting PTSD for LTE reduced PTSD heritability by 31%. Multivariate analysis of PTSD and LTE increased the effective sample size of the PTSD GWAS by 20% and identified 4 additional loci. Four of these 9 PTSD loci were independently replicated in the Million Veteran Program. Through using a quantitative trait measure of PTSD, we identified novel risk loci not previously identified using prior case-control analyses. PTSD and LTE have a high genetic overlap that can be leveraged to increase discovery power through multivariate methods. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of osteoporotic fractures is increasing with an ageing population. This has potential consequences for health services, patients and their families. Treatment of osteoporotic vertebral compression fractures (OVCFs) has been limited to non-surgical measures so far. The social and functional consequences of balloon kyphoplasty, a recent development for the treatment of VCF, were assessed in this cohort study. Methods: Data collected prospectively from 53 patients undergoing balloon kyphoplasty for symptomatic OVCF in our hospital's spinal unit were compared with data from an historical age-matched group of 51 consecutive patients treated conservatively for symptomatic OVCF. Social functionality was recorded prior to the injury, and at 6-month and 1-year follow-up; mortality was recorded at 6 months and 1 year. Results: The mortality rate in the balloon kyphoplasty group was 11 % (6/53) at 1 year post-OVCF, versus 22 % (11/51) in the conservatively treated controls. A drift to a lower level of social functionality (defined by a lower level of independence) was observed at 1 year in 21 % of patients in the balloon kyphoplasty group versus 53 % of patients in the conservatively treated group. A drift to a lower level of independence was noted in 67 % of the conservatively treated patients who started at a lower level of functionality versus 20 % drift in a similar group who were treated with balloon kyphoplasty. Conclusions: The reduction in mortality and drift in social functionality at 1 year following treatment with balloon kyphoplasty suggests that it is a viable option for the management of OVCFs. [ABSTRACT FROM AUTHOR]

This study compared the gastrointestinal (GI) absorption characteristics and absolute bioavailability of fenofibric acid and fenofibrate (which is converted to fenofibric acid in vivo) in healthy volunteers. Treatments were delivered to the proximal small bowel, distal small bowel, and colon using a site-specific delivery system (Enterion capsule) and to the stomach by oral administration of equimolar doses. Serial blood samples were collected for 120 hours postdose and assayed for plasma fenofibric acid concentrations. The absolute bioavailability of each treatment was determined relative to 50 mg of fenofibric acid administered intravenously. Plasma exposure to fenofibric acid following fenofibric acid administration was approximately 1.5 times higher than that following fenofibrate administration for delivery to the proximal and distal small bowel and following oral administration, and it was approximately 5 times higher following colon delivery. The absolute bioavailability in the stomach, proximal small bowel, distal small bowel, and colon was approximately 81%, 88%, 84%, and 78%, respectively, for fenofibric acid and 69%, 73%, 66%, and 22%, respectively, for fenofibrate (P < .0001 and P = .033 for fenofibric acid vs fenofibrate in the colon and distal small bowel, respectively). In conclusion, fenofibric acid is well absorbed throughout the GI tract and has greater bioavailability than fenofibrate in all GI regions. [ABSTRACT FROM AUTHOR]

Young AL, Peters CJ, Pocock PV, Millson CE, Prasad KR. Do smaller adults wait longer for liver transplantation? A comparison of the UK and the USA data. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01037.x © 2009 John Wiley & Sons A/S. The number of patients on the UK and the USA liver transplant list is increasing. As size match is an important factor in the UK organ allocation, we studied the effect of recipient size on liver transplantation in the UK and the USA. Methods: The UK Transplant and United Network for Organ Sharing databases were used to assess difference in access to transplantation between smaller adult patients and their larger counterparts over three time periods. Subsequently, proportions of split, NHBD and living-donor transplants were analyzed. Results: There were 1576 UK and 29 150 USA patients in our analysis. The UK small patients have been significantly disadvantaged in access to transplantation particularly in early years and in adult only transplant units. This contrasts to the USA where smaller patients have never been disadvantaged and transplantation rates are steadily increasing. Split-liver transplants are being carried out in increasing numbers in the UK but not the USA. Conclusions: Small adults are still less likely to be transplanted at six months in adult only units in the UK. The lack of size matched organs for smaller adults and the overall decrease in rates of transplantation in the UK may be remedied by careful consideration of allocation policy and increased use of innovative techniques. [ABSTRACT FROM AUTHOR]

As the result of the widening gap between supply and demand of organs for liver transplantation, efforts to improve allocation have become an increasingly important yet controversial subject. The MELD score has been adopted in the USA but its usefulness has rarely been examined in Europe. We carried out an intention to treat analysis of 422 patients placed on our transplant waiting list over a 5-year period. We examined multiple variables to investigate the value of MELD, sodium and other factors in predicting post-transplant outcomes. MELD at transplant was the most important indicator of post-transplant outcomes. In addition, delta-MELD and hyponatreamia were significant at predicting, which patients placed on the waiting list would not proceed to transplant. While a move to allocating solely by MELD is not justified in the UK allocation system, there is value in using MELD, delta-MELD and hyponatreamia in making decisions regarding the allocation of organs. This may subsequently help to improve overall outcomes. [ABSTRACT FROM AUTHOR]

The article comments on the importance of chronic kidney disease (CKD) guidelines in urology. The authors remark that this guideline was published to aid the investigation, identification, management and referral of CKD in adults in Great Britain. It adopted the international classification system based on the presence or absence of markers of CKD, like proteinuria and urologically unexplained hematuria, and on estimated glomerular filtration rate.

Presents several views on ethnic minority associations formed by doctors from minority groups in Great Britain. Views on the need to change the name and role of the Overseas Doctors Association; Risk in joining minority associations; Issues on racial discrimination and representation.