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Objectives: To examine the effectiveness of community diagnostic centres as a potential solution to increasing capacity and reducing pressure on secondary care in the UK. Methods: A comprehensive search for relevant primary studies was conducted in a range of electronic sources in August 2022. Screening and critical appraisal were undertaken by two independent reviewers. There were no geographical restrictions or limits to year of publication. A narrative synthesis approach was used to analyse data and present findings. Results: Twenty primary studies evaluating twelve individual diagnostic centres were included. Most studies were specific to cancer diagnosis and evaluated diagnostic centres located within hospitals. The evidence of effectiveness appeared mixed. There is evidence to suggest diagnostic centres can reduce various waiting times and reduce pressure on secondary care. However, cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Most included studies used weak methodologies that may be inadequate to infer effectiveness. Conclusion: Further well-designed, quality research is needed to better understand the effectiveness and cost-effectiveness of community diagnostic centres. [ABSTRACT FROM AUTHOR]

The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug–drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review. [ABSTRACT FROM AUTHOR]

Evidence-based practice provides the foundation for high quality patient care, and in the NHS, research is seen as vital to enable service transformation and improve outcomes. Research is one of the four pillars of enhanced and advanced clinical practice and is therefore a fundamental part of podiatric surgery services. In order to meet the UK health research strategies, the most recent being 'Saving and Improving Lives: The Future of UK Clinical Research Delivery' (2021), the Faculty of Podiatric Surgery in the UK agreed to support the development of research priorities in order to inform a future research strategy. The Podiatric Surgery Research Strategy Group was set up and embarked on a project with the aim of engaging its members in formulating and agreeing national research priorities. The initial stage included a national research scoping survey to identify key themes, topic, and research questions. The final stage consisted of developing and enabling a live consensus vote conducted at the 2022 national Faculty of Podiatric Surgery Conference. At the end of the vote, the top five research topics that met the agreement criteria were: 1. Surgical treatment – forefoot, 2. Patient reported outcome measures, 3. Post-operative management, 4. Surgical treatment – midfoot and 5. Service delivery. The top five research questions that met the criteria were1. How does quality of life improve following elective foot surgery? 2. How does podiatric surgery benefit the health of the population? 3. How does podiatric surgery benefit the health of the population in the at-risk foot? 4. What is the most effective Lapidus fixation option? and 5. What is the benefit of utilising PASCOM-10 to improve large scale outcome data? These will inform the initial UK podiatric surgery research priorities in the next three to five years. [ABSTRACT FROM AUTHOR]

Abstract: This article reviews the Nuffield Council on Bioethics’ report on Non‐Invasive Prenatal Testing (NIPT); and introduces two general questions provoked by the report – concerning, respectively, the nature and extent of the informational interests that are to be recognised in today's ‘information societies’ and the membership of today's ‘genetic societies’. The article also considers the role and nature of the Nuffield Council. While the Council's report identifies a range of individual and collective interests that are relevant to determining the legitimate uses of NIPT, we argue that it should put these interests into an order of importance; we sketch how this might be done; and we suggest that, failing such a prioritisation of interests, the Council should present its reflections in a way that engages public debate around a number of options rather than making firm recommendations. [ABSTRACT FROM AUTHOR]

If the central purpose of non-invasive prenatal testing (NIPT) is to deliver improved reproductive autonomy – by facilitating enhanced choice between the continuation and termination of pregnancy – any public-funded regime ought to be compatible with the legal grounds for decision-making in this context. It is problematic for a State to facilitate access to information that would or is likely to result in legal dilemmas and conceptual issues for those using these tests. Public-funded testing should not be available for purposes that would be or are likely to be ‘incompatible’ with any framework for lawful abortion. In England and Wales, those incompatible purposes currently include the identification of (1) gender in the absence of other genetic factors and (2) specific abnormality that is unlikely to yield serious disability at birth. Consequently, expansion of the NIPT regime to include these purposes should entail changes in the legal framework for abortion. [ABSTRACT FROM AUTHOR]

Background: Age-specific effects of mammographic screening, and the timing of such effects, are a matter of debate. The results of the UK Age trial, which compared the effect of invitation to annual mammographic screening from age 40 years with commencement of screening at age 50 years on breast cancer mortality, have been reported at 10 years of follow-up and showed no significant difference in mortality between the trial groups. Here, we report the results of the UK Age trial after 17 years of follow-up.Methods: Women aged 39-41 from 23 UK NHS Breast Screening Programme units years were randomly assigned by individual randomisation (1:2) to either an intervention group offered annual screening by mammography up to and including the calendar year of their 48th birthday or to a control group receiving usual medical care (invited for screening at age 50 years and every 3 years thereafter). Both groups were stratified by general practice. We compared breast cancer incidence and mortality by time since randomisation. Analyses included all women randomly assigned who could be traced with the National Health Service Central Register and who had not died or emigrated before entry. The primary outcome measures were mortality from breast cancer (defined as deaths with breast cancer coded as the underlying cause of death) and breast cancer incidence, including in-situ, invasive, and total incidence. Because there is an interest in the timing of the mortality effect, we analysed the results in different follow-up periods. This trial is registered, number ISRCTN24647151.Findings: Between Oct 14, 1990, and Sept 25, 1997, 160 921 participants were randomly assigned; 53 883 women in the intervention group and 106 953 assigned to usual medical care were included in this analysis. After a median follow-up of 17 years (IQR 16·8-18·8), the rate ratio (RR) for breast cancer mortality was 0·88 (95% CI 0·74-1·04) from tumours diagnosed during the intervention phase. A significant reduction in breast cancer mortality was noted in the intervention group compared with the control group in the first 10 years after diagnosis (RR 0·75, 0·58-0·97) but not thereafter (RR 1·02, 0·80-1·30) from tumours diagnosed during the intervention phase. The overall breast cancer incidence during 17 year follow-up was similar between the intervention group and the control group (RR 0·98, 0·93-1·04).Interpretation: Our results support an early reduction in mortality from breast cancer with annual mammography screening in women aged 40-49 years. Further data are needed to fully understand long-term effects. Cumulative incidence figures suggest at worst a small amount of overdiagnosis.Funding: National Institute for Health Research Health Technology Assessment programme and the American Cancer Society. Past funding was received from the Medical Research Council, Cancer Research UK, the UK Department of Health, and the US National Cancer Institute. [ABSTRACT FROM AUTHOR]

Provides a perspective on coalmining in Great Britain by assessing its performance from 1900 to 1946. Worldwide demand for British coal; Issues in assessing the coalowners' performance as entrepreneurs from 1900-1914 and from 1914-1946; Identification of work required before a more conclusive assessment of entrepreneurial performance can emerge.

A survey is made of the periodical literature on British business history in 1999. The topics covered in the literature for the year are categorized into I: Trade, transportation, mining and agriculture; II: Industry; and III: banking, finance, and accounting. The primary sector is poorly represented in 1999 and features largely in association with related topics or more general studies. Shipping is examined for outcomes additional to its facilitating role in trade. In the second category, manufacturing received much more extensive coverage than primary products, and engineering of all types featured prominently. In the third category, developments in accounting practice again received much direct attention. Nevertheless, there were also important contributions made in banking.

Presents information on a study which determined the rates of, and risk factors for, meningococcal carriage and acquisition among university students in Great Britain. Participants and methods; Results; Discussion.

The article examines the diversification strategies and organisational competencies of Harrisons & Crosfield PLC, a British-based multinational, between 1900 and 1980. Harrisons & Crosfield's ability to change its business portfolio over time--and to survive--makes it essentially interesting to explore questions of learning and organisational capability over time. It was founded in 1844 as a partnership engaged in tea trading. International trade remained the core of the group's business, but the scale of activity and the extent of vertical integration were far removed from nineteenth-century tea trading. Turnover was £62 million, £94 million in 1966, £221 million in 1973 and £639 million in 1979. The first stage in the transformation of Harrisons & Crosfield was the opening of a network of branches outside Great Britain between 1895 and 1910. In essence, the firm grew by using other people's money, to which it added its own managerial expertise. A broadening of scope also took place in rubber operations in that research and developer was undertaken. Timber extraction and processing represented the first major element of diversification on the part of Harrisons & Crosfield following entry into rubber and constituted by far the largest new aspect of inter-war activities.

Examines the demand for neonatal intensive care in Great Britain. Problems of the neonatal care in the country; Duration of the intensive care for premature infants; Gap between demand and provision of neonatal care.

The article examines the evidence of the development of management structures and information systems, in British coal companies between 1880 and nationalisation in 1947. Also, the article focuses on the emphasis made by author M.J. Dintenfass on the importance of entrepreneurial performance in a study of the inter-war British coal industry. This study has chosen a mix of companies operating in the South Wales coalfield and elsewhere. All companies in the sample are joint-stock concerns, but not all of them are particularly large or successful, one actually going into liquidation during the inter-war period. In this article particular attention is paid to elements of continuity and change exhibited by the management information systems, and an attempt is made to link these to similar developments in the management structure of the firms examined. The second section of this article discusses the general concept of management information systems as a backcloth to the empirical investigation contained in the remainder of the study.

Examines the effects of social class and town of residence on smoking and drinking habits of middle-aged men in Great Britain. Prevalence of smoking and drinking among social classes; Social class differences on the frequency and quantity of drinking, beverage type, and aspects of smoking behavior; Relation complexity between behavior and disease.

Focuses on the objectives of the British Regional Heart Study. Risk factors of cardiovascular disease in middle aged man; Assessment on the geographic variations in cardiovascular disease; Association of cardiovascular mortality with systolic blood pressure and the prevalence of cigarette smoking.

Information about a conference organized by the Royal College of Physicians of London in conjunction with the organization Association of Palliative Medicine in Great Britain as of July 25, 2014 for improving outcomes for patients who are older, frail or suffering from dementia, is presented. Topics discussed include advances in understanding of the genetics, neurobiology, and treatment of pain, a study on role of palliative care in dementia, and musculoskeletal pain in older adults.

When planning a multicentre clinical trial, it can be difficult to predict the time needed to open individual sites, and this in turn impacts on the total number of sites needed, the budget and the time frame for a clinical trial to be delivered successfully. This is of particular importance for funding applications with a limited time frame and budget such as NIHR RfPB. It is more efficient and cost-effective to open the total number of sites needed at the outset of a trial, rather than to respond later to slow site opening and recruitment. Here, we share our experience of successfully delivering a multicentre clinical trial for a rare disease within a limited time frame and budget by approximately doubling the number of sites initially predicted to be needed. We initially predicted 20 sites would be needed to deliver the clinical trial, but early on in the trial, the number of sites was more than doubled to allow successful recruitment of the target sample size within the desired time frame. Of the 48 ethically approved sites, the median time from ethical approval of a site to opening for recruitment was 182 days (95% confidence interval [143 to 245 days]) and ranged from 18 to 613 days. In four (9%) of these sites, part of the delay was due to pharmacy sign off not being given when R&D had issued capacity and capability (C&C). Delays due to pharmacy sign off varied from 10 days to over 3 months delay in two sites (94 days and 102 days). A mathematical solution to the problem of planning a study with a short recruitment window has been given to support the planning and costing of grants with fixed time constraints: number of sites = required sample size divided by (number of eligible patients per site per month times recruitment rate times (the number of months accrual minus 6 months)). We expect these results to help others who are planning multicentre clinical trials in the UK. Ethical approval from NRES Committee South West (IRAS number 225959). TRIAL REGISTRATION: EudraCT Number 2017-001171-23 . Registered on 26 June 2017. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the threat of bioterrorism in Great Britain. Heightened concern after terrorist attacks against the United States on September 11, 2001 and subsequent covert releases of anthrax; Threats from the release of weaponised biological agents, common pathogens, and hoaxes; Guidance from the Department of Health on how to deal with chemical and biological attacks; Role of the health care system in recognizing and treating attacks.

Aim: This study aimed to determine the prognostic significance of length of tumour (mrT stage) and depth of extramural spread (mrEMS) in anal squamous cell cancer (SCC) treated by chemoradiation with curative intent. Locally advanced anal SCC (T3-4 N+) have poorer prognosis, but it is unknown whether the lateral spread of the tumour (extramural spread beyond the bowel wall) also confers poor prognosis in anal SCC, as it does for rectal cancer. T stage and mrEMS can be readily assessed by pelvic magnetic resonance imaging (MRI) routinely undertaken to stage anal SCC., Materials and Methods: 125 patients were included. Baseline mrT, mrN and mrEMS were assessed with response to chemoradiation and outcomes. Receiver operating curve (ROC) curve was used to determine a binary cut-off for mrEMS according to 3-year progression- free survival (PFS)., Results: 43% were mrT3-4 and 38% were mrEMS poor at baseline. 87% achieved mrCR. 3-year PFS and overall survival (OS) were 70.6% and 82%. On univariate analysis worse 3-year PFS was seen for mrT3-4 (HR 3.105), mrEMS poor (HR 4.924) and failure to achieve mrCR (HR 20.591). By univariate analysis, worse 3-year OS was seen for mrT3-4 (HR 4.134), mrEMS poor (HR 10.251) and failure to achieve mrCR (HR 19.289). On multivariate analysis, only mrEMS poor and failure to achieve mrCR remained prognostic. mrN was not prognostic., Conclusion: MrEMS poor is a simple prognostic imaging biomarker for poorer survival which can be readily assessed by radiologists on routine imaging. mrEMS should be considered as a future stratification variable to identify high-risk SCC and consider escalation of treatment and surveillance strategies., (Copyright © 2024. Published by Elsevier Ltd.)

The process of determining the best treatments that should be offered to patients with newly diagnosed colon and rectal cancer remains highly variable around the world. The aim of this expert review was to agree the key elements of good quality preoperative treatment decision making., (Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)