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The Care Pathway project used a multilevel and multimethod approach to explore access to the care pathway for diabetic renal disease. Taking what was known about the outcomes of ethnic minority patients with diabetic renal disease; the study sought to explore and further understand how and why South Asian patients' experiences may be different from the majority of population in relation to access. Through improved understanding of any observed inequalities, the study aimed to inform the development of culturally competent diabetes services. The design incorporated audits of patient indicators for diabetes and renal health at key points in the pathway: Diagnosis of diabetes and referral to specialist renal services in two years- 2004 and 2007, and qualitativeindividual interviews with patients and providers identified through the 2007 samples. This article describes the care provide perspective of access to diabetes care from a thematic analysis of 14 semi-structured interviews conducted with professionals,at three study sites, with different roles in the diabetes pathway. National policy level initiatives to improve quality have been mirrored by quality improvements at the local practice level. These achievements, however, have been unable to address all aspects of care that service providers identified as important in facilitating access to all patient groups. Concordance emerged as a key process in improving access to care within the pathway system, and barriers to this exist at different levels and are greater for South Asian patients compared to White patients. A conceptual model of concordance as a process through which access to quality diabetes care is achieved and its relation to cultural competency is put forward. The effort required to achieve access and concordance among South Asian patients is inversely related to cultural competency at policy and practice levels. These processes are underpinned by communication. [ABSTRACT FROM AUTHOR]

Objective. This study compared the performance of cervical cytology plus human papilloma virus testing (Pap + HPV) or cervical spectroscopy (Pap + CS) for identifying high-grade cervical neoplasia in a high-risk population of women referred for colposcopy.Materials and Methods. Each of 113 subjects underwent spectroscopy, thin-layer cytology, HPV testing, colposcopy, biopsy when indicated, and/or endocervical curettage. Evaluable data for analysis were collected for 102 of the subjects. Sensitivity and specificity were calculated for both strategies.Results. Pap + HPV and Pap + CS achieved equivalent sensitivities (95%) for high-grade lesions, with both detecting 17 of 18 histology confirmed cervical intraepithelial neoplasia (CIN) 2+ lesions. Pap + HPV had a specificity of only 27.4% compared with 65.5% for Pap + CS (p < .0001).Conclusions. Spectroscopic interrogation of the cervix is equally sensitive and 2-fold more specific than HPV testing when combined with cervical cytology for identifying high-grade cervical neoplasia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the study was to evaluate the potential safety and effectiveness of tissue spectroscopy for the diagnosis of cervical cancer in a prospective multicenter study of women scheduled for colposcopy on the basis of an abnormal Pap test or other risk factor. MATERIALS AND METHODS: Five hundred seventy-two women underwent spectroscopy of the cervix during their colposcopy visit. Spectroscopy measurements taken over a scan period of 4 minutes and 30 seconds were integrated by a cross-validated pattern recognition model and compared with biopsy results to yield sensitivity and specificity of cervical spectroscopy. RESULTS: The median age of subjects enrolled in the study was 27.7 years. The sensitivity of cervical spectroscopy was 95.1% with a corresponding 55.2% specificity for benign lesions. Several potential confounding factors (eg, mucous, blood, patient motion, ambient light) were examined to determine their potential impact on the accuracy of the test. Ambient light seemed to have the greatest effect, but no single factor contributed significantly to the results. The subjects did not experience any adverse events from undergoing the test. CONCLUSIONS: Spectroscopy of the cervix has the potential to accurately detect cervical moderate and high-grade dysplasia while also reducing the false-positive rate for benign cervices. The test is relatively simple to implement and was well accepted by subjects enrolled in the study. [ABSTRACT FROM AUTHOR]

While sentinel lymph node biopsy (SLNB) has virtually replaced axillary dissection as the initial diagnostic procedure for invasive breast cancer, the role of SLNB in ductal carcinoma in situ (DCIS) remains controversial. The purpose of this study was to review our experience with SLNB in DCIS. All patients with DCIS or DCIS with microinvasion (DCISM) who underwent SLNB from June 1997 to April 2002 at the University of Florida were included for analysis. The indications for SLNB were at the discretion of the treating surgeon. Lymphatic mapping involved a sequential dermal-peritumoral radiocolloid injection and dynamic lymphoscintigraphy followed by an intraoperative assessment of radioactivity with a handheld gamma probe. All sentinel lymph nodes (SLNs) with radioactive counts >=10% of the ex vivo counts of the most radioactive SLN were removed. Pathologic analysis consisted of slicing the SLN at 2 mm intervals for permanent section. All paraffin blocks of the SLNs were step sectioned in 4 um sections (92 um spacing) through the entire lymph node. Slides were then stained with an immunohistochemical stain for cytokeratin (AE1/AE3) and evaluated by microscopy. Nodal metastases were classified using the 6th edition of the American Joint Committee on Cancer (AJCC) staging manual. From April 1998 to April 2002, 43 patients with DCIS underwent SLNB at the University of Florida. Seven patients (16%) with multifocal or extensive DCIS (five patients) or DCISM (two patients) who underwent SLNB had a positive sentinel node. Two of the three patients considered positive by immunohistochemistry alone had either DCISM or invasive disease. Four (80%) of the five patients with extensive DCIS and a positive sentinel node were ultimately determined to have invasive or microinvasive disease. While SLNB remains controversial in DCIS, our data suggest that patients with extensive DCIS should undergo SLNB at the initial procedure to avoid the need for a second operation. Data from clinical trials are needed to determine the impact of SLNB results on overall survival in patients with DCIS. [ABSTRACT FROM AUTHOR]

Short- and long-term hospital and community exercise programmes for patients with chronic obstructive pulmonary disease ELLIOTT M, WATSON C, WILKINSON E, MUSK AW, LAKE FR. Respirology 2004; 9: 345–351 Pulmonary rehabilitation in patients with COPD has been shown to be beneficial but the optimal setting is not known. In the present study, the efficacy of a short-term community-based exercise programme was compared with a standard hospital outpatient programme. Additionally, the usefulness of community or home programmes in maintaining improvements in the longer term was studied. Forty-three patients with moderate to severe COPD were randomized to one of the following three groups: a 3-month hospital programme then a 9 month home programme (Hospital/Home); a 3-month hospital programme then a 9-month community programme (Hospital/Community); or a 12-month community programme (Community/Community). The initial 3-month programme was analysed by comparing the Hospital group (Hospital/Home plus Hospital/Community) with the Community group (Community/Community). Six-minute walking distance (6MWD), quality of life (Guyatt chronic respiratory disease questionnaire, CRQ) and lung function were measured at 0, 3, 6 and 12 months and results were analysed using the Wilcoxon rank sum test. At 3 months, there was a significant improvement from baseline in 6MWD in the Hospital group (81.3 ± 18.3 m, P < 0.05, anova) but not the Community group (14.4 ± 28.5 m, not significant). The difference between the groups was not significant ( P = 0.058). At 3 months, there was a significant improvement in quality of life in the Hospital group (CRQ +16.3 ± 3.1, P < 0.01, anova) and in the Community group (CRQ +10.2 ± 4.9, P < 0.05, anova) but the difference between the groups was not significant. Following the initial 3-month programme, the dropout rate was high overall (73% by 12 months), and therefore data from the maintenance programme could not be analysed. A 3-month community-based exercise programme for patients with COPD did not improve 6MWD. The long-term retention rates in the programmes were poor. [ABSTRACT FROM AUTHOR]

Presents a study which investigated the outbreak of atypical rash in junior school students who attended an outdoor games event in Great Britain. Clinical characteristics of the rash; Laboratory analysis of water samples from water play events; Identification of Pseudomonas aeruginosa as the pathogenic etiology of the rash.

Objectives: We set out to examine our use of the squamous intraepithelial lesion (SIL) category, compare our SIL rate to rates reported by others, and determine the corre-lation between SIL and histologically proven cervical intraepithelial neoplasia (CIN) in our population.Materials and Methods: Reports from all Papanicolaou smears and associated histological specimens interpreted by the University of Florida Department of Pathology between 1992 and 1996 were reviewed.Results: Of 39,484 Papanicolaou smears, 2,101 (5.3%) were classified as low-grade squamous intraepithelial lesion (LGSIL) and 1,366 (3.5%) were classified as high-grade (HGSIL). Of the LGSIL cases, 972 (46.3%) underwent timely biopsy: Findings were benign in 29.9%; 41.7% had CIN1,20.9% had CIN2, and 7.5% had CIN3. Of the HGSIL cases, 932 (68.2%) underwent timely biopsy: Findings were benign in 12.3%; 17.1% had CIN1, 26.7% had CIN2, 42.2% had CIN3, and 1.6% showed squamous cell carcinoma. Condusions. Our LGSIL rate is similar to reported rates, but our HGSIL rate of 3.5% is higher. We found good correlation between SIL on Papanicolaou smear and CIN on biopsy (70.1% for LGSIL and 86% for HGSIL). [ABSTRACT FROM AUTHOR]

Objectives: We set out to determine our rate of atypical glandular cells of undetermined significance (AGUS) classification, to compare our AGUS rate to rates reported by others, and to determine the correlation between AGUS and histological abnormalities in our population.Materials and Methods: Reports from all Papanicolaou (Pap) smears and associated histological specimens interpreted by the University of Florida Department of Pathology between 1992 and 1996 were reviewed.Results: A total of 462 (1.2%) of 39,484 Pap smears were classified as epithelial cell abnormality-glandular cell, with 328 (0.83%) AGUS, 102 (0.26%) endometrial cells out of phase or in a postmenopausal woman, and 32 (0.08%) adenocarcinoma. A total of 146 (45%) of the AGUS cases had timely biopsies: 95 (65.1%) had benign findings, 27 (18.5%) had cervical intraepithelial neoplasia, 14 (9.6%) had adenocarcinoma (10 endometrial, 2 endocervical, 2 extrauterine), 9 (6%) had endometrial hyperplasia, and 1 (0.7%) showed endocervical glandular cell dysplasia.Conclusions: AGUS on Pap is associated with a clinically significant histological abnormality in a moderate percentage of patients. Both squamous and glandular lesions are seen, supporting the need for aggressive evaluation of the cervix, endocervix, and endometrium when AGUS is reported. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to determine whether office deep loop excision should replace cone biopsy for frozen-section endocervical evaluation before planned hysterectomy.Study Design: This cohort study comprised 31 patients who underwent office deep loop excision with frozen-section analysis followed by hysterectomy and 50 historic controls who underwent cone biopsy with frozen-section analysis followed by hysterectomy. Diagnostic accuracy, margin status, presence of residual disease, morbidity, and cost were compared.Results: Loop excision frozen sections had sensitivity (ectocervical specimen, 96%; deepest endocervical specimen, 93%), specificity (100%, 86%), and positive (100%, 88%) and negative (75%, 92%) predictive values similar to those of frozen cone biopsy (95%, 80%, 98%, and 67%, respectively. No differences in margin status, presence of residual dysplasia, or morbidity were observed. The shorter operating room time for vaginal hysterectomy after loop excision (p < 0.01) resulted in an approximate $2000 savings.Conclusion: Office loop excision is a cost-effective option for endocervical evaluation before planned hysterectomy. [ABSTRACT FROM AUTHOR]

This article describes a health authority's approach to setting up and evaluating a coronary heart disease prevention programme through the workplace. The Bedfordshire Healthy Workplace Project was set up in 1992 'to stimulate interest and activity in workplace health promotion' and has developed an action research model to evaluate the impact of working with local employers on coronary heart disease risk behaviour. Action research as a methodology for health promotion research, and some of the main benefits and barriers are discussed. [ABSTRACT FROM AUTHOR]

Using an oral fat load, it is demonstrated that the pattern of absorption in elderly subjects is significantly different from that found in younger controls. This change may be due to the slower gastric emptying or reduced pancreatic function observed in this study. The possibility of impaired small bowel absorption has not been excluded. [ABSTRACT FROM AUTHOR]

Investigations into the causes of osteomalacia in 12 geriatric patients with a histologically proven diagnosis, revealed no predominant aetiology. The metabolic bone disease in these patients appeared to have multifactorial causes in at least half the cases. [ABSTRACT FROM PUBLISHER]

The texture of steam-cooked potatoes from ten cultivars was sensory evaluated after two, four and nine months storage for three consecutive years. The sensory data were analyzed using Principal Component Analysis (PCA) and regression analysis. PCA revealed that the first two principal components explained 95% or more of the variance between the data. The first principal component was dominated by the descriptors mealy (M)/crumbly (A/M) on the positive side and the descriptors waxy (A/M) on the negative side. The descriptor firm (M) had a high positive loading on the second principle component. Regression analysis showed that cultivar effects dominated storage effects. Based on these data, a proposal is made to divide the ten cultivars in four groups which differ for the descriptors mealy (M)/crumbly (A/M), waxy (A/M) and firm (M). During storage, potato texture became more waxy (A/M) and sticky (A/M) with respect to both appearance and mouthfeel. Other changes in texture as a result of storage were strongly cultivar dependent. [ABSTRACT FROM AUTHOR]

A clinical and biochemical evaluation has been made of a new milk formula, Modified Carnation milk (MCM), based on cows' milk but with the mineral content and concentration of caloric nutrients altered to make it correspond more closely to human milk. MCM produced higher plasma calcium and magnesium concentrations in 6-day-old infants than those produced by unmodified evaporated and dried milks, achieving concentrations closer to those of breast milk. Plasma free amino acid concentrations in MCM-fed infants are nearer breast-fed values than those in unmodified milk-fed infants where higher individual plasma amino acid concentrations persist during the first 3 months. MCM-fed infants had low plasma urea concentrations and lower urine osmolalities at 6 days, 3 weeks, 6 weeks, 3 months, and 6 months than infants fed on the evaporated and dried milks, and similar plasma urea and urine osmolalities to those of breast-fed infants. MCM is likely to be superior to unmodified evaporated and dried milks in preventing convulsions of the hypocalcaemic/hypomagnesaemic/hyperphosphataemic type, and seems less likely to cause hypertonic dehydration. MCM is easily prepared, readily accepted by babies, and appears to be nutritionally adequate for the feeding of term infants. [ABSTRACT FROM AUTHOR]

This article discusses the pathogenicity of Gloeosporium album to maiden shoots of Cox's Orange Pippin trees. When pruned maiden shoots of Cox's Orange Pippin were inoculated with a standard spore suspension of G. album, only 9 of the 96 inoculations produced diebacks slightly longer than the amount of dead tissue which developed naturally at the tips of control shoots. It was concluded, therefore, that germinating spores of G. album are non-parasitic to pruning wounds of maiden shoots of this apple variety. Highest incidence of rotting occurred in fruits from trees inoculated in April 1957 on which the greatest number of induced diebacks had developed. It is suggested that induced diebacks can make a significant contribution to the spore load of fruits before harvesting.

Introduction Due to growing older population with increasing medical complexity and care needs, over-reliance on acute hospitals for care delivery, disconnect between social and medicalised care and challenging national health services (NHS) financial climate, it is essential to provide much of this care to our older patients outside the acute hospital before they reach crisis point. This prevents unnecessary hospital admissions and outpatient referrals especially to our geriatric services. Therefore, newer and innovative care models are required to cater the needs of our aging population especially within the community settings. The North West Surrey clinical commissioning group (CCG) catchment area is divided into three localities, namely SASSE Locality in Spelthorne, Thames Medical Locality in Runnymede/West Elmbridge, and the Woking Locality (Bedser hub) in Woking. Locality hub model of integrated care led by GP with multidisciplinary (MDT) input along with wellbeing coordinators was introduced to address above issue. Objectives Our mission was to find a way to manage the challenges we face from a growing older population within an integrated GP-led community service and in a manner that promotes independence, reduce social isolation, improve patient experience and safely deliver appropriate acute care in the community whilst reducing dependency on regional acute hospitals. A fully qualified geriatrician input was introduced within the hub model at Bedser hub. Results Total savings: £16,484, Geriatricians input cost: £16,500 Cost neutral intervention Locality Referrals from April 2016–March 2017 (n) Referrals from April 2017–March 2018 (n) Increase or decrease (%) Woking 203 155 23.65% - less SASSE 228 244 13.63% - more Thames Medical 285 330 6.55% - more Conclusions Newer models of collaborative healthcare within the community dwellings with GP and geriatrician input along with multidisciplinary approach are essential to deliver safe and high quality care to our older population, thus reducing reliance on our ever so stretched local acute NHS hospitals. Our intervention has resulted in reduction of referrals to geriatric outpatient clinic and enabled us to provide the required care to our older population closer to home. It has also led GPs to build their skills in managing the very frail patients with complex needs safely and effectively. In the long run, the intervention will be cost effective with further projected reduction in referrals. [ABSTRACT FROM AUTHOR]