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Blood donors' motivations and reasons for lapsing and never donating were determined from a questionnaire completed by 489 adults (89 regular donors, 105 lapsed donors, 295 never donors) in Leeds, UK. The free text responses were classified according to themes that arose. Altruistic motivations including reciprocation and kinship towards family, friends, and unknowns were most numerous. Other motivations related to the NHS or National Blood Service, obligation, occupation, self-interest, convenience, peer-influence, health benefits, a rare blood group, donations being useful, a TV programme, or ethnicity. Reasons for non-donation were personal, medical, donation centre- or procedure-related, exclusions, and age-related. Suggestions are offered to increase the blood supply. [ABSTRACT FROM AUTHOR]

Background:. The concept of comorbid mental health problems and substance misuse has gained prominence in the last two decades, due in part to the closure of large psychiatric hospitals and to the increasing prevalence of drug use in the community. This client group has a dual requirement for both medical and social care needs and is at risk for social exclusion. Methods:. A retrospective matched case-control study to examine aspects of social exclusion between service users who have comorbid diagnoses and those with a single diagnosis. Samples were drawn from the service users of a mental health Trust in the South-East of England, from both Adult Mental Health (n = 400) and Drug and Alcohol services (n = 190). Data were collected from Care Programme Approach assessment forms and medical records. McNemar’s χ2 and odds ratios via a conditional logit regression model are used to test for differences in the social exclusion indicators. Results:. There were significant differences in social exclusion between the comorbid and singly diagnosed clients of the Adult Mental Health service, but differences were less pronounced between the comorbid and singly diagnosed clients of the specialist Drug and Alcohol service. Conclusions:. Recent Government policy advocates treating comorbid clients within mainstream mental health services. Health care workers need to recognise the likelihood of high levels of social exclusion among clients with comorbid problems. [ABSTRACT FROM AUTHOR]

Presents abstracts of articles about audit and cancer pathways, to be discussed at the Annual Scientific Meeting of the British Association of Urological Surgeons from June 23,-27, 2003 in Manchester, England. 'Clinic overload!-A national audit of outpatient service provision,' by P.E. Gilmore et al.; `Use of urology theatre time: A retrospective audit,' by A. D'sa et al.

Background: Idiopathic intracranial hypertension (IIH) is associated with significant morbidity, predominantly affecting women of childbearing age living with obesity. Weight loss has demonstrated successful disease-modifying effects; however, the long-term cost-effectiveness of weight loss interventions for the treatment of IIH has not yet been established., Objectives: To estimate the cost-effectiveness of weight-loss treatments for IIH., Setting: Single-payer healthcare system (National Health Service, England)., Methods: A Markov model was developed comparing bariatric surgery with a community weight management intervention over 5-, 10-, and 20-year time horizons. Transition probabilities, utilities, and resource use were informed by the IIH Weight Trial (IIH:WT), alongside the published literature. A probabilistic sensitivity analysis was conducted to characterize uncertainty within the model., Results: In the base case analysis, over a 20-year time horizon, bariatric surgery was "dominant," led to cost savings of £49,500, and generated an additional 1.16 quality-adjusted life years in comparison to the community weight management intervention. The probabilistic sensitivity analysis indicated a probability of 98% that bariatric surgery is the dominant option in terms of cost-effectiveness., Conclusion: This economic modeling study has shown that when compared to community weight management, bariatric surgery is a highly cost-effective treatment option for IIH in women living with obesity. The model shows that surgery leads to long-term cost savings and health benefits, but that these do not occur until after 5 years post surgery, and then gradually increase over time., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: School-based social and emotional learning interventions can improve wellbeing and educational attainment in childhood. However, there is no evidence on their effects on health-related quality of life (HRQoL) or on their cost effectiveness., Objective: Our objective was to evaluate the cost effectiveness of the Promoting Alternative Thinking Strategies (PATHS) curriculum., Methods: A prospective economic evaluation was conducted alongside a cluster-randomised controlled trial of the PATHS curriculum implemented in the Greater Manchester area of England. In total, 23 schools (n = 2676 children) were randomised to receive PATHS, and 22 schools (n = 2542 children) were randomised to continue with usual practice. A UK health service perspective and a 2-year time horizon were used. HRQoL data were collected prospectively from all children in the trial via the Child Health Utility Nine-Dimension questionnaire. Micro-costing was undertaken to estimate the intervention costs. Missing data were imputed using multiple imputation., Results: The mean incremental cost of the PATHS curriculum compared with usual practice was £32.01 per child, and mean incremental quality-adjusted life-years (QALYs) were positive (0.0019; 95% confidence interval [CI] 0.0009-0.0029). Assuming a willingness-to-pay threshold of £20,000 per QALY, the expected incremental net benefit of introducing the PATHS curriculum was £5.56 per child (95% CI - 14.68 to 25.81), and the probability of cost effectiveness was 84%. However, this probability fell to 0% when intervention costs included teacher's salary costs., Conclusion: The PATHS curriculum has the potential to be cost effective at standard UK willingness-to-pay thresholds. However, the sensitivity of the cost-effectiveness estimates to key assumptions means decision makers should seek further information before allocating scarce public resources., Trial Registration Number: ISRCTN85087674.

Objectives: The rapid turnaround time of point-of-care (POC) cardiac troponin (cTn) assays is highly attractive for crowded emergency departments (EDs). We evaluated the diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a POC cTn assay., Methods: In a prospective diagnostic accuracy study at eight EDs, we included patients with suspected acute coronary syndromes (ACS). Blood drawn on arrival and 3 hours later was analysed for POC cTnI (i-Stat, Abbott Point of Care). The primary outcome was a diagnosis of ACS, which included both an adjudicated diagnosis of acute myocardial infarction (AMI) based on serial laboratory cTn testing and major adverse cardiac events (death, AMI or coronary revascularisation) within 30 days., Results: Of 716 patients included, 105 (14.7%) had ACS. Using serial POC cTnI concentrations over 3 hours could have 'ruled out' ACS in 198 (31.2%) patients with a sensitivity of 99.0% (95% CI 94.4% to 100.0%) and negative predictive value 99.5% (95% CI 96.5% to 99.9%). No AMIs were missed. T-MACS 'ruled in' ACS for 65 (10.4%) patients with a positive predictive value of 91.2% (95% CI 82.1% to 95.9%) and specificity 98.9% (97.6% to 99.6%)., Conclusion: With a POC cTnI assay, T-MACS could 'rule out' ACS for approximately one-third of patients within 3 hours while 'ruling in' ACS for another 10%. The rapid turnaround time and portability of the POC assay make this an attractive pathway for use in crowded EDs or urgent care centres. Future work should also evaluate use in the prehospital environment., Competing Interests: Competing interests: RB Speaker fees from Singulex; Roche (consultancy, research grant); Abbott Point of Care (speaker fee, research grant); FABPulous BV (consultancy); Alere (donation of reagents for research)., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Patients with severe dry eye disease (DED) often have limited treatment options with standard non-surgical management focused on the use of artificial tears for lubrication and anti-inflammatory drugs. However, artificial tears do not address the extraordinary complexity of human tears. Crudely, human tears with its vast constituents is essentially filtered blood. Blood and several blood-derived products including autologous serum, have been studied as tear substitutes. This study proposes to test the use of whole, fresh, autologous blood obtained from a finger prick for treatment of severe DED., Methods and Analysis: The research team at the two participating sites will approach patients with severe DED for this study. Recruitment will take place over 12 months and we expect to recruit 60 patients in total. The primary outcome of this feasibility study is to estimate the proportion of eligible patients approached who consent to and comply with study procedures including treatment regimen and completion of required questionnaires. The secondary outcome measures, although not powered for in this feasibility, include corneal inflammation (assessed by the Oxford corneal staining guide), patient pain and symptoms scores (assessed by the Ocular Surface Disease Index Score), and objective signs of DED as indicated by visual acuity (assessed by Schirmer's test, tear break-up time, lower and/or upper tear meniscus height measurement). Other secondary outcomes include patients' quality of life (assessed using the validated EQ-5D-5L Questionnaire), cost to the National Health Service (NHS) and patient (assessed via use of NHS services and privately purchased over-the-counter treatment related to DED) and safety measure of pressure within the eye (assessed by the Intraocular Pressure (IOP) Score)., Ethics and Dissemination: This protocol and any subsequent amendments, along with any accompanying material provided to the participant in addition to any advertising material used in this trial have been approved by the East of England - Cambridgeshire and Hertfordshire Research Ethics Committee (REC reference: 17/EE/0508). Written approval from the committee was obtained and subsequently submitted to the respective Trust's Research and Development (R&D) office with final NHS R&D approval obtained. Data obtained from this study will be published in a suitable peer-review journal and will also presented at international ophthalmic conferences including the American Academy of Ophthalmology, the Royal College of Ophthalmology Annual Congress, the Association for Research and Vision and Ophthalmology, and the European Society of Cataract and Refractive Surgery. Information will be provided to patient groups and charities such as the Sjogren's Society and the Royal National Institute of Blind People. This will also be shared with the study participants as well as with relevant patient groups and charities., Trial Registration Number: NCT03395431; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.)

Background: Stroke is a leading cause of death; between 20% and 30% of people die within 30 days of a stroke. High-quality palliative and end-of-life care are advocated for patients not expected to recover from stroke., Aim: To explore the perspectives of health professionals regarding the provision of palliative and end-of-life care in UK stroke units., Design and Setting: Qualitative focus groups and individual interviews were held with 66 health professionals working in UK specialist stroke units. Data were analysed thematically., Results: Three themes emerged from the data. Palliative care was recognised as an important component of stroke care; however, there was uncertainty when initiating transitions to palliative care in stroke, and issues were identified with the integration of acute stroke care and palliative care., Conclusions: The findings provide encouraging evidence that palliative and end-of-life care have been adopted as key components of specialist stroke care in UK stroke units. However, many patients stand to benefit from earlier identification of palliative care need and a consideration of quality-of-life approaches during active care. Encouraging collaboration and partnership when working with specialist palliative care services would optimise palliative care service delivery and may provide patients and their families with greater opportunities for documenting and achieving preferences for care and achieving a better quality of death.

Objective: To investigate the relationship between pre-symptom onset live births and functional outcome in women with inflammatory polyarthritis (IP)., Methods: 1872 women with no subsequent pregnancies were registered with the Norfolk Arthritis Register between 1990 and 2004 and followed-up for a median of 5 years. Functional disability over time was assessed by Health Assessment Questionnaire (HAQ). The number and calendar year of past live births were recorded. Differences in HAQ score over time by parity and time since last live birth (latency), adjusted for age and symptom duration, were examined using linear random effects models. The results were then adjusted for a number of potential confounders., Results: 1553 women (83%) had ≥1 live births before symptom onset. The median latency was 26 years (IQR 16-35). Parous women had significantly lower HAQ scores over time than nulliparous women (-0.19, 95% CI -0.32 to -0.06). Increasing latency was associated with increasing HAQ score; the mean HAQ score of women with a latency of approximately 32 years was the same as for nulliparous women. This was independent of autoantibody status, socioeconomic status, smoking history and comorbidity., Conclusion: Parous women who develop IP have better functional outcome over time than nulliparous women who develop IP. The beneficial effect of parity diminishes with time.

The purpose of this study was to examine a previous increase in male gallstone disease and to consider the burden of gallstones in a necropsy study with matched controls over a decade. Gallstone prevalence in 5,050 males fell from 20.2% to 19.1% (P=0.022) and in 4,125 females fell from 30.4% to 29.0% (P=0.03). Female gallstone subjects had a higher BMI than controls 24.5 vs. 23.3 (P<0.01), but males did not. Gallstones were twice as common in diabetics, but not with coronary heart disease (CHD). A third of elderly patients of both sexes had gallstones, but cholecystectomy was more common in females, 17:10%. Gallstone-related mortality was 0.7%. The prevalence of gallstones fell slightly. The association between gallstones and diabetes was confirmed, but not for CHD, and for BMI this was confined to females. Gallstones are very common in the elderly, but most are unoperated and seldom cause death., (© Springer Science+Business Media, LLC 2009)

Students commence nurse education with varying levels of understanding of human anatomy and physiology due to a wide range of previous exposure to the topic. All students, however, are required to attain a broad knowledge of this topic prior to qualification. This paper describes the use of a Virtual Learning Environment (VLE), Blackboard 5, and the associated development of appropriate resources aimed at supporting nursing students undertaking a human anatomy and physiology module at Higher Education Level 1. The VLE was used as part of a blended learning approach. The results suggested that the majority of students utilised the VLE throughout the academic year. Opportunities for independent and self-directed learning were available in that students chose when and where to learn. Students generally commented favourably on ease of use and type of resources available. Frequency of use of the VLE, however, did not correlate strongly with the final examination mark achieved. Overall the VLE and the associated available resources appeared useful in supporting student learning and has been adopted for use in subsequent years.

Objective: Patients with rheumatoid arthritis (RA) should start treatment early with the aim of suppressing the inflammatory process completely. It is not known if this strategy should, or can, be continued in later disease., Methods: In a multicentre, randomized, observer-blinded, controlled trial, 466 patients with established RA (>5 yr), on stable therapy for at least 6 months, were randomized to adequate symptom control/shared care setting (SCSC) or aggressive treatment/hospital setting (ATH). All were reviewed annually by a rheumatologist. The primary outcome after 3 yr was the Health Assessment Questionnaire (HAQ). Others included the OMERACT core set and the Disease Activity Score (DAS) 28., Results: Three hundred and ninety-nine patients completed the trial. There was a significant deterioration in HAQ in both arms. Only the physician global score differed between the arms., Conclusions: The trial showed no additional benefit of intensified treatment with traditional disease modifying anti-rheumatic drugs (DMARDs) in patients with stable, established RA. It proved hard to suppress C-reactive protein levels. Patients in the SCSC arm were able to initiate treatment changes when their symptoms deteriorated without frequent hospital assessment. Pending further evidence, the model of shared care with annual hospital review is as good as 4-monthly hospital review for these patients.

Ninety-two retrospective cases of human bite injury referred to a Plastic Surgery department are presented. Particular emphasis is placed on the relationship of alcohol intake to these injuries, their distribution and subsequent management. A review of the literature is conducted. The human bite is a leisure time injury of the young single male in the North East. It has been shown that there is a clear link to alcohol and in particular weekend drinking. Prompt operative intervention and wounds located at the head and neck have been shown to be associated with a decreased risk of subsequent infection, which reflects findings in the earlier literature. Fifteen cases were infected. One was the result of a postoperative complication. The remainder were infected on admission. The majority of infected cases were upper limb bites and were associated with a delayed presentation.

This paper discusses methodological issues arising in the initial stages of a larger epidemiological case-control study. Practitioners from both Generic Mental Health and Substance Misuse Services (n = 170) were asked to identify which of their clients, from a time-limited caseload (n = 2341), had comorbid mental health and substance misuse problems. Although practitioners were provided with a definition of 'singly diagnosed' and 'dually diagnosed', it became apparent that these definitions were applied pragmatically, depending on the nature of the client's primary problem and the agency they were presenting to. Issues raised include the time period in which a client was considered to have a concurrent mental health problem and substance misuse, how a 'mental health problem' was defined and whether a personality disorder should be categorized as a 'mental health problem'. There was also some disagreement about whether clients who were being treated primarily by Substance Misuse Services, but were also taking prescribed antidepressants, implicitly had a 'mental health problem'. We raise these methodological issues, as they have implications for determining the prevalence of 'dual diagnosis' and the subsequent provision of services.

Objective: To determine everyday practice in the hospital management of men undergoing prostatectomy and the extent of its variation., Patients and Methods: A total of 5361 patients, who represented 89% of all those undergoing prostatic procedures in four health regions (Mersey, Wessex, Northern and South West Thames) and one test site (within Trent) were recruited by 103 (97%) surgeons. Clinical information was collected on a pre-coded data collection form which was completed during the hospital stay by the principal operator. Patient identification occurred at the time of surgery., Results: Important findings included: (i) both older men and those of higher social class were more likely to undergo prostatectomy with fewer symptoms; (ii) men who waited longer for surgery had worse symptoms by the time of their operation; (iii) there were unexplained differences in routine pre- and post-operative investigation and treatment. Half the men had their flow rate or residual urine measured as part of their pre-operative assessment. About half the men received prophylactic antibiotics; (iv) when large groups were analysed, a consistent proportion of men throughout the study (12%) were undergoing the operation for a second time. The clinical course of men having a repeat operation differed in many ways from those having a first time procedure; (v) the larger proportion of men (62%) had surgery for strong indications as opposed to symptoms alone; (vi) although most operations were performed by consultants, emergency admissions, though symptomatically more severe and sicker, were more likely to be operated on by trainee surgeons; (vii) significant variation in mean pre-operative symptom severity and bother scores were seen between surgeons., Conclusion: The clinical management of prostatectomy has been defined in a large and representative UK sample. In some circumstances consistent variations have been identified. It is not yet clear whether these variations influence outcome. These data can be used by surgeons wishing to compare their own patient management with that described here.

Measurements have been made of cockpit temperatures in a Buccaneer aircraft exposed to high air temperatures and radiation loads. With the canopy open 8 cm, and with the wind direction unfavourable for convective cooling, air temperatures inside the cockpit exceeded those outside by approximately 20 degrees C. This reduced to 10 degrees C with a favourable wind direction. An assessment of the likely heating effect of cockpit avionic equipment indicated that the addition of 1 kW and 2 kW of heat would raise cockpit temperatures by 20 degrees C and 30 degrees C respectively. Prediction of the combined effect of solar and avionic heat suggests that, in hot weather conditions, cockpit temperatures will be considerably in excess of the upper limit for effective physiological temperature regulation. Therefore, if aircrews are to be required to remain on ground standby within their aircraft under such conditions, maximum use must be made of convective cooling of the cockpit by the prevailing wind, and of sun shades to eliminate the greenhouse effect completely.

This paper reports a high incidence of minor congenital anomalies in boys and girls with Perthes' disease compared with that in a control population. There is a similarity of the incidence of minor anomalies in the children with Perthes' disease to that in babies with a single major congenital defect. Multiple major defects were more numerous and more severe than in the control children. It is speculated that there may be a congenital abnormality affecting skeletal development which in some way makes the hip susceptible to Perthes' disease at a later date.

In a prospective study of gall stone related deaths in a single Health District, the biliary tract was examined at necropsy in 1701 cases and 8078 death certificates were searched. Gall stones were identified as the cause of death in only 21 cases (0.26%) but in 291 subjects found to have gall stones or cholecystectomy at necropsy, the mortality was 3.4%. The necropsy prevalence of gall stones in the adult population was 17.1% but nine out of 10 subjects with gall stones had not had a cholecystectomy and women were three times more likely to have had their gall stones removed than men. There were five postoperative deaths (mean age 60 years) with an operative mortality for cholecystectomy in the district of 1.2%. Death due to unoperated gall stones was identified in 16 subjects, most of whom were very elderly women (mean age 81) but carcinoma of the gall bladder was only found in one woman of 90 with gall stones. The prevalence of gall stones rose with age in both sexes but the cholecystectomy rate per head of population at-risk declined sharply in the seventh decade in women and the eighth decade in men. There are a large number of people with unoperated gall stones in the population but gall stone related deaths are very uncommon. The cholecystectomy rate in Britain, however, seems to be rising and it is suggested that if this trend continues there may be an increased number of deaths.

Evidence is presented for a minimal defect of peripheral nerve function in a group of lead accumulator workers without clinical evidence of a neurological lesion. Of the 19 men examined, 13 had blood levels above 80 mug./100 ml. and seven had haemoglobin levels below 12 g./100 ml., showing that considerable exposure to lead was occurring.