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IntroductionThe increasingly ageing population is associated with greater numbers of people living with dementia (PLwD) and mild cognitive impairment (MCI). There are an estimated 55 million PLwD and approximately 6% of people over 60 years of age are living with MCI, with the figure rising to 25% for those aged between 80 and 84 years. Sleep disturbances are common for this population, but there is currently no standardised approach within UK primary care to manage this. Coined as a ‘wicked design problem’, sleep disturbances in this population are complex, with interventions supporting best management in context.Methods and analysisThe aim of this realist review is to deepen our understanding of what is considered ‘sleep disturbance’ in PLwD or MCI within primary care. Specifically, we endeavour to better understand how sleep disturbance is assessed, diagnosed and managed. To co-produce this protocol and review, we have recruited a stakeholder group comprising individuals with lived experience of dementia or MCI, primary healthcare staff and sleep experts. This review will be conducted in line with Pawson’s five stages including the development of our initial programme theory, literature searches and the refinement of theory. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and reporting standards will also be followed. The realist review will be an iterative process and our initial realist programme theory will be tested and refined in response to our data searches and stakeholder discussions.Ethics and disseminationEthical approval is not required for this review. We will follow the RAMESES standards to ensure we produce a complete and transparent report. Our final programme theory will help us to devise a tailored sleep management tool for primary healthcare professionals, PLwD and their carers. Our dissemination strategy will include lay summaries via email and our research website, peer-reviewed publications and social media posts.PROSPERO registration numberCRD42022304679.

This paper explores the Dementia Enquirers approach to dementia research, and the 10 local projects which have been funded in the first wave of the programme. The paper is written by six people wit...

Congenital atresia of the esophagus as usually been regarded as an uncommon condition. In 1931, Rosenthal (to) recorded 255 cases from the literature, including a number of his own. Since then numerous additional cases have been published. We recently encountered two examples, associated with tracheo-esophandgeal fistula, within a month. During the previous ten years there had been 12,285 deliveries on the maternity service of Metropolitan Hospital, but among these the records fail to show a single case of esophageal atresia. Nor is it likely that any cases were overlooked, as a very high percentage of autopsies on the newborn is obtained at this institution, particularly in cases with unusual symptoms. The purpose of the present communication is to present our cases, to review briefly the salient clinical and radiographic features, and to describe a new and simple diagnostic procedure-aeroesophagography- for establishing a diagnosis of congenital atresia of the esophagus. A number of excellent reviews ha...

D URING acute and chronic disease of the respiratory tract, or states of excessive strain on the pulmonary apparatus, or following trauma, air may suddenly escape under pressure from the alveolar structures into the interstitial tissues of the lungs, the mediastinum, their fascial extensions, and the pleural spaces. The mechanism leading to the production of the resulting pulmonary interstitial and mediastinal emphysema, or airblock, and of pneumothorax has been described by Hamman 1' ~ and by the Macklins2, 4 The condition may develop unsuspectedly in infants and children, and may be exhibited clinically only by persistent dyspnea and cyanosis of a severity not accounted for by physical signs on examination. Roentgenography of the chest may provide the initial clue to the presence of extravasations of air that underlie the acute respiratory and circulatory embarrassment. To illustrate this sequence of events and to demonstrate some representative .causes of airblock, the following case histories are presented.

In a recent communication (1) we suggested aeroesophography as a simple roentgenographic procedure to establish the diagnosis of congenital atresia of the esophagus without the use of a liquid contrast medium. We postulated that air introduced into the esophagus through a catheter would clearly outline the upper segment in cases of atresia, thus permitting a definite diagnosis to be made. Since then we have had the opportunity of employing this method with complete success. E. H., a 36-hour-old infant, was referred for roentgen studies with a clinical diagnosis of congenital atresia of the esophagus with tracheo-esophageal fistula. The clinical picture was typical of this condition. On the night of delivery the only unusual feature noted was the presence of an excessive amount of mucus in the pharynx. All efforts at feeding on the following day resulted in regurgitation of the ingested milk through the mouth and nose, and in respiratory difficulty. A gavage feeding was attempted but the catheter could not...

Many case reports and articles have been published in recent years describing the adrenogenital syndrome in detail. The clinical picture and physiochemical explanation have become well known. There is, however, one minor anatomical variation which we believe has not been sufficiently stressed. This variation is one in which the urethra opens at the tip of a hypertrophied clitoris, giving the appearance of a normally formed penis with the labia completely fused. Admittedly, this is a rare occurrence, but can be misleading when it does exist if the possibility is ignored. We recently had occasion to see such a patient, and, although the adrenogenital syndrome was considered in the diagnosis, it was discarded because it was thought that the urethra in this condition always opened at the base of the enlarged clitoris or more posteriorly in the perineum. Report of Case The patient was born by uneventful delivery to a 25-year-old

Summary 1. Six cases of reactivation of rheumatic fever following smallpox vaccination have been presented. 2. The possibility that this reactivation was due to the vaccination has been discussed.

About sixty-two years ago 1 a rather rare and serious cutaneous disease of early infancy associated with epidermolysis was first described by Ritter von Rittersheim and called dermatitis exfoliativa infantum. Since then various reports have been published, but the nature and the treatment of the disorder have not been definitely determined. In view of this situation, it was thought that a case in which the patient responded well to therapy should be reported, since it might shed further light on the subject of Ritter's disease. REPORT OF CASE A. M., a 1 month old white boy was admitted to the hospital on Jan. 15, 1941. Two days prior to admission an eruption had appeared on the thighs and had spread rapidly to the face, the arms and the trunk. The child cried continuously, but his appetite was good and his bowel movements regular. The infant was delivered normally, his birth

Herpes zoster, a disease frequently encountered in adults, is much less often seen in children and is extremely rare in infancy. Lang, 1 in a review of 10,000 cases observed at the dermatologic clinic of the University of Vienna and a great number of additional cases gathered from the literature, reported in 1938 that the highest figure for incidence in infants was less than 0.07 per cent of all cases of herpes zoster. If patients seen in the first months of life alone are considered, this figure is still lower. During the course of forty years Comby 2 observed 84 cases of herpes zoster in children. Nine of the patients were in the first two years of life, the youngest an infant of 8 months. Gaehde 3 in 1897 reported a case of herpes zoster in a 3 week old infant of an eclamptic mother. Bonar and Pearsall 4 in