Doddington Hospital

Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.

Background Previous research has observed positive associations between perceived quality of social support and mental well-being. Having access to functional social support that provides sources of care, compassion and helpful information have shown to be beneficial for mental health. However, there is a need to identify the psychological processes through which functional social support can elicit therapeutic outcomes on mental well-being.Aims The present cross-sectional study aimed to examine the extent to which self-efficacy and self-esteem mediated the association between functional social support and mental well-being.Method Seventy-three people with a mental health diagnosis, who attended group-based activities as facilitated by a third sector community mental health organisation, took part in the present study. Participants were required to complete measures that assessed perceived quality of functional social support, self-efficacy, self-esteem, and subjective mental well-being.Results A multiple mediation analysis revealed that self-efficacy and self-esteem fully mediated the positive association between perceived functional social support and mental well-being.Conclusions The implications of these results are that social interventions, which aim to facilitate the delivery of functional social support, could enhance mental well-being via their positive effects on self-efficacy and self-esteem.

Civil libertarian accounts of the perilous state of civil liberties in modern liberal democracies are partial and unduly pessimistic, suggesting that the inevitable future for civil liberties can only be erosion. The concept of ‘normalisation’ purports to explain this erosion, but whilst examples of ‘normalisation’ are commonplace, contrary examples are equally prevalent but remain unacknowledged. This article proposes an equally plausible optimistic corrective to such pessimism, for civil libertarians have in the past successfully resisted and reversed the authoritarian instincts of governments faced with exceptional circumstances. They have done so overtly through the passage of legislation that has extended and enhanced civil liberties, such as the British Human Rights Act. They have also done so more quietly through the repeal of antiquated draconian legislation. In addition, civil libertarian pessimists exaggerate the illiberal predispositions of officials and police. Civil libertarian pessimism is good politics, but poor analysis. It testifies to the contested terrain over which the ‘struggle for civil liberties’ is fought.

"This paper discusses the advantages and disadvantages of case management systems for the co-ordination of care of people with long-term mental illness living in the community. Many of the principles are equally applicable to other client groups with long-term needs, e.g. elderly people or people with learning difficulties. Some of the historical background to the emergence of case management concepts is discussed, culminating in the recent White Paper on Community Care. The underlying concept of case management is examined, together with a number of fundamental questions concerning who should act as case managers, what kinds of training they will require, problems of inter- and intra-agency co-operation, and the empirical evidence regarding its effectiveness. It is concluded that case management could be an important element in a comprehensive range of mental health services, but it is not a substitute for basic community provisions."

SUMMARY As an aid to the identification of brachiopods from the Asbian (Lower Carboniferous) reef environments in the northern British Isles, 125 species known from Treak Cliff, Derbyshire, are listed and characterised. Their presence at other localities is recorded. A brief survey of literature related to Treak Cliff is provided.

Low-field MRI (lfMRI) has become increasingly accepted as a method for diagnosing canine meniscal tears in clinical practice. However, observer effects on diagnostic accuracy have not been previously reported. In this study, 50 consecutive stifle joints with clinical and radiologic evidence of cranial cruciate ligament insufficiency were investigated by lfMRI and arthroscopy. Fifteen observers who had varying levels of experience and who were unaware of arthroscopic findings independently reviewed lfMRI studies and recorded whether lateral and medial meniscal tears were present. Diagnostic accuracy (sensitivity, specificity, positive (PPV) and negative predictive value (NPV)) was determined for each observer and median values were calculated for all observers, using arthroscopy as the reference standard. Interrater agreement was determined based on intraclass correlation coefficient (ICC) analysis. Observer level of experience was compared with diagnostic sensitivity and specificity using correlation analysis. Based on pooled data for all observers, median sensitivity, specificity, PPV, and NPV for lfMRI diagnosis of lateral meniscal tears were 0.00, 0.94, 0.05, and 0.94, respectively. Median sensitivity, specificity, PPV, and NPV for medial meniscal tears were 0.74, 0.89, 0.83, and 0.79, respectively. Interrater agreement for all menisci was fair (0.51). Menisci were less consistently scored as having no tears (ICC = 0.13) than those scored as having tears (ICC = 0.50). No significant correlations between observer experience and diagnostic sensitivity/specificity were identified. Findings indicated that the accuracy of lfMRI for diagnosing canine meniscal tears was poor to fair and observer-dependent. Future studies are needed to develop standardized and widely accepted lfMRI criteria for diagnosing meniscal tears.

The care home staff influenza vaccination rate in England is significantly lower than the 75% World Health Organisation recommendation. This represents a substantial potential for resident harm. Barriers to staff vaccination stem from individual and organisational levels. Existing interventions address some but not all barriers and are not underpinned by behavioural science theory. This study aims to estimate the effectiveness and cost-effectiveness of a theory-informed intervention to improve care home staff vaccination rates compared to routine practice.Set in care homes with both nursing and residential focus, and a range of ownership status, only homes providing long stay care to older people with a staff vaccination rate below 40% are eligible to participate. Participation expressions of interest will be sought using a variety of approaches prior to seeking consent.The primary outcome measure is the proportion of staff vaccinated at 6 months, with secondary outcome measures being proportion vaccinated at 3 months, numbers of staff sick days, general practitioner and nurse visits to care home, care home resident hospitalisations and mortality.Based on the assumptions that the mean cluster (care home) size is 54 staff, a coefficient of variation of 0.48, control vaccination rate is 55%, intervention 75%, intra-cluster correlation coefficient of 0.2 and with 90% power, and 20% attrition, we require 39 care homes per arm.Blocked randomisation will be at the level of care home, stratified by the proportion of non-white care home staff, and implemented by Norwich Clinical Trials Unit.The intervention comprises co-designed information videos and posters, provision of in-house staff vaccination clinics, and incentive scheme and monthly data collection on trial outcomes. Beyond usual practice, the control arm will additionally contribute monthly data.Data will be collected at the start, monthly and at 6 months, and analysis will be blind to allocation. Statistical analysis will use the intention-to-treat principle with the difference in vaccination rates between groups compared using a random effect logistic regression model at the staff-level.This will be the first study to use a theory-informed intervention designed to comprehensively address identified barriers to care home staff influenza vaccination.Trial registration: ISRCTN ISRCTN22729870 . Registered on 24 August 22. Secondary identifiers: R209939, IRAS 316820, CPMS 53812.

Examination of the eye is a fundamental part of the evaluation of a patient with suspected systemic ill-ness. The combination of a peculiar mixture of the ability to directly visualize the vasculature directly

Although the statement agreed by our Society refers to papers on schizophrenia, the principles apply more generally to all publications in psychi atric journals. Perhaps it is time that responsible journals institute sensitive systems for evaluating papers submitted to them whenever such papers are concerned with questions of race so

The efficacy and tolerability of a once-daily, fixed combination of 50 mg atenolol and 20 mg nifedipine slow release were evaluated in a 12-month open study of 27 elderly hypertensives who were either newly presenting patients or were those who were inadequately controlled on previous monotherapy or had unacceptable side-effects with their current therapy. After 1-month's therapy with the combination, the mean sitting blood pressure 1 to 4 hours post-dose decreased from 176/103 mmHg to 146/83 mmHg and was maintained at this level for the remainder of the study. Eight patients complained of side-effects on study entry. Sixteen had complaints at some time during the 12 months of fixed combination treatment and 4 were withdrawn because of side-effects. Dizziness occurred in 6 patients on the combination but, as with side-effects overall, tended to resolve with time; its occurrence did not appear to correlate with the on-treatment blood pressure. In this group of elderly hypertension patients, therefore, the combination therapy with atenolol plus nifedipine slow release appeared to exert a greater antihypertensive effect compared with previous therapy, which included atenolol alone, with no evidence of tachyphylaxis and was reasonably well-tolerated over a 12-month period.

Emergency nurse practitioners often experienced difficulties when attempting to assess pain in children accurately. This article refers to a case study to discuss the complexities of measuring paediatric pain, reviews two of the most well-known pain assessment scales and emphasises the importance of family involvement in situations where children are asked to self-report their experiences.

BACKGROUND: The aim of this study was to evaluate the efficacy of high-throughput on-farm transthoracic ultrasound (TUS) to screen for ovine pulmonary adenocarcinoma (OPA), an infectious ovine disease of increasing concern. No other routine diagnosis of preclinical OPA is available, or any vaccine or treatment. METHODS: More than 80,000 rapid TUS scans were applied on farms with a history of OPA. The TUS results from a convenience sample of 171 TUS-negative and 269 TUS-positive sheep were compared with postmortem histology/immunohistochemistry results, the 'gold standard' reference test for OPA diagnosis. These results, together with new data on within-flock prevalence, allowed estimation of the efficacy of rapid TUS screening to identify OPA (defined as tumours of larger than 1 cm) on-farm. RESULTS: The TUS screening had an estimated specificity of 0.998 (95% confidence interval [CI]: 0.998-0.999) and an estimated sensitivity of between 0.76 (95% CI: 0.72-0.79) and 0.99 (95% CI: 0.97-0.99) depending on the presumed false-negative rate applied to the calculation. CONCLUSION: High-throughput TUS should be considered for screening to identify individual sheep with OPA and has potential application to indicate flocks at low risk of OPA. However, lower efficacy is likely if conducted by less experienced persons.

We report the case of an 85 year old woman, admitted to hospital with a two month history of a depressive illness. Within one week of commencing treatment with citalopram 20mg daily, she had developed a widespread rash, bilateral ankle oedema and a range of biochemical and haematological abnormalities, including marked elevations of plasma urea and creatinine and increased neutrophil and eosinophil counts. Following withdrawal of citalopram, her physical state returned to normal within two weeks. The episode is suggestive of acute interstitial nephritis triggered by citalopram, a phenomenon not previously reported in association with the selective serotonin reuptake inhibitors.

BACKGROUND: The Basset Hound is the largest chondrodystrophic breed predisposed to thoracolumbar intervertebral disc extrusion (TL-IVDE). However, literature describing this particular breed in terms of incidence, signalment, anatomical location, clinical severity and short-term outcome of TL-IVDE is lacking. METHODS: The medical histories of Dachshunds and Basset Hounds presenting to three neurology departments were retrospectively assessed. Information collected for each dog included signalment, whether it had received a diagnosis of TL-IVDE, duration of clinical signs, affected discs and anatomical region and neurological grading at presentation and discharge. RESULTS: A total of 270 Dachshunds and 188 Basset Hounds were included for incidence analysis. Of these, 154 Dachshunds and 68 Basset Hounds with confirmed TL-IVDE were included for signalment, anatomical location, clinical severity and short-term outcome analysis. Statistical analysis indicated a significantly higher incidence of TL-IVDE in Dachshunds than in Basset Hounds (77.4% vs. 36.2%, p < 0.05). Basset Hounds presenting to a neurology department were older (median 87.5 months vs. 66.5 months), had a greater proportion of midlumbar IVDE (L2-L5) and were more frequently ambulatory at discharge than Dachshunds. Only one Basset Hound presented as paraplegic without nociception, compared with 16 Dachshunds (1.5% vs. 10.4%). LIMITATIONS: The study had a retrospective design and included multicentric non-standardised cases. CONCLUSION: TL-IVDE incidence was higher in Dachshunds than in Basset Hounds. Basset Hounds were older at presentation, frequently affected more caudally in the vertebral column and more frequently ambulatory at discharge than Dachshunds. The differences found in this study could aid in the development of preventive strategies.

In this case study, history taking, clinical examination, and diagnostic skills are described in relation to treating a child with ear infection. The importance of responsible prescribing of antibiotics is discussed.

ObjectivesThis study aimed to describe the clinical characteristics, MRI findings, treatment and outcome in cats presumptively diagnosed with intramedullary intervertebral disc extrusions.MethodsA retrospective review was conducted of medical records and MRI data from cats presumptively diagnosed with intramedullary intervertebral disc extrusions. Long-term outcome (⩾6 months) was assessed through medical records, questionnaires completed by the owners or both.ResultsA total of 12 cats met the inclusion criteria. All presented with peracute or acute clinical signs, with nine having confirmed (n = 3) or possible (n = 6) external trauma based on history, physical examination or MRI findings. Seven cats were ambulatory and five were non-ambulatory. Eight cats presented with urinary incontinence; none exhibited faecal incontinence. Neuroanatomical localisation included the T3-L3 (n = 7) and L4-S3 (n = 5) spinal cord segments. MRI showed an intramedullary intervertebral disc extrusion at the following sites: T12-T13 (n = 1), T13-L1 (n = 1), L1-L2 (n = 2), L2-L3 (n = 2), L4-L5 (n = 3) and L5-L6 (n = 3). All cats underwent treatment and were discharged after a median hospitalisation time of 4 days (range 3-14). All non-ambulatory cats with available follow-up information (4/5) regained ambulation by the time of the short-term (<6 weeks) or long-term (⩾6 months) assessment. Moreover, all cats either retained or regained urinary continence by the time of discharge, the short-term (<6 weeks) or the long-term (⩾6 months) assessment. Overall, nine cats achieved a successful outcome and were considered functional pets at the short-term (<6 weeks) and/or long-term (⩾6 months) follow-up. Two cats were lost to follow-up, and one cat had perceived persistent generalised discomfort.Conclusions and relevanceMost cats presumptively diagnosed with an intramedullary intervertebral disc extrusion showed a favourable outcome with treatment in this study. This condition should be considered in cats presenting with peracute or acute signs of T3-L3 or L4-S3 spinal cord dysfunction, especially if there is a history or indication of trauma.

Among species trapped in the crowns of ancient pollarded trees in southern England are Megaselia russellsmithi Disney sp. n, M. velutinicavus Disney sp. n. and M. henrydisneyi Durska, which is a further addition to the British List. The hitherto unknown females of M. henrydisneyi, M. serrata (Wood) and M. speiseri Schmitz are described. M. gargarans Schmitz and M. basiturgida Disney & Durska are synonymised with M. crassipes (Wood) following recognition of an error in Schmitz’s description of M. gargarans and of other confusions in the literature.http://zoobank.org/urn:lsid:zoobank.org:pub:1CC46F9C-AB02-446C-BF83-4D9529508DFA

This article discusses the use of trimethoprim in the treatment of uncomplicated lower urinary tract infections (LUTI) in adult women. It takes the form of a case study and will explore the pharmacological dynamics of the drug, as well as comparing it to others also used in the treatment of LUTI. Trimethoprim is considered the gold standard for treatment and the three-day course has become the usual recommended treatment for non-complex LUTIs and for empirical treatment of cystitis with a 90% eradication rate (Salvatore et al, 2001; Scottish Intercolleguiate Guidance Network, 2006). This article describes the presenting symptoms, possible differentials, treatment, and rationale for the treatment chosen.

Journal Article F. Leighton, verse-writer, 1769 Get access John Loveday John Loveday 1Deddington Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume CLXIV, Issue apr29, 29 April 1933, Page 301, https://doi.org/10.1093/nq/CLXIV.apr29.301a Published: 29 April 1933