Hospital of St. Cross

An evaluation of the second round of faecal occult blood (FOB) screening in the English site of the UK Colorectal Cancer Screening Pilot (comprising the Bowel Cancer Screening Pilot based in Rugby, general practices in four Primary Care Trusts, and their associated hospitals) was carried out. A total of 127 746 men and women aged 50-69 and registered in participating general practices were invited to participate. In all, 15.9% were new invitees not included in the previous round. A total of 52.1% of invitees returned a screening kit. Uptake varied with gender, age, and level of deprivation; was lower than in the first round (51.9 vs 58.5% P<0.0001), but was high (81.1%) in those who had participated in the first round with a negative result. Test positivity was 1.77%, significantly higher than in the first round, and the detection rate of neoplasia similar (5.67 per 1000), resulting in a lower positive predictive value. The sensitivity of FOBt in the first round was estimated as 57.7-64.4%. There was a significant impact on workload, particularly on endoscopy services. The cancer detection rate (0.94 per 1000) was lower than in the first round. Effort will be required to minimise inequalities in uptake, and to ensure adequate capacity of endoscopy services.

BACKGROUND: Uptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening. METHODS: All people eligible for screening (men and women aged 60-74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July-August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020. FINDINGS: As all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163,525) and 2 (n=150,417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04-1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04-1·20, p=0·003) than in the least deprived (1·00, 0·94-1·06, p=0·98). Overall uptake was also increased (1·07, 1·03-1·11, p=0·001). INTERPRETATION: Of four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging. FUNDING: National Institute for Health Research.

We describe a 3 year old girl with the typical clinical features of the X linked recessive condition, Hunter's disease. The diagnosis was confirmed by the pattern of urinary excretion of glycosaminoglycans and the absence of iduronate sulphatase activity in her fibroblasts. She also had an apparently balanced reciprocal chromosomal translocation 46XX,t(X:5) with the X breakpoint being between q26 and q27. Pedigree analysis, and the normal iduronate sulphatase activity in the mother's fibroblasts, serum, and hair roots indicate that the affected child represents a new mutation. Since the parents' karyotypes are normal, it seems that the translocation disrupted the iduronate sulphatase gene itself, thus mapping this to Xq26-27 for the first time. The severe clinical features, not expected in a girl, may be explained by non-random X inactivation.

A method of reviewing a series of clinical trials by extracting the basic data in the form of 2 x 2 tables and analysing these by Fisher's two-tailed Exact Test is described, and illustrated by published imipramine-placebo trials. The results suggest that the benefit of this drug in patients with endogenous depression who have not become institutionalized is indisputable, and that further drug-placebo trials in this condition are not justified. Two of the three trials of imipramine in neurotic depression gave results showing significant improvement. Possible explanations of the apparent failure of this drug in groups of patients with undifferentiated depression are discussed.

BACKGROUND: Bowel cancer is a serious health burden and its early diagnosis improves survival. The Bowel Cancer Screening Programme (BCSP) in England screens with the Faecal Occult Blood test (FOBt), followed by colonoscopy for individuals with a positive test result. Socioeconomic inequalities have been demonstrated for FOBt uptake, but it is not known whether they persist at the next stage of the screening pathway. The aim of this study was to assess the association between colonoscopy uptake and area socioeconomic deprivation, controlling for individual age and sex, and area ethnic diversity, population density, poor self-assessed health, and region. METHODS: Logistic regression analysis of colonoscopy uptake using BCSP data for England between 2006 and 2009 for 24 180 adults aged between 60 and 69 years. RESULTS: Overall colonoscopy uptake was 88.4%. Statistically significant variation in uptake is found between quintiles of area deprivation (ranging from 86.4 to 89.5%), as well as age and sex groups (87.9-89.1%), quintiles of poor self-assessed health (87.5-89.5%), non-white ethnicity (84.6-90.6%) and population density (87.9-89.3%), and geographical regions (86.4-90%). CONCLUSION: Colonoscopy uptake is high. The variation in uptake by socioeconomic deprivation is small, as is variation by subgroups of age and sex, poor self-assessed health, ethnic diversity, population density, and region.

Journal Article CEREBRAL COMPLICATIONS OF WHIPPLE'S DISEASE Get access W. THOMAS SMITH, W. THOMAS SMITH Departments of Pathology and Medicine, University of Birmingham and The Hospital of St. CrossRugby Search for other works by this author on: Oxford Academic PubMed Google Scholar J. M. FRENCH, J. M. FRENCH Departments of Pathology and Medicine, University of Birmingham and The Hospital of St. CrossRugby Search for other works by this author on: Oxford Academic PubMed Google Scholar M. GOTTSMAN, M. GOTTSMAN Departments of Pathology and Medicine, University of Birmingham and The Hospital of St. CrossRugby Search for other works by this author on: Oxford Academic PubMed Google Scholar A. J. SMITH, A. J. SMITH Departments of Pathology and Medicine, University of Birmingham and The Hospital of St. CrossRugby Search for other works by this author on: Oxford Academic PubMed Google Scholar J. A. WAKES-MILLER J. A. WAKES-MILLER Departments of Pathology and Medicine, University of Birmingham and The Hospital of St. CrossRugby Search for other works by this author on: Oxford Academic PubMed Google Scholar Brain, Volume 88, Issue 1, March 1965, Pages 137–150, https://doi.org/10.1093/brain/88.1.137 Published: 01 March 1965

Background: ESBL-producing Enterobacteriaceae (ESBLPE) are increasing in prevalence worldwide and are more difficult to treat than non-ESBLPE. Their prevalence in the UK general population is unknown, as the only previous UK ESBLPE faecal colonization study involved patients with diarrhoea. Objectives: To estimate the prevalence of CTX-M ESBLPE faecal colonization in the general adult population of England in 2014, and investigate risk factors. Methods: A stratified random sample of 58 337 registered patients from 16 general practices within four areas of England were invited to participate by returning faeces specimens and self-completed questionnaires. Specimens were tested for ESBLPE and carbapenemase-producing Enterobacteriaceae (CPE). Results: 2430 individuals participated (4% of those invited). The estimated prevalence of colonization with CTX-M ESBLPE in England was 7.3% (95% CI 5.6%-9.4%) (Shropshire 774 participants, 4.9% colonization; Southampton City 740 participants, 9.2%; Newham 612 participants, 12.7%; Heart of Birmingham 234 individuals, 16.0%) and was particularly high in: those born in Afghanistan (10 participants, 60.0% colonization, 95% CI 29.7%-84.2%); those born on the Indian subcontinent (India, Pakistan, Bangladesh or Sri Lanka) (259 participants, 25.0% colonization, 95% CI 18.5%-32.9%); travellers to South Asia (India, Pakistan, Bangladesh, Sri Lanka or Nepal) in the last year (140 participants, 38.5% colonization, 95% CI 27.8%-50.5%); and healthcare domestics (8 participants, unweighted 37.5% colonization, 95% CI 8.5%-75.5%). Risk factors identified included: being born in the Indian subcontinent (aOR 5.4, 95% CI 3.0-9.7); travel to South Asia (aOR 2.9, 95% CI 1.8-4.8) or to Africa, China, South or Central America, South East or Pacific Asia or Afghanistan (aOR 2.6, 95% CI 1.7-4.1) in the last year; and working as a healthcare domestic (aOR 6.2, 95% CI 1.3-31). None of the 48 participants who took co-amoxiclav in the last year was colonized with CTX-M ESBLPE. blaCTX-M-15 accounted for 66% of CTX-M ESBLPE positives. 0.1% (two participants) were colonized with CPE. Conclusions: CTX-M ESBLPE are established in the general population in England and prevalence is particularly high in people from certain countries of birth or with recent travel. We recommend that these findings be taken into account in guidance on the empirical management of patients presenting with a likely Enterobacteriaceae infection.

Introduction The triple assessment for a lump in the breast is standard practice and the robustness of assessment towards the diagnosis of breast cancer is crucial. The combination of the modalities, physical examination, imaging (mammogram and ultrasound), and fine-needle aspiration cytology (FNAC) is more accurate than any modality alone. Aim To examine the combined and individual predictive values of physical examination (P), mammography (M), ultrasound (U), FNAC (C), with core biopsy (B) - triple assessment in the diagnosis of breast cancer. Methods To obtain the results of physical examination (P), mammography (M), ultrasound (U), FNAC (C), and core biopsy (B), we examined the records of 124 breast cancer patients seen between April 1, 2009, and March 30, 2010. To assess the diagnostic potential of the combination of the modalities (P, U, and M), we considered all cases with a score of 4 (probably malignant) and 5 (malignant) as positive for malignancy. All cases with a score of 3 (equivocal), 2 (benign), and 1 (normal) were considered negative for malignancy. For FNAC, a score of 1 (insufficient sample), 2 (benign), and 3 (atypia/probably benign) were considered. All the patients were diagnosed with breast cancer on excision biopsy. Among 124 patients, 12 were excluded, as they were unfit for intervention. Results The accuracy of physical examination (P) as confirmed by core biopsy (B) is dependent on the experience of the surgeon. It has limitations in younger women and smaller lesions. In our study, P has a positive predictive value (PPV) of 58.9% when compared with surgical biopsy, which is comparable with other studies. Our results showed PPV 66.1% and after an ultrasound scan, the overall radiological grading (M & U) gives a PPV of 81.3%, reflecting the important role of ultrasound scans. Our results showed the sensitivity of FNAC to be 73.2%. Core biopsy was diagnostic in 107 (95.5%) patients, making it a reliable tool. Our results confirmed that a combination of the modalities (P, M, U, R, FNAC) is more accurate than any modality alone. Conclusion When all the three modalities are positive for a diagnosis of malignant breast disease, surgical biopsy confirms the breast cancer diagnosis with a PPV of 100% and a sensitivity of 95.5%.

Health service providers sometimes express concern about the impact of prospective survey research upon patient behaviour. To date, there is little available evidence from which to estimate the likelihood of any 'Hawthorne' effect on patient behaviour in health service settings. We analysed data from one of our own surveys to investigate whether inviting people to participate in research had any impact on their subsequent uptake of a screening service. Findings showed that people sent a questionnaire were slightly faster to take up screening than those not sent a questionnaire. We obtained no significant difference in absolute service uptake rate at six months.

Preoperative hair removal by a depilatory cream was compared with routine shaving. Although the incidence of wound infection was similar in both groups, cream depilation was found to be better. It was effective, atraumatic, non-toxic, and could be self-administered. Furthermore, it could be used safely on granulating wounds and did not support bacterial growth. Depilation was associated with a significant reduction in skin surface bacteria and proved to be cheaper than shaving.

BACKGROUND: There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual's general practice (GP endorsement; GPE) reduced this gradient. METHODS: A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. RESULTS: We enrolled 265,434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04-1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78,000). CONCLUSIONS: Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP.

Highlights Urban greening can improve air quality, health, biodiversity, and climate resilience. Collaboration among communities and stakeholders is key to urban greening success. Community engagement ensures acceptance and long-term success of green infrastructure. Barriers like funding, regulations, and resistance impede green infrastructure projects. Accurate data and planning are essential for maximizing

The use of antipsychotics for the treatment of behavioural and psychological symptoms of dementia (BPSD) is controversial. Antipsychotics cause harm and evidence-based guidelines advise against their use. We argue that antipsychotics may be justified using a palliative model: by reducing severe distress in those whose life expectancy is short.

OBJECTIVE: To describe the typical tibial diaphyseal fracture ("footballer's fracture") and to clarify the circumstances and mechanism of the injury. METHODS: In an attempt to obtain a detailed analysis of the types of injury suffered, and thereby highlight areas for prevention, 100 consecutive adult football players with a tibial diaphyseal fracture were studied prospectively. Details of the circumstances and mechanism of injury were collected using a questionnaire (response rate 85%). Treatments depended on the Gustilo classification, displacement, and axial stability. Long term follow up was performed until clinical healing to define the overall prognosis. RESULTS: 61% of players suffered a fracture of both the tibia and the fibula. Ninety five percent of the tibial fractures were transverse or short oblique and were caused by impact during a tackle. Radiographic evidence of bridging callus was better than a classification of the bony injury for predicting weeks to clinical healing. The delayed union and non-union incidence following this injury is low. One patient suffered symptomatic shortening. One patient suffered symptomatic angulation and two patients with nonunion required bone grafting. CONCLUSIONS: Tibial fracture is an expensive injury. It prevents a young population from being employed and takes up valuable NHS resources. As 85% of players were wearing shin guards, it is likely that improvements in shin guard design could reduce the rate of tibial fracture.

BACKGROUND: The English arm of the UK Bowel Cancer Screening Pilot study recently concluded its third round. The primary aim was to assess the impact of faecal occult blood test (FOBT) screening on the detection of symptomatic (non-screen-detected) cancers within the target age group (50-69 years). The secondary aim was to assess differences between screened and non-screened cohorts in Dukes' classification at diagnosis. METHODS: This population-based study utilized retrospective analysis of existing validated colorectal cancer (CRC) data over 5 years (April 2000 to March 2005), encompassing rounds one and two of screening. RESULTS: There was a 23 per cent (P = 0.011) reduction in the diagnosis of over the 5 years. Presentations with symptomatic cancer reduced by 49 per cent (P = 0.049), with a proportionate (2.6-fold) rise in the detection of screened (asymptomatic) malignancy. Cancers were diagnosed at an earlier stage in the screened population, with significantly more Dukes' A tumours than in the non-screen-detected cohort (P < 0.001) and an estimated odds ratio of 0.27 (95 per cent confidence interval 0.08 to 0.91) (P = 0.035) for Dukes' 'D' cancers. CONCLUSION: FOBT screening resulted in a significant reduction in the number of symptomatic cancers detected within the target age group. Tumours detected by screening were diagnosed at an earlier pathological stage.

No AccessJournal of Urology1 Nov 1974Osteitis Pubis John M. Mynors John M. MynorsJohn M. Mynors More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)59823-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Osteitis Pubis." The Journal of Urology, 112(5), pp. 664–665 © 1974 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByTeichman J, Tsang T and McCarthy M (2018) Osteitis Pubis as a Complication of Transrectal Needle Biopsy of the ProstateJournal of Urology, VOL. 148, NO. 4, (1260-1261), Online publication date: 1-Oct-1992.Nissenkorn I, Servadio C and Lubin E (2018) The Treatment of Osteitis Pubis with HeparinJournal of Urology, VOL. 125, NO. 4, (528-529), Online publication date: 1-Apr-1981.Burns J and Gregory J (2018) Osteomyelitis of the Pubic Symphysis After Urologic SurgeryJournal of Urology, VOL. 118, NO. 5, (803-805), Online publication date: 1-Nov-1977. Volume 112Issue 5November 1974Page: 664-665 Advertisement Copyright & Permissions© 1974 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Mynors More articles by this author Expand All Advertisement PDF DownloadLoading ...

We review some of the difficulties previously encountered in defining the phase operator for finite quantum systems. We then propose the Wigner–Weyl quantization of the angle function φ on phase space as the phase operator, and derive a closed expression for its matrix elements with respect to the Hermite functions. We also determine the quantization of e^{iφ} , which turns out to be a weighted shift operator, its spectrum and that of its adjoint. This is done in the framework of quantization of a certain symbol class of phase space distributions, specialized to those which depend on one variable only. After recalling some results for the position and momentum variables, we apply the scheme to functions of radius or angle. We give necessary and sufficient conditions for operators obtained by quantizing functions of the angle to be elements of \mathscr L^+ [\mathscr S(\mathbf R)] and \mathscr L^+ [\mathscr S (\mathbf R), L^2(\mathbf R)] , and a sufficient condition for boundedness. We then consider the associated questions of commutation relations and uncertainties for operators in \mathscr L^+ [\mathscr S(\mathbf R), L^2(\mathbf R)] , which we define as bilinear forms. As must be the case, the commutator between our phase operator and the number operator exhibits noncanonical terms. Not surprisingly, the Poisson bracket of their phase space symbols also exhibits a noncanonical term.

An open study was carried out in 41 children with mild to moderate psoriasis to assess the effectiveness and tolerance of treatment with a 0.1% dithranol plus 17% urea preparation applied twice daily. Thirty-four patients completed 6-weeks' treatment and 8 of them continued for a further 4 to 6 weeks. The results showed considerable improvement in lesions and, in general, the preparation was well-tolerated and considered to be highly or very acceptable by the majority of the patients. Only 3 patients had to be withdrawn for treatment-related reasons which involved soreness or burning of the skin due to the dithranol.

The paper gives a general picture of the development of the multiple-circuit magnetron from the time of the first manufactured design up to the present day. The principles underlying magnetron design and operation are given as fully as space permits and detailed constructional features are discussed where they are of particular interest.The manufacture and performance of the earliest types is dealt with first. The use of the technique of “strapping” is then discussed, the effect on the resonance characteristics of the magnetron block being described. Further Sections deal with the mechanism of oscillation, and the calculation of operating performance.After summarizing the performance of the established types operating in the 10-cm wavelength range, the difficulties experienced in the design of valves for shorter wavelengths are outlined. Various constructional techniques for these valves are mentioned, together with the apparatus necessary to ensure that a finished valve shall operate with correct electrical characteristics.Further Sections deal with valves capable of generating the highest powers at wavelengths of 10 and 3 cm, and examples of finished designs are given. The fundamental difficulty of “mode change” is described, and a later Section discusses the method which has been evolved for estimating the mode-change performance of a given magnetron.The design of cathodes for magnetrons presents some unusual problems and these are discussed in detail.Finally, an appendix deals with some aspects of magnetron-circuit design using equivalent circuits.

Attendance at diabetic retinopathy screening in minority ethnic groups, including the South Asian population, is known to be poor. We describe a cluster randomised controlled trial conducted in 10 general practitioner (GP) surgeries in Coventry, UK, during 2007 which aimed to evaluate the use of a Link Worker-delivered intervention to improve attendance. The intervention consisted of a simple telephone reminder with the main outcome measure being attendance at diabetic retinopathy screening. We found a statistically significant difference between mean attendance proportions for intervention (0.89) and control (0.74) practices: difference (95% confidence interval (CI)) 0.15 (0.04-0.27), t = 3.03, p = 0.0162; this difference remained significant when adjusted for previous year's proportions. In this proof-of-concept study, in inner city Coventry, we demonstrated increased attendance at diabetic retinopathy screening by use of a simple Link Worker-implemented telephone call intervention. The use of Link Worker phone calls may be a useful tool to increase attendance for diabetic retinopathy screening in a group with high did-not-attend (DNA) rates and a high prevalence of diabetic retinopathy and visual impairment.