Market Drayton Cottage Hospital

BACKGROUND: Despite the high prevalence of constipation and its related public health implications, there is relatively little research available on the condition from large epidemiological studies. The aim of this study was to investigate the epidemiology of general practitioner (GP)-diagnosed constipation and the prescribing trends for laxatives in the UK, within the general population and during pregnancy. METHODS: A cohort study for the period from 2005 to 2009 was performed using the UK primary care database (General Practice Research Database), which contains information on over 3 million individuals. RESULTS: The prevalence of GP-diagnosed constipation ranged from 12 per 1000 persons in 2005 (0.012 per person year) to 12.8 per 1000 in 2009 (0.013 per person year). The prevalence was almost twice as high in women as in men, and was higher in older patients. In 2005 the most commonly prescribed laxatives were lactulose (37%), senna (26%), macrogol (19%), ispaghula (6%), docusate sodium (5%), bisacodyl (4%) and glycerol suppositories (2%). By 2009, this pattern had changed: macrogol (31%), lactulose (29%), senna (22%), ispaghula (5%), docusate sodium (6%), bisacodyl (3%) and glycerol suppositories (3%). In pregnancy, lactulose accounted for 81% of laxative use in 2005, falling to 64% by 2009. In contrast, macrogol use in pregnancy rose from 13% in 2005 to 32% in 2009. CONCLUSIONS: GP-diagnosed constipation is common, accounting for a large number of consultations. Laxative prescribing trends have changed over the 5-year study period, prescriptions for macrogol becoming increasingly common and prescriptions for lactulose and senna less common. Macrogol also appears to have been replacing lactulose for treating constipation in pregnant women.

The PR industry acknowledges that strategy should be an integral part of its communications programmes. Often (perhaps generally), however, this acknowledgement amounts to little more than lip‐service. This paper looks at some possible definitions of ‘strategy’ (to help us find its place within the communications planning process), identifies some tools and processes to help drive communications strategy forwards and looks at ways of embedding strategy within a planning cycle.

Rotavirus infections are the main cause of gastroenteritis in infants and children and it is expected that by the age of 5 years, nearly every child will have experienced at least one episode of rotavirus gastroenteritis. While severe cases are hospitalized, milder disease is either treated at home or by the GP, and as such the true prevalence of rotavirus infection in the community, and the burden of disease, is unknown. This paper reports the results of a cost-of-illness study which was conducted alongside a structured community surveillance study. Forty-eight percent of our sample was found to have rotavirus acute gastroenteritis; and the average total cost of a child presenting with rotavirus gastroenteritis ranged between pound sterling 59 and pound sterling 143 per episode, depending on the perspective. Given the prevalence and severity of the disease, the estimated burden of rotavirus gastroenteritis to society is pound sterling 11.5 million per year.

Aims and Method To describe Drayton Park, the first women-only residential mental health crisis facility in the UK and to investigate whether it is succeeding in its remit of providing a viable alternative to hospital admission. We randomly selected case files from 100 women admitted to Drayton Park since its opening and examined variables including demographic details, the reasons for referral, diagnosis and the source of referral. Results Our findings show that the service is able to respond quickly to referrals and appears to be functioning safely. The women admitted have a relatively short length of stay, half suffer from depressive episodes and one-third have a relapse of schizophrenia or bipolar disorder. Clinical Implications This project appears to be succeeding in providing a safe alternative to hospital admission for women with severe and enduring mental health problems.

The purpose of this randomized placebo-controlled crossover pilot study was to evaluate the effectiveness and acceptability of magnetic therapy for hot flashes among breast cancer survivors. Participants completed a 24-hour baseline hot-flash monitoring session, wore the magnetic devices or placebo for 3 days, completed an after-treatment hot-flash monitoring session, experienced a 10-day washout period, and then crossed over to the opposite study arm. Magnetic devices and placebos were placed on 6 acupressure sites corresponding to hot-flash relief. Complete data were available from 11 survivors of breast cancer. Results indicated magnetic therapy was no more effective than placebo in decreasing hot-flash severity, and contrary to expectations, placebo was significantly more effective than magnets in decreasing hot-flash frequency, bother, interference with daily activities, and overall quality of life. Implications for clinical practice and future research include the need to explore alternative interventions aimed at alleviating hot flashes in this population.

OBJECTIVE: To elicit patients' preferences for the treatment of angina. DESIGN: Angina patients were interviewed in order to elicit their personal reasons underlying preferences for various treatment options. Interviews followed a general repertory grid technique, in which seven treatment options were presented to patients in triads. Treatments considered ranged from medication to invasive revascularization therapies, with a 'no treatment' option. SETTING: Two general practices in Norwich, Norfolk. SUBJECTS: Twenty-one patients with diagnosed angina, which was both mild and stable. MAIN OUTCOME MEASURES: Treatment preferences verbalized by patients during interview, and the underlying reasons for these. RESULTS: Attitudes voiced towards the range of treatments for angina were diverse; 27 different reasons underlying patients' preferences were identified. Patients' preferences were largely justified by reasons associated with the conditional effectiveness or otherwise of treatments. When presented with treatment triads, medication (drug) treatments were over 2.5 times more likely to be chosen as a most preferred option than invasive or surgical treatments. Although surgical treatments were generally considered to be 'effective', it was perceived that they were more appropriate for situations when the condition became life-threatening. There were occasions, however, when preferences were driven by other reasons, such as a desire to avoid surgery because it was perceived negatively as 'invasive' and 'frightening'. Drug treatments were viewed as 'quick', 'easy' and reversible. Personal experiences of the effectiveness or otherwise of treatments were frequently cited as reasons for stated preferences. However, patients often commented that they would prefer the doctor to make the decision about their treatment. CONCLUSIONS: Patients choices among treatments was largely driven by perceptions of their effectiveness or otherwise. Although surgery was perceived as 'effective' it was also seen as conditionally so, dependent upon severity of the condition - which is not necessarily the case, as the risks of adverse events and surgical complications increase for emergency cases. As such, access to better information about the effectiveness and timeliness of interventions is needed. Although respondents held anxieties about treatment, particularly invasive or surgical treatments, fewer choices were driven by emotional and lifestyle factors unrelated to 'effectiveness', such as fear or ease of treatment.

Networks of constellations of longitudinal observational databases, often electronic medical records or transactional insurance claims or both, are increasingly being used for studying the effects of medicinal products in real-world use. Such databases are frequently configured as distributed networks. That is, patient-level data are kept behind firewalls and not communicated outside of the data vendor other than in aggregate form. Instead, data are standardized across the network, and queries of the network are executed locally by data partners, and summary results provided to a central research partner(s) for amalgamation, aggregation, and summarization. Such networks can be huge covering years of data on upwards of 100 million patients. Examples of such networks include the FDA Sentinel Network, ASPEN, CNODES, and EU-ADR. As this is a new emerging field, we note in this paper the conceptual similarities and differences between the analysis of distributed networks and the now well-established field of meta-analysis of randomized clinical trials (RCTs). We recommend, wherever appropriate, to apply learnings from meta-analysis to help guide the development of distributed network analyses of longitudinal observational databases.

In sacco studies are at present the most practical way of estimating the rumen degradability of feeds. The commonly adopted procedure (Standard Method = SM) has a number of disadvantages, including night work and the need to select bags at each sampling time. The Complete Exchange Method (CEM), described here, has been developed to meet the need for a convenient routine procedure.

Anesthetic management of patients who have suffered traumatic brain injuries can be challenging. We investigated the relationship between arterial to end-tidal carbon dioxide partial pressure gradients (Pa-etCO₂) and 3 predictor variables: (1) injury severity score, (2) use of positive end-expiratory pressure, and (3) presence of rib fractures. Using a convenient sampling method, we sampled 56 patients who arrived to the operating room intubated after traumatic brain injuries between 2005 and 2011. Two groups were compared retrospectively: those with Pa-etCO₂ greater than 10 mm Hg (case group) (n = 37) and those with Pa-etCO₂ gradients of 10 mm Hg or less (control group) (n = 19). Descriptive and inferential statistics were employed to identify any differences between the groups. Stepwise regression was also performed. Cross tabulation analysis revealed that injury severity score of 30 or more was a predictor of Pa-etCO₂ gradient. Stepwise regression analysis revealed the presence of rib fracture and body mass index to be significant predictors of Pa-etCO₂ gradient (P < .011). This study identified coexisting conditions in which the patients' Pa-etCO₂ gradients were large. Results showed that injury severity score of 30 or more, the presence of rib fractures, and higher body mass index were statistically significant predictors of Pa-etCO₂ gradients greater than 10 mm Hg. These observations should be considered when evaluating PetCO₂ in conjunction with arterial blood gas analysis to determine optimal ventilation status of these patients.

Summary A grope of young male drug misusers was compared with a group of young male delinquents of approximately the same age and range of intelligence, on two measures of personality and a Semantic differential. Then is great similarity between the two sets of findings; the differences found lie largely in the greater emotional vulnerability of the drug‐using group.

reported by Super and colleagues, one had completed their family and another five did not request parental diagnosis.This contrasts with the 12 heterozygous couples detected through our antenatal screening programmes,23 all of whom have requested prenatal diagnosis.It is impossible to measure the theoretical effectiveness of cascade testing by simple extrapolation.It is necessary to create models with family size distributions and alternative testing strategies.Our projections, using such modelling, suggest that less than 25% of heterozygous couples be detected by cascading to the second cousin level.4In contrast, we have already shown that over 50% of heterozygous couples can be detected by either of the two major forms of antenatal screening.

Aims and Method There are no data or guidelines on who should be referred to community mental health teams (CMHTs), resulting in enormous variability in referral patterns. General practitioners (GPs) and psychiatrists were surveyed using a purpose-designed questionnaire to assess their attitudes regarding referral of individuals with different psychiatric disorders. Results There was consensus among GPs and psychiatrists that individuals with psychotic disorders, mania, severe depression and phobias should be referred to CMHTs. GPs were more likely to refer personality disorder, whereas the reverse was true for moderate depression and anxiety/ panic disorders. There was disagreement within groups about referral for acute stress reaction, mild depression and adjustment disorders. Clinical Implications Uncertainty about appropriate referral causes variability in referral patterns and service provisions. This needs resolution through the Royal Colleges of Psychiatrists and General Practitioners, to provide guidance leading to equality of care for all.

Dog-driving methods are a subject on which no two people think alike, and whenever two or three men meet together in the Arctic, they form the basis for endless discussion and argument. We can remember many a good night's sleep lost when a visitor arrived apparently tired out, but with enough energy left to sit up all night arguing the relative merits of fan or centre trace, or something of that sort. For this reason we feel rather diffident in adding our opinions to those already published recently in The Polar Record . With regard to different equipment, harness, sledges and team formations—these are almost entirely a question of local conditions and, therefore, not really worth arguing about. For instance, in North-East Greenland, we used regularly fan, centre trace and tandem formations to suit differing snow conditions, etc., and each was, under the right conditions, definitely superior to the other two.

Binet created the psychology of mental deficiency and incidentally the concept of intelligence which for many years has been a central issue in both psychology and education. He was primarily concerned with learning difficulties in children and it is a wry paradox that his development of the notion of intelligence has proved such a barrier to the study of the learning process. Intelligence for Binet was a summary term which stood in place of all the component elements of learning weakness which he noticed and assessed. His successors such as Spearman (1923), Burt (1937), Vernon (1950) and Jensen (1975) tend to use the term in an explanatory fashion although it is doubtful whether ‘intelligence’ explains ‘mental age’ or ‘mental deficiency’ except as a descriptive cross-reference.

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Why am I coming into nursing (news August 17)? Well, it is to do a job that I have wanted to do for a long time. As the mother of three children and a part-time healthcare assistant, I find doing a full-time nursing diploma hard work. I need to know that I am going to have a job at the end of it.

<p class="first" id="d1019016e165">In this article, we outline the concept of knowledge infrastructure and describe how it differs from Information Technology (IT) infrastructure, with particular regard to the implications for education theory, practice and policy. We examine the inherent limits to growth for attempts to handle knowledge, as opposed to information, via the types of software and hardware likely to be available in the next few decades. We show how a simple process model can be used to identify pinch points where knowledge, as opposed to information, is a bottleneck. We also show how a simple model of knowledge types and knowledge locations can be combined with the process model to remove those bottlenecks via existing low-cost technology and a more efficient use of existing human expertise. We conclude that a minimal investment in knowledge infrastructure would provide significant human, social and economic benefits, by creating major added value from existing digital and organisational infrastructure.

AbstractProposed methods of reducing unemployment on a national scale mostly rely on indirect measures of a more or less traditional economic nature to stimulate the economy while simultaneously solving other major problems like inflation and the balance of payments. It is the thesis of this paper that unemployment could be reduced more straightforwardly by making it a primary goal of policy, and that this could be done without a severe impact on the other major macroeconomic problems. The introduction of a properly designed negative income tax scheme is the key first step. The argument is first presented in general terms, followed by a review of relevant earlier studies and then a discussion of the practical problems of applying the theory to the present-day U.K.

Clinical abstract presented at BSAVA Congress 2024. See full text for abstract and see clinical abstract sessions for a recording of the presentation. Abstracts are presented as supplied and have not been edited.

Support surfaces can offer a variety of rotational therapies, including continuous lateral rotation therapy (CLRT). In both rotational therapy and manual turning, the patient is rotated along the longitudinal axis; however, with manual turning the patient's posterior surface comes off the support surface. This paper will review the literature and attempt to answer the clinical question, "Does lateral rotation/rotational therapy replace manual turns for pressure injury (PI) prevention?" A literature review was undertaken, commencing with the introduction of CLRT in 1967. English language articles that were published using the search terms CLRT, lateral rotation, rotational therapy, kinetic therapy, oscillating therapy, pressure injuries, pressure ulcers, pneumonia, manual turning, and PI prevention were reviewed. Literature results that contained information related to PI were narrowed down to 9 articles and divided into 3 categories for review. The result of the review highlights the scarcity of direct evidence supporting CLRT for PI prevention. Based on the current literature, the author's practice recommendation is that PI prevention interventions such as turning and repositioning should continue to be implemented and that CLRT does not replace manual turning for PI prevention.