Sedgefield Community Hospital

Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target social isolation and loneliness among older people. Quantitative outcome studies between 1970 and 2002 in any language were included. Articles were identified by searching electronic databases, journals and abstracts, and contacting key informants. Information was extracted and synthesised using a standard form. Thirty studies were identified and categorised as ‘group’ (n=17); ‘one-to-one’ (n=10); ‘service provision’ (n=3); and ‘community development’ (n=1). Most were conducted in the USA and Canada, and their design, methods, quality and transferability varied considerably. Nine of the 10 effective interventions were group activities with an educational or support input. Six of the eight ineffective interventions provided one-to-one social support, advice and information, or health-needs assessment. The review suggests that educational and social activity group interventions that target specific groups can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes remains unclear.

RATIONALE: Studies have shown that risperidone is safe and efficacious in young and middle-aged adults with chronic schizophrenia, but considerably fewer data are available on the treatment of elderly patients with schizophrenia or other psychotic disorders, particularly long-term outcomes. OBJECTIVE: A 12-month, open-label study was conducted to assess the effects of risperidone in elderly, chronically ill, psychotic patients. METHODS: This study enrolled 180 elderly, chronically ill, psychotic patients (median age, 72 years [range 54-89]), 97 of whom completed the 12-month study. At endpoint, the mean dose of risperidone was 3.7 mg/day. RESULTS: Clinical improvement (> or =20% reduction in Positive and Negative Syndrome Score [PANSS] total score) was achieved by 54% of patients at endpoint. There were significant reductions in PANSS total, subscale (positive, negative, and general psychopathology), and cognition cluster scores at endpoint (p<0.001). Clinical Global Impressions severity of illness scores showed continued improvement through month 12 (p<0.001). In contrast, PANSS data from a historical comparable control group of patients receiving conventional antipsychotic agents showed no symptom improvement over a 12-month treatment period. The severity of preexisting extrapyramidal symptoms (EPS) in patients treated with risperidone decreased significantly from baseline to endpoint (p<0.001), and the use of antiparkinsonian medication decreased from 41.1% of patients before the trial to 25.6% during the trial. There were no spontaneous reports of tardive dyskinesia (TD) and the incidence of assessed TD was 4.3% in contrast to the expected 26% reported in middle-aged and elderly patients receiving conventional antipsychotic agents for 1 year. CONCLUSIONS: Long-term treatment with risperidone was associated with continued symptom improvement, a decrease in the severity of preexising EPS, and a low incidence of TD in elderly psychotic patients.

This review of the effects of treatment for urinary tract infection in children and of preventive interventions is one of over 60 chapters in the first issue of Clinical Evidence , published by the BMJ Publishing Group. #### Key messages Definition: Urinary tract infection is defined by the presence of a pure bacterial growth >105 colony forming units/ml. Lower counts of bacteria may be clinically important, especially in boys and in specimens obtained by urinary catheter. Any growth of typical urinary pathogens is considered clinically important if obtained by suprapubic aspiration. In practice, three age ranges are usually considered on the basis of differential …

The purpose of this study was to evaluate the extent of depressive side effects in women of child-bearing age currently taking oral contraceptives. The incidence of depression has been variously reported as between 2 per cent. and 5 per cent. (Any Questions, 1965), but clinical impression has been that this is an underestimate. Rather alarmingly, also, there has been a tendency to explain away symptomatology on a “scapegoat effect” basis (Bakker and Dightman, 1966). By blaming the Pill the patient has been held to increase her own self-esteem and avoid responsibility for lethargy, irritability, etc. Nevertheless, alert physicians have consistently recommended caution (Kaye, 1963; Grant, 1965).

Anxiety and agitation are common in people with dementia. Their consequences can be severe, including increased mortality rates and institutionalization. Despite the importance of these symptoms there is little literature in this area. Some studies have assumed that agitation is the outward manifestation of anxiety, while others have attempted to differentiate between them. The aim of this study was to investigate the relationship between anxiety and agitation in people with mild-to-moderate dementia. A secondary aim was to compare two measures of anxiety which have been used in people with dementia. A cross-sectional correlation design was used. Participants were 40 older adults with dementia. Agitation, anxiety, depression, and level of cognitive impairment were measured. The main finding from the study was that anxiety and agitation are associated in dementia. The degree of correlation did not support the use of agitation as a measure of anxiety. Anxiety symptoms of autonomic sensitivity were not correlated with agitation and could be used to differentiate between the two if this was required. The use of the Rating for Anxiety in Dementia (RAID) was supported as a measure of anxiety in people with dementia.

Dermatoglyphics of patients suffering from diabetes, schizophrenia, duodenal ulcer, asthma, and various cancers have been contrasted and significant differences in the digital ridge counts, maximum atd angles, and distal palmar loop ridge counts have been found. A discriminant analysis of the digital ridge counts was performed and the function was used to attempt differential diagnosis between these conditions on dermatoglyphic evidence alone. This diagnostic trial failed, and possible reasons for its failure are discussed. Attention is drawn to the possibility that prognostic implications of dermatoglyphics might be relevant to screening techniques.

BACKGROUND AND OBJECTIVES: Acute otitis media (AOM) not only affects childhood quality of life (QoL), but can also affect parental QoL. We adapted a previously published questionnaire on the effect of childhood recurrent ear, nose and throat infections on parental QoL for use with AOM and used it in an observational, multicentre, prospective study of children with AOM. METHODS: The AOM-specific parental QoL questionnaire grouped 15 items into emotional, daily disturbance, total and overall parental QoL impact scores. The questionnaire was assessed using item-convergent and item-discriminant validity criteria and internal consistency reliability; and then used with parents of children aged <6 years diagnosed with AOM at 73 practices in Germany, Italy, Spain, Sweden and the UK. Bivariate analyses explored the differences in mean parental QoL impact scores by various characteristics. RESULTS: The questionnaire demonstrated good to excellent internal consistency reliability for the various components (Cronbach's α 0.82-0.97). There were 1419 AOM episodes among 5882 healthy children over 1 year, of which 1063 episodes (74.9%) among 852 children had a questionnaire. Parents reported interrupted sleep (68.4%), worry (51.0%), altered daily schedule (44.6%) and less leisure time (41.5%) with a score ≥ 3 (1 = least to 5 = most impact). Factors that adversely affected parental QoL included: increased parental perception of AOM severity, younger child age and multiple AOM episodes. CONCLUSIONS: The AOM-specific parental QoL questionnaire demonstrated good performance across five European countries. Parental QoL was affected by childhood AOM proportionally to severity, number of episodes and younger child age.

A case of delusional parasitosis is presented in which a patient with classic symptoms of six years' duration responded to pimozide. Similarly chronic cases may be responsive to pimozide.

The study aimed to identify those patients referred to a psychiatric out-patient clinic who had sexual or marital difficulties and who could be offered help with these problems, although none of the patients had been referred primarily for sexual or marital therapy. The methods of assessment formed a series of filtering devices for screening the sample, and possible reasons for discrepancies in the results are discussed. Twelve per cent of the sample had sexual or marital problems and were offered treatment, and it is suggested that this proportion may be an underestimate of the 'true' frequency of such problems in the sample. Implications of this finding for the provision of treatment resources in the psychiatric out-patient setting are considered.

1. A case of multiple bone lesions in a patient infected by Avian-Battey bacillus is reported. 2. It is suggested that the prognosis in future Heaf-negative cases may be improved by studies of the cellular response to the infection.

The aim of this account of practice is to share my specific experience of action learning as an approach to effective working in a networking organisation. The context is delivery of public health at a regional level as part of a national organisation, The Health Development Agency. The action learning set took place with a consistent group over a 20-month period. The account includes my personal learning, views expressed by colleagues, and some reflections on ways the set improved my working practice with others as part of a 'networked organisation'. The account may be of relevance to anyone involved with developing networks, and/or a networked organisation. It is particularly pertinent to public health specialists, practitioners and others involved with developing networks as a tool to enhance good public health practice.

We demonstrate a silicon photonic 4×1 TTD beamformer operated in real-time. Beamforming of a 1 Gb/s QPSK signal carried at 28 GHz was validated by a fourfold improvement in output amplitude and EVM.

A study of anti-Parkinsonism agents in prolonged phenothiazine therapy seeks to clarify some anecdotal misconceptions. Antiparkinsonian agents do not appear to affect the therapeutic efficiency of phenothiazines, nor does using them on a "demand" basis increase the problems of control of parkinsonian side effects. Older patients, however, appear to require the extended usage of antiparkinsonian agents rather more than some studies would suggest. Sustained release antiparkinsonian agents may yet further simplify the management of schizophrenia.

Harris (1951) adequately summarizes the work done on nitrile compounds and their therapeutic use in psychiatric disorder. This work is highly controversial and the results contradictory. He adds a series of thirty cases of his own treated with dinitrile succinate (“Suxil” or “Psychil”), and concludes that no clear evidence of its therapeutic value was obtained. Twenty of his cases were treated by six or less injections of 0.1 gm. for the first, and 0.2 gm. for subsequent injections. He says: “Later, following representations by the manufacturers, this was extended to twelve.” He also comments on the suggestibility of some of his patients and the high spontaneous remission rate which make assessment of the efficacy of therapy peculiarly difficult. As far as can be seen from his paper, the assessments were made entirely impressionistically. Our preliminary trials, confirmed by our further experience with this drug, indicated (in complete harmony with Harris's opinion) that the drug is “safe, easy to administer, and quite free from toxic effects in the doses recommended.” We felt, therefore, that a further experimental trial was indicated.

Avian botulism has been reported in many areas worldwide, particularly in North America, where at times it has resulted in die-offs of hundreds of thousands of waterbirds. By contrast, there are few reported cases in wild waterbird communities in South Africa. Mass die-offs of waterbirds in the Wilderness Lakes, South Africa, were first observed in January 2015, raising concerns about the effect of disease on the status of waterbird communities in this Ramsar site. Surveys of bird carcasses were undertaken between 2015 and 2017. An estimated 1115 individuals from 23 species were affected, with sick individuals displaying symptoms of avian type C, C and D or E botulism. The highest mortality was amongst red-knobbed coot ( Fulica cristata ), Cape shoveler ( Anas smithii ) and yellow-billed duck ( Anas undulata ), respectively comprising 60%, 18% and 9% of affected individuals. Cape shoveler was found to be particularly susceptible to the disease. Deaths occurred mainly during summer and autumn (November–April). No mortalities were recorded amongst 44 waterbird species, of which common moorhen ( Gallinula choropus ), African purple swamphen ( Porphyrio madagascariensis ) and reed cormorant ( Phalacrocorax africanus ) are widespread and abundant. The reasons for the outbreaks remain elusive, as environmental changes characteristic of a botulism outbreak, notably a decline in water level and dissolved oxygen, did not differ substantially from earlier years when no disease outbreaks were observed. The role of fish, and in particular the recently introduced common carp ( Cyprinus carpio ) in the progression of the disease, remains speculative, although worthy of investigation. The removal of carcasses for disease control should be continued. Conservation implications: The long-term effect of repeated outbreaks of avian botulism on the abundance of susceptible waterbird species in the Wilderness Lakes is of concern. The previous regular high abundance of duck species, particularly yellow-billed duck and Cape shoveler, was the initial reason for the Wilderness Lakes being declared a Ramsar site. The effect of ongoing high disease-related mortalities may, in part, prevent these wetlands from continuing to regularly support globally significant populations of some waterbird species. The containment of the disease must be attempted by the regular collection and removal of dead birds and fish during the outbreak periods of November–June, and carcasses should be disposed of off-site. Further testing of affected individuals should be undertaken and the monitoring of environmental variables and affected individuals continued to improve the understanding of the drivers and progression of the disease.

Journal Article Sarcoma arising in a chronic actinomycotic sinus Get access Martin A Goodwin Martin A Goodwin Sedgefield General Hospital Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 44, Issue 187, March 1957, Pages 489–492, https://doi.org/10.1002/bjs.18004418711 Published: 05 December 2005

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# All lacerations need to be examined thoroughly {#article-title-2} EDITOR—Quinn et al show that conservative treatment is faster and less painful for small uncomplicated lacerations of the hand.1 However, we think that lacerations to the hand, no matter how small, must be examined thoroughly to exclude injuries to tendons, nerves, or joints. The authors make no comment on the mechanism of injury, which is extremely important. A knife stab laceration or glass injury to the hand would make exploration of the wound mandatory. An unimpressive skin wound may hide a remarkable amount of damage to deep structures.2 Similarly, injuries caused by thin slivers of glass produce unimpressive skin wounds but commonly divide flexor tendons and nerves in the forearm.3 In emergency settings we think that it is crucial to take a good history from the patient about the mechanism of injury and to examine the patient thoroughly before deciding on further management of hand lacerations, albeit suturing or conservative management. In our plastic surgery unit the nurse practitioners who refer cases of hand trauma to us have all been on a hand trauma study day organised by our department. If the mechanism of injury raises any suspicion of a tendon or nerve injury, patients are referred to us and their wounds formally explored in an operating theatre. 1. ↵1. Quinn J, 2. Cummings S, 3. Callaham M, 4. Sellers K . Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ 2002; 325: 299–300. (10 August.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. ↵1. Schwager RG, 2. Smith JW, 3. Goulian D . Small deep forearm lacerations. Plast Reconstr Surg 1975; 55: 190–194. [OpenUrl][3][PubMed][4] 3. ↵1. Joseph KN, 2. Kalus AM, 3. Sutherland AB . Glass injuries of the hand in children. Hand 1981; 13: 113–119. [OpenUrl][5][CrossRef][6][PubMed][7][Web of Science][8] # Hand lacerations should be explored before conservative treatment {#article-title-6} EDITOR—We are surprised by the publication of the article by Quinn et al on conservative treatment of small … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DQuinn%26rft.auinit1%253DJ.%26rft.volume%253D325%26rft.issue%253D7359%26rft.spage%253D299%26rft.epage%253D299%26rft.atitle%253DSuturing%2Bversus%2Bconservative%2Bmanagement%2Bof%2Blacerations%2Bof%2Bthe%2Bhand%253A%2Brandomised%2Bcontrolled%2Btrial%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.325.7359.299%26rft_id%253Dinfo%253Apmid%252F12169503%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=325/7359/299&atom=%2Fbmj%2F325%2F7372%2F1113.atom [3]: {openurl}?query=rft.jtitle%253DPlastic%2Band%2Breconstructive%2Bsurgery%26rft.stitle%253DPlast%2BReconstr%2BSurg%26rft.aulast%253DSchwager%26rft.auinit1%253DR.%2BG.%26rft.volume%253D55%26rft.issue%253D2%26rft.spage%253D190%26rft.epage%253D194%26rft.atitle%253DSmall%252C%2Bdeep%2Bforearm%2Blacerations.%2BDifferential%2Bdiagnosis%2Bof%2Bmuscle%2Band%2Bnerve%2Binjuries.%26rft_id%253Dinfo%253Apmid%252F1118476%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=1118476&link_type=MED&atom=%2Fbmj%2F325%2F7372%2F1113.atom [5]: {openurl}?query=rft.jtitle%253DThe%2BHand%26rft.stitle%253DHand%26rft.aulast%253DJoseph%26rft.auinit1%253DK.%2BN.%26rft.volume%253D13%26rft.issue%253D2%26rft.spage%253D113%26rft.epage%253D119%26rft.atitle%253DGlass%2Binjuries%2Bof%2Bthe%2Bhand%2Bin%2Bchildren.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0072-968X%252881%252980050-2%26rft_id%253Dinfo%253Apmid%252F7286795%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1016/S0072-968X(81)80050-2&link_type=DOI [7]: /lookup/external-ref?access_num=7286795&link_type=MED&atom=%2Fbmj%2F325%2F7372%2F1113.atom [8]: /lookup/external-ref?access_num=A1981LZ45900001&link_type=ISI

Ecosystem services provided by coastal and marine environments are increasingly recognised as of paramount importance for human wellbeing. To inform marine spatial planning and its implementation, as well as to manage conflicts between marine resource beneficiaries, we developed a comprehensive estimate of the economic value of the ecosystem services of Algoa Bay (AB) from 2000 to 2019. This is to assist in the development of effective policies concerning the management of marine resources. We quantified and assessed the monetary value by integrating 15 ecosystem services (ES) across five ecosystems using a range of economic valuation techniques and four scenarios. The scenarios differentiate between the local and global beneficiaries of the services and a conservative and alternative valuation estimate. These latter two valuation benefits are calculated using different sets of valuation estimates. We identified that onshore ecosystems, and recreation and tourism services, hold the most value. We estimated that the value grew from USD 613.4 million to USD 1695.9 million for local beneficiaries and from USD 1127.7 million to USD 2787.9 million for global beneficiaries between 2000 and 2019. The local values are roughly equivalent to the municipal budget, implying that the value of the ES is at least equal to that of the combined value of public service delivery. This highlights the significant economic contributions of marine and coastal ecosystems to local economies. This valuation provides a framework to make explicit the value that beneficiaries derive from marine ecosystems and provides a novel perspective on the valuation of ES in the coastal and marine ecosystems. This framework can be replicated elsewhere where there is a need to develop the ocean economy in an equitable and sustainable way.

(Uploaded by Plazi from the Biodiversity Heritage Library) No abstract provided.