Woking Community Hospital

In a multicentre, randomized, open study, 306 patients of either sex, over 18 years of age with stable chronic plaque psoriasis > 100 cm2 in surface area, and who gave informed consent, applied Dovonex (calcipotriol) ointment (50 micrograms/g) twice daily or Dithrocream (short-contact dithranol) 0.1-2% for up to 3 months. The number of patients 'cleared' or with 'marked improvement' at the end of treatment were: investigators' assessment--calcipotriol 92 of 153 (60.1%); dithranol 67 of 131 (51.1%); odds ratio 1.44 [95% confidence interval (CI) 0.90, 2.31; P = 0.128]; patients' assessment--calcipotriol 93 of 153 (60.8%); dithranol 65 of 131 (49.6%); odds ratio 1.57 (95% CI 0.98, 2.52; P = 0.059). Significant improvement in patients' quality of life as assessed by the Psoriasis Disability Index (PDI) and the Sickness Impact Profile (SIP) were seen in both treatment groups. Reduction in the total mean score for PDI was 6.5 in the calcipotriol group (95% CI 4.4, 8.6; P = 0.001) and 3.7 in the dithranol group (95% CI 1.1, 6.3; P = 0.005). The reduction in the total mean score for SIP was 2.8 in the calcipotriol group (95% CI 1.4, 4.3; P < 0.001) and 1.7 in the dithranol group (95% CI 0.2, 3.1; P = 0.024). Calcipotriol treatment tended to have advantages over treatment with dithranol in improving quality of life.

OBJECTIVES: The objectives of this study were to explore medical students' experiences of communicating with patients and their carers about death and dying, and to assess whether using high-fidelity simulation improved students' confidence in discussing cardiopulmonary resuscitation. METHODS: This qualitative study was carried out at a hospital in the south of England. Participants were 7 final-year medical students. Tutorials were developed using high-fidelity simulation to teach communication skills regarding discussion of cardiopulmonary resuscitation with patients and carers. Scenarios involved a simulated ward environment, a high-fidelity simulation mannequin and actor playing the role of a carer. Data were collected through joint interviews carried out by one researcher which were audio recorded and transcribed verbatim. The same researcher analysed the data using framework analysis. RESULTS: Students reported a lack of experience observing conversations with patients and carers about death and dying. They also reported a lack of opportunities to interact with dying patients during their training. Barriers reported by students included healthcare professionals' and patients' attitudes. Students reported a lack of confidence and preparedness to have consultations with patients and carers about death, dying and cardiopulmonary resuscitation as junior doctors. They perceived role-play scenarios observed by their peers to be stressful, and this detracted from the learning experience. Students reported that the high-fidelity simulation scenarios were more realistic than low-fidelity ('role-play') scenarios. This improved the learning gained from the sessions and improved confidence among some students. CONCLUSIONS: This study has suggested that high-fidelity simulation may be a useful adjunct for undergraduate communication skills training in palliative medicine. Further research is required to assess whether improvements in confidence described by students in this study translate to discernible improvements in competence, and whether using high-fidelity simulation in this setting is cost-effective.

This paper is concerned with the use of commercial security algorithms like the Advanced Encryption Standard (AES) in Earth observation small satellites. The demand to protect the sensitive and valuable data transmitted from satellites to ground has increased and hence the need to use encryption on board. AES, which is a very popular choice in terrestrial communications, is slowly emerging as the preferred option in the aerospace industry including satellites. This paper first addresses the encryption of satellite imaging data using five AES modes - ECB, CBC, CFB, OFB and CTR. A detailed analysis of the effect of single even upsets (SEUs) on imaging data during on-board encryption using different modes of AES is carried out. The impact of faults in the data occurring during transmission to ground due to noisy channels is also discussed and compared for all the five modes of AES. In order to avoid data corruption due to SEUs, a novel fault-tolerant model of AES is presented, which is based on the Hamming error correction code. A field programmable gate array (FPGA) implementation of the proposed model is carried out and measurements of the power and throughput overhead are presented.

Many inhaler devices with varying handling requirements for optimal use are available for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Patients may be prescribed different device types for reliever and maintenance medications, which may lead to confusion and suboptimal device use. We aimed to understand whether simplifying inhaler regimens by employing a single device type in patients who use multiple devices or prescribing a device with which a patient was already experienced could improve clinical and economic outcomes in asthma and COPD management. A targeted literature search was performed and additional articles were identified through hand searching citations within screened publications. A total of 114 articles were included in the final review. Findings suggest that simplifying inhaler regimens by applying the same type of inhaler for concomitant inhaled medications over time minimizes device misuse, leading to improved clinical outcomes and reduced health care use in patients with asthma or COPD. Physicians should consider a patient's suitability for a device and training needs when prescribing an inhaled medication and before changing the medication type or dose, especially when suboptimal treatment outcomes are observed. Further research is required to determine whether consistent use of the same device type is associated with better treatment adherence and persistence in patients with asthma or COPD. Nevertheless, this literature review identified clinical benefits and reduced health care use with simplified inhaler regimens.

DNA prepared from a field isolate of African swine fever virus, which causes high mortality and severe disease in domestic pigs, was cloned in bacteriophage lambda and plasmid vectors. Clones containing DNA inserts overlapping with each other and together covering the complete genome, apart from short fragments close to the cross-linked termini of the genome, were obtained. A complete restriction enzyme site map of the genome for three enzymes was deduced.

English Holistic education lacks a single definition but may be described through a number of recurrent themes that appear in the literature. These themes have been used to develop underlying values that reflect this educational approach and the behaviours associated with these values are described. A person profile is presented from these values and behaviours and describes the attributes, abilities and competencies of a student who has benefited from holistic education in the middle years of their education. The advantages of the person profile are discussed. French Il n'existe pas de définition unique de l'éducation globale; celle-ci peut cependant être décrite grÀce à un certain nombre de thèmes qui apparaissent de façon récurrente dans la littérature. L'auteur utilise ces thèmes pour développer les valeurs sous-jacentes qui caractérisent cette approche éducative et décrire les comportements associés à ces valeurs. Il établit le profil d'une personne à partir de ces valeurs et comportements, profil qui décrit les qualités, les aptitudes et les compétences d'un élève ayant bénéficié d'une éducation globale au cours du premier cycle du secondaire. Enfin, il analyse les avantages du profil de cette personne. Spanish No existe una definición única para `educación holística'; no obstante, ésta se puede describir por medio de una serie de elementos recurrentes en la literatura especializada. El autor se basa en tales elementos para desarrollar los valores subyacentes a la educación holística y describe las conductas asociadas a dichos valores. Presenta también un perfil personal basado en estos valores y conductas, y describe los atributos, habilidades y competencias esperados en los alumnos que hayan participado de una educación holística durante los años de enseñanza media. Asimismo, analiza las ventajas del perfil personal.

Abstract Aim: This study explored the influence of personal therapy on professional and personal development in a qualitative investigation. Method: Six semi‐structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). Findings: All participants recognised the important influence of personal therapy on personal growth. Influences on personal development were experienced in the physical, cognitive, emotional and spiritual worlds of participants. It was felt that skills, a better understanding of therapeutic relationships, and general support, enhanced professional development. Conclusion: In combination this can lead to an increase in self‐awareness and thus a more effective professionalism in counsellors.

SUMMARY: Consecutive admissions of 214 women with borderline personality disorder were investigated for patterns of specific forms of self-harm and reported developmental experiences. Systematic examination of clinical notes found that 75% had previously reported a history of childhood sexual abuse. These women were more likely to self-harm, and in specific ways that may reflect their past experiences. Despite this, treatment within a dialectical behaviour therapy-informed therapeutic community leads to relatively greater clinical gains than for those without a reported sexual abuse trauma history. Notably, greater behavioural and self-reported distress and dissociation were not found to predict poor clinical outcome. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

The history of the (British) Diabetic Association is bound up with the life of Dr R.D. Lawrence, its co-founder and first Chairman. Thus the story begins with a review of his early life and experience. He himself committed some memories to paper, in autobiographical context, to which he gave the title A Splendid Life, and this review draws freely on those unpublished notes, with the permission of his sons. Unfortunately, many records, letters and documents were destroyed when the flat of his secretary, the late Miss Lilian Pearce, was damaged by the 1987 hurricane storms, and later vandalized while she was in hospital. Academically brilliant, with his heart set on becoming a surgeon, Robin Lawrence was diagnosed as having diabetes in 1920, at the age of 28. The poor prognosis lead him to set up practice in Florence, where he could at least enjoy the splendours of Italian culture. His health deteriorated badly during the winter of 1922, but alerted to the introduction of insulin therapy by Dr. G.A. Harrison, he returned to King's College Hospital, London and received his first injection of insulin on 31 May 1923. Thereafter, he devoted his life to the understanding of the disease, and the welfare of those affected by it. Together with his patient, the author and scientist H.G. Wells, Robin Lawrence was responsible for the formation of the Diabetic Association, the first patient-oriented association to be established in the United Kingdom. Historical data are taken from early issues of the Diabetic Journal and minutes of meetings to which the author has been given access.

Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively. Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes. Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.

Cyclizine is an antihistamine, which is frequently used to manage nausea and vomiting in cancer patients. Antihistamines can be drugs of misuse/abuse, and the article describes four cancer patients who developed such problems after receiving parenteral cyclizine within the inpatient unit of a cancer centre. The article also briefly reviews the literature on the misuse/abuse of cyclizine and other antihistamines.

OBJECTIVES: The aim of this study was to investigate concordance between patients and non-professional carers about factors associated with a 'good death' and other end-of-life decisions. METHODS: Patients completed a questionnaire about end-of-life care issues, and were asked to rank the importance of factors linked to a 'good death'. Carers also completed a questionnaire about end-of-life care issues relating to the patient, and whether or not they agreed with those choices (ie, medical treatments, PPD). Carers were also asked to rank the importance of factors linked to a 'good death' to the patient, and to them personally at that point in time. RESULTS: Only 69% of patients stated they had discussed their preferences for end-of-life care with their respective carer. The rankings were similar for the patient and the carer's views of what was important for the patient, although the patients ranked 'to be involved in decisions about my care' as less important than the carers, while the carers ranked 'to have sorted out my personal affairs' as less important than the patients. CONCLUSIONS: When discussions around end-of-life choices do occur, carers generally appear to agree with the patients' preferences around end-of-life treatment, and preferred place of death.

The Managing Advanced Cancer Pain Together (MACPT) group is a team of European experts in pain management who recognise that, despite the great advances in cancer treatment and care, many people living with advanced cancer still receive suboptimal pain management, leading to distress and suffering. The MACPT group takes a person-centred approach to understanding and addressing all aspects of people’s pain, and believes that pain management can be improved. Building on international guidance and expert opinion, the group, working with patients with advanced cancer, has developed clinical based and easy to use MACPT guidance to support those working in the field. The guidance includes the newly developed MACPT conversation tool, to help people with cancer, and those caring for them, to talk about the hidden aspects of pain. The guidance and tool are available in English, French and German, and will be translated into other languages. This article discusses management of cancer pain and describes how to use the conversation tool.

Abstract The relation of science to secularisation is discussed in relation to the sociological frameworks of rationalisation and social differentiation in the context of cross-national and cross-cultural comparison. It is argued that there is no consistent relation between the degree of scientific advance and a reduced profile of religious influence, belief and practice. The crucial factors are sociological and historical, in particular the relation of religion to power and to the role of the intelligentsia in promoting radical social change. It is also argued that mental space constitutes a manifold so that there is in principle no zero-sum relation between science and religion. That there is such a relation derives from the Enlightenment master narrative and it acquires much of its emotional power not from the logical consequences for religion of science as from a putative relation between religion and moral evil and the legitimation of oppressive regimes. However there are indirect consequences of science for religion through the social consequences of technological change. In practice the consequences of historical studies, for example biblical criticism, are probably greater than the consequences of science.

Currently there is a widespread movement, not only amongst practitioners but also managers, purchasers and policy makers, to promote evidence‐based health care. There is therefore a growing concern that practitioners should be able to efficiently access and appraise evidence. This paper discusses some of the requirements which are necessary to enable nurses to achieve this goal. It is based on three sources of evidence: the evaluation of a workshop which was designed to facilitate practitioners' appraisal and use of research; a qualitative study of practitioners' and managers' attitudes to research; and the authors' experience of working in this field. A framework is suggested whereby not just the accruement of skills, but other requisites such as a positive culture, an appreciation of the wide range of research methodologies which might inform nursing, and an exploration of sources of evidence other than research, require attention.

Haematopoietic stem cell transplantation (HSCT) generally includes preparative or conditioning regimes containing chemotherapy and/or radiotherapy in high doses. These regimens, as well as other treatments before and after HSCT such as immunosuppressive drugs to prevent graft versus host disease (GvHD) (see Chap. 11), may affect the patient’s organs and tissues and may cause both acute and long-term complications. In the evolving field of stem cell therapies, some complications that traditionally have been regarded as early complications are now, due to changes in preparative regimens and choice of stem cell source, sometimes seen later in the post-transplant out-patient setting. The complications covered in this chapter generally occur within 100 days post HSCT and are thus classified as early complications. Two of the most common early complications are oral complications/mucositis and sepsis. Some other relatively rare complications are also covered here: haemorrhagic cystitis (HC), endothelial damage (ED) syndromes including engraftment syndrome (ES), idiopathic pneumonia syndrome (IPS), diffuse alveolar haemorrhage (DAH), transplant-associated microangiopathy (TAM) and sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD). For all complications, recommendations for prevention and principles for nursing care are presented since careful nursing monitoring, prompt intervention and care may have an influence on patients’ morbidity and mortality.

The typical spreadsheet, with its in-built mathematical functions and chart plotting facilities, can provide an interesting graphical interface for an insight into the solution of simple practical differential equations. This technique avoids problems that may present a difficulty to those students without certain mathematical tools, which can sometimes cloud the issue. The article explores simple equations such as the exponential decay function, a terminal velocity situation, and the more complex situations of the simple harmonic oscillator and damped oscillations.

Allogeneic stem cell transplantation was successfully performed in 1968, and its use has grown significantly over the past five decades with the total number now exceeding 1 million patients. HSCT is a curative treatment for many haematological cancers and other disorders. Almost 40,000 HSCT procedures are performed Europe-wide per annum (Passweg et al., Bone Marrow Transplant, 2016), and with a 5-year survival around 50% (Friedrichs, Lancet Oncol 11(4):331–338, 2010), the number of transplant recipients achieving ‘long-term survival’ and with late effects directly related to their treatment (Majhail et al., Hematol oncol Stem Cell Ther 5(1):1–30, 2012) is increasing. This growth in survivors is the result of improvements in transplant knowledge and expertise, refinements to conditioning regimes, developments in supportive care and increased numbers of procedures due to broadening transplant indications. The most common cause of death after transplant is relapsed disease. Yet, even without disease relapse, long-term survival is complex for many as other causes of mortality such as graft versus host disease (GvHD), infection, second malignancy, respiratory disease and cardiovascular disease (CVD) (Savani et al., 2011) prove difficult to address. Recovery post-HSCT is challenging, lasting several months to years. These individuals are susceptible to the development of post-treatment physical and psychological sequelae years to decades after completion of treatment leading to a reduced life expectancy with greater morbidity when compared to an age-adjusted population (Socié et al., N Engl J Med 341:14–21, 1999). Survivors with late effects experience significantly poorer physical and mental health, report more unmet needs for care and have significantly greater use of health services compared with survivors without late effects (Treanor et al., Psychooncology 22(11):2428–2435, 2013). Furthermore, as the number of survivors continues to grow, their long-term health problems and subsequent needs demand increasing attention. The unpredictable, complex and multifactorial nature of these long-term and late effects in HSCT survivors means that patients require regular life-long assessment guided by rigorous protocols. However, it is important to remember that even using standardised protocols, these should be different for adults and children and the resulting care must be tailored to the needs of the individual survivor. And finally, further consideration is needed for the growing number of young people and adult survivors in long-term follow-up who have been treated in childhood and transitioned into adult long-term follow-up care.

Pregnant sheep inoculated with Aspergillus fumigatus conidia developed agglutinating and precipitating antibodies for mycelial antigens. The agglutinins were initially exclusively of the IgM class, but were later supplemented by IgG antibodies, although IgM production was usually sustained throughout the serological response. Precipitins active in the immunodiffusion test were of the IgG class. They developed later in the immune response than agglutinins and declined more rapidly. The precipitins and IgG agglutinins were more closely associated with recent active infection than IgM agglutinins.

Woking Borough Council in the United Kingdom has long been committed to protecting the environment, a goal explicitly stated as one of the borough's top three priorities. Woking is also known for its pioneering approach in operating an extensive networked electricity and district heating system based on co- and trigeneration, as well as what is understood to be the United Kingdom's first commercially operating 200kW e fuel cell. Its other innovative measures to protect the environment and to reduce pollution include the adoption of energy- and water-saving techniques for council-owned buildings and public places, with revenue savings reinvested back into still additional measures to further improve sustainability. These various initiatives are providing a practical framework for advancing a more equitable, clean, decentralized, and socially cooperative energy system in service to Woking's inhabitants.