Serving children: the impact of poverty on children's experiences of services

This study arose from the identification of a gap in knowledge and corresponding need for the development of a better contemporary understanding of children's experiences of poverty. Focusing on children aged 10 - 14 years, the study aimed to provide a perspective on the lives of children and young people affected by poverty in Scotland through comparing the experiences of children living in poverty with those more economically advantaged

Clinical implications of increased testing in primary care

This is the final version. Available from BMJ Publishing Group via the DOI in this recor

How useful is thrombocytosis in predicting an underlying cancer in primary care? Systematic review protocol

Early diagnosis of cancer is imperative to reduce the cancer burden in the UK and improve cancer survival. Identifying early markers of cancer can help general practitioners to direct patients at the greatest risk of cancer to appropriate investigative services. A raised platelet count, or thrombocytosis, has been linked to malignancy and identified as a marker of poor prognosis in secondary care, but there is little evidence around the importance of this marker in a primary care setting, within a diagnostic context. This review aims to identify and explore the body of evidence concerning the association between thrombocytosis and cancer in primary care. This protocol was produced using guidance from the PRISMA-P statement

Cancer incidence in patients with a high normal platelet count: a cohort study using primary care data.

This is the author accepted manuscript. The final version is available from Oxford University Press via the DOI in this record.Background A platelet count >400×109/l (i.e. thrombocytosis) is a recently discovered risk marker of cancer. The risk of undiagnosed cancer in patients with thrombocytosis is 11.6% for men and 6.2% for women; well above the 3% risk threshold set by NICE for cancer investigation. Patients with a platelet count at the upper end of the normal range (325-400x109/l) could be at increased risk of undiagnosed malignancy. Objective To quantify the risk of an undiagnosed cancer in patients with a platelet count at the upper end of the normal range. Methods A primary care-based cohort study using Clinical Practice Research Datalink (CPRD) data from 2000 - 2013. The study sample comprised 2704 individuals stratified by platelet count: 325-349 x 109/l; 350-374 x 109/l; 375-399 x 109/l. Incident cancer diagnoses in the year following that platelet count were obtained from patient records. Results Cancer incidence rose with increasing platelet count: 2.6% (95% CI 1.9 to 3.6) in subjects with a count of 325-349x109/l; 3.7% (95% CI 2.5 to 5.3) in subjects with a count of 350-374x109/l; and 5.1% (95% CI 3.4 to 7.5) in those with a count of 375-399x109/l. Colorectal cancer was the most commonly diagnosed type in all three groups. Cancer incidence was consistently higher in males than in females. Conclusion These results suggest that clinicians should consider cancer in patients with a platelet count >375x109/l, and review the reasons for blood testing and any additional reported symptoms. Until these results are replicated on a larger scale, recommendations for clinical action cannot be made.The Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis receives funding for a research programme from the Department of Health Policy Research Programme. It is a collaboration between researchers from seven institutions (Queen Mary University of London, UCL, King’s College London, London School of Hygiene and Tropical Medicine, Hull York Medical School, Durham University, and the University of Exeter). Obioha Ukoumunne is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health

Blood markers for cancer

Cancer Research UKNational Institute for Health Research (NIHR)Policy Research Unit in Cancer Awareness, Screening and Early DiagnosisDepartment of Healt

Intervenção da equipe da saúde no combate a diabetes mellitus

As ações educativas são praticas inerentes ao projeto assistencial de saúde em todos os níveis de atenção. As causas de diabetes mellitus estão entre os fatores de risco modificáveis cujo controle associado a mudanças de vida pode ser estimulado no âmbito do atenção básica á saúde, minimizando a morbimortalidade por esta doença e seu impacto na saúde publica. Objetivo: Melhorar os níveis glicêmicos dos diabéticos tipo 2 da UBSF SQ 13 do município de Cidade Ocidental/GO, identificando fatores de risco para diabetes mellitus tipo 2 ,no período do projeto de intervenção e obter controle glicêmico adequado mediante aplicação de ações educativas contra os fatores de risco encontrados. Métodos: foram avaliados e acompanhados 25 pacientes da UBSF SQ 13, nos meses de setembro 2014 e maio de 2015, foram pacientes diagnosticados com diabetes desde há mais de 3 anos. A captação e coleta de amostras dos sujeitos da intervenção ocorreram nas dependências do posto de saúde SQ 13. As medições da glicemia séricas foram feitos no laboratório clinico publico em 3 ocasiões, as demais medições FDA glicemia capilar foram na UBSF SQ 13 e domicilio. As consultas foram agendadas para cada paciente cada três semanas para controle. Visitas domiciliar realizadas por medico a enfermeira e agentes de saúde de forma intercalada. As reuniões feitas em três momentos no período da intervenção com temáticas sobre diabetes e formas de tratamento, exercícios físicos e reunião de avaliação. Durantes as entrevistas individuais foram obtidos os principais fatores de risco sobre o descontrole glicêmico. Diante o acompanhamento, modificando os fatores que causam e medidas de educação em saúde, com os ajustes farmacológicos foram observadas a melhoria nas glicemias basais. A estimulação psicológica é importante para que os pacientes continuem e mantenham o tratamento continuo e o autocuidado. Alem disso a mais importante conclusão foi que a equipe organizada e determinada em resolver os problemas pode resolver situações da grande maioria sem precisar de recursos fora da unidade básica de saúde . Por tanto os resultados observados na intervenção foram satisfatórios em 92%, mostrando que os problemas ou descontrole da glicemia em sua grande maioria pode ser causadas por fatores simples, mais desencadeantes das complicações e que podem ser resolvidos a nível local

Colorectal cancer in symptomatic patients: How to improve the diagnostic pathway

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record Even in countries with national screening programmes for colorectal cancer, most cancers are identified after the patient has developed symptoms. The patients present these symptoms usually to primary care, or in some countries to specialist care. In either healthcare setting, the clinician has to consider cancer to be a possibility, then to perform triage investigations, followed by definitive investigation, usually by colonoscopy. This apparently simple pathway is not simple: most symptoms of colorectal cancer are more likely to represent benign disease than cancer, and each of these stages represents selection of patients into a higher-risk pool. This article summarises a symptom-based approach to selection and initial investigation of such patients in primary care. Some special groups need particular attention, including the younger patient, those with an inherited predisposition to cancer, and those with co-morbidities.Philanthropic DonationNational Institute for Health Research (NIHR

Progress in Lithotripsy Research

Shock wave lithotripsy (SWL) for the non-invasive treatment of kidney stones was introduced in the United States in 1984. SWL virtually eliminated the need for open surgery to remove kidney stones, and it did not take long for physicians and patients to endorse this revolutionary technology. Early reports told of the efficient removal of even the most troublesome stones without apparent complications, and SWL quickly became the "treatment modality of choice." It was not long, however, before concerned physicians began to report the occurrence of adverse effects in SWL, particularly involving vascular trauma and including cases of severe hemorrhage in the kidney and acute renal failure — significant side effects of serious consequence. Researchers quickly recognized the challenge and opportunity to determine the mechanisms of shock wave action in lithotripsy, and in 1988, the Acoustical Society of America held the first in a series of popular sessions devoted to the topic of shock waves in medicine. The goal of the inaugural session was to improve the fundamental understanding of lithotripsy — to bring better devices and treatments to patients. The goal of this paper is to report on progress in this effort