UK guideline on transition of adolescent and young persons with chronic digestive diseases from paediatric to adult care

The risks of poor transition include delayed and inappropriate transfer that can result in disengagement with healthcare. Structured transition care can improve control of chronic digestive diseases and long-term health-related outcomes. These are the first nationally developed guidelines on the transition of adolescent and young persons (AYP) with chronic digestive diseases from paediatric to adult care. They were commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology under the auspices of the Adolescent and Young Persons (A&YP) Section. Electronic searches for English-language articles were performed with keywords relating to digestive system diseases and transition to adult care in the Medline (via Ovid), PsycInfo (via Ovid), Web of Science and CINAHL databases for studies published from 1980 to September 2014. The quality of evidence and grading of recommendations was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The limited number of studies in gastroenterology and hepatology required the addition of relevant studies from other chronic diseases to be included. These guidelines deal specifically with the transition of AYP living with a diagnosis of chronic digestive disease and/or liver disease from paediatric to adult healthcare under the following headings; 1. Patient populations involved in AYP transition 2. Risks of failing transition or poor transition 3. Models of AYP transition 4. Patient and carer/parent perspective in AYP transition 5. Surgical perspectiv

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The making of a maritime explorer: the early career of Matthew Flinders

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal for Maritime Research on 09/08/2016, available online: https://www.tandfonline.com/doi/full/10.1080/21533369.2016.1172839This article examines the early career of Matthew Flinders (1774–1814) to determine the ways in which his training as a navigator, hydrographer and cartographer prepared him for undertaking the first circumnavigation of Australia in the Investigator between 1801 and 1803. Two main questions are answered in relation to this theme. First, why was such a young naval officer as Flinders (he was 26) selected to lead such an important voyage of discovery? And, second, in what ways did the choice of Flinders as the commander of the Investigator reflect the training he had received? The article argues that the making of Flinders as a maritime explorer was forged through his successive nautical achievements in the 1790s, partly in relation to William Bligh’s second breadfruit voyage to the Pacific in 1791–1792 and partly in relation to voyages along the coasts of New South Wales and Van Diemen’s Land that Flinders undertook between 1795 and 1800. During that period, Flinders jointly discovered Bass Strait and circumnavigated Van Diemen’s Land: these were the two most significant geographical discoveries in Australia since the era of Captain Cook. The article shows that when he returned from Port Jackson to London in 1800, Flinders was the most experienced candidate with knowledge of Australian waters who was available to lead the Investigator expedition. It also argues that Flinders placed himself in a highly favourable position to be selected as the leader of the circumnavigation through demonstrating to Sir Joseph Banks, his patron, that he had a thorough, up-to-date knowledge of what needed to be discovered about Australia through maritime exploration. Throughout, there will be an emphasis on the nautical skills Flinders acquired rapidly as a young midshipman and lieutenant and on his determination and initiative to devote his career to Australian discovery.The research was supported by an Australian Bicentennial Fellowship, Menzies Centre for Australian Studies, King’s College, London

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar