The incidence of surgical intervention following a suspected scaphoid fracture

Aims: The underlying natural history of suspected scaphoid fractures (SSF) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries and could potentially influence medicolegal actions around missed scaphoid fractures.Methods: Data on SSF was retrospectively gathered from Virtual Fracture Clinic (VFC) across a large Scottish Health Board over a four-year period from 1st January 2018 – 31st December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross referencing the unique patient Community Health Index [CHI] number for patients who underwent these scaphoid procedures with those seen at VFC for SSF over this four-year period.Results: 1739 patients were identified as having had a SSF. Five patients (0.28%) underwent early ORIF. One patient (0.06%) developed a non-union and underwent ORIF with bone grafting. All 6 patients undergoing surgery were male (p=0.0055). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%) compared with 3 in those without (0.27%)(p>0.576, Fishers exact test).Conclusions: Surgical intervention was rare following a SSF and was not required in women. A primary MRI policy did not appear be associated with any change in primary or secondary intervention. This data is the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF and may be used to guide surveillance and screening pathways as well as defining medicolegal risk involved in missing a true fracture in SSFs

Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study

BACKGROUND: Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes. METHODS: We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control. RESULTS: The study cohort was comprised of 72 (21.3%) Hispanic subjects (H), 35 (10.4%) African Americans (AA), and 226 (67%) non-Hispanic whites (NHW). The mean (SD) hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4)%, H 8.16 (1.6)%, AA 8.84 (2.9)%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002) compared to NHW. Insulin doses (unit/day) also differed significantly: NHW 70.6 (48.8), H 58.4 (32.6), and AA 53.1 (36.2), p < 0.01. Multivariate-adjusted insulin doses were significantly lower for AA (-17.8 units/day, p = 0.01) and H (-10.5 units/day, p = 0.04) compared to NHW. Decrements in insulin doses were even greater among minority patients with poorly controlled diabetes (A1c ≥ 8%). The disparities in glycemic control and insulin treatment intensity could not be explained by differences in age, body mass index, oral hypoglycemic medications, socioeconomic barriers, attitudes about diabetes care, diabetes knowledge, depression, cognitive dysfunction, or social support. We found no significant racial/ethnic differences in lipid or blood pressure control. CONCLUSION: In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings

Are you Ready? Assessing Whether Organisations are Prepared for Digital Preservation

In early 2009 the Planets project undertook a survey of national libraries, archives, and other content-holding organisations in Europe to better understand the organisations' digital preservation activities and needs, and to ensure that Planets' technology and services are designed to meet them. Over 200 responses were received including a cross-section of major libraries and archives especially in Europe. The results provide a snapshot of organisations' readiness to preserve digital collections for the future. The survey revealed a high level of awareness of the challenges of digital preservation within organisations. Findings indicated that approximately half of those organisations surveyed have taken measures to develop digital preservation policies and to budget for it, while a majority have incorporated digital preservation into their organisational planning. Organisations predict that within a decade they will need to store large quantities of data in a wide range of formats from a variety of sources; three quarters of them are looking to invest in a solution within the next two years. However, the findings also point to varying degrees of readiness. Organisations with a digital preservation policy are significantly further advanced in their work to preserve digital collections for the long-term than others

Pharmacogenomics of drug-induced liver injury (DILI): molecular biology to clinical applications

A number of drug-specific and host-related factors contribute to the development of drug-induced liver injury (DILI). Investigations focused on genetic susceptibility to DILI have advanced our understanding of the pathogenesis of this rare, yet potentially life-threatening adverse reaction. Candidate gene studies involving well-characterized patients with DILI and drug-exposed controls have identified single nucleotide polymorphisms (SNPs) affecting the metabolism and clearance of specific drugs and hence, influencing individual’s susceptibility to DILI. On the other hand, a series of genome-wide association studies (GWASs) have revealed a number of Human Leucocyte Antigen (HLA) alleles that are associated with DILI secondary to compounds with dissimilar chemical structures, highlighting the role of adaptive immune responses in the development of liver damage. These risk alleles, such as HLA-DRB1*15:02 illustrated by the example presented in the clinical vignette, determine the physicochemical properties of the peptide-binding grooves of the HLA molecules and increase the likelihood of DILI in a susceptible individual by altering the nature or the magnitude of immune-mediated liver injury. Associations of HLA alleles with DILI secondary to specific drugs can be translated into genetic tests, and when performed selectively, can improve the accuracy of diagnosis of DILI as well as assist in identifying the correct causal agent when the event could be attributed to more than one drug

Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Introduction Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Results Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making

Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme:The English Longitudinal Study of Ageing

Background The English NHS Bowel Cancer Screening Programme has offered biennial faecal occult blood testing to people aged 60–69 years since 2006, and to those aged 60–74 years since 2010. Analysis of the first 2.6 million screening invitations found that 54% of eligible people took up the invitation. The reasons for this low uptake are unclear. We investigated whether participation in screening varies according to cognitive ability and personality. Methods Participants were members of The English Longitudinal Study of Ageing. In 2010–2011, respondents were asked about participation in bowel cancer screening, and cognitive ability and the ‘Big Five’ personality traits were assessed. Logistic regression was used to examine the cross-sectional relationships between cognitive ability and personality and screening participation in 2681 people aged 60–75 years who were eligible to have been invited to take part in the UK national screening programme for bowel cancer. Results In age-adjusted and sex-adjusted analyses, better cognition and higher conscientiousness were associated with increased participation in cancer screening. ORs (95% CIs) per SD increase were 1.10 (1.03 to 1.18) for cognitive ability and 1.10 (1.01 to 1.19) for conscientiousness. After further adjustment for household wealth and health literacy—shown previously to be associated with participation—these associations were attenuated (ORs were 1.07 (1.00 to 1.15) and 1.07 (0.97 to 1.18), respectively). Conclusions We found some indication that better cognitive function and greater conscientiousness may be linked with a slightly increased likelihood of participation in bowel cancer screening. These relationships need investigation in other cohorts of older people

Using the Living CV to help students take ownership of their learning gain

There is an increasing emphasis on embedding employability skills and experience within the higher education curriculum to address new concepts of ‘learning gain’ and the perceived student demand for a value for money experience. An exploratory study, at a southern university in the UK, found that students articulated an improved work readiness when they were presented the ‘Living CV’, an initiative that connects programme learning outcomes into CV outputs. During 2018, a larger, mixed methods study (n=127) was conducted across all three years of fashion degrees. Students completed a pre and post questionnaire before and after a presentation on the Living CV and their views were further explored in a focus group and interviews. Results found that the Living CV presentation heightened students’ awareness of the applicability of their programme learning to their future employability and how they could use their academic learning outcomes on their CV as a tool to achieve this. The study recommends that personalised and explicit coaching on ‘work literacy’ should be integrated into university programmes at all levels to include the Living CV, discussion about and experience in the world of work, increased employer engagement and preparation for interview