Factors affecting patients' trust and confidence in GPs: evidence from the English national GP patient survey.

OBJECTIVES: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor. DESIGN: Secondary analysis of English national GP patient survey data (2009). SETTING: Primary Care, England, UK. PARTICIPANTS: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design. OUTCOME MEASURES: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors. RESULTS: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients. CONCLUSIONS: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor

Erneley Close passive house retrofit : resident experiences and building performance in retrofit to passive house standard

In May 2015, Eastlands Housing (now One Manchester) completed work on its retrofit to PassivHaus equivalent (EnerPHit) standard of 32 social housing flats in two blocks in Erneley Close, in the Manchester area Gorton. With a budget of £3.1 million, it was intended that the development would reduce energy bills, create new community greenspace and make the area a destination of choice (PassivHaus Trust 2015). Over the period December 2015 to February 2016, researchers at the Sustainable Housing and Urban Studies Unit (SHUSU) and the Applied Buildings and Energy Research Group (ABERG) monitored the thermal performance of the buildings and interviewed residents to understand their experiences of both the retrofit process and living in their retrofitted-flats. The research contributes to a nascent literature on retrofit of social housing to EnerPHit levels and to a broader literature base on processes and outcomes of retrofit across the UK housing stock. It finds broadly positive outcomes from the Erneley Close improvements, with monitoring indicating high expected comfort levels and the majority of tenants expressing satisfaction with the thermal performance of the flats and the heating systems. As with any major development, there are lessons that can be learnt, and opportunities to enhance the work: these relate primarily to ensuring residents, including vulnerable groups, understand fully how to get the best out of their retrofitted flats; and addressing some non-energy related tenant concerns. The report begins with an overview of the EnerPHit standard (Chapter 2), before outlining the methodology (Chapter 3). Chapters 4 and 5 present the findings from the qualitative interviews and the physical monitoring respectively. Finally, Chapter 6 offers a set of recommendations that relate to this and future social housing energy retrofit

Formulation and antibacterial properties of clay mineral-tetracycline and -doxycycline composites

Clay minerals have been used as adsorbents for decades but research into their use within healthcare as drug-carriers and modified drug release materials is an increasingly common area of interest. In current clinical practice the management of acute bacterial skin and skin-structure infections (ABSSSIs) requires patients to take systemic antibacterial treatment due to a lack of appropriate topical options. In this research tetracycline (TC) and doxycycline (DC) were adsorbed onto a range of clay minerals (kaolinite, montmorillonite, acid-activated montmorillonite, Laponite® RD and Laponite® XL21) to evaluate their potential as materials for the delivery of these antibiotics to infected wounds. A dispersion pH that favoured the zwitterionic form of the antibiotic molecules was shown to favour adsorption onto the clay minerals. FTIR and pXRD showed that positively charged groups on the antibiotic molecules interacted with the negatively charged clay mineral surface, whilst negatively charged groups on the antibiotic molecules could interact with the positively charged edge-sites of the clay minerals. Swelling clays such as the two Laponites® were able to adsorb much more TC and DC due to their structure and chemistry. The clay minerals alone did not have any antibacterial effects against Staphylococcus epidermidis, Cutibacterium acnes, and Pseudomonas aeruginosa. Antibiotic containing composites successfully released TC and DC, exhibiting activity against the three bacterial strains proportional to the antibiotic-loading on the composites. This research demonstrates the ability of these clay minerals to deliver TC and DC against common skin pathogens and their potential for future development towards clinical applications

Lyophilised Biopolymer-Clay Hydrogels for Drug Delivery

Clays have previously demonstrated potential as drug delivery carriers for the extended release of a variety of drugs. The objective of this study was to develop and characterise drug-containing clays in combination with natural hydrogels for the preparation of lyophilised xerogels. Sulfathiazole (STH) (a hydrophobic model drug) was intercalated within the interlayer spaces of Laponite® RDS (LAP RDS) or refined montmorillonite (MMT) and then mixed with either carageenen 812 (CAR 812) or hydrohydroxy ethyl cellulose (HEC) hydrogels prior to lyophilisation. The resulting xerogels were characterised visually, using differential scanning calorimetry (DSC) and with scanning electron microscopy (SEM). Optimal geo-polymeric wafers contained 1.5% W/W CAR 812 with 2% LAP RDSand 1% W/W intercalated STH. DSC and SEM results indicated the amorphous form of STH was intercalated inLAP RDS within theleafy structure of CAR 812. This xerogel hydrated up to1700% within 40 minutes and released the STH by Higuchikinetic model. Keywords: Polymer; Clay, Intercalation, Xerogel, Wound delivery, Amorphous, Physicochemical characterisation, Polymers, hydrogel, drug delivery, lyophilised wafer

False positive diagnosis of malignancy in a case of cryptogenic organising pneumonia presenting as a pulmonary mass with mediastinal nodes detected on fluorodeoxyglucose-positron emission tomography: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report the case of a patient with positive findings on a lung emission tomography/computed tomography (PET/CT) scan, with possible contra lateral mediastinal involvement, which strongly suggested an inoperable lung carcinoma. The lung mass proved to be a cryptogenic organising pneumonia. While the latter has previously been shown to be PET/CT positive, mediastinal involvement simulating malignant spread has not been previously reported.</p> <p>Case presentation</p> <p>A 50-year-old Caucasian woman presented with a history of unproductive cough and was found to have a mass in the right upper lobe as shown on chest X-ray and a computed tomography scan. A subsequent PET/CT scan showed strong uptake in the right upper lobe (maximum standard uptake values (SUVmax) 9.6) with increased uptake in the adjacent mediastinum and contralateral mediastinal nodes. Surgical resection and mediastinoscopy revealed cryptogenic organising pneumonia, with enlarged reactive mediastinal lymph nodes.</p> <p>Conclusion</p> <p>The case illustrates the limits of PET/CT scanning as a diagnostic tool, and emphasizes the importance of obtaining histological confirmation of malignant diseases whenever possible.</p

Galectin-1 as a potential cancer target

Galectins are a family of structurally related carbohydrate-binding proteins, which are defined by their affinity for poly-N-acetyllactosamine-enriched glycoconjugates and sequence similarities in the carbohydrate recognition domain. Galectin-1, a member of this family, contributes to different events associated with cancer biology, including tumour transformation, cell cycle regulation, apoptosis, cell adhesion, migration and inflammation. In addition, recent evidence indicates that galectin-1 contributes to tumour evasion of immune responses. Given the increased interest of tumour biologists and clinical oncologists in this field and the potential use of galectins as novel targets for anticancer drugs, we summarise here recent advances about the role of galectin-1 in different events of tumour growth and metastasis

Magnetic domain state diagnosis using hysteresis reversal curves

We present results for a series of hysteresis measurements that provide information about remanent, induced, transient-free, and transient magnetization components. These measurements, and differences between measurement types, enable production of six types of first-order reversal curve (FORC)-like diagrams which only double the number of measurements involved in a conventional FORC measurement. These diagrams can be used to distinguish magnetic signatures associated with each domain state. When analyzing samples with complex magnetic mineral mixtures, the contrasting domain state signatures are mixed together in a traditional FORC diagram, but these signatures can be identified individually when using the various FORC diagrams discussed here. The ability to make different FORC measurements and to identify separately each magnetic component by investigating different magnetization types can provide much-improved understanding of the information provided by FORC diagrams. In particular, the transient hysteresis FORC diagram provides a method to measure the nucleation field of magnetic vortices and domain walls. We provide a simple explanation for FORC results from natural multidomain samples that are not explained by conventional domain wall pinning models. We also provide software for processing the different types of FORC data.published_or_final_versio