Touching the Rock:An Experience of Blindness (1990)

Touching the Rock comprises the autobiographical reflections of Anglo-Australian theologian and educator John M. Hull in the period shortly after losing his sight, from summer 1983 to summer 1986. In the book, Hull discusses coming to terms with his impairment, his loss of memory of the visual, his damaged recollection of those things that were once familiar, and the diversity of reactions from those around him. Touching the Rock is a transcript of Hull's taped diary entries on various topics related to his blindness, including dream analyses; altered practices with familiar objects and the environment; reflections on sections of literature, including the Bible and other religious texts; his trials while forming a young family as a man without sight; and the kindness and cruelty of people during his initial three years of living in complete darkness.<br/

Children as frequent attenders in primary care: a systematic review

Background: Frequent paediatric attendances make up a large proportion of the general practitioner (GP) workload. Currently no systematic reviews on frequent paediatric attendances in primary care exists. Aim: To identify the socio-demographic and clinical characteristics of children who attend primary care frequently. Design and setting: A systematic review.Methods: The electronic databases MEDLINE, EMBASE and PsycINFO were searched up to January 2020, using terms relating to frequent attendance in primary care settings. Studies were eligible if they considered children frequently attending in primary care (0-19 years). Relevant data were extracted and analysed by narrative synthesis.Results: Six studies, of overall fair quality, were included in the review. Frequent attendance was associated with presence of psycho-social and mental health problems, younger age, school absence, presence of chronic conditions, and high level of anxiety in their parents.Conclusions: Various sociodemographic and medical characteristics of children were associated with frequent attendance in primary care. Research on interventions needs to account for the social context and community characteristics. Integrating GP services with mental health and social care could potentially provide a response to medical and psycho-social needs of frequently attending children and their families

Changes in heart failure management and long-term mortality over ten years: observational study

Objectives: To estimate the long-term survival of two cohorts of people diagnosed with heart failure 10 years apart and to assess differences in patient characteristics, clinical guideline compliance and survival by diagnosis setting. Methods Data: for patients aged 18 and over with a new diagnosis of heart failure in the Clinical Practice Research Datalink in 2001–2002 (5966 patients in 156 practices) and 2011–2012 (12 827 patients in 331 practices). Survival rates since diagnosis were described using Kaplan-Meier plots. Compliance with national guidelines was summarised. Results: 2011/2012 patients were older than those diagnosed a decade before, with lower blood pressure and cholesterol but more comorbidity and healthcare contacts. For those diagnosed in 2001/2002, the 5-year survival was 40.0% (40.2% in the 2011/2012 cohort), 10-year survival was 20.8%, and 15-year survival 11.1%. Improvement in survival between the two time periods was seen only in those diagnosed in primary care (5-year survival 46.0% vs 57.4%, compared with 33.9% and 32.6% for hospital-diagnosed patients). Beta-blocker use rose from 24.3% to 39.1%; renin–angiotensin system blockers rose from 31.8% to 54.3% (both p<0.001). There was little change for loop diuretics and none for thiazide diuretics. For the 9963 patients with symptoms recorded by their general practitioner before diagnosis, brain natriuretic peptide (BNP) testing was low, but echocardiogram use rose from 8.3% to 19.3%, and specialist referral rose from 7.2% to 24.6% (all p<0.001)