Clinical audit of core podiatry treatment in the NHS

<p>Abstract</p> <p>Background</p> <p>Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period.</p> <p>Methods</p> <p>The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health.</p> <p>Results</p> <p>1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – <it>better, same, worse </it>and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P < 0.001, though the confidence interval indicated that the improvement was relatively small.</p> <p>Conclusion</p> <p>Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the evidence base for podiatry.</p

Prévalence et comparaison des événements cardiovasculaires en Trail Running et Road Running

Context: The practice of running tends to reduce the death rate from all causes as well as the cardiovascular mortality rate. The number of participants in this practice has sharply increased during recent years. However, by generating a heavy strain on the cardiovascular system, it can cause cardiovascular accidents and even sudden deaths. Aim: To determine and compare the prevalence of serious cardiovascular events (CVE) in trail running and road running events. Method: This is a descriptive, retrospective, observational, epidemiological study, based on data collected at the treatment centres of 152 races, medicalized by the Dokever company over 3 years. Results: Out of 1,099,919 runners of which 257,067 did trail running (23.4%) and 842,852 road running (76.6%), 30 CVEs have been were identified, including 14 cardiorespiratory arrests (CRA) and 16 other CVEs. The prevalence of all CVEs was 2.73/100,000 runners in all disciplines combined. CRAs occur in our study only and significantly during road races (1.27/100,000 in road and 0/100,000 in trail, p-value=0.04). There is no significant difference in the prevalence of other CVEs between the 2 disciplines (1.556/100,000 in trail and 1.424/100,000 in road, p-value=1). Conclusion: CRAs are significantly more frequent in road running, as opposed to the other CVEs, which are equally frequent in both disciplines. However, if the prevalence of CRAs is lower in trail running, it is difficult to imagine that these events never occur. It would therefore be advisable to continue this prospective collection, given the scarcity of these events.Contexte : La pratique de la course à pied permet de réduire le taux de mortalité toutes causes confondues ainsi que le taux de mortalité cardiovasculaire. Cette pratique voit son nombre de participants exploser ces dernières années. Cependant, en sollicitant le système cardiovasculaire de façon importante, elle peut provoquer des accidents cardiovasculaires voire des morts subites. Objectif : Déterminer et comparer la prévalence des événements cardiovasculaires (ECV) graves dans les épreuves de trail running et de road running. Méthode : Il s’agit d'une étude épidémiologique rétrospective observationnelle descriptive, réalisée à partir des données collectées aux postes de soins de 152 courses, médicalisées par la société Dokever sur 3 ans. Résultats : Sur 1 099 919 coureurs dont 257 067 en trail running (23,4 %) et 842 852 en road running (76,6%), 30 ECV ont été identifiés, dont 14 arrêts cardio-respiratoires (ACR) et 16 autres ECV. La prévalence de l’ensemble des ECV est de 2,73/100 000 coureurs toutes disciplines confondues. Les ACR surviennent dans notre étude uniquement et significativement lors des courses sur route (1,27/100 000 en road et 0/100 000 en trail, p-value=0,04). Il n’y a pas de différence significative dans la prévalence des autres ECV entre les 2 disciplines (1,556/100 000 en trail et 1,424/100 000 en road, p-value=1).Conclusion : Les ACR sont significativement plus fréquents en road running, contrairement aux autres ECV qui sont aussi fréquents dans les 2 disciplines. Malgré tout, si la prévalence des ACR est plus faible dans le trail, il est difficile d’imaginer que ces événements ne surviennent jamais. Il conviendrait donc de poursuivre ce recueil prospectif, compte tenu de la rareté de ces événements

Representative sequencing: Unbiased sampling of solid tumor tissue

International audienceAlthough thousands of solid tumors have been sequenced to date, a fundamental under-sampling bias isinherent in current methodologies. This is caused by a tissue sample input of fixed dimensions (e.g., 6 mmbiopsy), which becomes grossly under-powered as tumor volume scales. Here, we demonstrate representative sequencing (Rep-Seq) as a new method to achieve unbiased tumor tissue sampling. Rep-Seq uses fixed residual tumor material, which is homogenized and subjected to next-generation sequencing. Analysis of intratumor tumor mutation burden (TMB) variability shows a high level of misclassification using current single-biopsy methods, with 20% of lung and 52% of bladder tumors having at least one biopsy with high TMB butlow clonal TMB overall. Misclassification rates by contrast are reduced to 2% (lung) and 4% (bladder) when a more representative sampling methodology is used. Rep-Seq offers an improved sampling protocol for tumor profiling, with significant potential for improved clinical utility and more accurate deconvolution of clonal structure