An evaluation of in-patient respite care at St. Vincent de Paul Residence

Aim: To identify the multi-dimensional characteristics and need for inter-disciplinary input associated with in-patient respite care. Methods: During the period January-December 2007, 91 in-patient respite users, aged ≥60 years, were assessed on admission for respite care at St. Vincent de Paule Residence. Assessment instruments used included the Barthel Index, the Mini-Mental State Examination, a Caregiver Strain Index, the Functional Oral Intake Scale and the Communicative Effectiveness Index. Findings: Of the study group (n=91), 65% of respite users were found to be suffering from moderate to severe dementia (Mini-Mental State Examination score 0-20). High dependency on the Barthel Index (0-7/20) was found in 52% of cases whilst 45% had low dependency (13-20/20). Carer strain was reported in 60% of care-givers (carers). Interdisciplinary input requirements in the group studied included nursing in 85%, dental (83%), speech language pathology (70%), physiotherapy (39%), occupational therapy (38%), medical (33%) and social worker assistance (24%). Conclusion: Elderly respite users are a mixed group with multiple and diverse needs. In their own homes, these care needs are principally met by informal helpers who are frequently under stress. The expansion of in-patient respite services will reinforce the informal community care network and will help avoid or postpone long-term institutionalisation.peer-reviewedpeer-reviewe

The influence of prior training on GPs’ attitudes to sickness absence certification post-fit note.

AimTo investigate the attitudes to health and work of general practitioners (GPs) with training in occupational medicine (OM) compared with non-OM trained GPs, since the introduction of the fit note.BackgroundChanges to the UK sickness certification system since 2010 and the introduction of the fit note required GPs to change their focus to what patients can do, rather than what they cannot do in relation to work. In an effort to reduce the UK sickness absence burden, GPs completion of the fit note should help to keep people in work, or assist patients to return to work as quickly as possible after a period of absence.MethodsQuestionnaire data were collected via the 7th National General Practitioner Worklife Survey.FindingsResults indicate that responses from GPs who had undertaken training in OM, and GPs having received some form of work and health training in the 12-month period before the study were associated with significantly more positive attitudes to patients’ returning to work and to the fit note. This study reveals evidence of a difference between trained and non-trained GPs in their attitude to the fit note, and to work and health generally. Further work investigating the effect of specific training in OM on the management and recognition of ill-health by GPs is recommended.</jats:sec

Incorporating case-based discussions within a medicines information advanced experiential placement

The Department of Pharmacy at the University of Malta offers a three-year international post-graduate Doctorate in Pharmacy program in collaboration with the University of Illinois, Chicago, United States of America. Within this course, students may opt for a Medicines Information Advanced Pharmacy Practice Experiential rotation. This rotation includes a case-based discussion (CBD) designed to structurally assess students on the delivery of patient care.peer-reviewe

Optimal resolution tomography with error tracking and the structure of the crust and upper mantle beneath Ireland and Britain

The classical Backus–Gilbert method seeks localized Earth-structure averages at the shortest length scales possible, given a data set, data errors, and a threshold for acceptable model errors. The resolving length at a point is the width of the local averaging kernel, and the optimal averaging kernel is the narrowest one such that the model error is below a specified level. This approach is well suited for seismic tomography, which maps 3-D Earth structure using large sets of seismic measurements. The continual measurement-error decreases and data-redundancy increases have reduced the impact of random errors on tomographic models. Systematic errors, however, are resistant to data redundancy and their effect on the model is difficult to predict. Here, we develop a method for finding the optimal resolving length at every point, implementing it for surface-wave tomography. As in the Backus–Gilbert method, every solution at a point results from an entire-system inversion, and the model error is reduced by increasing the model-parameter averaging. The key advantage of our method stems from its direct, empirical evaluation of the posterior model error at a point. We first measure inter- station phase velocities at simultaneously recording station pairs and compute phase-velocity maps at densely, logarithmically spaced periods. Numerous versions of the maps with varying smoothness are then computed, ranging from very rough to very smooth. Phase-velocity curves extracted from the maps at every point can be inverted for shear-velocity (V S ) profiles. As we show, errors in these phase-velocity curves increase nearly monotonically with the map roughness. We evaluate the error by isolating the roughness of the phase-velocity curve that cannot be explained by any Earth structure and determine the optimal resolving length at a point such that the error of the local phase-velocity curve is below a threshold. A 3-D V S model is then computed by the inversion of the composite phase-velocity maps with an optimal resolution at every point. The estimated optimal resolution shows smooth lateral variations, confirming the robustness of the procedure. Importantly, the optimal resolving length does not scale with the density of the data coverage: some of the best-sampled locations display relatively low lateral resolution, probably due to systematic errors in the data. We apply the method to image the lithosphere and underlying mantle beneath Ireland and Britain. Our very large data set was created using new data from Ireland Array, the Irish National Seismic Network, the UK Seismograph Network and other deployments. A total of 11 238 inter-station dispersion curves, spanning a very broad total period range (4–500 s), yield unprecedented data coverage of the area and provide fine regional resolution from the crust to the deep asthenosphere. The lateral resolution of the 3-D model is computed explicitly and varies from 39 km in central Ireland to over 800 km at the edges of the area, where the data coverage declines. Our tomography reveals pronounced, previously unknown variations in the lithospheric thickness beneath Ireland and Britain, with implications for their Caledonian assembly and for the mechanisms of the British Tertiary Igneous Province magmatism

A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe

STUDY QUESTION: How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER: MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY: With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION: A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS: The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE: By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS: The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations.peer-reviewe

The Experiences of Youth Who Identify as Trans* in Relation to Health and Social Care Needs: A Scoping Review

There is an increased interest in the experiences of youth who identify as trans* to promote individual human rights and provide socially inclusive health and social care. This scoping review aimed to explore the experiences of youth who identify as trans*. A full search of relevant electronic databases was undertaken from the years 2006 to 2016. The search resulted in 1,656 hits and following the application of rigorous criteria, 20 papers were included in the final review. Date extraction was executed by two of the authors and a quality assessment tool was used to review the papers. The data were analyzed, and the key themes that emerged included the following: stigma, discrimination, and mental health; family relationships and supports; educational concerns; health care experiences; and vulnerability and health risks. The findings from the review are discussed, and the implications for policy, research, education, and practice are highlighted

Canonical BMP–Smad Signalling Promotes Neurite Growth in Rat Midbrain Dopaminergic Neurons

Ventral midbrain (VM) dopaminergic (DA) neurons project to the dorsal striatum via the nigrostriatal pathway to regulate voluntary movements, and their loss leads to the motor dysfunction seen in Parkinson’s disease (PD). Despite recent progress in the understanding of VM DA neurogenesis, the factors regulating nigrostriatal pathway development remain largely unknown. The bone morphogenetic protein (BMP) family regulates neurite growth in the developing nervous system and may contribute to nigrostriatal pathway development. Two related members of this family, BMP2 and growth differentiation factor (GDF)5, have neurotrophic effects, including promotion of neurite growth, on cultured VM DA neurons. However, the molecular mechanisms regulating their effects on DA neurons are unknown. By characterising the temporal expression profiles of endogenous BMP receptors (BMPRs) in the developing and adult rat VM and striatum, this study identified BMP2 and GDF5 as potential regulators of nigrostriatal pathway development. Furthermore, through the use of noggin, dorsomorphin and BMPR/Smad plasmids, this study demonstrated that GDF5- and BMP2-induced neurite outgrowth from cultured VM DA neurons is dependent on BMP type I receptor activation of the Smad 1/5/8 signalling pathway

UNDER-DIAGNOSIS OF BIPOLAR AFFECTIVE DISORDER IN A BEDFORD CMHT

Background: Bipolar disorder is frequently misdiagnosed or diagnosed late. Misdiagnosis of Bipolar Disorder can have serious implications for prognosis and treatment of this condition. Method: Patients in a Community Mental Health Team were systematically screened for Bipolar Disorder. Results: There was a substantial increase in the number of bipolar patients diagnosed in the Community Mental Health Team. Discussion: The frequent misdiagnosis of Bipolar II disorder frequently leads to the treatment of these patients with antidepressants only.This leads to the possibility of patients becoming elated in mood, or going into mixed states, which can lead to increased suicidality. Conclusion: Appropriate diagnosis of bipolar II disorder requires skills at present found in secondary care. Such patients should therefore be referred to secondary care. Both Primary and Secondary care should be more aware of this diagnosis and its consequence