In the shadow of risk. How men cope with a partner's gynaecological cancer

This paper discusses a qualitative, grounded theory study of partners’ perspectives on gynaecological cancer that compared their experience of illness with that of the cancer patient. The study investigated, through unstructured interviews, gender differences in attitude to, and communication about, serious illness, with particular reference to coping and risk management. The results illuminate issues surrounding the sharing of a cancer diagnosis, offering an insight into the care processes that enhance or impede partner involvement. The paper discusses issues beyond immediate treatment, and explores the recovery process as both patient and partner experience it. The implications of the findings and the development of clinical practice are subsequently highlighted

Do changes in parent mental health explain trends in youth emotional problems?

There is evidence of a long-term rise in the prevalence of adolescent emotional problems in the UK and in other countries. The aim of this study was to test whether time trends in parents’ emotional difficulties contributed to these increases using data from two national surveys of English teenagers and parents studied twenty years apart (1986 and 2006). The 1986 sample is the age 16 follow-up of the 1970 British Cohort Study (N = 4524 adolescents, N = 7169 parents). The 2006 sample included 16/17-year-olds and their parents drawn from the 2002 and 2003 Health Surveys for England (N = 711). Both studies used identical self-complete questionnaire assessments of adolescent (GHQ-12 and Malaise Inventory) and parent (Malaise) symptoms of depression and anxiety. Follow-up data on emotional problems and psychiatric service use at age 30 years (N = 2785) for adolescents in the first cohort was used to validate the role of parent emotional problems as risk factors for offspring mental health. We found that maternal emotional problems increased across all socio-demographic groups between 1986 and 2006, mirroring increases in adolescent emotional problems over this period. They were cross-sectionally and prospectively associated with adolescent emotional problems. Cohort differences in adolescent emotional problems were attenuated when accounting for the increase in maternal emotional problems. Rising rates of maternal emotional problems have likely contributed to, but do not fully explain, recent time trends in adolescent emotional problems

Do changes in parent mental health explain trends in youth emotional problems?

There is evidence of a long-term rise in the prevalence of adolescent emotional problems in the UK and in other countries. The aim of this study was to test whether time trends in parents' emotional difficulties contributed to these increases using data from two national surveys of English teenagers and parents studied twenty years apart (1986 and 2006). The 1986 sample is the age 16 follow-up of the 1970 British Cohort Study (N = 4524 adolescents, N = 7169 parents). The 2006 sample included 16/17-year-olds and their parents drawn from the 2002 and 2003 Health Surveys for England (N = 711). Both studies used identical self-complete questionnaire assessments of adolescent (GHQ-12 and Malaise Inventory) and parent (Malaise) symptoms of depression and anxiety. Follow-up data on emotional problems and psychiatric service use at age 30 years (N = 2785) for adolescents in the first cohort was used to validate the role of parent emotional problems as risk factors for offspring mental health. We found that maternal emotional problems increased across all socio-demographic groups between 1986 and 2006, mirroring increases in adolescent emotional problems over this period. They were cross-sectionally and prospectively associated with adolescent emotional problems. Cohort differences in adolescent emotional problems were attenuated when accounting for the increase in maternal emotional problems. Rising rates of maternal emotional problems have likely contributed to, but do not fully explain, recent time trends in adolescent emotional problems.UK Trends Emotional problems Depression Anxiety Adolescent Parent

A prospective randomised controlled trial of intermittent self-catheterisation vs. supra-public catheterisation for post-operative bladder care following radical hysterectomy

Objective. To determine the potential benefits of ISC (intermittent self-catheterisation) over SPC (supra-pubic catheterisation) in the post-operative bladder care of women following radical hysterectomy. Methods. A prospective randomised controlled trial of women treated by radical hysterectomy for early stage cervical cancer. Results. 40 women were recruited to the study, 21 to ISC and 19 to SPC. All patients randomised to ISC were able to learn the technique of ISC satisfactorily following a period of pre-operative training. The day 3 and day 5 positive CSU (catheter specimen of urine) rate was significantly higher in the ISC group (42% and 63%) compared to the SPC group (6% and 18%), P = 0.05 and P = 0.004, respectively). Eight of 17 patients randomised to SPC (47%) documented having symptoms/problems arising from the SPC site of which 4 (23%) were shown to have a positive wound swab. There was no significant difference in length of period for bladder care between the two groups, P = 0.83. However, there were significant differences in patient acceptability (P = 0.009), freedom to lead a normal life (P = 0.000), disturbance at night (P = 0.006) and patient anxiety/embarrassment (P = 0.005) between the two groups. Conclusions. Patients are able to learn the technique of ISC without difficulty. Despite a greater urinary tract infection rate, the high incidence of SPC site problems can be avoided by use of ISC. The technique of ISC was seen to be more acceptable to patients allowing fewer disturbances at night, greater freedom to lead a normal life during the day and less anxiety/embarrassment compared to SPC

Venous Thromboembolism During Pregnancy and the Postpartum Period: Risk Factors, Diagnostic Testing, and Treatment.

ImportanceThe risk of venous thromboembolism (VTE) increases during pregnancy and the postpartum period. Deep vein thrombosis is the most common VTE during pregnancy, but pulmonary embolism is typically of greater concern as it contributes to far higher morbidity and mortality. Diagnosis and treatment of VTE during pregnancy differ substantially from the general nonpregnant population.ObjectiveThis review describes the epidemiology, risk factors, clinical presentation, diagnosis, and treatment of VTE during pregnancy and the postpartum period.Evidence acquisitionFirst, we reviewed the VTE guidelines from professional societies in obstetrics, cardiology, hematology, emergency medicine, pulmonology, and critical care. Second, we examined references from these documents and used PubMed to identify recent articles that cited the guidelines. Finally, we searched PubMed and Google Scholar for articles published since 2018 that included terms for pregnancy and the epidemiology, risk factors, diagnostic imaging, or treatment of VTE.ResultsVenous thromboembolism risk increases throughout pregnancy and peaks shortly after delivery. More than half of pregnancy-related VTE are associated with thrombophilia; other major risks include cesarean delivery, postpartum infection, and the combination of obesity with immobilization. Most VTE can be treated with low molecular weight heparin, but cases of limb- or life-threatening VTE require consideration of thrombolysis and other reperfusion therapies.Conclusions and relevanceVenous thromboembolism is far more frequent in antepartum and postpartum women than age-matched controls, and clinical suspicion for VTE in this population should incorporate pregnancy-specific risks. Treatment of limb- or life-threatening antepartum or postpartum VTE requires multispecialty coordination to optimize maternal and fetal outcomes

Research-intensive cancer care in the NHS in the UK

In the late 1990s, in response to poor national cancer survival figures, government monies were invested to enhance recruitment to clinical cancer research. Commencing with England in 2001 and then rolling out across all four countries, a network of clinical cancer research infrastructure was created, the new staff being linked to existing clinical care structures including multi-disciplinary teams. In parallel, a UK-wide co-ordination of cancer research funders driven by the ‘virtual’ National Cancer Research Institute, combined to create a ‘whole-system approach’ linking research funders, researchers and NHS clinicians all working to the same ends. Over the next 10 years, recruitment to clinical trials and other well-designed studies, increased 4-fold, reaching 17% of the incident cancer population, the highest national rate world-wide. The additional resources led to more studies opened, and more patients recruited across the country, for all types of cancers and irrespective of additional clinical research staff in some hospitals. In 2006, a co-ordinated decision was made to increasingly focus on randomized trials, leading to increased recruitment, without any fall-off in accrual to non-randomized and observational studies. The National Cancer Research Network has supported large successful trials which are changing clinical practice in many cancers