Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study

<b>Objective</b> To assess the nature and extent of physical-health comorbidities in people with schizophrenia and related psychoses compared with controls. <p></p> <b>Design </b>Cross-sectional study. <p></p> <b>Setting </b>314 primary care practices in Scotland. <p></p> <b>Participants </b>9677 people with a primary care record of schizophrenia or a related psychosis and 1 414 701 controls. Main outcome measures Primary care records of 32 common chronic physical-health conditions and combinations of one, two and three or more physical-health comorbidities adjusted for age, gender and deprivation status. <p></p> <b>Results</b> Compared with controls, people with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16 to 1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29 to 1.44) and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12 to 1.27). Rates were highest for viral hepatitis (OR 3.98, 95% CI 2.81 to 5.64), constipation (OR 3.24, 95% CI 3.00 to 4.49) and Parkinson's disease (OR 3.07, 95% CI 2.42 to 3.88) but people with schizophrenia had lower recorded rates of cardiovascular disease, including atrial fibrillation (OR 0.62, 95% CI 0.51 to 0.73), hypertension (OR 0.71, 95% CI 0.67 to 0.76), coronary heart disease (OR 0.75, 95% CI 0.61 to 0.71) and peripheral vascular disease (OR 0.83, 95% CI 0.71 to 0.97).<p></p> <b>Conclusions </b>People with schizophrenia have a wide range of comorbid and multiple physical-health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic under-recognition and undertreatment of cardiovascular disease in people with schizophrenia, which might contribute to substantial premature mortality observed within this patient group. <p></p&gt

Multimorbidity: Technical Series on Safer Primary Care

No abstract available

Secondary analysis of data on comorbidity/multimorbidity: a call for papers

Despite the high proportion and growing number of people with comorbidity/multimorbidity, clinical trials often exclude this group, leading to a limited evidence base to guide policy and practice for these individuals [1–5]. This evidence gap can potentially be addressed by secondary analysis of studies that were not originally designed to specifically examine comorbidity/multimorbidity, but have collected information from participants on co-occurring conditions. For example, secondary data analysis from randomized controlled trials may shed light on whether there is a differential impact of interventions on people with comorbidity/multimorbidity. Furthermore, data regarding comorbidity/multimorbidity can often be obtained from registration networks or administrative data sets

'Learning together': Sharing international experience on new models of primary care

No abstract available

Enhancing research quality and reporting: why the Journal of Comorbidity is now publishing study protocols

The Journal of Comorbidity was launched in 2011 and has since become established as a high-quality journal that publishes open-access, peer-reviewed articles, with a focus on advancing the clinical management of patients with comorbidity/multimorbidity. To further enhance research quality and reporting of studies in this field, the journal is now offering authors the opportunity to publish a summary of their study protocols – a move designed to generate interest and raise awareness in ongoing clinical research and to enable researchers to detail their methodologies in order that replication by scientific peers is possible

How to design and evaluate interventions to improve outcomes for patients with multimorbidity

Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems

Single-Longitudinal-Mode Brillouin/Erbium Fiber Laser with High Linewidth-Reduction Ratio

published_or_final_versio

Does elevating image receptor increase breast receptor footprint and improve pressure balance?

There is no consensus in the literature regarding the image receptor (IR) position for the cradio-caudal projection in mammography. Some literature indicates the IR should be positioned to the infra mammary fold (IMF); other literature suggests the IR be raised 2 cm relative to the IMF. Using 16 female volunteers (32 breasts) and a pressure sensitive mat we investigated breast footprint and pressure balance with IR at IMF and IR 2 cm above the IMF. Breast area on IR and paddle and interface pressure between IR/breast and paddle/breast were recorded. A uniformity index (UI) gave a measure of pressure balance between IR/ breast and paddle/breast. IR breast footprint increases significantly by 13.81 cm2 (p < 0.02) when IR is raised by 2 cm. UI reduces from 0.4 to 0.00 (p ¼ 0.04) when positioned at IMF þ2 cm demonstrating an improved pressure balance. Practitioners should consider raising the IR by 2 cm relative to the IMF in clinical practice. Further work is suggested to investigate the effects of practitioner variability and breast asymmetry

The Journal of Comorbidity affiliates with the Society for Academic Primary Care

No abstract available

TUMOR-HOMING CYTOTOXIC INDUCED NEURAL STEM CELLS FOR THE TREATMENT OF PRIMARY AND METASTATIC NON-SMALL CELL LUNG CANCER

Lung cancer accounts for more deaths than any other type of cancer. 44% of all brain metastases are due to non-small cell lung cancer (NSCLC), and the median survival for these patients, particularly if leptomeningeal metastases (LMM) are present, is only 3 months. Radiation is frequently used to treat NSCLC LMM, but this treatment alone cannot eradicate LMM. New therapies are desperately needed to treat this deadly disease, both in the primary stage and metastatic stages. Neural stem cells (NSCs) offer a useful method of drug delivery in the treatment of NSCLC because of their inherent tumoritropic properties. NSCs can be genetically engineered to secrete cytotoxic proteins to deliver a potent payload directly to tumors. In order to facilitate a readily available supply of autologous, tumor-homing cells, human induced neural stem cells (hiNSCs) can be transdifferentiated from an individual patient’s fibroblasts. A second generation of hiNSCs called hiNeuroS using a cell sphere-based culture system has shown significant improvement in migratory capacity compared to first-generation hiNSCs. This dissertation investigates the use of intravenous (IV) first-generation hiNSCs to track down and treat primary NSCLC and intracerebroventricular (ICV) second-generation hiNeuroSs to treat NSCLC LMM when combined with radiation.Doctor of Philosoph