Writing to patients: 'putting the patient in the picture'

We have explored consultant, general practitioner and patient attitudes towards the proposal that following an outpatient consultation, consultants should consider communicating directly with patients in the form of a summary letter, with a copy to the referring general practitioner or other professionals as appropriate. We conducted in-depth interviews with a purposive sample of 20 consultants, 16 patients and 12 general practitioners. The consultants and general practitioners were both involved in the care of participating patients. Patients highlighted the likely value of summary letters including, increased knowledge, improvement recall of the clinical encounter, and reassurance. Clinicians were concerned that patients would not understand letters from consultants. Additional concerns included the impact of letter on consultant-general practitioner relationship and medico-legal issues. These findings reflect fundamental differences in expectations about the nature and quality of communications between doctors and their patients

Writing to patients: a randomised controlled trial

It has been suggested that consultants should consider writing directly to patients with a summary of their outpatient consultation. In a controlled trial involving consecutive new referrals to a haematology outpatient clinic, we randomised patients to receive either a personal letter from their consultant summarising their consultation (n = 77) or a brief note thanking them for attending the clinic (n = 73). Patients were assessed for recall of and satisfaction with the consultation by a single independent observer, using standardised methods. At the second visit to outpatients, the patients' median percentage recall of items discussed during the consultation was 67% (IQ range 50-80%) in the intervention group, versus 57% (IQ range 43-76%) in the control group (p = 0.3). Strongly positive views on the personal letter were expressed by patients and referring clinicians. The findings suggest that although personal letters do not substantially improve recall of the clinical encounter, they are feasible, highly valued by patients and acceptable to referring clinicians

Alcohol consumption among university students: a typology of consumption to aid the tailoring of effective public health policy

Objective: Elevated levels of alcohol consumption among university students are well documented. Policymakers have attempted to combat this issue at a university, national and international level. Tailoring public health policy to effectively tackle alcohol use is crucial. Using Q-methodology, the current study aims to develop a typology of alcohol consumption in the Irish university student population. Setting: A large Irish university. Participants Hundreds of possible statements on types of consumption were generated from a systematic review and a set of one-on-one interviews. These were reduced to 36 statements, 6 statements which define each of the 6 previously defined consumption types. Participants were advised to scan through the 36 statements and fill the statements into a ‘forced choice, standardised distribution’. Following this, a 45–90 min interview was conducted with students to illuminate subjectivity surrounding alcohol consumption. Analysis was conducted using PQ Method and NVivo software. Principal component analysis, followed by varimax rotation, was conducted to uncover the final factor information. Results: In total, 43 students completed the Q-study: 19 men and 24 women. A typology describing 4 distinct groupings of alcohol consumer was uncovered: the guarded drinker, the calculated hedonist, the peer-influenced drinker and the inevitable binger. Factor loadings of each of the consumer groupings were noted for type description. Conclusions: This is the first study to propose ideal types of alcohol consumption among a university student population. Further research is required to investigate the degree to which each of these ideal types is subscribed. However, this typology, in addition to informing public policy and strategies, will be a valuable analytic tool in future research

Perthes' disease of the hip: socioeconomic inequalities and the urban environment.

INTRODUCTION: Perthes' disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as a risk factor, however socioeconomic deprivation often occurs within urban environments and it is unclear if this association is the result of confounding. The objective of the current work was to gain a greater understanding of the influence of the urban/rural environment in Perthes' disease. METHODS: This was a descriptive observational study using the Scottish Morbidity Record, based in Scotland, UK using data from 2000-2010. A total of 443 patients with a discharge diagnosis of Perthes' disease were included. Socioeconomic deprivation was determined using the Scottish Index of Multiple Deprivation, and exposure to the 'urban environment' was recorded based on the Scottish Urban-Rural Classification. RESULTS: There was a strong association with socioeconomic deprivation, with rates among the most deprived quintile more than twice those of the most affluent (RR 2.1 (95% CI 1.5 to 2.9)). Urban areas had a greater rate of Perthes' disease discharges (RR 1.8 (95% CI 1.1 to 3.2)), though this was a reflection of greater deprivation in urban areas. Stratification for socioeconomic deprivation revealed similar discharge rates in urban and rural environments, suggesting that the aetiological determinants were not independently associated with urban environments. CONCLUSIONS: The occurrence of Perthes' disease within urban environments is high, yet this appears to be a reflection of higher socioeconomic deprivation exposure. Disease rates appear equivalent in similarly deprived urban and non-urban areas, suggesting that the determinant is not a consequence of the urban environment

A Case of IgE Myeloma: Methodology and Review of the Literature

A 56-year-old man presented with a one-year history of progressive weakness predominantly affecting his extremities and persistent low back pain. Ouchterlony immunodiffusion of the concentrated urine detected a marked increase in lambda light chains. A sternal bone marrow documented a diagnosis of multiple myeloma. Screening high resolution agarose gel electrophoresis revealed diffuse hypogammaglobulinemia and, retrospectively, an equivocal, faint band which migrated in the fast gamma region. By using a combination of Immunoelectrophoresis and immunofixation electrophoresis, this questionable band was determined to represent an IgE lambda monoclonal protein. Radioimmunoassay for IgE documented a serum concentration of 50.6 mg/dl. No intact IgE was found in the urine. Following chemotherapy, the patient\u27s serum IgE level decreased significantly, and he is presently asymptomatic. Features of special interest in this case include the low serum IgE level on presentation, which was difficult to detect on the screening electrophoretogram, and the use of immunofixation electrophoresis in the detection and characterization of these difficult gammopathies

Three years of ocean data from a bio-optical profiling float

Ocean color, first measured from space 30 years ago, has provided a revolutionary synoptic view of near-surface fields of phytoplankton pigments. Since 1979, a number of ocean color satellite missions have provided coverage of phytoplankton biomass and other biogeochemical variables on scales of days to years and of kilometers to ocean basin. Because of the nature of visible light and its interaction with absorbing and scattering materials in the ocean and atmosphere, these measurements are biased toward nearsurface waters and are obscured by clouds. As a consequence, ocean color satellites miss significant fractions of phytoplankton biomass, marine primary productivity, and particle flux that occur at depths beyond their sensing range. They also miss phytoplankton blooms and other events that occur during periods of extended cloud cover

Applying phylogenomics to understand the emergence of Shiga Toxin producing Escherichia coli O157:H7 strains causing severe human disease in the United Kingdom

Shiga Toxin producing Escherichia coli (STEC) O157:H7 is a recently emerged zoonotic pathogen with considerable morbidity. Since the serotype emerged in the 1980s, research has focussed on unravelling the evolutionary events from the E. coli O55:H7 ancestor to the contemporaneous globally dispersed strains. In this study the genomes of over 1000 isolates from human clinical cases and cattle, spanning the history of STEC O157:H7 in the United Kingdom were sequenced. Phylogenetic analysis reveals the ancestry, key acquisition events and global context of the strains. Dated phylogenies estimate the time to the most recent common ancestor of the current circulating global clone to 175 years ago, followed by rapid diversification. We show the acquisition of specific virulence determinates occurred relatively recently and coincides with its recent detection in the human population. Using clinical outcome data from 493 cases of STEC O157:H7 we assess the relative risk of severe disease including HUS from each of the defined clades in the population and show the dramatic effect Shiga toxin complement has on virulence. We describe two strain replacement events that have occurred in the cattle population in the UK over the last 30 years; one resulting in a highly virulent strain that has accounted for the majority of clinical cases in the UK over the last decade. This work highlights the need to understand the selection pressures maintaining Shiga-toxin encoding bacteriophages in the ruminant reservoir and the study affirms the requirement for close surveillance of this pathogen in both ruminant and human populations