A care pathway approach to identifying factors that impact on diagnosis of heart disease in British Pakistani women

Purpose – The authors examined the cardiac care pathway with the aim of identifying factors that impact on diagnosis and treatment of coronary heart disease in British Pakistani women. Design/methodology/approach – This is an exploratory qualitative study. In depth interviews and focus groups with an opportunistic sample of Pakistani women and a purposive sample of clinicians working at different points along the care pathway were conducted. The authors used a pathways to care approach to illustrate how their individual and cumulative effect may contribute to differential receipt of treatment, including revascularisation, and health inequalities. Findings – Four major issues were identified: complex life circumstances; ‘‘atypical’’ presentation and ymptomatology; problems related to investigative testing; and poor communication. Mapping these barriers onto the Pathways to Care Model provided valuable insight into their impact on patients’progression through the different stages of the care pathway. Research limitations/implications – Adopting a care pathway approach demonstrated how individual factors have an impact at several points along the care pathway. It indicated where further, more detailed enquiry is merited and where intervention studies might usefully be directed to improve care. Practical implications – Examining the whole care pathway identified areas of service improvement that merit a co-ordinated response. Originality/value – The framework provided by the Pathways to Care Model offered insight into the causes of the previously observed attenuation in women’s progress along the cardiac diagnosis and treatment pathway and is an important first step to addressing this health inequality in a holistic way. Keywords Health, Gender, Inequalities, Women, Ethnicity, United Kingdom, Ethnic minorities, Personal health Paper type Research paper </p

Slugging their way to immortality: Driving mammary epithelial cells into a stem cell-like state

Delineating the molecular factors that define and maintain the mammary stem cell state is vital for understanding normal development and tumourigenesis. A recent study by Guo and colleagues identifies two master transcriptional regulators of mammary stem cells, Slug and Sox9, ectopic expression of which confers stem cell attributes on differentiated mammary epithelial cells. Slug and Sox9 expression was also shown to determine in vivo metastatic potential of human breast cancer cell lines. Understanding these factors in the context of normal lineage differentiation is an important step toward elucidating the mammary epithelial cell hierarchy and the origins of cancer stem cells

Shifting Demand for Non Medical Services Evaluation Report

This evaluation looked at the feasibility and utility of a city-wide, brief intervention provided by community support workers to link people with non-medical issues to a range of services and support. The GP referral system effectively identified people at high risk of avoidable hospital admissions. Over 90% of patients referred received an assessment from a community support worker (CSW). The approach used by CSWs was consistent with the international evidence base for providing effective peer support. Clients initially self-reported reduced anxiety and social isolation. After being linked, however, there were delays in getting needs met, leading to disengagement and return to the high risk group. Effectiveness of the service is dependent upon the capacity and responsiveness of the sectors to which clients are referred.<br