Primary care professionals and social marketing of health in neighbourhoods: A case study approach to identify, target and communicate with ‘at risk’ populations

Aim: In this article the authors illustrate using a case study approach how primary care professionals can use the combination of geodemographic data with hospital episode statistics (HES) to predict the location of people yat risk’ of diabetes mellitus (Type 2 diabetes) in the population of England. This approach facilitates social marketing of those yat risk'. Method: Geodemographic segmentation data for all households was combined with HES for 2001–2002, to predict population groups yat risk’ of Type 2 diabetes. Using a case study approach and quantitative data analysis techniques a profile of the undiagnosed and yat risk’ population of Slough Primary CareTrust was created at town, ward and street levels. Recent literature on social marketing was applied to predicate a discussion of the theory and practice of social marketing that was most likely to succeed in dealing with the prevention of Type 2 diabetes, via the reduction of obesity and overweight in the population. Discussion: The increase in lifestyle-related diseases, such as,Type 2 diabetes that are linked with the rise in overweight and obesity and create large disease management costs for the National Health Service (NHS) are of great concern to primary healthcare professionals and governments throughout the westernized world. Until recently, public and government responses have been very reactive in respect of population groups most in need of lifestyle change. Approaches to the identification of ‘sub-populations' most at risk of Type 2 diabetes and targeting of these is of direct relevance to the preventive work of primary care professionals. Conclusion: Geodemographic data overlaid onto official NHS and other routinely collected data, can aid the identification and targeting of groups most vulnerable to over-weight and obesity, through social marketing approaches including direct mail, telephone canvassing and door-to-door communication channels. © 2007, Cambridge University Press. All rights reserved

О становлении трансплантологии в Украине: юридические аспекты

Рассмотрены основные аспекты развития трансплантологии, их положительное и отрицательное влияние на прогресс пересадки органов в странах с различным уровнем развития демократических принципов. Показано значение юридических проблем в развитии клинической и экспериментальной трансплантологии.Main aspects of transplantology development, their favorable and unfavorable influence on the process of organ transplantation in the countries with different level of democracy are featured. Significance of legal problems in clinical and experimental transplantology is shown

Whole genome, transcriptome and methylome profiling enhances actionable target discovery in high-risk pediatric cancer

The Zero Childhood Cancer Program is a precision medicine program to benefit children with poor-outcome, rare, relapsed or refractory cancer. Using tumor and germline whole genome sequencing (WGS) and RNA sequencing (RNAseq) across 252 tumors from high-risk pediatric patients with cancer, we identified 968 reportable molecular aberrations (39.9% in WGS and RNAseq, 35.1% in WGS only and 25.0% in RNAseq only). Of these patients, 93.7% had at least one germline or somatic aberration, 71.4% had therapeutic targets and 5.2% had a change in diagnosis. WGS identified pathogenic cancer-predisposing variants in 16.2% of patients. In 76 central nervous system tumors, methylome analysis confirmed diagnosis in 71.1% of patients and contributed to a change of diagnosis in two patients (2.6%). To date, 43 patients have received a recommended therapy, 38 of whom could be evaluated, with 31% showing objective evidence of clinical benefit. Comprehensive molecular profiling resolved the molecular basis of virtually all high-risk cancers, leading to clinical benefit in some patients.</p

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)