Skin lesions suspected of malignancy:an increasing burden on general practice

BACKGROUND: Skin cancer is believed to impose a heavy burden on healthcare services, but the burden of skin lesions suspected of malignancy on primary healthcare has never been evaluated. Therefore the aim of this study was to determine the demand for care in general practice due to these suspected skin lesions (i.e. lesions that are suspected of malignancy by either the patient or the GP). METHODS: Registry study based on data (2001–2010) from the Registration Network Groningen. This is a general practice registration network in the northern part of the Netherlands with an average annual population of approximately 30,000 patients. All patient contacts are coded according to the International Classification of Primary Care (ICPC). Consultations for skin lesions suspected of malignancy were selected according to the assigned ICPC codes. Subsequently, the number of consultations per year and the annual percent change in number of contacts (using the JoinPoint regression program) were calculated and analysed. Additionally, the percentage of patients referred to secondary care or receiving minor surgery within one year after the first contact were calculated. RESULTS: From 2001 onwards we found an annual increase in demand for care due to skin lesions suspected of malignancy of 7.3% (p < 0.01) and in 2010 the benign:malignant ratio was 10:1. In total 13.0% of the patients were referred and after 2006, minor surgery was performed on 31.2% of the patients. Most surgeries and referrals took place within 30 days. CONCLUSIONS: Suspected skin lesions impose an increasing burden on primary healthcare and most likely on healthcare costs as well. General practitioners should therefore be trained in diagnosing skin lesions suspected of malignancy, as a high diagnostic accuracy can save lives in the case of melanoma, and may also prevent unnecessary, costly, excisions and referrals to secondary healthcare

Electromagnetic vertex function of the pion at T > 0

The matrix element of the electromagnetic current between pion states is calculated in quenched lattice QCD at a temperature of $T = 0.93 T_c$. The nonperturbatively improved Sheikholeslami-Wohlert action is used together with the corresponding ${\cal O}(a)$ improved vector current. The electromagnetic vertex function is extracted for pion masses down to $360 {\rm MeV}$ and momentum transfers $Q^2 \le 2.7 {\rm GeV}^2$.Comment: 17 pages, 8 figure

Dynamic shipments of inventories in shared warehouse and transportation networks

In shared warehouse and transportation networks, dynamic shipments of inventories are carried out based on up-to-date inventory information. This paper studies the effect of network structures on optimal decision-making. We propose a discrete time modeling framework with stochastic demand, capturing a wide variety of network structures. Using Markov decision processes, we obtain optimal order and dynamic shipment decisions for small networks. We compare optimal solutions of different four-node network structures. Results indicate product characteristics significantly influence the effectiveness of network structures. Surprisingly, two-echelon networks are occasionally costlier than any other network. Moreover, dynamic shipments yield considerable gains over static shipments

Are lower urinary tract symptoms in men associated with cardiovascular diseases in a primary care population:a registry study

BACKGROUND: Although lower urinary tract symptoms (LUTS) seem to be related to cardiovascular disease (CVD) in men, it is unclear whether this relationship is unbiased. In order to investigate this relationship, we used longitudinal data for establishing the possible predictive value of LUTS for the development of CVD in a primary care population. METHODS: We performed a registry study using data from the Registration Network Groningen (RNG). All data from men aged 50 years and older during the study period from 1 January 1998 up to 31 December 2008 were collected. Cox proportional hazard regression analysis was used to determine the association between the proportions of CVD (outcome) and LUTS in our population. RESULTS: Data from 6614 men were analysed. The prevalence of LUTS increased from 92/1000 personyears (py) in 1998 up to 183/1000 py in 2008. For cardiovascular diseases the prevalence increased from 176/1000 py in 1998 up to 340/1000 py in 2008. The incidence numbers were resp. 10.2/1000 py (1998) and 5.1/1000 py (2008) for LUTS, and 12.9/1000 py (1998) and 10.4/1000 py (2008) for CVD. Of all men, 23.2% reported CVD (41.1% in men with LUTS vs 19.5% in men without LUTS, p < 0.01). The hazard ratio of LUTS for cardiovascular events, compared to no LUTS, in the adjusted multivariate model, was 0.921(95% CI: 0.824 - 1.030; p = 0.150). CONCLUSION: Based on the results, LUTS is not a factor that must be taken into account for the early detection of CVD in primary care

Complete Genome Sequences of 11 Bordetella pertussis Strains Representing the Pandemic ptxP3 Lineage

Item does not contain fulltextPathogen adaptation has contributed to the resurgence of pertussis. To facilitate our understanding of this adaptation we report here 11 completely closed and annotated Bordetella pertussis genomes representing the pandemic ptxP3 lineage. Our analyses included six strains which do not produce the vaccine components pertactin and/or filamentous hemagglutinin

Practices of ritualization in a Dutch hospice setting

In this article, we explore rituals and ritualized care practices in a hospice in the Netherlands. The research is guided by two research questions. First, we want to know what kind of rituals and ritualized care practices are taking place in the hospice. Second, we aim to understand these practices from a cultural perspective, i.e., to what cultural values do these practices refer? We distinguish five types of ritual: (1) care practices in the morning; (2) meals; (3) care practices in the evening; (4) care practices in the dying phase; (5) a farewell ritual after a patient has died. Ritualization takes place in various degrees and forms, depending on changes in the state of liminality. Analysis of ritualized care practices shows that everyday care practices are enriched with non-instrumental elements that have a strong symbolic meaning, referring to the cultural value of the ‘good death’

Ritualization as Alternative Approach to the Spiritual Dimension of Palliative Care: A Concept Analysis

The spiritual dimension is considered to be a central component of palliative care. However, healthcare professionals have difculties incorporating the spiritual dimension into their everyday practice. We propose a new approach by looking beyond the mere functionality of care practices. Rituals and ritualized practices can serve to express and communicate meanings and values. This article explores how ritualized practices have the ability to open up space for the spiritual dimension of care in the context of palliative care

Better drug use in advanced disease:An international Delphi study

Patients with a limited life expectancy use many medications, some of which may be questionable. Objectives To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life. Methods A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies. Results A total of 42 experts from 13 countries participated. Response rate in the first round was 93%, mean agreement between experts for all solutions was 87 % (range 62%-100%); additional suggestions were given by 51%. The response rate in the second round was 74%. Awareness, education and timely communication about medication management came forward as top priorities for guidelines. In addition, solutions considered crucial by many of the experts were development of a list of inappropriate medications at the end of life and incorporation of recommendations for end-of-life medication management in disease-specific guidelines. Conclusions In this international Delphi study, experts reached a high level of consensus on recommendations to improve medication management in end-of-life care. These findings may contribute to the development of clinical practice guidelines for medication management in end-of-life care.</p

The Spatial String Tension and Dimensional Reduction in QCD

We calculate the spatial string tension in (2+1) flavor QCD with physical strange quark mass and almost physical light quark masses using lattices with temporal extent N_tau=4,6 and 8. We compare our results on the spatial string tension with predictions of dimensionally reduced QCD. This suggests that also in the presence of light dynamical quarks dimensional reduction works well down to temperatures 1.5T_c.Comment: 8 pages ReVTeX, 4 figure