Health behaviour mediates the relationship between type D personality and subjective health in the general population

Type D personality is associated with unhealthy behaviour and poor subjective health in the general population. This study investigated whether health behaviour mediates the relationship between Type D and subjective health. There were 217 participants who completed measures of Type D, health-related behaviour, physical symptoms and quality of life. Type D individuals reported significantly less healthy behaviour and significantly poorer subjective health than non-Type Ds. In addition, it was found that health behaviour partially mediates these relationships. The study demonstrates that health behaviour may partly explain the relationship between Type D and poor health outcomes

An evaluation of a multi-site community pharmacy based chronic obstructive pulmonary disease support service

Background Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition which can be effectively managed by smoking cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management and COPD is one area where they are ideally located to provide a comprehensive service. Objective To evaluate the effect of a community pharmacy based COPD service on patient outcomes. Method Patients in one UK location were recruited over a 3 month period to receive a community pharmacy based COPD support service consisting of signposting to or provision of smoking cessation service, therapy optimisation, and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data was collected over a six month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and NHS resource utilisation were measured. Key findings 306 patients accessed the service and full data to enable comparison before and after was available for 137. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine GP visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and A&E visits and hospital admissions). Conclusion Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective

The four or more medicines (FOMM) support service:results from an evaluation of a new community pharmacy service aimed at over-65s

Background: 57% of all prescriptions dispensed in the UK in 2003 were for people aged ≥60, where ≥20% of them were prescribed ≥ five medicines. Inappropriate prescribing and non-adherence have a significant impact on hospital admissions and patient quality of life. The English government has identified that community pharmacy could make a significant contribution to reducing non-adherence and improving the quality of prescribing, reducing both hospital admissions and medicines wastage. Objective: To evaluate a community pharmacy service aimed at patients over the age of 65 years prescribed four or more medicines. Method: Patients were invited to participate in the service by the community pharmacy team. The pharmacist held regular consultations with the patient and discussed risk of falls, pain management, adherence and general health. They also reviewed the patient’s medication using STOPP/START criteria. Data wereas analysed for the first six months of participation in the service. Key findings: 620 patients were recruited with 441 (71.1%) completing the six month study period. Pharmacists made 142 recommendations to prescribers in 110 patients largely centred on potentially inappropriate prescribing of NSAIDs, PPIs or duplication of therapy. At follow-up there was a significant decrease in the total number of falls (mean -0.116 (-0.217 - -0.014)) experienced and a significant increase in medicines adherence (mean difference in MMAS-8: 0.513 (0.337 – 0.689)) and quality of life. Cost per QALY estimates ranged from £11,885 to £32,466 depending on the assumptions made. Conclusion: By focussing on patients over the age of 65 years with four or more medicines, community pharmacists can improve medicines adherence and patient quality of life

Fragmentation of decorin, biglycan, lumican and keratocan is elevated in degenerate human meniscus, knee and hip articular cartilages compared with age-matched macroscopically normal and control tissues

Introduction: The small leucine-rich proteoglycans (SLRPs) modulate tissue organization, cellular proliferation, matrix adhesion, growth factor and cytokine responses, and sterically protect the surface of collagen type I and II fibrils from proteolysis. Catabolism of SLRPs has important consequences for the integrity of articular cartilage and meniscus by interfering with their tissue homeostatic functions. Methods: SLRPs were dissociatively extracted from articular cartilage from total knee and hip replacements, menisci from total knee replacements, macroscopically normal and fibrillated knee articular cartilage from mature age-matched donors, and normal young articular cartilage. The tissue extracts were digested with chondroitinase ABC and keratanase-I before identification of SLRP core protein species by Western blotting using antibodies to the carboxyl-termini of the SLRPs. Results: Multiple core-protein species were detected for all of the SLRPs (except fibromodulin) in the degenerate osteoarthritic articular cartilage and menisci. Fibromodulin had markedly less fragments detected with the carboxyl-terminal antibody compared with other SLRPs. There were fewer SLRP catabolites in osteoarthritic hip than in knee articular cartilage. Fragmentation of all SLRPs in normal age-matched, nonfibrillated knee articular cartilage was less than in fibrillated articular cartilage from the same knee joint or total knee replacement articular cartilage specimens of similar age. There was little fragmentation of SLRPs in normal control knee articular cartilage. Only decorin exhibited a consistent increase in fragmentation in menisci in association with osteoarthritis. There were no fragments of decorin, biglycan, lumican, or keratocan that were unique to any tissue. A single fibromodulin fragment was detected in osteoarthritic articular cartilage but not meniscus. All SLRPs showed a modest age-related increase in fragmentation in knee articular and meniscal cartilage but not in other tissues. Conclusion: Enhanced fragmentation of SLRPs is evident in degenerate articular cartilage and meniscus. Specific decorin and fibromodulin core protein fragments in degenerate meniscus and/or human articular cartilage may be of value as biomarkers of disease. Once the enzymes responsible for their generation have been identified, further research may identify them as therapeutic targets

Predicting 1-year mortality among patients with decompensated cirrhosis:results of a multicentre evaluation of the Bristol Prognostic Score

Objective Chronic liver disease continues to be a significant cause of morbidity and mortality yet remains challenging to prognosticate. This has been one of the barriers to implementing palliative care, particularly at an early stage. The Bristol Prognostic Score (BPS) was developed to identify patients with life expectancy less than 12 months and to act as a trigger for referral to palliative care services. This study retrospectively evaluated the BPS in a cohort of patients admitted to three Scottish hospitals. Method Routinely collated healthcare data were used to obtain demographics, BPS and analyse 1-year mortality for patients with decompensated liver disease admitted to three gastroenterology units over two 90-day periods. Statistical analysis was undertaken to assess performance of BPS in predicting mortality. Results 276 patients were included in the final analysis. Participants tended to be late middle-aged men, socioeconomically deprived and have alcohol-related liver disease. A similar proportion was BPS+ve (>3) in this study compared with the original Bristol cohort though had more hospital admissions, higher ongoing alcohol use and poorer performance status. BPS performed poorer in this non-Bristol group with sensitivity 54.9% (72.2% in original study), specificity 58% (83.8%) and positive predictive value (PPV) 43.4% (81.3%). Conclusion BPS was unable to accurately predict mortality in this Scottish cohort. This highlights the ongoing challenge of prognostication in patients with chronic liver disease, furthering the call for more work in this field.Publisher PDFPeer reviewe

ON 'SELF-FACILITATING' TEMPLATES FOR TECHNOLOGY AND INNOVATION STRATEGY WORKSHOPS

Aligning technology and other functional perspectives for innovation and strategy is challenging. This is compounded by communication barriers arising from high levels of complexity, uncertainty and ambiguity associated with technologically intensive innovation. Conceptual frameworks, tools and methods such as roadmapping, portfolio matrices and scenario planning are used to support the management of technology and innovation activities. These often have a strong visual aspect that helps to address the issues of dialogue exchange and interaction. From a visualisation perspective, roadmapping is of particular interest given its prominence as a flexible method and highly visual tool. This paper focuses on the mediating role that structured roadmapping templates have during interactive strategy workshops. A quasi-experiment comparing the performance of two templates is reported, comparing a ‘classic’ format with a new template that was designed to be ‘selffacilitating’. This new template incorporates guidance that a facilitator would normally provide, in order to minimise intervention and empower groups to organise their own strategic discussions. The new template is shown to perform significantly better in terms of completeness, consistency, quality and ease of use

Conclusion: Nature-Based Solutions in Flood Risk Management

Book Conclusion: Nature-Based Solutions in Flood Risk Management on Private Lan