Managing raised ferritin in Primary Care

What you need to know-Raised levels of ferritin can be associated with several serious underlying conditions and should be investigated appropriately-Determine whether raised ferritin reflects iron overload or another disease process-Initial tests for investigating raised ferritin in primary care are fasting transferrin saturation, full blood count, liver blood tests, and C reactive protein-Assess patients for organ damage associated with iron overload to determine further investigations, management, and whether the patient needs to be referred to secondary care-Haemochromatosis is a common genetic condition that can cause iron overload, and primary care clinicians can order HFE gene mutation analysis to diagnose the conditio

Spatial Thinking in Practice: A Snapshot of teacher’s Spatial Activity Use in the Early Years’ Classroom

Spatial thinking predicts Science, Technology, Engineering, and Mathematics achievement, yet is often absent from educational policy. We provide benchmarks of teachers' usage and perceptions of spatial activities in practice in the reception classroom (first year of primary school). In this questionnaire study of educational professionals working in the reception classroom in England (N = 104), we found that spatial and numeracy activities were perceived as significantly less important, and were reportedly completed significantly less often, than literacy or life skills. Despite the lower perceived importance of spatial skills in curriculum guidance in England, rates of reported spatial activity use were encouragingly high and were broadly comparable to those of numeracy. Teachers had moderate anxiety levels for both spatial and mathematics domains. The findings highlight a need to elevate teachers' understanding of the importance of developing children's early spatial and numeracy skills, which may begin with efforts to reduce spatial and mathematics anxiety

The prevention of glucocorticoid‐induced osteoporosis in patients with immune thrombocytopenia receiving steroids:a British Society for Haematology Good Practice Paper

Methodology This Good Practice Paper was compiled according to the British Society for Haematology (BSH) process at http://www.b-s-h.org.uk/guidelines/proposing-and-writing-a-new-bsh-guideline/. The BSH produces Good Practice Papers to recommend good practice in areas where there is a limited evidence base but for which a degree of consensus or uniformity is likely to be beneficial to patient care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org

Systemic immunosuppression depletes peripheral blood regulatory B cells in patients with immune thrombocytopenia

Regulatory B (Breg) cells are potentially implicated in the pathogenesis of immune thrombocytopenia (ITP). We analysed a prospective cohort of newly diagnosed steroid naïve ITP patients enrolled in the multicentre FLIGHT trial and found that the numbers of Bregs in their peripheral blood were similar to healthy controls. In contrast, Breg numbers were significantly reduced in ITP patients treated with systemic immunosuppression (glucocorticoids or mycophenolate mofetil). We also demonstrate that glucocorticoid treatment impairs Breg interleukin-10 production via an indirect T-cell-mediated mechanism