Thachil J.; Whitehead G.A; Indian Journal of Pediatrics; September 2012,

Clotting screen requests in pediatrics – an article published in Indian Journal of Pediatrics, September 2012, vol./is. 79/9(1233-1235), 0019- 456;0973-7693 (September 2012)

Author(s): Thachil J.; Whitehead G.A.

Institution: (Thachil) Department of Hematology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP,  (Whitehead) Department of Child Health, Macclesfield General Hospital, Macclesfield, United Kingdom
Language: English

blood sample

Abstract: Coagulation parameters are routinely requested among all age-groups in pediatrics to identify abnormalities which may contribute to bleeding manifestations or thrombotic complications. These results are vital especially in the management of sick children although in some cases, they may be helpful in identifying those with inherited bleeding disorders and to confirm or exclude non-accidental injury. Despite the usefulness of these screening tests, it is important that the professionals who are responsible for the care of children interpret the results of these tests in the most accurate manner to avoid unnecessary further investigations and inappropriate management.

Dr. K C Chaudhuri Foundation 2011.
Country of Publication: India
Publisher: Springer India (Barakhamba Road 110001, New Delhi 110 001, India)
Publication Type: Journal: Article

… K.Koss et al; Nature Genetics; October 2012,

This article “Common variants at the MHC locus and at chromosome 16q24.1 predispose to Barrett’s esophagus” was published in Nature Genetics, October 2012, vol./is. 44/10(1131-1136), 1061-4036;1546-1718 (October 2012)

Author(s): Su Z.; Gay L.J.; Strange A.; Palles C.; Band G.; Whiteman D.C.; Lescai F.; Langford C.; Nanji M.; Edkins S.; Van Der Winkel A.; Levine D.; Sasieni P.; Bellenguez C.; Howarth K.; Freeman C.; Trudgill N.; Tucker A.T.; Pirinen M.; Peppelenbosch M.P.; Van Der Laan L.J.W.; Kuipers E.J.; Drenth J.P.H.; Peters W.H.; Reynolds J.V.; Kelleher D.P.; McManus R.; Grabsch H.; Prenen H.; Bisschops R.; Krishnadath K.; Siersema P.D.; Van Baal J.W.P.M.; Middleton M.; Petty R.; Gillies R.; Burch N.; Bhandari P.; Paterson S.;
Edwards C.; Penman I.; Vaidya K.; Ang Y.; Murray I.; Patel P.; Ye W.; Mullins P.; Wu A.H.; Bird N.C.; Dallal H.; Shaheen N.J.; Murray L.J.; Koss K.;  Bernstein L.; Romero Y.; Hardie L.J.; Zhang R.; Winter H.; Corley D.A.; Panter S.; Risch H.A.; Reid B.J.; Sargeant I.; Gammon M.D.; Smart H.; Dhar A.; McMurtry H.; Ali H.; Liu G.; Casson A.G.; Chow W.-H.; Rutter M.; Tawil A.; Morris D.; Nwokolo C.; Isaacs P.; Rodgers C.; Ragunath K.; MacDonald C.; Haigh C.; Monk D.; Davies G.; Wajed S.; Johnston D.; Gibbons M.;

Abstract: Barrett’s esophagus is an increasingly common disease that is strongly associated with reflux of stomach acid and usually a hiatus hernia, and it strongly predisposes to esophageal adenocarcinoma (EAC), a tumor with a very poor prognosis. We report the first genome-wide association study on Barrett’s esophagus, comprising 1,852 UK cases and 5,172 UK controls in the discovery stage and 5,986 cases and 12,825 controls in the replication stage. Variants at two loci were associated with disease risk: chromosome 6p21, rs9257809 (P combined = 4.09 x 10<sup>-9</sup>; odds ratio (OR) = 1.21, 95% confidence interval (CI) =1.13-1.28), within the major histocompatibility complex locus, and chromosome 16q24, rs9936833 (P combined = 2.74 x 10<sup>-10</sup>; OR = 1.14, 95% CI = 1.10-1.19), for which the closest protein-coding gene is FOXF1, which is implicated in esophageal development and structure. We found evidence that many common variants of small effect contribute to genetic susceptibility to Barrett’s esophagus NHS Evidence | Page 7 and that SNP alleles predisposing to obesity also increase risk for Barrett’s esophagus.

2012 Nature America, Inc. All rights reserved.
Country of Publication: United States
Publisher: Nature Publishing Group (345 Park Avenue South, New York NY 10010-1707, United States)
Publication Type: Journal: Article

BMJ Editorial: The automation of systematic reviews

BMJ 2013; 346 doi: (Published 10 January 2013)

  1. Guy Tsafnat, senior research fellow1,      Adam Dunn, research fellow1,
  2. Paul Glasziou, professor2,                          Enrico Coiera, professor1

An extract from BMJ Editorial Jan 2013 – “The Cochrane handbook stipulates that systematic reviews should be examined every two years and updated if needed,1 but time and resource constraints mean that this occurs for only a third of reviews.2 Indeed, it may take as much time to update a review as it did to produce the original review. If this effort were redirected at developing methods to automate reviews, then updating might one day become almost effortless, immediate, and universal.”

Athen login required

Never Again? a book on the Health and Social Care Act 2012

Never Again? The story of the Health and Social Care Act 2012 explains why and how the Act became law; from the legislation’s origins 20 years ago, through the development of the 2010 White Paper Liberating the NHS to the passage of the controversial Bill through both Houses of Parliament.

The book, published jointly by the Institute for Government and The King’s Fund, focuses on what Andrew Lansley, Secretary of State for Health, is trying to achieve through the NHS reforms and considers the role the Liberal Democrats played in introducing amendments to the legislation and passing the Bill.

Written by ex-Financial Times public policy editor Nicholas Timmins, the book discusses:

  • the fact that details of the NHS reforms remained  unclear before  the May 2010 election
  • how ‘the pause’ to the legislation came about
  • the appointment of Sir David Nicholson as chief executive designate of the NHS Commissioning Board
  • Andy Burnham, Shadow Health Secretary, reviving opposition to the Bill
  • how the coalition government helped the passage of the legislation through the House of Lords.

See the key moments that led to the Act reaching the statute book in our Health and Social Care Act timeline
Read Anna Dixon’s blog: Evolution or revolution: the story behind the Health and Social Care Act 2012

The Staff Library does not endorse this book but merely includes it here as part of further reading around The Health and Social Care Act 2012.

News from NHS Networks

NHS Networks requires free subscription before you can read any of the following articles in full.

Elearning: If you are looking for a less physically demanding alternative to gym membership in January, try our e-learning courses for practice managers looking to build a healthier, more robust business to meet the challenges of the new year.  There is a free course on CQC compliance, plus several courses on finance, employment and HR issues and primary care medical contracts.

Children and young people’s health and wellbeing in changing times
The NHS Confederation has published a report on the impact of the health reforms on children and young people’s health and wellbeing. Read more »

NHS Improvement turns spotlight on stroke
NHS Improvement has published Spotlight on Stroke.  Read more »

Health survey comes of age
The Health and Social Care Information Centre is running the annual health survey for England (HSE) for the twenty-first time.  Read more »

Action plan for improving the use of medicines and reducing waste
A report commissioned by the Department of Health looks at how the NHS is working to improve the use of medicines and tackle avoidable medicines wastage.  Read more »

Direct access to diagnostic imaging for cancer 
NHS Improvement has produced a document to help diagnostic imaging for cancer. Read more »

The health and social care ratings review  The Nuffield Trust has been commissioned by the secretary of state to review whether aggregate ratings of provider performance should be used in health and social care.  Read more »

National continence survey
The all party parliamentary group (APPG) for continence care is pushing to make integrated services more widely available to all age groups, and also to help break the taboo which prevents individuals seeking and receiving medical attention. Read more »

Key performance indicators for improving access to psychological therapies
Latest figures from the NHS Information Centre.  Read more »

Smoking campaign gets under way
The Department of Health has launched a new campaign to encourage smokers to quit in the new year.  Read more »

Making integrated out of hospital care a reality
This report discusses the foundations for integrated care for adults, children and young people, with a focus on implementing out of hospital care, and connecting primary, community and social care. Read more »

Primary care IT services operating model published The NHS Commissioning Board has published a document setting out how the management of IT systems will be organised for primary care providers (dentists, pharmacists and optometrists) from April 2013.  Read more »

New child abuse alert system for hospitals announced  Hospitals will have a new system to help doctors and nurses spot children suffering from abuse and neglect, Health Minister Dr Dan Poulter has announced.  Read more »

Lessons learned from the hospital pathways programme The hospital pathways programme aims to improve both processes of care and interactions between staff and patients through a collaborative programme involving five acute trusts, the King’s Fund and the Health Foundation to apply techniques, not widely used in the NHS.  Read more »

Allied health professionals bulletin – December 2012
December edition of the Allied health professionals bulletin.   Read more »

Cancer services coming of age report published   The cancer services coming of age report has been published.   Read more »

NHS funding transfer to local authorities
The Department of Health has written to the NHS Commissioning Board with provisional information on the transfer of £859m in 2013/14 to from the NHS to local authorities.  Read more »

Transforming end of life care in acute hospitals
A short report reflecting the views from a focus group complements progress reports from acute trusts involved in the transform programme pilot.
Read more »

NHS Commissioning Assembly: next steps
The NHS Commissioning Board has published further information about the NHS Commissioning Assembly, the community of leaders for NHS commissioning.  Read more »

Payment by results 2013/14 road test package   The road test exercise provides an opportunity for the service to test out the new tariff and supports the planning process. Read more »

Advance care planning toolkit   A team at the National End of Life Care Programme (NEoLCP) has developed an advance care planning toolkit to help care providers approach the planning process with confidence and knowledge.  Read more »

Alkhalil M; Eid MA; Mahmood A; Babores M: BMJ Case Reports; 2010

This article “Unusual recurrence of small cell lung carcinoma” was published in BMJ Case Reports, 2010, vol./is. 2010/, 1757-790X (2010).  Apologies to our authors for late posting!

Author(s): Alkhalil M; Eid MA; Mahmood A; Babores M
Institution: Macclesfield General Hospital, Victoria Road, Macclesfield SK10 3BL, UK.
Language: English

Abstract: We report a case of malignant meningitis in a 63-year-old man with a background of treated small cell carcinoma. He presented with dizziness, vomiting and ataxia. His imaging investigations did not show any abnormalities, but lumbar puncture confirmed the diagnosis of malignant meningitis.
Country of Publication: England
Publication Type: Journal Article

Murthy, Creech, Burgoyne, Stead, Babores; American Journal of Respiratory and Critical Care Medicine: May 2011

Journal: Conference Abstract

Follow-on patient satisfaction survey of Rapid Access Lung Cancer Clinic (RALC) 5 years after initiation

Authors: (Naveed) Royal Liverpool University Hospital, Liverpool, United Kingdom;  (Murthy, Creech, Burgoyne, Stead, Babores) Macclesfield General Hospital, Macclesfield, United Kingdom

Language: English

Abstract: Introduction: A one stop RALC was set up in our hospital in 2003. We surveyed patients’ satisfaction six months following initiation of the clinic (2004) showing a very good response. We have, now, re-surveyed patients’ satisfaction five years later (2009) using the same questionnaire to assess whether we have maintained similarly high patients’ satisfaction. Method: A questionnaire was posted to 38 randomly selected patients between January ’09 to March ’09 and the responses were sent back to us anonymously. Analysis was performed on parameters such as satisfaction with the information provided, understanding of diagnosis, time to ask questions, things which could be improved by doctors/nurse, things which could be improved in the clinic as a whole, seeing a McMillan nurse in the clinic and finding that helpful. These results were then compared to those in 2004. Results: The response rate was 30/38 (80%). Most patients continued to be happy with the level of information they were given (29/30 (97%)). All patients felt satisfied with their understanding of the diagnosis and the time available to ask questions. 24/30 (80%) patients saw a Macmillan lung cancer nurse on the day of the clinic in 2009.  All of them found it helpful and felt that was the right time to see a Macmillan nurse.
Majority of patients felt that nothing could have been improved upon by the doctor or nurse in the clinic (28/30 (93%)). As regards improvement in the clinic as a whole, only 5/30 (17 %) felt that there were things that could be improved upon. Most of these
comments related to waiting times from being seen in clinic to having CT scans and bronchoscopy later on that day. Below is a comparison of the above parameters between 2004 and 2009 (Graph 1). (Graph presented) Conclusion: This survey demonstrates that patients continue to remain highly satisfied with the level of service provided by this one stop clinic five years from its conception. A ‘one-stop’ RALC clinic significantly reduces time from first appointment to referral to a tertiary centre without reducing patient care and satisfaction.
NHS Evidence |
Page 7  Conference Information: American Thoracic Society International Conference, ATS 2011 Denver, CO United States. Conference Start: 20110513 Conference End: 20110518
Publisher: American Thoracic Society
Publication Type: Journal: Conference Abstract

Marlow WJ; Singhal R; Dheerendra S; Ralte P; Fischer J; Waseem M; Acta Orthopaedica Belgica; June 2012

Distal radius volar locking plates: does a variable angle locking system confer a clinical advantage?.

Citation: Acta Orthopaedica Belgica, June 2012, vol./is. 78/3(309-16), 0001-6462;0001-6462  (2012 Jun)

Author(s): Marlow WJ; Singhal R; Dheerendra S; Ralte P; Fischer J; Waseem M

Institution: MacclesfieldDistrictGeneralHospital, Macclesfield, UK.

Language: English

Abstract: This retrospective study compared clinical, radiological and subjective outcomes between patients with a distal radius fracture fixed with a variable angle or fixed angle volar locking plate. Radiological parameters were assessed between initial and final post-operative films. Post-operative clinical range of motion as a proportion of that in the opposite wrist was assessed clinically, and satisfaction and subjective outcomes were assessed by  questionnaire. One hundred and seven patients were included in the study; 65 underwent fixation with a variable angle and 42 with a fixed angle locking plate.

There were five complications and secondary operations in each group. There was no significant difference between the groups in radiological parameters measured or the proportional range of motion. Visual analogue scale, Mayo Wrist and Quick DASH scores were not significantly different between the groups. Neither the subjective nor clinical outcomes of this study demonstrated clinical superiority of either plate system.

Country of Publication: Belgium

Publication Type: Journal Article

BMJ Learning: 14 January 2013

This module will help you support patients who have a diagnosis of cancer, especially after they have finished their primary treatment in hospital. It will also provide information and guidance about what you should cover in the cancer care review.

Additional modules include:

Medical Devices Alert: January 2013

One Liners issue 96 – January 2013  

A news sheet aimed at healthcare professionals highlighting concerns relating to the use of medical devices.



Poster for Safe use of bed rails (1504Kb)

Bed rails successfully prevent many falls, but their incorrect use has resulted in the deaths of bed occupants by asphyxiation through entrapment in gaps.

Risk assessment is key to ensure safe use. It should start with the bed occupant and include the combination of the proposed equipment, the bed and the mattress.   This poster complements our more detailed guidance ‘Safe use of bed rails’ DB 2006(06) v2.0.

Bed rails poster

News from National Health Executive Online

NHS to share digital medical records by 2018 Patients should be able to access their medical records online by 2015, health secretary Jeremy Hunt is to announce. The roll-out of the project will incorporate the whole NHS and be complete by 2018 ….     more >

Patients have their say – Friends and Family Test

Friends and Family Test

Patients will now be able to have their say about the care and treatment they receive in hospital, following the launch of the Friends and Family Test.

Patients admitted to East Cheshire NHS Trust’s hospitals will be given the opportunity to answer a single, simple question to gauge how well their expectations are being met. The question is ‘how likely is it that you would recommend this service to a friend or family?’ using an ‘extremely likely’ to ‘not at all likely’ scale.

The question is quick and easy, is used in other industries, and will enable hospitals to compare themselves and learn from the best. Hospitals will be required to achieve a 15% response rate. Responses will be made publicly available, alongside other measures of clinical quality, and will be useful to patients in making choices about their care.

A pilot will start on 28 January 2013, and be run in Wards 1 and 2 and A&E. Patients can respond online or by completing a paper copy. Each ward will have its own coded copies and post boxes will be placed at locations throughout the hospital. It is very important that all patients are encouraged to complete the survey on leaving the department, or to complete and return it when they get home.

Please see the link to the online survey:

Read more about the Friends and Family Test


Free event: Adopting innovation in the NHS: working in partnership

A free event, run in partnership with the Association of the British Pharmaceutical Industry (ABPI)  Adopting innovation in the NHS: working in partnership is taking place on Wednesday, 27 February 2013 in London.  This event has been designed to help you understand the process of adopting innovation, how to engage colleagues and other stakeholders and cross-agency involvement.

The speakers include:

  • Helen Bevan, Chief of Service Transformation at the NHS Institute for Innovation and Improvement
  • Kathy McLean, Medical Director of the Provider Development Agency
  • Stephen Whitehead, Chief Executive, ABPI

Four case studies that represent leading-edge work will be used to show innovation in practice. The case studies will focus on how partnerships can accelerate innovation and stimulate radical change, and will give you practical information on how to transfer these approaches to your workplace.

  • A new paradigm for admissions avoidance  Aintree University Hospitals NHS Foundation Trust working in partnership with Baxter Healthcare Ltd
  • Enabling patients to manage long term conditions at home – a whole pathway approach    Derby Hospitals NHS Trust, University Hospital of North Staffordshire and The Royal Free London NHS Foundation Trust working in partnership with Baxter Healthcare Ltd 
  • Reaching ‘at risk’ and ‘hard to access’ populations through innovative media channels     Chelsea and Westminster Hospital Foundation Trust working in partnership with Bristol-Myers Squibb Ltd.
  • New ways of experienced led commissioning, placing the patient at the centre of the commissioning process   Boehringer Ingelheim Ltd.  

When and where:    Wednesday 27 February 2013 at the Wellcome Collection Conference Centre, London.


Best Practice App – all clear

There is a new release of the Best Practice app available on iTunes. The technical issues with the display of some treatment options in the previous version, which caused us to temporarily withdraw the app, have been resolved and all users should update to the new release at the earliest opportunity.

As a previous user the new release should be available to you as an update and free of charge. If you have any problems please contact our Customer Services team at

NICE considers preventative treatment for breast cancer

breastc keyboardThe National Health Service is considering giving women with a strong family history of breast cancer treatment to prevent the disease from developing.

The National Institute for Health and Clinical Excellence (NICE) is currently in the process of updating its clinical guideline on familial breast cancer[i]. Today (15 January), NICE has begun a consultation on a draft version of the guideline with new, provisional recommendations relating to genetic testing[ii], screening and the use of preventive treatments. The draft update also, for the first time, makes recommendations for people with a recent diagnosis of breast cancer who also have a family history of the disease.

BMJ: How to read a paper

14 January 2013

readiconHow to read a paper

A big ‘thank you’ to the BMJ who have identified a number of very useful articles that explain how to read and interpret different kinds of research papers:

Map of Medicine: 5 new pathways for pain


The British Pain Society has launched five new pathways on the Map of Medicine to support commissioning and educate clinicians. The pathways may go on to inform the new NICE Quality Standard in pain.

The pathways are:

  • Initial assessment and early management of pain
  • Spinal pain
  • Chronic widespread pain, including fibromyalgia
  • Neuropathic pain
  • Pelvic pain
“Referral rates and quality of care for patients with pain problems show a concerning variation. For the first time, commissioners, providers and patients now have access to evidence-based and high-quality pain pathways through the Map of Medicine.  This is the first step in driving down variation in care, whilst enabling providers and commissioners to be able to negotiate and influence pain services in the best possible way to support patient care”

The pathways are available to healthcare professionals and can be adapted for local clinical use using Map of Medicine’s unique localising software tools available to clinical commissioning groups (CCGs). To take advantage of the high-quality, peer-reviewed pathways visit the Map of Medicine.

Mahmood A; Fountain J; Vasireddy N; Waseem M; The Open Orthopaedics Journal; 2012;

Wrist MRI Arthrogram v Wrist Arthroscopy: What are we Finding?

Citation: The Open Orthopaedics Journal, 2012, vol./is. 6/(194-8), 1874-3250 (2012)

Author(s): Mahmood A; Fountain J; Vasireddy N; Waseem MS Evidence |

Institution: Macclesfield District General Hospital, Victoria Road, Macclesfield, SK10 3BL, UK.

Abstract: The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at a District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month interval between the two procedures.The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthroscopies performed by two upper limb surgeons. Patients who underwent both procedures were identified. The arthrogram reports and operation notes were examined for correlation.

Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had 90% sensitivity and 75% specificity. The lunotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 91% sensitivity and 88% specificity.Wrist arthrogram and arthroscopy are both invasive techniques.


Greystoke A, Dean E, Saunders MP, Cummings J, Hughes A, Ranson M, Dive C, Renehan AG; British Journal of Cancer;

Multi-level evidence that circulating CK18 is a biomarker of tumour burden in colorectal cancer.

Citation:  British Journal of Cancer, 10 2012, vol./is. 107/9(1518-24), 0007-0920;1532-1827 (2012 Oct 23)
Author(s):  Greystoke A, Dean E, Saunders MP, Cummings J, Hughes A, Ranson M, Dive C, Renehan AG
Abstract:   Circulating total cytokeratin 18 (tCK18) and/or caspase cleaved cytokeratin 18 (cCK18) (measured by M65 and M30 enzyme-linked immunosorbent assays (ELISAs), respectively) are used as pharmacodynamic (PD) biomarkers of epithelial cell death in clinical trials. Having validated these ELISAs, we assessed their utility in colorectal cancer (CRC).METHODS: We applied the assays in several settings: 53 controls; 97 patients undergoing surgery and 74 patients with metastatic CRC undergoing chemotherapy (55 first line; 56 patients with repeated sampling through chemotherapy). Prognostic significance was evaluated using Kaplan-Meier life tables and Cox models; PD utility was assessed by analysis of repeated measures.RESULTS: Median cCK18 and tCK18 levels were elevated in patients with cancer (both P=0.0001), and among cancer patients, there were increasing trends from early to advanced stages (both P(trends)=0.0001). Increasing tCK18 predicted for reduced survival after surgery with curative intent (adjusted hazard ratio (HR) for doubling in concentration 1.77, 95% CI: 1.04, 3.01) and after first-line chemotherapy in metastatic disease (adjusted HR per doubling in concentration=1.78, 95% CI: 1.37, 2.30). In patients with progressive disease during chemotherapy, repeated sampling revealed profiles with high baselines and progressive upwardly increases after cycle 1.CONCLUSION: This study provides evidence for cytokeratin 18 (CK18) as a prognostic and PD biomarker in patients with CRC and supports continued deployment of circulating CK18 in biomarker-enhanced trials.
Publication type:  Journal Article,Research Support, Non-U.S. Gov’t
Source:  Medline

Chandramouli S., Kazmi S.M.H., Graham A., Bayliss J., Babores M.; American Journal of Respiratory and Critical Care Medicine; May 2010

Identification of non compliant patients and their characteristics from home oxygen data
Citation: American Journal of Respiratory and Critical Care Medicine, May 2010, vol./is. 181/1 MeetingAbstracts, 1073-449X (01 May 2010)

Author(s):  Chandramouli S., Kazmi S.M.H., Graham A., Bayliss J., Babores M.

Abstract:   The Home Oxygen Service (HOS) caters to 90,000 people in England and Wales. Since 2008, Air Products plc, principal supplier of oxygen, has been providing information on concordance to Primary Care Trusts and Local Health Boards with a concordance report issued every quarter. This identifies patients whose actual oxygen usage differs significantly from their ordered usage and gives useful information on various aspects of their therapy. Aims: Identify oxygen prescribing patterns of patients non compliant with therapy Methods: We analyzed the quarterly report generated between November 2008 and February 2009 and focused on non compliant patients with a variance in oxygen usage of more than 30%. Patient demographics comprising age, sex and primary diagnoses were collected and prescribers identified. Patients were divided into over and under users and their oxygen usage data was studied in more detail to identify patterns. Results: A total of 240 patients were using oxygen of various modalities in our area. 60 (40%) non compliant patients were identified with a mean (SD) age of 75(12) years. Females=38 (63%) Nearly half had COPD (29/60) while in 19 (32%) a formal diagnosis was not documented. All of these prescriptions were from primary care. Respiratory nurse specialists (RNS) prescribed oxygen in 20(37%) patients and primary care in 30(50%) patients. Ten (16%) prescriptions were unknown. (Table presented) Conclusions: Amongst non compliant patients, a large proportion of oxygen prescriptions continue to emanate from primary care and a third of these patients do not have a formal diagnosis. Nearly all these patients are prescribed LTOT which is not only difficult to discontinue but also imposes considerable burden on healthcare resources. In our cohort, under-users were more likely to be female and SBOT users. SBOT is still being prescribed in both settings despite its lack of evidence although isolated SBOT prescriptions are almost completely confined to primary care. Comparison with patients who are compliant is needed to fully elucidate the difference between these groups. Finally, more attention to non compliant patients identified from this readily available data not only ensures cost savings but also appropriate oxygen therapy.

Publication type:   Journal: Conference Abstract

Radiology; Nov 2012; Advanced solid tumors treated with cediranib: …. 2012

This journal article “Advanced solid tumors treated with cediranib: Comparison of dynamic contrast-enhanced MR imaging and CT as markers of vascular activity” was published in Radiology, November 2012, vol./is. 265/2(426-436), 0033-8419;1527-1315 (November 2012)

Author(s):   Messiou C.,Orton M.,Ang J.E.,Collins D.J.,Morgan V.A.,Mears D.,Castellano I.,Papadatos-Pastos D.,Brunetto A.,Tunariu N.,Mann H.,Tessier J.,Young H.,Ghiorghiu D.,Marley S.,Kaye S.B.,DeBono J.S.,Leach M.O.,DeSouza N.M.
Abstract:  Purpose: To assess baseline reproducibility and compare performance of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging versus DCE computed tomographic (CT) measures of early vascular response in the same patients treated with cediranib (30 or 45 mg daily). Materials and Methods: After institutional review board approval, written informed consent was obtained from 29 patients with advanced solid tumors who had lesions 3 cm or larger and in whom simultaneous imaging of an adjacent artery was possible. Two baseline DCE MR acquisitions and two baseline DCE CT acquisitions 7 days or fewer apart (within 14 days of starting treatment) and two posttreatment acquisitions with each modality at day 7 and 28 (+/-3 days) were obtained. Nonmodeled and modeled parameters were derived (measured arterial input function [AIF] for CT, population-based AIF for MR imaging; temporal sampling rate of 0.5 second for CT, 3-6 seconds for MR imaging). Baseline variability was assessed by using intra- and intersubject analysis of variance and Bland-Altman analysis; a paired t test assessed change from baseline to after treatment. Results: The most reproducible parameters were DCE MR imaging enhancement fraction (baseline intrapatient coefficient of variation [CV] = 8.6%), volume transfer constant (CV = 13.9%), and integrated area under the contrast uptake curve at 60 seconds (CV = 15.5%) and DCE CT positive enhancement integral (CV = 16.0%). Blood plasma volume was highly variable and the only parameter with CV greater than 30%. Average reductions (percentage change) from baseline were consistently observed for all DCE MR imaging and DCE CT parameters at day 7 and 28 for both starting-dose groups (45 and 30 mg), except for DCE CT mean transit time. Percentage change from baseline for parameters reflecting blood flow and permeability were comparable, and reductions from baseline at day 7 were maintained at day 28. Conclusion: DCE MR imaging and DCE CT can depict vascular response to antiangiogenic agents with response evident at day 7. Improved reproducibility with MR imaging favors its use in trials with small patient numbers. RSNA, 2012.

New ‘Be Food Smart’ Change4Life campaign

Government launches new ‘Be Food Smart’ Change4Life campaign

via NeLM – Nutrition and Metabolism on 1/7/13

Source: Department of Health (DH)

The Public Health Minister is launching a new Change4Life campaign – ‘Be Food Smart’ – to promote healthier eating habits. Those who sign up to the campaign will receive a free ‘Food Smart Meal Mixer’ containing a number of quick, easy, healthier recipes, as well as a range of offers from a number of food manufacturers.   A prime time advertising slot is the centrepiece of the campaign, exposing the ‘hidden nasties’ in everyday foods, and helping people to be ‘food smart’.  The campaign also features a smart phone and tablet app featuring a meal mixer and a shopping list function, to help people make healthy choices in the supermarket.   Please see the link below for further details.