159 research outputs found
Supporting bereavement and complicated grief in primary care: a realist review.
Get PDFBACKGROUND: Bereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients. AIM: To identify what works, how, and for whom, in the management of complicated grief (CG) in primary care. DESIGN & SETTING: A review of evidence on the management of CG and bereavement in UK primary care settings. METHOD: A realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. RESULTS: Forty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients' needs can encourage a proactive response and help identify appropriate support. CONCLUSION: Bereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients
The importance of early arthroscopy in athletes with painful cartilage lesions of the ankle: a prospective study of 61 consecutive cases
Get PDFBACKGROUND
Ankle sprains are common in sports and can sometimes result in a persistent pain condition.
PURPOSE
Primarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. Secondly, in applicable cases, to evaluate the accuracy of MRI in detecting these injuries. Type of study: Prospective consecutive series.
METHODS
Over around 4 years we studied 61 consecutive athletes with symptomatic chondral lesions to the talocrural joint causing persistent exertion ankle pain.
RESULTS
43% were professional full time athletes and 67% were semi-professional, elite or amateur athletes, main sports being soccer (49%) and rugby (14%). The main subjective complaint was exertion ankle pain (93%). Effusion (75%) and joint line tenderness on palpation (92%) were the most common clinical findings. The duration from injury to arthroscopy for 58/61 cases was 7 months (5.7–7.9). 3/61 cases were referred within 3 weeks from injury. There were in total 75 cartilage lesions. Of these, 52 were located on the Talus dome, 17 on the medial malleolus and 6 on the Tibia plafond. Of the Talus dome injuries 18 were anteromedial, 14 anterolateral, 9 posteromedial, 3 posterolateral and 8 affecting mid talus. 50% were grade 4 lesions, 13.3% grade 3, 16.7% grade 2 and 20% grade 1. MRI had been performed pre operatively in 26/61 (39%) and 59% of these had been interpreted as normal. Detection rate of cartilage lesions was only 19%, but subchondral oedema was present in 55%. At clinical follow up average 24 months after surgery (10–48 months), 73% were playing at pre-injury level. The average return to that level of sports after surgery was 16 weeks (3–32 weeks). However 43% still suffered minor symptoms.
CONCLUSION
Arthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain. Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise such suspicion
‘A silent epidemic of grief’: a survey of bereavement care provision in the UK and Ireland during the COVID-19 pandemic
Get PDFObjectives: To investigate the experiences and views of practitioners in the UK and Ireland concerning changes in bereavement care during the COVID-19 pandemic. Design: Online survey using a snowball sampling approach. Setting: Practitioners working in hospitals, hospices, care homes and community settings across the UK and Ireland. Participants: Health and social care professionals involved in bereavement support. Interventions: Brief online survey distributed widely across health and social care organisations. Results: 805 respondents working in hospice, community, and hospital settings across the UK and Ireland completed the survey between 3 August and 4 September 2020. Changes to bereavement care practice were reported in: the use of telephone, video and other forms of remote support (90%); supporting people bereaved from non-COVID conditions (76%), from COVID-19 (65%) and people bereaved before the pandemic (61%); funeral arrangements (61%); identifying bereaved people who might need support (56%); managing complex forms of grief (48%) and access to specialist services (41%). Free-text responses demonstrated the complexities and scale of the impact on health and social care services, practitioners and their relationships with bereaved families, and on bereaved people. Conclusions: The pandemic has created major challenges for the support of bereaved people: increased needs for bereavement care, transition to remote forms of support and the stresses experienced by practitioners, among others. The extent to which services are able to adapt, meet the escalating level of need and help to prevent a ‘tsunami of grief’ remains to be seen. The pandemic has highlighted the need for bereavement care to be considered an integral part of health and social care provision
Analysis of dietary fibre of boiled and canned legumes commonly consumed in the United Kingdom
Get PDFThe use of different analytical methods to measure the dietary fibre content of foods complicates the interpretation of epidemiological studies. The aim of this study was to determine the total (TDF) and insoluble (IDF) fibre content of 14 boiled and canned legumes commonly consumed in the UK using the Association of Official Analytical Chemists (AOAC) enzymatic gravimetric method. The fibre values obtained were compared to non-starch polysaccharide (NSP) values. The results showed that mean values for TDF (2.7–11.2 g/100 g) were higher than NSP (2.6–6.7 g/100 g), with a mean NSP:TDF ratio of 1:1.43. TDF was correlated with NSP (r = 0.6; p = 0.02). Canning significantly reduced TDF and IDF by an average of 30% and 26% compared to boiling respectively. However, IDF represented at least 60% of the TDF in both boiled and canned samples. In conclusion, fibre values are affected by the processing and analytical method used
Exponential growth, high prevalence of SARS-CoV-2, and vaccine effectiveness associated with the Delta variant.
Get PDFSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were rising during early summer 2021 in many countries as a result of the Delta variant. We assessed reverse transcription polymerase chain reaction swab positivity in the Real-time Assessment of Community Transmission–1 (REACT-1) study in England. During June and July 2021, we observed sustained exponential growth with an average doubling time of 25 days, driven by complete replacement of the Alpha variant by Delta and by high prevalence at younger, less-vaccinated ages. Prevalence among unvaccinated people [1.21% (95% credible interval 1.03%, 1.41%)] was three times that among double-vaccinated people [0.40% (95% credible interval 0.34%, 0.48%)]. However, after adjusting for age and other variables, vaccine effectiveness for double-vaccinated people was estimated at between ~50% and ~60% during this period in England. Increased social mixing in the presence of Delta had the potential to generate sustained growth in infections, even at high levels of vaccination.The study was funded by the Department of Health and Social Care in England. Sequencing was provided through funding from the COVID-19 Genomics UK (COG-UK) Consortium. P.E. is Director of the Medical Research Council (MRC) Centre for Environment and Health (MR/L01341X/1, MR/S019669/1). P.E. acknowledges support from Health Data Research UK (HDR UK); the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre; NIHR Health Protection Research Units (HPRUs) in Chemical and Radiation Threats and Hazards, and Environmental Exposures and Health; the British Heart Foundation Centre for Research Excellence at Imperial College London (RE/18/4/34215); and the UK Dementia Research Institute at Imperial (MC_PC_17114). S.R., C.A.D. acknowledge support: MRC Centre for Global Infectious Disease Analysis, NIHR HPRU in Modelling and Health Economics, Wellcome Trust (200861/Z/16/Z, 200187/Z/15/Z), and Centres for Disease Control and Prevention (US, U01CK0005-01-02). G.C. is supported by an NIHR Professorship. H.War. acknowledges support from an NIHR Senior Investigator Award and the Wellcome Trust (205456/Z/16/Z). We thank The Huo Family Foundation for their support of our work on COVID-19. Quadram authors gratefully acknowledge the support of the Biotechnology and Biological Sciences Research Council (BBSRC); their research was funded by the BBSRC Institute Strategic Programme Microbes in the Food Chain BB/R012504/1 and its constituent project BBS/E/F/000PR10352. We thank members of the COVID-19 Genomics Consortium UK (COG-UK) for their contributions to generating the genomic data used in this study. COG-UK is supported by funding from the MRC, part of UK Research & Innovation (UKRI), NIHR and Genome Research Limited, operating as the Wellcome Sanger Institute
A transmission spectrum of the sub-Earth planet L98-59~b in 1.1-1.7 m
Get PDFWith the increasing number of planets discovered by TESS, the atmospheric
characterization of small exoplanets is accelerating. L98-59 is a M-dwarf
hosting a multi-planet system, and so far, four small planets have been
confirmed. The innermost planet b is smaller and lighter
than Earth, and should thus have a predominantly rocky composition. The Hubble
Space Telescope observed five primary transits of L98-59b in m,
and here we report the data analysis and the resulting transmission spectrum of
the planet. We measure the transit depths for each of the five transits and, by
combination, we obtain a transmission spectrum with an overall precision of
ppm in for each of the 18 spectrophotometric channels. With this level
of precision, the transmission spectrum does not show significant modulation,
and is thus consistent with a planet without any atmosphere or a planet having
an atmosphere and high-altitude clouds or haze. The scenarios involving an
aerosol-free, H-dominated atmosphere with HO or CH are inconsistent
with the data. The transmission spectrum also disfavors, but does not rules
out, an HO-dominated atmosphere without clouds. A spectral retrieval
process suggests that an H-dominated atmosphere with HCN and clouds or haze
may be the preferred solution, but this indication is non-conclusive. Future
James Webb Space Telescope observations may find out the nature of the planet
among the remaining viable scenarios.Comment: 17 pages, 5 figures, 7 tables, accepted for publication in A
Microbiota of De-Novo Pediatric IBD : Increased Faecalibacterium Prausnitzii and Reduced Bacterial Diversity in Crohn's But Not in Ulcerative Colitis
Get PDFACKNOWLEDGMENTS We are grateful for the expertise of our sequencing provider NewGene and in particular for the support and help of Dr Jonathan Coxhead.Mrs Karen McIntyre and Dr Dagmar Kastner were invaluable in identifying patients for recruitment in Dundee. Mrs Ann Morrice provided administrative support in Aberdeen. Dr Paul Henderson gave helpful comments on the manuscript. We appreciate the generosity of the families who freely gave their time and samples to make this study possible and the theatre staff of all centers who allowed time for sample collection during busy endoscopy lists.Peer reviewedPublisher PD
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