Lessons learnt from establishing a high dose opioid review clinic for people living with HIV.

People living with HIV represent a unique aging population, living with a chronic condition associated with significant pain. A number take high dose, long-term opioids to manage moderate to severe chronic pain, presenting specific risks. This article highlights the size and impact of this problem and outlines the service objectives and set up of a specialist clinic to manage people living with HIV on high dose opioids, alongside its successes and learning points.

Practical dynamic de Bruijn graphs.

Motivation: The de Bruijn graph is fundamental to the analysis of next generation sequencing data and so, as datasets of DNA reads grow rapidly, it becomes more important to represent de Bruijn graphs compactly while still supporting fast assembly. Previous implementations of compact de Bruijn graphs have not supported node or edge deletion, however, which is important for pruning spurious elements from the graph.

Results: Belazzougui et al.

Severe Cushing's syndrome due to small cell prostate carcinoma: a case and review of literature.

Cushing's syndrome (CS) due to ectopic adrenocorticotrophic hormone (ACTH) is associated with a variety of tumours most of which arise in the thorax or abdomen. Prostate carcinoma is a rare but important cause of rapidly progressive CS. To report a case of severe CS due to ACTH production from prostate neuroendocrine carcinoma and summarise previous published cases.

Smoking and common mental disorders in patients with chronic conditions: An analysis of data collected via a web-based screening system.

Objective: Smoking is the largest preventable cause of death and disability in the UK and remains pervasive in people with mental disorders and in general hospital patients. We aimed to quantify the prevalence of mental disorders and smoking, examining associations between mental disorders and smoking in patients with chronic physical conditions.

Method: Data were collected via routine screening systems implemented across two London NHS Foundation Trusts.

Health Information Technologies for Geriatrics: The Big Picture.

Nearly five decades ago in 1970, Simone de Beauvoir's "The Coming of Age" painted a broad-strokes picture of urgent issues affecting the welfare of elders in many cultures. Using her agenda and others, this panel will attempt to sketch what specific technological advances and applications offer to older citizens, clients and patients - over these 50 years and into the future. Rapid aging societies warrants the need to transform health systems to be focused on preventions and patient engagement rather than the curative care.

Body Image Disturbance in Acromegaly Patients Compared to Nonfunctioning Pituitary Adenoma Patients and Controls.

Purpose. Excess growth hormone secretion in adults results in acromegaly, a condition in which multiple physical changes occur including bony and soft tissue overgrowth. Over time these changes can markedly alter a person's appearance.

Case report: clues to the diagnosis of an unsuspected massive levothyroxine overdose.

There is currently little literature pertaining to levothyroxine overdose apart from minor or accidental overdoses in the pediatric population. In particular, there is little information available on how to confidently differentiate levothyroxine overdose from endogenous causes of thyrotoxicosis when there is no history available at the time of assessment. We report a levothyroxine (15,800 mcg) and citalopram (2,460 mg) overdose in a 55-year-old woman presenting with seizure and tachycardia in which the diagnosis was not initially suspected.

A waste walk through clinical pharmacy: how do the 'seven wastes' of Lean techniques apply to the practice of clinical pharmacists.

Aims And Objectives: This study used a 'Lean' technique, the 'waste walk' to evaluate the activities of clinical pharmacists with reference to the seven wastes described in 'Lean' including 'defects', 'unnecessary motion', 'overproduction', 'transport of products or material', 'unnecessary waiting', 'unnecessary inventory' and 'inappropriate processing'. The objectives of the study were to categorise the activities of ward-based clinical pharmacists into waste and non-waste, provide detail around what constitutes waste activity and quantify the proportion of time attributed to each category.

Setting: This study was carried out in a district general hospital in the North West of England.

Players of Matching Pennies automatically imitate opponents' gestures against strong incentives.

There is a large body of evidence of apparently spontaneous mimicry in humans. This phenomenon has been described as "automatic imitation" and attributed to a mirror neuron system, but there is little direct evidence that it is involuntary rather than intentional. Cook et al.

"Murder or mercy?" An innovative module helping UK medical students to articulate their own ethical viewpoints regarding end-of-life decisions.

This module was designed to equip UK medical students to respond ethically and sensitively to requests encountered as qualified doctors regarding euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment.The module is delivered by a multidisciplinary team, providing students with the working knowledge to actively discuss cases, articulate their own views and practice ethical reasoning.

The effect of patient characteristics upon uptake of the influenza vaccination: a study comparing community-based older adults in two healthcare systems.

Background: the uptake of influenza vaccination represents a simple marker of proactive care of older people. However, many still do not receive the vaccine. To understand this challenge better, we investigated the relationship between patient characteristics (demographic, physical and psychological health and health service use) and vaccination uptake in a sample of community-dwelling older people in two adjacent but differently structured healthcare systems (Northern Ireland (NI) and the Republic of Ireland (RoI)).

Wholeness of healing: an innovative Student-Selected Component introducing United Kingdom medical students to the spiritual dimension in healthcare.

Objective: This Student Selected Component (SSC) was designed to equip United Kingdom (UK) medical students to engage in whole-person care. The aim was to explore students' reactions to experiences provided, and consider potential benefits for future clinical practice.

Methods: The SSC was delivered in the workplace.

Management of varicella contacts in pregnancy: VZIG or vaccination?

Background: Varicella infection during pregnancy poses a serious risk for both foetus and mother. It has been suggested that it would be more cost-effective to screen antenatally with post-partum vaccination, which occurs in the US, than the current policy of checking immune status post varicella exposure, with VZIG administration where necessary. Additionally, it is doubtful whether the current policy provides best patient care, when a vaccine is available.

Stroke presentation and hospital management: comparison of neighboring healthcare systems with differing health policies.

Background And Purpose: Acute stroke care is shaped by healthcare policies. Differing policies in similar populations allow for assessment of policy impact on health and healthcare outcomes. The purpose of this study was to compare stroke presentation and hospital care in two adjacent healthcare systems with differing healthcare policies.

Community-based treatment for chronic hepatitis C in drug users: high rates of compliance with therapy despite ongoing drug use.

Background: Chronic hepatitis C infection is common in drug users. Treatment of injectors is possible under controlled conditions, but many have not yet been included in treatment programmes as there are concerns about their ability to comply with therapy. It is not known which factors influence compliance.

Angiographically confirmed coronary heart disease and periodontal disease in middle-aged males.

Background: The aim of this study was to investigate whether an association could be demonstrated between coronary heart disease (CHD) and chronic periodontitis in a population of middle-aged males in Northern Ireland.

Methods: A case-control design was used. Cases were men aged over 40 years with angiographically proven CHD.

Home heating and respiratory symptoms among children in Belfast, Northern Ireland.

In this study, the authors assessed whether home heating with a glass-fronted solid fuel fire (GFF) affected the respiratory health of children in Belfast, Northern Ireland. Questionnaires were mailed to 2,480 households within 4 medical general practice areas of the city. Respiratory symptoms, tobacco exposure, socioeconomic status, and crowding were studied.

A 6-month open-label study of the effectiveness and tolerability of galantamine in patients with Alzheimer's disease.

The objective of this study was to assess the effectiveness and tolerability of galantamine in patients with mild-to-moderate Alzheimer's disease (AD) in everyday clinical practice. Patient selection was made on 36 sequential patients attending Belfast City Hospital Memory Clinic between December 2000 and June 2001. Patients were treated with galantamine for 6 months, starting from 4 mg twice daily increasing to 8 mg twice daily and then to 12 mg twice daily at 4-weekly intervals.

Seasonal changes in platelets, fibrinogen and factor VII in elderly people.

Background: an increase in mean platelet volume and a decrease in platelet total have been reported following stroke and increased mean platelet volume in acute myocardial infarction has been shown to be predictive of mortality.

Objective: given the established seasonal variation in morbidity and mortality from cardiovascular disease and various risk factors for the disease, we explored the seasonal variation in mean platelet volume and platelet total.

Methods: we assessed levels of platelet count, platelet volume, fibrinogen, factor VII, core body and ambient temperatures in 54 healthy community dwelling elderly volunteers over a period of 1 year.

Factors influencing prescription of CNS medications in different elderly populations.

Factors influencing the use of neuroleptic and other CNS-acting medications ('antidepressants' and 'hypnotics/anxiolytics') were examined in different elderly populations (> 65 years): long-stay care hospital subjects (n = 381), nursing home subjects (n = 1247), private residential home subjects (n = 321), statutory residential home subjects (n = 525), old age psychiatry facility subjects (n = 48), community dwellers (n = 97), in different geographical areas (urban n = 1223 and rural n = 1396). Neuroleptics were prescribed in 28% of the individuals, hypnotics/anxiolytics in 33% and antidepressants in 12%. Prescription of neuroleptics was significantly predicted by institutional placement (other than long-stay care hospital facility), lower cognitive function and rural geographical area.

How reliable is a radiological report in osteoporosis in diagnosing low bone density?

Patients are often referred to osteoporosis clinics with a radiological diagnosis of osteoporosis. Previous studies attempting to ascertain risk of osteoporosis from radiographs have been conflicting. The aim of our study was to determine how reliable spinal radiographs were at detecting low bone density compared with Dual Energy X ray Absorptiometry (DXA).

Institutional care for elderly people in North and West Belfast. A decade of change from 1989-1999.

Background And Aims: We wished to document the pattern of institutional care for dependent elderly people during a period of altered provision of care, namely a shift from National Health Service long-term hospital care provision to residential and nursing home provision in the private sector.

Methods: We systematically studied all Institutionalized people aged 65+ years in a single geographic area in 1989, 1992, 1995 and 1999. Subjects' physical and mental function was assessed using the Barthel Index and the Abbreviated Mental Test.

Changes in seasonal deaths from myocardial infarction.

Background: Cardiovascular disease is the major contributor to excess morbidity and mortality in winter. With the rise in temperatures through global warming, and the use of central heating and air conditioning, this seasonal variation may be declining.

Aim: To study possible changes in seasonal variation in case-fatality rates of myocardial infarction (MI), in men and women, over a 20-year period and compare this with possible environmental influences.

Treating an opiate-dependent inpatient population: a one-year follow-up study of treatment completers and noncompleters.

Introduction: The aim of this study was to compare the characteristics of patients who completed (completers) inpatient treatment of drug dependence with those who failed to complete this programme (noncompleters).

Method: Participants were assessed at admission using the Substance Abuse Assessment Questionnaire (SAAQ) to obtain information about the sociodemographic background, history of drug and alcohol use, physical health, mental health, offending behaviour, and interpersonal relationships. Follow-up interviews were carried out 3, 6, 9, and 12 months after discharge using the SAAQ-Follow-up.

Common guidelines and equitable service: variation between adjacent districts regarding admissions to elderly care institutions.

With the increasing number of older people, the cost of providing institutional care has become a major issue. In 1993 the introduction of care management and a needs-led approach aimed to remove the existing 'perverse incentive' to institutional care and to ensure equality in the dependency levels of those who were admitted to care. To test this consistency, we examined the dependency levels of all persons aged > or = 65 years admitted to residential and nursing homes in two adjacent Health and Social Services (HSS) Community Trusts in Belfast, Northern Ireland, in the year following the introduction of care management.