Continuity of care and consultation mode in general practice: a cross-sectional and longitudinal study using patient-level and practice-level data from before and during the COVID-19 pandemic in England.

Objectives: Investigate trends in continuity of care with a general practitioner (GP) before and during the COVID-19 pandemic. Identify whether continuity of care is associated with consultation mode, controlling for other patient and practice characteristics.

Design: Retrospective cross-sectional and longitudinal observational studies.

Effect of an integrated care pathway on use of primary and secondary healthcare by patients at high risk of emergency inpatient admission: a matched control cohort study in Tower Hamlets.

Objectives: To assess the effects of an integrated care pathway on the use of primary and secondary healthcare by patients at high risk of emergency inpatient admission.

Design: Observational study of a real-life deployment of integrated care, using patient-level administrative data. Regression analysis was used to compare integrated care patients with matched controls.

Thoracoscore and European Society Objective Score Fail to Predict Mortality in the UK.

Background: Thoracoscore and the European Society Objective Score (ESOS.01) are two scoring systems used in thoracic surgery to estimate operative mortality risk. We aimed to evaluate if these are valid tools for use in the UK population.

The effects of the school environment on student health: a systematic review of multi-level studies.

Health outcomes vary between schools and it is theorised that this may be partly attributable to variation in the school environment. Existing systematic reviews have not drawn authoritative conclusions because of methodological limitations in the review or studies available. We identified 42 multi-level studies, ten of which were judged of sufficient quality to narratively synthesize.

Road traffic accident fatalities: 1961 to 1986.

The various trauma-induced pathologies found at necropsy following road traffic accidents in the Bassetlaw area of Nottinghamshire from 1961 to 1986 were recorded and related to the time of death. The catchment area was mainly rural, including stretches of the A1 and A57, but included two small towns (Worksop and Retford). Pick up times varied considerably depending on the site of the accident, extraction procedures and ambulance journey distance.

Diagnosing an American Psycho.

This paper provides an illustration of problems in making diagnosis based on a single film. American Psycho provides an overview of the personality traits of an individual who may be suffering from a number of potential conditions. These are discussed in relation to diagnostic categories.

Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature.

We present our experience and also review the world literature on the management of retrosternal goitres (RSGs). There is now irrefutable evidence that almost all RSGs will continue to grow and eventually cause airway compression. We describe the diagnosis, investigation and surgical approach to the management of this condition.

Pericardio-diaphragmatic avulsion and concomitant rupture of the central tendon of the diaphragm.

Two patients, treated for blunt thoracoabdominal trauma with ruptured diaphragm and concomitant avulsion of the pericardial sac in its entirety from the central tendon of the diaphragm, are presented. We do not think this entity has been reported before. We explain this type of lesion on the basis of embryological development of the pericardium at the level of the central tendon of the diaphragm.

A possible terrestrial analogue for haematite concretions on Mars.

Recent exploration has revealed extensive geological evidence for a water-rich past in the shallow subsurface of Mars. Images of in situ and loose accumulations of abundant, haematite-rich spherical balls from the Mars Exploration Rover 'Opportunity' landing site at Meridiani Planum bear a striking resemblance to diagenetic (post-depositional), haematite-cemented concretions found in the Jurassic Navajo Sandstone of southern Utah. Here we compare the spherical concretions imaged on Mars to these terrestrial concretions, and investigate the implications for analogous groundwater-related formation mechanisms.

Surgical management of large rotator cuff tears combined with instability in elite rugby football players.

Large rotator cuff tears are extremely uncommon in young people and when they occur they may be associated with shoulder instability. This paper reports on a series of six elite rugby union and rugby league footballers who presented with shoulder instability and large rotator cuff tears. They were treated with a two stage procedure: an open rotator cuff repair followed by an open shoulder stabilisation some 10 weeks later.

Management of the submerged deciduous tooth: I. Aetiology, diagnosis and potential consequences.

The management of submerged deciduous teeth can present a dilemma for general practitioner and specialist alike. These teeth are often extracted to avoid potential problems. The recent literature, mainly publications in specialist journals of paediatric dentistry and orthodontics, suggests that a conservative approach is often preferable, particularly when the permanent successor is present.

Management of the submerged deciduous tooth: 2. Treatment.

The previous article in this series dealt with the aetiology, diagnosis and potential consequences of submerging deciduous teeth. This paper will discuss the appropriate treatment options. The management is highly dependent on whether the permanent successor is present or absent.

Cisplatin induces N-acetyl cysteine suppressible F2-isoprostane production and injury in renal tubular epithelial cells.

In the low intracellular chloride milieu, chloride ions of cisplatin may exchange for cellular SH moieties resulting in glutathione depletion, H2O2 accumulation, and lipid peroxidation. Cisplatin-induced lipid peroxidation, in addition to causing direct cellular injury, may further contribute to cisplatin-induced renal dysfunction by generating vasoconstrictive E2- and F2-isoprostanes. The aim of this study was to determine whether cisplatin-induced renal epithelial (LLC-PK1 and primary human proximal tubular) cell injury is associated with increased production of isoprostanes, and whether this can be suppressed with a thiol donor, N-acetyl cysteine.

An 11-month-old with anti-glomerular basement membrane disease.

Anti-glomerular basement membrane antibody disease is an autoimmune disease that has rarely been described in children, and no cases have previously been described in a patient younger than 2.5 years of age. We report an 11-month-old infant girl who developed anti-glomerular basement membrane disease and progressed to end-stage renal disease and eventual renal transplantation.

Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus.

Ninety-one patients with dilated cardiomyopathy were studied by two-dimensional, pulsed, and color Doppler echocardiography (1) to detect and quantify mitral regurgitation (MR), (2) to record apical flow velocities in systole and diastole, and (3) to detect the presence of left ventricular thrombi. MR was detected in 57% of the patients and thrombi were present in 40%, but the occurrence of both MR and thrombus was rare (8%). Apical flow velocity was significantly higher throughout the cardiac cycle in the group with MR (diastole 15 +/- 7 vs 9 +/- 7 cm/sec; systole 29 +/- 12 vs 16 +/- 13 cm/sec; p less than 0.

Flow patterns in dilated cardiomyopathy: a pulsed-wave and color flow Doppler study.

In 48 patients with dilated cardiomyopathy, pulsed-wave and color Doppler examination were performed. In addition, 14 normal patients served as control subjects. Peak inflow velocity at the level of the mitral valve, middle left ventricle, and apex and outflow velocity at the level of the apex, middle left ventricle, and subaortic area were measured.

Flow characteristics in the dilated left ventricle with thrombus: qualitative and quantitative Doppler analysis.

In an attempt to determine whether mural thrombus in a dilated left ventricle is associated with specific flow patterns, a study was undertaken to assess qualitatively and quantitatively the flow characteristics by conventional pulsed and two-dimensional Doppler color flow examination. Forty patients with cardiomyopathy formed the study group (20 with an apical thrombus and 20 without). The groups did not differ with respect to age, gender, origin of ventricular dysfunction, ventricular size and ejection fraction.

Doppler evaluation of changing cardiac dynamics during Cheyne-Stokes respiration.

For the purpose of elucidating the mechanisms and/or effects of the cardiovascular changes occurring during Cheyne-Stokes respiration, we utilized Doppler echocardiography to determine intracardiac flow velocity profiles during the changing phases. Left ventricular inflow (LVI) and outflow (LVO) were examined in ten patients, nine with heart failure and one with a cerebrovascular accident. The mean LVI, peak early (E) and late diastolic (A) and LVO velocities were measured at the end of both the hyperpneic and apneic phases.