The effect of multidisciplinary team care on cancer management.

Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit.

Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction.

Background: It is widely believed that cardiac rehabilitation following acute myocardial infarction (MI) reduces mortality by approximately 20%. This belief is based on systematic reviews and meta-analyses of mostly small trials undertaken many years ago. Clinical management has been transformed in the past 30-40 years and the findings of historical trials may have little relevance now.

Neural tube defects in Wales: changing demographics from 1998 to 2009.

Objective: To establish if there is evidence for the perceived increase in the number of live births with a Neural tube defect (NTD) in South Wales from 1998 to 2009.

Methods: Data was obtained from the Congenital Abnormalities Register Information Services (CARIS), which recorded 305 cases of pregnancies involving neural tube defects. Descriptive analysis was carried out for each year in this period to obtain the number of live births, the proportion of live births compared to NTD pregnancies, plus the number and the percentage terminated each year.

Effect of inspiratory muscle training intensities on pulmonary function and work capacity in people who are healthy: a randomized controlled trial.

Background: Inspiratory muscle training (IMT) has been shown to improve inspiratory muscle function, lung volumes (vital capacity [VC] and total lung capacity [TLC]), work capacity, and power output in people who are healthy; however, no data exist that demonstrate the effect of varying intensities of IMT to produce these outcomes.

Objectives: The purpose of this study was to evaluate the impact of IMT at varying intensities on inspiratory muscle function, VC, TLC, work capacity, and power output in people who are healthy.

Design: This was a randomized controlled trial.

The prevention of cervical cancer in Africa.

In this article we aim to draw attention to the burden of cervical cancer in Africa for reproductive health and review strategies for prevention, including appropriate noncytology-based cervical screening and prophylactic human papillomavirus vaccination. We consider the heavy burden of disease attributable to human papillomavirus infection borne by developing countries, particularly in Africa. Following identification of the human papillomavirus as the infectious etiological agent and elucidation of the long natural history of cervical neoplasia, cervical cancer is now one of the most preventable of all cancers.

Diabetes, metformin and lactic acidosis.

Objective: Metformin has long been thought to cause lactic acidosis (LA) but evidence from various sources has led researchers to question a direct causative relationship. We assessed the relationship of metformin prescription and other factors to the incidence of LA.

Methods: All cases of LA at a single hospital were identified from laboratory lactate measurements.

Which injuries may indicate child abuse?

Making the decision as to whether an injury is a result of child abuse or not is stressful for both the family involved and the clinical team. It is not a decision that is taken lightly, and with an increasing expectation by the investigating agencies, lawyers and the public in general, to ensure that it is based on explicit 'evidence', clinicians need to be up to date with the latest scientific publications in the field. This article aims to summarise the current evidence in relation to all physical injuries except those pertaining to the central nervous system, which will form a separate article.

Review article: Left ventricular dysfunction and heart failure in metabolic syndrome and diabetes without overt coronary artery disease--do we need to screen our patients?

The metabolic syndrome and its components, glucose intolerance, T2DM, hypertension, dyslipidaemia and obesity are increasingly common. Patients with the metabolic syndrome have a higher prevalence of chronic heart failure (CHF) and, once diagnosed, CHF in such subjects is associated with a higher mortality than in those without this co-morbidity. However, early diagnosis of LV systolic dysfunction and symptomatic heart failure may prevent deterioration of heart failure and improve prognosis.

Trabecular bone strains around a dental implant and associated micromotions--a micro-CT-based three-dimensional finite element study.

The first objective of this computational study was to assess the strain magnitude and distribution within the three-dimensional (3D) trabecular bone structure around an osseointegrated dental implant loaded axially. The second objective was to investigate the relative micromotions between the implant and the surrounding bone. The work hypothesis adopted was that these virtual measurements would be a useful indicator of bone adaptation (resorption, homeostasis, formation).

Expression of the ERM family members (ezrin, radixin and moesin) in breast cancer.

The ERM family is composed of the proteins ezrin, moesin and radixin, which are cell structure-related proteins. Despite the detection of viable roles of ERM family proteins, the impact of these molecules in cancer pathogenesis has yet to be investigated. Evidence emerging from clinical and translational studies showed that the ERM family is linked to disease progression in clinical cancers.

A rare and life-threatening cause of pseudo-obstruction in two surgical patients.

We describe two patients who presented with non-mechanical bowel obstruction as a consequence of an underlying, undiagnosed phaeochromocytoma. The first patient was referred by his general practitioner with signs and symptoms of small bowel obstruction on a background of frequent constipation. An abdominal scan revealed an adrenal tumour (subsequently found to be a phaeochromocytoma) but no structural cause for obstruction.

The molecular basis of lactose intolerance.

A staggering 4000 million people cannot digest lactose, the sugar in milk, properly. All mammals, apart from white Northern Europeans and few tribes in Africa and Asia, lose most of their lactase, the enzyme that cleaves lactose into galactose and glucose, after weaning. Lactose intolerance causes gut and a range of systemic symptoms, though the threshold to lactose varies considerably between ethnic groups and individuals within a group.

Mediation by illness perceptions of the effect of personality and health threat communication on coping with the diagnosis of diabetes.

Objectives: (1) To examine the relationship of personality traits and diabetes health threat communication (DHTC) to the coping strategies of newly diagnosed diabetes patients; (2) to determine to what extent these postulated effects are mediated by illness representations (IRs).

Design: A longitudinal prospective study based on the common sense model.

Methods: Patients were assessed shortly after diagnosis and 2 years after the diagnosis of diabetes.

Relationship between malocclusion, orthodontic treatment, and tooth wear.

Introduction: Although the association between orthodontic treatment and dental health has been studied previously, no studies have hitherto investigated whether the need for, or the receipt of, orthodontic treatment leads to differences in tooth wear in the long term.

Methods: In this retrospective, cross-sectional, association study, an index specifically designed for dental study casts was used to examine tooth wear in 307 adults aged 30 to 31 years.

Results: The men showed significantly higher levels of tooth wear than did the women.

Genetic overlap between measures of hyperactivity/inattention and mood in children and adolescents.

Objective: Evidence suggests that there is substantial comorbidity between attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder in childhood and adolescence. This study aims to investigate the degree to which etiological factors are shared between the symptoms of these significantly heritable disorders.

Method: A twin study design was used to determine to what extent the covariation between the traits of ADHD and depression is genetically or environmentally mediated, based on parental reports.

A pilot study of the use and perceived utility of a scale to assess clinical dental teaching within a UK dental school restorative department.

Introduction: Feedback on individual teaching performance gives an important contribution and support to the reflective practices of educators. Unfortunately, feedback is an infrequent exercise provided to dental teachers about their teaching practices. The Effective Clinical Dental Teaching (ECDT) scale has been used previously to assess clinical teachers, but has not been used within the UK.

P2RX7: A bipolar and unipolar disorder candidate susceptibility gene?

The chromosomal region 12q24 has been previously implicated by linkage studies of both bipolar disorder and unipolar mood disorder and we have reported two pedigrees segregating both bipolar disorder and Darier's disease that show linkage across this region. The gene P2RX7 is located in this chromosomal region and has been recently reported as a susceptibility gene for bipolar disorder and unipolar depression. The non-synonymous SNP rs2230912 (resulting in amino-acid polymorphism Q460R) showed the strongest association and has been postulated to be pathogenically relevant.

The importance of health belief models in determining self-care behaviour in diabetes.

Patients' self-care behaviours have a major role in diabetes management. Diabetes education provides the required knowledge, but despite this, self-care is often suboptimal. The degree to which patients follow advice as regards the various self-care behaviours is determined by their health beliefs (Illness Representations or Personal Models) of diabetes.