Explore the vast range of titles available.

Three medical conditions—cervical carotid artery disease, atrial fibrillation, and hypertension—cause the majority of strokes. Discovering these silent, immediate causes of stroke through screening, so they can be treated before stroke occurs, can potentially prevent strokes on an epidemiologic scale. A rapid, accurate, and cost-effective stroke prevention screening (SPS) protocol was developed. The SPS protocol was used to screen 6,073 seniors residing in the central valley of California, at Madigan Army Medical Center, at New York University, and by the American Vascular Association at 68 leading institutions. The screening was estimated to have prevented 30 strokes and to have saved the health care system >$2 million. Implementation of a national SPS for seniors can discover the silent, immediate causes of strokes so they can be managed before stroke occurs and can potentially prevent the majority of strokes that we are currently not preventing.

The Nurse Practitioner Planning Network (NPPN) is group representing professional associations, nursing regulatory bodies and organizations, provincial and territorial governments, and nurse educators. Organizations supporting the development of this project include the Canadian Nurses Association, the Canadian Association of University Schools of Nursing, the Aboriginal Nurses Association of Canada, the Nurse Practitioner Association of Ontario, and the provinces/territories of Newfoundland and Labrador, Nova Scotia, New Brunswick, Ontario, Saskatchewan, Manitoba, Alberta, British Columbia, the Yukon, the Northwest Territories and Nunavut; support from Quebec and PEI is also expected. Whue there is a large body of evidence that demonstrates that nurse practitioners can provide high-quality, cost-effective primary health care and play a critical role in primary health care renewal, the implementation of the nurse practitioner role in Canada has been sporadic and inconsistent. The Canadian public has limited understanding of the role of nurse practitioners and the scope of the health services they provide. Physicians, pharmacists, and other providers have different expectations and understandings of the scope of practice and competencies of their nurse practitioner colleagues. The five provinces that have passed legislation and have certification in place are not consistent regarding scope of practice, licensure or continuing competence requirements for nurse practitioners.

Objective We undertook this study to examine the X chromosome complement in participants with systemic sclerosis (SSc) as well as idiopathic inflammatory myopathies. Methods The participants met classification criteria for the diseases. All participants underwent single‐nucleotide polymorphism typing. We examined X and Y single‐nucleotide polymorphism heterogeneity to determine the number of X chromosomes. For statistical comparisons, we used χ2 analyses with calculation of 95% confidence intervals. Results Three of seventy men with SSc had 47,XXY (P = 0.0001 compared with control men). Among the 435 women with SSc, none had 47,XXX. Among 709 men with polymyositis or dermatomyositis (PM/DM), seven had 47,XXY (P = 0.0016), whereas among the 1783 women with PM/DM, two had 47,XXX. Of 147 men with inclusion body myositis (IBM), six had 47,XXY, and 1 of the 114 women with IBM had 47,XXX. For each of these myositis disease groups, the excess 47,XXY and/or 47,XXX was significantly higher compared with in controls as well as the known birth rate of Klinefelter syndrome or 47,XXX. Conclusion Klinefelter syndrome (47,XXY) is associated with SSc and idiopathic inflammatory myopathies, similar to other autoimmune diseases with type 1 interferon pathogenesis, namely, systemic lupus erythematosus and Sjögren syndrome.

Transition into adult services can be a challenging time, where young patients are very quickly expected to take responsibility for their own medical care. Studies have shown that transition can be linked to a decline in health, as patients struggle to cope with the stresses and demands that go with the change from paediatric to adult services. In order to support children through transition, GOSH launched ‘Growing Up, Gaining Independence’ support programme. To further develop the support available through this programme, the Audiology team designed a mobile app aimed at patients preparing to transition into adult care.As part of a joint collaboration between GOSH and UCL computer science (CS) through the industry exchange network, the prototype mobile app ‘Hear Me Out’ was developed using Ionic. In addition, a content management system was developed using NodeJS, with a MySQL database to allow content delivered via the app to be to edited and updated.The mobile app provides helpful information to patients and families, including features such as ‘MyStory’ that allows patients to log important events such as appointments or symptoms. The app has support in the form of a glossary to help patients to understand medical terminology and includes information on NHS support services that provide further patient support. The app is ready to be trialled with patients and families, to gather feedback on how the design and content can be improved. This app is an example of how technology can be developed to support children and young people gain independence and manage their medical care with confidence.

ObjectivesThe aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes.DesignDiscrete event simulation model using data from routine electronic health records from 2011.ParticipantsPatients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke.InterventionsIncluded existing versus previous (less same day clinics) and hypothetical service reconfiguration (7-day service with less availability of clinics per day).Outcome measuresThe primary outcome of the model was the prevalence of major stroke after TIA. Secondary outcomes included service costs (including those of treating subsequent stroke) and time to treatment and attainment of national targets for service provision (proportion of high-risk patients (according to ABCD2 score) seen within 24 hours).ResultsThe estimated costs of previous service provision for 490 patients (aged 74±12 years, 48.9% female and 23.6% high risk) per year at each site were £340 000 and £368 000, respectively. This resulted in 31% of high-risk patients seen within 24 hours of referral (47/150) with a median time from referral to clinic attendance/treatment of 1.15 days (IQR 0.93–2.88). The costs associated with the existing and hypothetical services decreased by £5000 at one site and increased £21 000 at the other site. Target attainment was improved to 79% (118/150). However, the median time to clinic attendance was only reduced to 0.85 days (IQR 0.17–0.99) and thus no appreciable impact on the modelled incidence of major stroke was observed (10.7 per year, 99% CI 10.5 to 10.9 (previous service) vs 10.6 per year, 99% CI 10.4 to 10.8 (existing service)).ConclusionsReconfiguration of services for TIA is effective at increasing target attainment, but in services which are already working efficiently (treating patients within 1–2 days), it has little estimated impact on clinical outcomes and increased investment may not be worthwhile.

The mental health needs of children and adolescents in secure care are a matter of concern, but little systematic research has been done. Our aim was to assess the mental health, social, and educational needs of these young people in a prospective, longitudinal study. We enrolled 97 boys aged 12–17 years who had been admitted to secure care. We assessed their needs (n=97) at the time of admission and 3 months later (n=90) with standardised interviews and psychometric tests. 26 (27%) boys had an intelligence quotient (IQ) of less than 70. The need for psychiatric help was high on admission to a secure unit, with the most frequent disorders being depression and anxiety. There were high rates of aggression, substance misuse, self harm, and social, family, and educational problems, and associated needs. The mean number of needs was 8·5 (SD 2·9) on admission and 2·9 (SD 2·4) after 3 months (mean difference 5·6, 95% CI 5·0–6·3). Areas in which needs were mostly met included education, substance misuse, self care, and diet. Areas where the frequency of need fell substantially, but remained high, were social and family problems, and aggressive behaviours. Psychological needs persisted, with new onsets of depression, anxiety problems, and post-traumatic-stress symptoms shortly after admission. The most frequently required interventions were psychological assessment and cognitive behavioural work. Boys in secure care have many needs and a high rate of psychiatric morbidity. During the admission period, secure care units address some domains of need, but others remain unchanged or get worse. Psychological and psychiatric provision in secure units need to be improved. Published online May 21, 2002. http://image.thelancet.com/extras/01art3150web.pdf

Longitudinal studies are helpful in understanding developmental trajectories and recognising opportunities for early intervention. This paper describes the long-term needs and mental health of an initial sample of male juvenile offenders, now adults 6 years after their index admission to secure care. In this prospective cohort study of 97 male juvenile offenders admitted to secure, offenders were assessed initially on admission, 2 and 6 years later. Interviews were conducted with 54 offenders at the 6-year follow-up and included an assessment of psychosocial need, mental health and psychopathy. Outcome data on offending behaviour were collected on a total of 71 offenders. Persistent offenders have needs in multiple domains as they transition into adulthood. The majority of offenders were single and about a half were in neither employment nor training. Almost nine out of ten offenders had a substance misuse disorder and a similar number met the criteria for a diagnosis of antisocial personality disorder. Substance misuse in adolescence was strongly correlated with later substance misuse in adulthood, emphasising the importance of early intervention. A diagnosis of antisocial personality disorder and living with friends and family were both significantly associated with persistent offending behaviour. Many offenders continued to reoffend despite receiving offence-related interventions and custodial care. Interventions currently aimed at reducing recidivism in more severe offenders appear to be ineffective. Persistent offenders would benefit from a multi-modal approach based on individual needs, rather than receiving generic interventions.