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IntroductionYoung people with type 1 diabetes face considerable demands in managing their condition: monitoring and treatment, lifestyle adaptations, and increasing independence and autonomy over their health. Group-consultations(shared medical appointments) are likened to a ‘learning community’, in which bonds between participants can give them more motivation to share common struggles and offer support and solutions to one another.Aim:In this paper, we describe the development, implementation and evaluation of a school-based group-consultation model, designed with continuous patient involvement and comprehensive stakeholder engagement. In this iteration of our school-based model, a 2-hour session was delivered to a group of 6 young people, in the absence of their parents, requiring a single facilitator and two clinicians.Population and stakeholder engagementConsultation design has been informed by (1) patient and parent involvement, (2) engagement of the diabetes multidisciplinary team, (3) literature review of peer-reviewed papers reporting experience with group-consultations.Timeline:Design, planning stage and implementing of our first iteration was completed within a 2-month period. A second iteration modified in accordance with our evaluation (below) is planned.Highlights, innovations, outcomesWe adopted a multimodal approach in assessing outcomes that are relevant and impactful for patients. All participants communicated that their experience was positive. When asked: “If you were invited to another group-consultation, would you like to attend?” All participants answered yes. Group discussion revealed some misconceptions and importantly, a strong desire to learn about the biology of type 1 diabetes, and the relevance of HbA1c. All clinicians involved expressed strongly positive views about the consultation, particularly noting the value of shared learning, and of adding variation to clinical practice.Feedback illustrates that young people were given greater opportunity to steer discussion to address their concerns, benefited from peer-to-peer learning, and felt supported to share care constructively with their parents. Patients and clinicians alike highlighted the benefits in the school setting, where familiarity has a role in making young people more able to draw personal value from the consultation.Sustainability:Our experience indicates a school-based model can be implemented without use of additional space, time or staff. Additionally, the setting of a school has the added advantage of having no estate costs, no travel costs for young people and minimal disruption to the routines of young people and their families.TransferabilityGroup-consultation model are increasingly adopted across both paediatric and adult populations to manage long-term conditions in young people, including asthma and epilepsy. Our group are exploring the use of group consultations in children with asthma, in addition to evaluating differing consultation models.DiscussionOur development and evaluation demonstrates that group consultations are acceptable, popular and effective in young people with type 1 diabetes. Our experience demonstrates that previously unacknowledged gaps in knowledge, or psychosocial stressors, can be brought to light through group-consultations. The impact of these benefits may extend to patients’ medication adherence, school and social functioning and overall health and lifestyle behaviours. Our results indicate good compatibility and few barriers, which we attribute to our patient-led design process.

Background: CXCL12 (SDF1) is reported to promote cancer progression in several preclinical models and this is corroborated by the analysis of human tissue specimens. However, the relationship between CXCL12 expression and cancer survival has not been systematically assessed. Methods: We conducted a systematic review and meta-analysis of studies that evaluated the association between CXCL12 expression and cancer survival. Results: Thirty-eight studies inclusive of 5807 patients were included in the analysis of overall, recurrence-free or cancer-specific survival, the majority of which were retrospective. The pooled hazard ratios (HRs) for overall and recurrence-free survival in patients with high CXCL12 expression were 1.39 (95% CI: 1.17–1.65, P =0.0002) and 1.12 (95% CI: 0.82–1.53, P =0.48) respectively, but with significant heterogeneity between studies. On subgroup analysis by cancer type, high CXCL12 expression was associated with reduced overall survival in patients with oesophagogastric (HR 2.08; 95% CI: 1.31–3.33, P =0.002), pancreatic (HR 1.54; 95% CI: 1.21–1.97, P =0.0005) and lung cancer (HR 1.37; 95% CI: 1.08–1.75, P =0.01), whereas in breast cancer patients high CXCL12 expression conferred an overall survival advantage (HR 0.5; 95% CI: 0.38–0.66, P <0.00001). Conclusions: Determination of CXCL12 expression has the potential to be of use as a cancer biomarker and adds prognostic information in various cancer types. Prospective or prospective–retrospective analyses of CXCL12 expression in clearly defined cancer cohorts are now required to advance our understanding of the relationship between CXCL12 expression and cancer outcome.

This study is a systematic review. Congenital upper limb anomalies (CULAs) are often associated with psychosocial difficulties including negative body image, low self-esteem, and withdrawal from social activities. The purpose of the study was to identify, describe, and evaluate all published psychosocial assessment tools used in the assessment and management of CULAs, to direct the use of these tools in clinical practice, and to identify areas requiring development. A systematic search of Medline, EMBASE, Pubmed, and PsychInfo databases was performed. In total, 23 studies were included for analysis. Data extracted included study and population characteristics, psychosocial measures utilized, psychosocial outcomes reported, and the reliability and validity of measures. Seventeen patient-reported measures were identified. The most commonly used tool was a Likert scale (n =7) with satisfaction with appearance and function, the most commonly evaluated outcome (n = 18). Other evaluated domains included quality of life or psychosocial functioning (n = 9), self-image (n = 2), and psychological well-being (n = 5). There is no well-established, validated assessment tool in regular use to effectively address psychosocial outcomes for children with CULAs. Although the majority of children born with a CULA appear to adjust well, this is by no means the case for all children. There is a need for routine psychosocial evaluation preoperatively and postoperatively with long-term follow-up data to help direct patient-orientated management. A clear understanding of these, and how to measure them, is needed to help for a patient-centred, multidisciplinary, evidence-driven approach to CULA management. •Congenital upper limb anomalies are often associated with psychosocial difficulties.•Limited consensus between studies with regard to the extent of these difficulties.•There is no validated psychological assessment tool for the CULA population.•Consensus needed regarding most appropriate psychosocial well-being assessment tool.

To analyze antipsychotic prescribing patterns in a UK high security hospital (HSH) that treats seriously violent men with either schizophrenia or personality disorder and examine how different groups consented to treatment and prescribing for metabolic conditions. We hypothesized that there would be high prevalence of antipsychotic polypharmacy, and high-dose antipsychotic and clozapine prescribing. HSHs treat seriously violent, mentally disordered offenders, and the extant literature on prescribing patterns in forensic settings is sparse. Prescribing and clinical data on all 189 patients in a UK HSH were collected from the hospital's databases. Data were analyzed using SPSS. The population was split into the following groups: schizophrenia spectrum disorder (SSD-only), personality disorder (PD-only), and comorbid schizophrenia spectrum disorder and PD. The majority (93.7%) of all patients were prescribed at least one antipsychotic, and (27.5%) were on clozapine. Polypharmacy was prevalent in 22.2% and high-dose antipsychotic in 27.5%. Patients on clozapine were more likely to be prescribed antidiabetic, statins, or antihypertensive medication. Patients in the PD-only group were more likely to be deemed to have the capacity to consent to treatment and be prescribed clozapine in contrast to the SSD-only group. Rates of clozapine and high-dose antipsychotic prescribing were higher than in other psychiatric settings, while polypharmacy prescribing rates were lower. Higher clozapine prescribing rates may be a function of a treatment-resistant and aggressive population. A higher proportion of PD-only patients consented to treatment and received clozapine compared with in-house SSD-only as well as other psychiatric settings. Implications of the findings are discussed.