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About 5% of the UK population are military veterans and have specific medical needs sometimes different from the general population. Veterans may be reluctant to seek help or talk about their problems, which means they do not always access care, support and treatments that are available. Others may face difficulty getting the right help. Veterans may think ‘civilians’ do not understand military culture or know about options for help and services that are available. Experience has shown that general practitioners (GPs) would like more help and support when looking after veterans. The Royal College of General Practitioners has developed the ‘Veteran Friendly GP Practice Accreditation Programme’, which involves a simple online process of accreditation where practices are required to meet the specified criteria and provide evidence that they are supportive of veterans’ healthcare. The aim is to improve healthcare provided to veterans and their families by GPs working in primary healthcare.

Objectives To assess the knowledge of members of the Royal College of General Practitioners (RCGP) on veteran's health issues, assess present support, and establish what support is required for GPs when treating veterans. Methods An electronic survey of RCGP members across selected faculties. Results Forty-seven per cent of respondents were 'unsure' or 'didn't know' how many veterans they were responsible for. However, many GPs replied that they had seen a veteran in the last month. Only 7.9% of respondents used the unique Read Code for veterans. Disappointingly, 75% of GPs indicated that they had not seen the RCGP leaflet on veterans' health, and less than 2% had used the RCGP On-Line e-learning resource. Conclusions Surveyed GPs had little understanding of how many veterans were registered with their practice, and only a few had accessed learning resources available. GPs requested more information on how to assess veterans and where they could be referred. Further work is required to identify the true size of the problem, while continuing to provide proactive guidance and support to GPs on the health needs of veterans.

Background Qualitative and quantitative assessment of renal blood flow is valuable in the evaluation of patients with renal and renovascular diseases as well as in patients with heart failure. The temporal pattern of renal flow velocity through the cardiac cycle provides important information about renal haemodynamics. High temporal resolution interleaved spiral phase velocity mapping could potentially be used to study temporal patterns of flow and measure resistive and pulsatility indices which are measures of downstream resistance. Methods A retrospectively gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Phase velocity maps were acquired in the proximal right and left arteries of 10 healthy subjects in each of two separate scanning sessions. Each acquisition was analysed by two independent observers who calculated the resistive index (RI), the pulsatility index (PI), the mean flow velocity and the renal artery blood flow (RABF). Inter-study and inter-observer reproducibility of each variable was determined as the mean +/− standard deviation of the differences between paired values. The effect of background phase errors on each parameter was investigated. Results RI, PI, mean velocity and RABF per kidney were 0.71+/− 0.06, 1.47 +/− 0.29, 253.5 +/− 65.2 mm/s and 413 +/− 122 ml/min respectively. The inter-study reproducibilities were: RI −0.00 +/− 0.04 , PI −0.03 +/− 0.17, mean velocity −6.7 +/− 31.1 mm/s and RABF per kidney 17.9 +/− 44.8 ml/min. The effect of background phase errors was negligible (<2% for each parameter). Conclusions High temporal resolution breath-hold spiral phase velocity mapping allows reproducible assessment of renal pulsatility indices and RABF.

Outcomes of metastatic papillary renal cell carcinoma (pRCC) patients are poorly characterized in the era of targeted therapy. A total of 5474 patients with metastatic renal cell carcinoma (mRCC) in the International mRCC Database Consortium (IMDC) were retrospectively analyzed. Outcomes were compared between clear cell (ccRCC; n = 5008) and papillary patients (n = 466), and recorded type I and type II papillary patients (n = 30 and n = 165, respectively). Overall survival (OS), progression‐free survival (PFS), and overall response rate (ORR) favored ccRCC over pRCC. OS was 8 months longer in ccRCC patients and the hazard ratio of death was 0.71 for ccRCC patients. No differences in PFS or ORR were detected between type I and II PRCC in this limited dataset. The median OS for type I pRCC was 20.0 months while the median OS for type II was 12.6 months (P = 0.096). The IMDC prognostic model was able to stratify pRCC patients into favorable risk (OS = 34.1 months), intermediate risk (OS = 17.0 months), and poor‐risk groups (OS = 6.0 months). pRCC patient outcomes were inferior to ccRCC, even after controlling for IMDC prognostic factors. The IMDC prognostic model was able to effectively stratify pRCC patients. We show that pRCC patients have significantly worse outcomes than ccRCC patients, that no targeted therapy to date is superior to one‐another, and that metastatic type I pRCC is far less common than type II but may convey a better survival outcome. Furthermore, this is the first study to demonstrate that the IMDC prognostic model effectively stratifies pRCC patients into good, intermediate, or poor‐risk groups, providing physicians with more evidence to inform patients of their expected prognosis.

Background Temporal patterns of coronary blood flow velocity can provide important information on disease state and are currently assessed invasively using a Doppler guidewire. A non-invasive alternative would be beneficial as it would allow study of a wider patient population and serial scanning. Methods A retrospectively-gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Velocity maps were acquired in 8 proximal right and 15 proximal left coronary arteries of 18 subjects who had previously had a Doppler guidewire study at the time of coronary angiography. Cardiovascular magnetic resonance (CMR) velocity-time curves were processed semi-automatically and compared with corresponding invasive Doppler data. Results When corrected for differences in heart rate between the two studies, CMR mean velocity through the cardiac cycle, peak systolic velocity (PSV) and peak diastolic velocity (PDV) were approximately 40 % of the peak Doppler values with a moderate - good linear relationship between the two techniques (R 2 : 0.57, 0.64 and 0.79 respectively). CMR values of PDV/PSV showed a strong linear relationship with Doppler values with a slope close to unity (0.89 and 0.90 for right and left arteries respectively). In individual vessels, plots of CMR velocities at all cardiac phases against corresponding Doppler velocities showed a consistent linear relationship between the two with high R 2 values (mean +/−SD: 0.79 +/−.13). Conclusions High temporal resolution breath-hold spiral phase velocity mapping underestimates absolute values of coronary flow velocity but allows accurate assessment of the temporal patterns of blood flow.

Background Qualitative and quantitative assessment of renal blood flow is valuable in the evaluation of patients with renal and renovascular diseases as well as in patients with heart failure. The temporal pattern of renal flow velocity through the cardiac cycle provides important information about renal haemodynamics. High temporal resolution interleaved spiral phase velocity mapping could potentially be used to study temporal patterns of flow and measure resistive and pulsatility indices which are measures of downstream resistance. Methods A retrospectively gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Phase velocity maps were acquired in the proximal right and left arteries of 10 healthy subjects in each of two separate scanning sessions. Each acquisition was analysed by two independent observers who calculated the resistive index (RI), the pulsatility index (PI), the mean flow velocity and the renal artery blood flow (RABF). Inter-study and inter-observer reproducibility of each variable was determined as the mean +/- standard deviation of the differences between paired values. The effect of background phase errors on each parameter was investigated. Results RI, PI, mean velocity and RABF per kidney were 0.71+/- 0.06, 1.47 +/- 0.29, 253.5 +/- 65.2 mm/s and 413 +/- 122 ml/min respectively. The inter-study reproducibilities were: RI -0.00 +/- 0.04 , PI -0.03 +/- 0.17, mean velocity -6.7 +/- 31.1 mm/s and RABF per kidney 17.9 +/- 44.8 ml/min. The effect of background phase errors was negligible (<2% for each parameter). Conclusions High temporal resolution breath-hold spiral phase velocity mapping allows reproducible assessment of renal pulsatility indices and RABF. Keywords: Spiral, Phase velocity mapping, Renal blood flow, Resistive index, Pulsatility index, Reproducibility

Doc number: E42

Doc number: P133

In most conflicts there is the potential that there will be Captured Persons (CPERS) whose medical care is the responsibility of the capturing army. The standard of this care should be to the same standard as that afforded to one's own troops. However the medical practicalities of maintaining such standards can be difficult. This article reviews the practicalities of the medical care of CPERS as part of the UK deployment in Afghanistan on Operation HERRICK.