Factors affecting psychological well-being: Evidence from two nationally representative surveys.

Financial status is thought to be an important determinant of psychological well-being. We investigate this relationship, and the effect of other factors, using a parametric mixed modelling approach for panel data, controlling the problem of unobservable heterogeneity. Two nationally representative surveys, the British Household Panel Survey (BHPS) and the Understanding Society Survey (USS), were used to construct a unified data set which measured psychological well-being and associated factors using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 score for the head of the household was used as the dependant variable and its relationship with multiple independent demographic and financial status variables was investigated. Following assessment of growth curve characteristics with linear, curvilinear and higher-order polynomial modelling; several variance-covariance structures were tested to assess the error covariance structure of the longitudinal data. The random intercept and random slope were allowed to vary across participants, and methods such as natural splines and B-splines were used to improve the fit of some variables. Our final model demonstrated the most important variables affecting self-reported psychological well-being, as determined by GHQ-12, were perception and expectation of future financial situation and problems meeting household expenditure. Gender, age, marital status, number of children at home, highest qualification and job status were also significantly implicated. Unlike previous studies however we did not find that size of income was significant. These results provide further strong evidence of the impact that financial concerns have on self-reported measures of psychological well-being.

Change the habit to change the practice: Do audits really ever change anything?

INTRODUCTION: Methicillin resistant staphylococcus aureus (MRSA) eradication by nurses and pre-op induction antibiotics are mandated for emergency surgery, where true status is unknown. We assessed adherence to local MRSA guidelines for patients undergoing emergency hip fracture surgery and employed point of decision prompts to influence clinicians' behaviour. METHODS: We undertook a retrospective record review for all patients undergoing emergency hip fracture surgery at a UK major trauma centre over 3-months. Demographics, MRSA eradication therapy and antibiotics were recorded. Admission-to-MRSA swab result time was compared to the admit-to-operation time. Posters on induction antibiotics were placed in anaesthetic rooms, stickers on MRSA eradication therapy on nursing care bundles and standards re-audited after 6 months. RESULTS: The case-mix was similar in both audit cycles: initial audit (n=69, mean age 76.9, range 33-94), re-audit (n=77, mean age 73.8, range 18-95). There was a small rise in adherence to eradication therapy prescription (1% vs 8%) after sticker distribution, although compliance was poor pre and post intervention. Correct antibiotic choice for MRSA unknown patients (18% vs 94%) improved significantly after poster intervention. Operations occurred at a median of 24.05h (Q1 17.6, Q3 32.3) from admission but MRSA swab results returned at a median of 48h (Q1 41.5, Q3 59.5) p=<0.0001. CONCLUSION: Providing reminders at the points where decisions are to be made are effective. Audit interventions should be easily undertaken and will become habitual if connected in sequence to old behaviours.

Angiosarcoma and Dialysis-related Arteriovenous Fistulae: A Comprehensive Review.

OBJECTIVE/BACKGROUND: To conduct a comprehensive review of cases, presentation, diagnosis, and management of angiosarcoma in arteriovenous fistulae (AVF) created for haemodialysis. METHODS: Two authors independently conducted systematic searches and extraction of articles from the Embase, AMED, Health Management Information Consortium, and MEDLINE databases in keeping with the inclusion/exclusion criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. RESULTS: Twenty-two unique patient cases were identified; 20 of the cases were men and mean ± SD age of presentation was 54.9 ± 13.6 years. Nineteen cases were post-transplant and 18 were on antirejection agents. The most common presenting symptom was pain, with or without a mass. The initial diagnosis was most often thrombosis/infection of the AVF and the diagnostic interval to a correct diagnosis of angiosarcoma was between 2 and 40 weeks. Mean ± SD time to presentation of symptoms from fistula formation was 118.9 ± 57.5 months, while from transplant it was 96.9 ± 70.0 months. Amputation was the most common treatment modality and mean ± SD survival was 8.8 ± 3.7 months. CONCLUSION: Angiosarcoma should be suspected in previously quiescent AVF that presents with pain. The presence of a rapidly enlarging mass or bleeding/bruising should be taken as alarm indicators and warrant urgent investigation in accordance with local cancer guidelines. Any surgical procedure should involve histological samples as a matter of course.

Clinical assessment of carotid atherosclerosis inflammation by positron emission tomography.

Stroke caused by carotid atherosclerosis is a leading cause of mortality and the leading cause of disability in the developed world. For carotid plaques within the neurovascular territory of a recent stroke or transient ischaemic attack, surgical removal of the plaque (endarterectomy) has been clearly shown to reduce future cerebrovascular events. Management of asymptomatic plaques, however, is less clear because only a minority of these plaques will ultimately become symptomatic. Inflammation is a key feature which predicts whether a plaque is likely to rupture and hence lead to stroke. By identifying inflammation in vivo, positron emission tomography (PET) may be able to identify high risk plaques. This will allow clinicians to target intensive medical or surgical treatment to high risk patients.