A scoping review of risk-stratified bowel screening: current evidence, future directions.

PURPOSE: In this scoping review, we examined the international literature on risk-stratified bowel screening to develop recommendations for future research, practice and policy. METHODS: Six electronic databases were searched from inception to 18 October 2021: Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Forward and backwards citation searches were also undertaken. All relevant literature were included. RESULTS: After de-deduplication, 3,629 records remained. 3,416 were excluded at the title/abstract screening stage. A further 111 were excluded at full-text screening stage. In total, 102 unique studies were included. Results showed that risk-stratified bowel screening programmes can potentially improve diagnostic performance, but there is a lack of information on longer-term outcomes. Risk models do appear to show promise in refining existing risk stratification guidelines but most were not externally validated and less than half achieved good discriminatory power. Risk assessment tools in primary care have the potential for high levels of acceptability and uptake, and therefore, could form an important component of future risk-stratified bowel screening programmes, but sometimes the screening recommendations were not adhered to by the patient or healthcare provider. The review identified important knowledge gaps, most notably in the area of organisation of screening services due to few pilots, and what risk stratification might mean for inequalities. CONCLUSION: We recommend that future research focuses on what organisational challenges risk-stratified bowel screening may face and a consideration of inequalities in any changes to organised bowel screening programmes.

A systematic review of the effectiveness of individual, community and societal-level interventions at reducing socio-economic inequalities in obesity among adults.

BACKGROUND: Socioeconomic inequalities in obesity are well established in high-income countries. There is a lack of evidence of the types of intervention that are effective in reducing these inequalities among adults. OBJECTIVES: To systematically review studies of the effectiveness of individual, community and societal interventions in reducing socio-economic inequalities in obesity among adults. METHODS: Nine electronic databases were searched from start date to October 2012 along with website and grey literature searches. The review examined the best available international evidence (both experimental and observational) of interventions at an individual, community and societal level that might reduce inequalities in obesity among adults (aged 18 years or over) in any setting and country. Studies were included if they reported a body fatness-related outcome and if they included a measure of socio-economic status. Data extraction and quality appraisal were conducted using established mechanisms and narrative synthesis was conducted. RESULTS: The 'best available' international evidence was provided by 20 studies. At the individual level, there was evidence of the effectiveness of primary care delivered tailored weight loss programmes among deprived groups. Community based behavioural weight loss interventions and community diet clubs (including workplace ones) also had some evidence of effectiveness-at least in the short term. Societal level evaluations were few, low quality and inconclusive. Further, there was little evidence of long term effectiveness, and few studies of men or outside the USA. However, there was no evidence to suggest that interventions increase inequalities. CONCLUSIONS: The best available international evidence suggests that some individual and community-based interventions may be effective in reducing socio-economic inequalities in obesity among adults in the short term. Further research is required particularly of more complex, multi-faceted and societal-level interventions.

Defying deprivation: a cross-sectional analysis of area level health resilience in England.

Previous research has found evidence that some economically deprived areas in England exhibit 'health resilience' in terms of lower than expected mortality rates. Consistent with earlier research we analysed area 'resilience' for parliamentary constituencies and our work extends previous research by including measures of morbidity. Standardised Morbidity Ratios (SMRs) of self-reported general health, limiting long-term illness, emergency hospital admissions, and CHD hospital admissions were derived from the 2001 UK Census and 2001 Hospital Episodes Statistics, and combined into a Composite Morbidity Index (CMI). Area variation in the CMI was compared with previous findings about mortality rates. Multiple Correspondence Analysis (MCA) was used to test the associations between area level 'health resilience' and ethnic composition, residential mobility, employment type, housing tenure, and an indicator of social cohesion. Nine areas were 'resilient' in terms of morbidity. Only four areas of England exhibited 'health resilience' in terms of both mortality and morbidity. MCA revealed that there may be several factors associated with greater 'health resilience'.

BASH: a tool for managing BeadArray spatial artefacts.

SUMMARY: With their many replicates and their random layouts, Illumina BeadArrays provide greater scope fordetecting spatial artefacts than do other microarray technologies. They are also robust to artefact exclusion, yet there is a lack of tools that can perform these tasks for Illumina. We present BASH, a tool for this purpose. BASH adopts the concepts of Harshlight, but implements them in a manner that utilizes the unique characteristics of the Illumina technology. Using bead-level data, spatial artefacts of various kinds can thus be identified and excluded from further analyses. AVAILABILITY: The beadarray Bioconductor package (version 1.10 onwards), www.bioconductor.org

How to involve staff in developing an outcomes-oriented organization.

Outcomes management requires the active participation of clinical staff and/or network providers to succeed. They form the bedrock of the system, since they are the ones who most typically administer the outcomes assessment questionnaires to consumers, encourage them to complete them, and respond to questions and complaints about them. Resistance from clinicians can cause even the most well-designed outcomes management system to fail. Yet with the application of several basic principles, organizations can maximize active participation from its clinicians to operate a dynamic outcomes management system. The authors of this article describe the principles involved, and the action steps necessary to implement them. These principles include: articulate the value of the outcomes management system, involve clinical staff in its design, make it relevant to treatment goals, assure clinicians the system will not be used punitively, show them how it will be used to improve treatment, obtain staff feedback routinely on how the system is working, and demonstrate how the organizational culture from top management down uses the outcomes information to make decisions.

The treatment of rupture of the pregnant uterus. Analysis of 93 cases treated in a rural hospital in Zambia.

In this study 93 cases of uterine rupture, treated in a rural hospital in Zambia have been analyzed. Clinical characteristics and mortality rate were found to be comparable to those reported in other series from developing countries. An attempt was made to compare the outcome of various surgical procedures. No statistically significant differences were found between the mortality rates after repair, subtotal and total hysterectomy (12%, 13% and 28%, respectively). A survey of recent literature on the treatment of uterine rupture in developing countries revealed a wide divergence of opinions and criteria of selection, precluding reliable comparisons. A proposition for individualized treatment is outlined, concluding that repair should be performed when suitable but that hysterectomy is preferable when the tear is extensive, bruised and contaminated.

Splenectomy in chronic myeloid leukaemia. A case report and review.

We report the case of a man with chronic myeloid leukaemia, whose disease had undergone transformation and whose life was threatened. Splenectomy was performed, and two years later he is alive and well, taking no anti-leukaemic therapy. Since splenectomy he has had one severe attack of malaria, and one episode of jaundice thought to be due to viral hepatitis. He discontinued his malaria prophylaxis one year ago and has not been ill since. Splenectomy as a last resort will benefit some patients with chronic myeloid leukaemia after transformation, and elective splenectomy should be considered in the management of patients with this disease. However, final unequivocal proof of the value of elective splenectomy is still awaited.

The function of the ectodermal apical ridge and distinctive characteristics of adjacent distal mesoderm in the avian wing-bud.

Blocks of mesoderm about 0-1 mm in diameter were isolated from various regions of chick wing-buds of stages 17 through 22 and cultured individually, or sometimes in pairs, in microtest plate wells. Cell deaths had occurred after 10 h of culture in those explants that had come from the region associated with the thickest part of the ectodermal ridge, and after 11-12 h in all other mesoderm. When the adjacent ectodermal ridge was left attached to the mesodermal block there were almost no cell deaths for up to 24 h of culture. When the dorsal ectoderm immediately proximal to the apical ridge was left attached, but no ridge was present, cell deaths occurred just as they did in mesoderm with no ectoderm. When a number (usually six) of complete ridges were suspended in a wire basket at the top of a well, cell deaths did not occur in a test mesodermal block at the bottom of the well (six of eight cases). These experiments support previous evivence for a special function of the ectodermal apical ridge in limb morphogenesis, and indicate that there is a chemical messenger. The cells that migrated from distal mesodermal explants (the band up to 0-15 mm from the apical ridge) differed sharply in morphology and behavior from those coming from explants from any more proximal region. Within the proximal mesoderm there was a less striking variation alons the antero-posterior axis. These observations reveal that there is present even at early stages a detailed pattern within the mesoderm of the limb-bud. The particularly striking and distinctive characteristics of that mesoderm closest to the apical ectodermal ridge provide new possibilities for the understanding of the function of the ridge in limb morphogenesis.