Unique presentation of palatal metastasis from high-grade spindle cell sarcoma of the bone.

Spindle cell sarcoma (SCS) is a rare malignant tumour which can arise in bone and accounts for 2%-5% of primary bone cancer cases. Distant metastasis occurs predominantly in the lungs. However, metastasis to the soft palate, to the best of our knowledge, has never been previously reported. In this case report, we describe a unique presentation of soft palate metastasis in a patient with a history of high-grade SCS of the bone who presented with progressive dysphagia and nausea and vomiting who underwent surgical excision for palliation of symptoms.

Comparing the Impact of Primary Care Practice Design in Two Inner City UK Homelessness Services.

Background: Specialist homeless primary health care services in the United Kingdom have arisen from the need for bespoke approaches to providing health care for people experiencing homelessness but descriptions of the design characteristics of homeless health services together with associated long-term condition (LTC) prevalence, health care utilization, and prescribing remain unexplored, thereby limiting our understanding of potential impact of service configuration on outcomes. Aim: Description of specialist homeless general practitioner services in Glasgow and Edinburgh, in terms of practice design (staff, skill mix, practice systems of registration, and follow-up); and exploration of the potential impact of differences on LTC prevalence, health care utilization, and prescribing. Method: Patient data were collected from computerized general practitioner records in Glasgow (2015, n = 133) and Edinburgh (2016, n = 150). Homeless health service configuration and anonymized patient data, including demographics, LTCs service utilization, and prescribing were summarized and compared. Results: Marked differences in infrastructure emerged between 2 practices, including the patient registration process, segmentation versus integration of services, recording systems, and the availability of staff expertise. Patient characteristics differed in terms of LTC diagnoses, health care utilization and prescribing. Higher rates of recorded mental health and addiction problems were found in Edinburgh, as well as higher rates of physical LTCs, for example, cardiovascular and respiratory conditions. There were significantly higher rates of consultations with nurses and other staff in Edinburgh, although more patients had consultations with pharmacists in Glasgow. Medication adherence was low in both cohorts, and attendance at referral appointments was particularly poor in Glasgow. Conclusion: Service design and professional skill mix influence recording of LTCs, service uptake, and identification and management of health conditions. Service configuration, professional skill mix, and resources may profoundly affect diagnoses, utilization of health care, and prescribing. Attention to homeless service design is important when providing care to this disadvantaged patient group.

Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data.

BACKGROUND: There is a paucity of current health data regarding users of a specialist homeless health service in the UK. AIM: To describe the health of users of a specialist homeless health service by assessing levels of multimorbidity, social exclusion - by measuring severe and multiple disadvantage (SMD) - and patient engagement with health care. DESIGN & SETTING: Analysis of patient-level data from computerised records of patients registered with a specialist homeless health service in Glasgow, Scotland. METHOD: Data for 133 patients were extracted using a data extraction form. Multimorbidity and SMD were described using categorisation adapted from previous literature in this field. Stepwise regression analysis was carried out to assess the relationship between domains of SMD experienced and the number of long-term conditions (LTCs) a patient had. RESULTS: The average age of patients in the cohort was 42.8 years, however levels of multimorbidity were comparable to those aged ≥85 years in the general population. The average number of LTCs was 2.8 per patient, with 60.9% of patients having both mental and physical comorbidity. SMD was categorised into three domains: homelessness; substance misuse; and previous imprisonment. More than 90.0% of patients experienced ≥2 domains of SMD, and SMD experiences were associated with multimorbidity: as domains of SMD experiences increased, so did the number of LTCs a patient was recorded as having. CONCLUSION: This cohort of patients has a complex burden of health and social care needs, which may act as barriers in the provision of effective health care.