Llanfrechfa Grange Hospital

The efficacy of cyproterone acetate in the treatment of sexual overactivity has been assessed in fifty male patients over a period of five years. Homosexual activity was reduced in its intensity but not in its direction. Masturbation was diminished in subnormal and chronic schizophrenic patients and there was a social improvement in elderly men guilty of sexual misbehaviour. Two sado-masochists showed greater clinical improvement when cyproterone acetate was added to psychotherapy than occurred with the latter therapy alone. Physical aggression exhibited by two subnormal patients which was resistant to conventional therapy, responded dramatically to cyproterone acetate administration. There were no significant side-effects.

UNLABELLED: Autistic spectrum disorder (ASD) is a developing area for dietetic referrals. There is little published data on current dietetic practice. Some children with ASD are referred for gluten/casein free diet. The theory is that abnormal metabolites in the urine may be a result of incomplete breakdown of gluten and casein in the gut. There are some published open studies that support the efficiency of such a diet [Knivsberg et al. (1995) Scand. J. Educ. Res.39: 223; Lucarelli et al. (1995) Panminerva Med.37: 137; Whiteley et al. (1999) Int. J. Res. Practice 3: 45] and also that there are many anecdotal reports that the diet helps some children. AIMS AND OBJECTIVES: This study aimed to audit the types of referral made to the dietetic service to identify key dietetic issues and to describe factors which may influence outcome/disease management. METHODS: Dietetic records were used to audit the referrals to the dietetic service over a 3-month period. Seven-day diet histories were assessed using computer food composition tables and topics of interest recorded against a draft protocol agreed within the profession. RESULTS: Requests for gluten-free and casein-free dietetic advice, and/or the management of food selectivity and dysfunctional feeding behaviour constituted the majority of referrals. In many cases, child's environment was rarely simple. CONCLUSIONS: Despite the limitations of this small study, the findings suggest that the management of these referrals is highly complex. A dietitian's input should ensure that the nutritional adequacy of the diet is maintained or restored.

AIMS AND OBJECTIVES: To review hospital passports currently in use for people with intellectual disabilities in the UK and to make recommendations for practice. BACKGROUND: Hospital passports have been introduced internationally to address communication barriers that may limit access to appropriate health care for people with intellectual disabilities. They are viewed as promoting patient safety and person-centred care but their format may vary, they are not always used appropriately, and hence, their effectiveness may be limited. DESIGN: Qualitative content analysis. METHODS: Sixty hospital passports in use in the UK were reviewed against a coding frame by two members of the research team. Areas of interest included key patient and primary care information, support network details, consent and capacity, support required in relation to activities of daily living, length of the document and completion details. Results were entered into Excel. RESULTS: Considerable variation was found between documents in terms of terminology, length and format. Most included information regarding communication and support needs although some omitted important information such as allergies, risk assessment and need for reasonable adjustments. CONCLUSIONS: Considerable variation exists between current hospital passports, which may limit their effectiveness: key information required may not be included and/or it may not be easy to locate. Greater standardisation of documents is required, but this process should include input from all key stakeholders. RELEVANCE TO CLINICAL PRACTICE: Internationally nurses provide care for people with intellectual disabilities and others with communication difficulties. Hospital passports are one way of enhancing safety and person-centred care, need to be accessed and used as a basis for care planning. However, variation in format may limit this effectiveness and nurses should work with others to develop a more standardised approach, which better meets the needs of all stakeholders.

This paper examines the link between a self‐report Anger Inventory (Benson & Ivins, 1992) and incidents of challenging behaviour by people with intellectual disabilities. Records of challenging behaviour were kept by significant others while the people with intellectual disabilities themselves were asked to complete the Anger Inventory on a number of different occasions. The inventory was used to evaluate and follow up the impact of an anger management group, and in some cases other associated interventions. Data are presented on five individuals for time periods of between two and three years. Visual inspection of the data suggests a degree of correspondence between the levels of challenging behaviour reported by staff and scores reported on the Anger Inventory by participants and this relationship is confirmed statistically. The implications of these results are discussed.

Three issues are addressed in this article. First, and briefly, the objectives of occupational psychology are touched upon. Then a higher priority than hitherto for studies of professional workers employed in health and ‘caring’ organizations, as distinct from industry and commerce, is argued for. In this context some of the grounds, including evidence from research, for turning some of our attention particularly towards the nursing profession are highlighted. Thirdly, it illustrates why the relationships among stress, satisfaction, and performance for nurses afford a challenging exemplar of occupational problems every bit as important, and relevant to specialized interests, as the current (and, of course, perfectly proper[ddot]) preoccupation with industrial employment and unemployment. Don Willis began his professional career as a Royal Navy psychologist studying human factor problems in signal detection, man—machine interaction, environmental stress, and training. Subsequently he moved to the government's Department of Employment as its Chief Psychologist, responsible for the research and professional work of a large group of occupational psychologists. From 1970 to 1973 he was also an Industrial Professor at Loughborough. In 1974 he was appointed to the first Chair in Applied Psychology of the University of Wales. He has recently retired from headship of the Department of Applied Psychology at UWIST, Cardiff, where his research interests have focused upon organizational behaviour and occupational stress in ‘service’ areas of the public sector.

OBJECTIVE: The aim is to characterise early and late respiratory and bloodstream co-infection in patients admitted to intensive care units (ICUs) with SARS-CoV-2-related acute hypoxemic respiratory failure (AHRF) needing respiratory support in seven ICUs within Wales, during the first wave of the COVID-19 pandemic. We compare the rate of positivity of different secondary pathogens and their antimicrobial sensitivity in three different patient groups: patients admitted to ICU with COVID-19 pneumonia, Influenza A or B pneumonia, and patients without viral pneumonia. DESIGN: Multicentre, retrospective, observational cohort study with rapid microbiology data from Public Health Wales, sharing of clinical and demographic data from seven participating ICUs. SETTING: Seven Welsh ICUs participated between 10 March and 31 July 2020. Clinical and demographic data for COVID-19 disease were shared by each participating centres, and microbiology data were extracted from a data repository within Public Health Wales. Comparative data were taken from a cohort of patients without viral pneumonia admitted to ICU during the same period as the COVID-19 cohort (referred to as no viral pneumonia or 'no viral' group), and to a retrospective non-matched cohort of consecutive patients with Influenza A or B admitted to ICUs from 20 November 2017. The comparative data for Influenza pneumonia and no viral pneumonia were taken from one of the seven participating ICUs. PARTICIPANTS: A total of 299 consecutive patients admitted to ICUs with COVID-19 pneumonia were compared with 173 and 48 patients admitted with no viral pneumonia or Influenza A or B pneumonia, respectively. MAIN OUTCOME MEASURES: Primary outcome was to calculate comparative incidence of early and late co-infection in patients admitted to ICU with COVID-19, Influenza A or B pneumonia and no viral pneumonia. Secondary outcome was to calculate the individual group of early and late co-infection rate on a per-patient and per-sample basis, with their antimicrobial susceptibility and thirdly to ascertain any statistical correlation between clinical and demographic variables with rate of acquiring co-infection following ICU admission. RESULTS: A total of 299 adults (median age 57, M/F 2:1) were included in the COVID-19 ICU cohort. The incidence of respiratory and bloodstream co-infection was 40.5% and 15.1%, respectively. Staphylococcus aureus was the predominant bacterial pathogen within the first 48 h. Gram-negative organisms from Enterobacterales group were predominantly seen after 48 h in COVID-19 cohort. Comparative no viral pneumonia cohort had lower rates of respiratory tract infection and bloodstream infection. The influenza cohort had similar rates respiratory tract infection and bloodstream infection. Mortality in all three groups was similar, and no clinical or demographic variables were found to increase the rate of co-infection and ICU mortality. CONCLUSIONS: Higher incidence of bacterial co-infection was found in COVID-19 cohort as compared to the no viral pneumonia cohort admitted to ICUs for respiratory support.

A case of a chromatin positive, mentally deficient 51 year old male who is clinically an example of Klinefelter’s syndrome and has a sex chromosome constitution of XXYY is described. He has some of the features of the four cases previously described by Muldal et al. (1962), Carr et al. (1961), Ellis et al. (1961) and Vague et al. (1961), but also has abnormalities of the serum mucoproteins and the urine chondroitin sulphate levels and very prominent frontal sinuses. The possible aetiology of the chromosome, biochemical and x-ray abnormalities are discussed.

AIM: To define the characteristics of patients consulting with active dyspeptic symptoms in urban general practice, and to consider the implications of applying the British Society of Gastroenterology Dyspepsia management guidelines. DESIGN: Prospective observational study over a period of 12 months. SETTING: Two multipartner, two-centre general practices in the City of Leeds (UK) with a combined target population of 11 011 registered patients. SUBJECTS: A total of 340 patients consulting with active dyspeptic symptoms (52% male; mean age 53 years, range 16-89 years). RESULTS: Of the practice population, 3% consulted with dyspepsia (first-time consulter: 19%; previous consulter not yet investigated: 30%; previously investigated: 51%). Of 168 undiagnosed patients, 43% had upper abdominal pain (dysmotility-like symptoms in 42%), 35% had reflux symptoms, 22% had mixed symptoms, 12% had 'alarm' symptoms and 18% had a history of NSAID use. Patients < 45 years old with simple dyspepsia accounted for 32% of undiagnosed cases. A fifth of the workload was in dealing with undiagnosed dyspeptics over 45 years old. One per cent of the population would require endoscopy if all undiagnosed cases either > 45 years or with complicated dyspepsia were investigated. Of 172 previously investigated patients, 29% had negative tests, 25% had 'minor' findings, and 45% had evidence of acid-peptic disease. Patients with duodenal ulcer disease accounted for 12% of the total workload. CONCLUSIONS: A knowledge of the characteristics of patients consulting with dyspepsia in primary care should allow the adaptation of guidelines, to ensure advice is relevant to local case mix and compatible with local resources.

Over a period of 11 years, 33 sheep or goat holdings lost their maedi-visna or caprine arthritis-encephalitis accredited status (mean 2.8 per year [0.09 per cent] of the accredited holdings in Great Britain). Of these, 22 sheep flocks and two goat herds eradicated the infection and regained their accredited status. In addition, 10 sheep flocks and two goat herds managed to eradicate infection, having joined the scheme with infected animals. In flocks and herds with a high initial prevalence of infection, the adoption of an indirect ELISA, with greater sensitivity than the agar gel immunodiffusion test, improved success rates. A strategy was devised to interpret the ELISA results depending upon the prevalence of infection at the time. Eighteen of the 33 flocks/herds (54.5 per cent) that had introductions of infection also owned non-accredited stock.

BACKGROUND: several different models of out-of-hours primary care now exist in the UK. Important outcomes of care include users' satisfaction and enablement to manage their illness or condition, but the determinants of these outcomes in the unscheduled care domain are poorly understood. Aim. To identify predictors of user satisfaction and enablement across unscheduled care or GP out-of-hours service providers in Wales. The design of the study is a cross-sectional survey. The setting of the study is nine GP out-of-hours services, three Accident and Emergency units and an all Wales telephone advice service in Wales. METHODS: postal survey using the Out-of-hours Patient Questionnaire. Logistic regression was used to fit both satisfaction and enablement models, based on demographic variables, service provider and treatment received and perceptions or ratings of the care process. RESULTS: eight hundred and fifty-five of 3250 users responded (26% response rate, range across providers 14-41%, no evidence of non-response bias for age or gender). Treatment centre consultations were significantly associated with decreased patient satisfaction and decreased enablement compared with telephone advice. Delays in call answering or callback for triage and shorter consultations were significantly associated with lower satisfaction. Waiting more than a minute for initial call answering was associated with lower enablement. CONCLUSIONS: giving users more time to discuss their illness in consultations may enhance satisfaction and enablement but this may be resource intensive. More simple interventions to improve access by quicker response and triage, and keeping users informed of waiting times, could also serve to increase satisfaction and ultimately impact on their enablement.

AIMS: To conduct a meta-analysis of randomized controlled trials (RCTs) to assess the effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on inflammatory biomarkers. METHODS: Medline, Embase and the Cochrane Library were searched for RCTs investigating the effect of SGLT2 inhibitors on inflammatory biomarkers, adipokine profiles and insulin sensitivity. RESULTS: Thirty-eight RCTs were included (14 967 participants, 63.3% male, mean age 62 ± 8.6 years) with a median (interquartile range) follow-up of 16 (12-24) weeks. Meta-analysis showed that SGLT2 inhibitors significantly improved adiponectin, interleukin-6, tumour necrosis factor receptor-1 (vs. placebo alone: standardized mean difference [SMD] 0.34 [95% confidence interval {CI} 0.23, 0.45], mean difference [MD] -0.85 pg/mL [95% CI -1.32, -0.38], SMD -0.13 [95% CI -0.20, -0.06], respectively), leptin and homeostatic model assessment of insulin resistance index (vs. CONTROL: SMD -0.20 [95% CI -0.33, -0.07], MD -0.83 [95% CI -1.32, -0.33], respectively). There were no significant changes in C-reactive protein (CRP), tumour necrosis factor-α, plasminogen activator inhibitor-1, fibroblast growth factor-21 or monocyte chemoattractant protein-1. CONCLUSIONS: Our analysis shows that SGLT2 inhibitors likely improve adipokine biomarkers and insulin sensitivity, but there is little evidence that SGLT2 inhibitors improve other inflammatory biomarkers including CRP.

Determining virulence towards race‐specific resistance genes is a prerequisite to understanding the response of pathogen populations to resistant cultivars, and therefore to assess the durability of these resistance genes and the performance of resistance management strategies. In Phytophthora infestans , virulence testing began shortly after the introduction of R‐genes from Solanum demissum into S. tuberosum cultivars. However, the characteristics of R‐gene expression, the sensitivity of the phenotype to environmental and physiological parameters, and the diversity of experimental protocols make the comparison of data from different studies problematic. This prompted European teams working on P. infestans diversity to: (i) design a joint protocol, using detached leaflets from greenhouse‐grown plants of a shared set of differential cultivars inoculated with standardized suspensions of inoculum, and (ii) assess the performance of this protocol in a blind ring test involving 12 laboratories and 10 European isolates of the pathogen. A high level of consensus in the determination of virulence/avirulence to R1, R3, R4, R7, R8, R10 and R11 was achieved among the collaborators, showing that the protocol could be robustly applied across a range of laboratories. However, virulence to R2, R5 or R9 was detected more frequently in some laboratories, essentially from northern Europe; these genes are known to be highly sensitive to host and environmental conditions. The consensus determination was often markedly different from the original virulence phenotype of the isolates, suggesting virulence instability in stored P. infestans isolates. This indicates that creating reliable core collections of pathogen isolates with known virulences could be difficult.

Accessible summary • We ran a group for 6 people with a learning disability who worry a lot. The group last for 12 weeks and each person in the group brought someone with them. • People said they found the group helpful. People said they learnt ways to cope when they get worried. • This research will help staff to think about how they can help people who worry a lot. More research is needed to find out which bits of the group were most helpful. Summary An anxiety management group utilizing a cognitive behavioural intervention, of 12 weeks duration, for six people with mild to moderate learning disabilities is described. A number of techniques to assist in developing clients’ understanding of their anxiety, cognitive and behavioural coping strategies and maximizing generalizability of skills learnt were implemented. Outcome measures demonstrated that two participants showed a clinically significant reduction in anxiety levels. Qualitative feedback from both participants and carers suggested that all group members developed coping strategies. Measures also indicated that carers demonstrated a better understanding of the individual's difficulties and were able to support them more effectively. Adopting a cognitive behavioural approach proved valuable and recommendations for future interventions are made.

The increasing rates of youth unemployment have given rise to concern in academic and political circles as well as amongst the general public. So much so that successive governments have introduced employment schemes specifically for this age group. Although a variety of opinions have been expressed concerning the value of such schemes and much thought and planning has gone into the design of successive generations of schemes, there appears to be little hard evidence concerning the effects they have on the well-being of young people. In the course of a study of the wider aspects of unemployment amongst school leavers, the authors collected evidence which they believe bears directly on this question. In a prospective study, which began by assessing fifth formers before they left school, it was found that in general those who went on to YOP schemes occupied an intermediate position between those who obtained work and those who remained unemployed, on a variety of measures of psychological well-being. However, it was found that those on Schemes were less likely than those in either of the other two groups to believe that they had a measure of personal control over their lives. The findings are discussed in relation to the design of employment schemes and the longer term implications.

The use of continuous-flow isotope-ratio mass spectrometry (CF-IRMS) as a tool in soil analysis has been assessed as part of a larger study using a number of geological techniques applied in a forensic context. Carbon and nitrogen isotopic ratios, delta13C and delta15N, have been analysed to investigate situations which have arisen from crime casework. Three questions have been addressed: the role of spatial variation found over the short-scale (less than 20 m), temporal variation over a period of almost 2 years, and the variation found between source soils and soil transferred to footwear soles during a simple one-stage transfer process. Results are presented for the three experiments. The use of carbon and nitrogen isotopes has been shown to be useful in discriminating between soil types and sample locations, even when sampling occurs at a different time (as might be the case with a crime scene). In cases of primary transfer (from a source soil by a one-stage transfer to another surface, in this case, shoes and boots), the combination of carbon and nitrogen isotope ratios is a valuable tool in discriminating between sites and in showing the relationship of the transferred samples to the relevant source soils. Used in combination with other analytical techniques, isotopic analysis may prove to be a useful tool in a forensic context.

Abstract A survey examined the differences between managers and direct carers working in community homes for people with intellectual disabilities in terms of the nature and causes of stress. Fifty‐seven managers and 49 direct carers provided data relating to perceived levels of pressure and support from a variety of sources. The questionnaire administered consisted of the Powell questionnaire of sources of stress and support ratings, a stress measure, and information on the background characteristics of participants. Analysis of the data revealed that managers of group homes were reporting higher levels of anxiety and pressure than direct carers. This was associated with managers reporting higher ratings for sources of stress. The implications of these findings are discussed.

The zebrafish is an important animal system for modeling human diseases. This includes kidney dysfunction as the embryonic kidney (pronephros) shares considerable molecular and morphological homology with the human nephron. A key clinical indicator of kidney disease is proteinuria, but a high-throughput readout of proteinuria in the zebrafish is currently lacking. To remedy this, we used the Tol2 transposon system to generate a transgenic zebrafish line that uses the fabp10a liver-specific promoter to over-express a nanoluciferase molecule fused with the D3 domain of Receptor-Associated Protein (a type of molecular chaperone) which we term NL-D3. Using a luminometer, we quantified proteinuria in NL-D3 zebrafish larvae by measuring the intensity of luminescence in the embryo medium. In the healthy state, NL-D3 is not excreted, but when embryos were treated with chemicals that affected either proximal tubular reabsorption (cisplatin, gentamicin) or glomerular filtration (angiotensin II, Hanks Balanced Salt Solution, Bovine Serum Albumin), NL-D3 is detected in fish medium. Similarly, depletion of several gene products associated with kidney disease (nphs1, nphs2, lrp2a, ocrl, col4a3, and col4a4) also induced NL-D3 proteinuria. Treating col4a4 depleted zebrafish larvae (a model of Alport syndrome) with captopril reduced proteinuria in this system. Thus, our findings validate the use of the NL-D3 transgenic zebrafish as a robust and quantifiable proteinuria reporter. Hence, given the feasibility of high-throughput assays in zebrafish, this novel reporter will permit screening for drugs that ameliorate proteinuria, thereby prioritizing candidates for further translational studies.

This study evaluates the implementation of Safewards on an assessment and treatment unit (ATU) for people with an intellectual disability. There are no previous studies evaluating this model in this context and previous research has focused largely on acute mental health services. The 'Patient-Staff Conflict Shift Report' was used at baseline for 1 month and 1 year later, after all the interventions had been implemented, to evaluate the impact of Safewards. Significant reductions were found in conflict and containment measures used within the service after the implementation of Safewards. Staff who led on the interventions were also asked to give feedback on their experiences, the challenges they faced and how they would like to move forward. Safewards was generally seen as a positive approach by the team. Limitations of this study are highlighted and suggestions for future research are made.

BACKGROUND: Several models of GP out-of-hours provision exist in the UK but there is little detail about their effectiveness to meet users' needs and expectations. AIM: To explore users' needs, expectations, and experiences of out-of-hours care, and to identify proposals for service redesign. SETTING: Service providers in urban (GP cooperative), mixed (hospital based), rural (private) locations in Wales. PARTICIPANTS: Sixty recent service users or carers (20 in each location). METHOD: Semi-structured telephone interviews; thematic analysis. RESULTS: Users' concerns were generally consistent across the three different services. Efficiency was a major concern, with repetitive triage procedures and long time delays at various stages in the process being problematic. Access to a doctor when required was also important to users, who perceived an obstructive gatekeeping function of preliminary contacts. Expectations moderated the relationship between user concerns and satisfaction. Where expectations of outcome were unfulfilled, participants reported greater likelihood of reconsulting with the same or alternative services for the same illness episode. Accurate expectations concerning contacts with the next administrative, nursing, or medical staff professional were managed by appropriate information provision. CONCLUSION: Users require more streamlined and flexible triage systems. Their expectations need to be understood and incorporated into how services advise and provide services for users, and actively managed to meet the aims of both enhancing satisfaction and enabling users to cope with their condition. Better information and education about services are needed if users are to derive the greatest benefit and satisfaction. This may influence choices about using the most appropriate forms of care.

Background In the UK, Early Intensive Behavioural Intervention [EIBI] programmes typically are conducted within the homes of children with autism. Despite evidence for their effectiveness in producing appreciable developmental gains in children with autism, a concern expressed about EIBI programmes is that stressful effects from the high levels of demand they place on family resources could undermine their effectiveness [The Effectiveness of Early Interventions for Children with Autistic Spectrum Disorders (ASD). A report for the DfES South East Regional Special Educational Needs Partnership. SERSEN Website, 2004]. This study investigates the positive impacts and the stressors experienced by families running EIBI programmes. Method Sixteen parents from nine different families participated in semi‐structured qualitative interviews on their experiences of running a home‐based EIBI programme. Data were analysed using the Grounded Theory process. Results Positive and negative impacts of the programmes were reported. Analysis indicated that sources of support obtained through the programmes’ benefits offset sources of stress through the programmes’ demands. Conclusions The interaction between programme demands and benefits and the resources available to each family strongly influences the impact of running a home‐based EIBI programme.