In 2012, the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland, the Association of Upper Gastrointestinal Surgeons, the College of Radiologists and Macmillan Cancer Support published guidance on the optimal management of acute and chronic
Background: Antibodies against glutamic acid decarboxylase (GAD) are associated with Stiff Person Syndrome (SPS). Case report: A 50-year-old woman presented with symptoms progressed over 9 years, resulting in a cerebellar ataxia and right upper limb tremor. Investigations revealed elevated serum and CSF anti-GAD antibody titres (98.6 and 53.4 μ/ml, respectively). Treatment included intravenous immunoglobulin and immunomodulation (infliximab and rituximab), improving her stiffness, but with no impact on the ataxia-related symptoms. Subsequent high-dose steroids led to diabetic ketoacidosis and unmasking of an insulin-dependent diabetes mellitus. Discussion: This case illustrates several key features: (1) the combined clinical picture of SPS and cerebellar ataxia is a rare phenotype associated with anti-GAD antibodies; (2) the cerebellar ataxia described was progressive and poorly responsive to immunomodulatory therapy; and (3) the potential for development of further autoimmune sequelae in response to immunosuppression, namely, the development of insulin-dependent diabetes in response to treatment with high-dose oral steroids.
To determine how users of mental health services would like to be addressed by professionals, a survey of 302 persons participating in a variety of inpatient and outpatient psychiatric programs was conducted. Forty-five percent of the sample preferred the term "client," 20 percent preferred the term "patient," 8 percent preferred the term "consumer," and 27 percent either expressed no clear preference for one term or provided another term. The results suggest that no one term is favored by users of mental health services. Professionals and persons receiving mental health services are encouraged to talk over individual preferences to help establish a working alliance.
To (i) assess the reproducibility of manual linear measurements of brain volume using magnetic resonance imaging (MRI) in a cohort of patients with multiple sclerosis (MS) and (ii) explore correlations between manual brain measurements and disability. Thirty-six MS patients were selected based on a
The presence of apathy is associated with less favourable outcomes in dementia, including more rapid functional and cognitive decline, greater disease severity and increased mortality. We aimed to explore and gain an understanding into how people with dementia experience apathy, and consequently suggest effective interventions to help them and their carers.12 participants (6 dyads of 6 people with dementia and their family carers) were recruited from memory cafés, social groups, seminars and Patient and Public Involvement (PPI) meetings. People with dementia and their carers were interviewed separately and simultaneously. Quantitative data was collected using the following validated scales: Apathy Evaluation Scale (AES), short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Montreal Cognitive Assessment (MOCA), Cornell Scale for Depression in Dementia (CSSD) and Hospital Anxiety and Depression (HAD). The interviews were semi-structured, focusing on the subjective interpretation of apathy and impact on behaviour, habits, hobbies, relationships, mood and activities of daily living. Interviews were recorded and transcribed and analysed using interpretative phenomenological analysis (IPA) which generated codes and patterns, which were collated into themes.The participants with dementia had mild to moderate degrees of cognitive impairment, with a range between 9-22 (out of 30) on the MOCA. They reported moderate levels of apathy on the AES. Four superordinate themes were identified, three of which highlighted the challenging aspects of apathy: "Losing one's sense of self"; "Feeling like a burden" and "Hindered by invisible obstacles". One theme: ''What keeps me going'', described the positive aspects of the individuals' efforts to overcome apathy and remain connected with the world and people around them.This study is the first to illustrate and conceptualise the subjective experience of apathy in dementia, portraying it as a more complex and active phenomenon than the traditional view of apathy being simply negative and hopeless. Our study reveals a struggle against cognitive difficulties, fear of failure and invisible obstacles, with individuals desperate to remain connected, and appreciative of their carers' efforts to help them. Apathy and its effects warrant more attention from clinicians, researchers and others involved in dementia care.
Previous studies of the social structure and climate of a psychiatric ward in a general hospital have shown that the utilisation of patient treatment time follows an harmonic distribution. Factors contributing to the process have reference to the patient, his treatment, length of stay and selection. A comparison of 1966 with 1962 shows that the same basic pattern of utilisation is maintained, possibly reflecting quantitatively a community group with extreme difficulties, of which family disruption is one indicator.
In 2012 the BSG with the Association of Coloproctology and others published guidance on the optimal management of acute and chronic GI toxicities of cancer treatments. A RCT (Lancet 2013) showed that targeted interventions delivered by a nurse or gastroenterologist can make a significant difference to those with chronic toxicity. The largest single group of people affected are those treated for colorectal cancer. Follow-up after colorectal cancer treatment is increasingly devolved to junior or paramedical staff and largely focuses on possible recurrence. This study investigated how toxicity after colorectal cancer is assessed and managed in a large district hospital.
Methods
Outpatient clinic letters and inpatient discharge letters of a random selection of patients diagnosed with a new primary colorectal cancer during 2017, treated with curative intent and with at least one follow up appointment were audited retrospectively.
Results
462 patients were discussed at the colorectal MDT in 2017. Notes of 252 patients, 54% men (n=136) were scrutinised. Of these, 54% (n=145 age range 2–8 years) were treated with curative intent. The site of the primary cancer was anus 1% (n=2), rectum 34% (n=49), sigmoid 16% (n=23), left colon 5% (n=7), transverse 8%(n=11), right colon 35% (n=51) and appendix 1% (n=2). 79% (n=114) had a one-year follow-up. 65% (n=94) were treated with surgery alone. 26% (n=37) underwent surgery and adjuvant therapy (chemotherapy and/or radiotherapy). 5% (n=8) had surgery and neoadjuvant (chemotherapy and/or radiotherapy). 3% had chemotherapy and radiotherapy but no surgery (n=5) and 1% (n=1) were treated with polypectomy alone. 19% were readmitted with complications of surgery (n=28) - mean length of stay, 10 days. Only 50% (n=73) of follow up letters documented a conversation about side effects; GI 39% (n=56) psychological 6%(n=8); sexual 1%(n=1); tiredness 12% (n=17); quality of life 8% (n=11); urinary incontinence 8%(n=12). GI problems included frequency, urgency, loss of appetite, abdominal pain, weight loss, diarrhoea, rectal bleeding, faecal incontinence and nocturnal defecation. Only 22% of patients (n=16) were offered investigations other than to rule out recurrent cancer, 41% (n=30) were offered advice and only 22% (n=16) were offered follow up to see if this advice helped.
Conclusions
Survival after colorectal cancer is improving rapidly. However, it is associated with frequent and predictable side effects. In our busy hospital trust, there is little evidence of systematic enquiry about side effects of cancer treatment or appropriate investigation and effective treatments being offered at follow-up. The lessons learnt during the UK's 10-year survivorship programme run by the Department of Health and MacMillan Cancer Support have not impacted clinical practice.
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