Claghorn Lesem Research Clinic

<h3>Introduction</h3> Heart failure (HF) is a complex and highly debilitating clinical syndrome. Clear guidelines identify the optimum management of patients living with HF in primary settings but implementation of these is suboptimal. <h3>Aim</h3> The aim of this service improvement project was to develop a tool kit, The Greater Manchester Heart Failure Investigation Tool (GM-HFIT), to improve the ongoing management of people diagnosed with HF. <h3>Methods</h3> The GM-HFIT development was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. A prospective, pre-test, post-test design informed an audit conducted between 13^th February 2012 and 12^th December 2013 with data from two clinical commissioning groups (CCGs) across North West Manchester. <h3>Results</h3> Data from 1146 matched cases were analysed using McNemar tests (SPSS v20). Preliminary analysis suggests that at baseline, 22% of patients were not eligible to be on the HF register, which decreased to 15% after introduction of the tool (P &lt; 0.001). The recording of blood pressure (BP) was high at both time points (95%), while the recording of pulse and rhythm improved from 58% to 64% and 44% to 49% respectively (P = 0.005). While control of BP remained the same (with 62% of patients with target BP &lt;130/70), the proportion of patients receiving the target dose of ACE Inhibitors and beta blockers improved significantly (70% to 85% and 68% to 85% respectively, P &lt; 0.001). In addition 578 missing patients were added to the heart failure register as a result of the case finding element of the project and a further 6 were recommended for further investigation before adding. <h3>Conclusion</h3> The GM-HFIT service improvment project led to improvements in identification and management of patients with HF in primary care.

The aim of this study was to evaluate the tolerability and effectiveness of the methylphenidate transdermal system (MTS) over 6 months in adolescents with attention-deficit/hyperactivity disorder (ADHD). This was an industry-sponsored, 30-center, open-label study of subjects aged 13-17 years with ADHD. Subjects were dose-optimized with MTS (10-30 mg/9 hours) over 5 weeks and then dose-maintained for up to 5 months. Tolerability evaluations included treatment-emergent adverse events (TEAEs) and dermal responses. Effectiveness was assessed with the ADHD-Rating Scale-IV (ADHD-RS-IV). A total of 162 subjects received MTS treatment. The majority of TEAEs (>99%) were mild or moderate in intensity, and the most frequently reported TEAE was decreased appetite (15.4%). Thirteen subjects discontinued the study due to TEAEs. The majority (93.6%) of dermatologic reactions indicated mild erythema. There was significant improvement in mean ADHD-RS-IV total scores from study entry to end point (p<0.001). Slightly more than half (54.0%) of subjects completed this 6-month, open-label extension study of MTS; the primary reason for discontinuation was withdrawn consent (36.0%). Reported TEAEs and skin tolerability findings were similar to those observed with MTS use in children and adolescents. MTS treatment resulted in a decrease in ADHD symptoms as rated by clinicians.

Vega-like stars are infrared excess stars either nearing or already on the main sequence. The infrared excess is interpreted as evidence for the presence of extended dusty disks surrounding the stars. In a few cases, the disks have been directly imaged. While most of the disks are difficult to observe at optical and near-infrared wavelengths, a few disks are bright enough to study at 10 microns. Mid-infrared spectra from several of these mid-infrared bright Vega-like stars reveals a range of silicate emission features. Such features arise from the thermal emission of silicate grains in the disks. In some cases, the silicate features seen are similar to those seen towards some solar-system comets and interplanetary dust particles.