Harold Wood Hospital

September 18, 2013, marks 2 years since the monumental meeting of Heads of State at the United Nations in New York to take action against noncommunicable diseases (NCDs), which includes cancer, cardiovascular disease (CVD), diabetes mellitus, and chronic respiratory disease. Recognizing that the rising human and financial costs of NCDs required a profound shift in the way countries viewed development, United Nations member states gathered for the second time in history to address a health concern (the first being the United Nations General Assembly Special Session on HIV/AIDS in 2001). Supporting the United Nations Political Declaration on the Prevention and Control of NCDs, countries acknowledged NCDs as a development issue and made a commitment to address this global crisis by taking action on the major modifiable risk factors— including tobacco use, raised blood pressure, poor nutrition, physical inactivity—triggering the new pandemic of NCDs, as well as the social, economic, and political determinants that shape these lifestyle choices.1 Although the declaration was a political commitment, it was an important first step, bringing together health and development leaders from across the globe to ensure that progress would be made to reduce the burden of NCDs. The past 2 years have witnessed concrete commitments, meaning that our work is only just beginning. The World Heart Federation and its members spearheaded global advocacy, with other colleagues in the NCD community, calling on the World Health Organization and member states to commit to tangible and achievable goals.2 In 2012, a global target was adopted to reduce premature NCD mortality 25% by 2025—“25by25.”3 Now in 2013, this target, as well as 8 additional targets addressing modifiable risk factors and committing to the use of essential medicines, technologies, and drug therapies to prevent …

An international collaborative study was conducted on an HPLC method with fluorescent detection (FLD) for the determination of flavanols and procyanidins in materials containing chocolate and cocoa. The sum of the oligomeric fractions with degree of polymerization 1-10 was the determined content value. Sample materials included dark and milk chocolates, cocoa powder, cocoa liquors, and cocoa extracts. The content ranged from approximately 2 to 500 mg/g (defatted basis). Thirteen laboratories representing commercial, industrial, and academic institutions in six countries participated in the study. Fourteen samples were sent as blind duplicates to the collaborators. Results from 12 laboratories yielded repeatability relative standard deviation (RSDr) values that were below 10% for all materials analyzed, ranging from 4.17 to 9.61%. The reproducibility relative standard deviation (RSD(R)) values ranged from 5.03 to 12.9% for samples containing 8.07 to 484.7 mg/g. In one sample containing a low content of flavanols and procyanidins (approximately 2 mg/g), the RSD(R) was 17.68%. Based on these results, the method is recommended for Official First Action for the determination of flavanols and procyanidins in chocolate, cocoa liquors, powder(s), and cocoa extracts.

‘Various studies have found intravesical chemotherapy with mitomycin-C to be an effective treatment in preventing the recurrence rate of superficial bladder cancer.’ The use of intravesical therapy for the treatment of superficial bladder cancer aims to reduce morbidity and mortality by eradicating existing disease, preventing tumor recurrence and attempting to halt tumor progression. Mitomycin-C is a commonly used intravesical treatment option for superficial bladder cancer and was used for the first time by Shida and colleagues in 1967 [1]. It is an antitumor antibiotic with a molecular weight of 334.3 and is soluble in water and organic solvents. Mitomycin-C is usually minimally absorbed on intravesical instillation due to its high molecular weight and hydrophobic nature. The use of an instillate at the lowest achievable osmotic strength appears to be optimal for the intravesical instillation of the drug and, hence, sterile water is preferred over saline. Its dose is typically 40 mg per instillation – this regimen has been shown to exhibit a longer time-torecurrence and less recurrence compared with the standard regimen (20 mg) in patients with Stage Ta and grade 1–2 bladder cancer [2].

<h3>Background</h3> The Royal College of General Practitioners Veteran Friendly Practice Accreditation Programme launched in 2019, aiming to allow practices to better identify, treat and refer veterans, where appropriate, to dedicated NHS services. <h3>Aim</h3> Evaluate the effectiveness of the accreditation programme, focusing on benefits for the veteran, the practice and the delivery of the programme itself. <h3>Design &amp; setting</h3> The study evaluated the views of Veteran Friendly Accredited GP Practices across England. <h3>Method</h3> Mixed-methods study collecting data via an online survey from 232 accredited Primary Healthcare (PHC) staff and 15 semi-structured interviews with PHC Veteran Leads. Interviews were analysed using modified Grounded Theory. <h3>Results</h3> 99% (N=228) of respondents would recommend the programme, 77% (N=124) reported improved awareness and 84% (N=193) a better understanding of veteran’s needs. 72% (N=166) identified benefits for veterans who were engaging more with PHC but participants felt more time was needed, largely due to the Covid-19 pandemic, to fully assess the impact of the programme on help-seeking behaviour. Challenges included identifying veterans already registered, promoting the accreditation process and ensuring all PHC staff were kept up to date with veteran issues. <h3>Conclusions</h3> The programme has increased signposting to veteran specific services and greater understanding of the NHS priority referral criteria for veterans. Recording of veteran status has improved and there was evidence of a better medical record coding system in PHC practices. These findings add to the limited empirical evidence exploring veteran engagement in PHC and demonstrate how accreditation results in better treatment and identification of veterans.