Retford Hospital

People with learning disabilities are living longer and are therefore at risk of developing age-related conditions such as dementia. They also tend to develop dementia at a younger age than the general population. However, people with learning disabilities experience a range of health inequalities and barriers to accessing healthcare services, including dementia assessment and diagnostic services. Furthermore, the early signs and symptoms of dementia in this group tend to differ from those in the general population. It is vital, therefore, that those working with people with learning disabilities are able to recognise the early signs and symptoms of dementia in this population and know how to refer the person for assessment.This article discusses dementia in people with learning disabilities, including early signs and symptoms, and uses a case study to explore an ‘ideal’ dementia diagnostic pathway for this population.

The ICH Q4 guidelines are generally seen as one of the least successful of the ICH quality initiatives. ICH Q4 is split into Q4A (Pharmacopoeial Harmonization) and Q4B (Evaluation and Recommendation of Pharmacopoeial Texts for Use in the ICH Regions). ICH Q4 and Q4B are often used interchangeably and this is the case in this chapter. The objective of harmonization is to develop interchangeable methods or requirements. Using the process described, a series of general chapters were identified for harmonization. A summary of the status of the harmonized general chapters is tabulated, and unless otherwise stipulated, the title of each of the regional pharmacopoeial monographs is as stated in the ICH Q4B annex. The current pharmacopoeial procedures to control inorganic impurities, allied with the Residue on Ignition/Sulfated Ash test, together with other wet-chemistry tests.

Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

Abstract While Richard Dawkins' polemic against religion scores easy points against Christian fundamentalisms, he supposes his target to be much vaster: “I am not attacking any particular version of God or gods. I am attacking God, all gods”. Given The God Delusion's lack of extended argument, historical ignorance and unfamiliarity with the literature, the praise it has received from some distinguished scientists is troubling.This essay seeks, first, to examine some of the book's chief weaknesses – its ignorance of the grammar of “God” and of “belief in God”; the crudeness of its account of how texts are best read; its lack of interest in ethics – and, second, to address the question of what it is about the climate of the times that enables so ill‐informed and badly argued a tirade to be widely welcomed by many apparently well‐educated people.The latter issue is addressed, first, by considering the illusion, unique to the English‐speaking world, that there is some single set of procedures which uniquely qualify as “scientific” and give privileged access to truth; second, by examining historical shifts in the senses of “religion”; thirdly, by locating Dawkins' presuppositions concerning both “science” and “religion”, his paradoxical belief in progress, and the reception which the book has received, in relation to tensions in our culture signalled, fifty years ago, by C. P. Snow.

Numerical evidence relevant to the evaluation of the constant κ 3 \kappa _3 in the conjectural distribution of three-prime Carmichael numbers of Granville and Pomerance (2001) is summarised.

Julie Cotton discusses the development of an integrated palliative care service in a primary care trust and describes the services provided to patients

The Diabetes National Service framework (NSF), and the quality payments in the new contract for UK General Practitioners, promote regular screening for diabetes complications. The new contract also includes immediate incentives to meet screening and quality targets, but it will be difficult to meet these targets in primary care. We have developed a mobile 'annual review' programme for patients with Type 2 diabetes managed solely in primary care, that screens for cardiovascular disease, hypertension, retinopathy and neuropathy at the patient's general practice, and gives written foot care, dietary advice and level 1 smoking cessation advice to all patients.

A case of acute urinary obstruction due to early lichen sclerosus disease is described. In this case both histological corroboration and efficacy of potent topical steroid have been beneficial.

The fruit diets of Sylvia warblers, and some thrushes, were studied during 1989 at a coastal scrubland site, using faecal examination. Fruit feeding commenced as the earliest berries ripened in late July, but there were differences of timing between species. Amongst both warblers and thrushes, the larger species commenced earlier and ate more fruit. Almost all Blackcap and Garden Warbler faeces examined from early August contained some fruit remains, as did most Whitethroat faeces from mid-month. Mean fruit contents of faecal samples exceeded 80% infrequently, indicating that even the most frugivorous species always took other food, normally insects, to supplement their diet. Each species differed in their fruit diet: Blackcaps, and to a lesser extent Garden Warblers, ate Woody Nightshade berries in preference to Blackberries, as they are structurally adapted for feeding on the former plant. Only inexperienced juveniles of other species regularly chose the Nightshade berries. Elder berries, abundant from ...