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Survey on current practice in thrombophilia testing: from phenotype to genotype. Communication from the SSC of the ISTH
No full textDiagnosing inherited thrombophilia as cause of venous thromboembolism is important for patient management. Deficiencies in antithrombin, protein C, and protein S, are usually diagnosed by plasma-based assays. Genetic testing can confirm the congenital nature of these deficiencies. Factor V Leiden can be detected using activated protein C resistance assays, followed by or replaced by molecular confirmation, while prothrombin G20210A can only be detected genetically. During the last decade, molecular techniques have evolved from single-gene sequencing to multi-gene sequencing panels.
To understand current thrombophilia testing practices, a questionnaire was designed focussing on thrombophilia testing in coagulation laboratories and how they place genetic testing in their diagnostic workflow. All ISTH members and participants in external quality control schemes on thrombophilia testing were invited to complete the survey. Eighty-two unique responses were received.
This international survey showed that laboratories perform plasma-based thrombophilia testing, but 42% restrict it to requests from thrombosis/haemostasis specialists, patients without anticoagulant treatment or those with a strong personal of familial history of venous thrombosis. Phenotypic testing is however not always performed according to published guidelines. More specifically, the transference of reference intervals from manufacturers or literature is often suboptimal. For result interpretation, anticoagulant use and acquired causes were considered the most.
Genetic testing is not systematically included in the diagnostic work-up algorithms and is mostly restricted to single-variant testing. Multi-gene panel testing is performed only by a minority of laboratories. Our results highlight the necessity for recommendations on how and when to perform this kind of testing
Is there really fashion in Jamaica?
No full textThis online article challenge the Eurocentric view of fashion, asserting that Jamaica has a rich, yet underrepresented, fashion history. It explores how Jamaican fashion expresses the island's unique culture and post-colonial identity, highlighting the Jamaica Fashion Guild and the author's personal archival project to preserve this significant cultural heritage
Making and selling Greek food in London: migrant hospitality professionals talk about food authenticity over dinner
Get PDFThe 2007/2008 financial crisis more than doubled the number of Greek nationals in London (Pratsinakis et al. 2020, ONS 2022). This transformation is visible in London’s foodscapes, as the number of Greek restaurants in the city boomed over the last decade, which was also marked by Brexit and the COVID-19 pandemic. This paper, based on a Research England-funded project, shows how professionals in London’s Greek food businesses oscillated between competitive and solidarity positionings in conversations over dinner. The data were collected in focus group interactions and using multi-sited, participatory, multisensory ethnographic tools (Pink 2015). Five Greek hospitality workers and four researchers participated in discussions that took place over dinner in three Greek restaurants in London; these were followed by two online conversations. The data were analysed using concepts from Membership and Conversation Analysis (Smith, Fitzerald & Housley 2021, Mondada 2018) to examine the negotiation of categorisations situated in the glocal economic conditions. Participants claimed, ascribed and negotiated a range of professional roles (from novice to expert) and other regional and social class identities and contrasting positionings vis-à-vis what is considered “Greek” food, including juxtapositions between homecooked and professionally prepared food and contrasting constructions of authenticity, tradition and modernity in Greek food and hospitality. At the same time, participants also constructed some solidarity positionings as joint members of the Greek food hospitality industry in the UK, looking to forge shared networks that would help them face the shared challenges in staffing and costs created by the wider economic and political forces of Brexit and the post-Covid recession. The participants’ limits as to how far they were prepared to go in terms of making intra-sector alliances at a time of crisis provides a glimpse into the wider neoliberal context of the UK (food) market of free competition, gig economy and gentrification
Association of muscle strength and cardiorespiratory fitness with all-cause and cancer-specific mortality in patients diagnosed with cancer: a systematic review with meta-analysis
Get PDFObjectives: To examine the association between muscle strength and cardiorespiratory fitness (CRF) with all-cause and cancer-specific mortality in patients diagnosed with cancer, and if these associations are affected by type and/or stage of cancer.
Design: Systematic review with meta-analysis.
Data source: Five bibliographic databases were searched to August 2023.
Results: Forty-two studies were included (n = 46,694). Overall, cancer patients with high muscle strength or CRF levels (when dichotomised as high vs. low) presented a significant reduction in risk of all-cause mortality by 31 to 46% compared to those with low physical fitness levels. Similarly, a significant 11% reduction was found for change per unit increments in muscle strength. In addition, muscle strength and CRF were associated with a 8 to 46% reduced risk of all-cause mortality in patients with advanced cancer stages, and a 19 to 41% reduced risk of all-cause mortality was observed in lung and digestive cancers. Lastly, unit increments in CRF were associated with a significant 18% reduced risk of cancer-specific mortality.
Conclusion: High muscle strength and CRF were significantly associated with lower all-cause mortality risk. In addition, increases in CRF were associated with a reduced risk in cancer-specific mortality. These fitness components were especially predictive in patients with advanced cancer stages as well as in lung and digestive cancers. This highlights the importance of assessing fitness measures for predicting mortality in cancer patients. Given these findings, tailored exercise prescriptions to improve muscle strength and CRF in patients with cancer may contribute to reducing cancer-related mortality
A coach's guide to velocity-based training: definitions and diagnostics
No full textVelocity-based training (VBT) utilizes the measurement of velocity to help inform and influence testing, monitoring, programming, autoregulation, and feedback strategies within strength and conditioning (S&C) practice. This review focuses specifically on the definitions and underpinning principles of VBT, as well as load-velocity profiling, while undertaking an in-depth evaluation of the literature and translating this information into practical recommendations for S&C coaches. There is a detailed evaluation of the different ways to construct a load-velocity profile (LVP), providing examples of simplicity, time efficiency, increased accuracy, and optimizing training prescriptions and manipulations. New approaches, such as combining ballistic and non-ballistic exercises and methods of extrapolation have been explored. Additionally, this paper highlights practical considerations regarding data analysis, specific exercises, statistical modeling, number of loads, and extrapolation methods. A worked example of utilizing LVP data within excel has also been presented. Finally, there is a focus on one repetition maximum prediction, the benefits and challenges of implementing such an approach, and the most appropriate ways of collecting reliable and valid data
Digital innovation in healthcare: quantifying the impact of digital sepsis screening tools on patient outcomes-a multi-site natural experiment
Get PDFIntroduction
The National Health Service (NHS) ‘move to digital’ incorporating electronic patient record systems (EPR) facilitates the translation of paper-based screening tools into digital systems, including digital sepsis alerts. We evaluated the impact of sepsis screening tools on in-patient 30-day mortality across four multi-hospital NHS Trusts, each using a different algorithm for early detection of sepsis.
Methods
Using quasi-experimental methods, we investigated the impact of the screening tools. Individual-level EPR data for 718 000 patients between 2010 and 2020 were extracted to assess the impact on a target cohort and control cohort using interrupted time series analysis, based on a binomial regression model. We included one Trust which uses a paper-based screening tool to compare the impact of digital and paper-based interventions, and one Trust which did not introduce a sepsis screening tool, but did introduce an EPR.
Results
All Trusts had lower odds of mortality, between 5% and 12%, after the introduction of the sepsis screening tool, before adjustment for pre-existing trends or patient casemix. After adjustment for existing trends, there was a significant reduction in mortality in two of the three Trusts which introduced sepsis screening tools. We also observed age-specific effects across Trusts.
Conclusion
Our findings confirm that patients with similar profiles have a lower mortality risk, consistent with our previous work. This study, conducted across multiple NHS Trusts, suggests that alerts could be tailored to specific patient groups based on age-related effects. Different Trusts may require unique indicators, thresholds, actions and treatments. Including additional EPR information could further enhance personalised care
The European Union Artificial Intelligence Act: a regulatory model for Argentina and Latin America from the perspective of constitutional law
No full textThis article analyses the Artificial Intelligence Regulation (also known as the Artificial Intelligence Act, hereinafter referred to as the AIA) approved by the European Union, considering its potential as a model for regulating artificial intelligence in Argentina and Latin America from a constitutional law perspective. The article is based on the premise that AI presents significant constitutional challenges, particularly regarding the protection of fundamental rights, due process, algorithmic transparency, and accountability. Through a comparative and normative approach, it examines the main pillars of the AIA and assesses its potential reception and adaptation within the Argentine constitutional framework. Additionally, the article explores both the opportunities and limitations for developing region-specific regulatory frameworks in Latin America, taking into consideration institutional diversity and technological gaps. It concludes that, although the AIA cannot be directly transplanted, it does provide a valuable foundation for designing AI regulations grounded in constitutional rights and principles
Family support, prevention and early help: endurance and erosion. A decade of writing through policy and practice
No full textThe aim of this work is to examine the theoretical and practical applications of a ‘family support’ approach through the lens of my published works. This analytical and reflective work is presented here and provides a reflection of the journey through practice and publication. Included is some narrative policy exploration that takes a historical perspective and compares similarity and divergence, using examples from family policy in neighbouring anglophone nations. An application of the theoretical lenses of family support theory and poverty-informed practice to current issues and perspectives is provided, along with key professional perspectives such as relationship and strengths-based practice.
A contribution to knowledge is presented through an application of family support theory and through an argument that the set of ideas that form family support theory, by promoting a ‘consciously supportive approach’, could provide a more explicit emphasis on supportive approaches for individual practitioners. The term ‘consciously supportive practice’ is developed throughout as an organising concept that extends existing ideas on supportive, relational and strengths-based practice. The application of the theoretical lens of family support, through the published works and supporting literature, have enabled the presentation of discussions and arguments that are pertinent to the social work and social care field
The power of unsaid suffering: a reflexive thematic analysis on countertransference in psychological work with fibromyalgia and related symptoms
No full textBackground
Fibromyalgia presents a clinical challenge - characterised by persistent, debilitating pain that does not easily fit within standard medical explanations. Patients are frequently left feeling unheard or misunderstood, while therapists and healthcare professionals can find themselves unsure how to respond. While existing research show connections with developmental trauma, attachment insecurity, and alexithymia; the relational dimension of this condition remains largely unexplored. This study uses psychoanalytic theory, especially relational ideas about countertransference and mind-body connections. It looks beyond symptoms to view fibromyalgia as involving both a “speechless mind and speaking body”. From this perspective, pain is not just something symptomatic; it can become a form of communication, a way for the body to express what the mind cannot yet put into words.
Aims
This study seeks to explore the distinct relational dynamics that unfold in psychotherapy with individuals experiencing fibromyalgia. It aims to deepen understanding of how countertransference can serve as a meaningful tool for attuning to patients’ embodied expressions of distress.
Methods
Qualitative data was collected via semi-structured interviews with 6 UK-based psychological therapists with experience of working with fibromyalgia patients. The data was analysed using a reflective thematic analysis approach.
Findings
The overarching theme, as captured in the title, is that unsaid suffering holds powerful relational force. Within that, four key themes emerged: (1) “Thinking about body-mind, mind-body all the time”; (2) Unspoken pain takes op space within therapists; (3) Therapists’ Loss of psychological ground; and (4) Therapy relationship is negotiated through suffering – pain as a relational gesture. Therapists described feeling pulled into a primitive, affective space. Pain and patients’ physical suffering seemed to carry emotional messages. Therapists often experienced feelings of deprivation, helplessness, anger, and confusion that seemed to come before words; importantly, these feelings in turn give therapists access to the patients’ unsymbolic experiences of bodymind.
Conclusions
These findings offer important insights for psychological work with individuals suffering from fibromyalgia and related somatic conditions. Recognising countertransference not as a hindrance, but as a vital mode of attunement to patients’ speechless distress, invites a more embodied and relationally nuanced therapeutic stance. Counselling psychology is uniquely positioned to deepen the understanding of fibromyalgia as it respects the emotional aspects of physical experience and challenging the persistent separation between mind and body that remains prevalent in healthcare. The findings also have broader implications for healthcare policy and practice, especially in developing care approaches that are more relationally sensitive and psychologically informed when treating patients with complex physical symptoms
Outcome 21: an examination of practice and policy as a response to adolescent nude image sharing
No full textThis research explores adolescent nude image sharing, a growing phenomenon in the digital age, through a critical examination of current legal frameworks, safeguarding responses, and the lived experiences of adolescents. Using a mixed-methods approach, the study incorporates perspectives from frontline practitioners, thematic analysis of anonymous legal advice requests, and a comprehensive evaluation of Outcome 21—a policing response designed to divert young people from formal criminal prosecution for youth-produced sexual imagery offences (YPSIOs).
The findings reveal that adolescent nude sharing is often driven by developmental immaturity, emotional factors, and the unique social dynamics of digital platforms rather than a deliberate intent to engage in deviant behaviour. However, the current legal and safeguarding responses, including Outcome 21, fail to address these complexities adequately. Instead, these measures often stigmatise adolescents by labelling them as suspects, exacerbating psychological distress, including anxiety, shame, and suicidal ideation. Moreover, the inconsistent application of Outcome 21 across jurisdictions highlights significant gaps in training and understanding among practitioners.
The study underscores the need for reforms prioritising education, prevention, and support over punitive measures. Key recommendations include revising laws to differentiate between malicious and non-malicious image sharing, ensuring that Outcome 21 records are expunged upon adulthood, and implementing comprehensive, age-appropriate digital literacy and online safety education starting at a younger age. The research also emphasises the role of technology companies in creating safer online environments. It calls for stricter moderation, enhanced age verification, and accountability measures to address the risks posed by unregulated digital spaces. Additionally, the study advocates for multiagency collaboration to improve safeguarding protocols and the training of frontline practitioners.
This study contributes to knowledge by providing new insights into the motivations and consequences of adolescent nude sharing, critiquing existing responses, and proposing evidence-based reforms to reduce harm and safeguard adolescent well-being. It highlights the importance of a child-centred approach that balances education, legal clarity, and supportive interventions, fostering informed decision-making and resilience in the face of digital risks. By addressing systemic gaps, this research aims to shape policy and practice to reflect the realities of adolescence in a digital age, promoting both accountability and empathy in responses to youth-produced sexual imagery offences