Determining whether coeliac disease case-finding in primary care is better than random testing: a retrospective study.

BACKGROUND: Over 75% of patients (approximately half a million) with coeliac disease in the UK have not been formally diagnosed. AIM: To determine if case-finding of coeliac disease is better than random testing in primary care. DESIGN & SETTING: A pragmatic study looked at all referrals across a 12-month period (December 2013-November 2014) for coeliac serology testing and the indications for testing across 38 GP practices in a well-defined geographical area in North Yorkshire. There was further follow-up for an additional 12 months to determine conversion of positive serology to duodenal biopsy. METHOD: All serology samples sent into York Hospital biochemistry department during the study period were analysed for the indication for testing. Positive results were cross-referenced for duodenal biopsies over the following 12 months on the York Hospital pathology database. RESULTS: Case-finding of coeliac patients in primary care is no better than random testing of the population. Only 71% of patients with positive serology went on to have a duodenal biopsy in the following 12 months. CONCLUSION: More education of the population and of primary care physicians is needed around the indications for checking for coeliac disease. It may be that primary care is not the best place to case-find patients with coeliac disease.

Safeguarding Rights to Liberty and Security where People with Disability are Subject to Detention and Restraint: A Rights-based Approach (Part One).

This is the first article in a two-part series that establishes a framework for evaluating law as it affects the rights to liberty and security for people with intellectual and cognitive impairments. Such laws include those which permit the detention and use of restrictive practices for 'challenging behaviours' or 'behaviours of concern'. This article begins by examining the nature of rights and in particular those of liberty and security. Both are recognised not only as human rights but also as common law rights. The article then develops a rights-based approach to law that protects these rights. Taking a 'thin' version of the rule of law as the starting point, the approach expands this by adding a requirement to respect not only common law rights but human rights. The rights-based approach then argues for the inclusion of the principle of justice requiring the prioritisation of rights over other policy imperatives and a commitment to equal concern and respect.

Safeguarding Rights to Liberty and Security where People with Disability are Subject to Detention and Restraint: A Practical Approach to the Adjudication, Interpretation and Making of Law (Part Two).

This is the second article in a two-part series that establishes a framework for evaluating law as it affects the rights to liberty and security for people with intellectual and cognitive impairments. This article uses the rights-based approach developed in the first article to establish a methodology to evaluate the range of ways in which law can be made or interpreted in this area. The methodology considers the adjudication of common law rights by courts, judicial interpretation of statute and the making of laws. Key areas of law considered are those that permit the detention and use of restrictive practices for 'challenging behaviours' or 'behaviours of concern'. The article concludes by arguing that a rights-based approach and a method to assess how law applies it is essential to ensure that a 'thick' rule of law can protect and promote the rights and interests of people with intellectual and cognitive impairments.