Youths in custody in NSW: aspirations and strategies for the future

Aim: To investigate the extent to which youths in custody 1) rate specific life goals as important and likely to eventuate; 2) have strategies to achieve their goals; and 3) can anticipate barriers to achieving their goals.Method: A total of 107 detainees drawn from NSW Juvenile Justice centres were interviewed about their life goals.Results: Most youths rated specific life goals, such as having a well-paying job and avoiding trouble with the police, as ‘quite important’ or ‘very important’ goals to achieve in the future. When youths were asked how likely it was that these specific goals would be realised, the most common response was ‘quite likely’ or ‘very likely’. The most frequently identified strategies for having a well-paying job included getting the necessary diplomas and starting in a junior position to get experience. The most frequently identified strategies for avoiding trouble with the police were resisting peer pressure and obeying the law. Commonly reported barriers to achieving these goals included associating with antisocial peers, drugs and alcohol usage. Many youths also recognised that getting into trouble with the law would also be a barrier to having a well-paying job.Conclusion: Most youths interviewed in this study placed high importance on specific life goals and were generally optimistic about achieving them. Furthermore, most youths could think of strategies that would help them achieve their goals as well as identify possible barriers to achieving them. These findings have the potential to help service providers and policy makers target their services and policies appropriately

Participant satisfaction with Youth Justice Conferencing

Aims: To evaluate offender and victim satisfaction with New South Wales (NSW) Youth Justice Conferences (YJCs) immediately after conference participation and to re-assess victim satisfaction 4 months after the conference date.Method: A self-report survey designed to assess satisfaction with YJCs was completed by 263 offenders and 141 victims immediately following their participation in a NSW YJC. Additionally, 96 victims also participated in a phone-based survey 4 months after the conference.Results: When asked immediately following the conference, more than 85 per cent of offenders and victims reported being ‘satisfied’ or ‘very satisfied’ with most aspects of the conference. High levels of satisfaction with conferencing were also reported by victims 4 months after the conference. For some measures, however, the percentage of victims who were ‘satisfied’ or ‘very satisfied’ was not as high at the 4-month follow-up, as it was in the baseline survey. The aspect of conferencing that victims at the 4-month follow-up reported the least satisfaction with was the lack of feedback they received from conference staff about the offender’s completion of the outcome plan. Fewer than half of the victims were ‘satisfied’ or ‘very satisfied’ with this part of the conference.Conclusion: The results of this study suggest that offender and victim satisfaction is high immediately following a YJC. Even 4 months after a YJC, victim satisfaction with most aspects of conferencing remains high. Satisfaction levels may be increased still further if, at some point prior to the end of the statutory time-period for completing the plan, victims were provided with feedback about the offender’s progress towards completing the outcome plan. Further research also needs to be conducted comparing victim satisfaction following a conference with victim satisfaction following a court appearance

Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis

Purpose: This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes. Patients and Methods: All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items). Results: The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range ( 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents). Conclusion: This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC

Platelet rich plasma injection for acute Achilles tendon rupture:PATH-2 randomised, placebo controlled, superiority trial

Objective:To determine whether an injection of platelet rich plasma improves outcomes after acute Achilles tendon rupture.Design:Randomised, placebo controlled, two arm, parallel group, participant and assessor masked, superiority trial.Setting:Secondary care trauma units across 19 hospitals in the United Kingdom’s health service.Participants:Recruitment commenced in July 2015 and follow-up was completed in March 2018. 230 adults aged 18 years and over were included, with acute Achilles tendon rupture presenting within 12 days of injury and managed with non-surgical treatment. Exclusions were injury at the insertion or musculotendinous junction, major leg injury or deformity, diabetes mellitus, platelet or haematological disorder, systemic corticosteroids, anticoagulation treatment, and other contraindicating conditions.Interventions:Participants were randomised 1:1 to platelet rich plasma (n=114) or placebo (dry needle; n=116) injection. All participants received standard rehabilitation care (ankle immobilisation followed by physiotherapy).Main outcomes and measures:Primary outcome was muscle tendon function at 24 weeks, measured objectively with the limb symmetry index (injured/uninjured×100) in maximal work done during the heel rise endurance test (an instrumented measure of repeated single leg heel rises until fatigue). Secondary outcomes included patient reported function (Achilles tendon rupture score), quality of life (short form 12 version 2®), pain (visual analogue scale), goal attainment (patient specific functional scale), and adverse events. A central laboratory analysed the quality and content of platelet rich plasma. Analyses were by modified intention to treat.Results:Participants were 46 years old on average, and 57 (25%) of 230 were female. At 24 weeks, 202 (88%) participants completed the heel rise endurance test and 216 (94%) the patient reported outcomes. The platelet rich plasma was of good quality, with expected growth factor content. No difference was detected in muscle tendon function between participants receiving platelet rich plasma injections and those receiving placebo injections (limb symmetry index, mean 34.7% (standard deviation 17.7%) v 38.5% (22.8%); adjusted mean difference −3.9% (95% confidence interval −10.5% to 2.7%)) or in any secondary outcomes or adverse event rates. Complier average causal effect analyses gave similar findings.Conclusions:There is no evidence to indicate that injections of platelet rich plasma can improve objective muscle tendon function, patient reported function, or quality of life after acute Achilles tendon rupture compared with placebo, or that they offer any patient benefit

Decision regret in men living with and beyond nonmetastatic prostate cancer in the United Kingdom: A population‐based patient‐reported outcome study

Objective: Clinical options for managing nonmetastatic prostate cancer (PCa) vary. Each option has side effects associated with it, leading to difficulty in decision‐making. This study aimed to assess the relationship between patient involvement in treatment decision‐making and subsequent decision regret (DR), and quantify the impact of health‐related quality of life (HRQL) outcomes on DR. Methods: Men living in the United Kingdom, 18 to 42 months after diagnosis of PCa, were identified from cancer registration data and sent a questionnaire. Measures included the Decision Regret Scale (DRS), Expanded Prostate cancer Index Composite short form (EPIC‐26), EQ‐5D‐5L, and an item on involvement in treatment decision‐making. Multivariable ordinal regression was utilized, with DR categorized as none, mild, or moderate/severe regret. Results: A total of 17 193 men with stage I‐III PCa completed the DRS: 36.6% reported no regret, 43.3% mild regret, and 20.0% moderate/severe regret. The odds of reporting DR were greater if men indicated their views were not taken into account odds ratio ([OR] = 6.42, 95% CI: 5.39‐7.64) or were involved “to some extent” in decision‐making (OR = 4.63, 95% CI: 4.27‐5.02), compared with men who were “definitely” involved. After adjustment, including for involvement, men reporting moderate/big problems with urinary, bowel, or sexual function were more likely to experience regret compared with men with no/small problems. Better HRQL scores were associated with lower levels of DR. Conclusions: This large‐scale study demonstrates the benefit of patient involvement in treatment decision‐making for nonmetastatic PCa. However, men experiencing side effects and poorer HRQL report greater DR. Promoting engagement in clinical decision‐making represents good practice and may reduce the risk of subsequent regret

Platelet Rich Plasma in Achilles Tendon Healing (PATH-2) Trial:Protocol for a multi-centre, participant and assessor-blinded, parallel-group randomised clinical trial comparing Platelet Rich Plasma (PRP) injection versus placebo injection for Achilles tendon rupture

Background Achilles tendon injuries give rise to substantial long-lasting morbidity and pose considerable challenges for clinicians and patients, especially during the lengthy healing and recovery period. Current treatment strategies struggle to curb the burden of this injury on health systems and societal cost due to lengthy rehabilitation, absence from work and the risk of re-injury. Platelet Rich Plasma (PRP) is an autologous preparation that has been shown to improve the mechanobiological properties of tendons in laboratory and animal studies. The use of PRP in musculoskeletal injuries is on the increase despite the lack of adequately powered clinical studies. Methods and DesignWe aim to undertake a multi-centre randomised controlled trial to evaluate the efficacy and mechanism of PRP in patients with acute Achilles tendon rupture. All adult patients with acute Achilles tendon rupture presenting within 12 days of the injury that are to be treated non-operatively are potentially eligible to take part. A total of 214 consenting patients will be randomly allocated (1:1) via a remote web-based randomisation service to receive either PRP injection or placebo (imitation) injection to the site of the injury. All participants will be blinded to the intervention and will receive standardised rehabilitation to reduce the risk of efficacy interference from substantial variation in rehabilitation. Participants will be followed up with blinded assessments of muscle-tendon function, quality of life, pain and overall patient’s functional goals at 4, 7, 13, 24 weeks and 24 months post treatment. The primary outcome is the heel rise endurance test (HRET), which will be supervised by a blinded assessor at 24 weeks. A subgroup of 16 participants in one centre will have needle biopsy under ultrasound guidance at 6 weeks. Blood and PRP will be analysed for cell count, platelet activation and growth factors concentration. Discussion This article presents the protocol for a multi-centre randomised controlled trial that is currently recruiting. It gives details of methods and describes the key procedures taken to avoid bias and to ensure validity. <br/

Strategies for living well with hormone responsive advanced prostate cancer: A qualitative exploration

Purpose. Due to recent treatment advances, men are increasingly living longer with advanced prostate cancer (PCa). This study sought to understand men’s experiences of living with and adjusting to advanced hormone-responsive PCa and how this influenced their quality of life (QoL), in order to highlight how support could be optimized. Methods. Participants were recruited through a UK wide survey—the ‘Life After Prostate Cancer Diagnosis’ study. In-depth telephone interviews were conducted with 24 men (aged 46–77 years) with advanced (stage IV) hormone-responsive PCa diagnosed 18–42 months previously. Thematic analysis was undertaken using a framework approach. Results. Most participants perceived their QoL to be relatively good, which was influenced by the following factors (enablers to ‘living well’ with PCa): a sense of connectedness to others, engagement in meaningful activities, resources (social, cognitive, financial), ability to manage uncertainty, utilization of adjustment strategies and support, communication and information from health professionals. Barriers to ‘living well’ with PCa were often the converse of these factors. These also included more troublesome PCa-related symptoms and stronger perceptions of loss and restriction. Conclusions. In our study, men living with advanced hormone-responsive PCa often reported a good QoL. Exploring the influences on QoL in men with advanced PCa indicates how future interventions might improve the QoL of men who are struggling. Further research is required to develop and test interventions that enhance QoL for these men