The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure

Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10741-015-9508-5) contains supplementary material, which is available to authorized users

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta-analysis

AIMS: To conduct a systematic review and meta-analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end-stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM). MATERIALS AND METHODS: Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta-analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350). RESULTS: Thirty-two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001). CONCLUSION: The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non-albuminuric pathways of progression to ESRD

Measurement of the β-p emission of ²⁰Mg and the breakout from the hot CNO cycle

In the astrophysically important reaction 19Ne(p,γ) 20Na, the rate is dominated by a single key resonance at 450 keV above the proton-emission threshold in 20Na. Throughout the last few decades many experiments have been performed aimed at finding the identity of this state. Despite this, the spin-parity of the key resonant state is still up for debate. The present paper describes a new experiment studying the β-delayed proton decay of 20Mg aimed at solving this issue. © 2010 American Institute of Physics

β-Delayed proton-decay study of 20Mg and its implications for the Ne19(p,γ)Na20 breakout reaction in X-ray bursts

Under astrophysical conditions of high temperature and density, such as for example found in X-ray bursts, breakout can occur from the hot CNO cycles into the rapid proton capture process. A key breakout route is via the sequence O15(α,γ)Ne19(p,γ)Na20. The Ne19(p,γ)Na20 reaction rate is expected to be dominated by a single resonance at 457(3) keV. The identity of the resonance has been under discussion for a long time, with J π=1 + and 3 + assignments suggested. In this study of the β-delayed proton decay of 20Mg we report a new, significantly more stringent, upper limit on the β-decay branch to this state of 0.02% with a confidence level of 90%. This makes a 1 + assignment highly unlikely and favours a 3 + assignment for which no branch is expected to be observed. The 3 + state is predicted to have a significantly higher resonance strength, and to produce a proportionately higher Ne19(p,γ)Na20 reaction rate in X-ray burst conditions. © 2012 Elsevier B.V

Measurement of the β-p emission of ²⁰Mg and the breakout from the hot CNO cycle

In the astrophysically important reaction 19Ne(p,γ) 20Na, the rate is dominated by a single key resonance at 450 keV above the proton-emission threshold in 20Na. Throughout the last few decades many experiments have been performed aimed at finding the identity of this state. Despite this, the spin-parity of the key resonant state is still up for debate. The present paper describes a new experiment studying the β-delayed proton decay of 20Mg aimed at solving this issue. © 2010 American Institute of Physics

β-Delayed proton-decay study of 20Mg and its implications for the Ne19(p,γ)Na20 breakout reaction in X-ray bursts

Under astrophysical conditions of high temperature and density, such as for example found in X-ray bursts, breakout can occur from the hot CNO cycles into the rapid proton capture process. A key breakout route is via the sequence O15(α,γ)Ne19(p,γ)Na20. The Ne19(p,γ)Na20 reaction rate is expected to be dominated by a single resonance at 457(3) keV. The identity of the resonance has been under discussion for a long time, with J π=1 + and 3 + assignments suggested. In this study of the β-delayed proton decay of 20Mg we report a new, significantly more stringent, upper limit on the β-decay branch to this state of 0.02% with a confidence level of 90%. This makes a 1 + assignment highly unlikely and favours a 3 + assignment for which no branch is expected to be observed. The 3 + state is predicted to have a significantly higher resonance strength, and to produce a proportionately higher Ne19(p,γ)Na20 reaction rate in X-ray burst conditions. © 2012 Elsevier B.V