What is the best way to manage benign paroxysmal positional vertigo?

A simple repositioning maneuver, such as the Epley maneuver, performed by an experienced clinician, can provide symptom relief from benign paroxysmal positional vertigo (BPPV) lasting at least 1 month (strength of recommendation [SOR]: A, systematic review of randomized controlled trials). Medical therapy with benzodiazepines for vestibular suppression provides no proven benefit for BPPV (SOR: B, 1 small randomized controlled trial). For undifferentiated dizziness, vestibular rehabilitation may provide symptomatic relief (SOR: B, 1 randomized controlled trial)

The AAACF Community Scholarship Program: A Strategic Approach to Building Community

Five years ago, the Ann Arbor Area Community Foundation decided to take a strategic approach to offering college scholarships that would address gaps in educational achievement among local students. To increase the impact of its scholarship program, the foundation shifted its emphasis from one-time awards to promoting degree attainment, and determined that the criteria for new scholarships would be based on impact data instead of donor intent. The Community Scholarship Program awards multiyear scholarships to local students of color, students from low-income families, and first-generation college students, and provides them with a dedicated college success coach to help them successfully navigate through higher education. The program is in the midst of a four-year evaluation of its impact on persistence and degree completion among its scholarship recipients, and early assessments indicate positive outcomes. This article outlines the evolution of the program, examining its design, implementation, and outcomes to date. To encourage replication in other communities, it concludes with recommendations for other community foundations interested in addressing disparities in access to college and degree attainment in the United States

Do COX-2 inhibitors worsen renal function?

No, COX-2 inhibitors, as a class, do not worsen renal function for those without renal disease. Celecoxib is the only COX-2 inhibitor available, and it is associated with a lower risk of renal dysfunction and hypertension when compared with controls. Available data do not allow for adjusted risk assessment for patients with preexisting renal disease on COX-2 inhibitors (strength of recommendation [SOR]: A, based on meta-analysis)

How should patients with Barrett's esophagus be monitored?

Some patients who have been diagnosed with Barrett's esophagus will develop dysplasia and, in some cases, esophageal carcinoma (strength of recommendation [SOR]: A, based on consistent cohort studies). Endoscopic surveillance is recommended for all patients with Barrett's esophagus as it is superior to other methods for detecting esophageal cancer (SOR: B, based on systematic review)

Do abnormal fetal kick counts predict intrauterine death in average-risk pregnancies?

Structured daily monitoring of fetal movement doesn't decrease the rate of all- cause antenatal death in average-risk pregnancies (strength of recommendation [SOR]: B, single good-quality, randomized controlled trial [RCT]). Although maternal perception of decreased fetal movement may herald fetal death, it isn't specific for poor neonatal outcome (SOR: B, single good-quality, diagnostic cohort study). Monitoring fetal movement increases the frequency of non-stress test monitoring (SOR: B, single good-quality RCT)

Electronic Medical Record and Adherence to Guidelines for the Prevention of Group B Beta-hemolytic Streptococcus Disease in Neonates

Background: Group B beta-hemolytic streptococcal (GBS) disease causes significant neonatal morbidity and mortality in the United States. Universal screening and use of intrapartum prophylaxis for women identified to be at risk has been promoted through recent Centers for Disease Control (CDC) national guidelines. Despite the recommendation for universal screening, many women present in labor with unknown GBS status. Interventions that decrease rates of unknown GBS status may improve providers' ability to effectively implement the GBS prevention guideline. Research Question: r Does electronic access to GBS screening results reduce the rates of both unknown GBS status and subsequent delivery of inappropriate care for the prevention of GBS disease? Study Design: A retrospective cohort study using data from an extensive perinatal database is described. Included subjects are women delivering babies at University of North Carolina (UNC) Women's Hospital between 1996 and 2003, who received care at a university managed or affiliated prenatal care site. Rates of delivery of appropriate care based on GBS status are assessed and the effect of access to an electronic medical record on rates of inappropriate care is examined. Results: A total of 7102 births were eligible for assessment of adherence to GBS prevention guidelines. 28.3% of women had unknown GBS status and 24.8% of the entire sample received inappropriate care. Lack of an electronic medical record (EMR) was significantly associated with both a higher rates of both unknown GBS status (OR 1.54. 95%CI 1.34-1.71) and inappropriate care (OR 1.12, 95% CI 1.11-1.13). Conclusions: Results of prenatal GBS screening, required in order to correctly implement GBS preventive measures, are often missing on admission to the hospital for delivery. Access to an electronic medical record improves the ability of providers to maximize the protective effect of GBS prevention measures.Master of Public Healt

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Correction to: A nonsynonymous mutation in PLCG2 reduces the risk of Alzheimer's disease, dementia with Lewy bodies and frontotemporal dementia, and increases the likelihood of longevity.

The IPDGC (The International Parkinson Disease Genomics Consortium) and EADB (Alzheimer Disease European DNA biobank) are listed correctly as an author to the article, however, they were incorrectly listed more than once

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. Funding: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D’Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca