The Lived Experiences of Post-Operative Pain Management for Patients with Fibromyalgia

This review introduces an initial understanding of fibromyalgia and then focuses on the lived experiences of post-operative pain management for patients with fibromyalgia; this is a specific period within fibromyalgia patients’ healthcare journey that has not been identified within research. Most research on fibromyalgia is related to overall, day-to-day pain within fibromyalgia or specific pharmacological or non-pharmacological outcomes following specific surgery. This review relates to post-operative pain management when undergoing nonfibromyalgia related surgery and how various factors contribute to fibromyalgia patients’ pain. It highlights the reduced pain assessments and management pathways available specific to fibromyalgia pain and new acute surgical pain. If further research was to be undertaken, then a blanket post-operative surgical pathway could be introduced specifically for fibromyalgia patients to improve their surgical experience and reduce symptoms and co-morbidities from being exacerbated during the post-operative period. This research could also promote the education of healthcare professionals and introduce new guidance and pathways to help individualise pain plans for all fibromyalgia patients in the pre-operative periods to prepare for the post-operative stage. Having a wider knowledge base of pain assessments, management and analgesia for fibromyalgia patients will allow them to be assessed correctly with a personalised pain plan that relates to their individual pain instead of being based on the surgical procedure undertaken. It will also help decrease the stigmatism around fibromyalgia, as due to limited knowledge biases have been identified leading to fibromyalgia patients feeling isolated and misjudged. Many nurses have highlighted the importance of the wider knowledge of fibromyalgia, and many would like to increase their knowledge to improve overall patient experience and quality of care provided

LoCATE - Local Community Archaeological Training & Equipment Project

The Local Community Archaeological Training and Equipment (LoCATE) Project is a partnership between archaeologists at BU and the New Forest National Park Authority (NFNPA). Working with archaeological societies and community groups from across Dorset and Hampshire, the project provides access, training, and support for the use of advanced survey equipment that would otherwise be hard to get access to. LoCATE aims to support the research that local groups already do by extending the range of techniques and skills they can use. Our goal is to enable an even greater contribution to the understanding of the rich archaeological heritage of our region

Co-creation and archaeological prospection: LoCATE – The Local Community Archaeological Training and Equipment Project.

This paper is based on the co-creation of research through an innovative partnership focused around archaeological prospection techniques. LoCATE (Local Community Archaeological Training and Equipment) is a project that brings together archaeologists at Bournemouth University and the New Forest National Park Authority (NFNPA) with archaeological societies and community groups from across Dorset and Hampshire. LoCATE provides access, training, and support for the use of advanced survey equipment that can otherwise be hard to get hold of. It supports the work that all partners already do by extending the range of techniques and skills they can use, and expanding their capacity to undertake research. The idea for LoCATE was first instigated in 2015 when member of the Avon Valley Archaeological Society approached the University and asked them to consider providing access to older, but serviceable geophysical equipment that was not being used regularly for teaching and other activities. Working with the New Forest National Park Authority LoCATE was developed, and the first instrument made available was a Geoscan Research FM36 followed a year later by a Geoscan Research RM15. Most recently a total station has been added to the equipment pool, funded through the Heritage Lottery Funding (Our Past and Our Future, Landscape Partnership Scheme) and the Hampshire Field Club and Archaeological Society. Access to the equipment is managed through the New Forest’s volunteer equipment loan system. LoCATE members are given access to free training on these techniques using a variety of expertise situated across the partnership, and LoCATE members sign up to a code of responsible survey and data sharing. Open data is a core value, and LoCATE also encourages members to use open access materials and software, for example Snuffler freeware geophysics software (Staveley 2018). Inter-partner support is fostered through a variety of means including shared prospection activities, and project social media channels. Now in its fourth year, LoCATE has become well established, enabling relationships that support the research agendas of all partners. It has developed both capacity and expertise in the use of archaeological prospection activities in the local region. Example of the success of the project can be seen through the diversity of the outcomes from the work of LoCATE members from prehistoric monuments, including previously understudied Neolithic long and oval barrows and Bronze Age double ring ditches, to extensive Romano-British sites along the Avon Valley and on Cranborne Chase (Hampshire) (Gill 2019a, b). Through these surveys LoCATE members have achieved their own research aims, but also contributed to the collective goal of the project in enabling an improved understanding of the rich archaeological heritage of our region. In conclusion, LoCATE provides a new model for community engagement in archaeological prospection projects. In an era where the integration of techniques and data are central themes, it is perhaps timely to also consider the integration of people, and how we best work with a variety of different communities to create a shared understanding of our collective past. Bibliography Gill, M. 2019a. New long barrow discoveries in the vicinity of the middle Avon Valley and Cranborne Chase. PAST 91, 5-7. Gill, M. 2019b. Putting old kit to good use, the LoCATE geophysical project. British Archaeology, March/April 2019, 30-5. Staveley, D 2018. Snuffler - Freeware Geophysics Software. Available from: http://www.sussexarch.org.uk/geophys/snuffler.htm

Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: Results from a national survey of Australian paramedics

Objective Continuing stigma towards mental health problems means that many individuals—especially men—will first present in crisis, with emergency services often the first point of call. Given this situation, the aims of this paper were to assess paramedics’ ability to recognise, and their attitudes towards, males with clinically defined depression and psychosis with and without comorbid alcohol and other drug (AOD) problems. Methods A cross-sectional national online survey of 1230 paramedics throughout Australia. The survey was based on four vignettes: depression with suicidal thoughts, depression with suicidal thoughts and comorbid alcohol problems, and psychosis with and without comorbid AOD problems. Results Just under half of respondents recognised depression, but this decreased markedly to one-fifth when comorbid AOD problems were added to the vignette. In contrast, almost 90% recognised psychosis, but this decreased to just under 60% when comorbid AOD problems were added. Respondents were more likely to hold stigmatising attitudes towards people in the vignettes with depression and psychosis when comorbid AOD problems were present. Respondents endorsed questionnaire items assessing perceived social stigma more strongly than personal stigma. Desire for social distance was greater in vignettes focusing on psychosis with and without comorbid AOD problems than depression with and without comorbid AOD problems. Conclusions Paramedics need a well-crafted multicomponent response which involves cultural change within their organisations and more education to improve their recognition of, and attitudes towards, clients with mental health and AOD problems. Education should focus on the recognition and care of people with specific mental disorders rather than on mental disorders in general. It is essential that education also focuses on understanding and caring for people with AOD problems. Educational interventions should focus on aligning beliefs about public perceptions with personal beliefs about people with mental disorders and AOD problems. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial

Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation.

BACKGROUND: A high proportion of hypertensive patients remain above the target threshold for blood pressure, increasing the risk of adverse health outcomes. A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients' home readings were raised was found to be effective in lowering blood pressure over 12 months. This mixed-methods process evaluation aimed to develop a detailed understanding of how the intervention was implemented in Primary Care, possible mechanisms of action and contextual factors influencing implementation. METHODS: One hundred twenty-five practitioners took part in a randomised controlled trial, including GPs, practice nurses, nurse-prescribers, and healthcare assistants. Usage data were collected automatically by the digital intervention and antihypertensive medication changes were recorded from the patients' medical notes. A sub-sample of 27 practitioners took part in semi-structured qualitative process interviews. The qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics and correlations to explore factors related to adherence. The two sets of findings were integrated using a triangulation protocol. RESULTS: Mean practitioner adherence to escalating medication was moderate (53%), and the qualitative analysis suggested that low trust in home readings and the decision to wait for more evidence influenced implementation for some practitioners. The logic model was partially supported in that self-efficacy was related to adherence to medication escalation, but qualitative findings provided further insight into additional potential mechanisms, including perceived necessity and concerns. Contextual factors influencing implementation included proximity of average readings to the target threshold. Meanwhile, adherence to delivering remote support was mixed, and practitioners described some uncertainty when they received no response from patients. CONCLUSIONS: This mixed-methods process evaluation provided novel insights into practitioners' decision-making around escalating medication using a digital algorithm. Implementation strategies were proposed which could benefit digital interventions in addressing clinical inertia, including facilitating tracking of patients' readings over time to provide stronger evidence for medication escalation, and allowing more flexibility in decision-making whilst discouraging clinical inertia due to borderline readings. Implementation of one-way notification systems could be facilitated by enabling patients to send a brief acknowledgement response. TRIAL REGISTRATION: ( ISRCTN13790648 ). Registered 14 May 2015

Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors

SARS-CoV-2 antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. From cross-sectional antibody testing of 9,361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies (jointly in April-May 2021, and TwinsUK only in November 2021-January 2022), we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection and SARS-CoV-2 vaccination variables. Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had 3-fold greater odds of SARS-CoV-2 infection over the next six to nine months, compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK "Shielded Patient List" had consistently greater odds (2 to 4-fold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations. These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies

Associations of Insulin and Insulin-Like Growth Factors with Physical Performance in Old Age in the Boyd Orr and Caerphilly Studies

Objective Insulin and the insulin-like growth factor (IGF) system regulate growth and are involved in determining muscle mass, strength and body composition. We hypothesised that IGF-I and IGF-II are associated with improved, and insulin with worse, physical performance in old age. Methods Physical performance was measured using the get-up and go timed walk and flamingo balance test at 63–86 years. We examined prospective associations of insulin, IGF-I, IGF-II and IGFBP-3 with physical performance in the UK-based Caerphilly Prospective Study (CaPS; n = 739 men); and cross-sectional insulin, IGF-I, IGF-II, IGFBP-2 and IGFBP-3 in the Boyd Orr cohort (n = 182 men, 223 women). Results In confounder-adjusted models, there was some evidence in CaPS that a standard deviation (SD) increase in IGF-I was associated with 1.5% faster get-up and go test times (95% CI: −0.2%, 3.2%; p = 0.08), but little association with poor balance, 19 years later. Coefficients in Boyd Orr were in the same direction as CaPS, but consistent with chance. Higher levels of insulin were weakly associated with worse physical performance (CaPS and Boyd Orr combined: get-up and go time = 1.3% slower per SD log-transformed insulin; 95% CI: 0.0%, 2.7%; p = 0.07; OR poor balance 1.13; 95% CI; 0.98, 1.29; p = 0.08), although associations were attenuated after controlling for body mass index (BMI) and co-morbidities. In Boyd Orr, a one SD increase in IGFBP-2 was associated with 2.6% slower get-up and go times (95% CI: 0.4%, 4.8% slower; p = 0.02), but this was only seen when controlling for BMI and co-morbidities. There was no consistent evidence of associations of IGF-II, or IGFBP-3 with physical performance. Conclusions There was some evidence that high IGF-I and low insulin levels in middle-age were associated with improved physical performance in old age, but estimates were imprecise. Larger cohorts are required to confirm or refute the findings

Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Gokstad Viking Age trading site: a voyage of physicochemical prospection

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