Factors affecting patient’s decision-making about treatment for cancer: a literature review.

Decision-making about cancer treatment is complex. This literature review explores factors that impact on patients’ decision-making about treatment. Results were returned in MEDLINE, British Library, PsycINFO and Science Direct databases. These were filtered, using a PRISMA flowchart and inclusion and exclusion criteria applied. Six original papers, assessed as high quality using Critical Skills Appraisal Programme checklists, were reviewed. Data was collated and thematically analysed. Four themes were developed: communication and information giving, children and family influences, hope and treatment toxicities. These themes demonstrate the complexity of factors that influence decision-making about treatment and reinforce the importance of nurses, particularly clinical nurse specialists, using effective communication skills to make shared decision-making a reality. Developing a strong therapeutic relationship and getting to know patients over the course of their cancer journey, using communication tools, enables nurses to recognise and respond to emotional cues from patients and to start sensitive conversations about factors affecting them. Facilitating information sharing around treatment decision-making enhances patient’s experience by supporting their autonomy

'Selling it as a holistic health provision and not just about condoms ?' Sexual health services in school settings: current models and their relationship with sex and relationships education policy and provision

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in - or closely linked with - schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop 'young people friendly' services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision - and inter-professional collaboration - in a climate where, in many schools, there is still considerable ambivalence about discussing 'sex' openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools

Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial

Background: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke. Methods: We did this randomised trial at hospitals with specialised stroke or neurology services (39 in the UK and seven in Australia). We included patients with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days. Patients were randomly assigned (1:1) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs (specific treatment decided by the local clinician) for 3 months. Patients and clinicians were not masked to allocation, but investigators assessing endpoints were. The primary endpoint was ipsilateral stroke or death in the intention-to-treat population. The trial was registered with EUDract (2006-002827-18) and ISRN (CTN44555237). Findings: We enrolled 250 participants (118 carotid, 132 vertebral). Mean time to randomisation was 3·65 days (SD 1·91). The major presenting symptoms were stroke or transient ischaemic attack (n=224) and local symptoms (headache, neck pain, or Horner's syndrome; n=26). 126 participants were assigned to antiplatelet treatment versus 124 to anticoagulant treatment. Overall, four (2%) of 250 patients had stroke recurrence (all ipsilateral). Stroke or death occurred in three (2%) of 126 patients versus one (1%) of 124 (odds ratio [OR] 0·335, 95% CI 0·006–4·233; p=0·63). There were no deaths, but one major bleeding (subarachnoid haemorrhage) in the anticoagulant group. Central review of imaging failed to confirm dissection in 52 patients. Preplanned per-protocol analysis excluding these patients showed stroke or death in three (3%) of 101 patients in the antiplatelet group versus one (1%) of 96 patients in the anticoagulant group (OR 0·346, 95% CI 0·006–4·390; p=0·66). Interpretation: We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice. Funding: Stroke Association.H.S. Markus ... T. Kleinig ... et al. (CADISS trial investigators

School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities

Background: Report based on a service-mapping study and a systematic review concerning sexual health services for young people, either based in or closely linked to schools. Objectives: To identify current forms of school-based sexual health services (SBSHS) and school-linked sexual health services (SLSHS) in the UK, review and synthesise existing evidence from qualitative and quantitative studies concerning the effectiveness, acceptability and cost-effectiveness of these types of service and to identify potential areas for further research. Data sources: Electronic databases were searched from 1985 onwards. For published material: the Cochrane Library (1991–), MEDLINE, PREMEDLINE (2007–), CINAHL, EMBASE, AMED, ASSIA (1987–), IBSS, ERIC, PsycINFO, Science Citation Index (SCI) and Social Sciences Citation Index. For unpublished material and grey literature: the Social Care Institute of Excellence Research Register; the National Research Register (1997–), ReFeR; Index to Theses, and HMIC. Review methods: A service-mapping questionnaire was circulated to school nurses in all parts of the UK, and semistructured telephone interviews with service coordinators in NHS and local authority (LA) roles were conducted. An evidence synthesis was performed based on a systematic review of the quantitative evidence about service effectiveness, qualitative evidence about user and professional views and a mixed-methods synthesis. A proof-of-concept model for assessing cost-effectiveness was drawn up. Results: Three broad types of UK sexual health service provision were identified. Firstly, SBSHS staffed by school nurses, offering ‘minimal’ or ‘basic’ levels of service. Secondly, SBSHS and SLSHS staffed by a multiprofessional team, but not medical practitioners, offering ‘basic’ or ‘intermediate’ levels of service. Thirdly, SBSHS and SLSHS staffed by a multiprofessional team, including medical practitioners offering ‘intermediate’ or ‘comprehensive’ levels of service. The systematic review showed that SBSHS are not associated with higher rates of sexual activity among young people, nor with an earlier age of first intercourse. There was evidence to show positive effects in terms of reductions in births to teenage mothers, and in chlamydial infection rates among young men, although this evidence coming primarily from the USA. Therefore, the findings need to be tested in relation to UK-based services. Also evidence to suggest that broad-based, holistic service models, not restricted to sexual health, offer the strongest basis for protecting young people’s privacy and confidentiality, countering perceived stigmatisation, offering the most comprehensive range of products and services, and maximising service uptake. Findings from the mapping study also indicate that broad-based services, which include medical practitioner input within a multiprofessional team, meet the stated preferences of staff and of young people most clearly. Partnership-based developments of this kind also conform to the broad policy principles embodied in the Every Child Matters framework in the UK and allied policy initiatives. However, neither these service models nor narrower ones have been rigorously evaluated in terms of their impact on the key outcomes of conception rates and sexually transmitted infection (STI) rates, in the UK or in other countries. Therefore, appropriate data were not found to support cost-effectiveness modelling. Limitations: Low response rate to the questionnaire. Scotland, Wales and Northern Ireland were under-represented. Also, the distinction made in the questionnaire between ‘general health’ and ‘sexual health’ services did not prove robust. Conclusions: There is no single, dominant service model in the UK. The systematic review demonstrated that the evidence base for these services remains limited and uneven, and draws largely on US studies. Qualitative research is needed to develop robust process and outcome indicators for the evaluation of SLSHS/SBSHS in the UK. These indicators could then be used both in local evaluations, and in large, longitudinal studies of service effectiveness and cost-effectiveness. Future research should examine the impact of the differing types of services currently evolving in the UK, encompassing school-based and school-linked models, as well as models with and without medical practitioner involvement

Using On-Farm Demonstrations to Evaluate Newly Developed Cool-Season Forages in the Southeastern USA

Multiple demonstration sites throughout Florida were designed to evaluate and provide hands-on producer and county faculty access to newly developed cool-season winter forage crops that can be grown in the southeastern United States. Research funding for these projects was provided by the Dairy Research and Education Project, supported through the Georgia/Florida Dairy Industry check-off dollars. Early adopter producers interested in evaluating forages were identified for this cooperation. Long-term goals are to have the early adopter producer aid in the trialing and dissemination of information about improved varieties. Cool-season forages for use on southeastern US livestock operations benefit the producer in providing highly nutritional greenchop or silage crop for livestock, winter cover to provide erosion and leaching protection on cultivated acreage, potentially recycle nutrients or remove significant nutrients from the forage system, and serve as a sentinel plots to help identify new or emerging pest problems related to forage production. We also focus developing forages for both low and high end input systems that address environmental issues related to N and P in the soils. In the southeastern U.S. particularly in Florida, nitrogen and phosphorus accumulate in many production fields and these nutrients impact surface and ground water resources. We participate with the Florida Department of Agriculture and the dairy and beef cattle industry to develop “best management practices” (BMPs) that guide producers to lessen their negative impacts on the environment and improve upon their operation’s sustainability and economic returns. This effort has led to the release of new cultivars from the University of Florida’s Forage Program. While we focus, primarily, on cool-season small grains and ryegrass, our program also includes breeding other subtropical forage species for adaptation to our environment and to improve adoption of BMPs

Efficacy of supplementation of probiotics on maternal glycaemic control – A systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the evidence pertaining to the efficacy of the supplementation of probiotics on the blood glucose level of pregnant women with gestational diabetes mellitus (GDM). Background: Women with the GDM are subsequently at risk to develop type 2 diabetes mellitus, within three to six years after delivery. This makes it crucial for all pregnant women with the GDM, to monitor their blood glucose levels regularly to minimize the adverse pregnancy outcomes. The earlier studies revealed that the probiotics could improve glycaemic control and mitigate the adverse effects of type 2 diabetes mellitus. Design: A systematic review and meta-analysis. Data sources: The Google Scholar, Pubmed/Medline, Cochrane library, ProQuest, Ovid, and EMBASE were systematically searched for the available clinical trials. Review methods: Randomized clinical trials (RCTs) for evaluating the effects of the probiotics on the pregnancy outcomes such as glycaemic control as primary outcome were included to achieve the aim of this review and meta-analysis. Two reviewers from the team extracted the data and assessed the risk of bias in the eligible studies independently. The meta-analysis was performed by applying a model of fixed effects using the Revman 5.3 software. Results: Nine clinical trials involving 1053 participants were included in the meta-analysis. Though the components of probiotics varied significantly, Lactobacillus species was given to all the participants in all the trials included in this review. The results showed that the probiotics asignificantly improved the glycaemic control biomarkers (Fasting blood glucose and insulin sensitivity level) (P < 0.005). Conclusion: Probiotic-supplements seemed to improve the glycaemic control biomarkers. Thus, this review highlights the considerable evidence that the supplementation of probiotics has the beneficial effects on the glycaemic control markers and may be useful as a supplementary therapy among the women with the GDM. This finding would foster the health care professionals and the nurses to create awareness on the potential benefits of the supplementation of the probiotics among the women with the GDM and elevated glycaemic control biomarkers

Experience of pelvic floor muscle exercises among women in Taiwan: a qualitative study of improvement in urinary incontinence and sexuality

Aims and objectives To gain an in-depth understanding of women's experiences of performing pelvic floor muscle exercises for urinary incontinence and the impact on their sexuality. Background Urinary incontinence is not a life-threatening disorder; however, it has been shown to have detrimental effects on quality of life in terms of psychological, social and sexual dysfunction. Pelvic floor muscle exercises is the first recommended strategy for managing mild to moderate urinary incontinence as it is noninvasive and cost effective. Pelvic floor muscle exercises reduce incontinence and strengthen the pelvic floor muscles, which positively affects sexual function in women. Currently, the data are scarce for qualitative literature regarding the subjective experiences of Taiwanese women undergoing pelvic floor muscle exercises and the impact on their urinary incontinence and sexuality. Design Qualitative exploratory study. Methods Semi-structured in depth interviews were undertaken with twelve women who had completed a pelvic floor muscle exercises program in Taiwan. Data were analysed using thematic analysis. Results Themes were related to Taiwanese women's initial feelings that urinary incontinence was inevitable and the effects on their sexuality. Three core themes were identified: perceptions of inevitability, developing awareness and gaining control and sexual taboo. Through developing awareness and control of their pelvic floor muscles women expressed improvement in urinary incontinence. Sexual enjoyment, body image, self confidence and sexuality were also enhanced. Conclusion Pelvic floor muscle exercises had a positive effect on urinary incontinence and sexuality. The findings demonstrated that sex is a taboo topic for many Taiwanese women. With the sensitive management of pelvic floor muscle exercises programs this issue can be addressed. Relevance to clinical practice This study raises awareness of healthcare professionals by identifying how Taiwanese women perceive pelvic floor muscles. The positive impact of pelvic floor muscle exercises upon both urinary incontinence and sexuality within the Taiwanese context are addressed. Nurses may also, with greater confidence initiate discussion of women's sexual concerns as part of managing urinary incontinence

The effectiveness and characteristics of mHealth interventions to increase adolescent's use of sexual and reproductive health services in Sub-Saharan Africa: a systematic review

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent's uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the 'International Prospective Register for Systematic Reviews' (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent's uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA