From progesterone in biopsies to estimates of pregnancy rates: Large scale reproductive patterns of two sympatric species of common dolphin, Delphinus spp. off California, USA and Baja, Mexico

Blubber progesterone levels were measured in biopsy samples and used to predict the pregnancy status of 507 female common dolphins (204 long-beaked common dolphins, Delphinus capensis, and 303 short-beaked common dolphins, D. delphis). Samples were collected in the coastal waters of the eastern North Pacific between central California, USA and the southern end of Baja California, Mexico. The percentage of females pregnant was similar between the two species: 22.1% (n = 45) of D. capensis and 28.1% (n = 85) of D. delphis. For both species we found strong geographic patterns in pregnancy, suggesting that some areas were more conducive for pregnant females. A sizable drop in percent pregnant from early (38.8%, n = 133) to late (25.3%, n = 91) autumn was found in D. delphis but not in D. capensis. The potential for sample selectivity was examined via biopsies collected either from a large research ship or from a small, rigid-hull inflatable boat (RHIB) launched from the larger ship. An analysis of “Tandem Biopsy Sampling”, replicate biopsy effort on the same schools from each vessel/platform, yielded little evidence that disproportionately more pregnant female common dolphins were biopsied from one platform versus the other. This result plus an analysis of pregnancy status relative to the duration of biopsy operations failed to uncover strong evidence of unaccounted sampling bias with respect to pregnancy state. In total, these results demonstrate the utility of blubber progesterone concentrations to assess pregnancy status in free-ranging cetaceans and they highlight potential factors associated with population-level variation in dolphin pregnancy rates

A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people

Background: The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people. Methods: A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated ‘positively deviant’ patient care. Results: Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented. Conclusion: This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes

Effectiveness of interventions to support the early detection of skin cancer through skin self-examination: a systematic review and meta-analysis.

BACKGROUND: As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self-examination (SSE); however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE interventions. OBJECTIVES: To systematically examine, map, appraise and synthesize, qualitatively and quantitatively, studies evaluating the early detection of skin cancer, using SSE interventions. METHODS: This is a systematic review (narrative synthesis and meta-analysis) examining randomized controlled trials (RCTs) and quasiexperimental, observational and qualitative studies, published in English, using PRISMA and National Institute for Health and Care Excellence guidance. The MEDLINE, Embase and PsycINFO databases were searched through to April 2015 (updated in April 2018 using MEDLINE). Risk-of-bias assessment was conducted. RESULTS: Included studies (n = 18), totalling 6836 participants, were derived from 22 papers; these included 12 RCTs and five quasiexperiments and one complex-intervention development. More studies (n = 10) focused on targeting high-risk groups (surveillance) than those at no higher risk (screening) (n = 8). Ten (45%) study interventions were theoretically underpinned. All of the study outcomes were self-reported, behaviour related and nonclinical in nature. Meta-analysis demonstrated the impact of the intervention on the degree of SSE activity from five studies, especially in the short term (up to 4 months) (odds ratio 2·31, 95% confidence interval 1·90-2·82), but with small effect sizes. Risk-of-bias assessment indicated that 61% of the studies (n = 11) were of weak quality. CONCLUSIONS: Four RCTs and a quasiexperimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer. However, the actual clinical impact remains unclear, and this is based on overall weak study (evidence) quality

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK

Background: People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. Methods: We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. Results: The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation. Conclusion: We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial

A systematic review of cognitive function and psychosocial well-being in school-age children with narcolepsy

Introduction: Narcolepsy is a neurological sleep disorder characterised by excessive daytime sleepiness and attacks of muscle weakness which are often precipitated by strong emotions (cataplexy). In August 2010, concerns were raised about an increase in the incidence rate of narcolepsy diagnosis in children and adolescents. It is therefore timely to systematically review the current research that has investigated the consequences of this chronic disorder in childhood on cognitive function and psychosocial well-being. Objective: The review was conducted to assess whether cognitive function and psychosocial well-being is impaired in school-age children with narcolepsy and to assess the quality of the previous research. Data sources: Four electronic databases were searched on 27th June 2015; The Cochrane Library, EMBASE, Ovid MEDLINE and PsycINFO. Eligibility criteria for selecting studies: Research primarily concerned with; narcolepsy (and/or cataplexy) and cognitive function and/or psychosocial well-being in children aged between 5-17 years old. Studies matching this criteria, published between 2005-2015 and written in English were included in this review. Results: Eight studies met the inclusion criteria for the present review. Collectively the results provided evidence to suggest that children who develop narcolepsy are at significant cognitive and psychological risk. The findings suggest that narcolepsy puts children and adolescents at particular risk of cognitive impairment in at least one domain and emotional problems including depression, anxiety and low self-esteem which may consequently lead to poorer quality of life. Conclusions: This review has highlighted that children with narcolepsy are at significant risk of cognitive and psychological impairments. However, current research is limited by small sample sizes and lack of standardised assessments, appropriate controls and longitudinal data. In order to gain further understanding about the cognitive and psychological consequences of childhood narcolepsy, future research must address these limitations so that the results can enable recommendations to be made for any extra support needed at home and at school so that children with narcolepsy are able to achieve their full potential

Does electronic monitoring influence adherence to medication? Randomized controlled trial of measurement reactivity.

BACKGROUND: Electronic monitoring is recommended for accurate measurement of medication adherence but a possible limitation is that it may influence adherence. PURPOSE: To test the reactive effect of electronic monitoring in a randomized controlled trial. METHODS: A total of 226 adults with type 2 diabetes and HbA1c ≥58 mmol/mol were randomized to receiving their main oral glucose lowering medication in electronic containers or standard packaging. The primary outcomes were self-reported adherence measured with the MARS (Medication Adherence Report Scale; range 5-25) and HbA1c at 8 weeks. RESULTS: Non-significantly higher adherence and lower HbA1c were observed in the electronic container group (differences in means, adjusting for baseline value: MARS, 0.4 [95 % CI -0.1 to 0.8, p = 0.11]; HbA1c (mmol/mol), -1.02 [-2.73 to 0.71, p = 0.25]). CONCLUSIONS: Electronic containers may lead to a small increase in adherence but this potential limitation is outweighed by their advantages. Our findings support electronic monitoring as the method of choice in research on medication adherence. (Trial registration Current Controlled Trials ISRCT N30522359)

Electronic Systems for Patients to Report and Manage Side Effects of Cancer Treatment: Systematic Review

Background: There has been a dramatic increase in the development of electronic systems to support cancer patients to report and manage side effects of treatment from home. Systems vary in features that they offer to patients which may impact on how patients engage with them, and subsequently on the benefit that may be derived in terms of patient centred outcomes. Objectives: This review aimed to 1) Describe the features and functions of existing electronic symptom reporting systems (e.g. symptom monitoring, tailored self-management advice etc.), 2) Explore which features may be associated with patient engagement and patient-centred outcomes. Method: The review was registered with PROSPERO and followed guidelines from the Centre for Reviews and Dissemination. Primary searches were undertaken of MEDLINE, EMBASE, PsychInfo, Web of Science, Cochrane Central Register of Controlled Trials and the Health Technology Assessment databases. Secondary searches were undertaken by screening reference lists and citations. Two researchers applied broad inclusion criteria to identify and select relevant records. Data was extracted and summarised using Microsoft Excel. In order to meet the aims, study selection, data extraction and data synthesis evolved into two stages. Stage 1: Identifying and characterising available systems and Stage 2: Summarising data on patient engagement and patient centred outcomes. Results: 77 publications were identified relating to 41 distinct systems. Stage 1: All publications were included (n=77). Features identified which supported clinicians and care were: facility for health professionals to remotely access and monitor patient reported data (58%) and function to send alerts to health professionals for severe symptoms (41%). Features which supported patients were: facility for patients to monitor/review their symptom reports over time (e.g. graphs) (46%), general patient information about cancer treatment and side-effects (41%), tailored automated patient advice on symptom management (29%), feature for patients to communicate with the healthcare team (15%) and a forum for patients to communicate with one another (10%). Stage 2: Only publications which included some data on patient engagement and/or patient-centred outcomes were included (n=29). A lack of consistency between studies in how engagement was defined, measured or reported and a wide range of methods chosen to evaluate systems meant it was not possible to compare across studies or make conclusions on relationships with system features. Conclusion: Electronic systems have the potential to support patients to manage side effects of cancer treatment with some evidence to suggest a positive effect on patient centred outcomes. However, comparison across studies is difficult due to the wide range of assessment tools used. There is a need to develop guidelines for assessing and reporting engagement with systems, and a set of core outcomes for evaluation. We hope that this review will contribute to the field by the introduction of a taxonomy for characterising system features

A core outcome set for trials evaluating self-management interventions in people with severe mental illness and coexisting type 2 diabetes

BACKGROUND: People with severe mental illness (SMI), such as schizophrenia, have higher rates of type 2 diabetes and worse outcomes, compared to those without SMI and it is not known whether diabetes self-management interventions are effective for people who have both conditions. Research in this area has been impeded by a lack of consensus on which outcomes to prioritise in people with co-existing SMI and diabetes.AIMS: To develop a core outcome set (COS) for use in effectiveness trials of diabetes self-management interventions in adults with both type 2 diabetes and SMI.METHODS: The COS was developed in three stages: (i) identification of outcomes from systematic literature review of intervention studies, followed by multi-stakeholder and service user workshops; (ii) rating of outcomes in a two-round online Delphi survey; (iii) agreement of final 'core' outcomes through a stakeholder consensus workshop.RESULTS: Seven outcomes were selected: glucose control, blood pressure, body composition (body weight, BMI, body fat), health-related quality of life, diabetes self-management, diabetes-related distress and medication adherence.CONCLUSIONS: This COS is recommended for future trials of effectiveness of diabetes self-management interventions for people with SMI and type 2 diabetes. Its use will ensure trials capture important outcomes and reduce heterogeneity so findings can be readily synthesised to inform practice and policy.</p