Patients' experiences of screening for type 2 diabetes:prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial

Objectives To provide insight into factors that contribute to the anxiety reported in a quantitative study of the psychological effect of screening for type 2 diabetes. To explore expectations of and reactions to the screening experience of patients with positive, negative, and intermediate results. Design Prospective qualitative interview study of patients attending a screening programme for type 2 diabetes. Setting Seven general practices in the ADDITION (Cambridge) trial in the east of England. Participants 23 participants (aged 50-69) attending different stages in the screening process. Results Participants' perceptions changed as they progressed through the screening programme; the stepwise process seemed to help them adjust psychologically. The first screening test was typically considered unimportant and was attended with no thought about its implications. By the final diagnostic test, type 2 diabetes was considered a strong possibility, albeit a “mild” form. After diagnosis, people with screen detected type 2 diabetes tended to downplay its importance and talked confidently about their plans to control it. Participants with intermediate results seemed uncertain about their diagnosis, and those who screened negative were largely unaware of their remaining high risk. Conclusions This study helps in understanding the limited psychological impact of screening for type 2 diabetes quantified previously, in particular by the quantitative substudy of ADDITION (Cambridge). The findings have implications for implementing such a screening programme in terms of timing and content

Investigating the usefulness of Automated Check-in Data Collection in general practice (AC DC Study): a multicentre, cross-sectional study in England.

Objectives: To investigate the usefulness of using automated appointment check-in screens to collect brief research data from patients, prior to their general practice consultation.Design: A descriptive, cross-sectional study.Setting: Nine general practices in the West Midlands, UK. Recruitment commenced in Autumn 2018 and was concluded by 31 March 2019.Participants: All patients aged 18 years and above, self-completing an automated check-in screen prior to their general practice consultation, were invited to participate during a 3-week recruitment period.Primary and secondary outcome measures:The response rate to the use of the automated check-in screen as a research data collection tool was the primary outcome measure. Secondary outcomes included responses to the two research questions and an assessment of impact of check-in completion on general practice operationalisationResults: Over 85% (n=9274) of patients self-completing an automated check-in screen participated in the Automated Check-in Data Collection Study (61.0% (n=5653) women, mean age 55.1 years (range 18–98 years, SD=18.5)). 96.2% (n=8922) of participants answered a ‘clinical’ research question, reporting the degree of bodily pain experienced during the past 4 weeks: 32.9% (n=2937) experienced no pain, 28.1% (n=2507) very mild or mild pain and 39.0% (n=3478) moderate, severe or very severe pain. 89.3% (n=8285) of participants answered a ‘non-clinical’ research question on contact regarding future research studies: 46.9% (n=3889) of participants responded ‘Yes, I’d be happy for you to contact me about research of relevance to me’.Conclusions: Using automated check-in facilities to integrate research into routine general practice is a potentially useful way to collect brief research data from patients. With the COVID-19 pandemic initiating an extensive digital transformation in society, now is an ideal time to build on these opportunities and investigate alternative, innovative ways to collect research data.Trial registration number ISRCTN82531292

Bringing high-grade arteriovenous malformations under control: clinical outcomes following multimodality treatment in children.

OBJECTIVE:Brain arteriovenous malformations (AVMs) consist of dysplastic blood vessels with direct arteriovenous shunts that can hemorrhage spontaneously. In children, a higher lifetime hemorrhage risk must be balanced with treatment-related morbidity. The authors describe a collaborative, multimodal strategy resulting in effective and safe treatment of pediatric AVMs. METHODS:A retrospective analysis of a prospectively maintained database was performed in children with treated and nontreated pediatric AVMs at the University of California, San Francisco, from 1998 to 2017. Inclusion criteria were age ≤ 18 years at time of diagnosis and an AVM confirmed by a catheter angiogram. RESULTS:The authors evaluated 189 pediatric patients with AVMs over the study period, including 119 ruptured (63%) and 70 unruptured (37%) AVMs. The mean age at diagnosis was 11.6 ± 4.3 years. With respect to Spetzler-Martin (SM) grade, there were 38 (20.1%) grade I, 40 (21.2%) grade II, 62 (32.8%) grade III, 40 (21.2%) grade IV, and 9 (4.8%) grade V lesions. Six patients were managed conservatively, and 183 patients underwent treatment, including 120 resections, 82 stereotactic radiosurgery (SRS), and 37 endovascular embolizations. Forty-four of 49 (89.8%) high-grade AVMs (SM grade IV or V) were treated. Multiple treatment modalities were used in 29.5% of low-grade and 27.3% of high-grade AVMs. Complete angiographic obliteration was obtained in 73.4% of low-grade lesions (SM grade I-III) and in 45.2% of high-grade lesions. A periprocedural stroke occurred in a single patient (0.5%), and there was 1 treatment-related death. The mean clinical follow-up for the cohort was 4.1 ± 4.6 years, and 96.6% and 84.3% of patients neurologically improved or remained unchanged in the ruptured and unruptured AVM groups following treatment, respectively. There were 16 bleeding events following initiation of AVM treatment (annual rate: 0.02 events per person-year). CONCLUSIONS:Coordinated multidisciplinary evaluation and individualized planning can result in safe and effective treatment of children with AVMs. In particular, it is possible to treat the majority of high-grade AVMs with an acceptable safety profile. Judicious use of multimodality therapy should be limited to appropriately selected patients after thorough team-based discussions to avoid additive morbidity. Future multicenter studies are required to better design predictive models to aid with patient selection for multimodal pediatric care, especially with high-grade AVMs

Energy compensation in the real world. Good compensation for small portions of chocolate and biscuits over short time periods in complicit consumers using commercially available foods.

While investigations using covert food manipulations tend to suggest that individuals are poor at adjusting for previous energy intake, in the real world adults rarely consume foods with which they are ill-informed. This study investigated the impact in fully complicit consumers of consuming commercially available dark chocolate, milk chocolate, sweet biscuits and fruit bars on subsequent appetite. Using a repeated measures design, participants received four small portions (4 × 10-11 g) of either dark chocolate, milk chocolate, sweet biscuits, fruit bars or no food throughout five separate study days (counterbalanced in order), and test meal intake, hunger, liking and acceptability were measured. Participants consumed significantly less at lunch following dark chocolate, milk chocolate and sweet biscuits compared to no food (smallest t(19) = 2.47, p = 0.02), demonstrating very good energy compensation (269-334%). No effects were found for fruit bars (t(19) = 1.76, p = 0.09), in evening meal intakes (F(4,72) = 0.62, p = 0.65) or in total intake (lunch + evening meal + food portions) (F(4,72) = 0.40, p = 0.69). No differences between conditions were found in measures of hunger (largest F(4,76) = 1.26, p = 0.29), but fruit bars were significantly less familiar than all other foods (smallest t(19) = 3.14, p = 0.01). These findings demonstrate good compensation over the short term for small portions of familiar foods in complicit consumers. Findings are most plausibly explained as a result of participant awareness and cognitions, although the nature of these cognitions cannot be discerned from this study. These findings however, also suggest that covert manipulations may have limited transfer to real world scenarios

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices

ABSTRACT Objectives: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. Patients and Methods: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. Results: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. Conclusion: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection

Gender differences in visuospatial planning: an eye movements study.

Gender studies report a male advantage in several visuospatial abilities. Only few studies however, have evaluated differences in visuospatial planning behaviour with regard to gender. This study was aimed at exploring whether gender may affect the choice of cognitive strategies in a visuospatial planning task and, if oculomotor measures could assist in disentangling the cognitive processes involved. A computerised task based on the travelling salesperson problem paradigm, the Maps test, was used to investigate these issues. Participants were required to optimise time and space of a path travelling among a set of sub-goals in a spatially constrained environment. Behavioural results suggest that there are no gender differences in the initial visual processing of the stimuli, but rather during the execution of the plan, with males showing a shorter execution time and a higher path length optimisation than females. Males often showed changes of heuristics during the execution while females seemed to prefer a constant strategy. Moreover, a better performance in behavioural and oculomotor measures seemed to suggest that males are more able than females in either the optimisation of spatial features or the realisation of the planned scheme. Despite inconclusive findings, the results support previous research and provide insight into the level of cognitive processing involved in navigation and planning tasks, with regard to the influence of gender

Improving safety for older public transport users (OPTU) - a feasibility study

On the whole, the UK public transport system is generally considered to provide a safe means of mobility. However, each year, around 6,000 people are reported by the UK police to be injured whilst using buses with more than 400 persons killed or seriously injured. Approximately 50% of those injured or killed are aged over 65 years (Department for Transport 2008). However it is thought that there are many more injured older bus-users who are not included in the national statistics and whom may now avoid travelling on public transport because of previous injuries and experiences. Whilst free travel (particularly on buses) has allowed senior citizens the freedom to travel for pleasure and social inclusion, injuries or near-falls that may occur during the journey can impact on future decisions to travel leading in some cases to anxiety/fear of sustaining further injury, loss of personal mobility and ultimately social isolation. This Feasibility Study was funded within the Medical Research Council (MRC) Lifelong Health and Wellbeing programme in order to examine the general safety (but not security) of older public transport users. It explores injury type and causation and proposes design interventions for injury prevention with an overall objective of exploring how public transport use could possibly be made safer for older transport-users. A mixed methods design was used to collect and collate data from a number of sources. These included published research literature, national accident datasets, bus-operator records, service user consultations and other stakeholder consultations with groups representing the 60+ year’s age group. The ultimate aim was to develop a pilot injury surveillance database that could in principle be used to determine vehicle design requirements, transport operator procedures and transport-user behaviors that could prevent injuries from occurring...(continues)

Mind the Gaps: Assuring the Safety of Autonomous Systems from an Engineering, Ethical, and Legal Perspective

This paper brings together a multi-disciplinary perspective from systems engineering, ethics, and law to articulate a common language in which to reason about the multi-faceted problem of assuring the safety of autonomous systems. The paper's focus is on the “gaps” that arise across the development process: the semantic gap, where normal conditions for a complete specification of intended functionality are not present; the responsibility gap, where normal conditions for holding human actors morally responsible for harm are not present; and the liability gap, where normal conditions for securing compensation to victims of harm are not present. By categorising these “gaps” we can expose with greater precision key sources of uncertainty and risk with autonomous systems. This can inform the development of more detailed models of safety assurance and contribute to more effective risk control