Clinician and patients’ views about self-management support in arthritis: a cross-sectional UK survey

Objective The overall aims of the study are to (a) establish receipt and provision of self-management support for patients with inflammatory arthritis in the UK; and (b) establish if receipt of selfmanagement support is associated with patient’s knowledge, skills and confidence to selfmanage. Methods Questionnaire for patients and healthcare professionals were sent to members and associates of the National Rheumatoid Arthritis Society (NRAS). Patients completed the Patient Activation Measure (PAM), and questions about receipt of self-management support. Healthcare professionals completed the Clinician Support PAM and questions about provision of self-management support. Results A total of 886 patients and 117 healthcare professionals completed a questionnaire. Only 15% of patients had attended a structured self-management programme. Over half of patients reported having the skills, confidence and knowledge to self-manage and this was associated with receipt of self-management support embedded in routine care. All healthcare professionals felt that patients should be actively involved in their own care, however, 60% were unable to offer structured self-management support. Healthcare professionals reported engaging in more embedded self-management support than patients reported receiving in routine care

Optimization of Advertising Resources over Time: A Strategic Analysis

AMS subject classification: 90B60, 90B50, 90A80.Strategic behaviour has long been a crucial issue for modern corporations. To maximize potential profits and market share, firms are more than willing to invest in sales promotion to boost long term manufacturing output. Knowing that the sales of the firm not only respond to own advertising budgets, but also depend upon rivals’ advertising strategies, oligopolistic firms form part, therefore of a continuous race with reference to non-price competition. Efficient use of investment resources is crucial for business operations and long term strategic success. This paper aims to investigate the key issue of optimization of strategic advertising outlays. By using mathematical modelling techniques, strategic linkages between rival companies are identified and advertising impacts explained. Since advertising influences can persist through time, our discussion extends to explore this fundamental point by constructing a more advanced model to examine into the problems of optimization over time. Empirical data is used to test the predictive power of these models and assess relative efficiencies. All in all, this paper intends to highlight the importance of continuous strategic advertising investment and consequently provides comprehensive insights into the impact of modern advertising functions over time

Interpretación errónea del concepto de entropía

Background Cetylpyridinium chloride (CPC) and sodium fluoride augment oral hygiene by inactivating bacteria and inhibiting enamel demineralisation, respectively. However, there are few reports in the literature documenting the antibacterial efficacy of their combined use in mouthrinses. We have used six experimental systems to compare the antibacterial effects of mouthrinses containing 0.075 % CPC (test rinse, TR) or 0.075 % CPC with sodium fluoride (test fluoride rinse, TFR). Results Effects against planktonic bacteria were determined using viable counting (for Streptococcus mutans and salivary bacteria), a redox dye (for Actinomyces viscosus and salivary bacteria) and viable counting (for ex vivo oral rinses). Effects against saliva-derived biofilms were quantified using confocal microscopy and differential viable counting. Inhibition of biofilm formation was evaluated by pre-treating hydroxyapatite coupons with mouthrinses prior to inoculation. Otherwise-identical controls without CPC (control rinse and control fluoride rinse, CR and CFR, respectively), were included throughout. Compared to the controls, TFR and TR demonstrated significant antimicrobial effects in the redox assays, by viable counts (>3 log reductions) and in oral rinse samples (>1.25 log reductions, p 3 log difference, p < 0.05). Overall, there were no consistent differences in the activities of TR and TFR. Conclusions Sodium fluoride did not influence the antibacterial and anti-biofilm potency of CPC-containing formulations, supporting the combined use of CPC and sodium fluoride in mouthrinses to control oral bacteria and protect tooth enamel

High-intensity interval walking in combination with acute green tea extract supplementation reduces postprandial blood glucose concentrations in physically inactive participants

Background: Exercise and green tea supplementation have been shown to have the potential to improve postprandial blood glucose concentrations, but past interventions have not often investigated attainable and time effective exercise protocols. Aim: The purpose of this study was to investigate the effects of interval walking exercise and acute green tea extract supplementation on the glycaemic response to an oral glucose tolerance test (OGTT). Method: Twelve physically inactive participants (nine male, three female, age: 22 ± 1 years; body mass: 81.2 ± 16.3 kg; stature: 175.7 ± 9.6 cm; body mass index (in kg/m2): 26.2 ± 4.3) underwent a 2-h OGTT immediately following i) no intervention (REST), ii) placebo and exercise (EX-PLAC), iii) green tea extract supplementation and exercise (EX-GTE), in a random order. The walking exercise consisted of 6 × 1 min of brisk walking (7.92 ± 0.56 km/h) separated by 1 min of slower walking (4.8 km/h). Differences between groups were identified using magnitude-based inferences. Results: The EX-GTE intervention resulted in a ∼9% most likely beneficial effect on blood glucose area under the curve response to the OGTT (702.18 ± 76.90 mmol/L–1·120 min–1) compared with REST (775.30 ± 86.76 mmol/L–1·120 min–1), and a very likely beneficial effect compared with the EX-PLAC (772.04 ± 81.53 mmol/L–1·120 min–1). Conclusion: These data suggest that an EX-GTE intervention can reduce postprandial glucose concentrations in physically inactive individuals

From Soldier to Student II: Assessing Campus Programs for Veterans and Service Members

The United States is in the process of bringing more than 2 million service members home from Iraq and Afghanistan and reducing the size of America's military. Today's veterans are the beneficiaries of the Post-9/11 GI Bill, which has provided unprecedented financial support for attending college. More than 500,000 veterans and their families have utilized Post-9/11 GI Bill benefits since the law's enactment in 2008. Many returning veterans -- as well as service members in the active and reserve components of the armed forces -- will enroll in higher education to enhance their job prospects, achieve career goals, expand their knowledge and skill sets for both personal and career enrichment, and facilitate their transition to civilian life.How well prepared is higher education to serve these new students, and what changes has it made in response to the first wave of Post-9/11 GI Bill recipients on campus? Despite the long history of veterans' education benefits and presence of veteran students on campus, current research is still catching up to the veteran and military student population. This report represents the second assessment of the current state of programs and services for veterans and service members on campuses across the nation, based on survey results from 690 institutions

Autofluorescence imaging – a useful adjunct in imaging macular trauma

Autofluorescence imaging is a rapid, noninvasive technique, with several applications becoming slowly integrated into ophthalmic clinical practice. We describe its use as a valuable tool for predicting the function of the retinal pigment epithelium following damage from blunt ocular trauma

Lactobacillus rhamnosus GG inhibits the toxic effects of Staphylococcus aureus on epidermal keratinocytes

Few studies have evaluated the potential benefits of the topical application of probiotic bacteria or material derived from them. We have investigated whether a probiotic bacterium, Lactobacillus rhamnosus GG, can inhibit Staphylococcus aureus infection of human primary keratinocytes in culture. When primary human keratinocytes were exposed to S. aureus, only 25% of the keratinocytes remained viable following 24 h of incubation. However, in the presence of 10(8) CFU/ml of live L. rhamnosus GG, the viability of the infected keratinocytes increased to 57% (P = 0.01). L. rhamnosus GG lysates and spent culture fluid also provided significant protection to keratinocytes, with 65% (P = 0.006) and 57% (P = 0.01) of cells, respectively, being viable following 24 h of incubation. Keratinocyte survival was significantly enhanced regardless of whether the probiotic was applied in the viable form or as cell lysates 2 h before or simultaneously with (P = 0.005) or 12 h after (P = 0.01) S. aureus infection. However, spent culture fluid was protective only if added before or simultaneously with S. aureus. With respect to mechanism, both L. rhamnosus GG lysate and spent culture fluid apparently inhibited adherence of S. aureus to keratinocytes by competitive exclusion, but only viable bacteria or the lysate could displace S. aureus (P = 0.04 and 0.01, respectively). Furthermore, growth of S. aureus was inhibited by either live bacteria or lysate but not spent culture fluid. Together, these data suggest at least two separate activities involved in the protective effects of L. rhamnosus GG against S. aureus, growth inhibition and reduction of bacterial adhesion

A patient-initiated DMARD selfmonitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial

Objective: To determine the effectiveness of a patient-initiated DMARD self-monitoring service for people with rheumatoid (RA) or psoriatic arthritis (PsA) on methotrexate. Methods: A two-arm, single centre, randomised controlled trial assessing superiority in relation to healthcare utilisation, clinical and psychosocial outcomes. Participants were 100 adults with either RA or PsA on a stable dose of methotrexate, randomly assigned to usual care or the patient-initiated service. Intervention participants were trained how to understand and interpret their blood tests and use this information to initiate care from their clinical nurse specialist (CNS). The primary outcome was the number of outpatient visits to the CNS during the trial period. Differences between groups were analysed using Poisson regression models. Secondary outcomes were collected at baseline and after the 3rd and 6th blood tests. Disease activity was measured using either the DAS28 or PsARC, pain and fatigue using a visual numeric scale and the HAQII, HADS and SF12 were completed to assess disability, mood and quality of life, respectively. Differences between groups over time on secondary outcomes were analysed using multi-level models. Results: The patient-initiated DMARD self-monitoring service was associated with 54.55% fewer visits to the CNS (p<0.0001), 6.80% fewer visits to the rheumatologist (p=0.23) and 38.80% fewer visits to the GP (p=0.07), compared with control participants. There was no association between trial arm and any of the clinical or psychosocial outcomes. Conclusions: The results suggest that a patient-initiated service that incorporates patients self-monitoring DMARD therapy can lead to significant reductions in healthcare utilisation, whilst maintaining clinical and psychosocial well-being

Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals

Objectives To establish healthcare professionals’ (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI). Design Cross-sectional, postal and online survey. Setting Trusts within the National Health Service (NHS), mental health and diabetes charities and professional bodies. Participants HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK. Primary and secondary outcome measures The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework (TDF). Results Responders were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (p<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the regression analyses were a lack of knowledge (p=0.003); a need for training in communication and negotiation skills (p=0.04); a lack of optimism about the health of their clients (p=0.04) and their ability to manage T2DM in people with SMI (p=0.003); the threat of being disciplined (p=0.02); fear of working with people with a mental health condition (p=0.01); a lack of service user engagement(p=0.006) and a need for incentives (p=0.04). The significant enablers were an understanding of the need to tailor treatments (p=0.04) and goals (p=0.02) for people with SMI. Conclusions This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of a HCP’s role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced