Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

<b>Background</b> Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.<p></p> <b>Methods</b> A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.<p></p> <b>Results</b> Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.<p></p> <b>Conclusions</b> Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings

Collaborative Epistemic Discourse in Classroom Information Seeking Tasks

We discuss the relationship between information seeking, and epistemic beliefs – beliefs about the source, structure, complexity, and stability of knowledge – in the context of collaborative information seeking discourses. We further suggest that both information seeking, and epistemic cognition research agendas have suffered from a lack of attention to how information seeking as a collaborative activity is mediated by talk between partners – an area we seek to address in this paper. A small-scale observational study using sociocultural discourse analysis was conducted with eight eleven year old pupils who carried out search engine tasks in small groups. Qualitative and quantitative analysis were performed on their discussions using sociocultural discourse analytic techniques. Extracts of the dialogue are reported, informed by concordance analysis and quantitative coding of dialogue duration. We find that 1) discourse which could be characterised as ‘epistemic’ is identifiable in student talk, 2) that it is possible to identify talk which is more or less productive, and 3) that epistemic talk is associated with positive learning outcomes

Exercise Assessment for People with End-stage Renal Failure

First paragraph: Progressive loss of kidney function is often described as chronic kidney disease (CKD). Chronic kidney disease may progress to end stage renal failure (ESRF), at which point the kidneys are not able to perform their regulatory and excretory functions. The transition into end-stage renal failure, with the concomitant derangement of normal biochemical, metabolic and endocrine functions, is almost always accompanied by the clinical syndrome of uraemia. Symptoms such as anorexia, generalised lethargy and fatigue, sleep disorder, neurological dysfunction, nausea and vomiting are frequently evident. The appearance of these symptoms is remarkably consistent and appears to coincide with abnormal plasma levels of many substances including urea, creatinine, phosphate, and parathyroid hormone, which have been identified as potential uraemic toxins. Accompanying clinical signs of ESRF include fluid retention (peripheral and pulmonary oedema), raised blood pressure, diminishing haemoglobin levels and abnormal biochemistry (creatinine, serum urea and potassium) (Bommer 1992, Moore 2000)

Targeting sexual health services in primary care: a systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age

BACKGROUND: Women using primary care vary in need for sexually transmitted infections (STIs) testing and contraception. Psychosocial correlates of these needs may be useful for targeting services. We undertook a systematic review to identify psychosocial correlates of STI acquisition, unplanned pregnancy (UP), abortion and risky sexual behaviours in general population samples of women of reproductive age. METHODS: We searched bibliographic databases for probability surveys of women aged 16-44years in the European Union, USA, Canada, Australia, UK or New Zealand undertaken January 1994-January 2014. RESULTS: Eleven papers were included. Unplanned pregnancy was associated with smoking, depression, being single and sexual debut <16years. Abortion was associated with lack of closeness to parents, leaving home at an early age, and relationship break-up. Multiple partnerships were associated with intensity of marijuana and alcohol use, and smoking. STI diagnosis was associated with relationship break-up and younger partners. Non-use of contraception was associated with smoking, obesity, relationship status, sedentary lifestyles, fatalistic pregnancy attitudes and lower alcohol use. Condom non-use was higher (at first sex) with partners 5+years older and lower (at last sex) in less stable partnerships. CONCLUSION: Psychosocial variables, particularly relationship status and smoking, may help identify women in primary care for STI testing and contraception advice and supply

How and why do South Asians attend GUM clinics? Evidence from contrasting GUM clinics across England

Background: Improving access to sexual healthcare is a priority in the UK, especially for ethnic minorities. Though South Asians in the UK report low levels of sexual ill health, few data exist regarding their use of genitourinary medicine (GUM) services. Objectives: To describe reasons for attendance at GUM clinics among individuals of South Asian origin relative to patients of other ethnicities. Methods: 4600 new attendees (5% South Asian; n=226) at seven sociodemographically and geographically contrasting GUM clinics across England completed a questionnaire between October 2004 and March 2005, which were linked to routine clinical data. Results: South Asians were more likely than other groups to be signposted to the GUM clinic by another health service-for example, in women 14% versus 8% respectively (p=0.005) reported doing so from a family planning clinic. These women also reported that they would be less likely to go to the clinic if their symptoms resolved spontaneously compared with other women (51% vs 31%, p=0.024). However, relative to other clinic attendees, no differences in the proportions of South Asians who had acute STI(s) diagnosed at clinic were noted. Furthermore, South Asian men were more likely to report as their reason for attendance that they wanted an HIV test (23.4% vs 14.8%, p=0.005). Conclusion: Despite having similar STI care needs to attendees from other ethnic groups, South Asians, especially women, may be reluctant to seek care from GUM clinics, especially if their symptoms resolve. Sexual health services need to develop locally-delivered and culturally-appropriate initiatives to improve care pathways

The association of seasonal influenza vaccination with pandemic influenza H1N1 2009 infection

Letter to the editor; Comment on Vaccine. 2011 Nov 15, v. 29 n. 49, p. 9194-200In 2010 Skowronski and colleagues reported that seasonal influenza vaccine appeared to increase the risk of pandemic influenza H1N1 2009 (pH1N1) infection during the first pandemic wave in Canada [1]. They suggested a number of possible explanations for their unexpected finding: firstly, that the results were an artefact of selection bias or confounding; secondly, that the results were due to partial mediation through a biological mechanism; and thirdly, that the results were due to a direct immune mechanism, such as antibody dependent enhancement [1]. In a recent paper in Vaccine, Rosella and colleagues have investigated in detail the first of these possibilities, confirming that it is unlikely an unidentified confounder could have explained the findings [2]. © 2011 Elsevier Ltd.postprin

Validität des automatisierten Learning Progress Assessments im geschriebenen Englisch für Schüler:innen mit Lernschwierigkeiten

We evaluated the validity of an automated approach to learning progress assessment (aLPA) for English written expression. Participants (n = 105) were students in Grades 2–12 who had parent-identified learning difficulties and received academic tutoring through a community-based organization. Participants completed narrative writing samples in the fall and spring of 1 academic year, and some participants (n = 33) also completed a standardized writing assessment in the spring of the academic year. The narrative writing samples were evaluated using aLPA, four hand-scored written expression curriculum-based measures (WE-CBM), and ratings of writing quality. Results indicated (a) aLPA and WE-CBM scores were highly correlated with ratings of writing quality; (b) aLPA and more complex WE-CBM scores demonstrated acceptable correlations with the standardized writing subtest assessing spelling and grammar, but not the subtest assessing substantive quality; and (c) aLPA scores showed small, statistically significant improvements from fall to spring. These findings provide preliminary evidence that aLPA can be used to efficiently score narrative writing samples for progress monitoring, with some evidence that the aLPA scores can serve as a general indicator of writing skill. The use of automated scoring in aLPA, with performance comparable to WE-CBM hand scoring, may improve scoring feasibility and increase the likelihood that educators implement aLPA for decision-making. (DIPF/Orig.)Wir evaluierten die Validität eines automatischen Ansatzes des Learning Progress Assessments (aLPA) in geschriebener Sprache. Schüler:innen der Klassen 2 bis 12 (n = 105) mit Lernschwierigkeiten, die deren Eltern festgestellt hatten, nahmen an Nachhilfeunterricht, welcher von einer gemeinnützigen Organisation durchgeführt wurde, teil. Die Schüler:innen erstellten im Herbst und Frühjahr eines Schuljahres Schreibproben. Weiterhin nahmen einige Schüler:innen (n = 33) an einer standardisierten Schreibprüfung im Frühjahr teil. Die Schreibproben wurden mit aLPA, vier handkodierten Curriculum-Based Measures (WE-CBM) und hinsichtlich deren Schreibqualität ausgewertet. Unsere Ergebnisse zeigen, (a) aLPA- und WE-CBM-Werte korrelierten hoch mit der Bewertung der Schreibqualität, (b) aLPA- und die komplexeren WE-CBM-Werte zeigten akzeptable Korrelationen mit der standardisierten Rechtschreib- und Grammatikprüfung, jedoch nicht mit tatsächlicher Qualität, und (c) aLPA-Werte zeigten geringe, statistisch signifikante Verbesserungen von Herbst zu Frühjahr. Diese Ergebnisse deuten darauf hin, dass aLPA als effiziente Methode zur Bewertung von Schreibproben verwendet werden kann und der aLPA-Wert als allgemeiner Schreibkompetenzindikator dienen kann. Automatische Bewertung im aLPA, dessen Validität mit der von WE-CBM vergleichbar ist, kann die Bewertung vereinfachen und damit ist es wahrscheinlicher, dass Lehrkräfte aLPA verwenden. (DIPF/Orig.

Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial

Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation

Duodenal intraepithelial lymphocytes of children with cow milk allergy preferentially bind the glycan-binding protein galectin-3

A breakdown in intestinal homeostasis results in inflammatory bowel diseases including coeliac disease and allergy. Galectins, evolutionarily conserved beta-galactoside-binding proteins, can modulate immune-epithelial cell interactions by influencing immune cell fate and cytokine secretion. In this study we investigated the glycosylation signature, as well as the regulated expression of galectin-1 and -3 in human duodenal samples of allergic and non-allergic children. Whereas galectin-1 was predominantly localized in the epithelial compartment (epithelial cells and intraepithelial lymphocytes) and the underlying lamina propria (T cells, macrophages and plasma cells), galectin-3 was mainly expressed by crypt epithelial cells and macrophages in the lamina propria. Remarkably, expression of these galectins was not significantly altered in allergic versus non-allergic patients. Investigation of the glycophenotype of the duodenal inflammatory microenvironment revealed substantial alpha2-6-linked sialic acid bound to galactose in lamina propria plasma cells, macrophages and intraepithelial lymphocytes and significant levels of asialo core 1 O-glycans in CD68+ macrophages and enterocytes. Galectin-1 preferentially bound to neutrophils, plasma cells and enterocytes, while galectin-3 binding sites were mainly distributed on macrophages and intraepithelial lymphocytes. Notably, galectin-3, but not galectin-1 binding, was substantially increased in intraepithelial gut lymphocytes of allergic patients compared to non-allergic subjects, suggesting a potential role of galectin-3-glycan interactions in shaping epithelial-immune cell connections during allergic inflammatory processes.Fil: Mercer, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Guzman, Luciana. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de la Plata; ArgentinaFil: Cueto Rua, Eduardo. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de la Plata; ArgentinaFil: Drut, Ricardo. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de la Plata; ArgentinaFil: Ahmed, H.. University of Maryland; Estados UnidosFil: Vasta, G. R.. University of Maryland; Estados UnidosFil: Toscano, Marta Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Docena, Guillermo H.. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Plata; Argentin