Decision aids to improve informed decision-making in pregnancy care: a systematic review

Rapid development in health care has resulted in an increasing number of screening and treatment options. Consequently, there is an urgency to provide people with relevant information about benefits and risks of healthcare options in an unbiased way. Decision aids help people to make decisions by providing unbiased non-directive research evidence about all treatment options. To determine the effectiveness of decision aids to improve informed decision making in pregnancy care. We searched MEDLINE (1953-2011), EMBASE (1980-2011), CENTRAL (CENTRAL, the Cochrane Library; 2011, Issue 4), Psycinfo (1806-2011) and Research Registers of ongoing trials (www.clinicaltrials.gov, www.controlled-trials.com). We included randomised controlled trials comparing decision aids in addition to standard care. The study population needed to be pregnant women making actual decisions concerning their pregnancy. Two independent researchers extracted data on quality of the randomised controlled trial (GRADE criteria), quality of the decision aid (IPDAS criteria), and outcome measures. Data analysis was undertaken by assessing group differences at first follow up after the interventions. Ten randomised controlled trials could be included. Pooled analyses showed that decision aids significantly increased knowledge, (weighted mean difference 11.06, 95% confidence interval 4.85-17.27), decreased decisional conflict scores (weighted mean difference -3.66, 95% confidence interval -6.65 to -0.68) and decreased anxiety (weighted mean difference -1.56, 95% confidence interval -2.75 to -0.43). Our systematic review showed the positive effect of decision aids on informed decision making in pregnancy care. Future studies should focus on increasing the uptake of decision aids in clinical practice by identifying barriers and facilitators to implementatio

Fragmentation characteristics of glycopeptides

Mass spectrometric analysis of glycopeptides is an emerging strategy for analysis of glycosylation patterns. Here we present an approach using energy resolved collision induced decomposition (CID) spectra to determine structural features of glycopeptides. Fragmentation of multiply protonated glycopeptides proceeds by a series of competing charge separation processes by cleavage of a glycosidic bond, each producing two charged products: a singly charged, “B” type sugar (oxonium) ion, and a complementary high mass fragment. Energy requirements (activation energies) of these processes are similar to each other, and are far less, than that required for peptide fragmentation. At higher collision energies these first generation products fragment further, yielding a complex fragmentation pattern. Analysis of low energy spectra (those corresponding to ca. 50% survival yield) are straightforward; the ions observed correspond to structural features present in the oligosaccharide, and are not complicated by consecutive reactions. This makes it feasible to identify and distinguish antenna- and core-fucosylated isomers; antenna fucosylation usually suggests presence of the Lewis-X antigen. In general, analysis of the triply protonated molecules are most advantageous, where neutral losses and monosaccharide oxonium ion formation are less abundant

Towards climate-smart dairy development

Bill & Melinda Gates Foundatio

of the Nature of the Preparation of Practice Educators in Five Health Care Disciplines

Overview This study aimed to investigate university-based preparation of physiotherapy practice-based educators, in order to explore perceived needs and identify principles of good practice. Physiotherapy (alongside occupational therapy, radiography, dietetics and nursing) was studied throughout the UK and Ireland. Questionnaires were sent out to all pre-registration physiotherapy courses (n=37) and 21 were returned, giving a response rate of 57%. The questionnaire findings were synthesised with analysis of policy documents and the wider literature Current practice Students must complete a minimum of 1000 hours of assessed satisfactory clinical practice under the supervision of a practice-based educator, who must be a registered physiotherapist. All universities provide training for clinical educators, but the nature of provision varies. There is a nation-wide shortage of clinical placements within physiotherapy at a time when student numbers are rising. The debate on how to counteract the placement crisis centres on three main issues: • The requirement for specialist physiotherapy practice placements in defined areas. • Models of clinical supervision where physiotherapy practice educators are responsible for more than one student. • The timing of physiotherapy placements within the curriculum and competition for placements in particular geographical areas. The perceived benefits of being a clinical educator include the contribution it makes to continuing professional development, fulfilment of professional responsibility and the opportunity to market services to potential recruits. Problems associated with taking students on placement were perceived to derive largely from resource constraints. Discussion Several areas of innovative practice emerged in the areas of practice educator preparation, interprofessional student learning, models of student supervision and evidencing student competence in specialist areas. The Chartered Society of Physiotherapy has recently launched a scheme for accrediting clinical educators (ACE) that it hopes will be adopted across all courses. Summary Increasing student numbers places growing pressure on an already stretched placement resource. There are many challenges in providing appropriate clinical learning experiences, particularly as physiotherapy moves increasingly towards primary care and interprofessional working. It is recommended that managers, universities and the multidisciplinary team should adopt key roles in supporting physiotherapy practice-based educators. Profile PHYSIOTHERAPY content

Using the CLEANED approach to assess the environmental impacts of livestock production

Bill & Melinda Gates Foundatio

A framework for environmental ex-ante impact assessment of livestock value chains

Livestock and fish industries are a significant source of livelihoods and income globally. They are organised in complex market chains that employ at least 1.3 billion people globally and directly support the livelihoods of 600 million poor smallholder farmers in the developing world. Livestock and fish production, processing and marketing as well as the waste produced along the value chain also cause important environmental impacts. They include atmospheric and water pollution, global warming, soil degradation, water use and pollution and biodiversity loss. Efforts to maximize yields of milk and meat, and to „intensify‟ livestock and fish production, need to be balanced with long-term sustainability and overall efficiency. We must figure out how to produce, process and market livestock and fish in ways that work for individuals, communities and the planet alike. It is thus important to assess environmental impacts before embarking on large-scale development projects geared towards livestock production and aquaculture intensification and value chain transformation. Here we present a generic conceptual framework for environmental ex-ante impact assessment of livestock and fish value chains. It is taking into account all value chain components, different spatial and temporal scales and environmental impacts across different dimensions. The framework guides users through a step-wise procedure for assessing how interventions are likely to change the production system and value chain. Through providing rapid results and flagging the main environmental issues, it can support evidence-based discussions of alternative development pathways

Effect of radiotherapy on freedom from seizures in dogs with brain tumors.

BACKGROUND: Seizures are a common presenting sign in dogs with brain tumors. HYPOTHESIS/OBJECTIVES: To investigate the effect of radiotherapy on freedom from brain tumor-associated seizures and survival time in dogs. ANIMALS: Thirty-two client-owned dogs with brain tumor-associated seizures; 18 received medical treatment and radiotherapy, 14 received medical treatment alone. METHODS: Multicenter retrospective study. Baseline characteristics (seizure semiology, magnetic resonance imaging [MRI] characteristics, and treatment) and duration of seizure freedom were recorded for the 2 treatment groups. Duration of seizure freedom between groups was compared (log-rank test) using Cox's proportional hazard analysis, with baseline characteristics entered as covariates. RESULTS: The duration of seizure freedom and survival time were significantly longer in the radiotherapy group (P < .001), with a mean of 24 months (95% confidence interval [CI], 14.3-33.8) versus 1.7 months in the control group (95% CI, 0.5-2.9) and a mean of 34.6 months (95% CI: 25.2-44.1) versus 6.2 months in the control group (95% CI, 2.6-9.7) respectively. Baseline characteristics were not associated with duration of seizure freedom after the start of treatment. In the radiotherapy group, 5 dogs were euthanized during the study period because of causes other than seizures. In the control group, recurrence of seizures was observed before death in all dogs. CONCLUSIONS AND CLINICAL IMPORTANCE: A longer period of seizure freedom and longer survival time was observed in dogs with brain tumors after radiotherapy compared to medical treatment only. The pathophysiological mechanisms of epileptogenesis and the effect of radiation therapy on seizure control are unclear to date. Further prospective studies are needed