“Somebody to Say ‘Come On We Can Sort This’”:A Qualitative Study of Primary Care Consultation Among Older Adults With Symptomatic Foot Osteoarthritis

OBJECTIVE: To examine the experiences of primary care consultation among older adults with symptomatic foot osteoarthritis (OA). METHODS: Eleven participants (6 women and 5 men) ages 56–80 years who had radiographically confirmed symptomatic foot OA and consulted a general practitioner in the last 12 months for foot pain were purposively sampled. Semistructured interviews explored the nature of the foot problem, help-seeking behaviors, and consultation experiences. Verbatim transcripts were analyzed using interpretative phenomenological analysis. RESULTS: The decision to consult a physician was often the outcome of a complex process influenced by quantitative and qualitative changes in symptoms, difficulty maintaining day-to-day roles and responsibilities and the effect this had on family and work colleagues, and a reluctance to present a fragile or aging self to the outside world. Self-management was commonly negotiated alongside multimorbidities. Upon seeking help, participants often believed they received limited information, they were given a brief or even cursory assessment, and that treatment was focused on the prescription of analgesic drugs. CONCLUSION: This is the first qualitative study of primary care experiences among patients with symptomatic foot OA. The experience of primary care seldom appeared to move beyond a label of arthritis and an unwelcome emphasis on pharmacologic treatment

Seasonal and interannual variability of feeding in Antarctic benthos

The seasonal and interannual variability of feeding in 15 species of benthic marine suspension feeder was studied over 8 yr at Ryder Bay, Antarctica. Feeding was strongly seasonal in bryozoans, gorgonians, polychaetes, and dendrochirote holothurians. The winter non-feeding period was longest in the holothurians and shortest in bryozoans. Bryozoans started feeding in late winter at very low chlorophyll concentrations, often when surface fast-ice was still present. In hydroids and actinians, feeding tentacles were deployed continuously throughout the year, though hydroid feeding intensity declined slightly in late winter. Water column phytoplankton biomass was strongly seasonal with marked interannual variability in the timing and intensity of the bloom, driven principally by ice dynamics. Correlation across years between the start of feeding and the development of the bloom was poor, and in seasons when a dense spring bloom of benthic filamentous microalgae developed, the start of feeding in many benthic species was delayed. This study indicates that feeding in benthic marine suspension feeders in Antarctica is influenced by factors additional to the seasonal availability of food in the water column

Clinical diagnosis of symptomatic midfoot osteoarthritis:cross-sectional findings from the Clinical Assessment Study of the Foot

OBJECTIVE: To derive a multivariable diagnostic model for symptomatic midfoot osteoarthritis (OA). METHODS: Information on potential risk factors and clinical manifestations of symptomatic midfoot OA was collected using a health survey and standardised clinical examination of a population-based sample of 274 adults aged ≥50 years with midfoot pain. Following univariable analysis, random intercept multi-level logistic regression modelling that accounted for clustered data was used to identify the presence of midfoot OA independently scored on plain radiographs (dorso-plantar and lateral views), and defined as a score of ≥2 for osteophytes or joint space narrowing in at least one of four joints (first and second cuneometatarsal, navicular-first cuneiform and talonavicular joints). Model performance was summarised using the calibration slope and area under the curve (AUC). Internal validation and sensitivity analyses explored model over-fitting and certain assumptions. RESULTS: Compared to persons with midfoot pain only, symptomatic midfoot OA was associated with measures of static foot posture and range-of-motion at subtalar and ankle joints. Arch Index was the only retained clinical variable in a model containing age, gender and body mass index (BMI). The final model was poorly calibrated (calibration slope, 0.64, 95% CI: 0.39, 0.89) and discrimination was fair-to-poor (AUC, 0.64, 0.58, 0.70). Final model sensitivity and specificity were 29.9% (22.7, 38.0) and 87.5% (82.9, 91.3), respectively. Bootstrapping revealed the model to be over-optimistic and performance was not improved using continuous predictors. CONCLUSIONS: Brief clinical assessments provided only marginal information for identifying the presence of radiographic midfoot OA among community-dwelling persons with midfoot pain

Long-term improvements following a residential combined physical and psychological programme for chronic low back pain

Objectives Evaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain. Design A longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews. Setting Residential, multimodal rehabilitation. Participants 136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation. Intervention A 3-week residential CPPP. Outcome measures Primary outcome measures were the STarT Back screening tool score; pain intensity-11-point Numerical Rating Scale; function-Oswestry Disability Index (ODI); health status/quality of life-EQ-5D-5L EuroQol five-Dimension-five level; anxiety-Generalised Anxiety Disorder-7; depression-Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;. Results At discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain. Conclusions Participants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting

Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes.

The PROGRESS series (www.progress-partnership.org) sets out a framework of four interlinked prognosis research themes and provides examples from several disease fields to show why evidence from prognosis research is crucial to inform all points in the translation of biomedical and health related research into better patient outcomes. Recommendations are made in each of the four papers to improve current research standards What is prognosis research? Prognosis research seeks to understand and improve future outcomes in people with a given disease or health condition. However, there is increasing evidence that prognosis research standards need to be improved Why is prognosis research important? More people now live with disease and conditions that impair health than at any other time in history; prognosis research provides crucial evidence for translating findings from the laboratory to humans, and from clinical research to clinical practice This first article introduces the framework of four interlinked prognosis research themes and then focuses on the first of the themes - fundamental prognosis research, studies that aim to describe and explain future outcomes in relation to current diagnostic and treatment practices, often in relation to quality of care Fundamental prognosis research provides evidence informing healthcare and public health policy, the design and interpretation of randomised trials, and the impact of diagnostic tests on future outcome. It can inform new definitions of disease, may identify unanticipated benefits or harms of interventions, and clarify where new interventions are required to improve prognosis

Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot

Background Midfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to manage this condition. Research question To compare plantar pressures between people with and without symptomatic radiographic midfoot OA. Methods This was a cross-sectional study of adults aged ≥50 years registered with four UK general practices who reported foot pain in the past year. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints. Cases were matched 1:1 for sex and age (± 5 years) to asymptomatic controls. Peak plantar pressure and maximum force in 10 regions of the foot were determined using a pressure platform (RSscan International, Olen, Belgium) and compared between the groups using independent samples t-tests and effect sizes (Cohen’s d). Results We included 61 midfoot OA cases (mean age 67.0, SD 8.1, 31 males, 30 females) and matched these to 61 controls (mean age 66.0, SD 7.9). Midfoot OA cases displayed greater force (d=0.79, medium effect size, p=<0.001) and pressure at the midfoot (d=0.70, medium effect size, p=<0.001), greater force at the fourth metatarsophalangeal (MTP) joint (d=0.28, small effect size, p=0.13), and fifth MTP joint (d=0.37, small effect size, p=0.10) and greater pressure at the fifth MTP joint (d=0.34, small effect size, p=0.13). They also displayed lower force (d=0.40, small effect size, p=0.02) and pressure at the hallux (d=0.50, medium effect size, p=<0.001) and lower force (d=0.54, medium effect size, p=<0.001) and pressure at the lesser toes (d=0.48, small effect size, p=<0.001) compared with controls. Significance Midfoot OA appears associated with lowering of the medial longitudinal arch, greater lateral push off and less propulsion at toe off. Longitudinal studies are needed to establish causal relationships

Structural foot characteristics in people with midfoot osteoarthritis: Cross‐Sectional findings from the clinical assessment study of the foot

Objective: This study compared radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA). Methods: This was a cross‐sectional study of adults aged 50 years and older registered with four UK general practices who reported foot pain in the past year. Bilateral weightbearing dorsoplantar and lateral radiographs were obtained. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last 4 weeks, combined with radiographic OA in one or more midfoot joints (first cuneometatarsal, second cuneometatarsal, navicular‐first cuneiform, and talonavicular). Midfoot OA cases were matched 1:1 for sex and age to controls with a 5‐year age tolerance. Eleven radiographic measures were extracted and compared between the groups using independent sample t‐tests and effect sizes (Cohen's d). Results: We identified 63 midfoot OA cases (mean ± SD age was 66.8 ± 8.0 years, with 32 male and 31 female participants) and matched these to 63 controls (mean ± SD age was 65.9 ± 7.8 years). There were no differences in metatarsal lengths between the groups. However, those with midfoot OA had a higher calcaneal‐first metatarsal angle (d = 0.43, small effect size, P = 0.018) and lower calcaneal inclination angle (d = 0.46, small effect size, P = 0.011) compared with controls. Conclusions: People with midfoot OA have a flatter foot posture compared with controls. Although caution is required when inferring causation from cross‐sectional data, these findings are consistent with a pathomechanical pathway linking foot structure to the development of midfoot OA. Prospective studies are required to determine the temporal relationships between foot structure, function, and the development of this common and disabling condition

First high resolution interferometric observation of a solar prominence with ALMA

We present the first observation of a solar prominence at 84 − 116 GHz using the high resolution interferometric imaging of ALMA. Simultaneous observations in Hα from Białkaw Observatory and with SDO/AIA reveal similar prominence morphology to the ALMA observation. The contribution functions of 3 mm and Hα emission are shown to have significant overlap across a range of gas pressures. We estimate the maximum millimetre-continuum optical thickness to be τ3mm ≈ 2, and the brightness temperature from the observed Hα intensity. The brightness temperature measured by ALMA is ∼6000 − 7000 K in the prominence spine, which correlates well with the estimated brightness temperature for a kinetic temperature of 8000 K

Prognosis research strategy (PROGRESS) 4: Stratified medicine research

In patients with a particular disease or health condition, stratified medicine seeks to identify thosewho will have the most clinical benefit or least harm from a specific treatment. In this article, thefourth in the PROGRESS series, the authors discuss why prognosis research should form acornerstone of stratified medicine, especially in regard to the identification of factors that predictindividual treatment respons