Clinical implications of the Royal College of Physicians three questions in routine asthma care: A real-life validation study

BACKGROUND: Annual recording of the Royal College of Physicians three questions (RCP3Q) morbidity score is rewarded within the UK 'pay-for-performance' Quality and Outcomes Framework. AIMS: To investigate the performance of the RCP3Qs for assessing control in real-life practice compared with the validated Asthma Control Questionnaire (ACQ) administered by self-completed questionnaire. METHODS: We compared the RCP3Q score extracted from a patient's computerised medical record with the ACQ self-completed after the consultation. The anonymous data were paired by practice, age, sex, and dates of completion. We calculated the sensitivity and specificity of the RCP3Q scale compared with the threshold for good/poor asthma control (ACQ greater than 1). RESULTS: Of 291 ACQ questionnaires returned from 12 participating practices, 129 could be paired with complete RCP3Q data. Twenty-five of 27 patients who scored zero on the RCP3Q were well controlled (ACQ less than 1). An RCP3Q score greater than 1 predicted inadequate control (ACQ greater than 1) with a sensitivity of 0.96 and specificity of 0.34. Comparable values for RCP3Q greater than 2 were sensitivity 0.50 and specificity 0.94. The intraclass correlation coefficient of 0.13 indicated substantial variability between practices. Exacerbations and use of reliever inhalers were moderately correlated with ACQ (Spearman's rho 0.3 and 0.35) and may reflect different aspects of control. CONCLUSIONS: In routine practice, an RCP3Q score of zero indicates good asthma control and a score of 2 or 3 indicates poor control. An RCP3Q score of 1 has good sensitivity but poor specificity for suboptimal control and should provoke further enquiry and consideration of other aspects of control such as exacerbations and use of reliever inhalers

Differences in access to evidence-based practice training among health professionals

0813-053

ABSORPTION OF CONTROLLED RELEASE MORPHINE SULPHATE IN THE IMMEDIATE POSTOPERATIVE PERIOD

The absorption of morphine sulphate, given orally as a controlled release preparation, was studied in 10 patients who had undergone peripheral vascular surgery with a standard opioid-based general anaesthetic technique. Serum morphine concentrations were measured (high pressure liquid chromatography) every 2 h for the first 16 h after surgery and the results were strongly suggestive of a decrease in the rate of absorption of morphine in this situatio

PACE and EISCAT radar observations of short-lived flow bursts on the nightside

Concurrent observations from two widely spaced radar experiments of quasi periodic flow bursts in the nightside are presented. The flow bursts closely resemble single radar observations reported by Williams et al. By using the Polar Anglo-American Conjugate Experiment (PACE) HF radar array at Halley Bay in conjunction with the EISCAT Common Program (CP) 2-D experiment, the flow bursts are shown to be a global phenomenon and important information as to their development and propagation can be determined

Multi-phase synthetic contrast enhancement in interventional computed tomography for guiding renal cryotherapy

PURPOSE: Minimally invasive treatments for renal carcinoma offer a low rate of complications and quick recovery. One drawback of the use of computed tomography (CT) for needle guidance is the use of iodinated contrast agents, which require an increased X-ray dose and can potentially cause adverse reactions. The purpose of this work is to generalise the problem of synthetic contrast enhancement to allow the generation of multiple phases on non-contrast CT data from a real-world, clinical dataset without training multiple convolutional neural networks. METHODS: A framework for switching between contrast phases by conditioning the network on the phase information is proposed and compared with separately trained networks. We then examine how the degree of supervision affects the generated contrast by evaluating three established architectures: U-Net (fully supervised), Pix2Pix (adversarial with supervision), and CycleGAN (fully adversarial). RESULTS: We demonstrate that there is no performance loss when testing the proposed method against separately trained networks. Of the training paradigms investigated, the fully adversarial CycleGAN performs the worst, while the fully supervised U-Net generates more realistic voxel intensities and performed better than Pix2Pix in generating contrast images for use in a downstream segmentation task. Lastly, two models are shown to generalise to intra-procedural data not seen during the training process, also enhancing features such as needles and ice balls relevant to interventional radiological procedures. CONCLUSION: The proposed contrast switching framework is a feasible option for generating multiple contrast phases without the overhead of training multiple neural networks, while also being robust towards unseen data and enhancing contrast in features relevant to clinical practice

What do we want to get out of this?:a critical interpretive synthesis of the value of process evaluations, with a practical planning framework

BACKGROUND: Process evaluations aim to understand how complex interventions bring about outcomes by examining intervention mechanisms, implementation, and context. While much attention has been paid to the methodology of process evaluations in health research, the value of process evaluations has received less critical attention. We aimed to unpack how value is conceptualised in process evaluations by identifying and critically analysing 1) how process evaluations may create value and 2) what kind of value they may create. METHODS: We systematically searched for and identified published literature on process evaluation, including guidance, opinion pieces, primary research, reviews, and discussion of methodological and practical issues. We conducted a critical interpretive synthesis and developed a practical planning framework. RESULTS: We identified and included 147 literature items. From these we determined three ways in which process evaluations may create value or negative consequences: 1) through the socio-technical processes of ‘doing’ the process evaluation, 2) through the features/qualities of process evaluation knowledge, and 3) through using process evaluation knowledge. We identified 15 value themes. We also found that value varies according to the characteristics of individual process evaluations, and is subjective and context dependent. CONCLUSION: The concept of value in process evaluations is complex and multi-faceted. Stakeholders in different contexts may have very different expectations of process evaluations and the value that can and should be obtained from them. We propose a planning framework to support an open and transparent process to plan and create value from process evaluations and negotiate trade-offs. This will support the development of joint solutions and, ultimately, generate more value from process evaluations to all. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01767-7

Hegemonic masculine conceptualisation in gang culture

This research sought to investigate the relationship between gang processes and differing forms of masculine expression. Three hundred and sixteen male participants, drawn from secondary schools within Cape Town, were included in the study. These schools were in areas differentially characterised by gang activity. The questionnaire included the newly devised Male Attitude Norm Inventory designed to explore hegemonic conceptualisations of masculinity. Factor analytic procedures rendered a three-factor model stressing the importance of male toughness, success and control. Through a series of t-tests for independent samples, as well as supporting qualitative data, participants from areas characterised by high gang activity were found to support these hegemonic elements to a significantly greater extent

Supported self-management for people with type 2 diabetes:a meta-review of quantitative systematic reviews

OBJECTIVES: Self-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about the effectiveness of self-management support strategies for people with type 2 diabetes, and which interventions work best and for whom. DESIGN: A meta-review of systematic reviews of randomised controlled trials (RCTs) was performed adapting Cochrane methodology. SETTING AND PARTICIPANTS: Eight databases were searched for systematic reviews of RCTs from January 1993 to October 2016, with a pre-publication update in April 2017. Forward citation was performed on included reviews in Institute for Scientific Information (ISI) Proceedings. We extracted data and assessed quality with the Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR). PRIMARY AND SECONDARY OUTCOME MEASURES: Glycaemic control as measured by glycated haemoglobin (HbA1c) was the primary outcome. Body mass Index, lipid profiles, blood pressure and quality of life scoring were secondary outcomes. Meta-analyses reporting HbA1c were summarised in meta-forest plots; other outcomes were synthesised narratively. RESULTS: 41 systematic reviews incorporating data from 459 unique RCTs in diverse socio-economic and ethnic communities across 33 countries were included. R-AMSTAR quality score ranged from 20 to 42 (maximum 44). Apart from one outlier, the majority of reviews found an HbA1c improvement between 0.2% and 0.6% (2.2-6.5 mmol/mol) at 6 months post-intervention, but attenuated at 12 and 24 months. Impact on secondary outcomes was inconsistent and generally non-significant. Diverse self-management support strategies were employed; no single approach appeared optimally effective (or ineffective). Effective programmes tended to be multi-component and provide adequate contact time (>10 hours). Technology-facilitated self-management support showed a similar impact as traditional approaches (HbA1c MD -0.21% to -0.6%). CONCLUSIONS: Self-management interventions using a range of approaches improve short-term glycaemic control in people with type 2 diabetes including culturally diverse populations. These findings can inform researchers, policy-makers and healthcare professionals re-evaluating the provision of self-management support in routine care. Further research should consider implementation and sustainability.MC is supported by the Scottish School of Primary Care (academic fellowship in general practice)