Common hand and wrist conditions: creation of UK research priorities defined by a James Lind Alliance Priority Setting Partnership

Objective Prioritisation of important treatment uncertainties for ‘Common Conditions Affecting the Hand and Wrist’ via a UK-based James Lind Alliance Priority Setting Partnership. Setting This process was funded by a national charitable organisation and based in the UK. Participants Anyone with experience of common conditions affecting the adult hand and wrist, including patients, carers and healthcare professionals. All treatment modalities delivered by a hand specialist, including therapists, surgeons or other allied professionals, were considered. Interventions Established James Lind Alliance Priority Setting Partnership methods were employed. Electronic and paper questionnaires identified potential uncertainties. These were subsequently confirmed using relevant, up-to-date systematic reviews. A final list of top 10 research uncertainties was developed via a face-to-face workshop with representation from patients and clinicians. Impact of research was sought by surveying hand clinicians electronically. Outcome measures The survey responses and prioritisation—both survey and workshop based. Results There were 889 individually submitted questions from the initial survey, refined to 59 uncertainties across 32 themes. Eight additional uncertainties were added from published literature before prioritisation by 261 participants and the workshop allowed the final top 10 list to be finalised. The top 10 has so far contributed to the award of over £3.8 million of competitively awarded funding. Conclusions The Common Conditions in the Hand and Wrist Priority Setting Partnership identified important research questions and has allowed research funders to identify grant applications which are important to both patients and clinician

Financial system

Background-Lanoteplase (nPA) is a rationally designed variant of tissue plasminogen activator with greater fibrinolytic potency and slower plasma clearance than alteplase. Methods and Results-InTIME (Intravenous nPA for Treatment of Infarcting Myocardium Early), a multicenter, double-blind, randomized, double-placebo angiographic trial, evaluated the close-response relationship and safety of single-bolus, weight-adjusted lanoteplase. Patients (n=602) presenting within 6 hours of acute myocardial infarction were randomized and treated with either a single-bolus injection of lanoteplase (15, 30, 60, or 120 kU/kg) or accelerated alteplase. The primary objective was to determine TIMI grade flow at 60 minutes. Angiographic assessments were also performed at 90 minutes and on days 3 to 5. Follow-up was continued for 30 days. Lanoteplase achieved its primary objective, demonstrating a dose-response in TIMI grade 3 flow at 60 minutes (23.6% to 47.1% of subjects, P Conclusions-Lanoteplase, a single-bolus, weight-adjusted agent, increased coronary patency at 60 and 90 minutes in a dose-dependent fashion. Coronary patency at 90 Minutes was achieved more frequently with 120 kU/kg lanoteplase than alteplase. In this study, safety with lanoteplase and alteplase was comparable. InTIME-II, a worldwide mortality trial, will evaluate efficacy and safety with this promising new agent

The presentation, diagnosis and management of non-traumatic wrist pain: An evaluation of current practice in secondary care in the UK NHS

Objectives. The study aims were to assess the burden of non-traumatic wrist pain in terms of numbers of referrals to secondary care and to characterize how patients present, are diagnosed and are managed in secondary care in the UK National Health Service. Methods. Ten consecutive patients presenting with non-traumatic wrist pain were identified retrospectively at each of 16 participating hospitals, and data were extracted for 12 months after the initial referral. Results. The 160 patients consisted of 100 females and 60 males with a median age of 49 years, accounting for ∼13% of all new hand/wrist referrals. The dominant wrist was affected in 60% of cases, and the mean symptom duration was 13.3 months. Diagnoses were grouped as follows: OA (31%), tendinopathy (13%), ganglion (14%), ulnar sided pain (17%) and other (25%). The OA group was significantly older than other groups, and other groups contained a predominance of females. The nonsurgical interventions, in decreasing frequency of usage, were as follows: CS injections (39%), physiotherapy (32%), splint (31%) and analgesics (12%). Of those who underwent surgery, all patients had previously received non-surgical treatment, but 42% had undergone only one non-surgical intervention. Conclusions. Non-traumatic wrist pain represents a significant burden to secondary care both in terms of new patient referrals and in terms of investigation, follow-up and treatment. Those presenting with OA are more likely to be older and male, whereas those presenting with other diagnoses are more likely to be younger and female

Career Development and Educational Status of the Sexual Abuse Victims: The First Data from Turkey

Ulas-Kilic, Ozlem/0000-0002-2757-7905; Kocturk, Nilufer/0000-0001-6124-1842WOS: 000459009900015Child sexual abuse (CSA) is not only a serious danger for children and families, but it is also a problem that concerns society economically and spiritually. The aim of this study is to examine career choices and educational problems of individuals who have experienced CSA. Participants of this study consist of 73 CSA victims. The data have been collected via a telephone survey. According to the findings, 83.6% of the victims attended their formal education during the time they reported CSA, and only 38 participants (51%) continued into higher education. Also, it was determined that approximately 51% of them dropped out of school, and 72% of them experienced problems at school due to CSA. When the victims' reasons for dropping out of school were examined before and after CSA, it was seen that victims dropped out of school due to CSA (44.2%) mostly. In addition to these, it was found that approximately 25% of victims could not concentrate on classes, 56% of them had a drop in their academic success, 30% of them were reluctant to go to school or had absence, 25% of them repeated a grade, and 23% of them switched schools. Also, it was determined that 56.2% of the participants wanted to continue their education. Findings were discussed in the light of relevant literature

Learning English as a second language at the university level in Jordan: motivation, self-regulation and learning environment perceptions

The overarching aim of this study was to investigate students’ perceptions of the learning environment and whether these influenced their motivation and self-regulation in learning English as a second language at the university level in Jordan. Our sample involved 994 students, drawn from 13 schools, within three faculties (humanities, health sciences and engineering) of one university. The collection of data involved the administration of two surveys: one to assess students’ perceptions of the learning environment and another to assess students’ motivation and self-regulation in learning English as a second language. The results of analyses strongly supported the reliability and validity of the surveys when used at the university level in Jordan, thereby providing confidence in the results of the present study. Simple correlation and multiple regression analysis were used to examine the influence of students’ perceptions of the learning environment of English language classes on self-reports of motivation and self-regulation. Statistically significant (p < 0.05) simple correlations were found between students’ perceptions of their learning environment and their motivation and self-regulation. The regression weights (ß) indicated that scales of the learning environment were positively, statistically significantly (p < 0.05) and independently related to the motivation and self-regulation outcomes