Shared decision making in consultations for hypertension:Qualitative study in general practice

Abstract Background Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim To understand patients’ and clinicians’ experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design Longitudinal qualitative study. Setting Five general practices in south‐west England. Method Interviews with a purposive sample of patients with hypertension, and with the health‐care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio‐recorded and observational field notes taken. Data were analysed thematically. Results Forty‐six interviews and 18 consultations were observed, with 11 patients and nine health‐care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients’ understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or Public Contribution A patient group contributed to the design of this study

The impact of axial length on retinal tamponade for gas, silicone oil, and heavy silicone oil, using an in vitro model

Background: To investigate whether ocular axial length influences the tamponade efficacy of three commonly used agents: gas, silicone oil, and heavy silicone oil. Methods: A series of filling experiments was conducted using 19-mm and 25-mm surface-modified spherical model eye chambers to mimic the vitreous cavity. For each agent, tamponade efficacy was assessed across a range of percentage fills, and comparison was made between the two model eye chambers. The behavior of each tamponade agent was quantified by measuring (1) the maximum height of the tamponade bubble, and calculating (2) the arc of retinal contact subtended by the tamponade bubble. Results: Polynomial regression analysis found no statistically significant difference between the regression models for the different-sized model eye chambers for bubble height or arc of retinal contact subtended. This applied to all of the tamponade agents under investigation. Conclusions: Across the range of cavity sizes under investigation, no significant difference in tamponade efficacy (as reflected by the measured dimensions of the tamponade bubble) was identified. © 2010 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Preferences of women for web-based nutritional information in pregnancy

Objectives During pregnancy, women are increasingly turning to web-based resources for information. This study examined the use of web-based nutritional information by women during pregnancy and explored their preferences. Study design Cross-sectional observational study. Methods Women were enrolled at their convenience from a large maternity hospital. Clinical and sociodemographic details were collected and women\u27s use of web-based resources was assessed using a detailed questionnaire. Results Of the 101 women, 41.6% were nulliparous and the mean age was 33.1 years (19–47 years). All women had internet access and only 3% did not own a smartphone. Women derived pregnancy-related nutritional information from a range of online resources, most commonly: What to Expect When You\u27re Expecting (15.1%), Babycenter (12.9%), and Eumom (9.7%). However, 24.7% reported using Google searches. There was minimal use of publically funded or academically supported resources. The features women wanted in a web-based application were recipes (88%), exercise advice (71%), personalized dietary feedback (37%), social features (35%), videos (24%) and cooking demonstrations (23%). Conclusions This survey highlights the risk that pregnant women may get nutritional information from online resources which are not evidence-based. It also identifies features that women want from a web-based nutritional resource

Biocatalytic approaches to a key building block for the anti-thrombotic agent ticagrelor

Three different enzymatic routes were employed to produce a precursor of the important antithrombotic agent Ticagrelor with high ee.</p

A web-based dietary intervention in early pregnancy and neonatal outcomes: A randomized controlled trial

Background Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes. Methods Women \u3c18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women. Results Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P \u3e 0.05). Conclusions We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women’s engagement and modifies dietary behaviour

Increasing Cervical Cancer Screening in a Hispanic Migrant Farmworker Community through Faith-Based Clinical Outreach

Objective: Partnerships between academic medical centers and faith-based community organizations have been associated with increased screening rates in low-income minority women. We describe clinical outcomes of an outreach partnership between a cancer center and a faith-based outreach clinic offering gynecologic screening services in central Florida to increase cervical cancer screening adherence in a priority population of primarily Hispanic farmworker women. Methods: Data sources included a retrospective chart review. This descriptive study examined patterns of cervical cancer screening behavior among the patient population of the faith-based outreach clinic. Results: Findings suggest that among this group of patients, the demographic factors that predict adherence with cervical cancer screening recommendations are number of years having lived in the United States and marital status. Women residing in the United States for more than 5 years were significantly more adherent with cervical cancer screening recommendations compared with women who have resided in the United States for 5 years or less (p = .05), and married women were more likely to be adherent than unmarried women (p = .02). Conclusions: The partnership was successful in increasing cervical cancer screening adherence in this medically underserved population. When enabling barriers to screening adherence are removed through faith-based clinical outreach and engaged continuously for a number of years, uninsured, low-income Hispanic women are more likely to receive recommended preventive services

Motor traffic on urban minor and major roads: impacts on pedestrian and cyclist injuries

This article compares per-mile risks posed by motor traffic to pedestrians and cyclists on urban major and minor roads. Carrying out new analysis of police injury data from 2005-15, the paper finds that per billion vehicle miles, motor vehicles on minor roads create more pedestrian casualties than motor vehicles on major roads. Specifically, for KSI (killed or seriously injured) injuries the rate per billion motor vehicle miles is 17% higher on minor roads (47 versus 40 KSIs per billion vehicle miles), while for slight injuries it is 66% higher (188 vs. 123 slight injuries per billion vehicle miles). Examining the costs of injuries sustained, these are 7.4% higher for pedestrians per motor vehicle mile travelled on urban minor roads, compared to major roads. For cyclists, injury costs are slightly higher (4.2%) on major roads per mile driven, compared to minor roads. These results suggest that re-routing motor traffic to major roads in urban areas may reduce pedestrian casualties. However, if cyclist safety on major roads is not improved, shifting motor traffic from minor to major roads may result in unintended negative injury consequences for cyclists

Development of the American College of Rheumatology Electronic Clinical Quality Measures for Gout

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143639/1/acr23500.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143639/2/acr23500-sup-0001-AppendixS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143639/3/acr23500_am.pd

“When my Autism Broke”: A Qualitative Study Spotlighting Autistic Voices on Menopause

Autistic women often struggle with the onset of menstruation, a key transition point in the female reproductive lifespan. Presently, there is no research investigating how autistic people navigate the menopausal transition, and whether it poses additional challenges in addition to those already faced by neurotypical women. As a preliminary participatory study in this area, we conducted an online focus group with seven autistic individuals, aged 49-63 years (median=64.5 years) and assigned female at birth, to explore the state of knowledge about the menopause in autism, difficulties the menopause might bring, support that might be needed, and what questions require scientific investigation. Thematic analysis of the discussion generated three themes: 1)Lack of knowledge and understanding; 2)Cracking the mask and adaptive functioning; and 3)Finding support. Themes suggested a lack of professional knowledge, understanding and communication about menopause for autistic people, and an absence of support. Menopause was discussed as heightening pre-existing and generating new cognitive, social, emotional and sensory difficulties. This study illustrates the need for greater focus of attention towards how autistic people cope with the major life transition of menopause

Perturbation evolution with a non-minimally coupled scalar field

We recently proposed a simple dilaton-derived quintessence model in which the scalar field was non-minimally coupled to cold dark matter, but not to `visible' matter. Such couplings can be attributed to the dilaton in the low energy limit of string theory, beyond tree level. In this paper we discuss the implications of such a model on structure formation, looking at its impact on matter perturbations and CMB anisotropies. We find that the model only deviates from $\Lambda$CDM and minimally coupled theories at late times, and is well fitted to current observational data. The signature left by the coupling, when it breaks degeneracy at late times, presents a valuable opportunity to constrain non-minimal couplings given the wealth of new observational data promised in the near future.Comment: Version appearing in Physical Review D. 10 pages, 9 figs. Comparison with SN1a and projected MAP results, and appendix adde