Peripheral arterial disease: diagnostic challenges and how photoplethysmography may help

Peripheral arterial disease (PAD) affects approximately 20% of patients aged ≥60 years.1 A GP with an average list size of 1800 patients can expect to have 50–60 patients with PAD. Ankle-brachial pressure index (ABPI), which is the ratio of the ankle to brachial systolic pressure measured by sphygmomanometer and hand-held Doppler ultrasound probe, is used to assess PAD in general practice. ABPI has been shown to have a sensitivity of 95% and specificity of 99% compared to angiographic imaging,2 however it is relatively time-consuming and requires adequately trained staff. There are limitations with ABPI in patients with diabetes, renal disease, and older people where an underestimation of disease can occur with a falsely high ratio due to the presence of incompressible calcified blood vessels

Feasibility of a Research Protocol to Investigate the Effect of the TherapressureTM Program Using Salivary Cortisol

Background: There is an absence of high quality research to support the use of the Therapressure ProgramTM. This pilot study aimed at developing appropriate research protocols to investigate the effectiveness of the Therapressure ProgramTM on the stress response in children with sensory overresponsivity. Method: A one-group pre-test/post-test repeated measures design was conducted using a convenience sample. Six children (6-8 years of age) with sensory overresponsivity received 14 consecutive days of the Therapressure ProgramTM by their parents at home. Parents concurrently collected salivary cortisol samples from their children. Results: Children with sensory overresponsivity displayed both hyper- and hypo-cortisolism at baseline. All of the children’s cortisol levels shifted toward a normative range after intervention. Aspects have been identified related to the data collection protocol. Conclusion: When testing children with sensory overresponsivity who are constantly activating their stress response system, we raise awareness of the need to check for both hyper- and hypo-cortisolism during statistical analysis. Preliminary pilot data may also show modulation of sympathetic arousal following the intervention. Further research is warranted and recommendations are made related to data collection protocols

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Background: Commissioning innovative health technologies is typically complex and multi-faceted. Drawing on the negotiated order perspective, we explore the process by which commissioning organisations make their decisions to commission innovative health technologies. The empirical backdrop to this discussion is provided by a case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. Methods: The research involved an empirical case study of four Clinical Commissioning Groups (CCGs) involved in the commissioning of services in primary and secondary care. Semi-structured in-depth interviews (16 in total) and two focus groups (a total of eight people participated, four in each group) were conducted with key individuals involved in commissioning services in the NHS including (i) senior NHS clinical leaders and directors (ii) commissioners and health care managers across CCGs and (iii) local general practitioners. Results: Commissioning of a new diagnostic technology for peripheral arterial disease in primary care involves high levels of protracted negotiations over funding between providers and commissioners, alliance building, conflict resolution and compromise of objectives where the outcomes of change are highly contingent upon interventions made across different care settings. Our evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations. Conclusions: Innovative health technologies such as the diagnostic technology for peripheral arterial disease are commissioned in care pathways where the value of such technology is realised by those delivering care to patients. The detail of how care pathways are commissioned is complex and involves high degrees of uncertainty concerning such issues as prioritisation decisions, patient benefits, clinical buy-in, value for money and unintended consequences. Recent developments in the new care models and integrated care systems (ICSs) in the UK offer a unique opportunity for the successful commissioning arrangements of innovative health technologies in primary care such as the new diagnostic technology for peripheral arterial disease. Keywords: Commissioning, Decision-making, Diagnostics, Innovative health technologies, Primary care, Peripheral arterial disease, United Kingdo

A systematic review on fitness testing in adult male basketball players : tests adopted, characteristics reported and recommendations for practice

Background: As basketball match-play requires players to possess a wide range of physical characteristics, many tests have been introduced in the literature to identify talent and quantify fitness in various samples of players. However, a synthesis of the literature to identify the most frequently used tests, outcome variables, and normative values for basketball-related physical characteristics in adult male basketball players is yet to be conducted. Objective: The primary objectives of this systematic review are to (1) identify tests and outcome variables used to assess physical characteristics in adult male basketball players across all competition levels, (2) report a summary of anthropometric, muscular power, linear speed, change-of-direction speed, agility, strength, anaerobic capacity, and aerobic capacity in adult male basketball players based on playing position and competition level, and (3) introduce a framework outlining recommended testing approaches to quantify physical characteristics in adult male basketball players. Methods: A systematic review of MEDLINE, PubMed, SPORTDiscus, Scopus, and Web of Science was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies. To be eligible for inclusion, studies were required to: (1) be original research articles; (2) be published in a peer-reviewed journal; (3) have full-text versions available in the English language; and (4) include the primary aim of reporting tests used and/or the physical characteristics of adult (i.e., ≥ 18 years of age) male basketball players. Additionally, data from the top 10 draft picks who participated in the National Basketball Association combined from 2011–12 to 2020–21 were extracted from the official league website to highlight the physical characteristics of elite 19- to 24-year-old basketball players. Results: A total of 1684 studies were identified, with 375 being duplicates. Consequently, the titles and abstracts of 1309 studies were screened and 231 studies were eligible for full-text review. The reference list of each study was searched, with a further 59 studies identified as eligible for review. After full-text screening, 137 studies identified tests, while 114 studies reported physical characteristics in adult male basketball players. Conclusions: Physical characteristics reported indicate a wide range of abilities are present across playing competitions. The tests and outcome variables reported in the literature highlight the multitude of tests currently being used. Because there are no accepted international standards for physical assessment of basketball players, establishing normative data is challenging. Therefore, future testing should involve repeatable protocols that are standardised and provide outcomes that can be monitored across time. Recommendations for testing batteries in adult male basketball players are provided so improved interpretation of data can occur. Clinical Trial Registration: This review was registered with the International Prospective Register of Systematic Reviews and allocated registration number CRD42020187151 on 28 April, 2020. © 2022, The Author(s)

Expectations and changing attitudes of bar workers before and after the implementation of smoke-free legislation in Scotland

BACKGROUND: In Scotland on March 26, 2006 a comprehensive prohibition on smoking in all enclosed public places was introduced. This study examines bar workers' attitudes towards a smoke-free working environment. METHODS: An intervention study comparing bar workers' opinions before and after the implementation of the smoke-free legislation. Bars were randomly selected in three Scottish cities (Glasgow, Edinburgh & Aberdeen) and towns (Aberdeenshire & Borders). Bar workers were recruited from 72 bars that agreed to participate from 159 approached. Pre- and post-implementation attitudes towards legislation, second-hand smoke and smoke-free working environments were compared. RESULTS: Initially the majority of bar workers agreed with the proposed legislation on smoking (69%) and the need for it to protect the health of workers (80%), although almost half (49%) thought the legislation would damage business. In 266 bar workers seen at both surveys, a significant positive attitudinal change towards the legislation was seen. Post-implementation, support for the legislation rose to 79%, bar workers continued to believe it was needed to protect health (81%) and concerns about the impact on business were expressed by fewer than 20%. Only the statement that the legislation would encourage smokers to quit showed reduced support, from 70% pre-implementation to fewer than 60% post-implementation. Initial acceptance was greater among younger bar workers; older workers, initially more sceptical, became less so with experience of the legislation's effects. CONCLUSION: This study shows that bar workers had generally positive attitudes towards the legislation prior to implementation, which became stronger after implementation. The affirmative attitudes of these key stakeholders are likely to contribute towards the creation of 'smoke-free' as the new social norm

Prospective assessment of the diagnostic accuracy of multi-site photoplethysmography pulse measurements for diagnosis of peripheral artery disease in primary care

Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9-87.6%), with specificity 71.9% (95% CI 63.7-79.2%). ABPI sensitivity was 80.2% (95% CI 70.8-87.6%), with specificity 88.6% (95% CI 82-93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care

TLC Year in Review

With contributions by Matthew Schehl, Shona Dunn, Ali Rodgers, Betsy Wallace, Miriam Bergue Alves, Michael Guerrero, Aileen B. Houston, Cheryldee Huddleston, Leo Blanken and Cecilia Panella, and a forward by Scott Bischoff, Dennis Lester, and Tom Rosko

Notch signalling influences cell fate decisions and HOX gene induction in axial progenitors

The generation of the post-cranial embryonic body relies on the coordinated production of spinal cord neurectoderm and presomitic mesoderm cells from neuromesodermal progenitors (NMPs). This process is orchestrated by pro-neural and pro-mesodermal transcription factors that are co-expressed in NMPs together with Hox genes, which are critical for axial allocation of NMP derivatives. NMPs reside in a posterior growth region, which is marked by the expression of Wnt, FGF and Notch signalling components. While the importance of Wnt and FGF in influencing the induction and differentiation of NMPs is well established, the precise role of Notch remains unclear. Here, we show that the Wnt/FGF-driven induction of NMPs from human embryonic stem cells (hESCs) relies on Notch signalling. Using hESC-derived NMPs and chick embryo grafting, we demonstrate that Notch directs a pro-mesodermal character at the expense of neural fate. We show that Notch also contributes to activation of HOX gene expression in human NMPs, partly in a non-cell-autonomous manner. Finally, we provide evidence that Notch exerts its effects via the establishment of a negative feedback loop with FGF signalling.</p

Negotiating professional and social voices in research principles and practice

This paper draws on work conducted for a qualitative interview based study which explores the gendered racialised and professional identifications of health and social care professionals. Participants for the project were drawn from the professional executive committees of recently formed Primary Care Trusts. The paper discusses how the feminist psychosocial methodological approach developed for the project is theoretically, practically and ethically useful in exploring the voices of those in positions of relative power in relation to both health and social care services and the social relations of gender and ethnicity. The approach draws on psychodynamic accounts of (defended) subjectivity and the feminist work of Carol Gilligan on a voice-centred relational methodology. Coupling the feminist with the psychosocial facilitates an emphasis on voice and dialogic communication between participant and researcher not always captured in psychosocial approaches which tend towards favouring the interviewer as ‘good listener’. This emphasis on dialogue is important in research contexts where prior and ongoing relationships with professional participants make it difficult and indeed undesirable for researchers to maintain silence