Achieving patient weighing in UK primary care. A conversation analytic study

Addressing issues of weight with people with type 2 diabetes is increasingly becoming part of the workload of primary care. This includes taking weight measurements during consultations. Evidence suggests that weighing is experienced as difficult for health professionals and patients. This study explores how weighing is accomplished and identifies strategies and practices that can be used in primary care settings. Data are drawn from two large UK based archives of over 600 audio and video recorded primary care consultations. Conversation analysis was used to systematically inspect the consultation data. We identified the linguistic practices employed by GPs and resulting interactions around the measurement of weight in primary care. Seven consultations form this corpus. We identify the sequential interactional pattern through which GPs and patients engage to achieve weighing and identify delicacy features in GPs talk which are used to build alignment with patients to achieve weighing. The analysis also highlighted the ways in which GPs justify their need to weigh patients, including marking the measurement as clinically necessary and preferring a need for an objective measure of weight. The analyses highlight that patient responses to requests to weigh are varied and that weighing patients can necessitate considerable interactional effort. Achieving weighing of patients in primary care consultations requires considerable interactional work between GPs and patients and it is important for the delicacy of these requests to be appreciated. There is a need for greater attention to how to achieve weighing, given the increasing attention weight has in relation to health

Achieving patient weighing in UK primary care. A conversation analytic study

Addressing issues of weight with people with type 2 diabetes is increasingly becoming part of the workload of primary care. This includes taking weight measurements during consultations. Evidence suggests that weighing is experienced as difficult for health professionals and patients. This study explores how weighing is accomplished and identifies strategies and practices that can be used in primary care settings. Data are drawn from two large UK based archives of over 600 audio and video recorded primary care consultations. Conversation analysis was used to systematically inspect the consultation data. We identified the linguistic practices employed by GPs and resulting interactions around the measurement of weight in primary care. Seven consultations form this corpus. We identify the sequential interactional pattern through which GPs and patients engage to achieve weighing and identify delicacy features in GPs talk which are used to build alignment with patients to achieve weighing. The analysis also highlighted the ways in which GPs justify their need to weigh patients, including marking the measurement as clinically necessary and preferring a need for an objective measure of weight. The analyses highlight that patient responses to requests to weigh are varied and that weighing patients can necessitate considerable interactional effort. Achieving weighing of patients in primary care consultations requires considerable interactional work between GPs and patients and it is important for the delicacy of these requests to be appreciated. There is a need for greater attention to how to achieve weighing, given the increasing attention weight has in relation to health

Strategies for Systems Change: Lessons Learned from the Transforming Early Educator Lead Teacher Preparation Programs Through Multi-Partner Innovation Grant Program

In 2021–22, The Collaborative awarded eight grants in support of partnerships between institutions of higher education (IHEs) and states/territories/tribal nations to transform their preparation programs for early educators. To support our grantees in their work, The Collaborative engaged School Readiness Consulting (SRC) to develop a learning community to foster peer learning and collective problem-solving.Two years into this work, The Collaborative and SRC provided grantees with an opportunity to reflect on their experiences through the lens of an overarching question: How have the IHEs and their partners made meaningful, systemic changes to address barriers on their campuses, in their communities, and in the field at large?This report describes the strategies grantees used for systems change, as well as their reflections on next steps and sustainability.Key insights from the report include:Grantees readily leveraged policies, practices, and resources to create immediate and measurable impacts on their institutions and their students. Strategies include centering equity in student recruitment and retention, enhancing coursework offerings and strengthening classes related to culturally relevant practices, and investing in resources driven by the actual needs of their students.In addition, grantees identified strategies to create the conditions needed to maintain progress and enable further changes to best support their students. These strategies include strengthening and creating connections, shifting power dynamics, and changing mental models

Early Cognitive Indicators of Dyslexia in Preliterate Children at Genetic Risk

The aim of this thesis was to assess a sample of 81 preliterate children (3 to 5 years old) who were from a Family At Risk of dyslexia (FAR) or Not Easily Associated with Risk (NEAR) in respect to a range of working memory and standardised language tasks (children's measures) in an attempt to identify cognitive features that might be implicated in dyslexia. Because dyslexia appears to have hereditary components, parent's performance on a range of reading related tasks was also correlated with children's performance to assess which tasks were most predictive of risk status. Utilising information gained by previous longitudinal studies, standardized tasks provided a continuous classification of the children's likely risk status based on their own performance. Three factors were gleaned from a factorial analysis, component manipulation ability, rapid automatised naming, and letter knowledge, and this accords with current research (Bishop, 2003) suggesting that these three factors are good predictors of future reading success. In terms of the children's non-standardised measures, the ability to pair visual stimuli with articulated and synthesised sounds was investigated. Measures of central executive functions (cognitive inhibition, susceptibility to interference, various span measures, speed, and controlled attention) were also examined. Tasks were adapted, or developed, specifically to meet the attentional, knowledge and skill levels of these young children. Children were categorised in terms of risk status using two methods based upon their parent's literacy performance. Firstly, several continuous predictors were identified. Of these, the worst parent's comprehension score was the best predictor of children's performance and supports the idea that the hereditary component of dyslexia appears more likely to involve central executive functions, like speed, and possibly central coherence, which in turn impact on phonological processing. The second method produced the discrete categories of family at risk (FAR) and not easily associated with risk (NEAR). This method proved to be most informative when categorisation was based on self-report by the parents concerning their past competence in reading

Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study

BACKGROUND: Many health professionals lack the skills to find and appraise published research. This lack of skills and associated knowledge needs to be addressed, and practice habits need to change, for evidence-based practice to occur. The aim of this before and after study was to evaluate the effect of a multifaceted intervention on the knowledge, skills, attitudes and behaviour of allied health professionals. METHODS: 114 self-selected occupational therapists were recruited. The intervention included a 2-day workshop combined with outreach support for eight months. Support involved email and telephone contact and a workplace visit. Measures were collected at baseline, post-workshop, and eight months later. The primary outcome was knowledge, measured using the Adapted Fresno Test of Evidence-Based Practice (total score 0 to 156). Secondary outcomes were attitude to evidence-based practice (% reporting improved skills and confidence; % reporting barriers), and behaviour measured using an activity diary (% engaging/not engaging in search and appraisal activities), and assignment completion. RESULTS: Post-workshop, there were significant gains in knowledge which were maintained at follow-up. The mean difference in the Adapted Fresno Test total score was 20.6 points (95% CI, 15.6 to 25.5). The change from post-workshop to follow-up was small and non-significant (mean difference 1.2 points, 95% CI, -6.0 to 8.5). Fewer participants reported lack of searching and appraisal skills as barriers to evidence-based practice over time (searching = 61%, 53%, 24%; appraisal 60%, 65%, 41%). These differences were statistically significant (p = 0.0001 and 0.010 respectively). Behaviour changed little. Pre-workshop, 6% engaged in critical appraisal increasing to 18% post-workshop and 18% at follow-up. Nearly two thirds (60%) were not reading any research literature at follow-up. Twenty-three participants (20.2%) completed their assignment. CONCLUSION: Evidence-based practice skills and knowledge improved markedly with a targetted education intervention and outreach support. However, changes in behaviour were small, based on the frequency of searching and appraisal activities. Allied health educators should focus more on post-workshop skill development, particularly appraisal, and help learners to establish new routines and priorities around evidence-based practice. Learners also need to know that behaviour change of this nature may take months, even years

A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa

Background: Recognition of atypical anorexia nervosa (AAN) has challenged underweight as a defining factor of illness severity in anorexia nervosa (AN). The present study aimed to compare rates of medical instability in adolescents with underweight (AN) and non‐underweight (AAN) anorexia nervosa. Methods: The study examined assessment data from specialist eating disorder services in the UK between January and December 2022. Participants (n = 205) aged 11–18 years were recruited across eight eating disorder clinics and diagnosed with AN (n = 113) or AAN (n = 92) after clinical assessment. Parameters associated with risk of medical instability were compared between AN and AAN groups, using t tests and regression analysis. Results: Rates of bradycardia and hypotension did not differ significantly between AN and AAN groups (p = 0.239 and p = 0.289). Although white blood cell counts were lower in the AN group, rates of leukopaenia could not be statistically compared as a result of there being too few counts in at least one group. No incidences of hypophosphataemia were found in the sample. A significant regression equation was found for percentage median body mass index, but not rate of weight loss, as a predictor of blood pressure, serum phosphorous and magnesium. Conclusions: Our findings indicate that medical instability occurs across a range of body weights in young people with AN and AAN. Although certain parameters of risk such as blood pressure, serum phosphorous and magnesium may be worsened at lower weight, both AN and AAN are serious mental health conditions that can lead to medical instability

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

The Epigenetics of Coronary Artery Disease: A Study of DNA Methylation

Coronary artery disease (CAD) is a complex condition, the development of which involves interaction between both genetic and environmental factors. Epigenetic mechanisms, including DNA methylation, may contribute significantly to disease pathogenesis. The DNA methylation profile of CAD has been relatively poorly described in the current literature. Therefore, an opportunistic post-hoc analysis of an Otago-based cardiovascular disease epigenome-wide association study (EWAS) cohort was conducted to investigate differential methylation patterns at cytosine-phosphate-guanine dinucleotide (CpG) sites associated with coronary artery disease. Genome-wide DNA methylation profiles of 487 males taken from whole blood samples were analysed using the Illumina Infinium HumanMethylation450 BeadChip array, which assessed 456,279 CpG sites across the human genome. A post-hoc EWAS based on CAD status was conducted on this cohort which included 203 CAD cases and 284 controls. Methylation data was analysed using principal component analysis and multivariate regression. Of all CpG sites analysed, 6.4% (29,336 CpG sites) demonstrated genome-wide significant associations with CAD (P-value<5x10-6), after adjustment for age and blood cell composition. The top three CpG sites (cg22671939, cg00589493, cg14042137) showed particularly strong associations with CAD, consistent across all adjustment models for conventional risk factors of CAD. Evaluation of genes associated with the top 1500 CpG sites using Metascape pathway enrichment analysis identified biological pathways with potential CAD-related plausibility relating to vascular morphology, immune processes, and nervous systems. Additionally, a form of sensitivity analysis was conducted to evaluate the ability of the dataset to detect existing differential methylation patterns associated with the risk factors of age, smoking exposure, and type II diabetes mellitus. These post-hoc EWAS produced results that demonstrated concordance with epigenetic associations purportedly associated with the specific phenotypes, as reported in previously published EWAS. While suggesting that the CAD EWAS dataset may have the sensitivity with which to detect real associations, such validation also demonstrates the possible robustness of CpG site methylation as disease biomarkers. Epigenetic markers may have potential in disease risk prediction, guidance of disease management decisions, and development of precision medicine. A large number of differentially methylated CpG sites associated with CAD were identified by this CAD EWAS. These DNA methylation markers may have potential as indicators of, and treatment targets for, coronary artery disease. However, further study in a de novo CAD EWAS setting is required to validate the associations identified by this post-hoc discovery EWAS, and broaden generalisability of study findings