Non-antibiotic treatment of acute urinary tract infection in primary care: a qualitative study.

Background: The views of women with acute, uncomplicated urinary tract infection (auUTI) on the acceptability of non-antibiotic treatment options are poorly understood. Aim: To establish women’s thoughts on and experience of non-antibiotic treatment for auUTIs. Design and setting Qualitative: interview study with primary care patients in Oxfordshire, UK, embedded within the Cranberry for Urinary Tract Infection (CUTI) feasibility trial. Method: One-to-one, semi-structured interviews were conducted between August 2019 and January 2020 with some CUTI trial participants and some patients who were not part of the CUTI trial who had experienced at least one urinary tract infection (UTI) in the preceding 12 months in Oxfordshire, UK. Interviews were analysed using thematic analysis. Results: In total, 26 interviews were conducted and analysed. Women expected to receive an immediate antibiotic for their UTI but were aware of the potential harms of this approach. They were keen to find a non-antibiotic, ‘natural’ alternative that could effectively manage their symptoms. In certain situations (early illness, milder illness, and with no important upcoming engagements), women indicated they would be prepared to postpone antibiotic treatment by up to 3 days, especially if offered an interim non-antibiotic option with perceived therapeutic potential. Conclusion: Many women with auUTIs are open to trying non-antibiotic treatments first in certain situations. There is scope for more dialogue between primary care clinicians and patients with auUTI around delaying antibiotic treatment and using non-antibiotic options initially, which could reduce antibiotic consumption for this common infection

Mild autonomic dysfunction in primary Sjögren's syndrome: a controlled study

Introduction The aim of this study was to compare cardiovascular autonomic nervous system function in patients with primary Sjögren's syndrome (pSS) with that in control individuals, and to correlate the findings with autonomic symptoms and the presence of exocrine secretory dysfunction. Methods Twenty-seven female patients with pSS and 25 control individuals completed the COMPASS (Composite Autonomic Symptom Scale) self-reported autonomic symptom questionnaire. Beat-to-beat heart rate and blood pressure data in response to five standard cardiovascular reflex tests were digitally recorded using a noninvasive finger pressure cuff and heart rate variability was analyzed by Fourier spectral analysis. Analysis was performed by analysis of variance (ANOVA), multivariate ANOVA and repeated measures ANOVA, as indicated. Factor analysis was utilized to detect relationships between positive autonomic symptoms in pSS patients. Results Multiple, mild autonomic disturbances were observed in pSS patients relating to decreased heart rate variability, decreased blood pressure variability and increased heart rate, which were most evident in response to postural change. There was a strong trend toward an association between decreased heart rate variability and increased severity of the secretomotor, orthostatic, bladder, gastroparesis and constipation self-reported autonomic symptom cluster identified in pSS patients. This symptom cluster was also associated with fatigue and reduced unstimulated salivary flow, and therefore may be an important component of the clinical spectrum of this disease. Conclusion There was evidence of mild autonomic dysfunction in pSS as measured with both cardiovascular reflex testing and self-reported symptoms. Pathogenic autoantibodies targeting M3 muscarinic receptors remain a strong candidate for the underlying pathophysiology, but practical assays for the detection of this autoantibody remain elusive.Fin ZJ Cai, Sue Lester, Tim Lu, Helen Keen, Karyn Boundy, Susanna M Proudman, Anne Tonkin and Maureen Rischmuelle

Midregional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients: The LIPID study

Background: Biomarkers may contribute to risk stratification in coronary heart disease (CHD). We examined whether plasma midregional proadrenomedullin (MR-proADM) concentration at baseline and its change over one year predicts long-term outcomes in stable CHD patients. Methods: The LIPID study randomised patients 3–36 months after an acute coronary syndrome with total cholesterol 4.0–7.0 mmol/L (155–271 mg/dL), to placebo or pravastatin 40 mg. Follow-up was 6.0 years. MR-proADM plasma concentrations at baseline and one year later were determined in 7863 and 6658 patients, respectively. These were categorised into quartiles to perform Cox regression analysis, adjusting for baseline parameters. Results: Baseline MR-proADM concentrations predicted major CHD events (non-fatal myocardial infarction or CHD death; hazard ratio (HR) 1.52, 1.26–1.84 for Q4–Q1), CHD death (HR 2.21, 1.67–2.92), heart failure (HR 2.30, 1.78–2.97) and all-cause mortality (HR 1.82, 1.49–2.23). Associations were still significant after adjustment for baseline B-type natriuretic peptide (BNP) concentration. Increase in MR-proADM after one yearwas associated with increased risk of subsequent CHD events (HR 1.34, 1.08–1.66), non-fatalmyocardial infarction (HR 1.50, 1.12–2.03), heart failure (HR 1.78, 1.37–2.30) and all-causemortality (HR 1.31, 1.04–1.64). Associations with heart failure and all-causemortality remained significant after adjusting for baseline and change in BNP concentration. Change in MR-proADM moderately improved risk reclassification for major CHD events (net reclassification improvement (NRI) 3.48%) but strongly improved risk reclassification for heart failure (NRI 5.60%). Conclusions: Baseline and change in MR-proADM concentrations over one year are associated with risk of major clinical events, even after adjustment for BNP concentrations.National Heart Foundation of Australi

How do Healthcare Workers 'Do' Guidelines? Exploring How Policy Decisions Impacted UK Healthcare Workers During the First Phase of the COVID-19 Pandemic

We describe how COVID-19-related policy decisions and guidelines impacted healthcare workers (HCWs) during the UK’s first COVID-19 pandemic phase. Guidelines in healthcare aim to streamline processes, improve quality and manage risk. However, we argue that during this time the guidelines we studied often fell short of these goals in practice. We analysed 74 remote interviews with 14 UK HCWs over 6 months (February–August 2020). Reframing guidelines through Mol’s lens of ‘enactment’, we reveal embodied, relational and material impacts that some guidelines had for HCWs. Beyond guideline ‘adherence’, we show that enacting guidelines is an ongoing, complex process of negotiating and balancing multilevel tensions. Overall, guidelines: (1) were inconsistently communicated; (2) did not sufficiently accommodate contextual considerations; and (3) were at times in tension with HCWs’ values. Healthcare policymakers should produce more agile, acceptable guidelines that frontline HCWs can enact in ways which make sense and are effective in their contexts

PENERAPAN MODEL PEMBELAJARAN KOOPERATIF TIPE MAKE A MATCH DENGAN MEDIA FLASH CARD UNTUK MENINGKATKAN HASIL BELAJAR BAHASA INGGRIS PESERTA DIDIK KELAS V MI IRSYADUT THOLIBIN TUGU REJOTANGAN TULUNGAGUNG

ABSTRAK Skripsi dengan judul “Penerapan Model Pembelajaran Kooperatif Tipe Make A Match Dengan Media Flash Card Untuk Meningkatkan Hasil Belajar Bahasa Inggris Peserta Didik Kelas V MI Irsyadut Tholibin Tugu Rejotangan Tulungagung”ini ditulis oleh Sufiya, Ulfa Ayu Ainin NIM. 2817133194, Jurusan Pendidikan Guru Madrasah Ibtidaiyah, Fakultas Tarbiyah dan Ilmu Keguruan, Institut Agama Islam Negeri Tulungagung, yang dibimbing oleh Bapak Dr. Susanto, M.Pd. Kata Kunci: Make A Match, Flash Card, Hasil Belajar, Bahasa Inggris. Penelitian ini dilatar belakangi oleh permasalahan pembelajaran Bahasa Inggris di MI Irsyadut Tholibin, Rejotangan Tulungagung. Berdasarkan hasil observasi awal permasalahan tersebut disebabkan oleh penggunaan metode pembelajaran yang kurang bervariatif bagi peserta didik, sehingga peserta didik menjadi lebih cepat bosan dan kurang aktif selama proses pembelajaran. Tentu saja hal tersebut menyebabkan hasil belajar peserta didik yang rendah. Rumusan masalah dalam penulisan skripsi ini adalah: 1) Bagaimana penerapan Model Pembelajaran Kooperatif Tipe Make A Match yang dikembangkan dengan media Flash Card pada mata pelajaran Bahasa Inggris pokok bahasan Shapes Kelas V MI Irsyadut Tholibin, Rejotangan Tulungagung? 2) Bagaimana peningkatan keaktifan pada mata pelajaran Bahasa Inggris materi Shapes melalui penerapan Model Pembelajaran Kooperatif Tipe Make A Match yang dikembangkan dengan media Flash Card pada peserta didik Kelas V MI Irsyadut Tholibin, Rejotangan Tulungagung? 3) Bagaimana peningkatan hasil belajar pada mata pelajaran Bahasa Inggris materi Shapes melalui penerapan Model Pembelajaran Kooperatif Tipe Make A Match yang dikembangkan dengan media Flash Card pada peserta didik Kelas V MI Irsyadut Tholibin, Rejotangan Tulungagung? Penelitian ini menggunakan penelitian tindakan kelas (PTK) sebanyak dua siklus. Setiap siklus terdiri dari empat tahap, yaitu perencanaan, pelaksanaan, pengamatan, dan refleksi. Adapun teknik pengumpulan datanya menggunakan tes, wawancara, observasi, catatan lapangan, dan dokumentasi. Tes digunakan untuk menggali data tentang hasil belajar peserta didik. Sedangkan observasi, wawancara, dan catatan lapangan digunakan untuk menggali data tentang proses pembelajaran Bahasa Inggris, respon peserta didik, keadaan peserta didik dan guru serta keaktifan peserta didik. Analisis data yang digunakan mencakup reduksi data, penyajian data, dan penarikan kesimpulan. Akhirnya dalam refleksi I dan II data yang terkumpul dianalisis untuk mengetahui apakah indikator yang telah ditentukan sebelumnya sudah dipenuhi apa tidak. Hasil penelitian menunjukkan bahwa penerapan Model Pembelajaran Kooperatif Tipe Make A Match yang dikembangkan dengan media Flash Card dengan langkah-langkahnya dapat meningkatkan keaktifan dan hasil belajar peserta didik. Keaktifan peserta didik dalam pembelajaran Bahasa Inggris meningkat dari Siklus I ke Siklus II yaitu pada Siklus I keaktifan peserta didik mencapai taraf keberhasilan 80% dengan kriteria baik dan pada Siklus II keaktifan peserta didik mencapai taraf keberhasilan 95% dengan kriteria sangat baik. Sedangkan hasil belajar Bahasa Inggris peserta didik meningkatkan, yaitu pada Pre Test rata-rata peserta didik yaitu 44,37 dengan ketuntasan belajar 4,17%, meningkat pada Siklus I rata- rata peserta didik 74,37 dengan ketuntasan belajar pada Siklus I 70,83%. Hasil belajar peserta didik meningkat pada Siklus II yaitu dengan rata-rata 96 dengan ketuntasan belajar 100%. Dari data tersebut terlihat bahwa penerapan Model Pembelajaran Kooperatif Tipe Make A Match dengan media Flash Card dapat meningkatkan hasil belajar Bahasa Inggris peserta didik Kelas V MI Irsyadut Tholibin, Tugu Rejotangan Tulungagung

Nanoparticle vesicle encoding for imaging and tracking cell populations.

For phenotypic behavior to be understood in the context of cell lineage and local environment, properties of individual cells must be measured relative to population-wide traits. However, the inability to accurately identify, track and measure thousands of single cells via high-throughput microscopy has impeded dynamic studies of cell populations. We demonstrate unique labeling of cells, driven by the heterogeneous random uptake of fluorescent nanoparticles of different emission colors. By sequentially exposing a cell population to different particles, we generated a large number of unique digital codes, which corresponded to the cell-specific number of nanoparticle-loaded vesicles and were visible within a given fluorescence channel. When three colors are used, the assay can self-generate over 17,000 individual codes identifiable using a typical fluorescence microscope. The color-codes provided immediate visualization of cell identity and allowed us to track human cells with a success rate of 78% across image frames separated by 8 h

Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices.

BackgroundTrials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use.MethodsThis was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically.ResultsNine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience - participants viewed the strategies as having limited value as 'clinical tools', perceiving them as useful only in 'rare' instances of clinical uncertainty and/or for those less experienced. Strategies as 'social tools' - participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities - participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context - various other situational and practical issues were raised with implementing the strategies.ConclusionsHigh-prescribing practices do not view DPs and POC-CRPT as sufficiently useful 'clinical tools' in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as 'social tools' to reduce unnecessary antibiotic use. Attention should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies that need addressing to support wider and more consistent implementation

Implementing antibiotic stewardship in high prescribing English general practices: a mixed-methods study

Background Trials have identified antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England. The authors co-developed an implementation intervention to improve use of three AMS strategies: enhanced communication strategies, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs). Aim To investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing. Design and setting Nine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via a website with practices required to identify an ‘antibiotic champion’. Method Routinely collected prescribing data were compared between the intervention and the control practices. Intervention use was assessed through monitoring. Surveys and interviews were conducted with professionals to capture experiences of using the intervention. Results There was no evidence that the intervention affected prescribing. Engagement with intervention materials differed substantially between practices and depended on individual champions’ preconceptions of strategies and the opportunity to conduct implementation tasks. Champions in five practices initiated changes to encourage use of at least one AMS strategy, mostly POC-CRPTs; one practice chose all three. POC-CRPTs was used more when allocated to one person. Conclusion Clinicians need detailed information on exactly how to adopt AMS strategies. Remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use