Planning Network UK (PNUK): a manifesto for planning and land reform

The Manifesto is an analysis of the shortcomings of the current planning and land policy system in the UK with a number of policy proposals for refor

Is it better to take that antihypertensive at night?

A large RCT in a primary care setting comparing bedtime to upon-waking administration of antihypertensives answers the question. PRACTICE CHANGER: Advise patients to take blood pressure (BP) medication at bedtime rather than upon waking because it results in a decrease in major cardiovascular disease events. STRENGTH OF RECOMMENDATION: B: Based on a single, good-quality, multi-center trial

Can vitamin D prevent acute respiratory infections?

Review of: Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.Can vitamin D prevent acute respiratory infections? A systematic review and meta-analysis says Yes, but the dosages used may not be what you'd expect. PRACTICE CHANGER: Reduce acute respiratory tract infections in those with significant vitamin D deficiency (circulating 25-hydroxyvitamin D levels < 10 ng/mL) with daily or weekly vitamin D supplementation--not bolus vitamin D treatment. STRENGTH OF RECOMMENDATION A: Based pm a systematic review and meta-analysis of 25 trials.Bob Marshall, MD, MPH, MISM, FAAFP; Nick Bennett, DO; Ashley Smith, MD; Robert Oh, MD, MPH, FAAFP; Jeffrey Burket, MD, MBA, FAAFP Madigan Family Medicine Residency, Gig Harbor, Was

Nutritional risk amongst community-living Maori and non-Maori older people in Hawke’s Bay

Karen Anne Hicks - ORCID 0000-0002-7274-9745 https://orcid.org/0000-0002-7274-9745INTRODUCTION: Maintaining good nutrition is vital for healthy ageing. Poor nutrition increases the risk of hospitalisation, disability and mortality. Research shows clinical malnutrition is preceded by a state of nutritional risk and screening can identify older people at risk of poor nutrition or who currently have impaired nutritional status. AIM: To assess the population prevalence of nutritional risk amongst community-living Maori and non-Maori older people in Hawke’s Bay. METHODS: A postal survey of 1268 people aged 65 years or older on the electoral roll for Hawke’s Bay was conducted. Nutritional risk was measured using the SCREEN II questionnaire. RESULTS: Responses from 473 people were received (43.8% male, 49.9% female, 6.3% unspecified) with an estimated average age of 74 years. Nutritional risk was present amongst 56.5% of older people with 23.7% at risk and 32.8% at high risk. Maori were 5.2 times more likely to be at nutritional risk than non-Maori. Older people living alone were 3.5 times more likely to be at nutritional risk than those living with others. The most frequent risk factors were low milk-product intake, perception of own weight being more or less than it should be, and low meat and alternatives intake. Skipping meals and low fruit and vegetable intake were additional frequent risk factors for Maori. DISCUSSION: Both living situation and ethnicity are associated with nutritional risk. Further investigation is needed to confirm these findings and to determine issues specific for older Maori, including barriers to good nutrition and opportunities for nutritional improvement.https://doi.org/10.1071/HC122994pubpub

Harvest Incentives: A Tool for Managing Aquatic Invasive Species

Conclusion The success of any harvest incentive program to address aquatic invasive species will depend upon numerous biological, socioeconomic, and legal considerations. Programs that encourage harvest may be a successful management tool in targeting small, distinct populations; in high priority areas within a larger invasion; or they may play a supplementary role within larger control programs. Their use, however, will require careful review, planning, and monitoring to ensure success and that they do not unintentionally lead to further spread of invasive species, cause additional harm to native species, or waste valuable resources

First-time, mild diverticulitis: Antibiotics or watchful waiting?

Review of: Daniels L, Ünlü Ç, de Korte N, et al, for the Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017;104:52-61.First-time, mild diverticulitis: antibiotics or watchful waiting? Don't jump to antibiotic Tx for mild, uncomplicated diverticulitis, a recent RCT says. Observation may be just as effective. Practice changer: For mild, computed tomography-proven acute diverticulitis, consider observation only instead of antibiotic therapy. Stength of recommendation: B: Based on a single randomized controlled trial.Bob Marshall, MD, MPH, MISM, FAAFP; Shailendra Prasad, MBBS, MPH; Mary Alice Noel, MD; Jeffrey Burket, MD, FAAFP; Michael Arnold, DO, FAAFP; Benjamin Arthur, MD; Nick Bennett, DO; Ashley Smith, MD ; Madigan Family Medicine Residency, Gig Harbor, Wash (Drs. Marshall, Noel, Burket, Arnold, Arthur, Bennett, Smith); University of Minnesota Family Medicine and Community Health, Minneapolis (Dr. Prasad

Case studies of training advantage for remote Aboriginal and Torres Strait Island learners

[Extract] The case studies that follow are a compilation of learnings derived from the research project, Enhancing training advantage for remote Aboriginal and Torres Strait Islander learners. The project, funded by the National Centre for Vocational Education Research (NCVER), was conducted by a consortium of researchers from five institutions: TAFE SA, Batchelor Institute of Indigenous Tertiary Education, University of New England, James Cook University and the University of Notre Dame Australia. The research was conducted during 2016 with participants from five locations: the Anangu Pitjantjatjara Yankunytjatjara Lands of South Australia, the Northern Territory, western New South Wales, the Kimberley region of Western Australia, and the Cape York and Torres Strait Island regions of Queensland. Based on training programs considered to be successful, the project was designed in order to gain an understanding of the dynamics of retention and completion towards employability. Nationally, for very remote Aboriginal and Torres Strait Islander trainees, completion rates for VET courses are on average 16.6%, with an even lower figure for certificate I courses. Full details about the project and its cross-cutting findings, with a literature review and additional statistical information, are contained in the report, available from the NCVER Portalat . The case studies presented here mostly present qualitative findings

Enhancing training advantage for remote Aboriginal and Torres Strait Islander learners

[Extract] Aboriginal and Torres Strait Islanders in very remote parts of Australia are increasingly participating in vocational education and training (VET); however, completion rates remain low and employment outcomes are not improving. This project identifies how retention and completion can be improved and what other indicators of success are important outcomes of training in remote communities. Using a case study approach to investigate five unique training programs in remote areas of Australia, the report finds a that range of factors contribute to retention, including: - trainer qualities and characteristics of delivery - family, personal, community and cultural factors - training coordination and support - supportive relationships with other students - local community ownership of training - training that is connected to culture and local knowledge

Can viscous fiber lower glycemic markers in type 2 diabetes?

Review of: Jovanovski E, Khayyat R, Zurbau A, et al. Should viscous fiber supplements be considered in diabetes control? Results from a systematic review and meta-analysis of randomized controlled trials. Diabetes Care. 2019;42:755-766. Published correction appears in Diabetes Care. 2019;42:1604.Can viscous fiber lower glycemic markers in type 2 diabetes? The first meta-analysis to focus on viscous dietary fiber in T2D suggests a potential role for this supplement in improving glycemic control. PRACTICE CHANGER: Unless contraindicated, recommend viscous fiber supplementation to your patients with type 2 diabetes (T2D), in addition to the usual evidence-based standards of care, to improve markers of glycemic control. STRENGTH OF RECOMMENDATION: C: Based on a meta-analysis and systematic review of 28 randomized controlled trials, without discussion of patient-oriented outcomes.Erica S. Meisenheimer, MD, MA; Bob Marshall, MD, MPH, MISM, FAAFP, FAMIA; Samuel M. Tiglao, DO, FAAFP; Tyler S. Rogers, MD; David C. Bury, DO, FAAFP; Michael M. Dickman, DO, FAAFP; Robert C. Oh, MD, MPH, FAAFP (Family Medicine Residency, Madigan Army Medical Center, Joint Base Lewis- McChord, WA)Includes bibliographical reference