A Systematic Review of the Uptake and Adherence Rates to Supervised Exercise Programs in Patients with Intermittent Claudication

Background Intermittent claudication (IC) is a common and debilitating symptom of peripheral arterial disease and is associated with a significant reduction in a sufferer's quality of life. Guidelines recommend a supervised exercise program (SEP) as the primary treatment option; however, anecdotally there is a low participation rate for exercise in this group of patients. We undertook a systematic review of the uptake and adherence rates to SEPs for individuals with IC. Methods The MEDLINE, Embase, and PubMed databases were searched up to January 2015 for terms related to supervised exercise in peripheral arterial disease. The review had 3 aims: first, to establish the rates of uptake to SEPs, second, the rates of adherence to programs, and finally to determine the reasons reported for poor uptake and adherence. Separate inclusion and/or exclusion criteria were applied in selecting reports for each aim of the review. Results Only 23 of the 53 potentially eligible articles for uptake analysis identified on literature searches reported any details of screened patients (n = 7,517) with only 24.2% of patients subsequently recruited to SEPs. Forty-five percent of screen failures had no reason for exclusion reported. Sixty-seven articles with 4,012 patients were included for analysis of SEP adherence. Overall, 75.1% of patients reportedly completed an SEP; however, only one article defined a minimal attendance required for SEP completion. Overall, 54.1% of incomplete adherence was due to patient withdrawal and no reason for incomplete adherence was reported for 16% of cases. Conclusions Reporting of SEP trials was poor with regard to the numbers of subjects screened and reasons for exclusions. Only approximately 1 in 3 screened IC patients was suitable for and willing to undertake SEP. Levels of adherence to SEPs and definitions of satisfactory adherence were also lacking in most the current literature. Current clinical guidelines based on this evidence base may not be applicable to most IC patients and changes to SEPs may be needed to encourage and/or retain participants

“Intermittent claudication a real pain in the calf”—Patient experience of diagnosis and treatment with a supervised exercise program

© 2017 Society for Vascular Nursing, Inc. Intermittent claudication (IC) is a common condition which has severe impacts on quality of life, physical function, and mental health. Supervised exercise is the recommended first-line treatment for patients with this condition; however, these are not always feasible or accessible to patients. As the proportion of patients who have this treatment remains suboptimal, it is important to better understand the perception of exercise in this population. A gap in the literature exists about the barriers and facilitators to exercise in patients completing, dropping out of, or declining an exercise program. A qualitative analysis was undertaken to understand this further. Twenty-five patients were interviewed face to face, 10 who had completed exercise, 10 who had declined, and 5 who had dropped out of an exercise program. Three major themes emerged from the data, IC, and perception to exercise and experience or beliefs of the exercise program.Addressing the barriers and facilitators to exercise in patients with IC is crucial in optimizing the delivery and uptake of exercise programs. More education or time investment is needed with these patients during initial diagnostic to help overcome perceived barriers and emphasis healthy behavioral changes

A door lock only accessible from one side at a time

A retrofit replacement to a Euro profile cylinder lock, ideal for secondary doors which are rarely accessed from the outside of a property

Factors affecting decision-making in Gaelic Football: a focus group approach

ObjectivesResearch examining decision-making in sports has predominantly used experimental approaches that fail to provide a holistic understanding of the various factors that impact the decision-making process. The current study aimed to explore the decision-making processes of Senior (expert) and Academy (near-expert) Gaelic Football players using a focus group approach.MethodsFour focus groups were conducted; two with Senior players (n = 5; n = 6) and two with U17 Academy players (n = 5; n = 6). In each focus group, short video clips of Senior Gaelic football games were played, and the action was paused at key moments. The group then discussed the options available to the player in possession, the decision they would make in that situation, and importantly, what factors influenced the final decision. Thematic analysis was used to identify themes that emerged from the focus groups.Results and discussionFour primary themes emerged that affected the decision-making process. Three themes were related to information sources, namely, pre-match context (coach tactics and instructions, match importance, and opposition status), current match context (score and time remaining), and visual information (player positioning and field space, and visual search strategy), and the fourth theme related to individual differences (self-efficacy, risk propensity, perceived pressure, physical characteristics, action capabilities, fatigue) that moderated the decision-making process. Compared to the near-expert Academy players, the expert Senior players displayed a more sophisticated understanding of the various sources of information and were able to integrate them in a more complex manner to make projections regarding future scenarios. For both groups, the decision-making process was moderated by individual differences. A schematic has been developed based on the study findings in an attempt to illustrate the hypothesized decision-making process

Self-management skills in adolescents with chronic rheumatic disease: A cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>For adolescents with a diagnosis of lifelong chronic illness, mastery of self-management skills is a critical component of the transition to adult care. This study aims to examine self-reported medication adherence and self-care skills among adolescents with chronic rheumatic disease.</p> <p>Methods</p> <p>Cross-sectional survey of 52 adolescent patients in the Pediatric Rheumatology Clinic at UCSF. Outcome measures were self-reported medication adherence, medication regimen knowledge and independence in health care tasks. Predictors of self-management included age, disease perception, self-care agency, demographics and self-reported health status. Bivariate associations were assessed using the Student's t-test, Wilcoxon rank sum test and Fisher exact test as appropriate. Independence in self-management tasks were compared between subjects age 13-16 and 17-20 using the chi-squared test.</p> <p>Results</p> <p>Subjects were age 13-20 years (mean 15.9); 79% were female. Diagnoses included juvenile idiopathic arthritis (44%), lupus (35%), and other rheumatic conditions (21%). Mean disease duration was 5.3 years (SD 4.0). Fifty four percent reported perfect adherence to medications, 40% reported 1-2 missed doses per week, and 6% reported missing 3 or more doses. The most common reason for missing medications was forgetfulness. Among health care tasks, there was an age-related increase in ability to fill prescriptions, schedule appointments, arrange transportation, ask questions of doctors, manage insurance, and recognize symptoms of illness. Ability to take medications as directed, keep a calendar of appointments, and maintain a personal medical file did not improve with age.</p> <p>Conclusions</p> <p>This study suggests that adolescents with chronic rheumatic disease may need additional support to achieve independence in self-management.</p

Virology under the microscope—a call for rational discourse

Viruses have brought humanity many challenges: respiratory infection, cancer, neurological impairment and immunosuppression to name a few. Virology research over the last 60+ years has responded to reduce this disease burden with vaccines and antivirals. Despite this long history, the COVID-19 pandemic has brought unprecedented attention to the field of virology. Some of this attention is focused on concern about the safe conduct of research with human pathogens. A small but vocal group of individuals has seized upon these concerns – conflating legitimate questions about safely conducting virus-related research with uncertainties over the origins of SARS-CoV-2. The result has fueled public confusion and, in many instances, ill-informed condemnation of virology. With this article, we seek to promote a return to rational discourse. We explain the use of gain-of-function approaches in science, discuss the possible origins of SARS-CoV-2 and outline current regulatory structures that provide oversight for virological research in the United States. By offering our expertise, we – a broad group of working virologists – seek to aid policy makers in navigating these controversial issues. Balanced, evidence-based discourse is essential to addressing public concern while maintaining and expanding much-needed research in virology

Constraintly inhered habitation

“One of the basic human requirements is the need to dwell, and one of the central human acts is the act of inhabiting, of connecting ourselves, however temporarily, with a place on the planet which belongs to us and to which we belong” (1). The ability to inhabit space within our cities has become increasingly difficult; the population continues to increase, while available land decreases. Space within our cities, is often underdeveloped and wasted because of greed, the desire for more personal space than one requires. The spatial boundaries of the space humans inhabit for the purpose of living will eventually have to be confined to basic human requirements. The spaces that humans inhabit are required to be used more efficiently; increasing the functional use and designing for adaptive multiple uses. As spaces become larger the ability to use the space efficiently greatly decreases as the resource to operate the spaces increases. 1. Jun’ichiro Tanizaki, In Praise of Shadows, trans. Thomas J. Harper and Edward G. Seidensticker (Sedgwick, Maine: Leete’s Island Books, 1977), vii

Letter - Ed Broadbent to Donald Ziraldo, 1987

The letter discusses the international level of Inniskillin wine and high standards of Canadian wine. John Crosbie's remarks about Canadian wines are also mentioned. The letter is dated 19 January, 1987 from the office of the New Democratic Party in the House of Commons

Partial Difference Sets in New Groups

We investigate the connections between partial difference sets and projective planes of several different orders in an attempt to locate a family of partial difference sets in new groups. We first show several Galois ring constructions, and then describe work using quadratic forms and Mathon-constructed maximal arcs to provide insight into their geometry and structure. Acknowledgement: We thank the University of Richmond Undergraduate Research Committee for their support of this research. We also thank Dr. Jim Davis for his guidance and support. 1

Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

Background Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. Aims To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. Method Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. Results There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient −21.1 days, 95% CI −24.6 to −17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Conclusions Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week