How do patients from South Asian backgrounds experience life on haemodialysis in the UK? : A multicentre qualitative study

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: End-stage kidney disease disproportionately affects people of South Asian origin. This study aimed to uncover the lived experiences of this group of patients on centre-based haemodialysis (HD), the most prevalent dialysis modality. DESIGN: The study utilised a qualitative focus group methodology. Seven focus groups were conducted across four NHS Trusts in the UK including three in Gujarati and two each in Punjabi and Urdu. This provided an inclusive opportunity for South Asian patients to contribute in their language of origin. A total of 24 patients participated. Focus groups were facilitated by bilingual project workers and data were forward translated and analysed using thematic analysis. RESULTS: Four themes were identified. This included (1) 'treatment imposition', which comprised of the restrictive nature of HD, the effects of treatment and the feeling of being trapped in an endless process. (2) The 'patient-clinician relationship' centred around the impact of a perceived lack of staff time, and inadequacies in the quality of interactions. (3) 'Coping strategies' highlighted the role of cognitive reappraisal, living in the moment and family support networks in facilitating adjustment. (4) 'Pursuit of transplantation' included equating this form of treatment with restoring normality, alongside cultural factors limiting hopefulness for receiving an organ. CONCLUSIONS: In general, the experiences of South Asian patients receiving HD were not unique to this ethnic group. We did find distinct issues in relation to interactions with healthcare professionals, views on access to transplantation and the importance of family support networks. The study provides useful insights which may help enhance culturally tailored renal care.Peer reviewe

Meaning in life in psychotherapy: The perspective of experienced psychotherapists

Objective Our goal was to explore the meaning experienced psychotherapists derive from providing psychotherapy, their beliefs about the role of meaning in life (MIL) in psychotherapy, how they worked with MIL with a client who explicitly presented concerns about MIL, and how they worked with a different client for whom MIL was a secondary and more implicit concern. Method Thirteen experienced psychotherapists were interviewed and data were analyzed using consensual qualitative research. Results Therapists derived self-oriented meaning (e.g., feeling gratified, fulfilled, connected) and other-oriented meaning (helping others, making the world a better place) from providing psychotherapy. They believed that MIL is fundamental and underlies all human concerns, including those brought to therapy. In contrast to the clients who had implicit MIL concerns, clients who explicitly presented MIL concerns were reported to have more interpersonal problems and physical problems, but about the same amount of psychological distress and loss/grief. Therapists used insight-oriented interventions, support, action-oriented interventions, and exploratory interventions to work with MIL with both types of clients, but used more exploratory interventions with implicit than explicit MIL clients. Conclusions MIL is a salient topic for experienced, existentially oriented psychotherapists; they work with MIL extensively with some clients in psychotherapy. We recommend that therapists receive training to work with MIL in therapy, and that they pay attention to MIL concerns when they conduct psychotherapy. We also recommend additional research on MIL in psychotherapy

"Aprender a aprender" en la universidad cubana actual

La Educación Superior cubana y en particular la Educación Superior para las Ciencias de la Salud están inmersas en un proceso de perfeccionamiento en aras de mejorar la pertinencia y calidad de sus egresados, donde aprender a aprender resulta imprescindible. Socializar los resultados de la encuesta aplicada comprobando que los estudiantes universitarios a la luz de las nuevas transformaciones de la Educación Superior aprenden a aprender. El análisis realizado se sustentó sobre la aplicación de una encuesta con un índice de fiabilidad de 0.969, a cuyos resultados se les realizó un análisis descriptivo haciendo uso de las medias, desviación típica y la correlación entre los diferentes indicadores. Los estudiantes encuestados otorgaron puntuaciones altas a cada uno de los indicadores, todo lo cual demuestra que los estudiantes universitarios, en especial los de las Ciencias de la Salud, desde su primer año aprenden a aprender. Independientemente de que los estudiantes universitarios dominen estrategias propias de aprendizaje, los docentes deben ser mediadores entre el conocimiento y la habilidad que poseen los estudiantes para aprender a aprender

Efectos psicosociales de la cirugía intraocular en una unidad oftalmológica

Introduction: as a result of the high incidence of low vision, as well as its negative consequences in the biological, psychological and social spheres, the authors take into account the insufficiency of interdisciplinary studies that collect the psychosocial effects of intraocular surgery for the improvement of the patients.Case presentation: 20-year-old black male patient with a personal pathologic history of bilateral congenital cataract, horizontal nystagmus and low vision; family ophthalmologic-pathologic history of congenital cataract through the maternal line. He was referred from his health area to a low vision consultation for progressive deterioration of bilateral vision. Previously, during his childhood, the patient had been treated in low vision consultation at Ramon Pando Ferrer Cuban Institute of Ophthalmology, where he was rehabilitated, inserted in the Diagnostic and Orientation Center where he finished his primary studies, later the patient went on to regular education to complete basic secondary education.Conclusions:  it can be a motivational facilitator that makes possible to direct the actions that lead to an in-depth study regarding the particularities of each of the cases.Introducción: como resultado de la elevada incidencia de la baja visión, así como sus consecuencias negativas en la esfera biológica, psicológica y social, los autores tienen en cuenta la escasez de estudios interdisciplinares que recojan los efectos psicosociales de la cirugía intraocular para la mejoría de los pacientes.Objetivo: describir los resultados de un caso de cirugía de catarata bilateral, en un paciente de baja visión, que no sólo considera los aspectos médicos, pero también una dimensión sico-psicológica.Presentación del caso: paciente masculino de 20 años de edad, de raza negra, con antecedentes patológicos personales de catarata congénita bilateral, nistagmo horizontal y baja visión; antecedentes patológicos familiares oftalmológicos de catarata congénita por la línea materna. Es remitido desde su área de salud a consulta de baja visión por deterioro progresivo de la visión bilateral. Anteriormente, durante su infancia, el paciente había sido atendido en consulta de baja visión en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer” donde fue rehabilitado, se insertó en el Centro de diagnóstico y orientación donde terminó sus estudios primarios, más tarde el paciente pasó a la enseñanza regular para culminar la secundaria básica.Conclusiones: puede ser un facilitador motivador que hace posible dirigir las acciones que llevan a un estudio en profundidad con respecto a las particularidades de cada uno de los casos

Placental Infection With Plasmodium vivax: A Histopathological and Molecular Study

Background. Evidence of the presence of Plasmodium vivax in the placenta is scarce and inconclusive. This information is relevant to understanding whether P. vivax affects placental function and how it may contribute to poor pregnancy outcomes. Methods. Histopathologic examination of placental biopsies from 80 Papua New Guinean pregnant women was combined with quantitative polymerase chain reaction (qPCR) to confirm P. vivax infection and rule out coinfection with other Plasmodium species in placental and peripheral blood. Leukocytes and monocytes/macrophages were detected in placental sections by immunohistochemistry. Results. Monoinfection by P. vivax and Plasmodium falciparum was detected by qPCR in 8 and 10 placentas, respectively. Seven of the 8 women with P. vivax placental monoinfection were negative in peripheral blood. By histology, 3 placentas with P. vivax monoinfection showed parasitized erythrocytes in the intervillous space but no hemozoin in macrophages nor increased intervillous inflammatory cells. In contrast, 7 placentas positive for P. falciparum presented parasites and hemozoin in macrophages or fibrin as well as intervillous inflammatory infiltrates. Conclusions. Plasmodium vivax can be associated with placental infection. However, placental inflammation is not observed in P. vivax monoinfections, suggesting other causes of poor delivery outcomes associated with P. vivax infectio

On positivity of Ehrhart polynomials

Ehrhart discovered that the function that counts the number of lattice points in dilations of an integral polytope is a polynomial. We call the coefficients of this polynomial Ehrhart coefficients, and say a polytope is Ehrhart positive if all Ehrhart coefficients are positive (which is not true for all integral polytopes). The main purpose of this article is to survey interesting families of polytopes that are known to be Ehrhart positive and discuss the reasons from which their Ehrhart positivity follows. We also include examples of polytopes that have negative Ehrhart coefficients and polytopes that are conjectured to be Ehrhart positive, as well as pose a few relevant questions.Comment: 40 pages, 7 figures. To appear in in Recent Trends in Algebraic Combinatorics, a volume of the Association for Women in Mathematics Series, Springer International Publishin

A pragmatic randomised controlled trial assessing the non-inferiority of counselling for depression versus cognitive-behaviour therapy for patients in primary care meeting a diagnosis of moderate or severe depression (PRaCTICED): Study protocol for a randomised controlled trial.

BACKGROUND: NICE guidelines state cognitive behavioural therapy (CBT) is a front-line psychological treatment for people presenting with depression in primary care. Counselling for Depression (CfD), a form of Person-Centred Experiential therapy, is also offered within Improving Access to Psychological Therapies (IAPT) services for moderate depression but its effectiveness for severe depression has not been investigated. A full-scale randomised controlled trial to determine the efficacy and cost-effectiveness of CfD is required. METHODS: PRaCTICED is a two-arm, parallel group, non-inferiority randomised controlled trial comparing CfD against CBT. It is embedded within the local IAPT service using a stepped care service delivery model where CBT and CfD are routinely offered at step 3. Trial inclusion criteria comprise patients aged 18 years or over, wishing to work on their depression, judged to require a step 3 intervention, and meeting an ICD-10 diagnosis of moderate or severe depression. Patients are randomised using a centralised, web-based system to CfD or CBT with each treatment being delivered up to a maximum 20 sessions. Both interventions are manualised with treatment fidelity tested via supervision and random sampling of sessions using adherence/competency scales. The primary outcome measure is the Patient Health Questionnaire-9 collected at baseline, 6 and 12 months. Secondary outcome measures tap depression, generic psychological distress, anxiety, functioning and quality of life. Cost-effectiveness is determined by a patient service receipt questionnaire. Exit interviews are conducted with patients by research assessors blind to treatment allocation. The trial requires 500 patients (250 per arm) to test the non-inferiority hypothesis of -2 PHQ-9 points at the one-sided, 2.5% significance level with 90% power, assuming no underlying difference and a standard deviation of 6.9. The primary analysis will be undertaken on all patients randomised (intent to treat) alongside per-protocol and complier-average causal effect analyses as recommended by the extension to the CONSORT statement for non-inferiority trials. DISCUSSION: This large-scale trial utilises routinely collected outcome data as well as specific trial data to provide evidence of the comparative efficacy and cost-effectiveness of Counselling for Depression compared with Cognitive Behaviour Therapy as delivered within the UK government's Improving Access to Psychological Therapies initiative. TRIAL REGISTRATION: Controlled Trials ISRCTN Registry, ISRCTN06461651 . Registered on 14 September 2014

Ten Years’ Research on a Cardiovascular Tonic: A Comprehensive Approach—From Quality Control and Mechanisms of Action to Clinical Trial

Objective. Mortality arising from cardiovascular pathologies remains one of the highest. Maintenance of cardiovascular health therefore remains a universal concern. Interventional therapies and medications have made impressive advances, but preventive measures would be of the same importance. Method. Ten years’ search for a simple herbal formula has resulted in a two-herb combination, consisting of Salviae Miltiorrhizae Radix et Rhizoma and Puerariae Lobatae Radix. The formula has been studied extensively on cardiovascular biological platforms and then put on three clinical trials. Results. In the laboratory, the formula was found to have the biological effects of anti-inflammation, anti-oxidation, anti-foam cell formation on vascular endothelium, and vasodilation. Clinical trials using ultrasonic carotid intima thickness as a surrogate marker showed very significant benefits. No significant adverse effects were encountered. Conclusion. It is therefore recommended that the herbal formula could be used as an adjuvant therapy in cardiac patients under treatment or as a preventive agent among the susceptible