Barton Community Health & Care Centre

Most studies to date exploring facilitators and barriers to adolescent and young adults' (AYAs') participation in clinical trials have been focused on external factors to AYAs' participation or recruitment strategies. The purpose of this mixed-methods study was to determine AYA cancer survivors' preferences for oncology symptom management clinical trial participation. Semistructured interviews and conjoint analysis were conducted to clarify potential attributes (eg, characteristics) and levels (eg, value of the characteristic) that may be important to AYA cancer survivors when considering clinical trial participation (n = 19). The final list of attributes and levels was administered within a choice-based conjoint analysis survey (n = 52). The utility score for each level was analyzed using hierarchical Bayes estimation, and the feature importance for each attribute was quantified. The type of new treatment (22.9%) and perceived importance of study topic (19.5%) were the most important attributes identified by participants. The levels with the highest utility scores within each attribute included prescription medicine treatment with mild side effects, electronic surveys, under-30-minute study visits, no follow-up visits, 4-week treatment period, and once-a-week treatment frequency. The data support that study designs with low participant burden, interventions with few side effects, and the involvement of AYAs in determining the priority of the research topic are appealing to AYAs when considering participation in symptom management trials. AYA participation in clinical trials is necessary to develop new symptom management modalities. Clinicians may use the results to introduce clinical trials containing trial characteristics that appeal to AYA cancer survivors.

Adverse drug reactions (ADRs) are common and a leading cause of injury. However, information on ADR risks of individual medicines is often limited. The aim of this hypothesis-generating study was to assess the relative importance of ADR-related and emergency hospital admission for large group of medication classes. This study was a propensity-matched case-control study in English primary care. Data sources were Clinical Practice Research Databank and Aurum with longitudinal, anonymized, patient level electronic health records (EHRs) from English general practices linked to hospital records. Cases aged 65-100 with ADR-related or emergency hospital admission were matched to up to six controls by age, sex, morbidity and propensity scores for hospital admission risk. Medication groups with systemic administration as listed in the British National Formulary (used by prescribers for medication advice). Prescribing in the 84 days before the index date was assessed. Only medication groups with 50+ cases exposed were analysed. The outcomes of interest were ADR-related and emergency hospital admissions. Conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI). The overall population included 121 546 cases with an ADR-related and 849 769 cases with emergency hospital admission. The percentage of hospitalizations with an ADR-related code for admission diagnosis was 1.83% and 6.58% with an ADR-related code at any time during hospitalization. A total of 137 medication groups was included in the main ADR analyses. Of these, 13 (9.5%) had statistically non-significant adjusted ORs, 58 (42.3%) statistically significant ORs between 1.0 and 1.5, 37 (27.0%) between 1.5-2.0, 18 (13.1%) between 2.0-3.0 and 11 (8.0%) 3.0 or higher. Several classes of antibiotics (including penicillins) were among medicines with largest ORs. Evaluating the 14 medications most often associated with ADRs, a strong association was found between the number of these medicines and the risk of ADR-related hospital admission (adjusted OR of 7.53 (95% CI 7.15-7.93) for those exposed to 6+ of these medicines). There is a need for a regular systematic assessment of the harm-benefit ratio of medicines, harvesting the information in large healthcare databases and combining it with causality assessment of individual case histories.

This study examined the effects of e-coaching on the implementation of a functional assessment-based intervention delivered by an early intervention provider in reducing challenging behaviors during home visits. A multiple baseline design across behavior support plan components was used with a provider-child dyad. The e-coaching intervention consisted of weekly training and support delivered via video conferencing software. Results demonstrated a functional relation between e-coaching and early intervention provider implementation of targeted behavior support plan strategies. Further, the child's challenging behaviors decreased over the course of the study. Contributions to the literature, implications for practice, and future directions are discussed.

OBJECTIVE: Virtual Histology Intravascular Ultrasound (VH™ IVUS) is valuable for estimating minimal lumen diameter (MLD) and plaque characterization. The clinical use of IVUS in the carotid arteries is not well characterized. To evaluate carotid plaque morphology, we performed VH™ IVUS in patients with known carotid artery stenosis. METHODS: From July 2010, patients were prospectively enrolled in an IRB approved study to undergo IVUS prior to an elective carotid stenting procedure. Hospital records were reviewed for co-morbidities, carotid/arch anatomy, preoperative carotid duplex velocity measurements, and incidence of postoperative microemboli. Comparison of pre- and postoperative diffusion-weighted MR images was used to identify microemboli. IVUS-derived MLD and vessel wall plaque characteristics were collected. Spearman correlation was performed between MLD and duplex estimated stenosis, and between plaque characteristics and frequency of postoperative microemboli. RESULTS: 14 patients were enrolled during the study period with carotid artery stenosis (average ICA/CCA ratio 5.5, 64.3% asymptomatic). Major co-morbidities included hyperlipidemia (79%), diabetes (71%), and angina (43%). 57% of patients had type 1 arches, and 50% of patients had heavily calcified irregular carotid plaques. MLD correlated with preoperative duplex ICA/CCA ratio (R2=-0.56,p=0.05), and carotid plaque area correlated with peak systolic and diastolic velocities (R2=-0.55,p=0.05). Although microembolic frequency did not correlate with preoperative patient characteristics, it correlated with IVUS-derived plaque necrotic core area (R2=0.53,p=0.05). CONCLUSION: We demonstrate that periprocedural carotid IVUS is clinically feasible and useful. Preoperative duplex measurements correlated with IVUS MLD confirming the fidelity of the technique. Moreover carotid IVUS demonstrates that patients with necrotic plaque cores have a higher frequency of postoperative microemboli. These findings suggest that carotid IVUS may be helpful to identify patients who are at higher risk of microemboli during carotid artery stenting.

This article, the seventh of eight in the health promotion series, aims to inform nurses about the health behaviours and outcomes of vulnerable groups, and to offer strategies for change.

The aim of this article, the second in the health promotion series, is to highlight the importance of assessing clients' motivation and readiness to change, and to offer advice on how to achieve this.

The MMR controversy has been characterized by two one-sided discourses. In the medical world, the weight of opinion is overwhelmingly in favour of MMR. In the public world, the anti-MMR campaign has a much greater influence, centred on the fears of parents that the triple vaccine may cause autism in their children. Both professionals and parents struggle to cope with the anxieties this creates, but find it difficult to find a balanced account of the issues.In MMR and Autism Michael Fitzpatrick, a general practitioner who is also the parent of an autistic child, explains why he believes the anti-MMR campaign is misguided in a way that will reassure parents considering vaccination and also relieve the anxieties of parents of autistic children. At the same time, this informative book provides health care professionals and health studies students with an accessible overview of a contemporary health issue with significant policy implications.