A feasibility study of educational tools for osteomalacia

Many people in the UK, particularly people of South Asian origin, are advised to supplement their vitamin D intake, yet most do not. This suggests an unmet educational need. The osteomalacia mind map was developed to meet this need. The mind map contains culturally sensitive images, translated into Urdu and made interactive on a DVD. This study explores the feasibility of a randomised controlled study to measure the effect of education on improving vitamin D knowledge and adherence. This was a pilot and feasibility study. Cluster randomisation was used to avoid inter person contamination. Two South Asian women’s groups were recruited to receive information about osteomalacia either by interactive DVD or an Arthritis Research UK leaflet. Knowledge and compliance were tested before and after the educational interventions via a knowledge questionnaire and the measurement of vitamin D and parathormone levels. The groups were found to be mismatched for knowledge, educational attainment and language at baseline. There were also organisational difficulties and possible confounding due to different tutors and translators. The DVD group had high knowledge at baseline which did not improve. The leaflet group had low knowledge at baseline that did improve. The DVD group had lower parathormone which did not change. The leaflet group had an increase in vitamin D but parathormone remained high. Performing a randomised study with this population utilising an educational intervention was difficult to execute. If cluster randomisation is used, extreme care must be taken to match the groups at baseline

A feasibility study of educational tools for osteomalacia

Many people in the UK, particularly people of South Asian origin, are advised to supplement their vitamin D intake, yet most do not. This suggests an unmet educational need. The osteomalacia mind map was developed to meet this need. The mind map contains culturally sensitive images, translated into Urdu and made interactive on a DVD. This study explores the feasibility of a randomised controlled study to measure the effect of education on improving vitamin D knowledge and adherence. This was a pilot and feasibility study. Cluster randomisation was used to avoid inter person contamination. Two South Asian women’s groups were recruited to receive information about osteomalacia either by interactive DVD or an Arthritis Research UK leaflet. Knowledge and compliance were tested before and after the educational interventions via a knowledge questionnaire and the measurement of vitamin D and parathormone levels. The groups were found to be mismatched for knowledge, educational attainment and language at baseline. There were also organisational difficulties and possible confounding due to different tutors and translators. The DVD group had high knowledge at baseline which did not improve. The leaflet group had low knowledge at baseline that did improve. The DVD group had lower parathormone which did not change. The leaflet group had an increase in vitamin D but parathormone remained high. Performing a randomised study with this population utilising an educational intervention was difficult to execute. If cluster randomisation is used, extreme care must be taken to match the groups at baseline

Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes

Ameliorative potential of quercetin and rutin on dextromethorphan-induced toxicity in Sprague-Dawley rats

Dextromethorphan as an antitussive has been reported to have deleterious effect on the testicular function. Quercetin is an extensive class of polyphenolic flavonoid compounds found in plant sources like green vegetables and tea. It is considered to be a strong antioxidant due to its ability scavenge free radicals and bind transition metal ions. Rutin is a flavonoid of the flavonol-type that is found in plant kingdom and a nutritional component of foodstuffs in apples, onions and black tea. In this study, we determined the effect of Quercetin and Rutin on Dextromethorphan-induced toxicity in males using Sprague-Dawley rats as models. Eighty male rats (150 ± 30 g) divided into four (N=20; A-D) were used for a duration of 16 weeks. Group A, control received distilled water (DW); group B-C received 20, 40 and 80 mg/kg of DM respectively. At the end of treatment period, 5 animals were selected and euthanized from each group. Seminal parameters and Hormonal milieu were analysed. The remaining 15 rats were divided into 3 groups (N=5; E-G). They received Quercetin (50 mg/kg) Rutin (25 mg/kg) and DW respectively for 16 weeks to ascertain recovery rate. The rats were sacrificed and the above parameters were analysed. Significant dose-dependent reduction in seminal parameters and hormones was observed in DM- treated groups. An increase in seminal parameters and hormonal milieu was observed when DM- treated and recovery-alone groups were compared to Rutin and Quercetin groups. The supplementation of Rutin and Quercetin showed significant increases in the parameters which could mitigate the toxic effect of Dextromethorphan and in turn translates into improved fertility in males

The Diffusion of Inclusion: An Open Polity Model of Ethnic Power Sharing

While there is a growing consensus that ethnic inclusion produces peace, less is known about what causes transitions to power sharing between ethnic groups in central governments in multiethnic states. The few studies that have addressed this question have proposed explanations stressing exclusively domestic factors. Yet, power sharing is spatially clustered, which suggests that diffusion may be at play. Inspired by studies of democratic diffusion, we study the spread of inclusive policies with an “open polity model” that explicitly traces diffusion from inclusion in other states. Our findings indicate that the relevant diffusion processes operate primarily at the level of world regions rather than globally or between territorial neighbors. Thus, the more inclusive the region, the more likely a shift to power sharing becomes. Shifts away from inclusion to dominance are less common since World War II, but they are more likely in regional settings characterized by ethnic exclusion

STABILITY OF BIOSURFACTANT PRODUCED BY PSEUDOMONAS TAENENSIS

Biosurfactants are one of the microbial bioproducts that are naturally synthesized and are applicable for many industrial purposes. In this study, antibacterial, stability and antibiotic susceptibility of biosurfactant was evaluated. Biosurfactants produced from different substrates (groundnut cake, cassava flour waste, pome, cooking oil, engine oil, cassava waste water, molasses, cassava peel, potato) by Pseudomonas taenensis were evaluated for antibacterial activity using agar well diffusion method. Antibiotics susceptibility of Pseudomonas taenensis was carried out using different antibiotics (augmentin, ofloxacin, tetracyclin and ciprofloxacin, cotrimoxazole, pefloxacin, amoxylin, ceftriazone, nitrofuranton and gentamycin). The stability of the biosurfactant was evaluated by adjusting the biosurfactant to: pH (2, 4, 6, 8, 10 and 12) using 1M NaOH and 1M HCl, temperature (4, 30, 37, 55, 75 and 100 °C) and NaCl (0, 5, 10, 15, 20 and 25 %). Results showed that only biosurfactant produced using cassava waste water as substrate was sensitive to Escherichia coli while biosurfactant produced using cassava flour waste, pome and molasses were sensitive to Staphylococcus aureus. Biosurfactant-producing isolate (Pseudomonas taenensis) was sensitive to four antibiotics (augmentin, ofloxacin, tetracyclin and ciprofloxacin) and resistant to six antibiotics (cotrimoxazole, pefloxacin, amoxylin, ceftriazone, nitrofuranton and gentamycin). Biosurfactant was stable over all the wide ranges of pH, temperature and sodium chloride concentrations investigated. This study therefore revealed that biosurfactant have good stability, thus, could survive environmental stress; Not all biosurfactant and biosurfactant producers have antimicrobial and antibiotic property.   &nbsp

Inflammatory arthritis in HIV positive patients: A practical guide

Background: Musculoskeletal manifestations of the human immunodeficiency virus (HIV) have been described since the outset of the global HIV epidemic. Articular syndromes that have been described in association with HIV include HIV-associated arthropathy, seronegative spondyloarthropathies (SPA) (reactive arthritis, psoriatic arthritis (PsA) and undifferentiated SPA), rheumatoid arthritis (RA) and painful articular syndrome. Methods: We carried out a computer-assisted search of PubMed for the medical literature from January 1981 to January 2015 using the keywords HIV, acquired immune-deficiency syndrome, rheumatic manifestations, arthritis, spondyloarthropathy, anti-TNF and disease modifying antirheumatic drugs. Only English language literature was included and only studies involving adult human subjects were assessed. Results: There are challenges in the management of inflammatory arthritis in patients who are HIV-positive, including difficulties in the assessment of disease activity and limited information on the safety of immunosuppressive drugs in these individuals. Conclusions: This review focuses on the clinical characteristics of the inflammatory articular syndromes that have been described in association with HIV infection and discusses the therapeutic options for these patients

Experiences of South Asian patients in early inflammatory arthritis clinic: a qualitative interview study

Objective: The aim was to explore how UK South Asian patients living with RA interact with health care professionals and experience receiving health information in an early inflammatory arthritis clinic. Methods: A semi-structured interview schedule, designed in conjunction with a patient partner, was used for face-to-face interviews. South Asian participants with RA were recruited from Central Manchester University Hospitals National Health Service Foundation Trust. Data were recorded and transcribed by an independent company. Data were analysed using inductive thematic analysis. Results: Fifteen participants were interviewed. Three predominant themes emerged around participants’ experiences and interaction with health care professionals in early inflammatory arthritis clinic. First, ‘the personal experiences of RA and cultural link to early inflammatory arthritis clinic’, where participants described the impact of RA as individuals and their altered roles within their cultural setting. Second, ‘experiences of interacting and receiving information in the early inflammatory arthritis clinic’, where participants described their limited engagement with health care professionals and the quality of information discussed in the clinic. Third, ‘views on future content for early inflammatory arthritis clinics’, where participants highlighted new innovative ideas to build on current practice. Conclusion: We believe this to be the first study to generate insight into the experiences of South Asian patients of interacting with health care professionals while attending an early inflammatory arthritis clinic. Policy directives aimed at improving access to services and delivery of information for ethnic minority groups in early inflammatory arthritis clinics should include consideration of the different roles of cultures. Professionals should be cognizant of the factors that drive health inequalities and focus on improving service delivery

Patient education in rheumatoid arthritis: is the needs-based approach the way forward?

In recent years, the assessment of patients’ needs has become an important area of research for several reasons; expenditure on healthcare has risen faster than the cost increases reported in other sectors of the economy, and medical advances and demographic changes will continue the upward pressure on costs. At the same time, the resources available for healthcare are limited, and the rising expectations of the public have led to greater concerns about the quality of the services they receive

Global excellence in rheumatology: Africa–The contribution of African women rheumatologists

Over the last few decades, the development of Rheumatology on the African continent has made great strides. Alongside an increasing recognition of the prevalence and burden of disease from these conditions, has been a determination to raise awareness of these disorders in Africa together with an appreciation of the associated disease impact on individuals, families and society as a whole. Great improvements have also been made across the continent with regards to the education of medical students, trainee doctors and allied health professionals of these conditions. Furthermore, high quality rheumatological research is now emanating from Africa. Taken together, these actions mean that Africa is making a significant contribution to global excellence in Rheumatology. Although this achievement has been made possible by visionary, hardworking and inspirational men and women, we believe that it is vital to bring to light the extraordinary efforts of African female rheumatologists in this endeavor. Their contribution is all the more remarkable because of the barriers that women still face in medicine in general and in academia in particular. We showcase here, four women of distinction who in their own unique way, have exemplified the contribution of African female rheumatologists to global excellence in Africa. We pay tribute to them and to their ongoing efforts to act as beacons of excellence in rheumatology in Africa to men and especially to other women