Involving patients in decisions about preventive medication : A focus group study

Original article can be found at: http://www.pccj.eu/ Copyright Sherborne Gibbs Ltd. [reproduced here with permission of publishers]Background: Patients may have unrealistic expectations of preventive treatment and frequently do not take long-term medication. Involvement of the patient in the decision to start such medication may improve this, but enabling an informed decision is notoriously difficult. Aims: To explore patients' perceptions of preventive medication, the desire for informed choice and how this could best be achieved. Method: Purposive sampling was used to select patients registered with one of two general practices in South England. Audio recording, transcription and computer-assisted textual analysis were conducted for focus group discussions. Results: This was a small study, but the majority of focus group participants who had been prescribed a preventive medication said they received very little or no information about benefits and disadvantages when it was started. Some felt that doctors did not want to share information. Older participants thought that choice was over-rated, trusted their doctor to recommend appropriate medication and did not necessarily wish to be involved in the decision. Younger participants wanted to be more involved. However, even those who expressed little interest in involvement felt that personalised information compared with population norms comparing individuals to the 'average person' would be helpful. Written information specific to the individual and on how the medication or lifestyle changes might affect them was considered welcome. Conclusions: Doctors need to be sensitive to patients' preferences for involvement in the decision-making process and for the way information on risk is shared. Providing written information specific to the individual patient is likely to facilitate shared decisions about preventive medication.Peer reviewedFinal Published versio

Longitudinal muon spin relaxation in high purity aluminum and silver

The time dependence of muon spin relaxation has been measured in high purity aluminum and silver samples in a longitudinal 2 T magnetic field at room temperature, using time-differential \musr. For times greater than 10 ns, the shape fits well to a single exponential with relaxation rates of \lambda_{\textrm{Al}} = 1.3 \pm 0.2\,(\textrm{stat.}) \pm 0.3\,(\textrm{syst.})\,\pms and \lambda_{\textrm{Ag}} = 1.0 \pm 0.2\,(\textrm{stat.}) \pm 0.2\,(\textrm{syst.})\,\pms

Learning to work together - lessons from a reflective analysis of a research project on public involvement

Abstract Background Patient and public involvement (PPI) is now an expectation of research funders, in the UK, but there is relatively little published literature on what this means in practice – nor is there much evaluative research about implementation and outputs. Policy literature endorses the need to include PPI representation at all stages of planning, performing and research dissemination, and recommends resource allocation to these roles; but details of how to make such inputs effective in practice are less common. While literature on power and participation informs the debate, there are relatively few published case studies of how this can play out through the lived experience of PPI in research; early findings highlight key issues around access to knowledge, resources, and interpersonal respect. This article describes the findings of a case study of PPI within a study about PPI in research. Methods The aim of the study was to look at how the PPI representatives’ inputs had developed over time, key challenges and changes, and lessons learned. We used realist evaluation and normalisation process theory to frame and analyse the data, which was drawn from project documentation, minutes of meetings and workshops, field notes and observations made by PPI representatives and researchers; documented feedback after meetings and activities; and the structured feedback from two formal reflective meetings. Findings Key findings included the need for named contacts who support, integrate and work with PPI contributors and researchers, to ensure partnership working is encouraged and supported to be as effective as possible. A structure for partnership working enabled this to be enacted systematically across all settings. Some individual tensions were nonetheless identified around different roles, with possible implications for clarifying expectations and deepening understandings of the different types of PPI contribution and of their importance. Even in a team with research expertise in PPI, the data showed that there were different phases and challenges to ‘normalising’ the PPI input to the project. Mutual commitment and flexibility, embedded through relationships across the team, led to inclusion and collaboration. Conclusion Work on developing relationships and teambuilding are as important for enabling partnership between PPI representatives and researchers as more practical components such as funding and information sharing. Early explicit exploration of the different roles and their contributions may assist effective participation and satisfaction

Reflections and Experiences of a Co-Researcher involved in a Renal Research Study

Background Patient and Public Involvement (PPI) is seen as a prerequisite for health research. However, current Patient and public involvement literature has noted a paucity of recording of patient and public involvement within research studies. There have been calls for more recordings and reflections, specifically on impact. Renal medicine has also had similar criticisms and any reflections on patient and public involvement has usually been from the viewpoint of the researcher. Roles of patient and public involvement can vary greatly from sitting on an Advisory Group to analysing data. Different PPI roles have been described within studies; one being a co-researcher. However, the role of the co-researcher is largely undefined and appears to vary from study to study. Methods The aims of this paper are to share one first time co-researcher's reflections on the impact of PPI within a mixed methods (non-clinical trial) renal research study. A retrospective, reflective approach was taken using data available to the co-researcher as part of the day-to-day research activity. Electronic correspondence and documents such as meeting notes, minutes, interview thematic analysis and comments on documents were re-examined. The co-researcher led on writing this paper. Results This paper offers a broad definition of the role of the co-researcher. The co-researcher reflects on undertaking and leading on the thematic analysis of interview transcripts, something she had not previously done before. The co-researcher identified a number of key themes; the differences in time and responsibility between being a coresearcher and an Advisory Group member; how the role evolved and involvement activities could match the co-researchers strengths (and the need for flexibility); the need for training and support and lastly, the time commitment. It was also noted that it is preferable that a co-researcher needs to be involved from the very beginning of the grant application. Conclusions The reflections, voices and views of those undertaking PPI has been largely underrepresented in the literature. The role of co-researcher was seen to be rewarding but demanding, requiring a large time commitment. It is hoped that the learning from sharing this experience will encourage others to undertake this role, and encourage researchers to reflect on the needs of those involved.Peer reviewedFinal Published versio

The ππ\pi\pi interaction in nuclear matter from a study of the π+A→π+π±A′\pi^+ A \to \pi^+ \pi^{\pm} A' reactions

The pion-production reactions $\pi^+ A \to \pi^+\pi^{\pm} A'$ were studied on $^{2}H$, $^{12}C$, $^{40}Ca$, and $^{208}Pb$ nuclei at an incident pion energy of $T_{\pi^{+}}$=283 MeV. Pions were detected in coincidence using the CHAOS spectrometer. The experimental results are reduced to differential cross sections and compared to both theoretical predictions and the reaction phase space. The composite ratio $\cal C$$_{\pi\pi}^A$ between the $\pi^{+}\pi^{\pm}$ invariant masses on nuclei and on the nucleon is also presented. Near the $2m_{\pi}$ threshold pion pairs couple to $(\pi\pi)_{I=J=0}$ when produced in the $\pi^+\to \pi^+\pi^-$ reaction channel. There is a marked near-threshold enhancement of $\cal C$$_{\pi^+\pi^-}^A$ which is consistent with theoretical predictions addressing the partial restoration of chiral symmetry in nuclear matter. Furthermore, the behaviour of $\cal C$$_{\pi^+\pi^-}^A$ is well described when the restoration of chiral symmetry is combined with standard P-wave renormalization of pions in nuclear matter. On the other hand, nuclear matter only weakly influences $\cal C$$_{\pi^+\pi^+}^A$, which displays a flat behaviour throughout the energy range regardless of $A$.Comment: 30 pages, 16 figures, PS format, accepted for publication in Nucl. Phys

The pi -> pi pi process in nuclei and the restoration of chiral symmetry

The results of an extensive campaign of measurements of the pi -> pi pi process in the nucleon and nuclei at intermediate energies are presented. The measurements were motivated by the study of strong pi pi correlations in nuclei. The analysis relies on the composite ratio C_{pi pi}^A, which accounts for the clear effect of the nuclear medium on the (pi pi) system. The comparison of the C_{pi pi}^A distributions for the (pi pi)_{I=J=0} and (pi pi)_{I=0,J=2} systems to the model predictions indicates that the C_{pi pi}^A behavior in proximity of the 2m_pi threshold is explainable through the partial restoration of chiral symmetry in nuclei.Comment: accepted for publication in Nucl. Phys.

Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals

We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS).<p></p> <b>Aims</b> (1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and complexity of complaints most frequently treated nationally; (3) to present a cross section of outcome scores by appointment number, including that for the most frequently treated medical complaints; (4) to explore approaches to standard setting for homeopathic practice outcome in patients treated at the homeopathic hospitals.<p></p> <b>Methods</b> A total of 51 medical practitioners took part in data collection over a 4-week period. Consecutive patient appointments were recorded under the headings: (1) date of first appointment in the current series; (2) appointment number; (3) age of patient; (4) sex of patient; (5) main medical complaint being treated; (6) whether other main medical complaint(s); (7) patient-reported change in health, using Outcome Related to Impact on Daily Living (ORIDL) and its derivative, the ORIDL Profile Score (ORIDL-PS; range, –4 to +4, where a score ≤−2 or ≥+2 indicates an effect on the quality of a patient's daily life); (8) receipt of other complementary medicine for their main medical complaint.<p></p> <b>Results</b> The distribution of patient age was bimodal: main peak, 49 years; secondary peak, 6 years. Male:female ratio was 1:3.5. Data were recorded on a total of 1797 individual patients: 195 first appointments, 1602 follow-ups (FUs). Size of clinical service and proportion of patients who attended more than six visits varied between hospitals. A total of 235 different medical complaints were reported. The 30 most commonly treated complaints were (in decreasing order of frequency): eczema; chronic fatigue syndrome (CFS); menopausal disorder; osteoarthritis; depression; breast cancer; rheumatoid arthritis; asthma; anxiety; irritable bowel syndrome; multiple sclerosis; psoriasis; allergy (unspecified); fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis; headache; vitiligo; seasonal allergic rhinitis; chronic intractable pain; insomnia; ulcerative colitis; acne; psoriatic arthropathy; urticaria; ovarian cancer; attention-deficit hyperactivity disorder (ADHD); epilepsy; sinusitis. The proportion of patients with important co-morbidity was higher in those seen after visit 6 (56.9%) compared with those seen up to and including that point (40.7%; P < 0.001). The proportion of FU patients reporting ORIDL-PS ≥ +2 (improvement affecting daily living) increased overall with appointment number: 34.5% of patients at visit 2 and 59.3% of patients at visit 6, for example. Amongst the four most frequently treated complaints, the proportion of patients that reported ORIDL-PS ≥ +2 at visit numbers greater than 6 varied between 59.3% (CFS) and 73.3% (menopausal disorder).<p></p> <b>Conclusions</b> We have successfully piloted a process of national clinical data collection using patient-reported outcome in homeopathic hospital outpatients, identifying a wide range and complexity of medical complaints treated in that setting. After a series of homeopathy appointments, a high proportion of patients, often representing “effectiveness gaps” for conventional medical treatment, reported improvement in health affecting their daily living. These pilot findings are informing our developing programme of standard setting for homeopathic care in the hospital outpatient context

End of life care interventions for people with dementia in care homes : addressing uncertainty within a framework for service delivery and evaluation

© 2015 Goodman et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedMethods: The data from three studies on EoL care in care homes: (i) EVIDEM EoL , (ii) EPOCH , and (iii) TTT EoL were used to inform the development of the framework. All used mixed method designs and two had an intervention designed to improve how care home staff provided end of life care. The EVIDEM EoL and EPOCH studies tracked the care of older people in care homes over a period of 12 months. The TTT study collected resource use data of care home residents for three months, and surveyed decedents' notes for ten months, Results: Across the three studies, 29 care homes, 528 residents, 205 care home staff, and 44 visiting health care professionals participated. Analysis of showed that end of life interventions for people with dementia were characterised by uncertainty in three key areas; what treatment is the 'right' treatment, who should do what and when, and in which setting EoL care should be delivered and by whom? These uncertainties are conceptualised as Treatment uncertainty, Relational uncertainty and Service uncertainty. This paper proposes an emergent framework to inform the development and evaluation of EoL care interventions in care homes. Conclusion: For people with dementia living and dying in care homes, EoL interventions need to provide strategies that can accommodate or "hold" the inevitable and often unresolvable uncertainties of providing and receiving care in these settingsPeer reviewe

A search for two body muon decay signals

Lepton family number violation is tested by searching for $\mu^+\to e^+X^0$ decays among the 5.8$\times 10^8$ positive muon decay events analyzed by the TWIST collaboration. Limits are set on the production of both massless and massive $X^0$ bosons. The large angular acceptance of this experiment allows limits to be placed on anisotropic $\mu^+\to e^+X^0$ decays, which can arise from interactions violating both lepton flavor and parity conservation. Branching ratio limits of order $10^{-5}$ are obtained for bosons with masses of 13 - 80 MeV/c$^2$ and with different decay asymmetries. For bosons with masses less than 13 MeV/c$^{2}$ the asymmetry dependence is much stronger and the 90% limit on the branching ratio varies up to $5.8 \times 10^{-5}$. This is the first study that explicitly evaluates the limits for anisotropic two body muon decays.Comment: 7 pages, 5 figures, 2 tables, accepted by PR