A qualitative study of the factors influencing recruitment to a pilot trial on the prevention of striae gravidarum

Myo-inositol nutritional supplement for prevention of gestational diabetes (EMmY): a randomised, placebo-controlled, double-blind pilot trial with nested qualitative study

OBJECTIVES

To determine the feasibility and acceptability of conducting a randomised trial on the effects of myo-inositol in preventing gestational diabetes in high-risk pregnant women.

DESIGN

A multicentre, double-blind, placebo-controlled, pilot randomised trial with nested qualitative evaluation.

SETTING

Five inner city UK National Health Service hospitals PARTICIPANTS: Multiethnic pregnant women at 12⁺⁰ and 15⁺⁶ weeks' gestation with risk factors for gestational diabetes.

INTERVENTIONS

2 g of myo-inositol or placebo, both included 200 µg folic acid, twice daily until delivery.

PRIMARY OUTCOME MEASURES

Rates of recruitment, randomisation, adherence and follow-up.

SECONDARY OUTCOME MEASURES

Glycaemic indices (including homoeostatic model assessment-insulin resistance HOMA-IR), gestational diabetes (diagnosed using oral glucose tolerance test at 28 weeks and by delivery), maternal, perinatal outcomes, acceptability of intervention and costs.

RESULTS

Of the 1326 women screened, 58% (773/1326) were potentially eligible, and 27% (205/773) were recruited. We randomised 97% (198/205) of all recruited women (99 each in intervention and placebo arms) and ascertained outcomes in 90% of women (178/198) by delivery. The mean adherence was 52% (SD 44) at 28 weeks' and 34% (SD 41) at 36 weeks' gestation. HOMA-IR and serum insulin levels were lower in the myo-inositol vs placebo arm (mean difference -0.6, 95% CI -1.2 to 0.0 and -2.69, 95% CI -5.26 to -0.18, respectively). The study procedures were acceptable to women and healthcare professionals. Women who perceived themselves at high risk of gestational diabetes were more likely to participate and adhere to the intervention. The powder form of myo-inositol and placebo, along with nausea in pregnancy were key barriers to adherence.

CONCLUSIONS

A future trial on myo-inositol versus placebo to prevent gestational diabetes is feasible. The intervention will need to be delivered in a non-powder form to improve adherence. There is a signal for efficacy in reducing insulin resistance in pregnancy with myo-inositol.

TRIAL REGISTRATION NUMBER

ISRCTN48872100.

Study on the methodology of striae gravidarum severity evaluation

Background

Striae gravidarum is a common occurrence in pregnancy and many women expect to prevent its development. At present, laser treatment has been used to improve the appearance of striae gravidarum, but the choice of laser type, treatment time, and frequency depend on the therapeutic effect. How to obtain an effective evaluation of striae gravidarum during and after treatment is very important. However, there is no unified evaluation parameter about striae gravidarum. In this paper, we studied the methodology evaluation of striae gravidarum severity. First, the laser therapeutic apparatus was selected as the experimental equipment and different striae gravidarum photos during treatment were obtained. Second, the subject evaluation parameters were chosen based on the literature research and the dermatologists’ guidance. Then, the striae gravidarum photos were divided into different groups by dermatologists based on these parameters. Finally, the objective detection parameters were designed based on the photos feature and subject evaluation parameters. Then, the objective detection parameters were used as the input of the support vector machine and the evaluation results were compared.

Results

Based on the subject evaluation parameters, the experimental data could be divided into mild, moderate and severe groups. The experiment results showed that the striae gravidarum severity of two randomly patients were improved before and after treatment, which verified the validity of the parameters. In addition, the chosen objective detection parameters were different among different groups. With all the objective parameters as the support vector machine input, we could achieve the best recognition rate (82.71%) in the striae gravidarum severity classification. The four parameters (color difference, average density, average width, distribution area) calculated from the photos as the input could achieve acceptable accuracy (81.69%).

Conclusions

The subject evaluation parameters and objective detection parameters proposed in this paper can be used to evaluate the striae gravidarum severity, which is of great significance for the construction of auxiliary diagnostic instrument for striae gravidarum treatment.

Patients' Perspectives of Grafting Materials in Implant Dentistry: A Qualitative Analysis

AIMS

The aim of this study was to evaluate the cultural, psychological, and religious influences on the choice of autografts, allografts, xenografts, and synthetic bone products for the grafting procedure and with implant placement.

MATERIALS AND METHODS

A qualitative methodology was employed, using the principles of the constant comparative method of the grounded theory; to investigate how people perceive and understand their experiences regarding the graft materials in implant dentistry. The data were collected using detailed qualitative interviews, till saturation was achieved, from 10 patients.

RESULTS

The three main themes that emerged in the analysis were: (a) grafting material preference, (b) religious and psychological influences, and (c) trust the doctor and cost influences. The three themes that emerged seemed to be interrelated. There were many statements of preference or rejection of choice based on religious, cultural, and psychological influences.

CONCLUSIONS

Within the limitations of this study, three themes emerged and they indicated that the influence on the grafting material's choice is unique to every individual; it also shares similarities, based on common religious and cultural values.