Patients' preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study

The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk.

PURPOSE

The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients' preferences regarding fracture risk communication.

METHODS

To assess patients' preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture.

RESULTS

A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk.

CONCLUSIONS

There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.

Investigation of Drug ResistantAcinetobacter baumannii Virulence Factors Implicated in Intracellular Survival Within Differentiated THP-1 Cells

Introduction/Objective

Acinetobacter baumannii is a nosocomial opportunistic pathogen that is usually associated with mucosal infections such as pneumonia, urinary tract infections or sepsis and less commonly with more severe illnesses such as meningitis, wound infection, or necrotizing fasciitis. Of late, A. baumanniihas been flagged by the CDC as an urgent threat due to multidrug-resistant properties it has acquired, making it a major concern to public health. Due to a sparsity of information on the virulence factors of immune evasion, it has been difficult to understand how this bacterium is able to gain a foothold and cause severe infections. We sought to study how necrotizing fasciitis-associated strains of A. baumannii interact with human macrophages to assess their capabilities in evasion of the host immune response.

Methods/Case Report

To this end, extensively drug resistant A. baumannii was isolated at two timepoints (strains NFAb-1 and NFAb-2) from a patient over the course of a lethal necrotizing fasciitis infection that led to sepsis. The intracellular survival of these two strains was compared with each other, as well as to the type strains, ATCC 19606 and ATCC 17978, within a human macrophage-differentiated monocyte cell line, THP-1. Survival studies were complemented with quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) to investigate expression of potential bacterial virulence factors, Catalase E (KatE), Phospholipase C (PLC), Outer membrane protein A (ompA), and Pilus A (PilA), that could contribute to immune evasion.

Results (if a Case Study enter NA)

The intracellular survival assay demonstrated enhanced survival and bacterial growth of NFAb-1 and NFAb-2 within macrophages compared to ATCC 19606 and 17978. Examining gene expression, KatE, PLC, and OmpA didn’t show any significant differences between the bacterial strains, while the PilA gene had much higher expression in NFAb-1 and NFAb-2 compared to ATCC 19606 and 17978.

Conclusion

This data establishes these nectrotizing fasciitis-causing A. baumannii strains are more likely to sruvivie a macrophage-mediatied immune response and expression of pilus-assocated genes may play a role in these interactions. our studies demonstrate a need to further investigate A. baumannii mechanisms of virulence to understand its ability to evade the immune response in hopes of understanding and combating infections.

A sharp debridement procedure devised by specialist nurses

In the clinical governance era, self-education is not adequate training for nurses to carry out sharp debridement, which is a risky process. Specialist nurses in south-east London drew up a workable procedure for training and practice.

Early post-prostatectomy pelvic floor biofeedback

PURPOSE

We determined whether biofeedback enhanced pelvic floor exercises begun 6 weeks after radical prostatectomy improve the early recovery of continence.

MATERIALS AND METHODS

We randomized 30 patients who underwent radical retropubic prostatectomy into a group that received 5 biofeedback sessions and a control group.

RESULTS

Overall 87% of patients were pad-free at 6 months with similar results in the treatment and control groups (86% versus 88%). There was no statistically significant difference in pad test results or voiding diary records in the 2 groups.

CONCLUSIONS

A treatment program of biofeedback enhanced pelvic floor exercises begun 6 weeks after radical retropubic prostatectomy did not significantly affect continence in this study.

Eugenics and birth control: contraceptive provision in North Wales, 1918-1939

The close relationship between the provision of birth control advice and the ideology of eugenics deserves closer attention. This paper focuses on the enthusiasm for eugenic ideas amongst an influential section of the medical profession and their ability to initiate contraceptive provision. A study of North Wales suggests that clinic provision in the interwar period reflected the enthusiasm or hostility of the medical profession more closely than the needs or demands of the female population, and illustrates how, for some doctors, the issue of contraception was seen in the wider context of the nation's health.

Restructuring life to face the future: the perspective of men after a positive response to protease inhibitor therapy

This article describes a qualitative study that explores the psychosocial changes and care delivery issues experienced by men with AIDS who were facing end-stage disease but then had dramatic physical improvement as a result of protease inhibitor therapy. In-depth interviews were conducted with 11 men with HIV/AIDS drawn from a community-based AIDS service organization in a large metropolitan area in the Southeast. Using Collaizi's model of content analysis, three broad categories, protease inhibitors as a reprieve, changed roles and relationships, and need for advocacy and support, emerged from the data. From the three broad categories, seven more specific themes were identified: guarded optimism, buying time, change in relationships, work versus disability, access to medications, access to HIV/AIDS competent health care, and focused support services. Collectively, the phenomenon resulting from these men's experiences and concerns can be described as efforts to restructure life to face a future they did not expect. These findings support the need for developing formal, structured interventions to help persons living with AIDS (PLWA) to restructure their lives as new antiretroviral therapies promote improvements in health.