An exploration of the experiences and self-generated strategies used when navigating everyday life with Long Covid

BACKGROUND

Around one in ten people who contract Covid-19 report ongoing symptoms or 'Long Covid'. Without any known interventions to cure the condition, forms of self-management are routinely prescribed by healthcare professionals and described by people with the condition. However, there is limited research exploring what strategies are used to navigate everyday life with Long Covid, and experiences that initiate development of these strategies. Our study aimed to explore the range and influence of self-generated strategies used by people with Long Covid to navigate everyday life within the context of their own condition.

METHODS

Forming part of the Long Covid Personalised Self-managemenT support co-design and EvaluatioN (LISTEN) project, we conducted a qualitative study using narrative interviews with adults who were not hospitalised with Covid-19. Participants aged over 18 years, who self-identified with Long Covid, were recruited from England and Wales. Data were analysed with patient contributors using a reflexive thematic analysis.

RESULTS

Eighteen participants (mean age = 44 years, SD = 13 years) took part in interviews held between December 2021 and February 2022. Themes were constructed which depicted 1) the landscape behind the Long Covid experience and 2) the everyday experience of participants' Long Covid. The everyday experience comprised a combination of physical, emotional, and social factors, forming three sub-themes: centrality of physical symptoms, navigating 'experts' and the 'true colour' of personal communities, and a rollercoaster of psychological ambiguity). The third theme, personal strategies to manage everyday life was constructed from participants' unique presentations and self-generated solutions to manage everyday life. This comprised five sub-themes: seeking reassurance and knowledge, developing greater self-awareness through monitoring, trial and error of 'safe' ideas, building in pleasure and comfort, and prioritising 'me'.

CONCLUSIONS

Among this sample of adults with Long Covid, their experiences highlighted the unpredictable nature of the condition but also the use of creative and wide ranging self-generated strategies. The results offer people with Long Covid, and healthcare professionals supporting them, an overview of the collective evidence relating to individuals' self-management which can enable ways to live 'better' and regain some sense of identity whilst facing the impact of a debilitating, episodic condition.

TRIAL REGISTRATION

LISTEN ISRCTN36407216.

A qualitative study exploring partner involvement in the management of gestational diabetes mellitus: The experiences of women and partners

AIMS

The aims of the study were to explore the experiences of women with gestational diabetes mellitus (GDM) and their partners and examine the factors influencing partner involvement in GDM management, seeking to inform a targeted couple-based intervention.

DESIGN

A descriptive qualitative study.

METHODS

We conducted semi-structured interviews with 14 women with GDM and their partners. Participants were recruited through convenience sampling from a tertiary hospital in Xi'an, China. Data were analysed using thematic analysis.

RESULTS

Three themes and 12 subthemes were identified. Theme I: Women's expectations of their partner's involvement in GDM management-practical support and emotional support. Theme II: Partner involvement in GDM management-constructive involvement, unhelpful involvement with good intentions and insufficient involvement. Theme III: Factors that influence partner involvement in GDM-knowledge of GDM, GDM risk perception, health consciousness, attitudes towards the treatment plan, couple communication regarding GDM management, family roles and appraisal of GDM management responsibility.

CONCLUSION

Women desired practical and emotional support from partners. The types of partner involvement in GDM management varied. Some partners provided constructive support, while some partners' involvement was limited, non-existent or actively unhelpful. By combining these results with the factors influencing partner involvement, our findings may help healthcare professionals develop strategies to involve partners in GDM care and enhance women's ability to manage GDM.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Partner involvement in GDM care may help them understand and better attend to women's needs, thus improving their experience and potential outcomes. This study highlights novel factors that need to be considered in developing couple-based interventions for this population.

REPORTING METHOD

The reporting follows the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

Some patients were involved in data interpretation. There is no public contribution.

The effects of a couple-based gestational diabetes mellitus intervention on self-management and pregnancy outcomes: A randomised controlled trial

AIMS

To estimate the effectiveness of the Couples Coping with Gestational Diabetes Mellitus (GDM) Programme on GDM self-management and pregnancy outcomes.

METHODS

A randomised controlled trial among pregnant women with suboptimal GDM self-management and their partners was undertaken. Couples recruited from three hospitals in China were randomly allocated to either intervention (n = 70) or control (n = 70) conditions. Couples in the intervention group underwent the couple-based intervention (GDM education, shared illness appraisals, initiation of collaborative action and consolidation of collaborative action). Women in the control group received individual GDM education. Data were analysed using the independent samples t-test, chi-square test, and generalised estimating equations.

RESULTS

GDM knowledge for the women and their partners and GDM self-management significantly improved in both the intervention and control groups, with stronger improvement in the intervention group. Women in the intervention group gained significantly less weight than those in the control group (11.2 kg ± 2.8 kg vs 13.1 kg ± 2.6 kg, p = 0.008). Infant birth weights were significantly lower in the intervention group (3.2 kg ± 0.3 kg vs 3.4 kg ± 0.4 kg, p = 0.008). There were no significant differences in other pregnancy outcomes.

CONCLUSIONS

The Couples Coping with GDM Programme was associated with improvements in GDM knowledge of women and their partners and in women's self-management, and with lower gestational weight gain and infant birth weight.

Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis

OBJECTIVE

This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness.

DATA SOURCES

Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023.

STUDY ELIGIBILITY CRITERIA

Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included.

METHODS

The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates.

RESULTS

A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US-based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US-based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6-16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8-10.0), followed by educational interventions (1 US-based study and 2 non-US-based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9-6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7-6.7).

CONCLUSION

The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.

The gestational diabetes future diabetes prevention study (GODDESS): A partially randomised feasibility controlled trial

OBJECTIVES

To assess the feasibility of an ante- and post-natal lifestyle intervention for women with gestational diabetes mellitus (GDM) to reduce type 2 diabetes risk.

DESIGN

A partially randomised patient preference feasibility trial.

SETTING

Diabetes antenatal clinics in two inner-London hospitals, UK.

PARTICIPANTS

Pregnant women ≥18 years with a GDM diagnosis and pre-pregnancy body mass index of ≥25kg/m2.

INTERVENTION

Participants in the intervention group were offered four motivational interview-based sessions (two antenatally and two postnatally, at 3 and 6 months postpartum), a WhatsApp support group, a FitBit and electronic self-help resources.

OUTCOME MEASURES

Recruitment; retention; intervention dose received; data completion; adaptions; proportion achieving ≥5% weight loss; weight change, blood glucose; blood pressure; diet, physical activity, breastfeeding and depression. Clinical outcomes were measured at baseline and 6 months postpartum.

RESULTS

50 participants were recruited from 155 eligible women (32% recruitment rate). Thirty-four were recruited to the intervention group (23 following randomisation (RI-group) and 11 based on preference (PI-group)); and 16 to the control group (13 randomised (RC-group) and 3 preference (PC-group)). Attrition was 44% (n = 22/50). Forty-six percent (n = 6) of the intervention group (25% (n = 2) of the RI-group and 80% (n = 4) of the PI-group) achieved ≥5% weight loss compared to 8% (n = 1) in the control group (95% confidence interval (CI) -0.69 to 0.07). Mean weight change was -2.1kg±9.0 in the intervention group (0kg±5.4 in the RI-group and -5.4kg±13.0 in the PI-group) compared to +4.4kg±4.9 in the control group (RC +4.4kg ±5.3 and PC +4.7kg ±3.1, 95% CI -12.4 to 0.2).

CONCLUSIONS

Recruitment was feasible, but strategies to improve retention are needed. The findings suggest the intervention can support women with GDM to lose weight. The observed weight loss was primarily in women who preferred the intervention. Therefore, future trials may need to adopt a preference design and consider factors associated with preference.

TRIAL REGISTRATION

Trial registration: ISRCTN52675820 https://www.isrctn.com/ISRCTN52675820?q=ISRCTN52675820&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.

The Mental Health of Women with Gestational Diabetes During the COVID-19 Pandemic: An International Cross-Sectional Survey

Introduction: There is evidence that women with gestational diabetes are at increased risk of the common mental disorders of anxiety and depression. The COVID-19 pandemic may have exerted an additional burden on the mental health of this population. The aim of this analysis was to compare levels of symptoms of common mental disorders and experiences during the COVID-19 pandemic between pregnant and postnatal women exposed and unexposed to gestational diabetes. Methods: Cross-sectional study utilizing quantitative data from an online survey administered across 10 countries to women who were pregnant or up to 6 months postpartum from 15 June to October 31, 2020. Women self-reported gestational diabetes and completed the Edinburgh Postnatal Depression Scale and GAD-7 (Generalized Anxiety Disorder 7 items) measures. The COPE-IS (Coronavirus Perinatal Experiences-Impact Survey) tool was also administered. Complete case analyses were conducted on a sample of 7,371 women. Results: There was evidence of an association between gestational diabetes and increased levels of depression symptoms, which was robust to adjustment for age, education, and employment status. There was only evidence of an association with anxiety in postnatal women. There was also evidence that women with gestational diabetes, particularly those in the postnatal period, experienced higher levels of pandemic-related distress, although they did not experience higher levels of COVID-19 infection in this sample. Conclusions: The increased risk of common mental disorders in women with gestational diabetes underscores the importance of integrated physical and mental health care for pregnant and postnatal women both during and beyond the pandemic. Clinical Trial Registration no. NCT04595123.

Protocol for a feasibility study and process evaluation of a psychosocially modelled diabetes education programme for young people with type 1 diabetes: the Youth Empowerment Skills (YES) programme

INTRODUCTION

Adolescence is a challenging period for young people with type 1 diabetes, associated with worsening glycaemia and care disengagement. Educational interventions in this period tend to focus on diabetes-specific skills, with less emphasis on the psychosocial challenges associated with diabetes experienced by young people. To address this limitation, we codesigned with young people a psychosocially modelled programme of diabetes education, named 'Youth Empowerment Skills' (YES). The programme aims to facilitate a positive adaptation to life with diabetes and engagement with diabetes care through peer-based learning, immersive simulations and support from an outreach youth worker. Here, we present a protocol for a feasibility study of the YES programme.

METHODS AND ANALYSIS

The study was designed following the Medical Research Council Complex Intervention Evaluation Framework to: test the feasibility (acceptance, implementability, recruitment and completion) of the YES programme; and estimate its efficacy in relation to metabolic and psychosocial outcomes. The study will take place in diabetes centres serving socioculturally diverse populations. We will conduct a feasibility randomised controlled trial (waiting-list design) with integrated process evaluation. Fifty young people with type 1 diabetes (aged 14-19 years) will be randomly allocated to either the YES intervention or a waiting-list control. Randomisation acceptability will be assessed with provision for a preference allocation. Outcomes will be evaluated at 6 months, at which point the waiting list participants will be exposed to the YES programme with further follow-up to 12 months. A simultaneous process evaluation will use a mixed-methods approach collecting qualitative and quantitative data. Study findings will be used to optimise the intervention components, outcome measures and recruitment methods to inform a subsequent definitive trial.

ETHICS AND DISSEMINATION

The protocol has ethical approval from the UK Health Research Authority (approval IRAS project ID: 279877). Findings will be disseminated in multiple formats for lay and professional audiences.

PROTOCOL DATE AND VERSION

7 April 2021, V.1.1.

TRIAL REGISTRATION NUMBER

NCT04670198.

455 Proton Beam Therapy in Rectal Cancer: A Systematic Review and Meta-Analysis

Introduction

Radiotherapy for locally advanced rectal cancer is conventionally performed using photon-based radiotherapy (PBR), carrying significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) potentially delivers equivalent dosimetric radiation to the targeted tissue with improved sparing of OAR. We aimed to compare dosimetric irradiation of OAR for PBT versus PBR in patients with rectal cancer and assess any oncological outcomes.

Method

An extensive electronic literature search was performed from inception till April 2020 and subsequent meta-analysis performed.

Results

Six articles met the inclusion criteria. Dosimetric data of irradiation delivered to OAR for PBT and PBR were calculated for the same patients. PBT had significantly less irradiated small bowel compared to 3DCRT and IMRT, (MD -16.95, 95% CI [-24.03, -9.88], p < 0.00001) and (MD -6.96, 95% CI [-12.99, -0.94], p = 0.02) respectively. Similar results were observed for bladder and pelvic bone marrow. Two studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43% and 68%.

Conclusions

Dosimetric treatment plans have less irradiation of OAR for rectal cancer with PBT compared to PBR. There is a need for further research in PBT and rectal cancer, as promising results have been shown in recurrent rectal cancer.

O11: MYOFERLIN: A NOVEL BIOMARKER OF RADIOSENSITIVITY IN LOCALLY ADVANCED RECTAL CANCER

Introduction

Our proteomic data has validated that high levels of the protein myoferlin confers poorer response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Myoferlin plays a role in membrane repair and VEGF signal transduction, and is associated with worse prognosis in numerous other epithelial cancers. We aim to assess the impact of myoferlin on the radiosensitivity of rectal cancer.

Method

Clonogenic assays were performed using immortalised colorectal cancer cells (HCT116,HT29,LIM,MDST8) to assess survival at escalating radiation doses following knockdown with myoferlin siRNA or a small molecular inhibitor(WJ460). 3D models (spheroids) were used to examine the effect of WJ460 on tumour growth.

Result

Quantification of myoferlin using immunoblotting demonstrated that MDST8 and LIM were higher expressors than HCT116 and HT29. Higher levels correlated with increasing radio-resistance as calculated by colony formation efficiency (CFE). Using clonogenic assays, cells treated with myoferlin siRNA or WJ460 demonstrated increased radiosensitivity compared to controls across all radiation doses, most significantly at 4Gy. Treatment of spheroids with WJ460 significantly reduced growth compared to controls at all radiation doses (p<0.05), with WJ460 limiting growth considerably more than treatment with the current gold standard 5-FU. HCT116 spheroid volume day 15; WJ460 4.96um3,5-FU 6.74um3,DMSO 24.9um3.

Conclusion

Inhibition of myoferlin is associated with increased radiosensitivity of colorectal cancer cells, and treatment with a small molecular inhibitor significantly reduces growth in spheroid models. Further work is required further validate its potential use as a biomarker in locally advanced rectal cancer.

Take-home message

We have found that myoferlin is a protein associated with poor response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Manipulation of this protein sensitises the cancer cells to radiotherapy.

O48: MYOFERLIN: A NOVEL PREDICTIVE BIOMARKER AND THERAPEUTIC TARGET IN ADVANCED COLORECTAL CANCER

Introduction

Myoferlin is a protein involved in cell proliferation, migration and angiogenesis, which are essential in tumour metastasis. Its expression correlates with a poorer prognosis in various epithelial cancers, but has yet to be associated with survival in colorectal cancer. We aim to investigate myoferlin's role in cell migration, and the development of metastases in our patients with rectal cancer.

Method

Tissue Microarrays (TMAs) of matched tumour and lymph node samples from 111 patients with rectal cancer were stained for myoferlin. Expression profiles were examined and correlated with clinical outcomes. Wound healing assays were used to assess the rate of migration in immortalised colorectal cells (HCT116, HT29) following myoferlin knockdown with siRNA.

Result

Our TMAs demonstrated that high myoferlin expression in rectal tumour samples was associated with metastatic spread to local lymph nodes (p<0.05). Positive lymph nodes had significantly higher levels of myoferlin than non-involved lymph nodes (p<0.001). The positive predictive value (PPV) of a highly expressing lymph node containing metastatic spread was 100%, negative predictive value (NPV) 88.41%, 95% CI [80.81, 93.24]. Wound healing assays demonstrated a decreased ability of cells to migrate following myoferlin knockdown with siRNA, compared to controls (p<0.05).

Conclusion

Our results demonstrate that high myoferlin expression is associated with metastatic spread to local lymph nodes, and increased migration and proliferation of cells. It is a predictor of poor clinical outcomes, and therefore warrants further investigation as a potential therapeutic target in both locally advanced and metastatic rectal cancer.

Take-home message

We have demonstrated that the protein myoferlin is associated with metastatic spread of rectal cancer to local lymph nodes. Therefore it is a potential predictive biomarker and therapeutic target in advanced rectal cancer.

Letter to the Editor: Healthy for Life: An Innovative and Collaborative Approach to COVID 19 Lockdown in New Zealand

Recently Boreskie and colleagues published an editorial in the Journal of Frailty and Aging on Preventing Frailty Progression During the COVID-19 Pandemic (1). In it they proposed the SAVE programme (Socialization, Adequate nutrition, Vitamin D, Exercise) to prevent frailty. They concluded that creative thinking and concerted efforts would be needed to disseminate health recommendations to maintain the health of pre-frail and frail older adults in unprecedented times, such as those posed by the COVID-19 pandemic.

1173 Reducing Cancellation and Improving the Patient’s Experience Through Quality Improvement Process

Introduction

Sleep study volume in our system has increased by 23% from 2017 to 2019 which makes unfilled sleep beds a significant concern. Cancellation rate impacts our sleep bed access. We hypothesized cancellation can be improved through quality improvement process which could ultimately lead to improve patient satisfaction.

Methods

A multi-disciplinary team was assembled to examine potential contributing factors. Using the Model for Improvement we developed, tested and implemented interventions using tools such as PDSA cycles, process map and a simplified FMEA (Failure Modes and Effects Analysis). A Key Driver Diagram helped guide our journey to improve the cancellation rate. We developed a Parent Advisory Group to help us with ideas to identify how we could improve the cancellation rate.

Results

The cancellation was 21% prior to the implementation of our interventions. To improve these measures, we have implemented several interventions. The content of our sleep study preparation handbook was improved, increased distribution of the education handbook and developed a series of sleep study videos which are available for viewing prior to the study to prepare patients and families. In addition, we standardized our process of reminder calls in the call center and sleep lab by defining roles and responsibilities. This improved our ability to answer questions and identify and mitigate barriers they may have. We implemented transportation assistance to patients who have transportation barriers and created a waitlist protocol to assist families with a preferred date. After 2 years of interventions, the cancellation rate has decreased from 21% to 14.7%. Interestingly, as we improved our cancellation rate, the overall patient satisfaction has been improved from 83% to 88%.

Conclusion

Using the Model for Improvement, we improved education, communication and scheduling processes, which has reduced cancellation rate and consequently improved patient satisfaction.

Support

 

A qualitative study exploring women's health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy

AIM

To inform targeted interventions for women with gestational diabetes mellitus (GDM) by exploring the factors that influence their health behaviours and their preferences for lifestyle support.

METHODS

Participants were women with previous GDM taken from a diverse inner-city UK population. Data collection involved focus groups (n = 35 women in six groups) and semi-structured interviews (n = 15 women). The transcribed data were analysed using framework analysis.

RESULTS

Eight themes relating to factors influencing health behaviour were identified: psychological legacy of pregnancy, relationships with healthcare professionals, physical impacts of pregnancy, social support and cultural norms, life-scheduling, understanding and risk perception, appetite regulation, and prioritization of the baby. The women's recommendations for intervention components included addressing the emotional stress of pregnancy; conveying personalized risk in a motivational way, adopting a family-centered approach, focusing on women's health rather than just the infant's, and developing flexible interventions. These recommendations were used to construct a model integrating the behaviour-regulating factors with a suggested framework for intervention.

CONCLUSIONS

This study identified some common drivers that may regulate the health behaviours of women following GDM, and recognized some ways to improve care to impact on this. Interventions for diabetes prevention in this population need to address factors at both the individual and systemic levels.

The effects of backgrounding system on growing and finishing performance and carcass characteristics of beef steers

The objective of this 2-yr study was to evaluate growing and finishing performance as well as carcass characteristics of spring-born steers backgrounded on 3 different systems, using feedstuffs readily available in the Midwest: 1) grazing corn residue and being supplemented with dried distillers plus solubles at 2.68 kg DM/steer 6 d/wk (RESIDUE), 2) grazing a late summer-planted oat-brassica forage mix (CCROP), or 3) being fed a corn silage-based diet in a drylot (DRYLOT). Steers ( = 715) were stratified by BW (278 kg ± 23 in yr 1 and 291 kg ± 91 in yr 2) and assigned to treatment and replicate (4 replications per treatment per yr). Steers assigned to DRYLOT were fed a corn silage-based diet for 54 d in yr 1 and 52 d in yr 2 before being transitioned to the finishing diet. Steers assigned to RESIDUE and those assigned to CCROP grazed 65 d in yr 1 and 66 d in yr 2 and then were fed a corn silage-based diet for 21 d in yr 1 and 33 d in yr 2 before being transitioned to the finishing diet. During backgrounding, the ADG (SEM 0.022) of steers assigned to DRYLOT (1.48 kg/d) was greater ( < 0.01) than that of steers assigned to both CCROP (1.05 kg/d) and RESIDUE (0.87 kg/d) and ADG of steers assigned to CCROP was greater ( < 0.01) than that of steers assigned to RESIDUE. At the start of the finishing period, BW of steers assigned to CCROP (381 kg) was greater ( < 0.01, SEM 2.5) than that of steers assigned to DRYLOT (361 kg) and RESIDUE (366 kg). The finishing period lasted 160 d for all treatments. Both 12th-rib fat ( = 0.89) and calculated yield grade ( = 0.39) did not differ among treatments. Finishing G:F of steers assigned to DRYLOT (0.162 kg/kg) was greater ( < 0.01, SEM 0.0015) than that of steers assigned to RESIDUE (0.153 kg/kg) and CCROP (0.153 kg/kg), which did not differ ( = 0.79). In yr 1, HCW of steers assigned to CCROP (402 kg) was greater ( < 0.01, SEM 2.1) than that of steers assigned to both RESIDUE (389 kg) and DRYLOT (391 kg), which did not differ ( = 0.40). This difference in HCW is most likely a result of differences in BW at the start of the finishing phase in yr 1. However in yr 2, HCW of steers assigned to CCROP (400 kg) and RESIDUE (397 kg) did not differ ( = 0.26, SEM 2.1) but were greater ( < 0.01) than that of steers assigned to DRYLOT (367 kg), despite the fact that steers assigned to RESIDUE entered the finishing phase at a lighter BW than steers assigned to CCROP. Marbling was greater ( = 0.01, SEM 3.9) for steers assigned to DRYLOT (429) than for steers assigned to RESIDUE (414), although steers assigned to CCROP (424) were not different ( ≥ 0.10) from steers assigned to DRYLOT or RESIDUE. When cost and price scenarios from the last 5 yr were conducted, no treatment appeared to be consistently superior in terms of cost of gain or net return. Therefore, all 3 systems appear to be viable options for producers.

Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study

Background

Gestational diabetes mellitus (GDM) is an increasingly common condition of pregnancy. It is associated with adverse fetal, infant and maternal outcomes, as well as an increased risk of GDM in future pregnancies and type 2 diabetes for both mother and offspring. Previous studies have shown that GDM can result in an emotionally distressing pregnancy, but there is little research on the patient experience of GDM care, especially of a demographically diverse UK population. The aim of this research was to explore the experiences of GDM and GDM care for a group of women attending a large diabetes pregnancy unit in southeast London, UK, in order to improve care.

Methods

Framework analysis was used to support an integrated analysis of data from six focus groups with 35 women and semi-structured interviews with 15 women, held in 2015. Participants were purposively sampled and were representative of the population being studied in terms of ethnicity, age, deprivation score and body mass index (BMI).

Results

We identified seven themes: the disrupted pregnancy, projected anxiety, reproductive asceticism, women as baby machines, perceived stigma, lack of shared understanding and postpartum abandonment. These themes highlight the often distressing experience of GDM. While most women were grateful for the intensive support they received during pregnancy, the costs to their personal autonomy were high. Women described feeling valued solely as a means to produce a healthy infant, and felt chastised if they failed to adhere to the behaviours required to achieve this. This sometimes had an enduring impact to the potential detriment of women’s long-term psychological and physical health.

Conclusions

This study reveals the experiences of a demographically diverse group of patients with GDM, reflecting findings from previous studies globally and extending analysis to the context of improving care. Healthcare delivery may need to be reoriented to improve the pregnancy experience and help ensure women are engaged and attentive to their own health, particularly after birth, without compromising clinical pregnancy outcomes. Areas for consideration in GDM healthcare include: improved management of emotional responses to GDM; a more motivational approach; rethinking the medicalisation of care; and improved postpartum care.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1657-9) contains supplementary material, which is available to authorized users.

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial

PURPOSE

To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand.

METHOD

A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES).

RESULTS

There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36).

CONCLUSIONS

Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants.

IMPLICATIONS FOR REHABILITATION

Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

Tooth wear, body mass index and management options for edentulous black flying-foxes (Pteropus alecto Gould) in the Townsville district, north Queensland, Australia

OBJECTIVE

We investigated the relationship between a body mass index and tooth wear in the black flying-fox (Pteropus alecto Gould) to provide guidance on management of edentulous individuals by wildlife carers and veterinarians.

METHODS

Flying-foxes brought into care because of injury were weighed, their forearms measured and the state of their teeth evaluated. Measurements were analysed by Chi-square, ANOVA, t-tests and regression to identify any relationship between the body mass index and the condition of canine and molar teeth, as well as in relation to sex and season.

RESULTS

There was no statistically significant relationship between a bat's dentition state and the body mass index being used.

CONCLUSIONS

In Townsville, the black flying-fox appears to experience a rapid decline in dental condition over time. Despite this, there is little indication that loss of teeth results in a decline in body condition. We attribute this to the dominance of floral foods in the bats' diet in Townsville and a lesser importance of hard fruit that requires intact dentition for consumption. Edentulousness on its own is not sufficient reason to euthanase black flying-foxes in either Townsville or similar relatively dry localities where blossom dominates the flying-fox diet.

Perceptions among women with gestational diabetes

Women with gestational diabetes are at high risk of developing type 2 diabetes, which could be prevented or delayed by lifestyle modification. Lifestyle interventions need to take into account the specific situation of women with gestational diabetes. We aimed to gain a deeper understanding of women's experiences of gestational diabetes, their diabetes risk perceptions, and their views on type 2 diabetes prevention, to inform future lifestyle interventions. We conducted a metasynthesis that included 16 qualitative studies and identified 11 themes. Factors that require consideration when developing a type 2 diabetes prevention intervention in this population include addressing the emotional impact of gestational diabetes; providing women with clear and timely information about future diabetes risk; and offering an intervention that fits with women's multiple roles as caregivers, workers, and patients, and focuses on the health of the whole family.

Evaluation of a community pharmacy delivered oral contraception service

INTRODUCTION

In the UK half of all pregnancies are unplanned and half of teenage pregnancies terminated. Southwark and Lambeth have the highest teenage conception rates in London. In 2009, many teenage pregnancies in Southwark led to terminations. A contraception service was established where qualified pharmacists supplied oral contraception (OC) using a patient group direction (PGD). This service evaluation aimed to assess this service delivered in five community pharmacies.

METHODS

Monthly data were submitted by each pharmacy to the Primary Care Trust on consultations, pills supplied, initial or subsequent supply and client referral. For specified periods consultation time was collected and a clinical notes audit undertaken. Client satisfaction was determined using a structured questionnaire returned to the pharmacy. Mystery shoppers were employed to assess the service.

RESULTS

A total of 741 consultations were undertaken by seven pharmacists at five community pharmacies (October 2009-June 2011) with many (45.5%) occurring following emergency contraception supply. The mean consultation time was 19&emsp14;minutes . Combined OC was most commonly supplied with nearly half (46.1%) of initial supplies to first-time pill users. Most consultations (92.2%) were with women aged under 30 years, with 22.5% aged under 20. Most consultations were with black or black British clients. Of the 99 women who completed the satisfaction questionnaires, most clients were very satisfied or satisfied with the service and felt comfortable talking to the pharmacist about contraception.

CONCLUSIONS

Trained pharmacists were clinically competent and provided OC in community pharmacy according to a PGD. This service was accessed by the target population; young women using emergency hormonal contraception who had not previously used OC. Clients were largely very satisfied with the service.

Search for doubly charged Higgs boson pair production in pp¯ collisions at √s=1.96 TeV

We present a search for pair production of doubly charged Higgs bosons in the processes qq¯→H(++)H(--) decaying through H(±±)→τ(±)τ(±),μ(±)τ(±),μ(±)μ(±). The search is performed in pp¯ collisions at a center-of-mass energy of √s = 1.96 TeV using an integrated luminosity of up to 7.0 fb(-1) collected by the D0 experiment at the Fermilab Tevatron Collider. The results are used to set 95% C.L. limits on the pair production cross section of doubly charged Higgs bosons and on their mass for different H(±±) branching fractions. Models predicting different H(±±) decays are investigated. Assuming B(H(±±)→τ(±)τ(±))=1 yields an observed (expected) lower limit on the mass of a left-handed H(L)(±±) boson of 128 (116) GeV and assuming B(H(±±)→μ(±)τ(±))=1 the corresponding limits are 144 (149) GeV. In a model with B(H(±±)→τ(±)τ(±))=B(H(±±)→μ(±)τ(±))=B(H(±±)→μ(±)μ(±))=1/3, we obtain M(H(L)(±±))>130 (138) GeV.

Wγ production and limits on anomalous WWγ couplings in pp collisions at sqrt[s] = 1.96 TeV

We measure the cross section and the difference in rapidities between photons and charged leptons for inclusive W(→lν) + γ production in eγ and μγ final states. Using data corresponding to an integrated luminosity of 4.2  fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider, the measured cross section times branching fraction for the process pp → Wγ + X → lνγ + X and the distribution of the charge-signed photon-lepton rapidity difference are found to be in agreement with the standard model. These results provide the most stringent limits on anomalous WWγ couplings for data from hadron colliders: -0.4<Δκ(γ)<0.4 and -0.08<λ(γ)<0.07 at the 95% C.L.

Search for a fermiophobic and standard model Higgs boson in diphoton final states

We present a search for the standard model Higgs boson and a fermiophobic Higgs boson in the diphoton final states based on 8.2  fb(-1) of pp collisions at sqrt[s]=1.96  TeV collected with the D0 detector at the Fermilab Tevatron Collider. No excess of data above background predictions is observed and upper limits at the 95% C.L. on the cross section multiplied by the branching fraction are set which are the most restrictive to date. A fermiophobic Higgs boson with a mass below 112.9 GeV is excluded at the 95% C.L.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs produced in association with b quarks in pp collisions at √s = 1.96 TeV

We report results from a search for neutral Higgs bosons produced in association with b quarks using data recorded by the D0 experiment at the Fermilab Tevatron Collider and corresponding to an integrated luminosity of 7.3 fb(-1). This production mode can be enhanced in several extensions of the standard model (SM) such as in its minimal supersymmetric extension (MSSM) at high tanβ. We search for Higgs bosons decaying to tau pairs with one tau decaying to a muon and neutrinos and the other to hadrons. The data are found to be consistent with SM expectations, and we set upper limits on the cross section times branching ratio in the Higgs boson mass range from 90 to 320 GeV/c(2). We interpret our result in the MSSM parameter space, excluding tanβ values down to 25 for Higgs boson masses below 170 GeV/c(2).

Precision measurement of the ratio B(t→Wb)/B(t→Wq) and extraction of V(tb)

We present a measurement of the ratio of top quark branching fractions R=B(t→Wb)/B(t→Wq), where q can be a d, s, or b quark, in the lepton+jets and dilepton tt final states. The measurement uses data from 5.4 fb(-1) of pp collisions collected with the D0 detector at the Fermilab Tevatron Collider. We measure R=0.90±0.04, and we extract the Cabibbo-Kobayashi-Maskawa (CKM) matrix element |V(tb)| as |V(tb)|=0.95±0.02, assuming unitarity of the 3×3 CKM matrix.

Search for a fourth generation t' Quark in p ̄p collisions at √s = 1.96 TeV

We present a search for pair production of a fourth generation t' quark and its antiparticle, followed by their decays to a W boson and a jet, based on an integrated luminosity of 5.3 fb(-1) of proton-antiproton collisions at √s = 1.96  TeV collected by the D0 Collaboration at the Fermilab Tevatron Collider. We set upper limits on the t' ̄t' production cross section that exclude at the 95% C.L. a t' quark that decays exclusively to W+jet with a mass below 285 GeV. We observe a small excess in the μ+jets channel which reduces the mass range excluded compared to the expected limit of 320 GeV in the absence of a signal.

Precise measurement of the top quark mass in the dilepton channel at D0

We measure the top quark mass (m(t)) in p ̄p collisions at a center of mass energy √s = 1.96 TeV using dilepton t ̄t→W(+)bW(-) ̄b→ℓ(+)ν(ℓ)bℓ(-) ̄ν(ℓ) ̄b events, where ℓ denotes an electron, a muon, or a tau that decays leptonically. The data correspond to an integrated luminosity of 5.4 fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider. We obtain m(t)=174.0±1.8(stat)±2.4(syst) GeV, which is in agreement with the current world average m(t)=173.3±1.1 GeV. This is currently the most precise measurement of m(t) in the dilepton channel.

Measurement of spin correlation in tt production using a matrix element approach

We determine the fraction of tt events with spin correlation, assuming that the spin of the top quark is either correlated with the spin of the top antiquark as predicted by the standard model or is uncorrelated. For the first time we use a matrix-element-based approach to study tt spin correlation. We use tt → W+ b W- b → ℓ+ νbℓ- ν b final states produced in pp collisions at a center-of-mass energy sqrt(s)=1.96  TeV, where ℓ denotes an electron or a muon. The data correspond to an integrated luminosity of 5.4  fb(-1) and were collected with the D0 detector at the Fermilab Tevatron collider. The result agrees with the standard model prediction. We exclude the hypothesis that the spins of the tt are uncorrelated at the 97.7% C.L.

Search for Resonant WW and WZ Production in pp collisions at √s=1.96 TeV

We search for resonant WW or WZ production by using up to 5.4 fb(-1) of integrated luminosity collected by the D0 experiment in run II of the Fermilab Tevatron Collider. The data are consistent with the standard model background expectation, and we set limits on a resonance mass by using the sequential standard model W' boson and the Randall-Sundrum model graviton G as benchmarks. We exclude a sequential standard model W' boson in the mass range 180-690 GeV and a Randall-Sundrum graviton in the range 300-754 GeV at 95% C.L.

Bounds on an anomalous dijet resonance in W+jets production in pp collisions at √s = 1.96 TeV

We present a study of the dijet invariant mass spectrum in events with two jets produced in association with a W boson in data corresponding to an integrated luminosity of 4.3 fb(-1) collected with the D0 detector at √s = 1.96 TeV. We find no evidence for anomalous resonant dijet production and derive upper limits on the production cross section of an anomalous dijet resonance recently reported by the CDF Collaboration, investigating the range of dijet invariant mass from 110 to 170 GeV/c(2). The probability of the D0 data being consistent with the presence of a dijet resonance with 4 pb production cross section at 145 GeV/c(2) is 8×10(-6).

Search for the standard model Higgs boson in the H→WW→lνq'q decay channel

We present a search for the standard model Higgs boson (H) in pp collisions at sqrt(s)=1.96  TeV in events containing a charged lepton (ℓ), missing transverse energy, and at least two jets, using 5.4  fb(-1) of integrated luminosity recorded with the D0 detector at the Fermilab Tevatron Collider. This analysis is sensitive primarily to Higgs bosons produced through the fusion of two gluons or two electroweak bosons, with subsequent decay H→WW→ℓνq'q, where ℓ is an electron or muon. The search is also sensitive to contributions from other production channels, such as WH→ℓνbb. In the absence of a signal, we set limits at the 95% C.L. on the cross section for H production σ(pp→H+X) in these final states. For a mass of M(H)=160  GeV, the limit is a factor of 3.9 larger than the cross section in the standard model and consistent with an a priori expected sensitivity of 5.0.

Abstract 1573: Early angiogenic switch-associated markers in pancreatic cancer development and progression

Background: There are no warning signs or accurate, noninvasive ways to detect pancreatic cancer (Pc) at early stages. The survival rate at 5 year for patients with Pc is less than 5 percent, and complete remission is rare. Current therapies are inadequate, necessitates development of better diagnostic markers and therapies. Angiogenesis is the process by which tumor cells develop blood supply necessary for their growth and development. Studies have reported an angiogenic switch (AS), a shift of balance occurs between pro-angiogenic and angiogenic state, and is considered a hallmark of cancer progression. Vascular endothelial growth factor (VEGF), the most potent endothelial cell mitogen, is the target for numerous biologic therapies in Pc and other malignancies. We analyzed the expression and sub-cellular localization of VEGF and its receptors1&2, neuropilin (NP-1), matrix mettaloproteinases (MMP) 2 & 9 and epidermal growth factor receptor (EGFR) in pancreatic tumor tissues and serum from 1) a transgenic mouse model of pancreatic ductal adenocarcinoma (PDA) and 2) from a cohort of 80 human Pc patients at various stages of Pc along suitably matched control. Methods: Immunohistochemistry and immunofluorescence staining and quantification of sub-cellular protein expression using ImageJ were performed in tissue samples from PDA mouse and human. Tumor area was distinguished from stroma by tumor “mask,” and sub-cellular locales using DAPI and cytokeratin stains. Scores for the target (i.e. VEGF) were then generated that corresponded to average signal intensity divided by locale area. ELISA and bio-plex cytokine arrays were performed to analyze the serum samples. Statistical analyses were performed using SAS version 9.2. Results: VEGF and other proteins were stained predominantly in the membrane / cytoplasm compartment of malignant epithelium and were over expressed in tumors versus adjacent stroma. Normal epithelium showed lower expression. MMPs specifically MMP-9 showed higher expression at earlier stages of Pc development whereas others showed consistent positive correlation with progression of disease. Using total expression within the tumor, high expressers consistently correlated with worse outcomes and decreased overall survival. These data have been confirmed by serum analyses. Conclusions: VEGF, NP-1, MMP 2 & 9, and EGFR were expressed at varying degrees in Pc and were higher in tumors versus stroma. Higher expression of MMP 2 & 9 showed correlation with earlier stage of Pc development. Further studies of the functional significance of these findings are warranted. The prognostic value of these candidate biomarkers within the tumor microenvironment may facilitate the development of a much needed early stage biomarker and a potential therapeutic target for Pc.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1573. doi:10.1158/1538-7445.AM2011-1573