Consulting communities on feedback of genetic findings in international health research: sharing sickle cell disease and carrier information in coastal Kenya.

Background: International health research in malaria-endemic settings may include screening for sickle cell disease, given the relationship between this important genetic condition and resistance to malaria, generating questions about whether and how findings should be disclosed. The literature on disclosing genetic findings in the context of research highlights the role of community consultation in understanding and balancing ethically important issues from participants' perspectives, including social forms of benefit and harm, and the influence of access to care. To inform research practice locally, and contribute to policy more widely, this study aimed to explore the views of local residents in Kilifi County in coastal Kenya on how researchers should manage study-generated information on sickle cell disease and carrier status.

Managing misaligned paternity findings in research including sickle cell disease screening in Kenya: 'consulting communities' to inform policy.

The management of misaligned paternity findings raises important controversy worldwide. It has mainly, however, been discussed in the context of high-income countries. Genetic and genomics research, with the potential to show misaligned paternity, are becoming increasingly common in Africa.

Total or Partial Knee Arthroplasty Trial - TOPKAT: study protocol for a randomised controlled trial.

Background: In the majority of patients with osteoarthritis of the knee the disease originates in the medial compartment. There are two fundamentally different approaches to knee replacement for patients with unicompartmental disease: some surgeons feel that it is always best to replace both the knee compartments with a total knee replacement (TKR); whereas others feel it is best to replace just the damaged component of the knee using a partial or unicompartment replacement (UKR). Both interventions are established and well-documented procedures.

Blood pressure and the contractility of a human leg muscle.

These studies investigate the relationships between perfusion pressure, force output and pressor responses for the contracting human tibialis anterior muscle. Eight healthy adults were studied. Changing the height of tibialis anterior relative to the heart was used to control local perfusion pressure.

Force-controlled balance perturbations associated with falls in older people: a prospective cohort study.

Balance recovery from an unpredictable postural perturbation can be a challenging task for many older people and poor recovery could contribute to their risk of falls. This study examined associations between responses to unpredictable perturbations and fall risk in older people. 242 older adults (80.

Monitoring and assessment of surface water acidification following rewetting of oxidised acid sulfate soils.

Large-scale exposure of acid sulfate soils during a hydrological drought in the Lower Lakes of South Australia resulted in acidification of surface water in several locations. Our aim was to describe the techniques used to monitor, assess and manage these acidification events using a field and laboratory dataset (n = 1,208) of acidic to circum-neutral pH water samples. The median pH of the acidified (pH < 6.

The Stroke Impact Scale: validation in a UK setting and development of a SIS short form and SIS index.

Background And Purpose: The Stroke Impact Scale (SIS) covers 8 dimensions and a composite disability score. This study evaluates the SIS in the UK context, and develops a single index and an 8-item short form.

Methods: Patients with a diagnosis of stroke were recruited through general practices in London and the North-West of England.

The galvanic whole-body sway response in health and disease.

Objective: To explore the galvanic-evoked vestibulospinal reflex in health and disease.

Methods: Vestibular-evoked whole-body movement was measured in 60 controls and eight patients with bilateral vestibular impairment, using 1mA × 2s Galvanic Vestibular Stimulation (GVS). The displacement (s) and velocity (v) of 7 markers placed on the head, neck, shoulders, mid-thorax and hips and ground reaction forces (F) were recorded.

Cost-minimisation analysis of subcutaneous methotrexate versus biologic therapy for the treatment of patients with rheumatoid arthritis who have had an insufficient response or intolerance to oral methotrexate.

This study aims to model the economic impact of subcutaneous methotrexate (SC MTX) or a biologic over a 12-month period using a hypothetical population of rheumatoid arthritis patients who failed to tolerate or respond to oral MTX and were suitable candidates for biologic therapy. A decision-based model was developed using current National Institute for Health and Clinical Excellence (NICE) guidance to determine the management of this hypothetical UK population. Published data on the continuation rates of SC MTX and biologics were used to compare the costs of the two treatment options.

Carer quality of life and experiences of health services: a cross-sectional survey across three neurological conditions.

Background: Neurological conditions have a substantial impact on carers, with carer well-being having been shown to be influenced by a number of demographic, patient and caregiving factors. Support given to carers can lead to better coping. This study investigated the relationship between carer well-being and experiences with health and social services.

Five-year results of a randomised controlled trial comparing mobile and fixed bearings in total knee replacement.

There is conflicting evidence about the merits of mobile bearings in total knee replacement, partly because most randomised controlled trials (RCTs) have not been adequately powered. We report the results of a multicentre RCT of mobile versus fixed bearings. This was part of the knee arthroplasty trial (KAT), where 539 patients were randomly allocated to mobile or fixed bearings and analysed on an intention-to-treat basis.

Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis.

Purpose: The purpose of this paper was to examine if pain and functioning can be distinguished in the Oxford Knee Score (OKS) in a meaningful way. This was done by (1) conducting exploratory factor analysis to explore the factorial structure of the OKS and (2) conducting confirmatory factor analysis to examine whether a two-factor solution is superior to a one-factor solution.

Methods: Secondary data analysis of four independent datasets containing OKS scores on 161,973 patients was performed.

Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial.

Objective: To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment.

Design: Economic evaluation nested in a pragmatic, cluster randomised controlled trial.

Setting: Community based telehealth intervention in three local authority areas in England.

A structured review of patient-reported outcome measures for patients with skin cancer, 2013.

Background: The collection of patient-reported outcome measures (PROMs) within the national PROMs programme for elective procedures is now established mandatory practice in the NHS with high response rates and completion.

Objectives: This review examines the evidence of PROMs for people with skin cancer.

Methods: Comprehensive searches were conducted using several sources and databases, using a detailed search strategy developed by the University of Oxford's PROM Group.

Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial.

Objective: To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.

Design: A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care.

Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial.

Objective: to assess the impact of telecare on the use of social and health care. Part of the evaluation of the Whole Systems Demonstrator trial.

Participants And Setting: a total of 2,600 people with social care needs were recruited from 217 general practices in three areas in England.

Patients' experiences of health and social care in long-term neurological conditions in England: a cross-sectional survey.

Objectives: To investigate patients' experiences of health and social care services in long-term neurological conditions in England.

Method: Cross-sectional survey of 5209 patient members of the Motor Neurone Disease Association (MND, n = 890), Multiple Sclerosis Society (MS, n = 2345) or Parkinson's UK (PD, n = 1974). A questionnaire on patient experiences of health and social care was completed by 2563 (49%) (505 MND, 1157 MS and 901 PD).

Factors influencing quality of life in caregivers of people with Parkinson's disease and implications for clinical guidelines.

The quality of life (QoL) of informal caregivers can be adversely affected by a number of factors. This issue, however, has not been well explored for carers of people with Parkinson's (PwP), with research largely restricted to the assessment of caregiver burden and caregiver strain. This study aims to determine the main influences on carer QoL in this population and consider results in the context of current clinical guidelines for the management of Parkinson's disease (PD).

A comparison of the seasonal movements of tiger sharks and green turtles provides insight into their predator-prey relationship.

During the reproductive season, sea turtles use a restricted area in the vicinity of their nesting beaches, making them vulnerable to predation. At Raine Island (Australia), the highest density green turtle Chelonia mydas rookery in the world, tiger sharks Galeocerdo cuvier have been observed to feed on green turtles, and it has been suggested that they may specialise on such air-breathing prey. However there is little information with which to examine this hypothesis.

Treatment of melasma with the 1,927-nm fractional thulium fiber laser: a retrospective analysis of 20 cases with long-term follow-up.

Background: Melasma is a common acquired symmetrical hyperpigmentation that is often recurrent and refractory.

Objectives: To investigate the efficacy and safety of a single administration of high-density fractional thulium fiber laser (1,927 nm) for the treatment of refractory melasma in 20 patients.

Materials And Methods: A retrospective chart and photographs review of 20 women (Fitzpatrick skin type II-IV) with clinical diagnosis of melasma treated with the 1,927-nm fractionated thulium laser at 10 or 20 mJ/cm(2) , with 60-70% surface area coverage.

The PDQ-Carer: development and validation of a summary index score.

Introduction: The PDQ-Carer is a 29 item measure of health related quality of life for use with carers of people with Parkinson's disease. The original development of the instrument identified four domains. This study examined the possibility that the four domains could reasonably be summed to provide a single summary index score.

Women's experience of transfer from midwifery unit to hospital obstetric unit during labour: a qualitative interview study.

Background: Midwifery units offer care to women with straightforward pregnancies, but unforeseen complications can arise during labour or soon after birth, necessitating transfer to a hospital obstetric unit. In England, 21% of women planning birth in freestanding midwifery units are transferred; in alongside units, the transfer rate is 26%. There is little high quality contemporary evidence on women's experience of transfer.

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator.

Background: To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare).

Methods: Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review.

Laser treatment of scars.

Recent advances in optical technologies have produced laser systems capable of optimizing the appearance of scars from various etiologies. Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Optimal results can now be attained with minimal down time.