Heparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial.

Background: Anticoagulant therapy might reduce the number of miscarriages and adverse pregnancy outcomes in women with recurrent pregnancy loss and inherited thrombophilia. We aimed to assess use of low-molecular-weight heparin (LMWH) versus standard care in this population.

Methods: The ALIFE2 trial was an international open-label, randomised controlled trial undertaken in hospitals in the UK (n=26), the Netherlands (n=10), the USA (n=2), Belgium (n=1), and Slovenia (n=1).

Reducing Opioid Use for Chronic Pain With a Group-Based Intervention: A Randomized Clinical Trial.

Importance: Opioid use for chronic nonmalignant pain can be harmful.

Objective: To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care.

Design, Setting, And Participants: Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain.

Role of immunosuppression in an antibiotic stewardship intervention and its association with clinical outcomes and antibiotic use: protocol for an observational study (RISC-sepsis).

Introduction: Sepsis is characterised by a dysregulated immune response to infection, with exaggerated pro-inflammatory and anti-inflammatory responses. A predominant immunosuppressive profile affecting both innate and adaptive immune responses is associated with increased hospital-acquired infection and reduced infection-free survival. While hospital-acquired infection leads to additional antibiotic use, the role of the immunosuppressive phenotype in guiding complex decisions, such as those affecting antibiotic stewardship, is uncertain.

Induction of labour for predicted macrosomia: study protocol for the 'Big Baby' randomised controlled trial.

Introduction: Large-for-gestational age (LGA) fetuses have an increased risk of shoulder dystocia. This can lead to adverse neonatal outcomes and death. Early induction of labour in women with a fetus suspected to be macrosomic may mitigate the risk of shoulder dystocia.

Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT.

Background: Upper limb problems are common after breast cancer treatment.

Objectives: To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery.

Design: This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1).

Mechanical versus manual chest compressions in the treatment of in-hospital cardiac arrest patients in a non-shockable rhythm: A multi-centre feasibility randomised controlled trial (COMPRESS-RCT).

Background: Mechanical chest compression devices deliver high-quality chest compressions. Early data suggests that mechanical devices may be superior to manual chest compressions in adults following an in-hospital cardiac arrest patients. To determine the feasibility of undertaking an effectiveness trial in this population, we undertook a feasibility randomised controlled trial.

Supervised pulmonary hypertension exercise rehabilitation (SPHERe): study protocol for a multi-centre randomised controlled trial.

Background: Supervised cardio-pulmonary rehabilitation may be safe and beneficial for people with pulmonary hypertension (PH) in groups 1 (pulmonary arterial hypertension) and 4 (chronic thromboembolic disease), particularly as a hospital in-patient. It has not been tested in the most common PH groups; 2 (left heart disease), 3 (lung disease), or 5 (other disorders). Further it has not been evaluated in the UK National Health Service (NHS) out-patient setting, or with long-term follow-up.

Testing a support programme for opioid reduction for people with chronic non-malignant pain: the I-WOTCH randomised controlled trial protocol.

Introduction: Chronic non-malignant pain has a major impact on the well-being, mood and productivity of those affected. Opioids are increasingly prescribed to manage this type of pain, but with a risk of other disabling symptoms, when their effectiveness has been questioned. This trial is designed to implement and evaluate a patient-centred intervention targeting withdrawal of strong opioids in people with chronic pain.

What do people talk about during reflexology? Analysis of worries and concerns expressed during sessions for patients with multiple sclerosis.

Background: Our previous study evaluated the use of reflexology compared to progressive muscular relaxation in improving the psychological and physical profile associated with multiple sclerosis. In this paper audiotapes from the reflexology sessions have been analysed to give a picture of the nature of interaction between patients and therapists during treatment.

Methods: A crossover design with two groups was chosen.

Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial.

Purpose: To compare the effects of reflexology and progressive muscle relaxation training for people with multiple sclerosis, provided by nurse therapists, on psychological and physical outcomes.

Methods: A crossover design was chosen with a 4-week break between treatment phases. The Short Form 36 and General Health Questionnaire 28 were completed by patients (n=50) pre and post each of the 6-week treatment phases.

A trial of empowerment-based education in type 2 diabetes--global rather than glycaemic benefits.

We have assessed the effect of a structured, empowerment-based educational system ("LAY or "Look After Yourself") for patients with type 2 diabetes. A randomised controlled trial (RCT) was conducted, testing the system against standard support. Using 3 centres, 89 patients participated in the study.

Information needs and decision-making preferences: comparing findings for gynaecological, breast and colorectal cancer.

This study examined information needs and decision-making preferences for women with gynaecological cancers (n=53) using structured interviews and compared findings to previous work involving breast and colorectal cancer patients. Measures of information needs (Information Needs Questionnaire) and decision-making preferences (Control Preferences Scale) were administered to women with gynaecological cancers, consistent with measures previously administered to breast (n=150) and colorectal (n=42) cancer patients. Therefore, statistical comparisons could be made across study groups.

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer.

Background: Life course research methodologies are used extensively in historical and social science research. In 1998 the life course paradigm was introduced to provide a way of tracing the interplay of person and setting. The method has had a very limited use in nursing research, but in this study it was utilized as a way of capturing dynamic change by placing the individual within a context of four domains; location in time and place, linked lives, human agency and timing of lives.

Obesogenic influences in public housing: a mixed-method analysis.

Background: Obesity prevalence is higher among those who live in impoverished environments. This investigation identified obesogenic factors in urban neighborhoods surrounding public housing developments (HDs).

Design: Cross-sectional quantitative survey data from 14 HD neighborhoods and qualitative interviews of the HD managers.

The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods.

Background: Neighborhood environment factors may influence physical activity (PA). The purpose of this study was to develop and test a brief instrument to systematically document and describe the type, features, amenities, quality and incivilities of a variety of PA resources.

Method: The one-page Physical Activity Resource Assessment (PARA) instrument was developed to assess all publicly available PA resources in thirteen urban lower income, high ethnic minority concentration neighborhoods that surrounded public housing developments (HDs) and four higher income, low ethnic minority concentration comparison neighborhoods.

Obesity and the built environment.

Biological, psychological, behavioral, and social factors are unable to fully explain or curtail the obesity epidemic. In this article we review research on the influence of the built environment on obesity. Studies were evaluated with regard to their methods of assessing the environment and obesity, as well as to their effects.

Women's experiences of information, psychological distress and worry after treatment for gynaecological cancer.

Sensitive, appropriate patient information is considered to be an important element in the psychological support of patients. Specialist nurses are seen to have a key responsibility for this work. With regard to gynaecological cancer, evidence suggests that women do not get optimum psychological care.

Using combined research methods for exploring diabetes patient education.

This paper explores a trial of an educational intervention designed for people who have Type 2 diabetes. The aim of the trial was to understand how the intervention had influenced outcomes in the context of participants' everyday lives. A randomised-controlled wait-list trial design was used.

Macmillan cancer and palliative care specialists: their practice development support needs.

This study explores the practice development support needs of specialist nurses working in cancer and palliative care, in order to assist in the improvement of cancer and palliative care services. Using a whole population survey, postal questionnaires were sent to 1144 Macmillan post holders in England, Scotland and Wales. There was a 75.

A Prospective Comparison Study of Different Methods of Gathering Self-Reported Family History Information for Breast Cancer Risk Assessment.

Currently there is much debate regarding the ability of mathematical models incorporating epidemiological information or mutation-based risk algorithms to accurately predict a woman's risk of developing breast cancer. Without access to accurate family history information these models have limited use. This study compares different methods of gathering family history information and the impact on subsequent risk assessment.

Patients' perceptions of what makes genetic counselling effective: an interpretative phenomenological analysis.

Little is known about what makes for effective genetic counselling. Helping counselees adjust to their genetic situation is highlighted as a goal in most definitions of genetic counselling, but the processes involved in this are less clear. The current investigation focused on counselees' perceptions of their genetic consultation as a possible influence on adjustment.

Professional support within hospices.

During a prospective study in two hospices, 41 nurses were interviewed about recent critical incidents at work. Questionnaires based on the work of House (1985) were used to measure their perceptions of professional support. At each interview, nurses detailed an average of four recent occasions when work-related support had been received.