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Background: Sheep scab, caused by the highly infectious Psoroptes ovis mite, is considered to be endemic in Northern Ireland, although little investigation has been reported. A pilot project was undertaken to engage farmers, confirm cases with diagnostic methods and identify specific barriers to control, with the aim of informing future control programmes., Methods: Through farmers self-reporting suspected outbreaks, on-farm risk assessments and clinical investigations were carried out by the farm's veterinary surgeon, who utilised light microscopy and serological testing to diagnose scab. Treatment was then provided and where macrocyclic lactones (MLs) were utilised, follow-up testing was attempted., Results: Sheep scab was identified in 60 flocks across all six counties of Northern Ireland. Serological testing proved essential in uncovering scab infestation where light microscopy failed to identify mites, or where no suitable lesions existed to scrape. Where MLs were used, follow-up was incomplete. Furthermore, four of six resampled flocks still showed a positive result. Barriers to better scab control included poor quarantine arrangements and preventative treatment strategies that ultimately proved ineffective., Conclusions: The project demonstrated that farmers were willing to engage in control efforts, they appreciated the support provided in managing outbreaks and they recognised the need for a coordinated effort to control scab. Greater awareness of biosecurity is needed among farmers. Facilitation of farmer-driven scab control activities is urgently needed, alongside greater understanding of the scale of the disease and the impact that ML treatment failure can have on scab dissemination through the national Northern Ireland flock., Competing Interests: The authors declare they have no conflicts of interest., (© 2024 The Author(s). Veterinary Record Open published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Purpose of Review: Genetic testing has become an integral component of clinical care when an inherited condition is suspected. However, the interpretation of variants identified with this testing can be nuanced. Variants of uncertain significance (VUS) are variants for which there is not enough data currently available to determine if the variant is causal for disease (i.e. pathogenic) or is benign. VUS can exist on a spectrum with some leaning towards suspected pathogenicity and others leaning towards likely benign. Clinician understanding of variant interpretation can improve clinical care by providing more context around how suspicious a VUS is, determining whether additional steps should be taken to further evaluate the variant in question, and ensuring patient understanding of these results., Recent Findings: Research on this topic highlights the complexities around VUS interpretation and counseling. VUS are not static: interpretations of pathogenicity change as new information is uncovered., Summary: This review aims to summarize this literature and provide insight into variant interpretation, practical steps clinicians can take to further assess a VUS, and considerations when counseling patients on these results., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Evaluating research activity in research departments and education programs is conventionally accomplished through measurement of research funding or bibliometrics. This limited perspective of research activity restricts a more comprehensive evaluation of a program's actual research capacity, ultimately hindering efforts to enhance and expand it. The objective of this study was to conduct a scoping review of the existing literature pertaining to the measurement of research productivity in research institutions. Using these findings, the study aimed to create a standardized research measurement tool, the Productivity And Capacity Evaluation in Research (PACER) Tool. The evidence review identified 726 relevant articles in a literature search of PubMed, Web of Science, Embase, ERIC, CINAHL, and Google Scholar with the keywords "research capacity" and "research productivity." Thirty-nine English-language studies applicable to research measurement were assessed in full and 20 were included in the data extraction. Capacity/productivity metrics were identified, and the relevance of each metric was data-charted according to 3 criteria: the metric was objective, organizational in scale, and applicable to varied research domains. This produced 42 research capacity/productivity metrics that fell into 7 relevant categories: bibliometrics, impact, ongoing research, collaboration activities, funding, personnel, and education/academics. With the expertise of a Delphi panel of researchers, research leaders, and organizational leadership, 31 of these 42 metrics were included in the final PACER Tool. This multifaceted tool enables research departments to benchmark research capacity and research productivity against other programs, monitor capacity development over time, and provide valuable strategic insights for decisions such as resource allocation., Competing Interests: Conflict of interest: The authors report no financial conflicts of interest., (© Copyright by the American Board of Family Medicine.)

Background: Primary care clinicians play a critical role in diagnosis and treatment of migraine, yet barriers exist. This national survey assessed barriers to diagnosis and treatment of migraine, preferred approaches to receiving migraine education, and familiarity with recent therapeutic innovations., Methods: The survey was created by the American Academy of Family Physicians (AAFP) and Eli Lilly and Company and distributed to a national sample through the AAFP National Research Network and affiliated PBRNs from mid-April through the end of May 2021. Initial analyses were descriptive statistics, ANOVAs, and Chi-Square tests. Individual and multivariate models were completed for: adult patients seen in a week; respondent years since residency; and adult patients with migraine seen in a week., Results: Respondents who saw fewer patients were more likely to indicate unclear patient histories were a barrier to diagnosing. Respondents who saw more patients with migraine were more likely to indicate the priority of other comorbidities and insufficient time were barriers to diagnosing. Respondents who had been out of residency longer were more likely to change a treatment plan due to attack impact, quality of life, and medication cost. Respondents who had been out of residency shorter were more likely to prefer to learn from migraine/headache research scientists and use paper headache diaries., Conclusions: Results demonstrate differences in familiarity with migraine diagnosis and treatment options based on patients seen and years since residency. To maximise appropriate diagnosis within primary care, targeted efforts to increase familiarity and decrease barriers to migraine care should be implemented., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Stewardship of antibiotics used in livestock production has come under increasing scrutiny, from both the animal welfare point of view and due to concerns that antibiotic use in livestock may pose a risk to human health through selection pressure to drive development of antibiotic resistant strains of bacteria. Despite this concern, however, antibiotic consumption in the sheep sector is currently poorly described. This study determines the range and quantities of antibiotics used in the Northern Irish (NI) sheep flock as well as exploring drivers for their use. A mixed-methods approach was utilised, with an anonymous online scoping survey, analysis of the medicine records from 52 NI sheep farms and semi-structured interviews undertaken with 27 farmers. Eighteen farmers contributed both records and participated in interviews. Veterinary medicine records were derived from two sources: on-farm medicine books (seven) or veterinary practice sales data (51). As six of these farmers provided information from both sources a total of 52 unique farms participated. Overall, antibiotic use in sheep on the 52 farms sampled was low, with a median value of 11.35 mgPCU -1 (mean 13.63 mgPCU -1 , sd 10.7; range 0-45.29 mgPCU -1 ), with all farms below 50 mgkg -1 . Critically important antibiotics accounted for 0.21% of all antibiotics purchased. Lameness was the main driver of antibiotic use identified by this study. Others included a range of prophylactic treatments such as oral antibiotics to prevent watery mouth, injectable antibiotics to prevent abortion and following assisted lambing. Farmers acknowledged some of these uses had become habitual over time. The veterinary medicine sales records demonstrated significant sales of antibiotics not authorised for use in sheep, on an ongoing, rather than case-by-case, basis. Farmers were positive about their veterinarian's ability and knowledge to improve flock welfare and productivity, but were unwilling to pay for this advice. However, veterinarians may have facilitated weak medicine stewardship through a failure to adequately challenge farmers seeking antibiotics. Farmers did not maintain accurate or up-to-date on farm medicine or production records in the majority of cases. Despite this lack of on-farm recording, veterinary sales records can be studied in consultation with farmers to provide veterinarians with a farm-specific insight into antibiotic use and related attitudes and behaviours. Farmers and veterinarians can then identify areas and behaviours to target collaboratively, improving antibiotic and wider medicine stewardship, whilst simultaneously improving flock health and productivity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In order to improve antimicrobial stewardship (AMS), including changes in antimicrobial prescribing and use, an enhanced understanding is needed of the barriers that veterinary surgeons (vets) encounter to institute such change., Methods: A qualitative approach, using grounded theory, was followed. Interviews and discussion groups, with vets and farm industry stakeholders in Northern Ireland (NI), were undertaken to identify and explore attitudes and behaviours surrounding AMS, with a particular emphasis on the barriers vets encountered and the context within which they were working., Results: Seven inter-related themes associated with improving AMS among their sheep farming clients were identified. The first six addressed barriers were working under commercial and practical constraints, farmer behaviour, multiple medicine sources, poor prescribing practice, a perceived lack of incentive or facilitation to improve AMS and a perceived lack of action by regulators to challenge poor AMS. The seventh theme revealed suggestions vets considered that may improve AMS in NI, including greater state intervention in recording and regulating medicine sales., Conclusions: Improving AMS will require vets and their client farmers to change behaviour. This will involve concerted effort over an extended period of time to enact and embed change. Veterinary surgeons believe that further action by the industry and state to develop centralised antimicrobial sales recording and by the state to enforce prescribing regulations will aid their efforts. However, critical to achieving this is the development of a sustainable and funded mechanism to create more meaningful farmer-vet consultation around flock health prior to every prescription to improve AMS and sheep welfare., Competing Interests: The authors declare they have no conflicts of interest., (© 2024 The Authors. Veterinary Record Open published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Sheep scab, caused by infestation with the ectoparasitic mite Psoroptes ovis , is an endemic disease in the Northern Ireland (NI) sheep flock and constitutes significant economic and welfare burdens for the NI farming industry. Despite its endemic nature, historically, little research has been undertaken to support the control of the disease in NI. This study offers the first attempt to analyse the psychological and behavioural factors influencing farmers' intentions to implement effective sheep scab control measures in NI. To achieve our objective, quantitative data from a sample of 126 sheep farmers were statistically analysed using an extended theory of planned behaviour approach in an ordered logistic regression modelling framework. Our analyses showed that sheep scab remains an issue of concern in Northern Ireland. The attitudes of the farmers, as well as perceived behavioural control, emotional effect, membership of Business Development Groups (BDGs), and higher education qualifications, were found to be statistically significant factors influencing farmers' intentions to adopt sheep scab control measures. This study provides a solid foundation for how to promote behavioural changes among sheep farmers to improve their ability to implement effective disease control measures, helping to tackle this challenging disease in a more sustainable way in the future.

Background and Objective: Quantitative measures extracted from ventricular fibrillation (VF) waveform reflect the metabolic state of the myocardium and are associated with survival outcome. The quality of delivered chest compressions during cardiopulmonary resuscitation are also linked with survival. The aim of this research is to explore the viability and effectiveness of a thoracic impedance (TI) based chest compression (CC) guidance system to control CC depth within individual subjects and influence VF waveform properties., Methods: This porcine investigation includes an analysis of two protocols. CC were delivered in 2 min episodes at a constant rate of 110 CC min -1 . Subject-specific CC depth was controlled using a TI-thresholding system where CC were performed according to the amplitude (Z RMS, 0.125 to 1.250 Ω) of a band-passed TI signal (Z CC ). Protocol A was a retrospective analysis of a 12-porcine study to characterise the response of two VF waveform metrics: amplitude spectrum area (AMSA) and mean slope (MS), to varying CC quality. Protocol B was a prospective 12-porcine study to determine if changes in VF waveform metrics, due to CC quality, were associated with defibrillation outcome., Results: Protocol A: A directly proportional relationship was observed between Z RMS and CC depth applied within each subject (r = 0.90; p <0.001). A positive relationship was observed between Z RMS and both AMSA (p <0.001) and MS (p <0.001), where greater TI thresholds were associated with greater waveform metrics., Protocol B: MS was associated with return of circulation following defibrillation (odds ratio = 2.657; p = 0.043)., Conclusion: TI-thresholding was an effective way to control CC depth within-subjects. Compressions applied according to higher TI thresholds evoked an increase in AMSA and MS. The response in MS due to deeper CC resulted in a greater incidence of ROSC compared to shallow chest compressions., Competing Interests: Declaration of Competing Interest O. McAlister, A. Harvey and B. McCartney are employees of HeartSine Technologies Ltd. D. McEneaney is a medical advisor for HeartSine Technologies Ltd. The presented research was fully funded by HeartSine Technologies Ltd. within the scope of an industrially sponsored PhD program., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Management of pain is critical to improve the welfare of farmed livestock and meet consumer expectations. There is limited published information about the use of analgesic drugs in the sheep sector., Methods: A mixed-method approach was followed. The range of analgesic drugs used on 52 Northern Irish sheep farms was determined through analysis of medicine purchase records. Through interview and discussion groups, with both farmer and veterinarian participants, attitudes towards the use and adoption of such medicines were explored., Results: The use of non-steroidal anti-inflammatory drugs (NSAIDs) was widespread and highly variable. One-third of farmers in the sample did not purchase any NSAID. Meloxicam was the most commonly purchased NSAID by mass (72%) and standardised dose (73%). During interviews and discussions, farmers outlined the benefits they saw in using NSAIDs and how veterinarians influenced their uptake of these medicines. Use of corticosteroid was evidenced on 50% of the farms that supplied medicine records for analysis., Conclusions: Veterinarians can influence farmers to adopt NSAIDs for the provision of analgesia in their sheep and farmers observed the benefits they delivered. However, many farmers are still to be reached with this message, perhaps due to being largely self-sufficient and rarely engaging with veterinarians. Veterinarians have the opportunity to challenge farmers about the provision of analgesia, especially when farmers seek antibiotics for painful conditions such as lameness. Currently, the lack of an authorised product in the UK, with associated treatment guidance and industry promotion, may limit veterinarians' confidence in prescribing drugs for pain control in sheep., Competing Interests: The authors declare they have no conflicts of interest., (© 2023 The Authors. Veterinary Record Open published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Background: In 2021, the Arts and Humanities Research Council commissioned a mass-media mental health campaign called "What's up With Everyone?" Here, innovative co-created messages were professionally storied and animated by an internationally recognized production company and focused on improving mental health literacy in five core areas: competition, social media, perfectionism, loneliness and isolation, and independence., Aims: This study examines the impact of the "What's up With Everyone?" campaign on young people's mental health awareness., Methods: Seventy-one (19 males, 51 females, M age = 19.20 years, SD  = 1.66, range = 17-22) young people completed a one-sample, pre-post experiment to measure changes in knowledge, attitudes, confidence, and stigma of mental health struggles, as well as help-seeking for mental ill-health before and following exposure to animations., Results: Paired and one-sample t -tests revealed that knowledge, attitudes, confidence, and willingness to seek support improved at post-test. There were also significant reductions in the stigma towards depression following the animations., Conclusions: Continued long-term investment in campaigns such as "What's up With Everyone?" seems warranted given the impact on mental health awareness, help-seeking, and stigma.

Objective: Achilles tendinopathy is a common musculoskeletal condition associated with decreased functionality. The insertional variant (<2cm from the calcaneus) is less responsive to eccentric-exercise therapy. This study looked at the effect of electroacupuncture (EA) + eccentric exercise for treating insertional Achilles tendinopathy., Materials and Methods: Fifty-two active duty and Department of Defense beneficiaries older than 18 years of age with insertional Achilles tendinopathy were randomized to treatment with either eccentric exercise or eccentric exercise with EA. They were evaluated at 0, 2, 4, 6, and 12 weeks. The treatment group received EA treatment in the first 4 visits. The Victorian Institute of Sports Assessment-Achilles Questionnaire (VISA-A; scored 0-100; higher score = increased function) was used to assess the patients and patient-reported pain (0-10, increasing pain with score) pre- and post-demonstration of the exercises during each visit., Results: Both the treatment group (53.6% reduction; confidence interval [CI]: 2.1, 3.9; P  < 0.001) and the control group (37.5% reduction; CI: 0.4, 2.9; P  = 0.023) reported decreased pain between the first and last visit. The treatment group had reduced pain (mean difference [MD] = 1.0; P  < 0.01) between pre- and post-eccentric-exercise performance at each visit, while the control group did not (MD = -0.3; P  = 0.065). VISA-A scores did not show a difference in functional improvement between the groups ( P  = 0.296)., Conclusions: EA as an adjunct to eccentric therapy significantly improves short-term pain control for insertional Achilles tendinopathy., Competing Interests: No financial conflicts of interest exist., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Background: There is a pressing need to create resources to promote mental health literacy among young people. Digital media is one of the methods that can be used to successfully promote mental health literacy. Although digital mental health resources are generally favorably perceived by young people, one of the essential factors in whether they choose to use these interventions is trust., Objective: The objective of this study was to explore young people's trust-related concerns about and recommendations for the cocreated mental health website "What's Up With Everyone" by using TrustScapes. Our aim was to use the findings to improve the trustworthiness of the website and to inform future creators of web-based mental health resources., Methods: In total, 30 young people (mean age 19, SD 1.509; range 17-21 years) participated in TrustScapes focus groups. Thematic analysis was carried out to analyze both the TrustScapes worksheets and audio transcripts., Results: Qualitative analysis revealed that the mental health website contains elements perceived to be both trustworthy and untrustworthy by young people. The relatable and high-quality design, which was achieved by cocreating the website with a team of design professionals and young people, was considered to increase trust. Creators' credibility also positively affected trust, but the logos and other information about the creators were recommended to be more salient for users. Suggestions were made to update the privacy policy and cookie settings and include communication functions on the platform to improve the trustworthiness of the website., Conclusions: Factors perceived to be trustworthy included the website's relatable, high-quality design and creators' credibility, whereas those perceived to be untrustworthy included the privacy policy and cookie settings. The findings highlighted the significance of collaborating with end users and industrial partners and the importance of making the trust-enabling factors salient for users. We hope that these findings will inform future creators of web-based mental health resources to make these resources as trustworthy and effective as possible., (©Sachiyo Ito-Jaeger, Elvira Perez Vallejos, Saruka Logathasan, Thomas Curran, Paul Crawford. Originally published in JMIR Mental Health (https://mental.jmir.org), 09.01.2023.)

Background: Patients with mental health problems experience numerous transitions into and out of hospital., Aim: The review studies assessing clinical care pathways between psychiatric hospitalization and community health services., Methods: We used publications between 2009-2020 to allow a broad scoping review of the published research. Sixteen review-articles were identified, 12 primary studies were chosen, both on care pathways in the transition between psychiatric hospital and community., Results: Organizational issues: Systems and procedures to ensure clear responsibilities and transparency at each stage of the pathways of care., Resources: Information-technology in objectively improving patient outcome. Information/documentation: Providing patients with adequate structured information and documented plans at the appropriate time. Patient/families: Continuous collaborative decision-making. Clinical care and teamwork: Collaboration between mental health and other professionals to guarantee that planned activities meet patient need., Ethical Issues: Respectful communication and patient-centred, non-humiliating care., Conclusions: System and procedures ensure clear responsibilities and transparency. Information technology support decision-making and referral and objectively improve patient outcomes in care pathways. Collaboration between mental health and other professionals guarantee that planned activities meet patients' needs along with regular meetings sharing key information. Around-the-clock ambulant-teams important to transition success. Informed-shared decision-making between parties, support patient participation and respectful communication., (© 2022. The Author(s).)

Background: Healthcare is witnessing a new disease with the emergence of Long Covid; a condition which can result in myriad symptoms, varying in frequency and severity. As new data are emerging to help inform treatment guidelines, the perspectives of those living with Long Covid are essential in informing healthcare practice. The research aimed to collect the narratives of people living with Long Covid to better understand the lived experience of this condition. In attempting to narrate complex or traumatic experiences the arts and humanities can offer alternative ways of expressing embodied narratives, representing rich sources of meaning. Therefore, the research specifically sought to elicit creative expressions from participants with lived experience of Long Covid., Methods: Data were collected via an online repository where participants could submit their pieces of creative writing. Data were collected between August 2021 and January 2022 and a total of 28 submissions were received from participants. These were mostly written creative narratives. However, a small number were submitted as audio or video files of spoken word poetry or songs. Data collection was stopped once data saturation was achieved., Results: The submissions were subjected to thematic analysis and five themes were generated. These five themes are Identity, social relationships, symptoms, interaction with healthcare systems and time. The results provide an insight into the experience of Long Covid as detailed by the participants' creative narratives., Conclusion: The results from this study provide a unique insight into the lived experience of Long Covid. In relation to clinical practice, the results suggest that adjustment reaction and loss of sense of self could be added as common symptoms., Patient and Public Contribution: Before undertaking the research, Long Covid community groups were contacted to discuss the potential value of this study and it was widely supported. One of the leading Long Covid support groups was also involved in disseminating information regarding the project. As part of ongoing work within this project, members of the team are actively disseminating the results within Long Covid communities and seeking to develop arts-based workshops specifically for people with Long Covid., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Mental health literacy is important as it relates to understanding mental illness, increasing help-seeking efficacy, and reducing mental illness-related stigma. One method to improve the mental health literacy of young people is a digital video intervention., Aims: A scoping review was conducted to map existing research in the area of digital video interventions for mental health literacy among young people., Methods: The scoping review was conducted following the PRISMA-ScR checklist. All results were screened based on our inclusion criteria., Results: Seventeen studies were selected for analysis. In most studies ( n  = 14), a digital video was the only intervention whereas three studies took a multi-intervention approach. Only two of the digital video interventions were co-created with people with mental illness or university students. All studies showed positive results in favor of digital video interventions in at least one component of mental health literacy or compared to one of the comparison conditions., Conclusions: Digital video interventions represent effective tools for enhancing mental health literacy. However, there is a need for active involvement of end-users in co-creation and to attend to the production quality so that the digital video intervention is as relevant, informed, and effective as possible.

This article presents the development of a power loss emulation (PLE) system device to study and find ways of mitigating skin tissue heating effects in transcutaneous energy transmission systems (TETS) for existing and next generation left ventricular assist devices (LVADs). Skin thermal profile measurements were made using the PLE system prototype and also separately with a TETS in a porcine model. Subsequent data analysis and separate computer modelling studies permit understanding of the contribution of tissue blood perfusion towards cooling of the subcutaneous tissue around the electromagnetic coupling area. A 2-channel PLE system prototype and a 2-channel TETS prototype were implemented for this study. The heating effects resulting from power transmission inefficiency were investigated under varying conditions of power delivery levels for an implanted device. In the part of the study using the PLE setup, the implanted heating element was placed subcutaneously 6-8 mm below the body surface of in vivo porcine model skin. Two operating modes of transmission coupling power losses were emulated: (a) conventional continuous transmission, and (b) using our proposed pulsed transmission waveform protocols. Experimental skin tissue thermal profiles were studied for various levels of LVAD power. The heating coefficient was estimated from the porcine model measurements (an in vivo living model and a euthanised cadaver model without blood circulation at the end of the experiment). An in silico model to support data interpretation provided reliable experimental and numerical methods for effective wireless transdermal LVAD energization advanced solutions. In the separate second part of the study conducted with a separate set of pigs, a two-channel inductively coupled RF driving system implemented wireless power transfer (WPT) to a resistive LVAD model (50 Ω) to explore continuous versus pulsed RF transmission modes. The RF-transmission pulse duration ranged from 30 ms to 480 ms, and the idle time (no-transmission) from 5 s to 120 s. The results revealed that blood perfusion plays an important cooling role in reducing thermal tissue damage from TETS applications. In addition, the results analysis of the in vivo, cadaver (R1Sp2) model, and in silico studies confirmed that the tissue heating effect was significantly lower in the living model versus the cadaver model due to the presence of blood perfusion cooling effects.

Schizophrenia is the most common psychotic mental disorder, and those affected have two to four times higher mortality than the general population. Genetic and environmental factors increase the risk of developing schizophrenia, and substance use disorder (particularly cannabis) may have the strongest link. Schizophrenia typically develops in young adulthood and is characterized by the presence of positive and negative symptoms. Positive symptoms include hallucinations, delusions, and disorganized speech. Negative symptoms include blunted affect, alogia, avolition, asociality, and anhedonia. Symptoms must be present for at least six months and be severe for at least one month to make a diagnosis. Because schizophrenia is debilitating, it should be treated with antipsychotics, and early treatment decreases long-term disability. Treatment should be individualized, and monitoring for effectiveness and adverse effects is important. Patients with a first episode of psychosis who receive a formal diagnosis of schizophrenia should be treated in a coordinated specialty care program. Second-generation antipsychotics are the preferred first-line treatment because they cause fewer extrapyramidal symptoms. Patients with schizophrenia who are treated with second-generation antipsychotics are at increased risk of cardiovascular disease and should receive at least annual metabolic screening and counseling with interventions to prevent weight gain and encourage smoking cessation. Treatment-resistant schizophrenia should be treated with clozapine. Adjunctive treatments include electroconvulsive therapy, antidepressants, and cognitive behavior therapy for psychosis. Family and social support are keys to improved outcomes.

Sheep scab (psoroptic mange), which is endemic in the United Kingdom (UK) flock, has a significant, negative impact on sheep welfare. Nothing has previously been published about the distribution of sheep scab in Northern Ireland (NI), nor about Northern Irish farmers' knowledge and behaviours relating to the disease, its treatment, prevention and control. Between March and June 2021 an online questionnaire on the disease was completed by sheep farmers in NI. Forty-four respondents out of a total of 122 valid returns (36%) indicated that they had at least one outbreak of sheep scab in their flock within the previous five years. These flocks were spread throughout NI and included flocks grazing on common land. Farmers reporting sheep scab in their flock considered movements of sheep between flocks to be the main cause of flock infestation. Respondents demonstrated knowledge gaps in relation to the parasite biology, disease transmission, prevention and treatment options, as well as a lack of awareness of some of the relevant industry guidelines. We highlight that some farmers rely on clinical signs alone to rule out the possibility that newly purchased sheep are infested with sheep scab before mixing them with their flock. This activity poses a high risk for the introduction of sheep scab into previously uninfested flocks. The inadequacy of some farmers' quarantine rules, or their inability to follow them, was also reported by farmers as being the cause of their flock infestation. Sheep scab outbreaks were shown to result in significant financial cost, with some farmers reporting their most recent outbreak had cost over £2500 ($3329). The paper also highlights that in addition to the animal health and welfare impact and financial cost, sheep scab was reported to have a social cost: 94 respondents (79%) agreed that a sheep scab outbreak caused emotional stress to affected farmers. These findings have provided evidence of the widespread nature of sheep scab in the NI flock, and of the knowledge gaps and behaviours which need to be addressed to improve sheep scab control. This will require a combination of focused research, knowledge exchange between farmers, advisors, policy makers and regulators, and co-developed disease control plans at a flock and national level., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Adolescence and young adulthood are especially critical times to learn about mental health, given that 75% of mental health issues are developed by the age of 24. Animations have great potential to effectively deliver mental health information to young people. A series of five short animated films to promote mental health literacy were created with and for young people in partnership with the multi-award-winning independent animation studio, Aardman Animations. The aim of this study was to explore young people's perceptions of the cocreated animated films., Methods: Seven Youth Juries were conducted to capture young people's opinions and recommendations about the content related to mental health literacy and presentation style of the cocreated animated films. Thematic analysis was used to analyse the audio transcripts., Results: Many participants reported a view that the animated films had the potential to promote mental health literacy, especially for understanding mental health and reducing stigma. Some recommendations were provided to improve the films, such as including subtitles and having a better transition to the companion website., Conclusion: Cocreated animations have great potential to promote the mental health literacy of young people. We hope that the findings from the present study will inform future media development to make them as effective as possible., Patient or Public Contribution: Young people were actively involved in the development, production, implementation and evaluation (up to the time before data analysis) of the animated films., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Aims: To investigate the effects of a curriculum that teaches medical decision making and interpersonal communication in the context of prediabetes (preDM) and type 2 diabetes (T2DM)., Methods: This evaluation was an active-controlled trial of 56 patients, including patients who received their diagnosis from intervention-trained clinicians or a control group. Patients attended a research appointment for informed consent and collection of baseline measures. Over the following six months, both groups were mailed surveys and informational handouts monthly. Upon conclusion, we recorded the most recent A1c from the patient's record., Results: An analysis of covariance test revealed patients who received a T2DM diagnosis from an intervention-trained clinician reported higher reassurance from the diagnosing clinician and had a higher perception of threat. Although not statistically significant, patients with T2DM in the intervention group had a lower A1c at follow up and patients in the intervention group reported less poor eating and a higher degree of diet decision making., Conclusions: The curriculum itself does not influence glycemic control, but our results demonstrate the positive impact on patients of the curriculum to teach critical skills to clinicians delivering a diabetes diagnosis., (Published by Elsevier Ltd.)

Aim: Automated external defibrillators (AEDs) use various shock protocols with different characteristics when deployed in pediatric mode. The aim of this study is to assess and compare the safety and efficacy of different AED pediatric protocols using novel experimental approaches., Methods: Two defibrillation protocols (A and B) were assessed across two studies: Protocol A: escalating (50-75-90 J) defibrillation waveform with higher voltage, shorter duration and equal phase durations. Protocol B; non-escalating (50-50-50 J) defibrillation waveform with lower voltage, longer duration and unequal phase durations.Experiment 1: Isolated shock damage was assessed following shocks to 12 anesthetized pigs. Animals were randomized into two groups, receiving three shocks from Protocol A (50-75-90 J) or B (50-50-50 J). Cardiac function, cardiac troponin I (cTnI), creatine phosphokinase (CPK) and histopathology were analyzed. Experiment 2: Defibrillation safety and efficacy were assessed through shock success, ROSC, ST-segment deviation and contractility following 16 randomized shocks from protocol A or B delivered to 10 anesthetized pigs in VF., Results: Experiment 1: No clinically meaningful difference in cTnI, CPK, ST-segment deviation, ejection fraction or histopathological damage was observed following defibrillation with either protocol. No difference was observed between protocols at any timepoint. Experiment 2: all defibrillation types demonstrated shock success and ROSC ≥ 97.5%. Post-ROSC contractility was similar between protocols., Conclusions: There is no evidence that administration of clinically relevant shock sequences, without experimental confounders, result in significant myocardial damage in this model of pediatric resuscitation. Typical variations in AED pediatric mode settings do not affect defibrillation safety and efficacy., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: BM, AH, AK, SM and OM are employed by HeartSine Technologies Ltd., Stryker Belfast. PC is a consultant paid by HeartSine Technologies Ltd., Stryker Belfast. DM sits on the HeartSine Technologies Ltd., Stryker Belfast Clinical Advisory Board and is provided remuneration (modest)., (© 2022 The Author(s).)

Background: Depressive symptoms erode both physical and mental aspects of health-related quality of life (HRQoL). Social support (SS) may improve HRQoL through its direct effects or buffering effects. The association among depressive symptoms, SS, and HRQoL has been studied in specific groups, but research in the general adult population remains limited. This study examined the association among depressive symptoms, SS, and HRQoL, including exploring whether SS (including its three dimensions: subjective SS, objective SS and support utilization) mediated or moderated the relationship between depressive symptoms and HRQoL among community-based adults., Methods: We conducted a cross-sectional survey in six communities in Shanghai, China, and 1642 adult participants with complete information on depressive symptoms and/or SS, and HRQoL were included. Linear regression analysis was used to investigate the association among depressive symptoms, SS, and HRQoL. In addition, we explored the mediating and moderating role of SS in the relationship between depressive symptoms and HRQoL., Results: More depressive symptoms were associated with lower physical HRQoL (B = -0.64, p < .001) and lower mental HRQoL (B = -0.83, p < .001). SS (B = 0.07, p = .02), specifically subjective SS (B = 0.09, p = .03), was positively related to mental HRQoL. After adjusting for covariates, we found no evidence for a mediating role of SS in the relationship between depressive symptoms and HRQoL, while SS (subjective SS and objective SS) moderated the association between depressive symptoms and mental HRQoL., Limitations: Due to the low voluntary participation rate of employees, participants represented approximately 50% of the individuals approached, thus limiting the generalizability of our findings. Data collected through self-report scales could lead to information bias., Conclusions: SS does not appear to underlie the relationship between depressive symptoms and HRQoL. However, interventions to increase SS (in particular, subjective SS and objective SS) should be studied to determine whether they may be beneficial in alleviating the adverse impact of depressive symptoms on mental HRQoL., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The landscape of mental health recovery is changing; there have been calls for a shift from the clinical expertise being the dominant voice within mental healthcare towards a more personalised and collaborative service that supports those in need of mental healthcare to define what recovery is for the individual. Within this new recovery movement, there has been a recognition of the importance of the social environment in which individuals are situated and the relationship of this to mental health and wellbeing. Included in this is the importance of an individual's role within society and the ways in which knowledge, such as experts by experience, can hold an important value. The argument then, is that social connectedness forms part of the recovery journey and that relationships can help us develop or re-connect with who we are in powerful ways. Such a view has only been strengthened by the recent and ongoing global COVID-19 pandemic. Within the UK, discussions of the importance of our wellbeing have become commonplace within the context of restricted social contact. With this heightened awareness of how the social contributes to wellbeing, it is important to consider the environments in which those in receipt of mental healthcare are situated. One of which is institutionalised care, where it is commonplace to restrict social contact. For example, by virtue of being within a locked environment, individuals' freedom of movement is often non-existent and thus contacts with those not residing or working within the institution is restricted. While such restrictions may be deemed necessary to protect the individual's mental health, such environments can be unintentionally toxic. Data are presented from an ethnography that was conducted within an inpatient forensic mental health hospital in the UK to highlight the problematic social environment which some individuals experience. Key interpersonal issues are presented, such as, trust, racism, the threat of physical violence and bullying that was experienced by staff and residents at the hospital. Consideration is given to the coping strategies enacted by residents and the pathologising of such behaviour. The consequences on interpersonal wellbeing are explored., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer TC declared a shared affiliation with several of the authors, MJ, GW, PC, to the handling Editor at time of review., (Copyright © 2021 Joyes, Jordan, Winship and Crawford.)

Manual therapy, or manipulative therapy, is performed primarily by osteopathic physicians, chiropractors, and physical therapists to relieve pain and improve function. As safe prescribing of opioids has become a concern and nondrug therapies for pain management are used more widely, manual therapy has become an attractive treatment option for many patients. A variety of techniques are used, including myofascial release, strain-counterstrain, muscle energy, high velocity/low amplitude, Still, and others. The most common conditions for which patients seek manual therapies are back pain, neck pain, and extremity problems. These therapies also are used to manage many other conditions. Studies show that, in general, manual therapies may improve pain and function in the short and moderate term in patients with acute and chronic back pain, neck pain, rotator cuff conditions, and temporomandibular joint disorders. These therapies also are used in patients with sciatica, migraine, carpal tunnel syndrome, pregnancy-related pelvic girdle pain, and infantile colic. Manual therapies may result in improvements in these conditions, but there is no high-quality research to confirm their benefits. Many studies show benefits that are similar to those of other commonly used therapies, or that are not superior to the benefits shown with sham manipulation., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Acupuncture is used to manage pain and a variety of medical and psychological conditions. It modulates nociceptive areas of the brain, affects neuropeptide and purinergic signaling, and stimulates production of opioid neuropeptides. There are many types of acupuncture, including traditional, dry needling, laser, auricular, scalp, Japanese, and Korean. There is evidence that traditional acupuncture is effective in the management of many conditions, with strong evidence of benefit for chronic back pain and osteoarthritis-related knee pain. In the United States, the conditions most commonly managed with acupuncture are low back pain, depression, anxiety, headache, and arthritis. There are no absolute contraindications. Relative contraindications include frailty and febrile illness. Acupuncture should not be used in areas of skin infection or breakdown. Acupuncture typically is avoided during the first trimester of pregnancy. Reports of serious adverse effects are rare but include pneumothorax, infection, organ or tissue injuries, and seizures. Serious adverse effects of electroacupuncture (eg, skin burns, pacemaker or implantable cardioverter-defibrillator dysfunction) are limited to case reports. Thirty-three states in the United States consider acupuncture to be within the scope of practice of physicians. Other states require specific acupuncture training. Medicare provides coverage for acupuncture for management of chronic low back pain., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Cannabis is a genus of flowering herbs in the Cannabaceae family. Federal law defines dried plant material preparations of the subspecies Cannabis sativa as marijuana . The term cannabis refers to all products derived from Cannabis plants. The active compounds in cannabis are cannabinoids, which include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive component, whereas CBD has no psychoactive effects. There are three Food and Drug Administration (FDA)-approved cannabis-related drugs. Dronabinol and nabilone (Cesamet) are approved for chemotherapy-induced nausea and vomiting; cannabidiol (Epidiolex) is approved for two pediatric epilepsy syndromes. FDA-approved cannabis-related drugs, marijuana, and cannabis formulations have been studied for the management of other conditions and symptoms (eg, cachexia, chemotherapy-induced nausea and vomiting, chronic pain, muscle spasticity) and have shown varying effectiveness. CBD formulations have been shown to be effective for certain forms of epilepsy. However, marijuana, cannabis-containing products, and cannabis-derived products in general are not approved by the FDA for any indication. Adverse effects include impaired executive function, cognition, and driving. Physicians can recommend use of marijuana under medical marijuana laws but cannot prescribe it, as it is classified as a Schedule I controlled substance. Laws regulating use of marijuana and cannabis products vary among states.

Various herbal medicines have been used around the world for more than 5,000 years. Herbal medicines, or herbal supplements, are defined as any products originating from plants and used to preserve or recover health. In the United States, the popularity of herbal supplements has increased in the last several decades. Many physicians do not ask patients about herbal supplement use, and one-third of patients do not inform their physician about supplement use. However, physicians should ask, because although many supplements are considered low risk and safe, some have significant risks of adverse effects. For example, St John's wort ( Hypericum perforatum ) can have significant drug interactions with prescription or over-the-counter drugs. The effectiveness of herbal supplements in the management of specific conditions varies. For some conditions, there is robust clinical data supporting the use of specific herbal supplements, but for other conditions there is poor or insufficient data. The content and safety of herbal supplements are the purview of the Food and Drug Administration (FDA). However, the FDA primarily responds to after-the-fact reports of postmarketing safety concerns. When an herbal supplement-related adverse effect is suspected, patients or physicians should report it to the FDA via the MedWatch reporting system., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Objectives: The purpose was to explain the process of diabetes-related diagnosis that prompts patient action (behavior change or treatment adherence). A secondary purpose was to identify barriers/gaps that prevent those outcomes., Methods: Using a grounded theory approach, we explored diagnosis from the patient's perspective and through the lens of the electronic health record (EHR). A thematic analysis was conducted on interview and EHR data from 28 patients, using the constant comparative method., Results: The emerging model of shared meaningful diagnosis included four stages: stimulus to screen, medical decision making, medical information transfer, and patient sensemaking. Barriers to a meaningful diagnosis emerged in clinical documentation, clinician communication, and patient sensemaking., Conclusions: This study expands current understanding of "diagnosis," suggesting additional stages between diagnostic labeling and disease management. The additional stages of medical information transfer and patient sensemaking are critical steps to a shared meaningful diagnosis that could enable teamwork among the patient and healthcare team., Practice Implications: To sustain meaningful diagnosis for the patient, clinicians should document what language they used to explain the diagnosis to the patient so that subsequent clinicians can use similar language. Clinicians who work as a team should unify their approach to discussing prediabetes., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Published by Elsevier B.V.)

Introduction: Ferric citrate (FC) is indicated as an oral iron replacement for iron deficiency anemia in adult patients with chronic kidney disease (CKD) not on dialysis. The recommended starting dose is one 1-g tablet three times daily (TID). This study investigated long-term efficacy and safety of different FC dosing regimens for treating anemia in nondialysis-dependent CKD (NDD-CKD)., Methods: In this phase 4, randomized, open-label, multicenter study, patients with anemia with NDD-CKD (estimated glomerular filtration rate, ≥20 mL/min and <60 mL/min) were randomized 1:1 to one FC tablet (1-g equivalent to 210 mg ferric iron) TID (3 g/day) or 2 tablets twice daily (BID; 4 g/day). At week 12, dosage was increased to 2 tablets TID (6 g/day) or 3 tablets BID (6 g/day) in patients whose hemoglobin (Hb) levels increased <0.5 g/dL or were <10 g/dL. Primary endpoint was mean change in Hb from baseline to week 24., Results: Of 484 patients screened, 206 were randomized and 205 received FC. Mean (standard deviation) changes from baseline in Hb at week 24 were 0.77 (0.84) g/dL with FC TID 3 g/day and 0.70 (0.98) g/dL with FC BID 4 g/day., Discussion/conclusions: FC administered BID and TID for 48 weeks was safe and effective for treating anemia in this population, supporting potentially increased dosing flexibility., (© 2021 S. Karger AG, Basel.)

Nascent research is beginning to link reduced opioid prescribing and increased well-being with acupuncture. While pain is the most common reason patients see physicians, acupuncture is often recommended to treat it. Due to lack of a common nomenclature around acupuncture treatment protocols, it can be difficult for clinicians to replicate research findings. This article discusses communication of ideas about how the National Institutes of Health (NIH) could help propagate meaningful research findings to practicing acupuncturists. While communication strategies can increase uptake of acupuncture in primary care and pain practices, the NIH could: (1) describe priorities in developing algorithmic acupuncture protocols; (2) require some grant applications to include both clinical and basic science outcomes; (3) develop a "dating service" to match clinical acupuncture researchers and those with the capability and interest to test mechanisms; and (4) initiating fellowships for young investigators that prioritize bringing together the art and science of acupuncture., Competing Interests: No financial conflicts of interest exist., (Copyright 2020, Mary Ann Liebert, Inc., publishers.)

Background: There is increasing cross-disciplinary research on the relationship between individuals' social, cultural and community engagement (SCCE) and mental health. SCCE includes engagement in the arts, culture and heritage, libraries and literature, sports and nature activities, volunteering, and community groups. Research has demonstrated the effects of these activities both on the prevention and management of mental illness. However, it remains unclear whether current research is focusing on the research questions that are of most immediate urgency and relevance to policy and practice., Aims: The current project was funded as part of the UK Research and Innovation cross-disciplinary mental health network programme to develop and co-produce a new cross-disciplinary research agenda on SCCE and mental health., Method: Established processes and principles for developing health research agendas were followed, with a six-phase design including engagement with over 1000 key stakeholders, consultations, integration of findings and collective prioritisation of key questions., Results: We identified four core themes: the mode of engagement, process of engagement, impact of engagement and infrastructure required to facilitate engagement. There were many points of agreement across all stakeholder groups on the priority questions within these themes, but also some specific questions of relevance to different sectors., Conclusions: This agenda is particularly timely given the extreme pressure on mental health services predicted to follow the current COVID-19 pandemic. It is important to identify how resources from other sectors can be mobilised, and what research questions are going to be most important to fund to support SCCE for mental health.

Aim: To explore how the patient is constructed and socially positioned in discourses of web-based pathways information available to people with cancer in Norway., Design: Mixed qualitative and quantitative design, using Corpus-Assisted Critical Discourse Analysis., Methods: The study, conducted in January 2020, examined the language of one general and six specific web-based cancer pathways information brochures. The approach combines analysis of word frequencies and concordance lines using corpus analysis software to identify the 'linguistic fingerprint' or 'aboutness' of the text prior to further qualitative critical discourse analysis., Results: The analysis identified three core discourses which constructed the patient differently: (a) a participating active person, in a brief, inclusive discourse; (b) a passive person lacking knowledge or perception of their situation in dominant, medical and interprofessional expert discourse; and (c) reduced to a disease and a code in the pathways discourse., Conclusion: This study offers insight into the construction of patients in online clinical pathways information for cancer treatment. The analysis revealed how governance systems such as New Public Management and its demands on efficiency and productivity influence the cancer pathways. The World Health Organization has promoted a person-centred approach, emphasizing the importance of participation and a partnership of equals. A person-centred approach to care was not evident in the discourse of the online documents. The dominant ideology of these pathways was paternalistic with patients constructed as passive persons who get standardized treatment., Impact: This study gives new insight that can be valuable for nurses, other healthcare professionals and the government. The lack of a person-centred focus in the cancer pathway information could have a negative impact on the patient's health outcomes by promoting a culture of inattention to the patients' needs and wishes among practitioners. The results may provide a stimulus for discussion about the role of patients in cancer treatment., (© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective : Acupuncture is one of the most widely used treatments of complementary and alternative medicine (CAM) within the military's health system. The success of CAM integration is partially dependent on both providers' and patients' perceptions that acupuncture is health-promoting. The aim of this research was to identify turning points, or changes, across treatments that enhanced or inhibited physicians' and patients' perception of acupuncture as health-promoting. Materials and Methods : Using a retrospective-interview approach, interviews were conducted with 15 family medicine physicians practicing medical acupuncture in a family medicine setting and with 17 patients ( N  = 32). Turning points were separated into 2 groups (health-promoting or health-inhibiting). Similarities and differences between perspectives were noted. Results : Patients and physicians identified two changes that enhanced their perspective of acupuncture as health-promoting: (1) observed health changes and (2) pain-medicine/narcotic reduction/elimination. Patients identified their ability to fulfill personal or professional roles, whereas physicians identified (1) training experiences and (2) enhanced relationships with patients. Health-inhibiting changes in perspective were identified as logistical constraints/barriers by both parties, although their perspectives differed to some degree. Turning points that were viewed as health-inhibiting treatment were identified as clinical challenges by physicians and as a lack of consistency in care by patients. Conclusions : The insight from these findings can help identify areas where medical acupuncture can be improved to promote successful integration in conventional medicine settings, as well as how providers can tailor communication with patients about acupuncture., Competing Interests: No financial conflicts of interest exist., (Copyright 2020, Mary Ann Liebert, Inc., publishers.)

Introduction: Most interventions to date regarding breaking bad news focus on late-stage disease or disclosing a cancer diagnosis. Little attention has been given to delivery of chronic metabolic disease diagnoses such as prediabetes/type 2 diabetes., Methods: Informed by the American Diabetes Association standards of care and formative research conducted by our research team, we developed this curriculum through the six-step approach to curriculum development. The curriculum consists of a 2- or 3-hour intervention that teaches medical decision-making, interpersonal communication, and clinical documentation in the context of prediabetes and type 2 diabetes followed by role-play and clinical practice., Results: Across three cohorts, 53 clinicians completed the curriculum. Across the three iterations, learners rated the curricular intervention as worthwhile and delivered at an appropriate level. In a community hospital setting, learners scored significantly higher on a knowledge check than did a control group of six clinicians ( p < .001). Learners in the community hospital also indicated high response efficacy and self-efficacy. At the academic medical center, simulated patients indicated high measures on the Diabetes Health Threat Communication Questionnaire., Discussion: The moment of diagnosis presents a key opportunity to affect patients' perceptions of the disease. This curriculum guides clinicians in making the most of diagnosis delivery. Pairing of qualitative, patient-centered research alongside the iterative curriculum design process allows the curriculum to be adaptable and scalable to multiple settings and learner types., (© 2020 Ledford et al.)

Background and Purpose: To investigate the effects of adding virtual activity groups to a multicomponent ambulatory activity monitoring intervention in managing chronic conditions such as obesity and type 2 diabetes., Methods: We randomized 120 subjects with type 2 diabetes to receive an activity monitor with or without placement into virtual activity groups. We monitored subjects over six months and collected HbA1c, weight, step count, blood pressure, and SF-36 questionnaire data., Results: All subjects lost significant weight over the course of the study (p = 0.005); however, there was no statistically significant difference in mean weight loss between two groups (p = 0.520). HbA1c decreased in both groups, but was not statistically significant (p = 0.084). Daily step counts were similar between groups (p = 0.633), but both groups did decrease significantly over time (p = 0.004). There was no linear correlation between daily step count and HbA1c (p = 0.609), but there was between daily step count and weight (p = 0.016) although this only accounted for 5.6% of weight loss. There were no significant differences found for blood pressure and Rand SF36 measures between groups or times, or group-time interactions with two exceptions. The SF36 Role functioning/emotional measure showed an interaction between group and time (p = 0.039) and the SF36 Health Change measure had a significant difference due to time irrespective of group (p < 0.0001). Compliance remained high, with 93.8% of subjects actively participating at the conclusion of the study., Conclusions: Activity monitoring with in-person goal-setting and scripted feedback over six months was associated with significant weight loss with or without virtual support groups., (Published by Elsevier Ltd.)

Background and Objectives: Research shows that limited time, lack of funding, difficulty identifying mentors, and lack of technical support limit resident and faculty ability to fully participate in scholarly activity. Most research to date focuses on medical student and resident attitudes toward research. This study aimed to understand the underlying attitudes of family medicine residency (FMR) leaders toward scholarship., Methods: Two focus groups of family medicine residency leaders were conducted in March 2018. The sample (N=19) was recruited through the membership directory of the Family Physicians Inquiry Network., Results: Leaders shared positive attitudes toward scholarship; however, motivation to engage residents and residency faculty in scholarship diverged. Motivations for promoting scholarly activity among participants were either extrinsic (through ACGME, program graduation, or promotion requirements) or intrinsic (through personal interest and natural drive)., Conclusions: Emerging themes illustrate differences in how FMR program leaders perceive the role of scholarship in residency programs. As programs aim to increase research and scholarship, more attention must be paid to the motivating messages communicated by the program's leadership.

Background: Past mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information., Objective: The primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense's Mobile Health Care Environment (MHCE) in a patient-centered medical home setting., Methods: A multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System. Phase I assessed preferences regarding the enhancement of the enabling technology. Phase II was a single-blinded 12-month feasibility study that randomly assigned 240 patients to either the intervention (n=123, received mHealth technology and behavioral messages tailored to Patient Activation Measure [PAM] level at baseline) or the control group (n=117, received equipment but not messaging. The primary outcome measure was PAM scores. Secondary outcome measures included Summary of Diabetes Self-Care Activities (SDSCA) scores and cardiometabolic outcomes. We used generalized estimating equations to estimate changes in outcomes., Results: The final sample consisted of 229 patients. Participants were 61.6% (141/229) male, had a mean age of 62.9 years, mean glycated hemoglobin (HbA 1c ) of 7.5%, mean BMI of 32.7, and a mean duration of T2D diagnosis of 9.8 years. At month 12, the control group showed significantly greater improvements compared with the intervention group in PAM scores (control mean 7.49, intervention mean 1.77; P=.007), HbA 1c (control mean -0.53, intervention mean -0.11; P=.006), and low-density lipoprotein cholesterol (control mean -7.14, intervention mean 4.38; P=.01). Both groups showed significant improvement in SDSCA, BMI, waist size, and diastolic blood pressure; between-group differences were not statistically significant. Except for patients with the highest level of activation (PAM level 4), intervention group patients exhibited significant improvements in PAM scores. For patients with the lowest level of activation (PAM level 1), the intervention group showed significantly greater improvement compared with the control group in HbA 1c (control mean -0.09, intervention mean -0.52; P=.04), BMI (control mean 0.58, intervention mean -1.22; P=.01), and high-density lipoprotein cholesterol levels (control mean -4.86, intervention mean 3.56; P<.001). Significant improvements were seen in AM scores, SDSCA, and waist size for both groups and in diastolic and systolic blood pressure for the control group; the between-group differences were not statistically significant. The percentage of participants who were engaged with MHCE for ≥50% of days period was 60.7% (68/112; months 0-3), 57.4% (62/108; months 3-6), 49.5% (51/103; months 6-9), and 43% (42/98; months 9-12)., Conclusions: Our study produced mixed results with improvement in PAM scores and outcomes in both the intervention and control groups. Structural design issues may have hampered the influence of tailored behavioral messaging within the intervention group., Trial Registration: ClinicalTrials.gov NCT02949037; https://clinicaltrials.gov/ct2/show/NCT02949037., International Registered Report Identifier (irrid): RR2-10.2196/resprot.6993., (©Ronald W Gimbel, Lior M Rennert, Paul Crawford, Jeanette R Little, Khoa Truong, Joel E Williams, Sarah F Griffin, Lu Shi, Liwei Chen, LingLing Zhang, Jennie B Moss, Robert C Marshall, Karen W Edwards, Kristy J Crawford, Marie Hing, Amanda Schmeltz, Brandon Lumsden, Morgan Ashby, Elizabeth Haas, Kelly Palazzo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2020.)

Aims: To identify communication cycles patients use to make sense of a diabetes diagnosis and barriers patients encounter in their sensemaking process., Methods: Researchers conducted interviews with 33 participants with type 2 diabetes mellitus or prediabetes at medical centers in Georgia and Nevada. A thematic analysis using the constant comparative method identified communication cycles., Results: Patients reported engaging three communication cycles to make sense of the diagnosis: (1) interacting with healthcare clinicians; (2) seeking information online; and (3) taking a nutrition/diabetes management class. Patients reported system-level barriers that impact sensemaking: (1) lack of consistent or routine care; and (2) lack of access to resources., Conclusion: Results here reinforce the theoretical proposition that receiving a diagnosis is an equivocal process that requires patients to make sense of new information through communication cycles. Patients in this sample repeatedly described communication cycles to interpret this new information rather than relying on assembly rules. Clinicians can promote patient understanding of diabetes and self-management by taking time to explain the diagnosis, maintaining consistent care, providing guidance to online sources, and ensuring patients have access to diabetes education., (Published by Elsevier B.V.)

Introduction: Understanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health., Methods: Research coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point., Results: Patients reported 5 interrelated turning points occurring at various times after diagnosis: 1) gaining knowledge, either through patients own research and/or a health care class; 2) making lifestyle changes, including exercising and healthier eating; 3) encountering a life-changing event/transition, including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) receiving social support, either through holding patients accountable or encouraging them to enact healthy behavior; and 5) interacting with clinicians, such as medication changes or behavior changes critical to disease management., Discussion: These turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care., Competing Interests: Conflicts of interest: None., (© Copyright 2020 by the American Board of Family Medicine.)

Introduction: Recent evidence reveals that diabetes and prediabetes (preDM) can be reversed to normal glucose regulation (NGR) through significant weight loss, but how physicians clinically identify the principles of partial and complete remission of diabetes is largely unknown., Methods: As part of the cross-sectional omnibus survey conducted in March 2019 at a professional annual meeting in the United States, physician participants answered case scenario questions about the diagnosis and documentation of patients with preDM and type 2 diabetes (T2DM)., Results: Of the registered conference attendees, 387 (72.7%) responded. When presented with the initial case of preDM, 201 physicians (70.8%) selected R73.03 Prediabetes. In a follow-up encounter with improved lab results, 118 physicians (58.7%) indicated that they would not chart any diabetes-related code and 62 (30.8%) would chart preDM again. When presented with the case of T2DM, 256 physicians (90.1%) indicated E11.0-E11.9 Type 2 Diabetes. In the follow-up encounter, only 38 (14.8%) coded a diagnosis reflecting remission from T2DM to prediabetes and 211 (82.4%) charted T2DM., Conclusion: Physicians may be reluctant to document diabetes regression as there is little evidence for long-term outcomes and "downgrading" the diagnosis in the medical record may cause screenings to be missed. Documenting this regression in the medical record should communicate the accurate point on the continuum of glucose intolerance with both the patient and the care team.

Rationale, Aims, and Objectives: Patients with mental health problems experience numerous transitions into and out of hospital. This study explores former patients' views of pathways in transition between district psychiatric hospital centres (DPCs) and community mental health services., Method: A descriptive qualitative design was chosen. Three focus group interviews with a total of 10 informants from five different communities were conducted. Interviews were transcribed and analysed thematically where themes describe promoting or inhibitory factors to the transition phase., Results: The informants shared their experiences on issues promoting and preventing successful care pathways in mental health. Four main paired themes were identified: (a) patient participation/activation/empowerment versus paternalism and institutionalization, (b) patient-centred care versus care interpreted as humiliation, (c) interprofessional collaboration or teamwork versus unsafe patient pathways in mental health services, and (d) sustainable integrated care versus fragmented, noncollaborative care., Conclusions: Shared decision making was reported more precisely as informed shared decision making. Shared information between all parties involved in care pathways is key., (© 2019 Norwegian University of Science and Technology. Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.)

Background and Purpose: Postpartum pain affects quality of life. Clinicians are increasingly using acupuncture for management of pain. Evidence based strategies that incorporate acupuncture for postpartum pain are lacking., Methods: We performed an exploratory, randomized clinical trial of Battlefield Auricular Acupuncture (BFA) plus standard analgesia versus standard analgesia alone for reduction of pain in the immediate postpartum period., Results: The mean time to 50% sustained reduction of initial pain in the standard analgesia group (n = 33) was 6 days compared to 5 days in the standard analgesia plus BFA (n = 37) group (p = 0.35). The mean total morphine equivalent units (MEUs) in the standard group compared to standard plus BFA group were 88 mg and 82 mg respectively (p = 0.45)., Conclusions: This exploratory comparison suggests that BFA may not provide additional benefit to standard analgesia for immediate postpartum pain; however, the trend toward faster reduction in pain indicates that a larger definitive study may be required., (Published by Elsevier Inc.)

Objective: This study aims to identify differences in how patients living with prediabetes (preDM) or type 2 diabetes (T2DM) perceive their illness., Methods: Following chart review, a cross-sectional survey was administered to patients diagnosed with preDM or T2DM at two US medical centers., Results: Among 757 respondents, multivariate tests demonstrate that patients living with T2DM have an overall different personal model of disease than patients living with preDM. Patients who have been diagnosed with T2DM report a better understanding of their disease and perceive it to be more chronic in nature than patients living with preDM. Findings revealed a potential but less significant difference in perceived seriousness., Conclusions: In this first application of personal models of disease to prediabetes, results inform implications for clinicians to talk with patients about preDM. Patients living with preDM indicate less understanding of the "disease" and perceive it to be less "chronic," which may result from unclear clinician communication about preDM., Practice Implications: When clinicians talk to patients about prediabetes, they should present the risk factor within the spectrum of glucose tolerance. Although labeled a risk factor, clinicians should emphasize that prediabetes remains a serious concern that will not lessen without intervention., (Published by Elsevier B.V.)

Objective: This qualitative study sought to identify and describe patients' variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis. Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients' perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients. Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients' beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears ; (ii) clinician communication ; and (iii) social comparisons . Conclusions: Beliefs about severity are influenced by patients' fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.

Background and Purpose: Medical acupuncture is an additional treatment for pain management, in which physicians are increasingly being trained., Methods: We surveyed graduates of the Nellis Family Medicine Residency/Acus Foundation Acupuncture Training initiative. We asked them about their acupuncture practice patterns, satisfaction with their practice, and queried other aspects affecting their practice., Results: 85% (50/59) graduates responded. All graduates were still practicing acupuncture, and reported that the most common ailment treated was back pain. Respondents reported that they are happier and prescribe fewer opioids than they did before learning acupuncture., Conclusions: Medical acupuncture can be learned during Family Medicine Residency and results in more satisfied physicians who report prescribing fewer opioids., (Published by Elsevier Inc.)

Background This paper reports on the learning from a 12-month interdisciplinary project (Dementia, Arts and Wellbeing Network- DA&WN) and its activities. These featured a series of four workshops on dance, visual art, theatre and music. The network was comprised of clinicians, academics, creative practitioners and people with lived experience of dementia and their carers. Methods The workshops were designed to draw out tacit knowledge about well-being in dementia through an action-based learning and research approach. This included, guided activities combined with reflective group discussions, visual documentation and baseline and follow-up questionnaires. Results Outcomes included new collaborations between group members, changes in creative practice for artists, and active and sustained involvement of people living with dementia and their carers in similar opportunities and participatory research. Conclusion This participatory and inclusive workshop model should be considered to develop and enhance interdisciplinary activities in dementia care.