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Background: Trial recruitment of Black, indigenous, and people of color (BIPOC) is key for interventions that interact with socioeconomic factors and cultural norms, preferences, and values. We report on our experience enrolling BIPOC participants into a multicenter trial of a shared decision-making intervention about anticoagulation to prevent strokes, in patients with atrial fibrillation (AF). Methods: We enrolled patients with AF and their clinicians in 5 healthcare systems (three academic medical centers, an urban/suburban community medical center, and a safety-net inner-city medical center) located in three states (Minnesota, Alabama, and Mississippi) in the United States. Clinical encounters were randomized to usual care with or without a shared decision-making tool about anticoagulation. Analysis: We analyzed BIPOC patient enrollment by site, categorized reasons for non-enrollment, and examined how enrollment of BIPOC patients was promoted across sites. Results: Of 2247 patients assessed, 922 were enrolled of which 147 (16%) were BIPOC patients. Eligible Black participants were significantly less likely (p < .001) to enroll (102, 11%) than trial-eligible White participants (185, 15%). The enrollment rate of BIPOC patients varied by site. The inclusion and prioritization of clinical practices that care for more BIPOC patients contributed to a higher enrollment rate into the trial. Specific efforts to reach BIPOC clinic attendees and prioritize their enrollment had lower yield. Conclusions: Best practices to optimize the enrollment of BIPOC participants into trials that examined complex and culturally sensitive interventions remain to be developed. This study suggests a high yield from enrolling BIPOC patients from practices that prioritize their care.

Background Shared decision making (SDM) implementation remains challenging. The factors that promote or hinder implementation of SDM tools for use during the consultation, including contextual factors such as clinician burnout and organizational support, remain unclear. We explored these factors in the context of a practical multicenter randomized trial evaluating the effectiveness of an SDM conversation tool for patients with atrial fibrillation considering anticoagulation therapy. Methods In this cross-sectional study, we recruited clinicians who were regularly involved in conversations with patients regarding anticoagulation for atrial fibrillation. Clinicians reported their characteristics and burnout symptoms using the two-item Maslach Burnout Inventory. Clinicians were trained in using the SDM tool, and they recorded their perceptions of the tool’s normalization potential using the Normalization MeAsure Development (NoMAD) survey instrument and verbally reflected on their answers to these survey questions. When possible, the training sessions and clinicians’ verbal responses to the conversation tool were recorded. Results Our study comprised 183 clinicians recruited into the trial (168 with survey responses and 112 with recordings). Overall, clinicians gave high scores to the normalization potential of the intervention; they endorsed all domains of normalization to the same extent, regardless of site, clinician characteristics, or burnout ratings. In interviews, clinicians paid significant attention to making sense of the tool. Tool buy-in seemed to depend heavily on their ability to see the tool as accurate and “evidence-based” and their perceptions of having time in the consultation to use it. Conclusions While time in the consultation remains a barrier, we did not find a significant association between burnout symptoms and normalization of an SDM conversation tool. Possible areas for improving the normalization of SDM conversation tools in clinical practice include enabling collaboration among clinicians to implement the tool and reporting how clinicians elsewhere use the tool. Direct measures of normalization (i.e., observing how often clinicians access the tool in practice outside of the clinical trial) may further elucidate the role that contextual factors, such as clinician burnout, play in the implementation of SDM. Trial registration ClinicalTrials.gov, NCT02905032. Registered on 9 September 2016.

Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial’s risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients’ perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients’ own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.

Context: Various drugs affect body weight as a side effect. Objective: We conducted this systematic review and meta-analysis to summarize the evidence about commonly prescribed drugs and their association with weight change. Data Sources: MEDLINE, DARE, and the Cochrane Database of Systematic Reviews were searched to identify published systematic reviews as a source for trials. Study Selection: We included randomized trials that compared an a priori selected list of drugs to placebo and measured weight change. Data Extraction: We extracted data in duplicate and assessed the methodological quality using the Cochrane risk of bias tool. Results: We included 257 randomized trials (54 different drugs; 84 696 patients enrolled). Weight gain was associated with the use of amitriptyline (1.8 kg), mirtazapine (1.5 kg), olanzapine (2.4 kg), quetiapine (1.1 kg), risperidone (0.8 kg), gabapentin (2.2 kg), tolbutamide (2.8 kg), pioglitazone (2.6 kg), glimepiride (2.1 kg), gliclazide (1.8 kg), glyburide (2.6 kg), glipizide (2.2 kg), sitagliptin (0.55 kg), and nateglinide (0.3 kg). Weight loss was associated with the use of metformin (1.1 kg), acarbose (0.4 kg), miglitol (0.7 kg), pramlintide (2.3 kg), liraglutide (1.7 kg), exenatide (1.2 kg), zonisamide (7.7 kg), topiramate (3.8 kg), bupropion (1.3 kg), and fluoxetine (1.3 kg). For many other remaining drugs (including antihypertensives and antihistamines), the weight change was either statistically nonsignificant or supported by very low-quality evidence. Conclusions: Several drugs are associated with weight change of varying magnitude. Data are provided to guide the choice of drug when several options exist and institute preemptive weight loss strategies when obesogenic drugs are prescribed.

O objetivo deste trabalho foi determinar a precisão das equações de predição de 1-RM propostas por Adams (1994), Baechle e Groves (2000), Brzycki (1993), Epley (1985), Lander (1985) e O’Conner et al. (1989) em alunos de ginásios. Foram selecionados 31 indivíduos do sexo masculino, praticantes de treino de força, com média de idades de 21.8 ± 4.0 anos, peso 75.9 ± 8.4 kg e estatura 178.1 ± 6.4 cm. O exercício escolhido para a realização do presente estudo foi o supino recto com barra. A coleta de dados referentes às cargas de trabalho no supino recto foi realizada em dois momentos: (a) carga referente ao teste de 1-RM; e, (b) carga referente ao teste submáximo e seus respectivos números de repetições. Através da análise de variância verificou-se que não houve diferença significativa (p > .05) entre os resultados das equações e o teste de 1-RM. Os coeficientes de determinação (r²) variaram entre .94 e .96. As equações tiveram erro padrão baixo (2.7 a 3.2 kg). Podemos concluir, com este trabalho, que as equações para predição de carga máxima selecionadas podem ser utilizadas com o intuito de predizer a carga máxima para o supino recto com barra com alto grau de precisão em alunos de academia. The purpose of this study was to assess the precision of the 1-RM prediction equations proposed by Adams (1994), Baechle and Groves (2000), Brzycki (1993), Epley (1985), Lander (1985) and O’Conner et al. (1989) for strength assessment in fitness programs. Thirty one healthy regular strength training male practitioners (mean ± SD: 21.8 ± 4.0 years of age; 75.9 ± 8.4 kg of weight; and 178.1 ± 6.4 cm of height) performed two tests on the bench press exercise: (a) maximum test - determination of the 1-RM load; and (b) submaximum test - determination of the load matching 4 to 10 maximum repetitions. Analysis of variance (ANOVA) found no significant difference (p > .05) between maximum load determination through prediction equations or through the 1-RM test. The coefficient of determination (r²) varied from .94 to .96. The prediction equations had small standard error of estimate (2.7 to 3.2 kg). Results indicate that the 1-RM prediction equations could be used to determine the maximum load at the bench press exercise in subjects with low strength training experience.

Made available in DSpace on 2013-08-12T18:58:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-01-01 Made available in DSpace on 2013-09-30T19:18:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:32:41Z No. of bitstreams: 0 Made available in DSpace on 2014-05-20T15:32:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-01-01 The objective of this work was to evaluate the biology of Orius insidiosus fed on eggs of Plutella xylostella and Anagasta kuehniella. The eggs used were obtained from the Laboratorio de Biologia e Criacao de Insetos, Departamento de Fitossanidade, FCAV/UNESP. The experiment was carried out with a total of 50 12-to-24-hour-old O. insidiosus nymphs, 1 per Petri dish (50 replications). P. xylostella or A. kuehniella eggs were places into each Petri dish daily, along with a small cotton pad moistened with distilled water. The evaluations were carried out daily. The adults were separated in couples, and placed in Petri dishes. The following biological aspects were evaluated: duration, survival rate and consumption of the nymph instars and of the nymph period; longevity of males and females; consumption per day and adult longevity; eggs per day; female fecundity; egg viability; embryonic period; preoviposition period, oviposition period, post-oviposition period. The fertility life table parameters were also evaluated. The predator O. insidiosus did not present significant differences for its biological characteristics, when feeding on P. xylostella and A. kuehniella eggs, however it showed improved fertility life table parameters when fedo n eggs of P. xylostella, suggesting the possibility of using these eggs in the mass rearing of this insect. Univ Estadual Paulista, Fac Ciencias Agr & Vet, Via Acesso Prof Paulo Donato Castellane S-N, Jaboticabal, SP, Brazil Univ Estadual Paulista, Fac Ciencias Agr & Vet, Via Acesso Prof Paulo Donato Castellane S-N, Jaboticabal, SP, Brazil