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Jones J.,University of Stirling | Thomson P.,University of Stirling | Irvine K.,Center for Health Science | Leslie S.J.,University of Stirling | Leslie S.J.,Raigmore Hospital
Journal of Alternative and Complementary Medicine | Year: 2013

Objectives: Reflexology claims that the feet are representative of the body and that massage to specific points of the feet increases blood supply to "mapped" organs in the body. This review provides the first systematic evaluation of existing reflexology randomized controlled trials (RCTs) to determine whether there is any evidence to suggest the existence of a reflexology treatment-related hemodynamic effect; to examine whether reflexology researchers used study designs that systematically controlled for nonspecific effects in order to isolate this specific component; and to highlight some of the methodological challenges that need to be overcome to demonstrate specific and beneficial hemodynamic effects. Design: Fifty-two RCTs of reflexology published from 1990 to September 2011 were initially retrieved. Setting/Location: Cardiorespiratory Department, Highland Heartbeat Centre, Raigmore Hospital, Inverness. Subjects: Adult subjects. Interventions: Studies using reflexology foot massage techniques as the intervention versus sham reflexology treatment, simple foot massage, conventional treatment, or no treatment as the control were then selected. Outcome measures: Outcome measures included any hemodynamic parameter potentially involved in the regulation of circulating blood volume and flow, including heart rate and systolic and diastolic arterial blood pressure. Results: Seven RCTs suggested that reflexology has an effect on selected cardiovascular parameters; however, five of these delivered the reflexology intervention as a whole complex treatment, with the data collector often delivering the intervention themselves. Conclusions: This systematic review found that although reflexology has been shown to have an effect on selected hemodynamic variables, the lack of methodological control for nonspecific general massage effects means that there is little convincing evidence at this time to suggest the existence of a specific treatment-related hemodynamic effect. Furthermore, the review found that few studies of reflexology controlled for nonspecific effects in order to isolate any specific active component, despite the hemodynamic claim being a key part of the therapeutic value of reflexology. Therefore, further research approaches using more innovative designs and robust methods that can allow a treatment-induced, therapeutically beneficial hemodynamic effect to reveal itself are needed to help reflexology purchasers make a more informed decision about the safety and product quality of the reflexology hemodynamic claim and for reflexologists to be able to guarantee minimum product quality, validity, and safety standards in their practice. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Sampson R.,Cairn Medical Practice | Cooper J.,Royal Infirmary | Barbour R.,Open University Milton Keynes | Polson R.,Center for Health Science | Wilson P.,University of Aberdeen
BMJ Open | Year: 2015

Objectives: To synthesise the published literature on the patient experience of the medical primary- secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Design: Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients' perspectives of the medical primary-secondary care interface. Setting: International primary-secondary care interface. Data sources: EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science and Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Eligibility criteria for selecting studies: Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients' perspectives of the medical primary- secondary care interface. Review methods: The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. Results: The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary-secondary care interface from the patients' perspective emerged: barriers to care, communication, coordination, and 'relationships and personal value'. Conclusions and implications of key findings: Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface.


Valli H.,University of Pittsburgh | Valli H.,Magee Womens Research Institute | Phillips B.T.,University of Pittsburgh | Phillips B.T.,Magee Womens Research Institute | And 7 more authors.
Fertility and Sterility | Year: 2014

Improved therapies for cancer and other conditions have resulted in a growing population of long-term survivors. Infertility is an unfortunate side effect of some cancer therapies that impacts the quality of life of survivors who are in their reproductive or prereproductive years. Some of these patients have the opportunity to preserve their fertility using standard technologies that include sperm, egg, or embryo banking, followed by IVF and/or ET. However, these options are not available to all patients, especially the prepubertal patients who are not yet producing mature gametes. For these patients, there are several stem cell technologies in the research pipeline that may give rise to new fertility options and allow infertile patients to have their own biological children. We will review the role of stem cells in normal spermatogenesis as well as experimental stem cell-based techniques that may have potential to generate or regenerate spermatogenesis and sperm. We will present these technologies in the context of the fertility preservation paradigm, but we anticipate that they will have broad implications for the assisted reproduction field. © 2014 by American Society for Reproductive Medicine.


Sampson R.,Postgraduate General Practice Education | O'Rourke J.,Postgraduate General Practice Education | Hendry R.,University of Aberdeen | Heaney D.,University of Aberdeen | And 3 more authors.
British Journal of General Practice | Year: 2013

Background There is little published research into the impact, on both doctor and patient, of handing over responsibility for choosing appointment length to the patient. Aim To investigate what impact giving patients control of their appointment length has on the patient and doctor experience. Design and setting A qualitative study in a single medical practice in Inverness, Scotland. Method Eligible patients making a 'routine' appointment were given a choice of appointment length (5, 10, 15, or 20 minutes). After the consultation, patients were invited to take part in a focused interview. Doctors were asked to keep an audio diary and their experience was explored further in a facilitated focus group. Data were analysed using a thematic analysis approach. Results Key themes that emerged for patients included the impact of the shift in power and the impact of introducing the issue of time. For doctors, important themes that emerged were impacts on the provider, on the doctor-patient relationship, and on the consultation. Conclusion Giving patients greater responsibility for choosing appointment length may improve the experience for both doctors and patients. © British Journal of General Practice.


Dacey B.,The Dacey Group Inc. | Bholat M.A.,University of California at Los Angeles | Bholat M.A.,Center for Health science
Primary Care - Clinics in Office Practice | Year: 2012

This article outlines the regulatory movement propelling physicians into the electronic health record environment and the subsequent emergence of quality issues in the medical record. There are benefits and downside risks for implementing electronic health records as part of the desire of a practice or institution to build patient-centered medical homes. The intersection of how a practice or institution collects and reports quality metrics using health information technology and subsequently submits claims for services rendered has created unforeseen challenges for which leadership must be aware and address proactively. © 2012.


Smith K.,Center for Health science | Czaplewski N.,Sam Noble Oklahoma Museum of Natural History | Cifelli R.L.,Sam Noble Oklahoma Museum of Natural History
Acta Palaeontologica Polonica | Year: 2016

The lowest part of the Monarch Mill Formation in the Middlegate basin, west-central Nevada, has yielded a middle Miocene (Barstovian Land Mammal Age) vertebrate assemblage, the Eastgate local fauna. Paleobotanical evidence from nearby, nearly contemporaneous fossil leaf assemblages indicates that the Middle Miocene vegetation in the area was mixed coniferous and hardwood forest and chaparral-sclerophyllous shrubland, and suggests that the area had been uplifted to 2700-2800 m paleoaltitude before dropping later to near its present elevation of 1600 m. Thus, the local fauna provides a rare glimpse at a medium- to high-altitude vertebrate community in the intermountain western interior of North America. The local fauna includes the remains of fish, amphibians, reptiles, birds, and 25 families of mammals. Carnivorans, the focus of this study, include six taxa (three of which are new) belonging to four families. Canidae are represented by the borophagine Tomarctus brevirostris and the canine Leptocyon sp. indet. The earliest record and second North American occurrence of the simocyonine ailurid Actiocyon is represented by A. parverratis sp. nov. Two new mustelids, Brevimalictis chikasha gen. et sp. nov. and Negodiaetictis rugatrulleum gen. et sp. nov., may represent Galictinae but are of uncertain subfamilial and tribal affinity. The fourth family is represented by the felid Pseudaelurus sp. indet. Tomarctus brevirostris is limited biochronologically to the Barstovian land mammal age and thus is consistent with the age indicated by other members of the Eastgate local fauna as well as by indirect tephrochronological dates previously associated with the Monarch Mill Formation. Actiocyon parverratis sp. nov. extends the temporal range of the genus Actiocyon from late Clarendonian back to the Barstovian. The Eastgate local fauna improves our understanding of mammalian successions and evolution, during and subsequent to the Mid-Miocene Climatic Optimum (∼14-17 Ma). Copyright © 2016 K. Smith et al.


Nibali L.,University College London | Madden I.,University College London | Madden I.,Center for Health Science | Franch Chillida F.,University College London | And 3 more authors.
Oral Diseases | Year: 2011

Aim: Genetic factors have recently been associated with presence of Aggregatibacter actinomycetemcomitans subgingivally in populations living in industrialized countries. The aim of this study was to analyse associations between Interleukin-6 (IL6) single nucleotide polymorphisms and presence and levels of A. actinomycetemcomitans and other subgingival microbes in a rural Indian population. Subjects and Methods: A total of 251 individuals from a rural village in India with a periodontal phenotype ranging from healthy to severe periodontitis were included. Checkerboard DNA-DNA analysis was performed to detect 40 periodontal taxa in subgingival plaque samples. Genomic DNA was extracted to genotype five polymorphisms in the IL6 promoter region. Results: The IL6 -174 GG genotype was associated with high (above median) counts of A. actinomycetemcomitans (both in all subjects and in periodontally healthy only) and with presence and counts of Capnocytophaga sputigena. Differences in detection of several other bacteria were noted between periodontitis and healthy subjects. Conclusions: These findings support the influence of genetic factors on the subgingival microbiota. © 2010 John Wiley & Sons A/S.


PubMed | University of Southern Denmark, Center for Health science and Colegio de Mexico
Type: Journal Article | Journal: Journal of epidemiology and community health | Year: 2016

A disproportionate number of homicides have caused Mexican life expectancy to stagnate during the new millennium. No efforts currently exist to quantify the harm of violent acts on the lives of the general population. We quantified the impact of perceived vulnerability on life expectancy.Three Mexican national surveys on perceptions of public safety, life tables, and crime and vital statistics (2000-2014) were used. Prevalence rates of vulnerability/safety by age and sex were obtained from surveys at 2 different levels: federal state and home. The Sullivan method was used to estimate life expectancy lived with and without vulnerability for Mexican women and men.Overall life expectancy at age 20 stagnated between 2005 and 2014 for females and males; yet, there was an increase of 40% and 70% in average number of years lived with vulnerability at the state and home levels, respectively. In 2014, female life expectancy at age 20 was 59.5years (95% CI 59.0 to 60.1); 71% of these years (42.3years, 41.6 to 43.0) were spent with perceived vulnerability of violence taking place in the state and 26% at the home (15.3years, 15 to 15.8). For males, life expectancy at age 20 was 54.5years (53.7 to 55.1); 64% of these years (34.6years, 34.0 to 35.4) were lived with perceived vulnerability of violence at the state and 20% at the home (11.1years, 10.8 to 11.5).The number of years lived with perceived vulnerability among Mexicans has increased by 30.5 million person-years over the last 10years. If perceived vulnerability remains at its 2014 level, the average Mexican adults would be expected to live a large fraction of his/her life with perceived vulnerability of violence. Acts of violence continue to rise in the country and they should be addressed as a major public health issue before they become endemic.


Chapman A.R.,Raigmore Hospital | Rushworth G.F.,Center for Health Science | Leslie S.J.,Raigmore Hospital
Cardiology Journal | Year: 2013

Background: Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated-such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. Methods and results: We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. Conclusions: In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether. © 2013 Via Medica.


Breese McCoy S.J.,Center for Health science
Thyroid Research | Year: 2011

Abstract. I developed Graves' Disease four months postpartum. After one year on propylthiouracil, I learned that omega-3 fatty acids may reduce inflammation associated with certain autoimmune disorders, although no investigations for thyroiditis have been reported. Within eight weeks of beginning flaxseed oil supplements, TSH levels normalized, but fell somewhat when flaxseed was decreased and PTU discontinued. During another pregnancy, plasma TSH normalized, but was again suppressed by four weeks postpartum, then undetectable by four months. This time, flaxseed supplementation alone coincided with TSH normalization. Omega-3 fatty acids should be investigated as a potential treatment for autoimmune thyroid disease. © 2011 Breese McCoy; licensee BioMed Central Ltd.

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