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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.,Highland Heartbeat Center
Journal of Alternative and Complementary Medicine

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. Source

Chapman A.R.,Cardiac Unit | Rushworth G.F.,Center for Health science | Leslie S.J.,Highland Heartbeat Center
Cardiology Journal

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. Source

Canudas-Romo V.,University of Southern Denmark | Canudas-Romo V.,Max Planck Institute for Demographic Research | Aburto J.M.,University of Southern Denmark | Aburto J.M.,Max Planck Institute for Demographic Research | And 2 more authors.
Journal of Epidemiology and Community Health

Objectives 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. Methods 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. Results 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 59.5 years (95% CI 59.0 to 60.1); 71% of these years (42.3 years, 41.6 to 43.0) were spent with perceived vulnerability of violence taking place in the state and 26% at the home (15.3 years, 15 to 15.8). For males, life expectancy at age 20 was 54.5 years (53.7 to 55.1); 64% of these years (34.6 years, 34.0 to 35.4) were lived with perceived vulnerability of violence at the state and 20% at the home (11.1 years, 10.8 to 11.5). Conclusions The number of years lived with perceived vulnerability among Mexicans has increased by 30.5 million person-years over the last 10 years. 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. © 2016 by the BMJ Publishing Group Ltd. Source

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

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. Source

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

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. Source

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