Controlling Hypertension through Education and Coaching in Kidney Disease (CHECK-D): protocol of a cluster randomised controlled trial.

INTRODUCTION: Chronic kidney disease (CKD) affects 30 million Americans. Early management focused on blood pressure (BP) control decreases cardiovascular morbidity and mortality. Less than 40% of patients with CKD achieve recommended BP targets due to many barriers. These barriers include a lack of understanding of the implications of their diagnosis and how to optimise their health.This cluster randomised control trial hypothesises that the combination of early primary care CKD education, and motivational interviewing (MI)-based health coach support, will improve patient behaviours aligned with BP control by increasing patient knowledge, self-efficacy and motivation. The results will aid in sustainable interventions for future patient-centric education and coaching support to improve quality and outcomes in patients with CKD stages 3-5. Outcomes in patients with CKD stages 3-5 receiving the intervention will be compared with similar patients within a control group. Continuous quality improvement (CQI) and systems methodologies will be used to optimise resource neutrality and leverage existing technology to support implementation and future dissemination. The innovative approach of this research focuses on the importance of a multidisciplinary team, including off-site patient coaching, that can intervene early in the CKD care continuum by supporting patients with education and coaching. METHODS AND ANALYSIS: We will test impact of BP control when clinician-delivered education is followed by 12 months of MI-based health coaching. We will compare outcomes in 350 patients with CKD stages 3-5 between intervention and control groups in primary care. CQI and systems methodologies will optimise education and coaching for future implementation and dissemination. ETHICS AND DISSEMINATION: This study was approved by the University of Michigan Institutional Review Boards (IRBMED) HUM00136011, HUM00150672 and SITE00000092 and the results of the study will be published on ClinicalTrials.gov, in peer-reviewed journals, as well as conference abstracts, posters and presentations. TRIAL REGISTRATION NUMBER: NCT04087798.

Managing food allergy in children: An evidence-based update.

What are the limits of skin-prick testing? Is prevention possible? And do most children outgrow food allergies? This review provides the evidence to guide your care.

Bringing the HPV vaccination rate into line with other adolescent immunizations.

Use simple practice measures and counsel parents with compelling evidence to help correct the low uptake of this vital vaccine.

Impact of an Electronic Health Record (EHR) Reminder on Human Papillomavirus (HPV) Vaccine Initiation and Timely Completion.

BACKGROUND: The initiation and timely completion of the human papillomavirus (HPV) vaccine in young women is critical. We compared the initiation and completion of the HPV vaccine among women in 2 community-based networks with electronic health records: 1 with a prompt and reminder system (prompted cohort) and 1 without (unprompted cohort). METHODS: Female patients aged 9 to 26 years seen between March 1, 2007, and January 25, 2010, were used as the retrospective cohort. Patient demographics and vaccination dates were extracted from the electronic health records. RESULTS: Patients eligible for the vaccine included 6019 from the prompted cohort and 9096 from the unprompted cohort. Mean age at initiation was 17.3 years in the prompted cohort and 18.1 years in the unprompted cohort. Significantly more (P < .001) patients initiated the vaccine in the prompted cohort (34.9%) compared with the unprompted cohort (21.5%). African Americans aged 9 to 18 years with ≥3 visits during the observation period were significantly more likely to initiate in the prompted cohort (P < .001). The prompted cohort was significantly more likely (P < .001) to complete the vaccine series in a timely manner compared with the unprompted cohort. CONCLUSION: More patients aged 9 to 26 years initiated and achieved timely completion of the HPV vaccine series in clinics using an electronic health record system with prompts compared with clinics without prompts.

Various-sourced pectin and polyethylene oxide electrospun fibers.

Pectin, a naturally occurring and biorenewable polysaccharide, is derived from plant cell wall tissue and used in applications ranging from food processing to biomedical engineering. Due to extraction methods and source variation, there is currently no consensus in literature as to the exact structure of pectin. Here, we have studied key material properties of electrospun pectin blends with polyethylene oxide (PEO) (1:1, v/v) in order to demonstrate the fabrication of a fibrous and less toxic material system, as well as to understand the effects of source variability on the resulting fibrous mats. The bulk pectin degree of esterification (DE) estimated using FTIR (bulk apple pomace (AP)=28%, bulk citrus peel (CP)=86% and bulk sugar beet pulp (SBP)=91%) was shown to inversely correlate with electrospun fiber crystallinity determined using XRD (PEO-AP=37%, PEO-CP=28% and PEO-SBP=23%). This in turn affected the trend observed for the mean fiber diameter (n=50) (PEO-AP=124 ± 26 nm, PEO-CP=493 ± 254 nm and PEO-SBP=581 ± 178 nm) and elastic tensile moduli (1.6 ± 0.2 MPa, 4.37 ± 0.64 MPa and 2.49 ± 1.46 MPa, respectively) of the fibrous mats. Electrospun fibers containing bulk AP had the lowest DE, highest crystallinity, smallest mean fiber diameter, and lowest tensile modulus compared to either the bulk CP or bulk SBP. Bound water in PEO-CP fiber and bulk pectin impurities in PEO-SPB were observed to influence fiber branching and mean diameter distributions, which in turn influenced the fiber tensile properties. These results indicate that pectin, when blended with PEO in water, produces submicron fibrous mats with pectin influencing the blend fiber properties. Moreover, the source of pectin is an important variable in creating electrospun blend fibrous mats with desired material properties.

Ectopic pregnancy: zero in on these lab and imaging clues.

Quantitative ß-hCG measurements and transvaginal ultrasound findings interpreted in light of a ß-hCG "cutoff" can reliably guide clinical decisions.

Chaperone use by family physicians during the collection of a Pap smear.

BACKGROUND: We wanted to determine whether variations exist in use of a chaperone during the performance of a pelvic examination by family physicians. METHODS: A self-administered questionnaire was mailed to 5,000 randomly selected active members of the American Academy of Family Physicians. RESULTS: There were 3,551 survey responses (71% response rate) and 2,748 useable questionnaires. Most respondents (75.4%) reported routinely using a chaperone in the room during the collection of a Papanicolaou (Pap) smear. Significantly (P < .00001) more male physicians (84.1%) than female physicians (31.4%) reported using a chaperone. Physicians reporting routine use of a chaperone were significantly younger (P = .01) and did fewer Pap smears per month (P < .00001). Regional reporting of chaperone use varied significantly (P < .00001), with 71.6% reporting use in the Northeast, 89.0% in the South, 65.7% in the Midwest, and 72.4% in the West. CONCLUSION: Family physicians vary considerably in the reported use of a chaperone during the collection of a Pap smear. The variation could reflect different regional or local norms, efficiency or resource issues in high-volume clinical settings, or other interpersonal factors. These issues need to be explored in more depth.

Trigger points: diagnosis and management.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.