Are plain-language summaries included in published reports of evidence about physiotherapy interventions? Analysis of 4421 randomised trials,systematic reviews and guidelines on the Physiotherapy Evidence Database (PEDro)

BackgroundA plain-language summary is a short and clearly stated version of a study’s results using non-scientific vocabulary that provide many advantages for patients and clinicians in the process of shared decision-making.ObjectivesThe primary objective was to investigate the extent to which published reports of physiotherapy interventions provide plain-language summaries. We investigate as the secondary objectives if the available plain-language summaries are at a suitable reading level for a lay person and if inclusion of plain-language summaries in these reports is increasing over time and is associated with trial quality (i.e. PEDro score).Data sourcesAll 4421 randomised controlled trials (RCT), systematic reviews and clinical practice guidelines that included plain-language summaries indexed on Physiotherapy Evidence Database (PEDro) were included.Main outcome measuresProportion of published reports with plain-language summaries, Flesch Reading Ease Score (FRES) and the Flesch–Kincaid Grade Level (FKGL).ResultsThe number of published reports with a plain-language summary doubled in the last 6 years. From a total of 34,444 reports indexed on PEDro, only 4421 reports had English plain-language summaries. RCTs with plain-language summaries had higher PEDro scores than RCTs without plain-language summaries (mean difference = 0.8 points, 95%CI 0.7 to 0.8). Only 2% of reports were considered at a suitable reading level by the FKGL formula and 0.1% by the FRES formula.ConclusionsAlthough the publication of plain-language summaries is increasing over time, the current number corresponds to only 13% of all published reports. In addition the majority of plain-language summaries are written at an advanced reading level.     

Touring Arkansas: A Statewide Project to Instruct Nurses and Patient Educators on Consumer Health Resources

Abstract

This article follows up a pilot project to help educate local nurses and patient educators on freely available consumer health resources. The Outreach Coordinator and Clinical Librarian at an academic medical center created a one-hour in-person and online class with continuing education credit and an online guide. Nurses frequently act as patient educators at the bedside and are therefore an important target for consumer health education. While nurses in an urban setting may have more access to educational opportunities, these opportunities are needed even more in rural settings. Librarians can obtain funding to travel and teach classes at rural community hospitals.     

Validity,potential clinical utility and comparison of a consumer activity tracker and a research‐grade activity tracker in insomnia disorder II: Outside the laboratory

Accurate assessment of sleep can be fundamental for monitoring, managing and evaluating treatment outcomes within diseases. A proliferation of consumer activity trackers gives easy access to objective sleep. We evaluated the performance of a commercial device (Fitbit Alta HR) relative to a research‐grade actigraph (Actiwatch Spectrum Pro) in measuring sleep before and after a cognitive behavioural intervention in insomnia disorder. Twenty‐five individuals with DSM‐5 insomnia disorder (M = 50.6 ± 15.9 years) wore Fitbit and Actiwatch and completed a sleep diary during an in‐laboratory polysomnogram, and for 1 week preceding and following seven weekly sessions of cognitive‐behavioural intervention for insomnia. Device performance was compared for sleep outcomes (total sleep time, sleep latency, sleep efficiency and wake after sleep onset). The analyses assessed (a) agreement between devices across days and pre‐ to post‐treatment, and (b) whether pre‐ to post‐treatment changes in sleep assessed by devices correlated with clinical measures of change. Devices generally did not significantly differ from each other on sleep variable estimates, either night to night, in response to sleep manipulation (pre‐ to post‐treatment) or in response to changes in environment (in the laboratory versus at home). Change in sleep measures across time from each device showed some correlation with common clinical measures of change in insomnia, but not insomnia diagnosis as a categorical variable. Overall, the Fitbit provides similar estimates of sleep outside the laboratory to a research grade actigraph. Despite the similarity between Fitbit and Actiwatch performance, the use of consumer technology is still in its infancy and caution should be taken in its interpretation.     

The contemporary landscape of genetic testing and breast cancer: Emerging issues

The landscape of genetic testing for breast cancer susceptibility has transformed dramatically over the last decade and a half. Traditionally, the process of genetic testing resided fully within a medical infrastructure, from identification of appropriate testing candidates to gene selection to risk mitigation recommendations. More recently, decreasing costs, advancing technology, and a growing understanding of therapeutic implications of certain genetic test results have led to more widespread uptake of testing that increasingly involves broad multigene panels. Germline genetic testing for breast cancer susceptibility can now be obtained through one of three approaches: through clinical care; a direct‐to‐consumer (DTC) approach that is entirely consumer‐driven; or a hybrid, patient‐initiated, provider‐mediated model. Increased access to testing has led to extensive dialogue about the best way to conduct testing and act on results. Points of discussion include: selection of appropriate candidates for genetic testing; optimal composition of genes on panels; informed consent; safe return of results; privacy; and legal protections for those found to have relevant pathogenic or likely pathogenic variants. As more individuals undergo genetic testing, a growing population of individuals with inherited breast cancer predisposition informs optimal management of cancer risk and also highlights unanswered questions. This article aims to review the current state of genetic testing for inherited breast cancer susceptibility including testing approaches, the legal, ethical and social landscape, and selected contemporary management issues.     

A pilot study of a novel smartphone application for the estimation of sleep onset

The aim of the study was to investigate the accuracy of Sleep On Cue: a novel iPhone application that uses behavioural responses to auditory stimuli to estimate sleep onset. Twelve young adults underwent polysomnography recording while simultaneously using Sleep On Cue. Participants completed as many sleep‐onset trials as possible within a 2‐h period following their normal bedtime. On each trial, participants were awoken by the app following behavioural sleep onset. Then, after a short break of wakefulness, commenced the next trial. There was a high degree of correspondence between polysomnography‐determined sleep onset and Sleep On Cue behavioural sleep onset, r = 0.79, P < 0.001. On average, Sleep On Cue overestimated sleep‐onset latency by 3.17 min (SD = 3.04). When polysomnography sleep onset was defined as the beginning of N2 sleep, the discrepancy was reduced considerably (M = 0.81, SD = 1.96). The discrepancy between polysomnography and Sleep On Cue varied between individuals, which was potentially due to variations in auditory stimulus intensity. Further research is required to determine whether modifications to the stimulus intensity and behavioural response could improve the accuracy of the app. Nonetheless, Sleep On Cue is a viable option for estimating sleep onset and may be used to administer Intensive Sleep Retraining or facilitate power naps in the home environment.     

From the Cover: PNAS Plus: Climate change,pink salmon,and the nexus between bottom-up and top-down forcing in the subarctic Pacific Ocean and Bering Sea

Climate change in the last century was associated with spectacular growth of many wild Pacific salmon stocks in the North Pacific Ocean and Bering Sea, apparently through bottom-up forcing linking meteorology to ocean physics, water temperature, and plankton production. One species in particular, pink salmon, became so numerous by the 1990s that they began to dominate other species of salmon for prey resources and to exert top-down control in the open ocean ecosystem. Information from long-term monitoring of seabirds in the Aleutian Islands and Bering Sea reveals that the sphere of influence of pink salmon is much larger than previously known. Seabirds, pink salmon, other species of salmon, and by extension other higher-order predators, are tightly linked ecologically and must be included in international management and conservation policies for sustaining all species that compete for common, finite resource pools. These data further emphasize that the unique 2-y cycle in abundance of pink salmon drives interannual shifts between two alternate states of a complex marine ecosystem.Predator control of community structure and ecosystem function became a tenet of intertidal and nearshore marine ecology following early studies of Paine and others (1–3), yet with few exceptions (4, 5), until more recent times the idea has been less well appreciated for open oceans. Growing attention now is being paid to the overexploitation of pelagic species, particularly those at higher trophic levels currently and in the past, and effects on ocean ecosystems of the loss, or development, of top-down forcing (6–12).The prevailing view has long held that most biological change in ocean ecosystems, apart from human exploitation, is driven from the bottom up (13–16). One striking example that has been linked to bottom-up processes driven by climate change is the burgeoning abundance of wild Pacific salmon (Oncorhynchus spp.), and in particular pink salmon (Oncorhynchus gorbuscha), in the subarctic North Pacific Ocean and Bering Sea (SNPO/BS). Underpinning the notion initially were studies that found (i) strong coherence between decadal patterns in the Aleutian Low pressure system, which exerts a large influence over climate in the North Pacific Ocean, and patterns in salmon production across a broad region of the SNPO/BS (17, 18); (ii) decadal patterns in primary production that could be explained by the effect of the Aleutian Low pressure system on basin scale wind fields (19); and (iii) decadal patterns in zooplankton, squid, and pelagic fish production that also were correlated with meteorological forcing over the North Pacific Ocean and consistent with patterns in primary production (20). Thus, the general explanation for waxing and waning abundances of salmon over the record in the 20th century was that physical forcing by shifts in the strength and position of the Aleutian Low altered winds, ocean temperatures, and primary and secondary production to the benefit or detriment of salmon. A decadal scale oscillation in the Aleutian Low, now often referred to as the Pacific Decadal Oscillation (PDO) (21), has been linked to numerous physical and biological variability in the SNPO/BS in addition to salmon abundance (21–23).It was subsequently shown that salmon population responses and their relation to the PDO were out of phase between Alaska and the northwest coast of North America during much of the 20th century (24); that warm anomalies in coastal temperatures were associated with increased survival of salmon in Alaska; and that regional-scale variability in ocean temperature was a better predictor of salmon survival than large, basin-scale variability characterized by the PDO (25). A recent analysis from around the rim of the North Pacific Ocean found regional covariance in abundance of pink salmon, chum salmon (Oncorhynchus keta), and sockeye salmon (Oncorhynchus nerka) associated with the Aleutian Low, and with smaller scale spatially coherent, but regionally distinct, patterns in climate (26).Water temperature can be important to the early growth and survival of pink salmon fry directly by its effect on physiology and indirectly by its effect on the timing and development of zooplankton prey stocks in nursery areas, which commonly is advanced and greater in warmer years than in cooler years. In cooler springs, fry grow more slowly and a greater number die both from lack of food and from an increased susceptibility to predators (27, 28). For example, a conceptual model for Prince William Sound, Alaska, holds that, in years of abundant spring zooplankton, fry grow faster and remain longer in the shelter of inshore nurseries where they are protected from walleye pollock (Theragra chalcogramma) and Pacific herring (Clupea pallasii), two chief predators that remain offshore feeding primarily on swarms of large calanoid copepods and other macrozooplankton. In cooler years of lower zooplankton biomass inshore, fry grow more slowly, move offshore earlier, and suffer higher predation by pollock and herring due to spatial overlap, smaller size, and less alternative prey for those two predators (28).Although the relationship between climate and pink salmon survival is likely complex, fluctuations in abundance appear to be modulated in large measure directly and indirectly by the thermal environment in which a stock lives. Such a fundamentally bottom-up explanation is bolstered by observations of high growth and survival rates of pink salmon during the period of warmer ocean temperatures and population increase (29, 30), and at this time provides a more parsimonious explanation for population dynamics than would explanations invoking strictly top-down control across such a broad region. Now, however, several lines of evidence indicate that pink salmon themselves are having a large top-down influence on other salmon species, other upper trophic level pelagic species, plankton standing stocks, and by inference, the functioning of the open-ocean ecosystem in the SNPO/BS.     

Perceptions of crisis care in populations who self‐referred to a telephone‐based mental health triage service

Although psychiatric crises are very common in people with mental illness, little is known about consumer perceptions of mental health crisis care. Given the current emphasis on recovery‐oriented approaches, shared decision‐making, and partnering with consumers in planning and delivering care, this knowledge gap is significant. Since the late 1990s, access to Australian mental health services has been facilitated by 24/7 telephone‐based mental health triage systems, which provide initial psychiatric assessment, referral, support, and advice. A significant proportion of consumers access telephone‐based mental health triage services in a state of crisis, but to date, there has been no published studies that specifically report on consumer perceptions on the quality and effectiveness of the care provided by these services. This article reports on a study that investigated consumer perceptions of accessing telephone‐based mental health triage services. Seventy‐five mental health consumers participated in a telephone interview about their triage service use experience. An eight‐item survey designed to measure the responsiveness of mental health services was used for data collection. The findings reported here focus on the qualitative data produced in the study. Consumer participants shared a range of perspectives on telephone‐based mental health triage that provide invaluable insights into the needs, expectations, and service use experiences of consumers seeking assistance with a mental health problem. Consumer perceptions of crisis care have important implications for practice. Approaches and interventions identified as important to quality care can be used to inform educational and practice initiatives that promote person‐centred, collaborative crisis care.     

Levels of satisfaction of 'low-risk' mothers with their current health visiting service

AIMS AND OBJECTIVES: To assess the expressed levels of satisfaction of 'low-risk' mothers with the current health visiting service. Setting Sheffield, England, Autumn 1997. METHODOLOGY: Self-completion, postal questionnaire (initial postcard reminder followed by a second letter and questionnaire) to a sample of 403 mothers assessed as 'low priority' by their health visitor. Questions largely related to maternal opinion of the adequacy of the health visiting service delivered during the first 9-12 months. The local research ethics committee approved the study. RESULTS: A corrected response rate of 75% with little evidence of significant bias. A high proportion (86%) of women stated that they were either 'fairly' or 'very' satisfied with the service they had received from their health visitor with regard to their baby. A lower proportion (72%) was equally satisfied with the service they had received in respect of their own health. Despite an average number of approximately 10 contacts in relation to infant health with the health visitor during the first year of life, some 6% of women wanted more frequent contacts, particularly in the first few weeks. Study limitations The questionnaire was designed specifically for the study and validation was limited. The study population comprised a selected, 'low-risk' group. CONCLUSIONS: The number of reported contacts with the health visitor seemed to greatly exceed those indicated by a basic child health surveillance programme. The overall level of maternal satisfaction is high, though a minority of women would like more support. Dissatisfaction was expressed with the lack of an appointment system for clinics, poor punctuality in home visits, and inappropriate or inadequate advice.