Small Body Of Evidence Research Articles

The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia – a systematic review and meta-analysis

Background Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. Aim This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. Methods PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Results Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD −1.05, 95% CI −2.02, −0.09) and follow-up (SMD −1.43, 95% CI −2.17, −0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. Conclusions The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.

Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery.

Updating evidence-based clinical practice guidelines is an onerous process and there is a call for more efficient determination of key questions that need updating. Especially for surgical techniques it is unclear if new evidence will result in substantial changes after wide implementation and if continuous updating is always necessary. This study analyses the impact of updating a surgical guideline and proposes suggestions for optimising this process. The Dutch Minimally Invasive Surgery guideline was developed in 2011 and updated in 2021. For both versions a multidisciplinary guideline working group (GDG) was created, that determined key questions. Changes in conclusions and recommendations were analysed by the GDG and statements for expected change of recommendations in the future were made. 15 key questions were formed, of which 12 were updates of the previous guideline. For only 27% of the updated key questions, the conclusions changed. In ten years, the body grew only marginally for most key questions and quality of the evidence did not improve substantially for almost all key questions. However, in this first update of the MIC guideline, many recommendations did change due to a more robust interpretation of the conclusions by the GDG. Based on analysis of this updating process, the GDG expects that only four out of 15 recommendations may change in the future. We propose an additional step at the end of guideline development and updating, where the necessity for updating in the future is determined for each key question by the GDG, using their valuable knowledge gained from developing or updating the guideline. For surgical guidelines, the authors suggest updating key issues if it includes a relatively newly introduced surgical- or adapted technique or a new patient group. Low quality or small body of evidence should not be a reason in itself for updating, as this mostly does not lead to new evidence-based conclusions. This new step is expected to result in a more efficient prioritising of key questions that need updating. By adding one additional step at the end of the updating process, the future updating process could become more efficient.

The prevalences and levels of occupational exposure to dusts and/or fibres (silica, asbestos and coal): A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

The prevalences and levels of occupational exposure to dusts and/or fibres (silica, asbestos and coal): A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

Testing Links of Food-Related Olfactory Perception to Peripheral Ghrelin and Leptin Concentrations.

The peptide hormones ghrelin and leptin play major roles in the regulation of appetite and food intake. However, the precise effects of these hormones on sensory processing remain a subject of debate, particularly with food related stimuli and its small body of evidence. Here, we test for relationships between ghrelin and leptin levels against olfactory performance with multiple food-related odours. Specifically, a total of 94 Caucasian males were tested for their supra-threshold sensitivity (i.e., d′), intensity, and valence perception to three odour compounds (i.e., vanilla, potato, and dairy odours). These sensory data were then analysed against peripheral ghrelin and leptin levels, both assessed in plasma samples. Participants’ body adiposity measures were also obtained. Results lent strong support to one of our original hypotheses, with ghrelin levels being positively correlated to the supra-threshold sensitivity of the dairy odour, (r = 0.241, p = 0.020), and intensity ratings to most of the food odours tested [dairy (r = 0.216, p = 0.037) and vanilla (r = 0.241, p = 0.020)]. By contrast, peripheral leptin levels were not significantly linked to any of the olfactory measures (p > 0.05). These relationships remained similar after controlling for variabilities of adiposity measures. The present study brings novel insights by identifying positive links between supra-threshold olfactory perception and ghrelin. This new knowledge is highly relevant for future research linking olfactory shifts to hormonal dysregulation and obesity.

Dogs with leishmaniosis: how are we managing proteinuria in daily practice? A Portuguese questionnaire-based study

BackgroundProteinuria is a common finding in dogs with leishmaniosis. Although antileishmanial therapeutic protocols are widely implemented, little information is available on which treatments are most adequate for identifying proteinuria in patients with canine leishmaniosis (CanL), especially regarding the use of immunosuppressants. The aim of this study was to explore the current paradigm regarding the antiproteinuric approach adopted by veterinary practitioners in Portugal to treat dogs with CanL.MethodsA questionnaire-based study was developed using Google Forms®. The questionnaire presented a number of different hypothetical scenarios of CanL, and the topics surveyed included the general features of the respondents and the protocols preferred by these respondents to manage proteinuria in the presented scenarios, including choice of therapeutic drugs, appropriate diet and use of immunosuppressants, in dogs with immune-mediated glomerulonephritis. The questionnaire was internally prevalidated and diffused online over a 2-month period through Portuguese veterinary social networking groups, and data were collected for descriptive analysis.ResultsA total of 86 veterinary practitioners responded to the survey. When exposed to theoretical scenarios of proteinuria in dogs with CanL at stages IIb, III and IV (LeishVet guidelines), 16.3%, 62.8% and 93.8% of the respondents, respectively, answered that they would treat it. The dog was started on a renal diet as therapy by 28.6%, 83.3% and 97.4% of respondents, respectively. Angiotensin-converting enzyme inhibitors (ACEI) were prescribed by 100%, 85.2% and 78.9% of respondents as first-choice drugs for CanL at stages IIb, III and IV, respectively, with ACEI used in monotherapy by 64.3%, 40.7% and 46.1%. In comparison, protocols using ACEI in combination with other compounds were chosen by 7.1%, 33.3% and 39.5% of respondents, and combination therapy which did not include ACEI was the choice of 0.0%, 12.9% and 14.5%. Regarding immunosuppressants, 44.2% of the respondents answered they would prescribe them, with 97.4% electing for prednisolone and 5.3% choosing mycophenolate mofetil.ConclusionsAmong the veterinary practitioners who responded, proteinuria treatment was considered since stage IIb CanL, although implementation of a therapeutic approach was more evident in advanced CanL stages. ACEI were the first-choice drugs, particularly for the treatment of stage IIb CanL; in advanced stages, a combination of antiproteinuric drugs was more often used. Immunosuppressant use was controversial, although when applied, prednisolone was the preferred choice. These findings reinforce the small body of evidence that supports the use of such drugs and the need to further explore their role in CanL.Graphical

Treatment-resistant depression: therapeutic options when first-line treatments fail

SUMMARYThe Cochrane review by Davies et al aimed to address the lack of clarity on the risks and benefits of switching and augmentation strategies in the pharmacological treatment of treatment-resistant depression in adults who did not respond (or partially responded) to at least 4 weeks of antidepressant treatment at a recommended dose. This commentary assesses their review and their conclusion that augmenting the current antidepressant with mianserin or with an antipsychotic improves depressive symptoms over the short-term (8 to 12 weeks). Their results need to be treated with caution owing to the small body of evidence and individual comparisons supported by one, two or three studies, the limited evidence on long-term effects and the significant gaps in the literature (e.g. a lack of studies assessing dose increases).

Healing of a Chronic Pressure Injury in a Patient Treated With Medical Cannabis for Pain and Sleep Improvement: A Case Report

A small body of evidence suggests medical cannabis may facilitate wound healing, but the exact mechanism of this effect is unclear. This case report describes a patient with a pressure injury (PI) who received cannabis oil treatment for pain management and sleep improvement. A 37-year-old woman with multiminicore disease, scoliosis, short-chain acyl-CoA dehydrogenase deficiency, and epilepsy presented to the Neurology Centre of Toronto with chronic pain and sleep disturbance, including difficulty initiating and maintaining sleep. She also had a 5-year history of a PI between her right iliac crest and right rib cage that had progressively worsened. The patient received a medical cannabis oil protocol that used a combination of cannabidiol and tetrahydrocannabinol. Cannabis oil was effective in treating pain and sleep difficulties. Unexpectedly, during the first 2 weeks of treatment, the PI started to heal and was almost completely closed at the 2-month follow-up. Although it is unknown if the observed healing of this refractory PI was indirectly or directly related to the cannabidiol and tetrahydrocannabinol treatment, the potential relationships among pain, sleep disturbance, cannabis treatment, and healing should be explored.

Pelvic Shadowing as a Diagnostic Predictor of Orthopedic Pathology in Orthopedic Trauma Patients

IntroductionThe Throckmorton sign, or John Thomas sign, is a well-established orthopedic eponym, anecdotally used in orthopedic surgery to correlate the direction of male genitalia, observed on a pelvic radiograph, with the laterality of an associated orthopedic pathology. In earlier studies, the direction of pelvic shadowing on X-ray has been neither a credible nor a reliable predictor of fracture laterality. Given this small body of evidence, we sought to further investigate the relationship between peri-trochanteric hip fracture laterality and male genitalia lie.MethodA single-center retrospective chart review was conducted of 397 consecutive male patients who received pelvic radiographs performed upon entry to an urban level 1 trauma center. Exclusion criteria included age less than 18 years or a prior history of pelvic or urological surgery. Of this cohort, 360 patients met the inclusion criteria and underwent investigation.ResultsThe study population had an average age of 42 years (range: 18-91 years). Statistical analysis yielded a 4.24 relative risk with pelvic shadowing laterality and respective peri-trochanteric hip fracture sidedness. Additionally, there was a 4.63 and 9.88 relative risk of tibial shaft fractures and distal radius fractures having a concomitant positive Throckmorton Sign, respectively.ConclusionPelvic shadowing can be used as an additional diagnostic tool in predicting peri-trochanteric hip fracture sidedness in a trauma bay setting.

Thermal Sensitivity of Axolotl Feeding Behaviors.

Musculoskeletal movement results from muscle contractions, recoil of elastic tendons, aponeuroses, and ligaments, or combinations thereof. Muscular and elastic contributions can vary both across behaviors and with changes in temperature. Skeletal muscles reach peak contraction speed at a temperature optimum with performance declining away from that optimum by approximately 50% per 10°C, following the Q10 principle. Elastic recoil action, however, is less temperature sensitive. We subjected Axolotls (Ambystoma mexicanum) to changes from warm (23°C), via medium (14°C), to cold (6°C) temperature across most of their thermal tolerance range, and recorded jaw kinematics during feeding on crickets. We sought to determine if suction feeding strikes and food processing chews involve elastic mechanisms and, specifically, if muscular versus elastic contribution vary with temperature for gape opening and closing. Measurements of peak and mean speed for gape opening and closing during strikes and chews across temperature treatments were compared with Q10-based predictions. We found that strike gape speed decreased significantly from warm and medium to cold treatments, indicating low thermal robustness, and no performance-enhancement due to elastic recoil. For chews, peak, and mean gape closing speeds, as well as peak gape opening speed, also decreased significantly from warm to cold treatments. However, peak gape opening and closing speeds for chews showed performance-enhancement, consistent with a previously demonstrated presence of elastic action in the Axolotl jaw system. Our results add to a relatively small body of evidence suggesting that elastic recoil plays significant roles in aquatic vertebrate feeding systems, and in cyclic food processing mechanisms.

Returning Citizens and Point of Entry: Is There a Match?

The period after incarceration and the influence of neighborhood effects are gaining interest among scholars as a small body of evidence is illustrating the difficulties returning citizens have obtaining basic services and needs, employment, stable housing, and other social and behavioral health supports in the areas where they are being released. Transitional planning efforts to ensure that returning citizens are prepared to engage in society and have necessary supports are often made. However, returning citizens may be in local communities that do not offer needed supports, such as in areas of high poverty and criminal activity, and low employment options. Findings from this study suggest that more attention is needed to where returning citizens are released following their period of incarceration.

The impact of suicide prevention education programmes for nursing students: A systematic review.

The purpose of this systematic review was to locate and synthesize peer-reviewed evidence regarding the effectiveness of providing suicide prevention education to nursing students. Systematic searches were conducted in seven databases (EMBASE, EmCare, Joanna Briggs, MEDLINE, PsycINFO, Scopus, and Web of Science). Results were screened in duplicate at two stages: title and abstract, and full text. Critical appraisal and data extraction were also completed in duplicate. Initial database searching yielded 303 results. Following the addition of seven records from relevant reference lists, and the removal of duplicates, a total of 118 results were included for screening. Eight articles were deemed eligible for inclusion in this review; most (n=5) were quantitative. While all were conducted within university settings, half were stand-alone education sessions, while the remaining were integrated with existing programmes/courses. The types of education programmes varied considerably across studies, with only three being established, evidence-based programmes. The studies explore a range of outcomes, which have been narratively categorized as enhanced skills, abilities, and self-confidence; development of positive attitudes and beliefs; acquisition of knowledge; and programme experience and evaluation. While there is a small body of evidence indicating that suicide prevention education programmes contribute to improvements in skills, abilities, self-confidence, and attitudes among nursing students, the variability in educational interventions and outcomes, coupled with short-term evaluation time frames, makes it difficult to fully understand the impact of this important suicide prevention strategy.

Appraising praise: experimental evidence on positive framing and demand for health services

ABSTRACT Standard economic models of human behaviour take the view that non-informative elements of communication (e.g. tone) do not affect behaviour. Casual observation of consumer and producer behaviour, as well as descriptive evidence, suggests this may be an overly strong assumption in many contexts, including healthcare. For example, 59% of female respondents in the 2011 Ethiopia Demographic and Health Survey reported that ‘rude attitude of health provider’ was a major problem that prevented them from seeking medical advice and treatment. Yet there is only a small body of evidence on the causal effects of non-informative elements of communication from real-world settings. We conducted a field experiment with over 800 HIV+ female sex workers (FSWs) in Ethiopia testing the effects of providing of Praise Message phone calls on retention in antiretroviral (ART) care and adherence to ART medication. We find mixed evidence on the effects of Praise Messages, suggesting further investigation into the effects of praise or other non-informative communication on health behaviour.

The effect of suprainguinal fascia iliaca block on the recovery of patients after arthroscopic hip surgery.

Adolescent and young adult patients undergoing arthroscopic hip surgery experience significant pain in the immediate postoperative period. There is a small body of evidence that indicates suprainguinal fascia iliaca blocks can improve comfort during recovery from this intervention. Our hypothesis was that patients undergoing hip surgery would consume fewer opioids and have less pain in the perioperative time frame if they received the block as part of their analgesic regimen. In this study, we evaluated the outcomes of 716 patients, including 275 who received a suprainguinal fascia iliaca block, and 441 who did not have a block. Inclusion criteria included all age groups and American Society of Anesthesiologists, functional classes 1-2. Patients who received other concurrent procedures or those with incomplete data sets were excluded. We utilized a regional anesthesia database that combined data from various repositories into one web-based relational system. The primary outcomes were total opioid consumption and pain scores in the recovery room. Secondary outcomes included opioid side effects, block-related complications, and total recovery room time. Multivariable logistic regression analysis was used to evaluate opioid consumption, side effects, and total recovery times. Pearson chi-square was applied to assess the level of pain between the two groups. Total opioid consumption was significantly less in the block group compared to those not receiving a block (0.28mg/kg vs 0.35mg/kg, P<0.001, 95% CI of difference in medians 0.04-0.10mg/kg), but there was no statistical difference in pain scores. Patients with the regional block had a lower frequency of emesis in the PACU (0.7% vs 4.3%; P<0.005, 95% CI of difference: 2-25) and shorter PACU times (93 vs 108minutes, P<0.001, 95% CI of difference: 8-23minutes). Our study supports the clinical effectiveness of suprainguinal fascia iliaca blocks in young patients undergoing arthroscopic hip surgery.

Obesity in adolescent females is cause of nutritional imbalance

Anemia is the most common disorder of the blood and it is very typical to identify anemia. Many biotechnological tools are developed regularly for identification of anemia e.g. Analyzers’ for CBC counting, Neubauer chamber for cell counting, Microscopic findings of Bone marrow examination etc. The tools are developed accordingly where there is less errors in assessing and also keeping in mind that less sample may be drawn from sufferer. The objectives of the study were to identify Anemia in various age groups females carried out with the following. Materials and Methods: The blood can be collected (without clots) by veripuncture in the EDTA tube (dipotassium salt) for the test performing are Complete Blood Count (CBC) including Erythrocyte Sedimentation Rate (ESR, method: wintrobe) by using automatic analyzer. Few samples was also examined by POC microscope for further evaluations or analysis. The collected blood samples of 1000 females includes with their symptomatic analysis of present and past history via questionnaire. Then findings are evaluated with sign and symptoms of sick persons, with their family history, clinical history and physical examinations (according to available data) for confirming Anemia. Results were categorized at different categories groups. Results: From the hematological analysis done by using automated analyzer and PDM device of one thousand samples, 57% samples are found as anemic. When their comparative analysis was performed with their weight it was found that about 34.9% females are overweight and affected with disease condition. When categorized type it was found that 29.2% students affected with mild anemia, 4.8% are by moderate anemia and 0.8% were with severe anemia. The maximum anemia cases of students living in PG or hostiles. Conclusion: After performing the hematological analysis it is found that 57% of sample indicating anemia. Day scholar 68.6% and hostiles 81.6% had prone to anemia. It was also seen 1.6% females with severe anemia. Some non anemic about 10% samples are also shows anemic condition with no symptoms of anemia. They are either suffered by chronic illness or infected by blood parasite. PDM device indicated around 5% of cases are with infectious disease cases like Tuberculosis or any other previous illness. The food habit of hostile was worse than those of day scholars. Their food may not contain nutritional content and their food habits are only sustaining their hunger but not supportive with health as much as they required. Based upon a relatively small body of evidence, there appears to be a strong and clinically significant association between anemia and different life threatening diseases like cardiovascular morbidity and mortality in MDS. While further research is needed, clinicians should seek to actively manage hemoglobin levels in all chronic disease patients before the point of transfusion dependency is reached. Keywords: CBC, Blood parasite, Anemia, Mortality, Morbidity, Hemoglobin, Transfusion.

Evaluation of Rescue Thrombolysis in Cardiac Arrest Secondary to Suspected or Confirmed Pulmonary Embolism.

Pulmonary embolism (PE) is the associated cause of unexplained cardiac arrest in 5% to 13% of patients. Although thrombolytic agents have been studied, patient outcomes during cardiac arrest are lacking. The purpose of this study was to describe outcomes of patients who received thrombolytic therapy during cardiac arrest for suspected or confirmed PE. This retrospective review included adults who received alteplase or tenecteplase during cardiac arrest for suspected or confirmed PE. The primary end point was incidence of survival to hospital discharge, whereas secondary end points included a description of dosing strategies of thrombolytic therapy, the incidence of return of spontaneous circulation (ROSC), the occurrence of minor or major bleeding, and intensive care unit and hospital lengths of stay. Of the 22 patients included in the study, 3 patients (13.6%) survived to hospital discharge, and ROSC was obtained in 11 patients (50%). Three patients had confirmed PE prior to cardiac arrest, with the remaining 19 patients having a documented suspicion for PE. The most frequent dosing strategy was alteplase 100 mg given via intravenous push (13 of 22 patients; 59%). One minor and no major bleeding events occurred. Conclusion and Relevance: Medical advances in PE management continue to evolve; yet the role of thrombolytic therapy in PE-related cardiac arrest remains unclear, with low overall rates of survival. These findings add to the relatively small body of evidence and highlight that optimal dosing remains unknown in this setting.

Post-treatment advice following botulinum toxin injections: a review

There is a paucity of published research evidence to support post-treatment recommendations commonly provided to patients following botulinum toxin injections. The purpose of this article is to review both the advice that is given to patients by aesthetic practitioners and the available evidence to substantiate these recommendations. A small body of evidence supports the recommendations for exercising treated muscles post administration to increase the uptake of botulinum toxin and avoiding ultraviolet B radiation with the use of a sunscreen with a sun protection factor of ≥30. Further studies are required to confirm these recommendations. There is no published evidence to support the recommendations of avoiding massaging the treated area, strenuous exercise, lying or bending down, of flying within 24 hours of administration. The practice of cooling to soothe and reduce bruising should no longer be recommended until further research is available.

A Novel Bedside-Focused Ward Surveillance and Response System

Rapid response systems (RRSs) have been universally adopted in much of the developed world; yet, despite broad implementation, their success has often been limited. Even with successful systems, there is a small body of evidence regarding effective organizational elements that are responsible for improved outcomes. New organizational processes were implemented that restructured the existing RRS, and the impact on the number of rapid response team (RRT) alerts, cardiac arrest, and mortality rates was evaluated. A prospective five-year before-and-after comparison of adult ward patient outcomes was conducted at a community regional medical center. The key intervention was expanded administrative oversight of the system, which led to (1) restructuring the content and depth of ward nurse education regarding early recognition of at-risk patients; (2) system changes empowering prompt mobilization of the RRT; (3) development of RRT treatment protocols; and (4) a more frequent and comprehensive data collection and analysis for system compliance and performance improvement. Some 28,914 patients were observed in the 24-month control period, and 39,802 patients were observed in the 33-month intervention period. RRT activations increased from 10.2 to 48.8/1,000 discharges (p <0.001), ward cardiac arrest decreased from 3.1 to. 2.4/1000 discharges (p = 0.04), hospital mortality decreased from 3.8% to 3.2% (p <0.001), and the observed-to-expected ratio decreased from 1.5 to 1.0 (p <0.001). Expanded administrative involvement of an existing RRS that focused on early recognition of patient deterioration by the bedside nurse led to improved performance of the system, with a significant increase in number of RRTs and decreases in cardiac arrests and hospital mortality.

Drug Therapy of Childhood Obesity

Over the last decades obesity prevalence among children and adolescents has increased dramatically and coincidentally the well-established comorbidities associated with the excess body weight have become a major health challenge worldwide. Despite intensive lifestyle modifications, patients severely obese might warrant adjunctive interventions. Although, antiobesity pharmacotherapy is emerging as a promising adjunctive strategy for adults who fail to respond to behavioral strategies, most of agents are not licensed for the treatment of obesity in children and adolescents. The aim of this narrative review is to discuss possible mechanisms by which drugs lead to weight loss and to summarize data concerning FDA-approved anti-obesity focusing on relatively small body of evidence concerning pharmacological options for managing pediatric obesity. Lifestyle and behavioral interventions remain the mainstream of the obesity treatment in children, but adjunctive pharmacotherapy may be beneficial in some patients. Although well-designed clinical trials are needed to properly evaluate safety and efficacy of anti-obesity drugs in children and adolescents, pediatricians dealing with obesity should know what drugs are available. Early identification, during childhood, of individuals who most likely respond favorably to a specific anti-obesity agent will be possibly more efficacious in addressing the global obesity epidemic, than pharmacotherapies started in older ages.

Preliminary Evidence for the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics.

BackgroundOnline communities of practice (oCoPs) may emerge from interactions on social media. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, there is only a small body of evidence in medicine or health care to verify the existence of an oCoP.ObjectiveWe aimed to examine the emergence of an oCoP through the study of social media interactions of the free open access medical education (FOAM) movement.MethodsWe examined social media activity in Twitter by analyzing the network centrality metrics of tweets with the #FOAMed hashtag and compared them with previously validated criteria of a community of practice (CoP).ResultsThe centrality analytics of the FOAM community showed concordance with aspects of a general CoP (in terms of community, domain, and practice), as well as some specific traits of a health care community, including social control, common purpose, flat hierarchy, and network-based and concrete achievement.ConclusionsThis study demonstrated preliminary evidence of an oCoP focused on education and based on social media interactions. Further examination of the topology of the network is needed to definitely prove the existence of an oCoP. Given that these communities result in significant knowledge translation and practice change, further research in this area appears warranted.

Survey of Attitudes to Self-Harm Patients Within a Burns and Plastic Surgery Department.

This study aims to build on the small body of evidence in previously published study exploring professional attitudes toward deliberate self-harm (DSH) patients from a predominantly burns and plastic surgery perspective. The authors distributed a short paper-based questionnaire within the burns and plastics department at the Queen Elizabeth Hospital, Birmingham, where the authors gathered a mixture of qualitative and quantitative data surrounding this issue. Professionals generally agree that DSH patients require input from multiple services and that surgery is not always the best option. The most common frustration among healthcare professionals regarding the care of DSH patients includes inconsistencies in care, lack of training/understanding, and the need for a policy to guide and standardize treatment. Improving training in line with UK National Institute of Health and Care Excellence (NICE) guidance along with introducing guidelines for the care of DSH patients may help smooth out inconsistencies in care and reduce frustrations among staff members.