Communicating Absolute Fracture Risk Reduction and the Acceptance of Treatment for Osteoporosis.

Healthcare professionals frequently communicate the benefits of treatments as a relative risk reduction (RRR) in the likelihood of an event occurring. Here we evaluated whether presenting the benefits of osteoporosis treatment as a RRR in fractures compared with an absolute risk reduction (ARR) changed the patient's attitudes towards accepting treatment. We surveyed 160 individuals attending a specialised osteoporosis clinic for face-to-face consultations between May 2018 and Jan 2021. They were presented with information on RRR for the treatment being considered followed by ARR and after each question were asked about how likely they would be to start treatment on a 5-point scale (1 = very likely, 5 = very unlikely). Participants were less likely to accept treatment when it was presented as ARR (mean score 2.02 vs. 2.67, p < 0.001, 95% CI for difference - 0.82 vs - 0.47) and thirty-eight participants (23.7%) declined treatment with knowledge of their ARR when they would have accepted the same treatment based on the RRR. Individuals who declined treatment had a lower 5-year risk of fracture than those who accepted treatment (9.0 vs. 12.5%, p < 0.001, 95% CI - 5.0 to - 1.6) and as fracture risk decreased, the participant was less likely to accept treatment (Spearman r - 0.32, 95% CI - 0.46 to - 0.17, p ≤ 0.001). Whilst presentation of data as ARR more accurately reflects individual benefit and helps facilitate shared decision-making, clinicians should be aware that this will lead to a proportion of patients with lower fracture risk declining treatment for osteoporosis.

Evaluation of supported self-management in gout (GoutSMART): a randomised controlled feasibility trial.

BACKGROUND: Improved outcomes for patients with gout are associated with the control of urate levels; yet, less than 40% of patients in the UK are currently offered urate lowering therapy, and it is typically offered without titration to target. Supported self-management has been shown to benefit patients with chronic health conditions; therefore, we aimed to determine whether a supported gout self-management approach, incorporating treatment-to-target urate, helped participants reach target urate levels. METHODS: In this randomised controlled feasibility study, conducted in one hospital in Edinburgh, UK, we included patients (aged ≥18 years) with gout and a physician recommendation for initiation or escalation of urate lowering therapy. We randomised participants in a 2:1 ratio to a supported self-management group or a usual care group using the GoutSMART smartphone app. Participants in the self-management group were given a urate self-testing meter and received direct advice from clinicians on escalation of urate lowering therapy through the app. Participants were identified following referral to rheumatology, or using the Scottish Health Research Register, and they were screened and offered a detailed management plan before randomisation. Participants in the usual care group had a limited version of the app, which only allowed it to function as a health diary, and their gout management plan was implemented by their general practitioner. The primary outcome was the percentage of participants achieving a urate target of 0·30 mmol/L or less at 24 weeks, and analysis was by intent to treat. The trial was registered with ClinicalTrials.gov, NCT03274063, and there is an extension study ongoing. There was no masking of participants or assessors. FINDINGS: Between April 5, 2019, and March 19, 2020, 60 (65%) of 92 patients screened were enrolled to the study. The mean age was 52.8 years (SD 14.6); 56 (93%) of the participants were male, and 4 (7%) were female. 58 (97%) of participants were White. 40 participants were assigned to the self-supported management group and 20 participants were assigned to the usual care group. A urate target of 0·30 mmol/L or less at 24 weeks was reached by 29 (73%) participants in the supported self-management group compared with 3 (15%) participants in the usual care group (risk difference 0·58 [95% CI 0·37-0·78]; p<0·0001). 90% of participants completed the study with no difference in the drop-out rate or adverse events between the two groups. INTERPRETATION: Supported self-management of gout results in substantially improved attainment of urate targets compared with usual care, and it is well tolerated. Larger trials will be needed to fully evaluate the clinical and cost-effectiveness of this approach. FUNDING: Edinburgh & Lothians Health Foundation.

Integrating distributed data sources with OGSA-DAI DQP and VIEWS.

OGSA-DAI (Open Grid Services Architecture Data Access and Integration) is a framework for building distributed data access and integration systems. Until recently, it lacked the built-in functionality that would allow easy creation of federations of distributed data sources. The latest release of the OGSA-DAI framework introduced the OGSA-DAI DQP (Distributed Query Processing) resource. The new resource encapsulates a distributed query processor, that is able to orchestrate distributed data sources when answering declarative user queries. The query processor has many extensibility points, making it easy to customize. We have also introduced a new OGSA-DAI Views resource that provides a flexible method for defining views over relational data. The interoperability of the two new resources, together with the flexibility of the OGSA-DAI framework, allows the building of highly customized data integration solutions.

Seasonal variations in human seminal parameters.

OBJECTIVES: To obtain data on seasonal variations of sperm parameters in an andrology laboratory. STUDY DESIGN: Semen parameter values and hormone values of 2454 patients attending our infertility clinic between 1990 and 1997 were analysed. Seasonal trends were calculated using the method of Edwards [Ann. Hum. Genet. 25 (1961) 83]. RESULTS: The total group of mean sperm count did not show a significant variation, but a significant circannual trend occurred of patients born in the groups 1950-1954, 1955-1959 and 1965-1969. A significant variation of acrosin activity occurred with a maximum in March. The other parameters did no show significant variations. CONCLUSIONS: The knowledge on circannual variation of semen parameters and hormone values may be of value in diagnostic and therapeutic decisions in reproductive medicine.