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Purpose: To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Methods: In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. Results: We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p= 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p= 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. Conclusions: Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. Clinical trial registration: ClinicalTrial.gov: NCT01502891.

This paper outlines the complexities — and unlikelihood — of keeping families together when facing, or in the aftermath of deportation. After discussing the context that limits or prevents reunification among immigrant families more generally, I outline several of the particular ways that families are divided when a member is deported. Drawing on case studies from longitudinal ethnographic research in Mexico and the United States, I describe: 1) the difficulties in successfully canceling deportation orders, 2) the particular limitations to family reunification for US citizen children when a parent is deported, and 3) the legal barriers to authorized return to the United States after deportation. I argue that without comprehensive immigration reform and concrete possibilities for relief, mixed-status and transnational families will continue to be divided. Existing laws do not adequately address family life and the diverse needs of individuals as members of families, creating a humanitarian crisis both within and beyond the borders of the United States. The paper concludes with recommendations for immigration policy reform and suggestions for restructuring administrative processes that directly impact those who have been deported and their family members.

To evaluate the preliminary efficacy, feasibility, and acceptability of a template-based intervention to facilitate shared decision making (SDM) in medication therapy management (MTM) consultations; and to examine the type and number of drug therapy problems (DTPs) discussed and how resolution was communicated to patients' primary care providers (PCPs).

IMPORTANCE: For antidepressants, the translation of evidence of comparative effectiveness into practice is suboptimal. This deficit directly affects outcomes and quality of care for patients with depression. To overcome this problem, we developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians consider the available antidepressants and the extent to which they improved depression and other issues important to patients. OBJECTIVE: Estimate the effect of DMC on quality of the decision‐making process and depression outcomes. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cluster randomized trial of adults with moderate to severe depression considering treatment with an antidepressant. Primary care practices in 10 rural, suburban, and urban primary care practices across Minnesota and Wisconsin were randomly allocated to treatment of depression with or without use of the DMC decision aid. INTERVENTION: Depression Medication Choice, a series of cards, each highlighting the effect of the available options on an issue of importance to patients for use during face-to-face consultations. MAIN OUTCOMES AND MEASURES: Decision-making quality as judged by patient knowledge and involvement in decision making, patient and clinician decisional comfort (Decisional Conflict Scale) and satisfaction, encounter duration, medication adherence, depression symptoms, and the Patient Health Questionnaire for depression (PHQ-9). RESULTS: We enrolled 117 clinicians and 301 patients (67% women; mean [SD] age, 44 [15] years; mean [SD] PHQ-9 score, 15 [4]) into the trial. Compared with usual care (UC), use of DMC significantly improved patients’ decisional comfort (DMC, 80% vs UC, 75%; P = .02), knowledge (DMC, 65% vs UC, 56%; P = .03), satisfaction (risk ratio [RR], from 1.25 [P = .81] to RR, 2.4 [P = .002] depending on satisfaction domain), and involvement (DMC, 47% vs UC, 33%; P<.001). It also improved clinicians’ decisional comfort (DMC, 80% vs UC, 68%; P < .001) and satisfaction (RR, 1.64; P = .02). There were no differences in encounter duration, medication adherence, or improvement of depression control between arms. CONCLUSIONS AND RELEVANCE: The DMC decision aid helped primary care clinicians and patients with moderate to severe depression select antidepressants together, improving the decision-making process without extending the visit. On the other hand, DMC had no discernible effect on medication adherence or depression outcomes. By translating comparative effectiveness into patient-centered care, use of DMC improved the quality of primary care for patients with depression. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01502891

The article presents the latest film version of the saga of Pocahontas and Captain John Smith titled "The New World," directed by Terrence Malick and starring Colin Farrell as Smith, Q'orianka Kilcher as Pocahontas, and Irene Bedard as the mother of Pocahontas. Reports indicate that the film is not a factual rendering, but rather a dramatization inspired by the legend. Everyone who worked on the film took great pains to achieve maximum authenticity and aesthetic effect in costuming, set design, body decoration and other details. Algonquian linguist Blair Rudes was hired to extrapolate it from a handful of remaining words, and the entire Native cast spoke their lines in this resurrected tongue. The cast also includes a number of Native American actors including August Schellenberg, Michael Greyeyes, Raoul Trujillo and Myrton Running Wolf.

The numbers of those affected by the HIV virus worldwide are staggering. Emerging research demonstrates a number of lower cost medical approaches that would significantly reduce the rates of transmission of the virus. Nursing plays a critical role in quality‐of‐life issues at time of diagnosis. Supportive caregiving by compassionate use of vocabulary and knowledgeable resourcing for patients is part of nursing practice in HIV/AIDS care.

The numbers of those affected by the HIV virus worldwide are staggering. Emerging research demonstrates a number of lower cost medical approaches that would significantly reduce the rates of transmission of the virus. Nursing plays a critical role in quality-of-life issues at time of diagnosis. Supportive caregiving by compassionate use of vocabulary and knowledgeable resourcing for patients is part of nursing practice in HIV/AIDS care.

Human colonic cancer cells (HT-29, 107cells/dose) were injected subcutaneously between the scapulae of 19 severe combined immunodeficient (SCID) mice. After 19 days, large tumours had developed in 18 out of the 19 animals and the mice were then killed. Metastases were detected in the lungs of 16 animals but not in other organs investigated. Surgical removal of the primary tumour in another group of five animals led to a prolonged survival and further growth of metastases in the lungs. HT-29 injection into the tail vein(n=5)resulted in colonization of the lungs. The tumours that developed in the animals were signet cell carcinomas; these forms are not seen in HT-29 cells in culture. Glycoconjugate expression of the tumours was assessed using several lectins. In many cases the results indicated a stability of lectin-binding patterns from cell culture conditions to implantation into the SCID mice. This was true for the lectinHelix pomatiaagglutinin (HPA), the binding of which is associated with a high metastatic potential in some human tumours, including colon cancer. All the primary tumours and metastases were HPA positive. This xenograft tumour model seems to be a clinically relevant system for the study of glycoconjugate expression in human colon cancer cells and their metastases.

The cervical cap is an ancient method of contraception revitalized during the 1970s by feminist health care practitioners. It acts as a contraceptive both mechanically and chemically. This study looks at the effectiveness and satisfaction of the cervical cap in 76 women fitted over a 1‐year period. The cap is 80.4% effective according to the Pearl Index and 89% of the women are satisfied with using the cap. There is a 51% continuation rate over a 1‐year period. The cervical cap appears to have a satisfactory rate of contraception when compared with other barrier methods and women are adept at its use. A significant finding is that most pregnancies occur in the first three months of cap use. A much higher effectiveness is seen subsequently.