Search

Objective: To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD). Background: The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized. Methods: Patients with obesity (body mass index =30 kg/m²), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.73 m² who underwent metabolic bariatric surgery at a large US health system (2010-2017) were compared with nonsurgical patients who continuously received GLP-1RA. The primary end point was CKD progression, defined as a decline of eGFR by =50% or to <15 mL/min/1.73 m2, initiation of dialysis, or kidney transplant. The secondary end point was the incident kidney failure (eGFR <15 mL/min/1.73 m2, dialysis, or kidney transplant) or all-cause mortality. Results: 425 patients, including 183 patients in the metabolic surgery group and 242 patients in the GLP-1RA group, with a median follow-up of 5.8 years (IQR, 4.4-7.6), were analyzed. The cumulative incidence of the primary end point at 8 years was 21.7% (95% CI: 12.2-30.6) in the surgical group and 45.1% (95% CI: 27.7 to 58.4) in the nonsurgical group, with an adjusted hazard ratio of 0.40 (95% CI: 0.21 to 0.76), P=0.006. The cumulative incidence of the secondary composite end point at 8 years was 24.0% (95% CI: 14.1 to 33.2) in the surgical group and 43.8% (95% CI: 28.1 to 56.1) in the nonsurgical group, with an adjusted HR of 0.56 (95% CI: 0.31 to 0.99), P= 0.048. Conclusions: Among patients with type 2 diabetes, obesity, and established CKD, metabolic surgery, compared with GLP-1RA, was significantly associated with a 60% lower risk of progression of kidney impairment and a 44% lower risk of kidney failure or death. Metabolic surgery should be considered as a therapeutic option for patients with CKD and obesity. [ABSTRACT FROM AUTHOR]

Dental hygiene for institutionalized patients and recurring Candida- associated denture stomatitis remain problematic because of a patient's limited dexterity or inability to eliminate Candida from denture surfaces. Although there has been extensive research into antimicrobial modification of denture base resins with inorganic materials, scoping reviews of the literature to identify knowledge gaps or efficacy of inorganic antimicrobial materials in denture base resins are lacking. The purpose of this scoping review was to provide a synopsis of the efficacy of the major classes of inorganic antimicrobial materials currently incorporated into denture base resins. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was applied. Four electronic databases, including Embase, PubMed, Web of Science, and Google Scholar, were accessed for articles in the English language, up to February 2019, without restrictions on the date of publication. From the 53 articles selected, 25 distinguishable inorganic materials were found and divided into 3 subgroups. Forty-three articles evaluated nanomaterials, where mostly silver ion nanoparticles and/or titanium dioxide nanoparticles were incorporated into denture base resins. Fourteen articles examined antimicrobial drugs and medications, including azole group medications, amphotericin-B, Bactekiller, chlorhexidine, Novaron, and Zeomic. Two articles classified as others explored hydroxyapatite- and fiber-incorporated denture base resins. Although nanotechnology and antimicrobial medications or drugs have been successfully used to reduce Candida- associated denture stomatitis, long-term solutions are still lacking, and their disadvantages continue to outweigh their advantages. [ABSTRACT FROM AUTHOR]

Having a visible difference caused by an appearance-altering condition or injury can impact psychosocial wellbeing. It remains unestablished whether the time at which a visible difference manifests, namely pre-memory (congenital) or later (acquired), predicts psychosocial outcomes associated with adjustment. In this survey study of 331 adults with visible differences, we tested whether their type, congenital (n = 161) or acquired (n = 170), would predict four key psychosocial outcomes: Appearance satisfaction, social appearance anxiety, life disengagement and intimacy distress. To account for other potential predictors and to test whether other variables would moderate any predictive effect found from the type of visible difference, the analyses also included demographic variables, visible difference characteristics and history, and interpersonal and intrapersonal factors. Four regression models were tested. With all variables entered, we found no evidence of type of visible difference as a significant predictor of any psychosocial outcome. Instead, the only consistent predictors of outcomes were optimism, social support and the extent to which participants felt able to disguise their difference. Overall, findings do not support the idea that there is a psychosocial advantage to having a congenital nor acquired visible difference, and broadly reinforce commonalities in adjusting to any cause. • Congenital versus acquired visible difference did not predict psychosocial outcomes. • Higher optimism and social support predicted more favourable outcomes. • Subjectively more disguisable differences predicted more favourable outcomes. [ABSTRACT FROM AUTHOR]

The article provides information on the Folger Shakespeare Library's podcast, "Shakespeare Unlimited," featuring over 200 episodes covering a diverse range of topics related to Shakespeare and early modern England, with hosts Rebeca Sheir, Neva Grant, and Barbara Bogaev.

To investigate mobility outcomes for a person with multiple sclerosis using functional electrical stimulation (FES) cycling and dalfampridine. This is a retrospective observational study of a single patient with multiple sclerosis over 68 weeks. The study settings include an outpatient neurological physical therapy center (14 weeks) and the patient's home (46 weeks). The patient was an ambulatory 40 year old male diagnosed with primary progressive multiple sclerosis and impaired walking function. The patient completed 16 sessions of FES cycling over 14 weeks of outpatient physical therapy, followed by 8 weeks with no intervention. Then, the patient began taking 10 mg of dalfampridine every 12 hours and completed 128 FES cycling sessions at home over 46 weeks. The primary outcome measures were the Timed 25-Foot Walk Test (T25FW), 6 Minute Walk Test (6MWT), 10 Meter Walk Test (10MWT), Timed Up and Go Test (TUG), Five Times Sit to Stand Test (5XSST), Functional Gait Assessment (FGA), and Berg Balance Scale (BBS). Across the study, the patient's outcomes improved from 4.81 s to 3.43 s on the T25FW, 1353 ft to 1837 ft on the 6MWT, 0.979 m/s to 1.255 m/s on the 10 MWT, 8.98 s to 6.02 s on the TUG, 14.85 s to 9.46 s on the 5XSST, 16/30 to 27/30 on the FGA, and 45/56 to 54/56 on the BBS. The patient in this case significantly improved his walking function with FES cycling and dalfampridine. The intervention outcomes are consistent with the available evidence for the benefits of FES cycling and dalfampridine for people with multiple sclerosis and impaired walking function, but more studies are needed to increase the level of evidence. All authors are employed by the manufacturer of one of the FES cycling devices used by the patient in this case report (MYOLYN, Inc.). M.B. and A.H. also hold stock in this organization and may gain or lose financially from the publication of this case report. [ABSTRACT FROM AUTHOR]

Long-term durability of weight loss is a prerequisite for a greater acceptance of bariatric surgery. To examine long-term weight trajectory in patients undergoing Roux-en-Y gastric bypass (RYGB) and determine factors predicting long-term follow-up and weight outcomes. University hospital. A retrospective cohort of adults who underwent RYGB during 1997–2010 were identified and followed until 2017. Predictors for attendance at periodic follow-up visits, reduction in body mass index (BMI), and percent excess BMI lost were determined using multivariable logistic regression and linear mixed-effects models. The latter was used to predict long-term weight outcomes for a typical patient. The study included 1104 patients with a mean age of 45.5 (standard deviation [SD] 9.9) years and a preoperative BMI of 54.7 (SD 10.9) kg/m2. Follow-up data were available for 92.8% of the patients after 1 year, 50.0% after 5 years, and 35.2% after 10 years post-surgery. Black patients, compared with White patients, were less likely to attend follow-up visits. Attendance at follow-up visits at least every other year was not associated with larger weight loss, but higher preoperative BMI, being White (versus Black), and female sex were. Predicted BMI reduction for a typical patient, a 45-year-old White female with a preoperative BMI of 54.7 kg/m2 and private health insurance, undergoing laparoscopic RYGB in 2004, was 18.3 (standard error [SE].36) kg/m2 at year 5 and 17.6 (SE.49) kg/m2 at year 10. RYGB results in clinically significant and durable weight loss. Attendance at periodic follow-up visits does not appear to be associated with long-term weight loss outcomes. Future work should focus on strategies to remove barriers to post-operative care. [Display omitted] • RYGB patients with a mean pre-operative BMI of 54.7 kg/m2 reached a maximum 39.0 percent total body weight loss (%TBWL) at 1.7 years post-surgery. • The %TBWL at 5 and 10 years were 33.3% and 31.0%, respectively • 38.1% of patients maintained post-operative visits at least every other year. • Attendance at follow-up visits at least every other year was not associated with long-term weight loss. [ABSTRACT FROM AUTHOR]

Globally, the number of citizen science clean-up projects, such as beach cleans, is increasing in an effort to reduce the amount of plastic pollution in the environment. Such activities offer the opportunity to gather insightful data on plastic abundance, distribution and composition. This information is key for informing effective management strategies aimed at reducing input but little work has been conducted to examine the challenges faced by existing citizen science projects, or the potential opportunities for maximising their impact. Here, we present the results of a questionnaire survey and follow-up workshop to explore the opinions of representatives from 20 organisations that deal with the issue of plastic pollution in the environment. Our results show that, of the organisations that conduct clean-up activities in the United Kingdom (UK), the majority collect data on plastic pollution to some extent. To ensure these data are scientifically meaningful and the necessary levels of public engagement are maintained, participants felt that survey protocols should be standardised across organisations and data submission should be as simple and easy as possible. The participants considered communication, inclusivity and volunteer diversity to be key for enhancing citizen engagement and improving data quality. Many organisations were unclear about how the information they hold can be most effectively used to help inform policies relating to managing plastic pollution. Moving forwards, there is a clear desire from clean-up organisations to collaborate with other sectors, such as commercial, policy, waste and recycling, education and technology stakeholders, as well as other non-governmental organisations and scientific researchers, to enhance the value and impact of citizen science in tackling the issue of plastic pollution. • The challenges and opportunities of using citizen science to address plastic pollution were explored. • Most clean-up organisations collect data on plastic pollution but protocols should be simple and standardised to ensure utility. • Communication, inclusivity and diversity are key for enhancing citizen engagement. • Citizen science offers great value for informing evidence-based policy aimed at reducing plastic pollution. [ABSTRACT FROM AUTHOR]

Insurance-mandated precertification requirements are barriers to bariatric surgery. The value of their prescription, based on insurance type rather that the clinical necessity, is unclear. To determine whether there is an association between insurance-mandated precertification criteria for bariatric surgery and short-term inpatient healthcare utilization. Pennsylvania Health Care Cost Containment Council's inpatient care databases for the years 2016-2017. The study included 2717 adults who underwent bariatric surgery in Southeastern Pennsylvania in 2016. Postoperative length of stay and rehospitalizations for these individuals were followed using clinical and claims data during the first year after bariatric surgery. The requirements for 3- to 6-month preoperative medical weight management, as well as pulmonology and cardiology examinations, were not associated with the patient length of stay, number of all-cause rehospitalizations, or number of all-cause rehospitalization days after adjusting for patient age, sex, race, ethnicity, the Elixhauser comorbidity score, type of the surgery, facility where the surgery was performed, primary payer type, and the estimated median household income. Among commercially insured individuals (n = 1499), the mean number of all-cause rehospitalizations during the study period was lower in patients with no medical weight management requirement by a factor of.57 (lower by 43.1%; 95% confidence interval,.35–.94, P =.03) and higher in patients with no requirement for preoperative cardiology and pulmonology evaluations by a factor of 2.09 (95% confidence interval 1.09–4.02, P =.03). The findings suggest that the precertification requirement for preoperative medical weight management is not associated with a reduction in inpatient healthcare utilization in the first postoperative year. [Display omitted] • Preoperative medical weight management requirement was not linked to less inpatient healthcare utilization • No requirement for preoperative cardiology and pulmonology evaluations was linked to more rehospitalizations in commercially insured patients [ABSTRACT FROM AUTHOR]

The present article considers the iterative method for the numerical solution of the Dirichlet problem for quasilinear elliptic equation. For constructing the iterative method, the difference analog of the Grin function for the Laplace operator is used. The uniform convergence of the iterative method is proved, as well as the convergence of the solution of the difference scheme to the exact solution of the initial differential problem. [ABSTRACT FROM AUTHOR]

The article discusses the problem of formation of moral values in the process of teaching mathematics. It reveals the fact that this process has a great potential for formation of both positive and negative moral values. We focus on the basic universal moral values - kindness, respect, love, dignity, duty, justice, tolerance, the purpose of life, happiness. We consider the problem of formation of moral values within the general approach to the problem and in the context of informatization of mathematical education. We suggest specific ways to prevent the formation of negative values and to encourage the formation of positive moral ones in the process of teaching mathematics. We find value-orientation teaching of mathematics as an approach to reach the goal. [ABSTRACT FROM AUTHOR]

A growing body of evidence supports the efficacy and safety of bariatric surgery for clinically severe obesity. Despite this empirical support, bariatric surgery remains profoundly underutilized. The reasons for underutilization are likely multifactorial, including health insurance coverage and benefits design, lack of awareness about bariatric surgery by patients, and anecdotal concerns about safety. We believe that there are two other factors—the occurrence of weight stigma and bias and suboptimal communication between patients and providers—that also serve as barriers to greater utilization. The article reviews the existing literature related to these two factors. The review also highlights the science of shared medical decision-making as a potential strategy to promote appropriate conversations between patients and providers, both surgical and nonsurgical, about the efficacy and safety of bariatric surgery. Shared medical decision-making is used in other areas where complex medical decisions are required. We believe that it has great potential to contribute to the increased utilization for the millions of individuals who could benefit from bariatric surgery. • The underutilization of bariatric surgery is likely multifactorial. • Weight stigma and bias, as well as suboptimal communication between patients and providers, are likely barriers to greater usage. • Shared decision making between patients and providers has potential to contribute to increased utilization of bariatric surgery. [ABSTRACT FROM AUTHOR]

Denture base resins (DBRs), such as polymethyl methacrylate, are commonly used in the fabrication of removable dentures because of their physical, mechanical, and esthetic properties. However, the denture base acts as a substrate for microorganism adherence and biofilm formation, which may lead to denture stomatitis and be further complicated by fungal infections, of especial importance with geriatric and immunosuppressed patients. Therefore, methods to enhance the antimicrobial property of DBRs will be beneficial. The purpose of this systematic review was to evaluate the literature on the antimicrobial activity of DBRs incorporating antimicrobial agents or materials. A search of English peer-reviewed literature up to February 2019 reporting on antimicrobial activity of DBRs with respect to antimicrobial agents or materials, antimicrobial test effects and methods, and conclusion or knowledge gaps was conducted by using Embase, Google Scholar, PubMed, and Web of Science databases. Search terms included denture base resin and antibacterial, denture base resin and antifungal, and denture base resin and antimicrobial. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for subsequent data analysis. Of 2536 identified articles, 28 met the inclusion criteria for the systematic review. Antimicrobial materials were divided into 3 groups: antimicrobial monomer or copolymer, phytochemical or phytomedical components, and other compounds. Strategies on how to incorporate these substances into DBRs and their impact on the reduction and prevention of the growth of microorganisms were identified. Although many efforts have been made to improve the antimicrobial ability of DBRs, this systematic review found that the effectiveness of incorporating of antimicrobial agents into DBRs has not been demonstrated conclusively. [ABSTRACT FROM AUTHOR]

We conducted a national survey of Health Information Exchanges (HIEs), targeting both not-for profit geographic and enterprise or federated exchanges. The aim of this study is to identify current best practices when exchanging information between Veterans Affairs (VA) systems and non-VA health systems. We identified and classified current interactions between HIEs and VA systems given recent passage of the MISSION Act. The MISSION Act allows veterans to seek care outside the VA health system, necessitating the need to reconcile care planning between VA systems and private care settings. We identified several differing best practices concerning information exchange between VA health systems and HIEs and assessed capabilities for HIEs to appropriately identify eligible VA participants within extant databases. [ABSTRACT FROM AUTHOR]

Bariatric surgery is underutilized in the United States. To examine temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in southeastern Pennsylvania and to investigate the associations between payor type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. Pennsylvania Health Care Cost Containment Council's databases in southeastern Pennsylvania during 2014–2018. All adult patients who underwent the most common types of bariatric surgery and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. Contingency tables, Pearson χ2 tests, and logistic regression were used for statistical analysis. Over the 5 years, there was an increase in the proportion of Black individuals (37.1% in 2014 versus 43.0% in 2018), Hispanics (5.4% versus 8.0%), and Medicaid beneficiaries (19.2% in 2014 versus 28.5% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payor type only between Medicare beneficiaries were statistically different (22% smaller odds) compared with privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payor categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared with those with private secondary insurance. Insurance plan design may be as important in determining the utilization of bariatric surgery as the general payor type after controlling for confounding socio-demographic factors. • Insurance plan type is strongly associated with the uptake of bariatric surgery. • So is supplemental insurance coverage among traditional Medicare beneficiaries. • The proportion of Black and Hispanic surgery patients increased in Southeastern PA. • Within the payer mix, there was an increase in Medicaid patients during 2014-2018. [ABSTRACT FROM AUTHOR]

Tenodesis and tenotomy are the main surgical options to treat different pathologies of the long head of the biceps tendon. Maintaining the functionality of the tendon during tenodesis makes it more preferable surgical option. The consensus on the most advanced tenodesis technique has not been reached. The article presents the arthroscopic all-inside technique of suprapectoral tenodesis of the biceps tendon using the technique of "zone marking" with 2 spinal needles or pins. [Display omitted] [ABSTRACT FROM AUTHOR]

• Climate action on the state level is dependent on political context (specifically, Republicanism)—an influence far less prominent on the local level. • At both state and local scales of governance, climate mitigation is somewhat more strongly influenced by power dynamics compared to climate adaptation. • State-level power dynamics best predict state climate action and, to a substantially weaker extent, combined state and local power dynamics best predict local climate action. • Power dynamics outweigh the influences of politics and climate risk on state and local climate action. American cities have played an increasingly critical role in advancing US climate change mitigation and adaptation. Subnational government support for these efforts, however, varies across social, political, economic, and biogeophysical contexts. While the influence of politics on US climate mitigation is well established, further research is required to identify barriers to—and discern complex influences on—US subnational climate action. This study examines the influences of power dynamics between public and private interests, political party affiliation within government and the public, and risk of climate impacts, on observed climate mitigation and adaptation efforts within 136 urban US cities and 33 states. The findings of this study shed light on the motivations of subnational governments to take climate action, and identify significant dynamics influencing the likelihood of key state or local government decision-makers to take climate action. [ABSTRACT FROM AUTHOR]

Background: This study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III-IV Miller periodontal recession (REC) defects on mandibular anterior teeth.Methods: This randomized clinical study evaluated 41 patients at 3 years follow-up. One hundred and fifty-six teeth were divided into two groups: test (CTG-EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient-centered outcomes were compared between the two groups.Results: At 36 months follow-up, patient level analysis showed that REC in the test group reduced significantly (5.71 ± 0.58 mm to 1.57 ± 0.85 mm) compared with the control group (5.94 ± 0.46 mm to 2.51 ± 0.62 mm) (P < 0.001), while KT width increased in the test group (1.51 ± 0.26 mm to 4.18 ± 0.34 mm) and was significantly greater than the control group (1.65 ± 0.21 mm to 2.90 ± 0.20 mm) (P < 0.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (P < 0.01). Significantly less pain was reported at 2, 7, and 14 days follow-up post-surgery in the test group (P < 0.001).Conclusions: The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III-IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post-surgery. [ABSTRACT FROM AUTHOR]

Bariatric surgery is underused in the United States. This study examined whether utilization of bariatric surgery is associated with payor and insurance plan type, after removing potential sociodemographic confounders. The study used Pennsylvania Health Care Cost Containment Council's data in 5 counties of Pennsylvania from 2014 to 2016. Bariatric surgery patients and eligible patients who did not undergo surgery were identified and 1:1 matched by age, sex, race, and zip code (n = 5114). A logistic regression was performed to investigate the association of payor type and insurance plan within payor type with odds of undergoing bariatric surgery. The odds of undergoing bariatric surgery were not statistically different based on payor type. Medicare preferred provider organization plan was associated with greater odds of undergoing surgery (odds ratio [OR] = 2.49, 95% confidence interval [CI] 1.23–5.04, P =.01) compared with Medicare health maintenance organization (HMO). Medicaid fee for service plan was associated with smaller odds of undergoing surgery (OR =.04, 95% CI.005–.27, P =.001) compared with Medicaid HMO. Individuals with Blue Cross preferred provider organization (OR = 2.43, 95% CI 1.83–3.24, P <.001), Blue Cross fee for service (OR = 1.79, 95% CI 1.32–2.43, P <.001), and Blue Cross HMO (OR = 1.85, 95% CI 1.39–2.46, P <.001) had greater odds of undergoing surgery compared with those with other commercial HMO plans. Specific aspects of insurance plan design, rather than more general payor type, is more strongly associated with the utilization of bariatric surgery. Further investigations could identify which components of insurance plan design have the greatest influence on the utilization of bariatric surgery. • Insurance plan is a stronger predictor of bariatric surgery uptake than payer type. • Commercial insurance is the most common payer for the surgery, followed by Medicaid HMO plan. • Insurance plan design may play an important role in the uptake of bariatric surgery. [ABSTRACT FROM AUTHOR]

Abstract Despite the effectiveness of bariatric surgery, both with respect to weight loss and improvements in obesity-related co-morbidities, it remains underused. Only 1% of the currently eligible population undergoes surgical treatment for obesity, with roughly 228,000 individuals receiving bariatric surgery in the United States each year. Several barriers to bariatric surgery have been identified, including limited patient and referring physician knowledge and attitudes regarding the effectiveness and safety of bariatric surgery. However, the role of insurance coverage and benefit design as a barrier to access to care has received less attention to date. Bariatric surgery is cost-effective compared with nonsurgical treatments among individuals with extreme obesity and type 2 diabetes. While it may not result in cost savings among all bariatric surgery eligible patients, for certain patient subgroups, bariatric surgery may be cost neutral compared with traditional treatment options. In addition, longer-term outcomes of bariatric surgery suggest decreased or stable costs in the long run. The purpose of this review paper was to synthesize the existing knowledge on why bariatric surgery remains largely underused in the United States with a focus on health insurance benefits and design. In addition, the review discusses the applicability of value-based insurance design to bariatric surgery. Value-based insurance design has been previously applied to bariatric surgery coverage with use of incentive-based cost-sharing adjustments. Its application could be further extended because the postoperative clinical outcomes and costs vary among the different subgroups of bariatric surgery eligible patients. [ABSTRACT FROM AUTHOR]

Summary Despite the potential negative impact of facial palsy, major gaps in understanding persist surrounding the treatment and care of those affected. This collaborative three-round Delphi process aimed to identify priorities for future facial palsy research, from the perspective of clinicians, researchers, patients and carers. It also determined whether the research priorities of patients and carers aligned with those of health professionals and researchers. In Round 1, participants (n = 85) were asked to generate research questions by focus groups or an online or postal survey. In Rounds 2 (n = 72) and 3 (n = 78), participants were asked to rate the priorities identified on a 5-point ordinal scale. Thirty-six questions reached the definition of 'high priority' consensus. Seven of each groups' top ten research priorities were shared. Prioritised questions included the provision and pathways of care, the psychosocial impact of living with facial palsy and the effective management of side effects. Establishing the research priorities in the field of facial palsy is a significant first step in ensuring that the future research agenda is focussed on topics that are considered important by both patients and health professionals. [ABSTRACT FROM AUTHOR]