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Background Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens' underlying preferences. The objective of this review is to systematically assess women's values and preferences research evidence on this topic. Methods We searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display. Results We screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process. Conclusions We are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient's values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy.

Objective: To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision making. Study Design and Setting: For this scoping review, we searched five bibliographic databases (from inception until February 2021), reference lists of included studies, trial registries, a thesis database and websites of relevant interest groups. Studies were eligible if they evaluated the application of decision analysis in a shared decision-making encounter. Pairs of reviewers independently screened and selected studies for inclusion, extracted study information using a data extraction form developed by the research team and assessed risk of bias for all studies with an experimental or quasi-experimental design. Data were narratively synthesized. Results: We identified 27 studies that varied greatly with regard to their patient population, design, content and delivery. A range of outcomes were evaluated to explore the effectiveness and acceptability of decision analytic interventions, with little information about the implementation process. Most studies found that decision analysis was broadly beneficial. Conclusion: Despite the compelling rationale on the potential for decision analysis to support shared decision-making, rigorous randomized controlled trials are needed to confirm these interventions' effectiveness, while qualitative studies should seek to understand their potential implementation. (c) 2021 Elsevier Inc. All rights reserved.

In response to the increase in student nurse places and its impact on the mentors supporting their practice modules, a number of coaching-based mentoring models have been piloted. These are facilitative rather than directive, encouraging self-awareness, responsibility and problem-solving skills. A one-day coaching course, run by educators from a higher education institute, was delivered to qualified healthcare staff in 12 NHS trusts. Evaluation forms revealed that attendees’ key learnings were the coaching models themselves and how these differ from mentoring. They considered the benefits of coaching to be increased student confidence and autonomy, decreased mentor fatigue and higher standards of patient care, while the challenges to implementing the model were preparing staff and students, time constraints and resistance to change. Following the workshops, the higher education institute has embedded the coaching model into its nursing curriculum.

The spectra in total neutral energy, ETOT0, have been measured in pp, dd and αα collisions at centre-of-mass energy per nucleon pair, sNN, of 31 GeV. The range in ETOT0 covered was 1 to 19 GeV in pp, 18 to 24 GeV in dd and 1 to 34 GeV in αα interactions. The ratio of the αα to the pp spectra rises monotonically from 7 at ETOT0 = 1.5 GeV to 105 at ETOT 0 = 19 GeV. Since ETOT0 is the sum over many particles in the detector, it is directly sensitive to multiple nucleon-nucleon collisions in the interacting α particles. The αα spectrum in the range 8 < ETOT0 < 17 GeV is consistent with being described by a simple model of 4 simultaneous nucleon-nucleon collisions with a cross section about equal to 10% of the observed αα interaction cross section. The spectrum of ETOT0 above 17 GeV is even flatter than this extreme case where four nucleon pairs are interacting. © 1984.

At present there appears to be a need for research conducted on the effects of vibration on the contractile ability of skeletal muscle tissue. The aim of this study was to address this issue by examining the effects of a superimposed muscle/tendon vibration at 50.42±1.16 Hz (acceleration 13.24 ± 0.18ms(-2): displacement ≈5mm) on muscular activation and maximal isometric contraction. Sixteen participants with a mean age, body mass, and height of 22 ± 4.4 years, 73.2 ± 11.7 kg and 173.1 ± 9.7 cms, respectively, were recruited for this study. Electromyography and accelerometry from the rectus femoris, and maximal isometric force data characteristics were collected from the dominant limb under conditions of vibration, and no-vibration. A superimposed 50 Hz vibration was used during the contraction phase for the maximal isometric leg extension for the condition of vibration. A one-way ANOVA revealed no significant (p0.05) differences between the vibration and no-vibration conditions for peak normalized EMGRMS (84.74% Vs 88.1%) values. An ANOVA revealed significant (p0.05) differences between the peak fundamental frequencies of the FFT between the conditions vibration (27.1 ± 12.2 Hz) and no-vibration (9.8 ± 3.5 Hz). Peak isometric force, peak rate of force development, rate of force development at times 0.05, 0.01, 0.1, 0.5 seconds, and rate of force development at 50, 75, and 90% of peak force were not significantly different. The results of this study suggest that the application of vibration stimulation at 50 Hz during the contraction does not contribute to muscle activation, or enhance force production for maximal isometric contractions. Key PointsThe application of a vibratory stimulation to the human body increases the normal acceleration resulting in an increase in force and a change in performanceThis study was to address this issue by examining the effects of a direct superimposed muscle/tendon vibration at 50 Hz on isometric strength characteristicsNo improvement or change in isometric force or rate of force developmentNo changes to peak normalized EMGRMS values.