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PurposeThis paper aims to expand the arguments put forth by (Van and Kubina, 2024) and discuss Precision Teaching (PT)’s role within allied health professions (AHPs).Design/methodology/approachWith services by AHPs becoming increasingly difficult to access, the need to accurately measure the efficacy of any input, however, limited, is a matter of priority, both for the sake of the service user and to ensure ongoing public funding of these professions. This commentary provides current clinical examples of the challenges faced by these professions.FindingsThe author discusses the use of PT as a way of ensuring the skills of AHPs are used as efficiently as possible.Originality/valuePractical implications are discussed.

Glyn Roger Williams was a consultant in infectious diseases based at Ayrshire Central and Crosshouse hospitals, Kilmarnock, in 1986-2007. Having pursued a career in infectious disease and tropical medicine after graduating, Glyn settled in Scotland in 1978, taking up a lecturer and registrar post with the University of Glasgow. He completed his postgraduate medical training at Ruchill Hospital, Glasgow.

Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society.

Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population. Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society.

Metformin is a widely used anti-diabetic drug. Several studies have suggested that metformin has anticancer activity in some malignancies, including prostate cancer. Metformin might also mitigate the adverse metabolic effects of androgen-deprivation therapy (ADT). We hypothesised that metformin might improve survival in patients with metastatic hormone-sensitive prostate cancer and reduce metabolic complications associated with ADT. The STAMPEDE multi-arm, multi-stage, randomised phase 3 trial recruited patients with high-risk locally advanced or metastatic adenocarcinoma of the prostate staged by conventional imaging with isotope bone and CT scanning. This publication reports findings for the most recent STAMPEDE research question, testing the addition of metformin to standard of care for non-diabetic (glycated haemoglobin [HbA1c] <48 mmol/mol [equivalent to <6·5%]) patients with metastatic disease with adequate renal function (glomerular filtration rate ≥45 ml/min/1·73 m2) and WHO performance status 0–2. This trial recruited from 112 hospitals in the UK and Switzerland to the STAMPEDE protocol. Patients were randomly allocated (1:1) to standard of care or standard of care plus metformin 850 mg twice daily. Random assignment was by telephone using minimisation with a random element of 20% (developed and maintained by the MRC Clinical Trials Unit at UCL), stratified for randomising hospital, age (<70 years vs ≥70 years), WHO performance status (0 vs 1 or 2), type of ADT, regular long-term use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs; yes vs no), pelvic nodal status (positive vs negative), planned radiotherapy (yes vs no), and planned docetaxel or androgen receptor pathway inhibitor (ARPI) use (docetaxel vs abiraterone, enzalutamide, or apalutamide vs none). Standard of care comprised ADT with or without radiotherapy and with or without docetaxel or ARPI. The primary outcome measure was overall survival, defined as the time to death from any cause, assessed in the intention-to-treat population. Safety was assessed in patients who started treatment. The trial is registered with ClinicalTrials.gov, NCT00268476 and ISRCTN, ISRCTN78818544. Between Sep 5, 2016, and Mar 31, 2023, 1874 patients with metastatic disease were randomly allocated to standard of care (n=938) or standard of care plus metformin (n=936). The median patient age was 69 years (IQR 63-73) and the median PSA was 84 ng/mL (24–352). 1758 (94%) of 1874 patients were newly diagnosed with metastatic disease and 116 (6%) were diagnosed with metachronous relapsing disease. 1543 (82%) of 1874 patients received ADT plus docetaxel and 52 (3%) received abiraterone, enzalutamide, or apalutamide. The median time to most recent case report form follow-up was 60 months (IQR 49–72). 473 deaths were reported in the standard of care group; median survival was 61·8 months (IQR 29·7 to not reached). There were 453 deaths in the metformin group; median survival was 67·4 months (32·5 to not reached; HR 0·91, 95% CI 0·80–1·03; p=0·15). Grade 3 or worse adverse events were reported in 487 (52%) of 938 patients in the standard of care group and 523 (57%) of 921 patients in the standard of care plus metformin group. 61 (7%) patients in the standard of care group and 84 (9%) patients in the standard of care plus metformin group reported at least one grade 3 or worse gastrointestinal adverse event; all other body systems showed no difference in grade 3 adverse events. There were six drug-related deaths in the standard of care group and one in the standard of care plus metformin group. We did not find significant evidence of an overall survival benefit of adding metformin to standard of care in the overall population of patients with metastatic hormone-sensitive prostate cancer. The side-effect profile of metformin was as expected and consisted mainly of diarrhoea. Adverse metabolic side-effects of ADT were significantly reduced in the metformin group compared with the standard of care group. Cancer Research UK, Prostate Cancer UK, and UK Research and Innovation Medical Research Council.

Depression accounts for the largest proportion of the burden associated with all mental health disorders and is predicted to be the second leading cause of the global burden of disease by 2020. Despite the apparent efficacy of prevention programmes, international rates of help-seeking for depression remain poor. Cognitive theories of help-seeking and empirical studies suggest that help-seeking for health conditions is largely determined by beliefs about the condition (e.g., likelihood and severity of the condition) as well as beliefs about help-seeking itself (e.g., how easy and beneficial it would be to get help). An understanding of the role of health beliefs in help-seeking for depression will hopefully close the gap between the number of people eligible for depression treatment and the number of people actually receiving it. A systematic review of literature was conducted to identify studies that examined the relationship between health beliefs and help-seeking for depression using the highest quality study design, i.e., experimental trial or prospective cohort. Six electronic databases were searched and a manual search of the reference lists of the included studies was conducted. Ten studies with a total of 7,878 participants were included in the review. In line with theories of health behaviour, what participants believed about depression and about preventive health action was related to whether they sought help; however, the association between beliefs and help-seeking varied across studies. Methodological issues and overall low study quality point to the need for high quality studies with clearly defined constructs and reliable and valid variable measurements. The findings of this review suggest that beliefs about depression are important targets for interventions aimed at improving rates of help-seeking for the illness.

The movement of acyl groups across biological membranes is essential for many cellular processes. One major family of proteins catalysing this reaction are the acyl transferase family 3 (AT3) proteins, which form a pore to allow acyl-CoA to penetrate the membrane for transfer onto an extracytosolic acceptor molecule. Recent structures of the sequence-unrelated human heparan-alpha-glucosaminide N-acetyltransferase (HGSNAT) support a similar transmembrane acyl-group transfer mechanism. Here we demonstrate that both protein families contain a conserved 10-transmembrane helical fold with high structural and detectable sequence conservation around the acyl-CoA pore, supporting the previously proposed Transmembrane Acyl Transferase (TmAT) protein superfamily. In addition, we identify TmAT proteins, including the human Golgi sialate-O-acetyltransferase (CASD1), the human/fungal PIG-W/GWT1 enzymes and the bacterial vancomycin resistance protein VanTG, where the TmAT domain's function has been largely unrecognised. We conclude that the TmAT fold represents an ancient architecture for transmembrane acyl-group transfer with important roles in the dynamic modification of glycans in diverse processes across the three domains of life.Competing Interest StatementThe authors have declared no competing interest.

Crynodeb Yn y traethawd hwn, edrychir ar O! tyn y gorchudd, Angharad Price ac ar dderbyniad y nofel er pan enillodd y Fedal Ryddiaith yn 2002 gan ddadansoddi pam y caiff ei galw’n ‘glasur cyfoes’. Yn y bennod gyntaf, olrheinir hanes a datblygiad cystadleuaeth y Fedal Ryddiaith er 1939, blwyddyn ei sefydlu. Edrychir ar sut y gwnaeth Angharad Price ac awduron eraill feithrin eu dawn trwy gystadlu a sut y gwnaeth y gystadleuaeth ddatblygu o ran ei phoblogrwydd a’i gwerth ar hyd y blynyddoedd wrth gystadlu yn erbyn seremonïau mawreddog y Gadair a’r Goron. Dadansoddiad o’r nofel ei hun a geir yn yr ail bennod, lle y trafodir y themâu a’r arddull a dyfais y traethydd, Rebecca, gan fynd i’r afael hefyd â’r cyfieithiad i’r Saesneg, y CD a’r cyfieithiad Braille. Mae’r bennod olaf yn ddadansoddiad o ymatebion yr holiaduron a ddosbarthwyd gan ddehongli atebion y darllenwyr cyffredin i’r nofel. Trafodir gwendidau a chryfderau’r nofel a’r effaith y mae ei phoblogrwydd wedi’i chael ar deulu Tynybraich. Rhoddir sylw hefyd i nodweddion ieithyddol y nofel a sut y mae’n cymharu â rhai nofelau Cymraeg poblogaidd eraill, gan geisio adnabod y nodweddion hynny sy’n peri iddi gael ei hystyried gan lawer yn glasur ac yn un o nofelau mwyaf poblogaidd ein cenhedlaeth.

The aim of this study was to determine whether the Arthritis Self-Management Programme (ASMP) is effective in promoting perceived control and self-management ability when delivered in an adult education setting. The study was a pre-test–post-test design based on a sample of 89 people attending an ASMP. Data were collected by self-administered questionnaires prior to the intervention and after the intervention, 4 months from baseline. The sample comprised 80% women, with a mean age of 57 years and a mean disease duration of 13 years. Most participants had either osteoarthritis or rheumatoid arthritis. After 4 months, participants demonstrated significant increases in arthritis self-efficacy (P < 0.0005), cognitive symptom management (P < 0.0005), communication with doctors (P = 0.018), exercise (P = 0.003) and relaxation (P < 0.00005). In addition, significant decreases were found in terms of pain (P = 0.034) and visits to other health professionals (P = 0.004). The first evaluation of the ASMP, delivered within the context of adult education, suggests that this form of community health education programme can offer substantial benefits for participants, particularly in terms of perceived ability to control various aspects of arthritis and in greater utilization of cognitive-behavioural techniques.

Notes that living with arthritis involves pain and fatigue, physical limitations, problems with social relationships and loss of social and leisure activities. Describes the psychosocial challenges associated with living with arthritis and examines whether, as a result of attending an arthritis self‐management programme (ASMP), participants felt more capable of meeting those challenges. Interviews were conducted with 16 participants before they attended the ASMP; two weeks after completing the course; and at eight months. During the ASMP, participants benefited from developing an empathic relationship with their peers, thereby reducing feelings of isolation. The ASMP also promoted positive behavioural changes such as exercise, relaxation and pain management. A greater sense of personal control served as a precursor for involvement in initiatives aimed at providing solutions for their local arthritis communities. Suggests a self‐management programme can provide a forum that facilitates peer support and improves coping skills.