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ObjectiveTo inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies.MethodsIn a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397.ResultsWe included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated.ConclusionsDue to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument’s content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.

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One hundred and twenty renal transplant recipients were investigated. Fifty-eight (48%) were found to have warts, 13 (11%) keratoses and six (5%) to have, or recently to have had cancers. The longer the time of immunosuppression, the greater the prevalence of warts; of those patients who had had their transplant for at least 5 years, 87% had warts. Those with a graft survival time of 10 years or more are at special risk of warts, keratoses and malignancy. Five (10%) of 50 women had genital warts, four of whom had internal lesions (vaginal, cervical or anal) and one developed a carcinoma of the vulva. These findings indicate the advisability of colposcopy for all female renal transplant recipients, a high risk group. Eighty-eight specimens from 42 patients were examined by DNA restriction enzyme analysis and cross hybridization for the presence and type of human papillomavirus (HPV). HPV DNA was detected in 66% of the warts examined, HPV2 and HPV4 occurring most often and HPV1 and HPV3 only infrequently. In sequential specimens from common hand warts of one individual, an HPV was found which could not be precisely identified but was related to HPV4. HPV16 was detected in a vaginal wart from one patient and an HPV6-related virus in a vulval wart of another. HPV DNA of an unknown type was demonstrated in one of 11 keratoses examined. With the probes used to examine the few samples of skin cancers available, HPV16 was found in a squamous cell carcinoma of the vulva, and faint bands from an unidentified type of HPV were detected in two squamous cell carcinomata from a patient's hand. One woman had plaque lesions morphologically and histologically resembling those found in epidermodysplasia verruciformis (EV). HPV5 was identified in these lesions. This is only the third reported case of HPV5, previously thought to be unique to EV, in a renal transplant recipient.

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Introduction-The changing epidemiology of genital herpes in Edinburgh is described in relation to herpes simplex virus (HSV) Type 1 and herpes simplex virus Type 2 infection over a period of 14

Most previous mark-recapture studies of the movement of European lobsters have used externally attached tags which were lost at ecdysis, restricting the range of possible recapture intervals. Published studies of this species with tags designed to be retained through ecdysis have focussed on artificially reared lobsters, or wild lobsters released in artificial habitat. Here, we report a mark-recapture study of the mobility of wild European lobsters conducted in 3 areas on the south coast of England, using persistent tags. Tagged lobsters were smaller than the fishery minimum landing size (50 to 84 mm carapace length) and were therefore likely to be predominantly sexually immature. The majority of these lobsters do not appear to undertake extensive alongshore or on-/offshore migrations. Recapture distances ranged from 0 to 45 km, but 95% of recaptured lobsters moved < 3.8 km from their original release positions over periods of up to 862 d. Distance moved did not differ between males and females, but there was a weak positive relationship between recapture distance and body size. The directional distribution of movements > 0.5 km differed between the 3 study areas and appeared to be related to the spatial configuration of local lobster habitat, but with a marked tendency for offshore movement in 2 of the areas. Movements > 5 km from all 3 release areas, which comprised 5% of recaptures after > 6 mo, were generally undertaken by larger lobsters and were almost exclusively to the west or southwest, against the general direction of tide-and wind-generated residual water movement in the English Channel.