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PubMedDate not supplied

Managing arthritis with exercise.

Almost half of all older adults have arthritis, either degenerative or inflammatory. Regular exercise is an important therapeutic intervention for all types of arthritis. Specifically, regular exercise can prevent deconditioning of the muscles, keep the joints stable, improve joint function and flexibility, decrease pain, enhance aerobic fitness, improve balance, and decrease falls. A comprehensive exercise program should include stretching exercises followed by a range-of-motion program for joints, muscle strengthening, and aerobic exercise, if possible. Unfortunately, despite these known benefits, most older adults with arthritis do not engage in regular exercise. The Seven Step Approach was developed to provide a practical framework to help overcome barriers and improve exercise activity in older adults with arthritis.

Accidental Falls↗
PubMed2001

Communication: an important assessment and teaching tool.

Communication, as a process, is essential to adequate nursing care; language is a key factor. This article reviews the aspects of language that impair, and those that improve, communication in the health care setting. Standards are cited, along with recommendations for developing optimal communication skills within nursing's professional practice area. This includes the importance of using interpreters when language is a barrier.

Communication↗
PubMed1999

The dermatoscopic ABCD rule does not improve diagnostic accuracy of malignant melanoma.

The dermatoscopic ABCD rule has been suggested to improve diagnostic performance regarding cutaneous malignant melanoma. Using this rule, a total dermatoscopy score is calculated from the presence of various dermatoscopic elements. A total dermatoscopy score above 4.75 signifies possible and 5.45 probable melanoma. We compared the diagnostic accuracy of dermatoscopy with and without the use of the ABCD rule. Furthermore, receiver operating characteristic analysis was performed for the ABCD rule. The area under the receiver operating characteristic curve was 0.854 (range 0.777-0.906) demonstrating that in 85.4% of the cases, cutaneous malignant melanomas were rated higher than the non-melanoma skin lesions. Sensitivity for the melanoma diagnosis was higher for simple dermatoscopy than when the ABCD rule was used (p<0.05). There was no difference in specificity when a total dermatoscopy score of 4.75 was used as cut-off point, but specificity was lower for simple dermatoscopy than when the total dermatoscopy score of 5.45 was used. Diagnostic accuracy was higher for simple dermatoscopy than for the ABCD rule (p<0.01). In conclusion, the dermatoscopic ABCD rule was not superior to simple dermatoscopy, and fewer malignant melanomas were identified with this rule.

Biopsy, Needle↗
PubMed2006

Dummy run for a phase II study of stereotactic body radiotherapy of T1-T2 N0M0 medical inoperable non-small cell lung cancer.

In forthcoming multicentre studies on stereotactic body radiotherapy (SBRT) compliance with volume and dose prescriptions will be mandatory to avoid unnecessary heterogeneity bias. To evaluate compliance in a multicentre setting we used two cases from an ongoing phase II study of SBRT of T1-T2N0M0 inoperable NSCLC in a dummy run oriented on volumes and doses. Six Scandinavian centres participated. Each centre received CT-scans covering the whole lung volumes of two patients with instructions to follow the study protocol when outlining tumour and target volumes, prescribing doses and creating dose plans. Volumes and doses of the 12 dose plans were evaluated according to the study protocol. For the two patients the GTV volume range was 24 to 39 cm3 and 26 to 41 cm3, respectively. The PTV volume range was 90 to 116 cm3, and 112 to 155 cm3, respectively. For all plans the margin between CTV and PTV in all directions followed in detail the protocol. The prescribed dose was for all centres 45 Gy/3 fractions (isocentre dose about 66 Gy). The mean GTV doses ranged from 63 to 67 Gy and from 63 to 68 Gy, respectively. The minimum doses for GTV were between 50-64 Gy and between 55-65 Gy, respectively. The dose distribution was conformed to PTV for 10 of 12 plans and 2 of 12 plans from one centre had sub-optimal dose distribution. Most of the volume and dose parameters for the participating centres showed fully acceptable compliance with the study protocol.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

A strategy for informing patients and health professionals about unconventional cancer therapies.

BACKGROUND: A Guide to Unconventional Cancer Therapies was produced by the Ontario Breast Cancer Information Exchange Project with the intention of meeting needs of patients, family members, and health professionals for information about unconventional therapies. Concerns raised by health professionals during the development of the guide serve as a focus for considering its impact on cancer patients who purchased it. MATERIALS AND METHODS: Purchasers of the guide were sent a survey questionnaire inquiring about their access to, use of, and attitudes toward it. RESULTS: A total of 634 individuals responded to the survey, including cancer patients, health professionals, and family members. The guide was rated moderately helpful overall, and health professionals found it significantly more helpful than did cancer patients. A minority of patients were influenced to try an unconventional therapy as a result of reading the guide. Those who did try a new therapy typically chose ones that are most popular and have few potential negative effects. CONCLUSIONS: As an informational strategy, the Guide to Unconventional Cancer Therapies has been successful. Concerns expressed by some health professionals about potential harm through implementing the strategy have been shown to be largely unwarranted, at least for study respondents.

Breast Neoplasms↗
PubMed2006

Tobacco cessation in dental settings: research findings and future directions.

The hazards associated with cigarette smoking and smokeless tobacco use have been well documented. In addition to its association with many cancers and coronary conditions, tobacco plays a role in the aetiology of a number of oral morbidities. Dental care practitioners are a largely untapped resource for providing advice and brief counselling to tobacco-using patients, and there are good reasons to believe that they can be effective. Data from seven randomised trials indicate there is ample evidence for the efficacy of dental office-based interventions, but adoption of these tobacco cessation activities into practice has been slow. The limited research on dissemination of tobacco interventions is promising, but there is a need to develop and evaluate new methods for encouraging adoption, implementation and maintenance of tobacco interventions into routine dental care. Several studies currently under way may help to increase the effectiveness and dissemination of office-based tobacco cessation programmes into routine dental care. If dental practitioners provided cessation assistance routinely to their patients and achieved even modest success rates, the public health impact would be enormous. Researchers and clinicians must continue to work together towards universal adoption of effective tobacco cessation interventions at each clinical encounter.

Dental Care↗
PubMed2001

The effects of temperature and pressure on airborne exposure concentrations when performing compliance evaluations using ACGIH TLVs and OSHA PELs.

Occupational hygienists perform air sampling to characterize airborne contaminant emissions, assess occupational exposures, and establish allowable workplace airborne exposure concentrations. To perform these air sampling applications, occupational hygienists often compare an airborne exposure concentration to a corresponding American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) or an Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL). To perform such comparisons, one must understand the physiological assumptions used to establish these occupational exposure limits, the relationship between a workplace airborne exposure concentration and its associated TLV or PEL, and the effect of temperature and pressure on the performance of an accurate compliance evaluation. This article illustrates the correct procedure for performing compliance evaluations using airborne exposure concentrations expressed in both parts per million and milligrams per cubic meter. In so doing, a brief discussion is given on the physiological assumptions used to establish TLVs and PELs. It is further shown how an accurate compliance evaluation is fundamentally based on comparison of a measured work site exposure dose (derived from the sampling site exposure concentration estimate) to an estimated acceptable exposure dose (derived from the occupational exposure limit concentration). In addition, this article correctly illustrates the effect that atmospheric temperature and pressure have on airborne exposure concentrations and the eventual performance of a compliance evaluation. This article also reveals that under fairly moderate conditions of temperature and pressure, 30 degrees C and 670 torr, a misunderstanding of how varying atmospheric conditions affect concentration values can lead to a 15 percent error in assessing compliance.

Air Pollution, Indoor↗
PubMedDate not supplied

Training for rural prehospital providers: a retrospective analysis from Montana.

OBJECTIVE: This paper provides a retrospective analysis of training methods used by rural Montana's prehospital care providers. Drawn from both published and unpublished sources and spanning the past 25 years, it examines the origins of training in this vast rural state and aims to shed light on successful, nontraditional training delivery methods currently being used. Because volunteer personnel traditionally provide prehospital emergency care in rural areas, development and implementation of effective training programs are generally considered important to helping these practitioners maintain the knowledge and skills they use in their lifesaving work. METHODS: Five different training programs used in Montana were assessed: Train-the-trainer; Local Cluster with videotape and guided practicals; Circuit Rider training with interactive videodisc; interactive video teleconference; and the TENKIDS statewide electronic infrastructure. Strengths and weaknesses of each training program were analyzed. RESULTS: Traditional train-the-trainer methods make training readily accessible, but it is difficult to ensure consistent, top-quality delivery of the materials. Electronic training is popular and effective but can be expensive and difficult to develop and distribute. Establishing an electronic infrastructure allows for easy delivery of high-quality electronic instruction. However, it remains somewhat expensive to develop. CONCLUSIONS: Efforts to improve capabilities of instructors in Montana have had varied success. Studies illustrate that remote training methods that train the providers directly are effective and popular. The application of electronic media and other distance learning techniques have demonstrated a positive impact on the frequency, quality, and standardization of training for volunteer prehospital EMTs.

Educational Measurement↗
PubMed2005

Clarification of the nomenclature for MSC: The International Society for Cellular Therapy position statement.

The plastic-adherent cells isolated from BM and other sources have come to be widely known as mesenchymal stem cells (MSC). However, the recognized biologic properties of the unfractionated population of cells do not seem to meet generally accepted criteria for stem cell activity, rendering the name scientifically inaccurate and potentially misleading to the lay public. Nonetheless, a bona fide MSC most certainly exists. To address this inconsistency between nomenclature and biologic properties, and to clarify the terminology, we suggest that the fibroblast-like plastic-adherent cells, regardless of the tissue from which they are isolated, be termed multipotent mesenchymal stromal cells, while the term mesenchymal stem cells is used only for cells that meet specified stem cell criteria. The widely recognized acronym, MSC, may be used for both cell populations, as is the current practice; thus, investigators must clearly define the more scientifically correct designation in their reports. The International Society for Cellular Therapy (ISCT) encourages the scientific community to adopt this uniform nomenclature in all written and oral communications.

Mesenchymal Stem Cells↗