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At least 919 records · Page 51Linked to original sources

PubMed2005

[Randomised clinical trial to evaluate the efficacy of a multi-factorial intervention to reduce hospitalisation and improve the quality of life of patients with heart failure].

OBJECTIVES: To evaluate the efficacy of a multi-disciplinary non-pharmacological intervention to reduce cardiovascular mortality and hospital re-admissions due to heart failure. DESIGN: Randomised, open, controlled, parallel, multi-centre prospective clinical trial. SETTING: Sardenya Primary Care Centre (PCC), les Corts PCC, "El Remei" PCC (Vic Sud), Vall d'Hebron Hospital, Hospital Clínic, Vic Hospital, Hospital Dos de Maig. PARTICIPANTS: 300 patients diagnosed with heart failure. INTERVENTION: Monthly home visits with intercalated phone calls from very well trained nursing staff to provide education on the illness and treatments, optimise therapy compliance, and inform on self-monitoring and management (especially early detection and treatment of decompensation). MAIN MEASUREMENTS: Combined variable of mortality for cardiovascular reasons and re-hospitalisation due to heart failure (via Casualty and/or Admissions) at 1 year. Health-related quality of life. DISCUSSION: Open study, as it is impossible to mask the intervention. The home intervention is not too complex and is easily performed by well-trained health professionals. Its use could be generalised, if a clinically relevant degree of efficacy was shown.

Data Interpretation, Statistical↗

PubMed2002

Animal-assisted interventions research: issues and answers.

Animal visitation programs have been used in a wide variety of clinical settings with predominantly positive outcomes reported anecdotally. However, there is also a growing body of research investigating the effects of these interventions. Developing and conducting rigorous studies of animal interventions can be a complex and challenging process, The purpose of this article is to identify and discuss several issues arising with this type of research and to posit suggestions for avoiding pitfalls.

Aged↗

PubMedDate not supplied

The Environmental Exposure and Sensitivity Inventory (EESI): a standardized approach for measuring chemical intolerances for research and clinical applications.

The lack of a generally accepted case definition for multiple chemical sensitivity (MCS) and the absence of a standardized approach for measuring salient aspects of chemical sensitivity that would permit cross-comparison of findings by different investigators have hindered progress in this area. Based upon findings from an earlier study of 112 persons with self-reported chemical sensitivity who attributed their chemical sensitivity to a well-defined exposure event, we developed an instrument with self-rating scales to assess Symptom Severity, Chemical (Inhalant) Intolerances, Other Intolerances (e.g., foods, medications, alcohol), Life Impact, and Masking (a measure of ongoing chemical exposures). When administered to four patient groups and controls, the scales showed good reliability and validity overall (n = 421) and in each group. Used together, the scales provided sensitivity of 92% and specificity of 95% in differentiating chemically sensitive persons from controls. Our results support use of these scales individually or collectively for a variety of applications including the selection of chemically sensitive subjects and controls for research, assessment of chemical sensitivity in various study populations, cross-comparison of groups studied by different investigators, pre- and post-assessment of therapeutic interventions, clinical evaluation of complex patients who report intolerances, and teaching medical residents and students how to evaluate patients for chemical sensitivity and MCS.

Environmental Exposure↗

PubMed2004

The rate and cost of hospital readmissions for preventable conditions.

The study estimates the rate and cost of preventable readmissions within 6 months after a first preventable admission, by age-group, and by payer and race within age-group. The descriptive results are contrasted with several hypotheses. The hospital discharge data are for residents of New York, Pennsylvania, Tennessee, and Wisconsin in 1999, from files of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. About 19 percent of persons with an initial preventable admission had at least one preventable readmission rate within 6 months. Hospital cost for preventable readmissions during 6 months was about 730 million US dollars. There were substantial differences in readmission rates by payer group and by race. Some evidence suggests that preventable readmissions may partly reflect complexity of underlying problems. Interventions to reduce cost might focus on identifying high-risk patients before discharge and devising new approaches to follow-up.

Adolescent↗

PubMed2004

Application of the transtheoretical model for HIV prevention in a facility-based and a community-level behavioral intervention research study.

This article describes the application of the transtheoretical model of behavior change to prevention programs for women at risk for or infected with HIV. The focus of these multisite demonstration projects was to increase condom and contraceptive use. The model was operationalized for use in the following two different intervention approaches: facility-based interventions (individual counseling for women in clinics, shelters, and drug treatment centers) and community-level interventions (including production of small media materials, street outreach, and community mobilization). The authors found that interventions derived from a complex theory can be disseminated to frontline providers who have little prior HIV education experience or academic training. They suggest that the transtheoretical model has value for the design and implementation of HIV prevention programs.

Community Health Services↗

PubMed2006

Design of the Jerusalem Handwashing Study: meeting the challenges of a preschool-based public health intervention trial.

BACKGROUND: Rates of communicable disease among young children are considerably higher in Israel than in other western countries. Strategies for reducing the disease rates are needed. PURPOSE: The goal of the Jerusalem Handwashing Study (JHS) was to evaluate a preschool-based hygiene programme aimed at reducing illness absenteeism. METHODS: The trial employed cluster randomization of preschools to intervention or control. The intervention programme was multifaceted, including various educational activities and environmental changes. The control group received the programme at the end of the study. A supplementary home component was tested using the innovative design strategy of an embedded individually-randomized trial. All-cause absenteeism and illness-related absenteeism was assessed by daily phone calls to the teachers, supplemented with phone calls to the parents to identify the cause of the absence. The primary endpoint was illness-related absenteeism. In an attempt to avoid bias, survey staff were blinded to the study design and the main outcome as well as intervention status. Validity checks were incorporated to assess the accuracy of educator absenteeism reports and were analysed for differences between the study arms. Observation of handwashing behaviour allowed assessment of behavioural change in the intervention group and spontaneous handwashing changes in the control group. RESULTS: Cluster randomization with delayed implementation in the control group was a feasible and efficient strategy. The individually-randomized embedded sub-trial proved to be an efficient way to test a supplemental intervention component, and is particularly well-suited to programmes run in educational or other group settings, including workplaces, clinics, and community centres. LIMITATIONS: The trial design did not permit analysis of the intervention effect on illness. CONCLUSIONS: The techniques used in this trial made it possible for a rigorous study of a complex community-based health intervention to be carried out successfully. They should prove helpful to future researchers.

Child, Preschool↗

PubMed2002

High-efficiency gene transfer into nontransformed cells: utility for studying gene regulation and analysis of potential therapeutic targets.

The elucidation of the signalling pathways involved in inflammatory diseases, such as rheumatoid arthritis, could provide long sought after targets for therapeutic intervention. Gene regulation is complex and varies depending on the cell type, as well as the signal eliciting gene activation. However, cells from certain lineages, such as macrophages, are specialised to degrade exogenous material and consequently do not easily transfect. Methods for high-efficiency gene transfer into primary cells of various lineages and disease states are desirable, as they remove the uncertainties associated with using transformed cell lines. Significant research has been undertaken into the development of nonviral and viral vectors for basic research, and as vehicles for gene therapy. We briefly review the current methods of gene delivery and the difficulties associated with each system. Adenoviruses have been used extensively to examine the role of various cytokines and signal transduction molecules in the pathogenesis of rheumatoid arthritis. This review will focus on the involvement of different signalling molecules in the production of tumour necrosis factor alpha by macrophages and in rheumatoid synovium. While the NF-kappaB pathway has proven to be a major mediator of tumour necrosis factor alpha production, it is not exclusive and work evaluating the involvement of other pathways is ongoing.

Animals↗

PubMed2005

Responding to rising cancer caseloads: family physician learning needs and challenges in cancer care.

BACKGROUND: In this study, we addressed physicians' learning needs and practice challenges throughout the continuum of cancer care using an interprofessional approach. METHODS: Data sources and tools included (1) 150 family physician questionnaires, (2) 11 oncologist interviews, (3) 13 focus groups with 125 health care providers, and (4) secondary sources. RESULTS: Family physicians wish to play a larger role in their cancer patients' care. Their self-reported learning needs were confirmed by other data sources. Important practice and systemic challenges to improving care exist. CONCLUSION: Decreasing cancer rates and improving cancer care are complex issues requiring educational interventions as well as organizational and communications initiatives.

Adult↗

PubMed2001

Regulation of corpora allata in females of Pyrrhocoris apterus (Heteroptera) (a mini-review).

Mechanisms for the transduction of photoperiodic and food signals to the corpus allatum (CA) are described. The focus of this paper is on the control of the CA by the brain in adult females of the firebug, Pyrrhocoris apterus. By using surgical interventions to the neuroendocrine complex of brain-subesophageal ganglion-corpora cardiaca-CA (BR-SG-CC-CA) in vivo and in vitro we were able to identify two regulatory pathways. (1) Slow regulation of the CA activity (stimulation or inhibition) needs a relatively long period of time to be accomplished (several d) in vivo and is associated with changes of the gland cell volume and ultrastructure. The stimulated or inhibited activity of the CA is maintained during short-term incubation of the isolated CA in vitro. (2) Fast inhibition of the CA activity is reversible during short-term incubation in vitro; the CA can be switched from lower to higher activity and vice versa, depending on the presence or absence of the BR-SG in the medium. Both slow and fast regulatory factors originate in the pars intercerebralis of the brain and in intact neuroendocrine complex they reach the CA via nerves. A slow inhibitor, induced by short d, causes reproductive diapause. A fast inhibitor prevents ovarian maturation in starved nondiapausing females. A slow stimulator, induced by feeding under long d, overcomes the fast inhibition of the CA, thereby stimulating vitellogenesis. Food signals are transmitted to the brain via humoral pathways.

Animals↗

PubMed1997

Subglottic stenosis complicating cardiac surgery in children.

OBJECTIVE: To highlight the incidence of subglottic stenosis (SGS) as a complication of surgery for congenital heart disease and the role of single-stage laryngotracheoplasty in treating this complication. DESIGN: Retrospective case series. SETTING: University-based referral center specializing in surgery for congenital heart disease and complex airway problem management. INTERVENTION: Laryngotracheal reconstruction (LTR). MAIN OUTCOME MEASURE: Successful airway expansion. RESULTS: At last follow-up, 87.5% (7 of 8) of patients remain free of obstructive airway symptoms. CONCLUSION: SGS can complicate surgery for congenital heart disease in children. Single-stage LTR is an effective treatment modality for this problem.

Acute Disease↗

PubMed2004

Percutaneous treatment of a large coronary aneurysm using the self-expandable Symbiot PTFE-covered stent.

We report a complex case of percutaneous intervention on a right coronary artery with calcific stenoses and a large coronary aneurysm with long longitudinal diameter, which was successfully performed using a polytetrafluoroethylene-covered self-expandable stent (Symbiot; Boston Scientific; Natick, MA). The use of this new device may enhance the anatomic indications for percutaneous interventions on coronary aneurysms.

Aged↗

PubMed2004

The complexity of PTEN: mutation, marker and potential target for therapeutic intervention.

Phosphatase and tensin homologue deleted on chromosome 10 (PTEN) is a phosphatase that removes phosphates primarily from lipids. It has also been called mutated in multiple advanced cancers 1 and transforming growth factor-beta regulated epithelial cell-enriched phosphatase 1. The best described substrate of PTEN is phosphatidyliniositol (3,4,5)-tris-phosphate [PtdIns(3,4,5)P3]. PTEN removes the phosphate in PtdIns(3,4,5)P(3) to generate PtdIns(4,5)P(2). PTEN serves to counter-balance the effects of phosphoinositide 3' kinase, which normally adds a phosphate to PtdIns(4,5)P(2) to generate PtdIns(3,4,5)P(3). PtdIns(3,4,5)P(3) recruits kinases such as phosphoinositide-dependent kinase 1, which in turn phosphorylate Akt, which phosphorylates other downstream proteins involved in regulation of apoptosis and cell-cycle progression. PTEN removal of the phosphate from PtdIns(3,4,5)P(3) inhibits this pathway by preventing localisation of proteins with pleckstrin homology domains to the cell membrane. Alterations of the PTEN gene are associated with cancer and other diseases. Novel therapeutic approaches have been developed to counteract the deletion/mutation of PTEN in human cancer. This review will discuss the role of PTEN in signal transduction and cancer as well as pharmacological approaches to combat PTEN loss in human cancer.

Animals↗

PubMed2003

The female athlete triad: an emerging role for physical therapy.

Over the last thirty years, participation by girls and women in organized athletics has increased dramatically. This presents unique challenges in the area of sports medicine, orthopaedics, and pediatrics. While the benefits of participation in sports and exercise vastly outweigh the risks of permanent injury, an evolving concern is the number of stress fractures in active women. The female athlete triad ("triad") describes the coexistence of 3 distinct medical conditions that may occur in athletic girls and women. Originally, the triad included eating disorders, amenorrhea, and osteoporosis. Presently, it includes eating disorders/disordered eating behavior, amenorrhea/oligomenorrhea, and decreased bone mineral density (osteoporosis and osteopenia). Briefly, when coupled with inadequate nutrition, the high caloric expenditure of exercise training resultsin a sustained negative caloric balance or low energy availability, which is exquisitely sensed by the hypothalamus, initiating a complex neuroendocrine adaptive cascade. This cascade is associated with changes in the hypothalamic-pituitary-ovarian axis, such that estrogen levels are decreased, resulting in reproductive dysfunction that may include amenorrhea, oligomenorrhea, or anovulation. Low estrogen in otherwise young healthy women, like menopause, is associated with decreased bone mineral density and increased risk of fractures. The triad is not an inevitable consequence of participation in sports or physical activity at any level, however, exercise may contribute to the disruption of caloric balance. The triad is a complex disorder that requires intervention by a multidisciplinary team. Physical therapists bring a unique expertise to the team. The present review summarizes each component of the triad, component linkage, and the role of physical therapy in prevention, assessment, and intervention.

Adolescent↗

PubMed1991

Preventive care guidelines: 1991. American College of Physicians. Canadian Task Force on the Periodic Health Examination. United States Preventive Services Task Force.

Clinicians increasingly are urged to integrate preventive services into their clinical practices. To facilitate this process, several groups have developed practice guidelines for preventing disease in asymptomatic patients. In this paper, we compare and contrast preventive guidelines from the American College of Physicians (ACP), the Canadian Task Force on the Periodic Health Examination (CTF), the United States Preventive Services Task Force (USPSTF), and other well-known authorities. We chose these groups because they based their recommendations on explicit methods that include critical appraisal of the pertinent literature. Recommendations from these authorities usually are consistent with each other. Moreover, the ACP, CTF, and USPSTF all favor a shift away from the relatively simple classification of patients by age and sex for general preventive interventions to the more complex stratification of patients by additional risk factors and the formulation of a selective prevention strategy that is specific to each risk profile. Some guidelines, particularly the criteria used to define patients who are at increased risk for preventable disease and who should have more intensive surveillance, are difficult to interpret. Further research is needed to address some areas of disagreement and ambiguity. In addition, new tools must be developed to help physicians apply preventive guidelines, particularly those that require noting many patient-specific characteristics.

Canada↗

PubMed1999

Reactive oxygen intermediates enhance Fc gamma receptor signaling and amplify phagocytic capacity.

Receptors for the Fc region of IgG (Fc gamma R) mediate internalization of opsonized particles by human neutrophils (PMN) and mononuclear phagocytes. Cross-linking of Fc gamma R leads to activation of protein tyrosine kinases and phosphorylation of immunoreceptor tyrosine-based activation motifs (ITAMs) within Fc gamma R subunits, both obligatory early signals for phagocytosis. Human PMN constitutively express two structurally distinct Fc gamma R, Fc gamma RIIa and Fc gamma RIIIb, and can be induced to express Fc gamma RI by IFN-gamma. We have previously shown that stimulation of PMN through Fc gamma RIIIb results in enhanced Fc gamma RIIa-mediated phagocytic activity that is inhibited by catalase. In the present study, we have tested the hypothesis that reactive oxygen intermediates (ROI) have the capacity to regulate Fc gamma R responses and defined a mechanism for this effect. We show that H2O2 augmented phagocytosis mediated by Fc gamma RIIa and Fc gamma RI in PMN and amplified receptor-triggered tyrosine phosphorylation of Fc gamma R-associated ITAMs and signaling elements. Generation of endogenous oxidants in PMN by cross-linking Fc gamma RIIIb similarly enhanced phosphorylation of Fc gamma RIIa and Syk, a tyrosine kinase required for phagocytic function, in a catalase-sensitive manner. Our results provide a mechanism for priming phagocytes for enhanced responses to receptor-driven effects. ROI generated in an inflammatory milieu may stimulate quiescent cells to rapidly increase the magnitude of their effector function. Indeed, human monocytes incubated in the presence of stimulated PMN showed oxidant-induced increases in Fc gamma RIIa-mediated phagocytosis. Definition of the role of oxidants as amplifiers of Fc gamma R signaling identifies a target for therapeutic intervention in immune complex-mediated tissue injury.

Adjuvants, Immunologic↗

PubMed1999

Decision analytic approach to severe head injury management.

Severe head injury management in the intensive care unit is extremely challenging due to the complex domain, the uncertain intervention efficacies, and the time-critical setting. We adopt a decision analytic approach to automate the management process. We document our experience in building a simplified influence diagram that involves about 3000 numerical parameters. We identify the inherent problems in structuring a model with unclear domain relationships, numerous interacting variables, and real-time multiple inputs. We analyze the effectiveness and limitations of the decision analytic approach and present a set of desiderata for effective knowledge acquisition in this setting. We also propose a semi-qualitative approach to parameter elicitation.

Craniocerebral Trauma↗

PubMed1995

Quality-of-Life Issues Associated With the Treatment of Prostate Cancer.

The incidence of prostate cancer in the United States has dramatically increased over the last several years. As a result of prostate-specific antigen testing, many more men have localized, asymptomatic prostate cancer at the time of initial diagnosis. Treatment options for patients with prostate-confined adenocarcinoma of the prostate include observation, radical prostatectomy, external beam radiotherapy, radioactive prostate implantation, hormonal therapy, cryotherapy, and various combinations of the above modalities. Quality of life can be affected by the tumor and by any of the hormonal, surgical, or radiotherapeutic interventions. These treatments raise complex and multidimensional issues. Although quality-of-life issues are becoming integral and important components of clinical research in prostate cancer, many challenges in research and practice remain.

Journal Article↗

PubMed2000

[Childhood trauma and chronic pain].

BACKGROUND: Chronic pain is a complex, multidimensional phenomenon. Medical intervention has often little effect. MATERIAL AND METHODS: The case histories of 100 patients evaluated by the multidisciplinary pain clinic team at Haukeland University Hospital in Bergen, Norway were examined. RESULTS: 44% of the patients reported serious trauma long before the development of pain. INTERPRETATION: Chronification of pain appears to be related to childhood trauma.

Alcoholism↗