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PubMed2003

Hallux valgus: immediate operation versus 1 year of waiting with or without orthoses: a randomized controlled trial of 209 patients.

Hallux valgus operations can not always be done immediately because of long waiting lists. In this study, 209 consecutive patients (mean age 48 years, 93% female) with a painful hallux valgus were randomized into 3 groups: immediate operation or 1 year waiting with or without foot orthoses. The follow-up period was 2 years. The main outcome measurement was the intensity of pain during walking. During the first year, 64/71, 0/69 and 4/69 patients were operated on in the surgery, orthosis and no orthosis groups, respectively, and during the 2-year follow-up, 66, 43 and 48, respectively. At the 1-year follow-up, the pain was least intense in the surgery group. At the 2-year follow-up, the intensity of pain was similar in all groups. The satisfaction with treatment was best in the surgery and orthosis groups. The total costs of care were similar in all groups. We conclude that immediate operation is superior to delayed operation or foot orthoses. However, if this is not possible because of limited possibilities for surgery, waiting for 1 year, with or without an orthosis, does not jeopardize the final outcome.

Costs and Cost Analysis↗

PubMed1990

Comparison of a hydrocolloid dressing and silver sulfadiazine cream in the outpatient management of second-degree burns.

The purpose of this prospective randomized study was to evaluate the use of an occlusive hydrocolloid dressing (Duoderm hydroactive, Squibb) and silver sulfadiazine (Silvadene, Marion) cream in the outpatient management of second-degree burns. The inclusion criteria consisted of burns less than 15% total body surface area that were evaluated within 24 hours of injury and did not require hospital admission. Fifty patients were randomly assigned after having been screened through a list of seven exclusion criteria. On initial evaluation the burns were photographed and screened for causative agent, location, size, depth, tetanus status, and presence of associated burns and injuries. Patients were seen in followup at least biweekly and evaluated for wound bed healing, wound margin healing, pain, number of dressing changes between visits, and ease of dressing application and removal. On final evaluation the burns were photographed and inspected for appearance of the healed burn, repigmentation, wound contraction, approximate time for dressing change, patient compliance, limitation of activity, overall impression of the treatment, and number of days for complete healing. Results were compared using a two-tailed t-test with p less than 0.01. Both groups were statistically similar in age, sex, and size. Duoderm-treated burns had statistically significantly better wound healing, repigmentation, less pain, fewer dressing changes, less time for dressing changes, and less cost. Duoderm-treated patients had statistically significantly less limitation of activity, better patient compliance, greater patient comfort, better overall acceptance, and felt the treatment was more aesthetically pleasing. The results reveal that the Duoderm Hydroactive dressings are superior to Silvadene cream in the outpatient management of second-degree burns.

Adolescent↗

PubMed1996

Paget's disease of bone and quality of life.

Little is known about how Paget's disease of bone affects quality of life. To better understand the relative impact of factors on quality of life, we mailed a brief survey to 2000 people randomly selected from the Paget's Foundation mailing list. The sample was geographically stratified to examine the effects of specialist availability. Nine hundred and fifty-eight persons responded to the questionnaire (53% response rate after adjustment for death, incorrect addresses, and nondeliverable mailings). The sample had equal proportions of males and females, with a mean age of 74 years (SD = 9.0). Most (97%) were white, with high levels of education (mean 13 years; SD 3.7) and income (60% earned more than $20,000 annually). They reported pagetic bone in the skull (34%), spine (35%), pelvis (49%), and leg (48%). The most frequently mentioned complications were hearing loss (37%) and bowed limbs (31%). Comorbidity included arthritis (64%), hypertension (32%), and heart problems (28%). Nearly half (47%) reported feelings of depression, and 42% said that their health was fair or poor. Only 21% reported that quality of life was very good or excellent. In multiple partial F-test regression analyses, variables were divided into four domains (social, psychological, care, and biomedical). The psychological domain explained 19% of the variance beyond that explained by all other variables; the social domain explained 3%, the biomedical domain explained 3% and the care domain explained 1%. The importance of the psychological aspects of Paget's disease suggests that treatment protocols should include psychological intervention to improve quality of life.

Adaptation, Psychological↗

PubMed2006

Pharmacological management of Huntington's disease: an evidence-based review.

INTRODUCTION: Despite the increasing body of published reports on pharmacological interventions in Huntington's disease (HD), an evidence based review (EBR) of treatment studies has not yet been published. METHOD: Systematic literature searches were done using Medline (1965-August 2005), the central database in the Cochrane Library (1969-August 2005), and reference lists published in review articles and other clinical reports. Randomized controlled trials (RCTs) were classified as level-I-studies in this paper. Level-II evidence was assigned to non-randomized, controlled clinical studies. Level-III-studies comprised open label trials excluding case reports. Measures of efficacy as well as safety and tolerability were considered for each compound. RESULTS: We identified 218 publications on pharmacological interventions in HD since 1965. Among them were 20 level-I, 55 level-II, 54 level-III trials, and 89 case reports. All these papers are listed and analyzed. Chorea was the primary end point in all level-I and level-II symptomatic intervention trials. There is some evidence for treating chorea with haloperidol or fluphenazine, and less evidence for olanzapine. These three drugs have been considered "possibly useful" for the treatment of chorea in this analysis. Other substances (e.g. amantadine, riluzole, and tetrabenazine) are considered "investigational" for chorea. There is very low evidence for the treatment of other problems: "possibly useful" drugs are L-dopa and pramipexole for rigidity; amitryptiline and mirtazapine for depression; risperidone for psychosis; and olanzapine, haloperidol, and buspirone for behavioral symptoms in HD. Three substances are considered "investigational" for possible neuroprotection: coenzyme Q10, minocycline, and unsaturated fatty acids. CONCLUSION: There is poor evidence in management of HD today. The analysis of the twenty level-I studies fails to result in any treatment recommendation of clinical relevance. High-quality RCT are highly warranted to advance HD treatment in clinical practice.

Antipsychotic Agents↗

PubMed1991

Fundholding in general practice and financial risk.

OBJECTIVE: To estimate the financial effect of random yearly variations in need for services on fundholding practices with various list sizes. DESIGN: A simulation model was derived using historical data on general practitioner referrals for the 113 surgical procedures covered by the general practitioner fund, combined with data on the hospital prices for those procedures. PATIENTS: Resident population of Central Birmingham Health Authority. MAIN OUTCOME MEASURES: Expected expenditure on the relevant surgical procedures for the whole district and for practices with list sizes of 9000, 12,000, 15,000, 18,000, 21,000, or 24,000 for each of 100 simulated years. RESULTS: By using average hospital prices for the West Midlands region the mean (SD) annual expenditure for the 179,400 residents was 4,832,471 pounds (87,149 pounds); the random variation between the 5th and 95th most expensive years was 5.7% of the mean cost. For a practice with a list size of 9000 the values were 244,891 pounds (18,349 pounds), with a variation of 27.5%. With a list size of 24,000 the values were 652,762 pounds (32,512 pounds), with a variation of 15.3%. CONCLUSIONS: Random variations in need for inpatient services will have a significant financial impact on the practice fund. The problem will be particularly great for smaller practices. Additional measures are required to ensure that the scheme is not undermined and that the potential benefits are secured.

Budgets↗

PubMed2006

The subcoronary Toronto stentless versus supra-annular Perimount stented replacement aortic valve: early clinical and hemodynamic results of a randomized comparison in 160 patients.

BACKGROUND: A stentless valve is expected to be hemodynamically superior to a stented valve. The aim of this study was to compare early postoperative hemodynamic function and clinical events in a randomized, prospective series of 160 stentless and stented biological replacement aortic valves. METHODS: We randomized 160 consecutive patients on 1 surgeon's list to receive either a Toronto stentless porcine valve (St Jude Medical, Inc, St Paul, Minn) or a Perimount stented bovine pericardial valve (Edwards Lifesciences, Irvine, Calif). Echocardiography was performed at discharge, between 3 and 6 months, and at 1 year after surgery. Statistical analysis was performed by both intention to treat and actual valves implanted. RESULTS: The mean labeled size of both designs of valve was 24.7. There were no statistically significant differences in results at any time interval or whether analysis was performed by actual valves implanted or intention to treat. At 3 to 6 months for the Toronto versus the Perimount valve, the effective orifice area was 1.58 versus 1.66 cm2, the mean pressure difference was 7.54 versus 7.42 mm Hg, and the peak velocity was 2.07 versus 2.0.1 m/s. There was no difference in mortality, regression of left ventricular hypertrophy, or complications other than paraprosthetic regurgitation at 12 months or on follow-up for a proportion of the sample to 8 years. The incidence of regurgitation through the valves was similar for Toronto (10%) and Perimount (13.8%) at 1 year, but mild paraprosthetic regurgitation was found in 5 patients with the Perimount valve and none with Toronto valves. CONCLUSIONS: There were no significant differences in hemodynamic function or clinical events between the stented and stentless biological valves chosen for comparison in the early postoperative period or in preliminary follow-up to 5 years.

Aged↗

PubMed2002

Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study.

The emotional content of health care professionals-cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy. One hundred and fifteen oncology nurses participating in a communication skills training workshop were assessed at three different periods. Nurses randomly allocated to a control group arm (waiting list) were assessed a first time and then 3 and 6 months later. Nurses allocated to the training group were assessed before training workshop, just after and 3 months later. Each nurse completed a 20-min clinical and simulated interview. Each interview was analysed by three content analysis systems: two computer-supported content analysis of emotional words, the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level, the Cancer Research Campaign Workshop Evaluation Manual. The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained (P=0.056): training group subjects use 4.3 (std: 3.7) emotional words per 1000 used before training workshop, and 7.0 (std: 5.8) right after training workshop and 5.9 (std: 4.3) 3 months later compared to control group subjects which use 4.5 (std: 4.8) emotional words at the first assessment point, 4.3 (std: 4.1) at the second and 4.4 (std: 3.3) at the third. The same trend is noticeable for emotional words used by health care professionals in simulated interviews (P=0.000). The emotional words registry used by health care professionals however remains stable over time in clinical interviews (P=0.141) and is enlarged in simulated interviews (P=0.041). This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training (P=0.005). This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression.

Adult↗

PubMed2004

Systematic review of progressive resistance strength training in older adults.

BACKGROUND: The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to reduce physical disability in older people. METHODS: Randomized controlled trials were identified from searches of relevant databases and study reference lists and contacts with researchers. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Only randomized controlled trials utilizing PRT as the primary intervention in participants, whose group mean age was 60 years or older, were included. Data were pooled using fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest. RESULTS: 62 trials (n = 3674) compared PRT with a control group. 14 trials had data available to allow pooling of disability outcomes. Most trials were of poor quality. PRT showed a strong positive effect on strength, although there was significant heterogeneity (41 trials [n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI -0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined and prospectively monitored. CONCLUSIONS: PRT results in improvements to muscle strength and some aspects of functional limitation, such as gait speed, in older adults. However, based on current data, the effect of PRT on physical disability remains unclear. Further, due to the poor reporting of adverse events in trials, it is difficult to evaluate the risks associated with PRT.

Age Factors↗

PubMed2003

Glaucoma and survival: the National Health Interview Survey 1986-1994.

OBJECTIVE: Associations between glaucoma and survival have not been studied extensively, in part, because of the relatively low prevalence of this condition. This study examines associations between self-reported glaucoma and mortality in a nationally representative sample of U.S. adults. DESIGN: Annual cross-sectional multistage area probability survey of the U.S. civilian noninstitutionalized population living at addressed dwellings. PARTICIPANTS: Mortality linkage with >96% of participants from the 1986 to 1994 National Health Interview Survey was performed by the National Center for Health Statistics through 1997. Complete data were available on 116796 adults >or=018 years old. METHODS: Adults within randomly selected households were administered a chronic conditions list that included questions about glaucoma and visual impairment. Proxy information on these conditions was obtained when household members were unavailable for interview. Statistical methods included Cox regression models with adjustments for covariates, as well as for the complex sample survey design. MAIN OUTCOME MEASURE: All-cause mortality and cardiovascular and cancer mortality. RESULTS: A total of 1559 (1.3%) glaucoma cases were reported. Nearly 19% of participants with reported glaucoma also had reported visual impairment (n = 303). Mortality linkage identified 8949 deaths; the average follow-up was 7.0 years. After controlling for survey design, gender, age, race, marital status, education level, and self-rated health, participants with reported glaucoma but without reported visual impairment were at significantly increased risk of death relative to participants without reported glaucoma, irrespective of visual impairment status (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.19-1.53); similar associations were found for participants with reported glaucoma and visual impairment vs. participants with no reported glaucoma (HR, 1.39; 95% CI, 1.14-1.71). An increased risk of cardiovascular disease mortality was found for participants with reported glaucoma both without (HR, 1.31; 95% CI, 1.11-1.55) and with (HR, 1.53; 95% CI, 1.15-2.05) reported visual impairment. Risk of mortality due to cancer was increased only in participants with reported glaucoma but without reported visual impairment (HR, 1.57; 95% CI, 1.25-1.98); this association was stronger when the mortality analysis was restricted to cancers amenable to early screening, including breast, cervical, colon, and prostate cancer (HR, 1.99; 95% CI, 1.41-2.81). CONCLUSIONS: Among adults residing in the United States, reported glaucoma is associated with an increased risk of all-cause and cardiovascular disease mortality. Associations between glaucoma and cancer were inconsistent and may reflect, in part, a detection bias, in which glaucoma is more likely to be diagnosed in adults receiving health care because of other medical conditions.

Adolescent↗

PubMed2003

The design and implementation of a motion correction scheme for neurological PET.

A method is described to monitor the motion of the head during neurological positron emission tomography (PET) acquisitions and to correct the data post acquisition for the recorded motion prior to image reconstruction. The technique uses an optical tracking system, Polaris, to accurately monitor the position of the head during the PET acquisition. The PET data are acquired in list mode where the events are written directly to disk during acquisition. The motion tracking information is aligned to the PET data using a sequence of pseudo-random numbers, which are inserted into the time tags in the list mode event stream through the gating input interface on the tomograph. The position of the head is monitored during the transmission acquisition, and it is assumed that there is minimal head motion during this measurement. Each event, prompt and delayed, in the list mode event stream is corrected for motion and transformed into the transmission space. For a given line of response, normalization, including corrections for detector efficiency, geometry and crystal interference and dead time are applied prior to motion correction and rebinning in the sinogram. A series of phantom experiments were performed to confirm the accuracy of the method: (a) a point source located in three discrete axial positions in the tomograph field of view, 0 mm, 10 mm and 20 mm from a reference point, (b) a multi-line source phantom rotated in both discrete and gradual rotations through +/- 5 degrees and +/- 15 degrees, including a vertical and horizontal movement in the plane. For both phantom experiments images were reconstructed for both the fixed and motion corrected data. Measurements for resolution, full width at half maximum (FWHM) and full width at tenth maximum (FWTM), were calculated from these images and a comparison made between the fixedand motion corrected datasets. From the point source measurements, the FWHM at each axial position was 7.1 mm in the horizontal direction, and increasing from 4.7 mm at the 0 mm position, to 4.8 mm, 20 mm offset, in the vertical direction. The results from the multi-line source phantom with +/- 5 degrees rotations showed a maximum degradation in FWHM, when compared with the stationary phantom, of 0.6 mm, in the horizontal direction, and 0.3 mm in the vertical direction. The corresponding values for the larger rotation, +/- 15 degrees, were 0.7 mm and 1.1 mm, respectively. The performance of the method was confirmed with a Hoffman brain phantom moved continuously, and a clinical acquisition using [11C]raclopride (normal volunteer). A visual comparison of both the motion and non-motion corrected images of the Hoffman brain phantom clearly demonstrated the efficacy of the method. A sample time-activity curve extracted from the clinical study showed irregularities prior to motion correction, which were removed after correction. A method has been developed to accurately monitor the motion of the head during a neurological PET acquisition, and correct for this motion prior to image reconstruction. The method has been demonstrated to be accurate and does not add significantly to either the acquisition or the subsequent data processing.

Algorithms↗

PubMed2003

Influence of the completeness of chemical shift assignments on NMR structures obtained with automated NOE assignment.

Reliable automated NOE assignment and structure calculation on the basis of a largely complete, assigned input chemical shift list and a list of unassigned NOESY cross peaks has recently become feasible for routine NMR protein structure calculation and has been shown to yield results that are equivalent to those of the conventional, manual approach. However, these algorithms rely on the availability of a virtually complete list of the chemical shifts. This paper investigates the influence of incomplete chemical shift assignments on the reliability of NMR structures obtained with automated NOESY cross peak assignment. The program CYANA was used for combined automated NOESY assignment with the CANDID algorithm and structure calculations with torsion angle dynamics at various degrees of completeness of the chemical shift assignment which was simulated by random omission of entries in the experimental 1H chemical shift lists that had been used for the earlier, conventional structure determinations of two proteins. Sets of structure calculations were performed choosing the omitted chemical shifts randomly among all assigned hydrogen atoms, or among aromatic hydrogen atoms. For comparison, automated NOESY assignment and structure calculations were performed with the complete experimental chemical shift but under random omission of NOESY cross peaks. When heteronuclear-resolved three-dimensional NOESY spectra are available the current CANDID algorithm yields in the absence of up to about 10% of the experimental 1H chemical shifts reliable NOE assignments and three-dimensional structures that deviate by less than 2 A from the reference structure obtained using all experimental chemical shift assignments. In contrast, the algorithm can accommodate the omission of up to 50% of the cross peaks in heteronuclear- resolved NOESY spectra without producing structures with a RMSD of more than 2 A to the reference structure. When only homonuclear NOESY spectra are available, the algorithm is slightly more susceptible to missing data and can tolerate the absence of up to about 7% of the experimental 1H chemical shifts or of up to 30% of the NOESY peaks.

Algorithms↗

PubMed2004

Trends in visual acuity impairment in US adults: the 1986-1995 National Health Interview Survey.

OBJECTIVE: To assess 10-year trends in reported visual impairment. METHODS: The National Health Interview Survey is a continuous multistage area probability survey of the US civilian noninstitutionalized population living at addressed dwellings. Adults within randomly selected households were administered a chronic conditions list that included questions about visual impairment. Proxy information on these conditions was obtained when household members were unavailable for interview. Complete data were available on 132 860 adults 18 years or older in survey years 1986 to 1995. Prevalence rates were adjusted for age and sample survey design. RESULTS: Annual age-adjusted rates of some visual impairment ranged from 3.6% to 4.6%. Rates of severe bilateral visual impairment ranged from 0.2% to 0.4%. There was some evidence for increasing rates of visual impairment among younger adults 18 to 39 years of age (annual increase, 0.03%; P =.03). However, there were no significant changes in reported visual impairment rates in older adults stratified into 10-year age groups. CONCLUSIONS: Data from the National Health Interview Survey provide no evidence that reported visual impairment rates are declining in the US noninstitutionalized population from 1986 to 1995. Additional treatment advances, greater use of existing treatments, including correcting refractive errors, and further reductions in risk factors for disabling eye diseases may be necessary before population-level reductions in visual impairment rates can be achieved.

Adolescent↗

PubMed2006

Intelligence and other predisposing factors in exposure to trauma and posttraumatic stress disorder: a follow-up study at age 17 years.

CONTEXT: Prospective data on standardized measures of early predispositions would allow a strong test of hypotheses about suspected risk factors of posttraumatic stress disorder (PTSD) and exposure to traumatic events. OBJECTIVE: To prospectively examine the extent to which intelligence, anxiety disorders, and conduct problems in childhood influence the risk for PTSD and for exposure to traumatic events. DESIGN: A longitudinal study of a randomly selected sample assessed at age 6 years and followed up to age 17 years. SETTING: Samples were randomly selected from the 1983-1985 newborn discharge lists of 2 major hospitals in southeast Michigan (N=823). PARTICIPANTS: Cohort members with follow-up data at age 17 years (n=713; 86.6% of the initial sample). MAIN OUTCOME MEASURES: Cumulative exposure up to age 17 years of qualifying traumatic events; DSM-IV PTSD among participants who have experienced 1 or more traumatic events. RESULTS: Youth with teacher ratings of externalizing problems above the normal range at age 6 years were at increased risk for exposure to assaultive violence (adjusted odds ratio, 2.6; 95% confidence interval, 1.4-4.9). Youth aged 6 years with an IQ greater than 115 had decreased risk for exposure to traumatic events (adjusted odds ratio for assaultive violence, 0.3; 95% confidence interval, 0.2-0.7); a decreased risk for nonassaultive trauma (adjusted odds ratio, 0.6; 95% confidence interval, 0.3-0.9); and a decreased conditional risk for PTSD (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.9). The conditional risk for PTSD was increased for youth with anxiety disorders and teacher ratings of externalizing problems above the normal range at 6 years of age. CONCLUSIONS: The results of this prospective community study highlight the role of intelligence in avoidance of exposure to traumatic experiences and their PTSD effects. They underscore the need for investigating cognitive processes in persons' responses to traumatic experiences and the involvement of general intelligence in these processes.

Adolescent↗

PubMed2005

Medicinal and injection therapies for mechanical neck disorders.

BACKGROUND: Medicinal therapies and injections are commonly recommended for neck pain, yet controversy persists over their effectiveness. OBJECTIVES: To determine the effect of medicines and injections on pain, function/disability, patient satisfaction and range of motion in participants with mechanical neck disorders (MND). SEARCH STRATEGY: We searched CENTRAL (Issue 4, 2002), and MEDLINE, EMBASE, MANTIS, CINHAL from their start to March 2003. We scrutinized reference lists for other trials. SELECTION CRITERIA: We included randomized controlled trials with adults with MND, with or without associated headache or radicular findings. We considered medicinal and injection therapies, regardless of route of administration. DATA COLLECTION AND ANALYSIS: Two authors independently selected articles, abstracted data and assessed methodological quality using the Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies using random-effects meta-analysis models. MAIN RESULTS: We found 32 trials that examined the effects of oral NSAIDs, psychotropic agents, injections of steroids, and anaesthetic agents. Overall, methodological quality had a mean of 3.2/5 on the Jadad Scale. For acute whiplash, administering intravenous methylprednisolone within eight hours reduced pain at one week, and sick leave but not pain at six months compared to placebo. For chronic MND at short-term follow-up, intramuscular injection of lidocaine was superior to placebo or dry needling, but similar to ultrasound. In chronic MND with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain and improved function at one-year follow-up compared to the intramuscular route. In subacute/chronic MND, we found conflicting evidence of pain reduction for oral psychotropic agents compared to placebo or control. Single trials of eperison hydrochloride and tetrazepam showed positive results. Results for cyclobenzaprine were mixed. Diazepam did not show benefit. Other treatments including NSAIDS and nerve blocks had unclear or limited evidence of benefit. In participants with chronic MND with or without radicular findings or headache, there was moderate evidence from five high quality trials showing that Botox A intramuscular injections were not better than saline in improving pain (pooled SMD: -0.39 (95%CI: -1.25 to 0.47), disability or global perceived effect. AUTHORS' CONCLUSIONS: Intra-muscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings. Oral psychotropic agents had mixed results. There was moderate evidence that Botox A intramuscular injections for chronic MND were no better than saline. Other medications, including NSAIDs, had contradictory or limited evidence of effectiveness.

Anesthetics, Local↗

PubMed2003

High versus low medium chain triglyceride content of formula for promoting short term growth of preterm infants.

BACKGROUND: In-hospital growth of most very low birth weight infants remains below the 10th percentile of reference intrauterine growth curves (Ehrenkranz 1999). To improve growth, fat is added to preterm formula in the form of medium chain triglycerides (MCT) or long chain triglycerides (LCT). MCT are easily accessible to the preterm infant with an immature digestive system while LCT are important in the development of the retina and visual acuity. Both have been incorporated into preterm formulas in varying amounts, but their effect on the preterm infant's short term growth is unclear. OBJECTIVES: To determine among preterm, formula fed infants, does high MCT as opposed to low MCT (high LCT) formula promote higher short term growth rates. SEARCH STRATEGY: MEDLINE (1966-2002), CINAHL (1982-2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), conference proceedings, and reference lists of articles were searched. SELECTION CRITERIA: All randomized trials comparing the effects of exclusive feeding of high versus low MCT formula (for a minimum of one week) on the short term growth of healthy, preterm infants. DATA COLLECTION AND ANALYSIS: Two reviewers assessed each study's quality and extracted data on growth parameters as well as adverse effects from included studies. All data used in analysis were continuous, and therefore weighted mean differences with 95% confidence intervals were reported. MAIN RESULTS: Eight randomized trials studying a total of 182 infants were included. There was no evidence of difference in short term growth parameters when high and low MCT formulas were compared. The meta-analysis of weight gain based on five studies yielded a WMD of -0.35 g/kg/d (95% CI -1.44, 0.74). Similarly, meta-analysis of weight gain in g/d based on two studies showed no evidence of difference (WMD 2.09 g/d, 95% CI -1.46, 5.64). Length gain, based on five studies, showed a non-significant WMD of 0.14 cm/wk (95% CI -0.04, 0.31). Head circumference gain, based on data from five studies, showed a non-significant WMD -0.03 cm/wk (95% CI -0.15, 0.08). Only one study reported skin fold thickness gain, with a mean difference -0.15 mm/wk (95% CI -0.41, 0.11), again not significant. Subgroup analyses according to % MCT in the high MCT formula, by 10% intervals, showed no evidence of effect of high MCT on short term weight gain within any subgroup. There are conflicting data (two studies) as to formula tolerance. There is no evidence of effect on incidence of necrotizing enterocolitis (NEC), based on small numbers in two trials. No studies were located addressing long term growth parameters or neurodevelopmental outcomes. REVIEWER'S CONCLUSIONS: There is no evidence of difference between MCT and LCT on short term growth, gastrointestinal intolerance, or necrotizing enterocolitis. Therefore, neither formula type could be concluded to improve short term growth or have less adverse effects. Further studies are necessary because the results from the included eight studies are imprecise due to small numbers and do not address important long term outcomes. Additional research should aim to clarify effects on formula tolerance and on long term growth and neurodevelopmental outcomes, and include larger study populations to better evaluate effect on NEC incidence.

Dietary Fats↗

PubMed2003

Communication skills training for health care professionals working with cancer patients, their families and/or carers.

BACKGROUND: Research suggests communication skills do not reliably improve with experience and considerable effort is dedicated to courses improving communication skills for health professionals. The evaluation of such courses is of importance to enable evidence-based teaching and practice. OBJECTIVES: To assess whether communication skills training is effective in changing behaviour of health professionals in cancer care with regard to communication/interaction with patients. SEARCH STRATEGY: We searched CENTRAL (Cochrane Library Issue 3 2001), MEDLINE (1966 to November 2001), EMBASE (1980 to November 2001), PsycInfo (1887 to November 2001), CINAHL (1982 to November 2001), AMED (1985 - October 2001), Dissertation Abstracts International (1861 to March 2002) and EBM Reviews (1991 to March/April 2001). Reference lists of relevant articles were searched. SELECTION CRITERIA: Randomized controlled trials or controlled before and after studies of communication skills training in cancer health professionals, measuring changes in behaviour/skills using objective and validated scales. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Although 2822 references were considered, only two trials involving 232 health professionals were included. One provided an intensive three-day course then assessed oncology doctors interacting with a total of 640 patients; the other provided a modular course then used role plays with oncology nurses for skill assessment. In one trial, course attendees used more focused questions (34% increase, probability < 0.005), focused and open questions (27% increase, p = 0.005), expressions of empathy (69% increase, p < 0.005) and appropriate responses to cues (38% increase, p < 0.05) at follow up than non-attendees. No significant differences were found between attendees and non-attendees in use of leading questions. From baseline to follow up in the same study, attendees had significantly different changes in rates of leading questions (relative risk 0.72, p < 0.05), focused questions (Relative Risk 1.25, p < 0.005), open questions (RR 1.17, p < 0.05) and empathy (RR 1.50, p = 0.005). The only significant difference in observed communication skills in the second trial was that the trained group were more in control of the follow-up interview than the untrained group (p < 0.05). Both studies investigated differences in summarising, interrupting and checking but found none. REVIEWER'S CONCLUSIONS: The training programmes assessed by these trials appear to be effective in improving cancer care professionals communication skills. It is not known whether the training would be effective if taught by other educators, nor has any trial compared the efficacy of both programmes.

Caregivers↗

PubMed2005

Factors that influence physicians' detection of distress in patients with cancer: can a communication skills training program improve physicians' detection?

BACKGROUND: No study to date has assessed the impact of skills acquisition after a communication skills training program on physicians' ability to detect distress in patients with cancer. METHODS: First, the authors used a randomized design to assess the impact, on physicians' ability to detect patients' distress, of a 1-hour theoretical information course followed by 2 communication skills training programs: a 2.5-day basic training program and the same training program consolidated by 6 3-hour consolidation workshops. Then, contextual, patient, and communication variables or factors associated with physicians' detection of patients' distress were investigated. After they attended the basic communication skills training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Interviews with a cancer patient were recorded before training, after consolidation workshops for the group that attended consolidation workshops, and approximately 5 months after basic training for the group that attended basic training without the consolidation workshops. Patient distress was recorded with the Hospital Anxiety and Depression Scale before the interviews. Physicians rated their patients' distress on a visual analog scale after the interviews. Physicians' ability to detect patients' distress was measured through computing differences between physicians' ratings of patients' distress and patients' self-reported distress. Communication skills were analyzed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: Fifty-eight physicians were evaluable. Repeated-measures analysis of variance showed no statistically significant changes over time and between groups in physicians' ability to assess patient distress. Mixed-effects modeling showed that physicians' detection of patients' distress was associated negatively with patients' educational level (P = 0.042) and with patients' self-reported distress (P < 0.000). Mixed-effects modeling also showed that physicians' detection of patient distress was associated positively with physicians breaking bad news (P = 0.022) and using assessment skills (P = 0.015) and supportive skills (P = 0.045). CONCLUSIONS: Contrary to what was expected, no change was observed in physicians' ability to detect distress in patients with cancer after a communication skills training programs, regardless of whether physicians attended the basic training program or the basic training program followed by the consolidation workshops. The results indicated a need for further improvements in physicians' detection skills through specific training modules, including theoretical information about factors that interfere with physicians' detection and through role-playing exercises that focus on assessment and supportive skills that facilitate detection.

Communication↗

PubMed1996

Computer gene mapping by Eagl-based STSs.

The rapid pace at which the human genome project has proceeded has greatly benefited from two classes of short sequence tags, genomic (STS) and transcribed (EST), which are listed in two separate databases. Usually, STSs are random genomic sequences derived only for mapping purposes, while ESTs represent transcribed sequences that have to be mapped one by one. Here, we propose a way of establishing links between these two sets of sequences, allowing the automatic mapping of EST sequences by simple comparison with relatively nonrandom STSs. We suggest that EagI-based STSs derived by selected genomic portions organized in YAC contigs can automatically finely map a relevant portion of the ESTs, partially bridging the gap between the two sets of sequences and saving a great amount of time in mapping efforts. To test this principle, we have selected 330 high-quality STSs derived from the Xq24-qter region and used them for transcript searches by comparing them to the EST as well as to the nonredundant database. This search detected four known genes and two additional EST clones. In contrast, when the same databases were searched with a set of 53 sequences derived from the same chromosomal region around EagI sites, 7 known genes and 6 additional ESTs were found. These findings, together with data obtained from simulation analysis on long sequences in the same chromosomal region, suggest that EagI-based STSs can partially bridge the gap between STSs and ESTs.

Chromosome Mapping↗