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PubMed1980

Nutrition intervention strategies in the Multiple Risk Factor Intervention Trial (MRFIT).

The Multiple Risk Factor Intervention Trial (MRFIT) simultaneously intervenes on three major risk factors for coronary heart disease: Hypercholesteremia, hypertension, and cigarette smoking. It was, therefore, essential to develop intervention strategies which would be appropriate across all modalities. The initial methodology combines the transfer of basic information, the use of small groups of participants and their homemakers to facilitate changes in life style, and the use of the principles of behavioral change and maintenance theory to encourage long-term success in adapting and maintaining new habits over a life time.

Behavior Therapy↗
PubMed1994

Prevention of esophageal cancer: the nutrition intervention trials in Linxian, China. Linxian Nutrition Intervention Trials Study Group.

In Linxian China, the esophageal/gastric cardia cancer mortality rates are among the highest in the world. There is suspicion that the population's chronic deficiencies of multiple micronutrients are etiologically involved. We conducted two randomized, placebo-controlled nutrition intervention trials to test the effects of vitamin and mineral supplements in lowering the rates of esophageal/gastric cancer. In the first trial, the dysplasia trial, 3318 adults with a cytological diagnosis of esophageal dysplasia received daily supplementation with 26 vitamins and minerals in doses typically 2-3 times the United States Recommended Daily Allowances, or placebos, for 6 years. The second trial, the general population trial, involved 29,584 adults and used a one-half replicate of a 2(4) factorial experimental design which tested the effects of four combinations of nutrients: A, retinol and zinc; B, riboflavin and niacin; C, vitamin C and molybdenum; and D, beta-carotene, vitamin E, and selenium. Doses for these daily supplements ranged from 1 to 2 times the United States Recommended Daily Allowances, and the different vitamin/mineral combinations or placebos were taken for a period of 5.25 years. As part of the general population trial, and end-of-intervention endoscopy survey was carried out in a small (1.3%) sample of subjects to see if supplementation affected the prevalence of dysplasia and early cancer. Herein we review the methods of these trials and the results of the endoscopic survey. Fifteen esophageal and 16 gastric cancers were identified in endoscopic biopsies from the 391 subjects evaluated from two villages, and nearly all were asymptomatic. No significant reductions in the prevalence of esophageal or gastric dysplasia or cancer were seen with any of the four supplement groups. However, the prevalence of gastric cancer among participants receiving retinol and zinc was 62% lower than those not receiving those supplements (P = 0.09), while participants receiving beta-carotene, vitamin E, and selenium had a 42% reduction in esophageal cancer prevalence (0.34). We have reported separately that cancer mortality over the entire 5.25-year period was significantly reduced among those receiving beta-carotene, vitamin E, and selenium. The findings from the overall trial and the endoscopic sample offer a hopeful sign and should encourage additional studies with these agents in larger numbers of subjects.

Adult↗
PubMed1996

[Cardiosurgical stand-by and acute interventions after interventional cardiologic procedures].

Interventional cardiologists and cardiac surgeons agree in the treatment of symptomatic coronary artery stenosis: high risk patients with severe coronary disease (such as left main stem stenosis, triple vessel disease and double vessel disease with involvement of the proximal LAD in particular with severely impaired ventricular function) are treated preferentially with coronary artery bypass grafting (CABG); less severe cases allow alternatively PTCA treatment. However, even in controlled and randomised studies (RITA, GABI, ERACI, CABRI, and BARI-studies) looking into these alternatives (PTCA versus CABG) it was found that 1.1% to 10.1% of all PTCA incidents required a surgical emergency procedure. Although, in favourable conditions the risk is considerably lower than the above value and despite of improvement of catheter techniques (stent implantation, perfusion catheters) in less favourable conditions which reduced the risk to a similar value, the results of surgical emergency procedures are still significantly impaired compared with elective procedures. Moreover it has been shown that there is a relation between the outcome of the surgical procedure and the time elapsed between PTCA-incident and surgical intervention. Perioperative myocardial infarction and mortality are much lower if there is no delay caused by occupied theaters, unsolved transportation problems and/or time intensive attempts of recanalisation by catheter. Considering the high numbers of PTCA procedures, in some centers even performed simultaneously, it seems acceptable to perform a dilatation in the low risk group without surgical standby. If strict observance of the indication criteria is provided early complication rate and mortality of PTCA is even less than in CABG-procedures. On the other hand (from a cardiosurgical point of view), it has to be emphasized that PTCA procedures in the high risk group potentially endangering large myocardial areas, a cardiosurgical standby has to be available and emergency surgery should be performed ultimately within 60 minutes (after myocardial infarction).

Angioplasty, Balloon, Coronary↗
PubMed2005

Attitudes of and influences on residents in English Canadian radiology programs regarding interventional radiology: results of a national survey by the Canadian Interventional Radiology Association (CIRA).

PURPOSE: There has been a North American trend toward reduced application to the subspecialty of Interventional Radiology (IR). Out of fear of a looming manpower shortage, this survey was conducted to better understand awareness and attitudes toward IR by radiology residents-in-training. MATERIALS AND METHODS: An anonymous online survey was emailed to the Diagnostic Radiology Residency Program Director/Department Chairperson of each of the 13 English medical schools in Canada, to be forwarded to each respective Radiology Residency Program's radiology residents. The survey was open for a period of 1 month. The survey consisted of 29 questions, which could be answered online using a web-based program. Responses to questions were tabulated and comments recorded. RESULTS: A total of 84 survey responses were received of a possible 333 (25%), including responses from each of the 13 English Programs. Responses regarding demographics, training, careers aspirations and motivations, and influences were collected. Fifty-one percent of respondents reported being either "moderately" or "very" interested in the field of IR; however, only 13% reported intention to perform an IR fellowship. A number of issues were identified as dissuading current radiology residents from pursuing IR, including income, work hours and hours of on-call, and turf issues. CONCLUSION: A number of issues were identified as factors which prevented residents with an interest in IR from applying to IR fellowships. These must be addressed to increase IR recruitment rates of radiology residents.

Adult↗
PubMed2005

Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association.

Cardiovascular disease is the leading cause of mortality for women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction, acute coronary syndromes, and angina, is the largest subset of this mortality, with >240,000 women dying annually from the disease. Atherosclerotic coronary artery disease (CAD) is the focus of this consensus statement. Research continues to report underrecognition and underdiagnosis of CAD as contributory to high mortality rates in women. Timely and accurate diagnosis can significantly reduce CAD mortality for women; indeed, once the diagnosis is made, it does appear that current treatments are equally effective at reducing risk in both women and men. As such, noninvasive diagnostic and prognostic testing offers the potential to identify women at increased CAD risk as the basis for instituting preventive and therapeutic interventions. Nevertheless, the recent evidence-based practice program report from the Agency for Healthcare Research and Quality noted the paucity of women enrolled in diagnostic research studies. Consequently, much of the evidence supporting contemporary recommendations for noninvasive diagnostic studies in women is extrapolated from studies conducted predominantly in cohorts of middle-aged men. The majority of diagnostic and prognostic evidence in cardiac imaging in women and men has been derived from observational registries and referral populations that are affected by selection and other biases. Thus, a better understanding of the potential impact of sex differences on noninvasive cardiac testing in women may greatly improve clinical decision making. This consensus statement provides a synopsis of available evidence on the role of the exercise ECG and cardiac imaging modalities, both those in common use as well as developing technologies that may add clinical value to the diagnosis and risk assessment of the symptomatic and asymptomatic woman with suspected CAD.

Coronary Artery Disease↗
PubMed2004

The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction: a major role of percutaneous coronary intervention-induced embolization.

OBJECTIVES: The aim of this study was to evaluate how decreased plaque volume during percutaneous coronary intervention (PCI) affects coronary flow in patients with acute myocardial infarction (AMI). BACKGROUND: Coronary flow after reperfusion therapy is a major determinant of clinical outcomes in patients with AMI. However, little is still known about the changes in coronary flow that appear after PCI in response to the decreased plaque during the procedure. METHODS: The study group comprised 60 patients with AMI who underwent pre- and post-PCI intravascular ultrasound (IVUS). Qualitative and quantitative analyses were performed on all IVUS procedures. External elastic membrane volume (EEMV), lumen volume (LV), and plaque volume (PV) were measured every 1.0 mm to include the lesion and reference segments 3.0 mm proximal and distal to the lesion. The difference between pre- and post-PCI PV was defined as the index of the decrease in plaque volume (DeltaPV). The corrected TIMI frame count (CTFC) was used to evaluate coronary flow after PCI. RESULTS: Plaque volume was decreased at post-PCI IVUS in all 60 patients. Inadequate reflow (CTFC >40) was observed in 13 patients (21.7%). The decrease in PV was significantly larger in patients with inadequate reflow than in those with reflow (49.4 +/- 18.9 vs. 31.7 +/- 15.5 mm(3), p = 0.0010). Also, DeltaPV was significantly correlated with CTFC after PCI (r = 0.415, p = 0.0012). CONCLUSIONS: The decrease in PV during PCI has a negative impact on coronary flow after PCI in patients with AMI. Embolization induced by PCI may occur in all patients with AMI.

Angioplasty, Balloon, Coronary↗
PubMed2006

Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions.

One of the areas receiving the greatest attention from researchers studying autism spectrum disorders in recent years involves psychologically based early intervention programs. Various claims of cure, marked improvement in social and communication skills, and improved I.Q. are among the conclusions that have been drawn by various researchers. However, little has been done to analyze the dependent variables used in these studies and their impact on the conclusions reached regarding treatment effectiveness. Obviously, this set of measures is crucial since these methods define which behaviors "improved" and to what extent. The present review analyzes the current status, strengths, and weaknesses of these measurements.

Autistic Disorder↗
PubMed2003

Is training in psychosocial interventions worthwhile? Report of a psychosocial intervention trainee follow-up study.

A follow-up study of psychosocial intervention (PSI) trainees from the Sheffield and Maudsley training centres was undertaken in three stages. In Stage 1, 141 students, at two PSI training centres, were sent a simple postal questionnaire to elicit career trajectory following PSI training. A response rate of 82% was achieved. The sub-group, who had been trained and who still engaged in clinical practice were identified and followed-up in more detail (n=96). The effect of PSI training in a range of domains was investigated. The impact of training may not be to equip students with formal technical skills in CBT and family work. What is more likely is that trainees acquired proficiency in: working effectively using a case management model; conveying 'therapeutic optimism'; enabling users to meet their own goals and helping them to develop better coping strategies; using 'stress vulnerability' and formal outcome measures as means of structuring this approach. The secondary aim of the study was to identify and prioritise the barriers that impede the effective implementation of PSI skills in routine service settings. For the second phase of the survey the response rate was again 82%. This group's service managers were identified and surveyed for the same information and 59% responded. The aim was to gather information about implementation issues from both the clinical and service perspectives. The results of the survey indicate that PSI training has a positive impact on the development of services for people with serious mental health problems although there are serious organisational hurdles for managers, trainees and organisations to overcome if PSI skills are to be properly implemented. Key factors that impact upon faithful implementation are related to resource issues (caseload size), organisational factors (the existence of an implementation plan and training strategy), and the extent to which the trainee's team is supportive.

Adult↗
PubMed2004

European Nicotinamide Diabetes Intervention Trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes.

BACKGROUND: Results of studies in animals and human beings suggest that type 1 diabetes is preventable. Nicotinamide prevents autoimmune diabetes in animal models, possibly through inhibition of the DNA repair enzyme poly-ADP-ribose polymerase and prevention of beta-cell NAD depletion. We aimed to assess whether high dose nicotinamide prevents or delays clinical onset of diabetes in people with a first-degree family history of type 1 diabetes. METHOD: We did a randomised double-blind placebo-controlled trial of nicotinamide in 552 relatives with confirmed islet cell antibody (ICA) levels of 20 Juvenile Diabetes Federation (JDF) units or more, and a non-diabetic oral glucose tolerance test. Participants were recruited from 18 European countries, Canada, and the USA, and were randomly allocated oral modified release nicotinamide (1.2 g/m2) or placebo for 5 years. Random allocation was done with a pseudorandom number generator and we used size balanced blocks of four and stratified by age and national group. Primary outcome was development of diabetes, as defined by WHO criteria. Analysis was done on an intention-to-treat basis. FINDINGS: There was no difference in the development of diabetes between the treatment groups. Of 159 participants who developed diabetes in the course of the trial, 82 were taking nicotinamide and 77 were on placebo. The unadjusted hazard ratio for development of diabetes was 1.07 (95% CI 0.78-1.45; p=0.69), and the hazard ratio adjusted for age-at-entry, baseline glucose tolerance, and number of islet autoantibodies detected was 1.01 (0.73-1.38; p=0.97). Of 168 (30.4%) participants who withdrew from the trial, 83 were on placebo. The number of serious adverse events did not differ between treatment groups. Nicotinamide treatment did not affect growth in children or first-phase insulin secretion. INTERPRETATION: Large-scale controlled trials of interventions designed to prevent the onset of type 1 diabetes are feasible, but nicotinamide was ineffective at the dose we used.

Autoimmune Diseases↗
PubMed2005

Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology.

In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents and newer adjunctive medications improved the outcome for PCI. The decision to recommend PCI or CABG surgery will be guided by technical improvements in cardiology or surgery, local expertise, and patients' preference. However, until proved otherwise, PCI should be used only with reservation in diabetics with multi-vessel disease and in patients with unprotected left main stenosis. The use of drug-eluting stents might change this situation. Patients presenting with NSTE-ACS (UA or NSTEMI) have to be stratified first for their risk of acute thrombotic complications. A clear benefit from early angiography (<48 h) and, when needed, PCI or CABG surgery has been reported only in the high-risk groups. Deferral of intervention does not improve outcome. Routine stenting is recommended on the basis of the predictability of the result and its immediate safety. In patients with STEMI, primary PCI should be the treatment of choice in patients presenting in a hospital with PCI facility and an experienced team. Patients with contra-indications to thrombolysis should be immediately transferred for primary PCI, because this might be their only chance for quickly opening the coronary artery. In cardiogenic shock, emergency PCI for complete revascularization may be life-saving and should be considered at an early stage. Compared with thrombolysis, randomized trials that transferred the patients for primary PCI to a 'heart attack centre' observed a better clinical outcome, despite transport times leading to a significantly longer delay between randomization and start of the treatment. The superiority of primary PCI over thrombolysis seems to be especially clinically relevant for the time interval between 3 and 12 h after onset of chest pain or other symptoms on the basis of its superior preservation of myocardium. Furthermore, with increasing time to presentation, major-adverse-cardiac-event rates increase after thrombolysis, but appear to remain relatively stable after primary PCI. Within the first 3 h after onset of chest pain or other symptoms, both reperfusion strategies seem equally effective in reducing infarct size and mortality. Therefore, thrombolysis is still a viable alternative to primary PCI, if it can be delivered within 3 h after onset of chest pain or other symptoms. Primary PCI compared with thrombolysis significantly reduced stroke. Overall, we prefer primary PCI over thrombolysis in the first 3 h of chest pain to prevent stroke, and in patients presenting 3-12 h after the onset of chest pain, to salvage myocardium and also to prevent stroke. At the moment, there is no evidence to recommend facilitated PCI. Rescue PCI is recommended, if thrombolysis failed within 45-60 min after starting the administration. After successful thrombolysis, the use of routine coronary angiography within 24 h and PCI, if applicable, is recommended even in asymptomatic patients without demonstrable ischaemia to improve patients' outcome. If a PCI centre is not available within 24 h, patients who have received successful thrombolysis with evidence of spontaneous or inducible ischaemia before discharge should be referred to coronary angiography and revascularized accordingly--independent of 'maximal' medical therapy.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Management of visceral interventional radiology catheters: a troubleshooting guide for interventional radiologists.

Visceral interventional radiology catheters can be difficult to exchange or remove for a variety of reasons. These reasons include exit of the guide wire through the side holes of the catheter, blockage of the catheter, difficulty unlocking the pigtail, retention of the string after catheter removal, migration of the string ahead of the guide wire, catheter fracture, and snaring of an adjacent stent by the pigtail. Secure fixation of the catheter to the skin is important. A technique that allows secure fixation without direct puncture and suturing of the catheter to the skin is recommended. If a catheter falls out or is inadvertently removed, access can occasionally be regained and the catheter can be replaced without repuncture. The timing of catheter removal is based on the clinical condition of the patient and the daily output from the catheter. "Tractography" is a useful study before removal of any catheter that requires a mature tract for removal, particularly cholecystostomy catheters and transpleural catheters. In biliary catheter exchange, the most vital issue is the position of the side holes of the catheter. If an abscess cavity remains large after catheter drainage, the catheter can be repositioned or a second catheter can be placed.

Catheters, Indwelling↗
PubMed1989

Crisis intervention for bereavement support. A model of intervention in the children's school.

A crisis intervention consultation service to the schools for bereavement support for children is described. Examples are offered of the author's experience in providing this service to children from the pre-kindergarten to senior high level, at private, parochial, and public schools. These requests were generally in response to tragic deaths of fellow students and significant adults, including teachers, parents, and friends. Suggestions are outlined for pediatric and mental health consultants who may wish to offer similar services within their communities, with particular emphasis on issues to address in program planning and implementation.

Adolescent↗
PubMed1991

[Parent counseling between crisis intervention and preventive intervention].

The presence of impairments in their newborn child entails parental mourning and coping processes, which are either accelerated, prolonged, or repressed by the professional help provided, depending on the nature and quality of such intervention. Based on Schuchardt's model of coping with crisis (1980), the interactional difficulties between professional helpers/parents and child in the various phases are set out, inferring potential modifications in this interaction, but also changes in training and research contents.

Adaptation, Psychological↗
PubMed1984

[Inpatient social psychiatric crisis intervention exemplified by the crisis intervention center of the Social Psychiatric University Clinic of Bern].

With a case-history of a puerperic psychosis we describe the crisis-interventions-technique in six steps used in our 16-bed, socio-psychiatric ward in the city of Berne at a general hospital. Out of more than 5 years of work we illustrate one year with client-data, working-methods and statistical results. With such a ward in the community, embedded in a complete net of socio-psychiatric institutions, we can treat quite serious psychosocial crisis adequately and in relatively short time.

Adolescent↗
PubMed1994

Human immunodeficiency virus early intervention physician guidelines, second edition. Advisory Group on HIV Early Intervention, Second Edition, American Medical Association.

An estimated 1 million people in the United States are presently infected with the human immunodeficiency virus (HIV). Each of these individuals should be under the care of a physician. Moreover, there is general consensus that early intervention should be managed in the primary care setting. Primary care physicians are well suited to manage the total treatment of persons with HIV throughout the disease process. These guidelines provide the primary care physician with the information to diagnose HIV infection, determine disease stage, and monitor and treat patients during early stages of infection. The guidelines also provide referral to sources of additional information and HIV training.

AIDS-Related Opportunistic Infections↗
PubMed2002

Type 1 diabetes intervention trials: what have we learned? A critical review of selected intervention trials.

Developing therapies to stop or slow the immune destruction of islets has been a goal of investigators in type 1 diabetes for several decades. This review of clinical interventions in patients with type 1 diabetes indicates both negative and positive outcomes with a variety of different therapeutic agents. An underlying theme of this article is that differences in study design may impact the outcome more than the therapy being tested. Thus, each of these results need to be considered in the context of important variables in study design. To date, there is no clear answer as to what study design is best to determine if an agent is effective against the diabetes disease process; however, the Immunology of Diabetes Society has recently developed guidelines for the conduct of these trials to facilitate comparisons of therapies in the future.

Age Factors↗
PubMed1985

Intervention orientation: quantification of "person-blame" versus "situation-blame" intervention philosophies.

Almost from its inception at the Swampscott conference in 1965, community psychology has criticized interventions focusing solely on "person variables" or "blaming the victim." In order to begin to explore this orientation more scientifically, these studies created a measure to tap person- and situation-blame orientations of service providers working with adolescents in legal jeopardy. Its reliability and construct validity were examined; implications for other social problem areas and for further research questions are explored.

Adolescent↗
PubMed2002

[Gene therapy in interventional coronary interventions].

BACKGROUND: 30-50% of patients develop restenosis after PTCA. While most pharmacologic strategies fail to reduce restenosis rate, only implantation of stents and brachytherapy have shown to improve long-term outcome of coronary angioplasty significantly. GENE THERAPY: With expanding knowledge of the process resulting in activation and inhibition of gene expression after angioplasty, a number of studies showed by inhibiting overexpression of some genes or overexpressing down-regulated other genes significant and extensive reduction of neointimal hyperplasia in different angioplasty models. Until now there have no results of clinical trials to reduce restenosis by gene therapy been published. COMPARISON WITH OTHER STRATEGIES TO REDUCE RESTENOSIS RATE: Gene therapy offer the opportunity to specifically inhibit activation of genes resulting in restenosis. However, until now no single gene responsible for the restenosis process could be identified. Several strategies interfering with gene expression at different levels, such as ligand-receptor binding, cell cycle regulation or induction of apoptosis have reduced restenosis in animal experimental models. This variety of successful interventions supports the concept of a redundancy in signaling pathways leading to vessel wall proliferatioin and restenosis. Restenosis rates have been reduced by stents and brachytherapy. The first results of trials with a coated stent eluting an immunosuppressant suggest a further reduction. These data raise the question whether a clinically successful and safe specific gene therapy can be developed before the problem of restenosis is largely solved by unspecific inhibition of proliferation.

Angioplasty, Balloon, Coronary↗