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A novel soy-based meal replacement formula for weight loss among obese individuals: a randomized controlled clinical trial.

OBJECTIVE: To assess the efficacy and safety of a low calorie soy-based meal replacement program for the treatment of obesity. DESIGN: A 12-week prospective randomized controlled clinical trial. SETTING: Outpatient weight control research unit. SUBJECTS: One hundred obese (28<BMI<or=41 kg/m(2)) volunteers between the ages of 35 and 65 y. Seventy-four participants completed the trial. INTERVENTION: Participants were randomized to either the meal replacement treatment group (n=50; 240 g/day, 1200 kcal/day) or control group (n=50). Both groups at baseline received a single dietary counseling session and a pamphlet describing weight loss practices. MAIN OUTCOME MEASURES: Weight, body fat, serum lipid concentrations. RESULTS: : By intent-to-treat analysis, the treatment group lost significantly more weight than the control group (7.00 vs 2.90 kg; P<0.001) and had a greater change in total (22.5 vs 6.8 mg/dl; P=0.013) and LDL cholesterol (21.2 vs 7.1 mg/dl; P<0.009). Among completers only, the treatment group again lost more weight (7.1 kg; n=37 vs 2.9 kg; n=37; P=0.0001) and had a greater reduction in total cholesterol (26.1 mg/dl; n=37 vs 6.7 mg/dl; P=0.0012) and a greater change in LDL cholesterol (21.6 vs 5.5 mg/dl; P=0.0025). (For any given degree of weight loss, the reduction in LDL cholesterol was significantly greater in the treatment group.) Treatment was well tolerated and no serious side effects were detected. CONCLUSIONS: Use of this soy-based meal replacement formula was effective in lowering body weight, fat mass and in reducing LDL cholesterol beyond what could be expected given the weight lost.

Adult↗

Evidence-based care of Chinese men having transurethral resection of the prostate (TURP).

AIM OF STUDY: To measure the effect of specific preoperative information on postoperative anxiety, satisfaction with information, and demand for analgesia, of Chinese males having transurethral resection of the prostate (TURP). DESIGN: A controlled experimental design. The researchers allocated all patients (n = 30) undergoing TURP in a general hospital in Hong Kong, during a 3-month period, to one of two groups. The experimental group (n = 15) received a specific information pamphlet and a general preoperative counselling video. The control group (n = 15) received a video alone. PROCEDURE AND MEASURES: Following ethical approval, a researcher took baseline measures of state and trait anxiety using the Chinese State-Trait Anxiety Inventory (C -STAI). Five days after surgery the researcher administered the C-STAI (A-State), a patients' satisfaction questionnaire, and, recorded requests for analgesia during the first 5 postoperative days. RESULTS: Experimental subjects reported significantly lower anxiety levels post-operatively and a significantly higher level of satisfaction with the preoperative information, than controls. Postoperative demand for analgesia did not significantly differ between groups. CONCLUSIONS: The findings support the importance of providing patients with specific, written preoperative information about their surgery and its effects to minimize their postoperative anxiety levels, and improve their satisfaction with the care provided.

Anxiety↗

Literacy, readability and cultural barriers: critical factors to consider when educating older African Americans about anticoagulation therapy.

The number of patients on anticoagulation therapy has increased dramatically over the past two decades. Yet, few studies have examined the psychosocial barriers of low literacy, culture and inappropriate patient education materials used to teach older African Americans about their anticoagulation therapy. The aims of this study were to investigate literacy levels among older patients, and evaluate the readability and determine the cultural sensitivity of written information used in an anticoagulation management clinic. A descriptive, correlational design was used. Patients' (n = 62) knowledge levels and the readability and cultural sensitivity of written materials were examined. The Rapid Estimate of Adult Literacy in Medicine (REALM) was used to measure reading skills of patients, while the SMOG formula (a formula for assessing readability) was used to test the readability of written educational materials used in an Anticoagulation Management Clinic. A Knowledge Information Profile, developed for this study by one of the authors (Wilson), was used to measure patient knowledge about warfarin, medication side-effects and food sources of vitamin K. A modified, culturally sensitive and easy-to-read pamphlet was used as an alternative teaching tool in the study. The results of the study revealed the average self-reported for highest grade completed in school was twelfth grade; however, the actual mean reading skills were between seventh and eighth grade. The readability of the written information was three to four grades higher than patients' reading abilities. None of the patient education materials were culturally sensitive. This study underscores the importance of having information that is understandable and culturally relevant to prevent the outcome of internal bleeding. Nurses have a vital role in educating patients and ensuring that teaching materials are appropriate for the target population.

Adult↗

Development of a patient decision aid for choice of surgical treatment for breast cancer.

PURPOSE: A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient. METHODS: A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction, self-reported anxiety, clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed. RESULTS: The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid, and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid. CONCLUSION: This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post-decisional regret.

Journal Article↗

Factors associated with the difference in score between women's and doctors' decisional conflict about hormone therapy: a multilevel regression analysis.

OBJECTIVE: To explore factors associated with the difference in score between women's and doctors' decisional conflict about hormone therapy (HT). DESIGN: Secondary analysis. SETTING AND PARTICIPANTS: family doctors were randomized to prepare women for counselling about HT using either a decision aid or a pamphlet. MAIN VARIABLES STUDIED: After each counselling session, decisional conflict was assessed in women and doctors using the Decisional Conflict Scale (DCS) and the Provider Decision Process Assessment Instrument (PDPAI), respectively. The difference in score between the DCS and PDPAI was computed and entered as the dependent variable in a multilevel regression analysis. MAIN OUTCOME RESULTS: A total of 40 doctors and 167 women were included in the analysis. The intra-doctor correlation coefficient was 0.25. Factors associated with women experiencing higher decisional conflict than their doctor were: age of doctor >45 years, women who were undecided about the best choice after the counselling session, women with a university degree and women who said that their doctor usually does not give them control over treatment decision. Factors associated with doctors experiencing more decisional conflict than women were: doctors who were undecided about the quality of the decision, length of visit <30 min and women who thought that the decision was shared with their doctor. CONCLUSION: In order to reduce the disparities between women's and doctors' decisional conflict about HT, interventions aimed at raising awareness of doctors about shared decision-making should be encouraged.

Canada↗

The effects of an educational programme on the anxiety and satisfaction level of parents having parent present induction and visitation in a postanaesthesia care unit.

BACKGROUND: In Hong Kong, some hospitals have established the practice of Parental Presence Induction (PPI) and visitation in Postanaesthesia Care Units (PACU) for children receiving surgery. The literature indicates that parents reported extreme anxiety and discomfort after being present at induction of anaesthesia and suggests that it would seem appropriate to devise a programme of education to reduce anxiety for parents. METHODS: A quasi-experimental pretest and post-test design was employed. Parents in the experimental group received an educational programme about the role and expectations of parents having PPI and visitation in PACU together with an information pamphlet. The comparison group received routine (verbal) instructions. The Chinese version of the State and Trait Anxiety Inventory and the Parental Satisfaction with Care Questionnaire were used to assess parents' anxiety and satisfaction with care. RESULTS: A total of 50 parents (mostly mothers) were recruited. Twenty-five were allocated in the intervention group and 25 in the comparison group. The children were aged 1--9 years with a mean age of 2.9 years. There were 46 male and four female children. The results demonstrate that parents who received an education programme reported a decrease in anxiety (P < 0.001) and an increase in their satisfaction with the care provided (P < 0.001). A significant negative relationship (r= -0.61, P < 0.001) between parental anxiety postoperatively and the satisfaction with care score was also obtained, suggesting that lower levels of parental anxiety are associated with higher levels of satisfaction. CONCLUSIONS: The study suggests that an educational programme preparing parents for their child's induction of anaesthesia and visitation to the PACU should be offered, as it can reduce their anxiety with the practice of PPI and visitation in the PACU and increase parents' satisfaction with care.

Adult↗

Approaches to the genetics of cardiovascular disease through genetic field work.

Successful molecular genetic studies of complex disease require exact, careful phenotypization, which is more difficult than that performed for monogenic diseases. We have developed a family-oriented field working approach, which relies on index patients, their primary care physicians, and a minimum number of field working staff. The patients are responsible for recruiting their family members. Packets containing an explanatory pamphlet, an informed consent statement, a questionnaire, and blood cuvettes are provided. Data are transferred from questionnaire and from the laboratory into a computer program that facilitates construction of the family tree. We have applied this genetic field working approach primarily to patients with lipid disorders. Coupling results from genetic field working with modern DNA diagnostic tests such as the oligonucleotide ligation assay, has enabled us to effectively identify patients with familial hypercholesterolemia in the German population. We are now extending genetic field working to hypertension. Hypertension is much more difficult to study, because the phenotype is more difficult to discern and document. Both complex diseases have the disadvantage that the parents of the index patients are likely to already be dead. Nevertheless, we concentrate on the recruitment of large pedigrees, sibling pairs with parents whenever possible, and trios consisting of index patient and both parents or index patient, parent and sibling. With these constellations we can conduct association studies, linkage analysis, and novel combinations of both approaches.

Automation↗

Patients with advanced cancer: a survey of the understanding of their illness and expectations from palliative radiotherapy for symptomatic metastases.

We conducted a pilot study to examine patients' understanding of their illness and their expectations for palliative radiotherapy for symptomatic metastases. Participants were asked to complete a survey consisting of seven questions prior to the initial consultation. Demographic details and information on extent of disease were collected. Patients were asked to score their symptom distress using the modified Edmonton Symptom Assessment System. Sixty patients participated in the pilot study between January and April 1999. Their median age was 68 years (range 46-90). The most common primary tumours were lung, prostate and breast. Twenty-one patients (35%) believed that their cancer was curable. Twelve (20%) expected that palliative radiotherapy would cure their advanced cancer and 23 (38%) believed that palliative radiotherapy would prolong their lives. Twenty-one patients (35%) had concerns about the effectiveness of radiation therapy and twenty (33%) had concerns about the side-effects of radiotherapy. Fifty-two (87%) were not familiar with the concept of radiation treatment. Forty-seven patients (78%) reported that they were not given information about the radiation treatment; 51 (85%) were not satisfied with the information that their own doctors had provided regarding radiation treatment prior to the consultation at our clinic. A significant proportion of the patients in this pilot study had misconceptions regarding their illness and unrealistic expectations from palliative radiotherapy. We plan to provide educational pamphlets for use in referring doctors' surgeries and clinics in order to inform patients of the nature, rationale and anticipated benefits and side-effects of palliative radiotherapy.

Aged↗

[Influence exercised by physicians on the vaccination rate].

This paper deals with the question whether physicians promote vaccinations among their patients. Besides this, we analyse which determinants influence the acceptance of vaccination among physicians. The investigations are based on data of a project granted by the DFG (Deutsche Forschungsgemeinschaft; "Munich Vaccination Study 2001"). Within this study physicians as well as parents have been interviewed. The vaccination rate of the physicians' patients are influenced by attitudes of the physician and the attitudes he/she believes his/her patients have, but not so much by aspects of his/her behaviour. How many pamphlets and posters about vaccination are available in the doctors' practice or how long consultations about vaccination last on average has only marginal effects on the rate of vaccination among the doctors' patients. If it is a political aim to enlarge vaccination rates steps should concentrate on changing relevant attitudes.

Adolescent↗

Safety in the presence of lightning.

Not enough emphasis is usually placed on the proactive ability to recognize the lightning hazard. Instead, most literature and training materials treat the reactive mode. The latter approach emphasizes the posture to take when a person is caught by surprise in the open by a thunderstorm when the lightning threat is at its greatest; in other words, it is too late for precautions. The same reactive approach concentrates on what a person is wearing or holding when lightning is overhead instead of how the person came to be in this situation in the first place. Rather than focusing on these last-minute factors, the primary issue must be on the ability of a person, whether in a baseball game, riding a bike, or on a golf course, to recognize in advance the existence of a major lightning threat. This proactive approach emphasizes advance planning and recognition of a potential threat from lightning. A complete plan involves a sequence of decisions on a time scale from days to seconds. Although most of the available information in pamphlets and safety guidelines is correct concerning the reactive phase of lightning safety, the hazard remains important because of the lack of emphasis on planning and awareness.

Humans↗

Public use of automated external defibrillators.

BACKGROUND: Automated external defibrillators save lives when they are used by designated personnel in certain public settings. We performed a two-year prospective study at three Chicago airports to assess whether random bystanders witnessing out-of-hospital cardiac arrests would retrieve and successfully use automated external defibrillators. METHODS: Defibrillators were installed a brisk 60-to-90-second walk apart throughout passenger terminals at O'Hare, Midway, and Meigs Field airports, which together serve more than 100 million passengers per year. The use of defibrillators was promoted by public-service videos in waiting areas, pamphlets, and reports in the media. We assessed the time from notification of the dispatchers to defibrillation, survival rate at 72 hours and at one year among persons with cardiac arrest, their neurologic status, and the characteristics of rescuers. RESULTS: Over a two-year period, 21 persons had nontraumatic cardiac arrest, 18 of whom had ventricular fibrillation. With two exceptions, defibrillator operators were good Samaritans, acting voluntarily. In the case of four patients with ventricular fibrillation, defibrillators were neither nearby nor used within five minutes, and none of these patients survived. Three others remained in fibrillation and eventually died, despite the rapid use of a defibrillator (within five minutes). Eleven patients with ventricular fibrillation were successfully resuscitated, including eight who regained consciousness before hospital admission. No shock was delivered in four cases of suspected cardiac arrest, and the device correctly indicated that the problem was not due to ventricular fibrillation. The rescuers of 6 of the 11 successfully resuscitated patients had no training or experience in the use of automated defibrillators, although 3 had medical degrees. Ten of the 18 patients with ventricular fibrillation were alive and neurologically intact at one year. CONCLUSIONS: Automated external defibrillators deployed in readily accessible, well-marked public areas in Chicago airports were used effectively to assist patients with cardiac arrest. In the cases of survivors, most of the users had no duty to act and no prior training in the use of these devices.

Aged↗

Violations of exhibiting and FDA rules at an American Psychiatric Association annual meeting.

We conducted a cross-sectional study of all exhibit booths for the 24 pharmaceutical companies at the 2002 American Psychiatric Association (APA) convention. We collected and categorized one of each item distributed by the companies at each booth. A total of 268 items were collected from 24 companies (median=8). The most common categories of items were "reprints or pamphlets" (37%) and "noneducational gifts" (27%), including music CDs and invitations to dinners and museums. There were a total of 16 violations of the APA's own exhibit rules: eight companies had one violation and two companies had four violations. Four companies engaged in FDA-prohibited off-label promotion; one also violated the APA code. Over half of all companies (54%) were in violation of either APA rules or FDA regulations. The APA's voluntary code has failed to adequately reduce inappropriate promotional activity at the annual APA meeting.

Congresses as Topic↗

Media interventions to promote responsible sexual behavior.

While the media have been used effectively to promote sexual responsibility in other countries for decades, few such opportunities have been seized in the United States. Mass media may be especially useful for teaching young people about reproductive health because elements of popular culture can be used to articulate messages in young people s terms, in language that won t embarrass them and may even make safe sex more attractive. Media can potentially change the way people think about sex, amidst cultural pressures to have sex at a young age, to have sex forcefully, or to have unsafe sex. Information can be communicated through a variety of channels--small media (e.g., pamphlets, brochures, and the Internet) and mass media--and in a variety of formats--campaigns, news coverage, and educational messages inserted into regular entertainment programming. Several international studies show that exposure to family planning messages through television, radio, and print media are strongly associated with contraceptive use. Domestically, safe sex media campaigns have been associated with increased teen condom use with casual partners, and reductions in the numbers of teenagers reporting sexual activity. Due to private ownership and First Amendment concerns, U.S. sexual health advocates have been working with the commercial media to incorporate subtle health messages into existing entertainment programming.

Adolescent↗

Educational intervention for parents and healthcare providers leads to reduced antibiotic use in acute otitis media.

We used a controlled before-and-after design with the aims of reducing both the total consumption of antibiotics and the use of broad-spectrum antibiotics against acute otitis media (AOM), and to study to what extent prescriptions for antibiotics against AOM were dispensed. Information on evidence-based treatment of uncomplicated AOM was provided to doctors and nurses, and written guidelines were implemented. Pamphlets and oral information concerning symptomatic treatment and the limited effect of antibiotic use in AOM were given to parents. Eligible patients were 819 children aged 1-15 y. The proportion of patients receiving a prescription for antibiotics was reduced from 90% at baseline to 74% during the study period. The proportion of prescriptions for penicillin V increased from 72% at baseline to 85% during the study period. There were no significant changes at the control site. The proportion of dispensed prescriptions was 70% both at baseline and during the study period. Educational efforts reduced the total consumption of antibiotics and the use of broad-spectrum antibiotics for AOM in children aged 1-15 y at an emergency call service. Data on antibiotic use in AOM based only on prescribing overestimates the use of antibiotics.

Acute Disease↗

Quality of brief guidelines produced by professional bodies: a study of the 'green-top' guidelines by the UK Royal College of Obstetricians and Gynaecologists.

Clinicians ignore lengthy guidelines and prefer pocket cards and concise pamphlets. However, brevity in guidelines may lead to deficiency in quality. Our objective, therefore, was to examine the quality of brief guidelines produced by professional bodies, using those produced by the UK Royal College of Obstetricians and Gynaecologists (RCOG) as an example. We assessed all 22 'green-top' guidelines, produced by September 2002, for quality using a validated 37-item appraisal instrument. This instrument evaluated the guidelines on three dimensions, namely rigour of development, context and content and applicability. Ten (45%), 18 (82%) and five (23%) of the 22 guidelines met at least half the quality criteria for rigour of development, context and content and applicability, respectively. We conclude that the brief guidelines were deficient in several specific quality items, particularly those in the applicability dimension. Guideline developers need to achieve the higher quality standards expected of professional bodies.

Female↗

MDMA misrepresentation: an unresolved problem for Ecstasy users.

The demand for MDMA (methylenedioxymethamphetamine) has increased, especially among teenagers 12 to 18 years old. It is estimated that approximately 2.8 million teens have at least tried this drug. Coincident with this trend has been an increasing body of literature that questions the safety of MDMA consumption in terms of possibly permanent neurological damage, associated with behavioral and functional deficits. Whatever the likelihood of those risks, there have been well-documented problems with dehydration, hyperthermia, rhabdomyolysis, disseminated intravascular coagulation, and multiple organ failure. In addition, there have been tablets sold which either contain no MDMA, and may be comprised of more dangerous chemicals, or may contain a mixture of both. The current response has been the emergence of several harm reduction strategies, including the publishing of pamphlets warning Ecstasy users to hydrate and cool themselves. Another has been the utilization of chemical tests of tablet shavings to observe color changes purported to help distinguish MDMA-containing tablets from substitutes. The utility of these tests and the consequences of their shortcomings are examined.

Animals↗

Using a memory handbook to improve everyday memory in community-dwelling older adults with memory complaints.

Community-dwelling, nondemented older people (60-70 years) with reported memory complaints were randomly assigned to either a memory-handbook (MHB) group (n = 20) or a placebo group (n = 20). The MHB group members were given a self-contained memory handbook and were individually trained on two of the handbook's sections that related to (a) remembering a person's name and (b) prospective memory, for approximately 30 minutes each. The placebo group was given an instructional pamphlet with a description of three list-learning mnemonics as a placebo treatment. Subjects were tested before and after the intervention. When compared with the placebo group, the MHB group members significantly improved their performance on a face-naming task and a strategies knowledge questionnaire, but not on the prospective memory measures, when compared with the placebo group. In addition, the MHB group showed a significant advantage on an everyday memory diary that was filled out by all subjects following the intervention. Following the study, the placebo group was also given the memory handbook, and both groups were then assessed on their knowledge and use of strategies by questionnaire at a 4-month follow-up. At this time the MHB group appeared to maintain most of its original gains, while the placebo group made some improvement.

Aged↗

How much is enough? Willingness to participate in alcohol interventions.

This study examined the willingness of drinkers to participate in alcohol interventions designed to cut down or stop alcohol use by degree of service-provider contact. One hundred fifty-six university students and staff who attended a campus health fair participated in an alcohol survey. Of the college drinkers, 73.7% reported they were willing to participate in one or more alcohol interventions with minimal provider contact, compared with 48.5% who said they would participate in programs with high provider contact. Respondents preferred minimal-contact strategies (use of nonalcoholic or low-alcohol beverages, information pamphlets, cash awards, television programs, and mailed instructions) to high-contact approaches. Men were significantly more willing (ps less than .05) than women to participate in nearly half (11 to 21) of the alcohol interventions. Three measures indicative of motivation to control drinking were significantly associated with greater willingness to participate in nearly all strategies. This study also suggested that drinkers who were highly motivated to control their drinking did not prefer minimal-contact interventions over high-contact interventions.

Adolescent↗