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PubMed2005

Guided self-help for bulimia nervosa in primary care: a randomized controlled trial.

BACKGROUND: To increase access to cognitive behavioural therapy for bulimia nervosa new delivery modes are being examined. Guided Self-Help (GSH) in primary care is potentially valuable in this respect. This research aimed to compare outcomes following GSH delivered by general practitioners (GPs) in the normal course of their practice to a delayed treatment control (DTC) condition, and to examine the maintenance of treatment gains at 3 and 6 months following completion of GSH. METHOD: Participants were 109 women with full syndrome or sub-threshold bulimia nervosa, randomly allocated to GSH ( n = 54) and DTC ( n = 55). The GSH group received direction and support from a GP over a 17-week period while working through the manual in Bulimia Nervosa and Binge-Eating: A Guide to Recovery by P. J. Cooper (1995). GSH and DTC groups were assessed pre-treatment and 1 week following the 17-week intervention or waiting interval. The GSH group was reassessed at 3- and 6-month follow-up. RESULTS: Intention-to-treat analyses at end of treatment revealed significant improvements in bulimic and psychological symptoms in GSH compared with DTC, reduction in mean frequency of binge-eating episodes by 60% in GSH and 6% in DTC, and remission from all binge-eating and compensatory behaviours in 28% of the GSH and 11% of the DTC sample. Treatment gains were maintained at 3- and 6-month follow-up. CONCLUSION: Outcomes in GSH compare favourably with those of specialist-delivered psychological treatments. These findings are considered in light of the nature of the therapy offered and the primary care context.

Adult↗
PubMed2000

Guidelines for clinical research in complementary medicine.

There are several stages in preparing clinical research studies. Stage 1 includes identifying the purpose of the inquiry and finding the essential financial resources. Careful thinking about the clinical practice to be investigated and the allocation of time for research is also necessary. Stage 2 involves assessing the feasibility of the study. Statistical decisions are best made before data are collected, and this means consultation with a statistician or methodologist. There has to be ethical approval from the cooperating institution. A thorough search of the literature is fundamental. In Stage 3, the final trial is designed, ethical approval obtained, and the proposal is submitted for funding. In the final stage, Stage 4, the trial is carried out, analyzed, and prepared for publication.

Complementary Therapies↗
PubMed1993

Neoadjuvant chemotherapy in bladder cancer: a randomized study. Nordic Cystectomy Trial I.

An analysis by the Nordic Cooperative Bladder Cancer Study Group concerned the possible benefit of neoadjuvant chemotherapy--given before scheduled low-dose irradiation and cystectomy. In the trial, started in 1985, 311 patients with locally advanced bladder cancer, T1 grade 3, T2-T4a NXMO, were randomly allocated to a 'chemotherapy' or a 'no chemotherapy' group. Chemotherapy consisted of two cycles comprising cisplatin 70 mg/m2 and doxorubicin 30 mg/m2, with a 3-week interval between cycles 1 and 2. All patients were locally irradiated with 4 Gy daily for 5 consecutive days. The follow-up included 266 cystectomized patients. In May 1992 the mean observation time was 18 months for all patients and 47 months for those still alive. The results suggest that a significant downstaging in the group randomized to chemotherapy was found only in T1, grade 3 tumours (56 patients, p = 0.002). The overall survival rate in all 311 patients was significantly higher in the chemotherapy group (p = 0.03) and likewise among the 253 patients with T2-T4a tumour (p = 0.018). For the 210 patients who underwent cystectomy for T2-T4a tumour, there was a trend towards longer survival when chemotherapy was given (p = 0.057). Patients with initially muscle-invasive tumour who responded to neoadjuvant treatment survived longer than non responders (p = 0.0005). The results suggest that neoadjuvant chemotherapy improve the outcome of radical surgery for muscle-invasive bladder cancer, though the effect on long-term survival is inconclusive. Further studies on the effect of neoadjuvant chemotherapy is initiated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Health reform: examining the alternatives.

This Issue Brief examines the major issues of the health reform debate. The issues that must be resolved before reform can be enacted include: allocation of health care resources, universal coverage versus universal access, composition of risk pools, employer and individual mandates, and distribution of health care services' costs. This report also contains short descriptions and analyses of the following proposals: McDermott-Wellstone, Clinton administration, Cooper-Breaux, Chafee-Thomas, Michel-Lott, Nickles-Stearns, and Gramm. Proposals without an individual mandate will not achieve universal coverage. An individual mandate raises significant enforcement issues. An employer mandate will not achieve universal coverage by itself. Depending on the number of hours an employee must work to be included in a mandate, an employer mandate could potentially extend health insurance coverage to as many as 85 percent of the currently uninsured. Each individual has a risk of needing health care services. Restructuring the health insurance market is accomplished by changing the way individuals and their risks are pooled. The composition of these risk pools will determine the costs of health insurance and the distribution of these costs. The theory behind medical saving accounts is that the market for health insurance currently leads to health care cost inflation because many events covered under most health insurance plans are not truly insurable. There are two issues involved in medical savings accounts--the impact on low-income individuals and individuals' ability to evaluate the quality of care they receive. The present market does not provide individuals with adequate information for assessing the quality or effectiveness of medical care. Among the critical issues in health reform is how to reduce the rate of health care cost inflation. The effect of proposals that impose explicit budget caps or price controls on health care cost inflation can be more easily estimated than other means of controlling costs if it is assumed that the political will exists to hold these caps and price controls at the levels set in the proposal. It seems unlikely that shortages or queues would develop in the near term if a single-payer health system were enacted. Currently, the U.S. health care system is characterized by overcapacity. In the longer term, however, with restrictions on hospitals' access to new technology and funds to invest in new equipment and beds, shortages and queues might develop.

Cost Control↗
PubMed2006

Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report.

UNLABELLED: Interest in comparative quality measurement and evaluation has grown considerably over the past two decades because of factors such as the recognition of widespread variation in clinical practice, the increased availability of evidence about medical effectiveness, and increasing concern about the cost and quality of health care. This article describes and contrasts two current efforts to develop health performance reporting systems: one, an international initiative-the Health Care Quality Indicator (HCQI) Project, sponsored by the Organization for Economic Cooperation and Development (OECD); and the other, a national project-the National Healthcare Quality Report (NHQR), sponsored by the US Agency for Healthcare Quality and Research. There are a number of lessons learned from a comparison of the two efforts that are relevant for the future of each project and for other indicator-based reporting efforts in quality of health care. These lessons are discussed in the article and include: Conceptual frameworks should be established to guide the selection of indicators. Choices should be made early on in the process to focus on a wide range of clinical conditions or to report on a few priority areas. METHODS: should be developed to add and subtract indicators while maintaining a stable set of indicators to track over time. Resources should be allocated to communication strategies and how best to present data results to diverse audiences. Mechanisms should be put in place to maintain project momentum.

Benchmarking↗
PubMed1992

The influence of implant design, application, and site on clinical performance and crestal bone: a multicenter, multidisciplinary clinical study. Dental Implant Clinical Research Group (Planning Committee).

This investigation is designed to provide scientific data that is directly relevant to the placement of dental implants. The study is concerned with the influence of implant design, application, and location on long-term clinical performance and crestal bone response over 5 years of function. It involves approximately 700 patients at 30 Veterans Administration Medical Centers from various geographic regions. Patients are being entered into the study over an 18-month period and monitored (post-loading) over 5 years. The participating centers were randomly assigned to one of two separate, independent study groups. Complications and adverse responses associated with the placement and use of the implants will be evaluated and all failures thoroughly documented. The experimental design and sample size are based on the primary hypothesis that an implant-supported prosthesis will be successful/functional over a 5-year period in at least 90 percent of the cases treated. Secondary hypotheses to be tested are (1) the success rate among implant designs are the same over a 5-year period; (2) the success rate among implant applications are the same over a 5-year period; (3) the success rate of individual implants are the same with regard to jaw location over a 5-year period; (4) the loss of crestal bone at the individual implant sites are the same among the implant designs over a 5-year period; and (5) the complications and adverse responses experienced with the different implant designs are the same over a 5-year period. The experimental design of this multicenter, multidisciplinary, randomized investigation is a cooperative effort of the Department of Veterans Affairs and several United States dental schools.

Alveolar Bone Loss↗
PubMed2003

Personality and the predisposition to engage in risky or problem behaviors during adolescence.

Longitudinal data from a representative sample of 1,978 Black and White adolescents were used to examine the role of personality in multiple risk or problem behaviors. Results indicate that covariation among diverse behaviors (educational underachievement, delinquent behavior, substance use, sexual behavior) can be adequately modeled by a single higher order factor, and that impulsivity and avoidance coping serve as generalized risk factors for involvement in these behaviors. Whereas none of the personality variables examined explained change in problem behaviors once established, avoidance coping prospectively predicted involvement among a subgroup of adolescents with little or no prior involvement. Results suggest that dysfunctional styles of regulating emotions and emotionally driven behaviors are core features of risky or problem behaviors during adolescence.

Adaptation, Psychological↗
PubMed1998

The relationships of body temperature to weight gain, feed consumption, and feed utilization in broilers under heat stress.

Commercial broiler males were used to evaluate body temperature response to heat stress and its relationship to gain, feed consumption, and feed conversion ratio. Individual gain, feed consumption, and feed conversion ratio were obtained from 28 to 49 d in a heat stress environment (32 C) and compared to a 21 C environment. Body temperatures were measured at 28, 35, and 42 d, then daily from 43 to 48 d, and correlated with 28 to 49 d gain, feed consumption, and feed conversion ratio. Feather cover was measured at 51 d of age as a percentage of BW. Initial 28-d body temperature was not significantly different between 21 and 32 C. Body temperature was significantly higher in the 32 C environment after 7 d of heat stress and was significantly higher than at 21 C at all points through 21 d of heat stress, with mean differences ranging from 0.5 to 1.0 C. Feather weight as a percentage of BW was significantly greater in the 21 C environment (6.22%) than the 32 C environment (5.03%). Mortality was not affected by the heat stress environment. Correlations between body temperature and gain, feed consumption, and feed conversion ratio were low and nonsignificant for most periods in the 21 C environment. In the 32 C environment, body temperature was significantly correlated with gain, feed consumption, and feed conversion ratio after 7 d of heat stress, with mean correlations of -0.40 for gain, -0.31 for feed consumption, and 0.24 for feed conversion ratio in Replicate 1 and -0.44 for gain, -0.40 for feed consumption, and 0.43 for feed conversion ratio in Replicate 2.

Aging↗
PubMed1990

Epidural fentanyl and 0.5% bupivacaine for elective caesarean section.

Either 100 micrograms fentanyl or 2 ml saline was added to 0.5% bupivacaine administered epidurally for elective Caesarean section in 30 patients, in a double-blind randomised study. Bupivacaine 0.5% was administered until a complete sensory block was established extending to the 4th thoracic dermatome. One of the patients who received epidural fentanyl required intravenous alfentanil and Entonox and another, Entonox only briefly during surgery, compared with seven in the control group who required intravenous alfentanil and Entonox and one who required Entonox only. Postoperative analgesia was of longer duration in those who received epidural fentanyl (p less than 0.01). There were no deleterious effects on neonatal or maternal outcome.

Adult↗
PubMed2004

Zymosan induces nitric oxide production by peritoneal mesothelial cells.

INTRODUCTION: The production of nitric oxide is an important peritoneal defense mechanism. We have evaluated the effect of various putative stimulants on nitric oxide production by peritoneal mesothelial cells. METHODS: Wistar rats were randomized to either a control group or a peritonitis group (5 mg zymosan intraperitoneally). Groups of five animals were sacrificed at 4, 18, 24, 48 and 96 h after the induction of peritonitis and their peritoneal fluid was harvested for assay. Cultures of peritoneal mesothelial cells were stimulated with lipopolysaccharide, myeloperoxidase, TNFalpha, zymosan, peritoneal fluid from a control animal and peritoneal fluid from a peritonitis animal. Supernatants were collected after incubation for 4, 24 and 48 h for assay. The assay for nitric oxide was based upon the nitrite content of the samples. RESULTS: The intraperitoneal administration of zymosan was associated with an increased production of nitric oxide (NO) when compared with control animals (P < 0.01). In cultures of peritoneal mesothelial cells, zymosan, but not the other putative stimulants, was associated with a marked output of nitric oxide (P < 0.001). CONCLUSION: Zymosan has a direct effect on peritoneal mesothelial cells, which are able to generate nitric oxide in the absence of co-stimulatory molecules. This suggests that it may be possible to use some form of external stimulation to up-regulate the NO response by peritoneal mesothelial cells.

Animals↗
PubMed1986

A comparison of primidone, propranolol, and placebo in essential tremor, using quantitative analysis.

The effects of placebo, propranolol and primidone were compared in 14 patients with essential tremor in a double blind, randomised, crossover study. Objective measures of tremor were obtained using an accelerometer with subsequent spectral analysis. Both propranolol (p less than 0.01) and primidone (p less than 0.01) gave significant improvement in tremor, but there was no significant difference in improvement between these drugs. Patients with higher dominant frequencies of tremor tended to respond to both drugs, while those with lower frequencies improved on one or other. There was no differential effect between the drugs with the frequency of tremor.

Clinical Trials as Topic↗
PubMed1991

Retardation by aminoguanidine of development of albuminuria, mesangial expansion, and tissue fluorescence in streptozocin-induced diabetic rat.

This study evaluated the relationship between the development of fluorescence related to advanced glycosylation end products (AGEs) in the kidney and experimental diabetic nephropathy over a 32-wk period. Control, untreated diabetic, and aminoguanidine-treated diabetic rats were followed for 32 wk with eight weekly measurements of urinary albumin excretion. After 32 wk, collagen-related fluorescence in aorta and kidney (whole kidney, isolated glomeruli, and renal tubules) and glomerular ultrastructure were evaluated. Diabetes was associated with a significant increase in collagen-related fluorescence in the aorta and kidney. Aminoguanidine prevented the increases in collagen-related fluorescence in aorta, isolated glomeruli, and renal tubules but not in whole kidney. Diabetes was associated with increased albuminuria, fractional mesangial volume, and glomerular basement membrane (GBM) thickness. Aminoguanidine attenuated the rise in albuminuria and prevented mesangial expansion without influencing GBM thickness in diabetic rats. The concomitant changes in collagen-related fluorescence, albuminuria, and mesangial expansion with aminoguanidine therapy are consistent with the hypothesis that AGEs may play a role in the development of diabetic nephropathy.

Albuminuria↗