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PubMed2006

Meta-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes.

This review applied meta-analytic procedures to integrate primary research that examined exercise fitness outcomes among adults with type 1 or type 2 diabetes. We used extensive literature searching strategies to locate published and unpublished intervention studies that tested exercise interventions. We conducted meta-analytic procedures using both fixed- and random-effects models. Analyses were conducted separately for type 1 and type 2 diabetes and separately for two-group and single-group data under two assumptions about pre-post fitness outcomes association: no association and a strong positive association (0.80). Codable data were extracted from 35 reports with 1074 subjects. The type 1 diabetes overall weighted mean effect size for two-group comparisons was 0.65. For treatment group pretest versus post-test, the effect was 0.62. The effect size among adults with type 2 diabetes for two-group comparisons was 0.35. The treatment group pretest versus post-test comparison effect was 0.37. Effect sizes among control group participants were not statistically different from 0. For type 2 diabetes two-group comparisons, larger effect sizes were associated with exercise prescription, fitness testing, supervised exercise, group sessions, and recommendations for longer duration exercise sessions. HbA1c, age, body mass index, and gender distribution were unrelated to fitness outcomes.

Adult↗
PubMed2004

Morphine state-dependent learning: sensitization and interactions with dopamine receptors.

In the present study, the effects of morphine sensitization on impairment of memory formation and the state-dependent learning by morphine have been investigated in mice. Pretraining administration of morphine (0.5, 2.5 and 5 mg/kg) dose dependently decreased the learning of a one-trial passive avoidance task. Pretest administration of morphine (0.5, 2.5 and 5 mg/kg) induced state-dependent retrieval of the memory acquired under pretraining morphine influence. Pretraining or pretest administration of naloxone (0.25, 0.5 and 1 mg/kg) reversed both responses to morphine (5 mg/kg). Amnesia induced by pretraining morphine was significantly reversed in morphine-sensitized mice which had previously received once daily injections of morphine [20 and 30 mg/kg, subcutaneously (s.c.)] for 3 days. Morphine sensitization tended to reverse but did not significantly affect morphine state-dependent memory. The inhibition of morphine-induced amnesia in morphine-sensitized mice was decreased by once daily administration of naloxone (0.5, 1 and 2 mg/kg) 30 min prior to injection of morphine (20 mg/kg/day x 3 days). Three-days administration of 1-phenyl-7,8-dihydroxy-2,3,4,5-tetrahydro-1H-3-benzazepine HCL (SKF 38393; 8, 16 and 32 mg/kg) or SCH 23390; R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine HCL (0.01, 0.05 and 0.1 mg/kg) before morphine (for 3 days) and during morphine-sensitization, decreased and increased, the amnesia induced by pretraining morphine, respectively. Similar administration of quinpirole (0.5, 1 and 2 mg/kg) or sulpiride (25, 50 and 100 mg/kg) before morphine also decreased and increased the amnesia induced by pretraining morphine, respectively. The results suggest that morphine sensitization affects the impairment of memory formation, but not the facilitation of retrieval induced by morphine and thus it is postulated that dopamine receptors may play an important role in this effect.

Animals↗
PubMed2025

Feasibility of using patient navigation to improve identification of hereditary cancer syndromes in newly diagnosed patients with colorectal cancer.

PURPOSE: Germline genetic testing to identify hereditary cancer syndromes in patients newly diagnosed with colorectal cancer (CRC) carries substantial benefits. We examined the feasibility of using patient navigation, an evidence-based approach to reduce structural barriers to recommended care, to improve test completion by increasing pretest counseling attendance. METHODS: We conducted key informant interviews with representatives from organizations providing cancer care to CRC patients. Interviews included questions derived from the Consolidated Framework for Implementation Research, which delineates barriers and facilitators to implementing evidence-based practices. We used an inductive-deductive coding approach to identify themes related to program feasibility. RESULTS: We interviewed 19 participants across 13 organizations. Key feasibility barriers included funding to implement and sustain a navigation program, staffing and supervising the navigator role, health information technology needs, gaining administrators' buy-in, and evolving genetic service delivery models. Participants suggested multiple strategies to address implementation barriers, but most would prefer other approaches to improve genetic test completion over implementing a genomics-focused patient navigation program. CONCLUSION: Stakeholders across a range of health care organizations saw limited value in improving the identification of hereditary CRC syndromes by implementing a program designed to increase pretest genetic counseling attendance. The need to scale up genetic testing has shifted interest toward delivery models better integrated in established care pathways, requiring fewer resources and providing broader reach.

Humans↗
PubMed2006

An educational program enhances food label understanding of young adolescents.

While much research has focused on intake and eating behaviors of young adolescents, few studies have examined their knowledge of the Nutrition Facts label. The goals of this project were to assess the understanding of Nutrition Facts labels and the response of young adolescents to an educational program about Nutrition Facts labels. Thirty-four young adolescents participated by answering a short questionnaire and taking a pretest about Nutrition Facts labels and their food choices, which involved using actual Nutrition Facts labels from foods typically eaten by adolescents. Then the subjects participated in a short educational program on how to read the Nutrition Facts label. This was followed by a posttest. Initial knowledge of the basic use of the Nutrition Facts label was marginal, with only 6.65 (standard deviation=2.23) or approximately 55% of pretest questions answered correctly. However, the subjects' scores improved significantly to 8.32 (standard deviation=2.01) or approximately 70% correct on the posttest (P<0.0001, Fisher's exact test) after the educational session. In conclusion, young adolescents can learn how to read and understand the Nutrition Facts labels through educational sessions.

Adolescent↗
PubMed2005

Simulator training for laparoscopic suturing using performance goals translates to the operating room.

BACKGROUND: The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum. STUDY DESIGN: Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experience, were enrolled in an IRB-approved, randomized controlled protocol. Subjects viewed an instructional video and were pretested on a live porcine laparoscopic Nissen fundoplication model by placing three gastrogastric sutures tied in an intracorporeal fashion. A blinded rater objectively scored each knot based on a previously published formula (600 minus completion time [sec] minus penalties for accuracy and knot integrity errors). Subjects were stratified according to pretest scores and randomized. The trained group practiced on a videotrainer suturing model until an expert-derived proficiency score (512) was achieved on 12 attempts. The control group received no training. Both the trained and control groups were posttested on the porcine Nissen model. RESULTS: For the training group, mean time to demonstrate simulator proficiency was 151 minutes (range 107 to 224 minutes) and mean number of attempts was 37 (range 24 to 51 attempts). Both the trained and control groups demonstrated significant improvement in overall score from baseline. But the trained group performed significantly better than the control group at posttesting (389 +/- 70 versus 217 +/- 140, p < 0.001), confirming curriculum effectiveness. CONCLUSIONS: These data suggest that training to a predetermined expert level on a videotrainer suture model provides trainees with skills that translate into improved operative performance. Such curricula should be further developed and implemented as a means of ensuring proficiency.

Adult↗
PubMed2004

Multiple medically unexplained physical symptoms and health care utilization: outcome of psychological intervention and patient-related predictors of change.

OBJECTIVES: To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. METHODS: In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. RESULTS: ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. CONCLUSION: Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.

Adult↗
PubMed2005

Safety halls--an evaluation.

PROBLEM: In most countries, drivers licensing systems usually include teaching some aspects of using safety equipment (e.g., airbags and seat belts). However, there is now evidence worldwide that such education is inadequate, as indicated by, for example, the overrepresentation of young drivers who do not use seat belts. METHOD: A randomized controlled study was conducted in Sweden to evaluate the effects of visiting a facility known as a "safety hall" in combination with the mandatory skid training. The results were assessed to determine the effects of the knowledge and attitudes of learner drivers in the following subjects: airbags, securing loads, seat belts, sitting posture, speed, and tires. An experimental group and a control group comprising 658 and 668 learners, respectively, answered identical questionnaires on three different occasions (pretest, posttest 1, and posttest 2). RESULTS: The results show that, for most of the topics considered, knowledge and attitudes in both groups were better at posttest 2 than at the pretest, and in general, the best knowledge and attitudes were found in the experimental group. The combined safety/skid training seems to have had the greatest effect on seat belts and loads. The findings also indicate that the safety halls can be further improved to achieve an even better effect. IMPACT ON TRAFFIC SAFETY: The use of safety halls has improved the knowledge and attitudes of learner drivers concerning several important areas related to traffic safety. Since knowledge and attitudes are important predictors of behavior, implementing safety halls can be expected to lead to improvements, especially regarding the use of safety belts and securing loads.

Accidents, Traffic↗
PubMed2004

Sensitivity to pain and c-Fos expression in brain structures in rats.

The induction of c-Fos protein--a product of the c-fos gene, a marker of changes in neuronal activity, was studied in brain structures of animals differing in their sensitivity to the acute painful stimulation, a foot-shock (MS--more sensitive rats; LS--less sensitive rats, according to the arbitrary criterion in the flinch-jump pretest). After the pretest the animals were dived into the control group, exposed on retest 10 days later to the testing cage only (C1 group), and aversively stimulated animals (MS and LS groups, given five mild footshocks 1.5 h before immunocytochemical part of the experiment). Additional control group of naive, intact animals, was studied in parallel (C group). It was shown that animals subjected to the flinch-jump test retained a strong emotional reaction on re-exposure to the shock cage on retest (a conditioned fear) 10 days later, as revealed by the widespread expression of c-Fos protein in the examined brain structures, as compared with the control, naive rats not exposed to the testing cage. In the lateral habenular nucleus (LHAB) a similar effect has been found in the control animals re-exposed to the testing cage only (C1 group), and in the MS group, suggesting that this brain area participates predominantly in processing of emotional-cognitive component of a painful stimulation. In the periaqueductal gray and basolateral nucleus of amygdala the most pronounced, but significantly higher in comparison with C group only, expression of c-Fos was detected in MS rats. Interestingly, a strong and uniform enhancement of c-Fos expression appeared in all other brain structures examined, including cortical areas, indicating their sensitivity to non-direct (conditioned) aversive stimuli. The only significant difference in c-Fos expression between LS and MS rats found in LHAB points to this brain structure as selectively engaged in processing of the emotional-cognitive component of a painful stimulation. The reactivity of LHAB may be responsible for the genetically determined differences in sensitivity to pain.

Analysis of Variance↗
PubMed2005

Coupled bilateral movements and active neuromuscular stimulation: intralimb transfer evidence during bimanual aiming.

Motor improvements in chronic stroke recovery accrue from coupled protocols of bilateral movements and active neuromuscular stimulation. This experiment investigated coupled protocols and within-limb transfer between distal and proximal joint combinations. The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints. Twenty-six volunteers completed one of three motor recovery protocols according to group assignments: (1) coupled bilateral involved concurrent wrist/finger movements on the unimpaired limb coupled with active stimulation on the impaired limb; (2) unilateral/active stimulation involved neuromuscular electromyogram-triggered stimulation on the impaired wrist/fingers; and (3) no protocol (control group). During the pretest and posttest, subjects performed transverse plane target aiming movements (29 cm) with vision available. The coupled bilateral group showed positive intralimb transfer post-treatment when both arms moved simultaneously. During the posttest, the coupled bilateral group displayed improved movement time, higher peak limb velocity, less variability in peak velocity, and less percentage of total movement time in the deceleration phase than during the pretest. The evidence confirms that within-limb transfer from distal joint training to proximal joint combinations is viable and generalizable in chronic stroke rehabilitation. Moreover, these intralimb transfer findings extend the evidence favoring motor improvements for coupled bilateral protocols during chronic stroke.

Electric Stimulation Therapy↗
PubMed2006

Impact of a 1-day ophthalmology experience on medical students.

OBJECTIVE: To improve the ophthalmic knowledge and eye examination skills of third-year medical students through the development and implementation of a 1-day ophthalmology experience. DESIGN: Noncomparative interventional case series. PARTICIPANTS: One hundred twenty-one third-year medical students at the Penn State College of Medicine completed the 1-day ophthalmology experience. METHODS: A 1-day ophthalmology curriculum, based on the Association of University Professors in Ophthalmology Policy Statement on Medical Student Education, was developed and implemented. The 1-day program consisted of a morning conference series and an afternoon case-based learning and eye examination skills session. MAIN OUTCOME MEASURES: The students completed a questionnaire to assess the impact of the experience on their ophthalmology knowledge and skills. In addition, the students completed a pretest and posttest to measure the impact of the 1-day ophthalmology experience on their ophthalmic knowledge. RESULTS: The 1-day ophthalmology experience was effective in improving the ophthalmic knowledge and eye examination skills of medical students based on the results of questionnaires, multiple choice examinations, and skills assessment. There was a statistically significant increase in test score percentage after the 1-day ophthalmology experience: the mean score on the pretest was 55%, compared with a mean score of 80% on the posttest. CONCLUSION: The ophthalmology-in-a-day experience is an effective way to improve the ophthalmic knowledge and eye examination skills of medical students.

Clinical Competence↗
PubMed2004

Sedative music reduces anxiety and pain during chair rest after open-heart surgery.

Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P< or =0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.

Aged↗
PubMed2005

Diagnosis and screening of coronary artery disease.

Diagnostic testing for CAD is aided by the calculation of the pretest probability using either the Diamond-Forrester score or the Morise score. Patients who have a low risk of CAD should not undergo testing. Exercise ECG testing should be reserved for patients who have pretest probabilities lower than 20%, because a negative test does not adequately reduce the posttest probability of significant CAD. For patients who are at intermediate risk, either nuclear perfusion imaging or stress echocardiography is an acceptable choice depending on local availability and practice. Due to its low specificity, CAC scoring is currently limited in its usefulness for the diagnosis of CAD in symptomatic patients. Currently, screening for CAD among patients at low risk should not extend beyond screening for traditional risk factors. Physicians should use the Framingham Risk Score to stratify patients into levels of 10-year risk for cardiac events. Due to its high rate of false positive tests and low sensitivity, exercise ECG is of limited value in screening. Among patients with higher levels of risk, in whom further risk stratification would be of use in making decisions about risk factor management, measurement of CAC either with EBCT or multidetector row CT scanning is a promising option, but more research is required before its use should become widespread. Measures of endothelial function are in development but lack data to support their widespread use currently.

Acute Disease↗
PubMed2004

Practical utility of clinical prediction rules for suspected acute pulmonary embolism in a large academic institution.

INTRODUCTION: In an attempt to standardize clinicians' approach to the determination of pretest probability (PTP) in pulmonary embolism (PE), two simplified scoring models have recently been proposed. We sought to determine the utility of these algorithms in patients with suspected PE in a large, tertiary, academic medical center. METHODS: We performed a retrospective analysis of 295 inpatients and outpatients from our institution who were evaluated for suspected PE. Pretest probability (PTP) was calculated using two previously formulated scoring systems by Wells et al. (Canadian score) and Wicki et al. (Geneva score). Our primary endpoint was the prevalence of PE within each strata of PTP. RESULTS: The prevalence of pulmonary embolism in our cohort was 30%. The prevalence of PE in the low, intermediate and high PTP groups using the Canadian score was 15.3% (95% CI 9.5-23.7%), 34.8% (95% CI 27.9-42.4%), and 47.2% (95% CI 32.0-63.0), respectively. When compared with the low PTP group, the odds ratios of the likelihood of PE was 2.95 (95% CI 1.56-5.59) in the intermediate PTP group and 4.95 (95% CI 2.11-11.64) in the high PTP. The Wicki analysis was divided into "Geneva pure" and "Geneva presumed", where the fractional inspired oxygen concentration was known and presumed to have been sampled on room air, respectively. Neither of the Geneva scores showed statistical significance in the prevalence of PE among the PTP groups. CONCLUSIONS: The Wells' clinical prediction score is easily applied and meaningfully risk stratifies patients with suspected PE. In our population, the Geneva score was less useful.

Academic Medical Centers↗
PubMed2006

Testing for heparin-induced thrombocytopenia antibodies.

Heparin-induced thrombocytopenia (HIT) has a distinct clinical profile and unique pathogenesis. It is caused by platelet-activating IgG antibodies that recognize multimolecular complexes of platelet factor 4 (PF4) bound to heparin or certain other polyanions. Although an immune response to PF4/heparin associated with heparin treatment is very common, clinical HIT occurs only among the minority of patients whose antibodies are capable of strongly activating platelets. This explains why certain platelet activation assays and anti-PF4/polyanion immunoassays have high sensitivity for HIT and why diagnostic specificity is highest for those assays that preferentially detect pathogenic antibodies, such as the washed platelet activation assays or immunoassays that detect only IgG antibodies. Negative results obtained in a solid-phase PF4/polyanion immunoassay generally exclude HIT (high negative predictive value), especially in a setting of a low pretest probability. In addition, because the magnitude of a positive test result correlates with greater likelihood of HIT, a Bayesian diagnostic approach that combines pretest probability and the magnitude of a positive test result is recommended. Recent studies suggest that presence of anti-PF4/polyanion antibodies in certain clinical settings confers an adverse prognosis, even without clinically evident HIT. Whether such antibodies impart "forme fruste" HIT or are simply a surrogate marker for a non-HIT adverse risk factor such as inflammation is unresolved.

Anticoagulants↗
PubMed2005

Randomized comparison of standard laparoscopic trainer to novel, at-home, low-cost, camera-less laparoscopic trainer.

OBJECTIVES: To evaluate the utility of a portable, at-home, low-cost, camera-less laparoscopic trainer to provide laparoscopy training inexpensively and outside the constraints of the hospital environment. METHODS: Twenty-two urology residents (postgraduate year 1 to 7) were tested prospectively on four basic laparoscopic tasks on a standard video laparoscopic trainer (pretest). Objective and subjective data were collected for each participant. The subjects were then randomized to 5 hours of training on either a portable, camera-less trainer (group 1) or a standard video laparoscopic trainer (group 2). Each resident was then retested on the initial same four laparoscopic tasks (post-test). Efficiency ratios were calculated for each task, incorporating both time and accuracy. Improvements between the pretest and post-test evaluations were compared between the two groups using the two-group t test. RESULTS: All subjects significantly improved their performance with training. The average improvement in the time required to complete the laparoscopic tasks for all participants was 36%. Efficiency increased by 52%. However, no difference was found between the two groups. In the poststudy self-evaluations, 91% of participants in group 1 either agreed or strongly agreed that the at-home trainer was a helpful teaching modality. CONCLUSIONS: The improvements in laparoscopic skills on our inexpensive, portable, at-home, camera-less trainer were not significantly different from those gained using a traditional video laparoscopic trainer. Participants trained on our portable trainer were able to improve objectively and subjectively by both external and internal evaluations. Thus, our system will allow trainees to develop their laparoscopic skills in an inexpensive manner in the comfort of their own home.

Adult↗
PubMed2005

A pilot study of the effect of Direct Instruction programming on the academic performance of students with intractable epilepsy.

Fifty-five students with intractable epilepsy and learning difficulties, aged 6.5 to 14.1 years with a mean IQ of 71.25 (SD=13.56), attended a hospital-based classroom of no more than eight students where they received Direct Instruction programming for 3 to 4.5 days a week, typically for up to 16 weeks. Pretest-posttest academic gains were evaluated in comparison to normative test performance. At pretest the students were achieving below test means in reading and mathematics, particularly in calculation. Direct Instruction was associated with significant improvement in all academic areas except word identification in reading. IQ level was related to certain academic gains, but gains were not associated with seizure variables or the number of days students spent in the program. Despite severe learning difficulties, students with intractable epilepsy can make academic gains when taught by highly structured teaching methods such as Direct Instruction.

Achievement↗
PubMed2004

Home-administered fecal occult blood test for colorectal cancer screening among worksites in Taiwan.

BACKGROUND: This study assessed the perceived acceptance, difficulty level, and screening efficacy of home-administered fecal occult blood test (FOBT) among a Chinese population. METHODS: Participants (age 40 and above) were recruited at various worksites in Taiwan during the summer of 2002. A single group pretest and posttest design was used. RESULTS: The 1-month follow up rate was 81% (304/375). Screening result return rate (76%) and FOBT completion rate (74%) using the home-administered kit (HAK) were both high. Intention towards FOBT in the coming year significantly increased after the intervention (P<0.001). At pretest, participants demonstrated higher perceived acceptance and screening completion efficacy of FOBT using home-administered kit (HAK) than the traditional method (P<0.001). At posttest, the perceived difficulty of FOBT using HAK was significantly lower than the traditional stool-collecting method (P<0.001). While the acceptance of HAK remained high both before and after the intervention, the acceptance and screening efficacy towards traditional FOBT decreased significantly (P<0.001). CONCLUSIONS: This study showed the great potential of using home-administered FOBT to promote colorectal cancer (CRC) screening among a Chinese population. Future intervention using innovative screening strategies will need to consider the participant's stage of adoption and cultural beliefs related to screening and preventive behaviors.

Adult↗
PubMed2006

Educating nurses about correct application of cricoid pressure.

ALTHOUGH THE APPLICATION of cricoid pressure is a technique that is performed almost daily in the OR, perioperative nurses may not be applying cricoid pressure correctly. THE PURPOSE of this quality improvement project was to develop an education program to assess perioperative nurses' skills and educate and train them regarding correct application of cricoid pressure. OF 51 PERIOPERATIVE NURSES who participated in a pretest, an education program, and a posttest, the number of participants who could apply the appropriate amount of pressure to the correct location increased from two (3.9%) on the pretest to 35 (68.6%) on the posttest.

Cricoid Cartilage↗