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Intervention Groups (intervention + groups)
Selected AbstractsBrief Intervention for Female Heavy Drinkers in Routine General Practice: A 3-Year Randomized, Controlled StudyALCOHOLISM, Issue 11 2000Mauri Aalto Background: Today, heavy drinking is a common health hazard among women. The evidence in favor of providing some kind of brief intervention to reduce drinking is quite convincing. However, we do not know if intervention works in a natural environment of routine health care. The purpose of this study was to evaluate the effectiveness of long-lasting, brief alcohol intervention counseling for women in a routine general practice setting. Methods: In five primary care outpatient clinics in a Finnish town, 118 female early-phase heavy drinkers who consulted their general practitioners for various reasons were given brief alcohol intervention counseling. Intervention groups A (n= 40) and B (n= 38) were offered seven and three brief intervention sessions, respectively, over a 3-yr period. The control group C (n= 40) was advised to reduce drinking at baseline. Main outcome measures were self-reported weekly alcohol consumption, carbohydrate-deficient transferrin, mean corpuscular volume (MCV), aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase. Results: Depending on the outcome measure and the study group, clinically meaningful reduction of drinking was found in 27% to 75% of the heavy drinkers. Within all the groups, MCV significantly decreased. However, there were no statistically significant differences between study groups A, B, and C in the mean changes between the beginning and endpoint in the main outcome measures. Conclusions: The present study indicated that minimal advice, as offered to group C, was associated with reduced drinking as much as the brief intervention, as offered to groups A and B, given over a 3-yr period. Furthermore, in the routine setting of the general practice office, the effectiveness of the brief intervention may not be as good as in special research conditions. The factors possibly reducing the effectiveness in a routine setting are unknown. Thus, different methods of implementing brief intervention need to be evaluated to find better ways to support general practice personnel in their efforts to help heavy-drinking female patients to reduce their drinking. [source] Effects of back care education in elementary schoolchildrenACTA PAEDIATRICA, Issue 8 2000G Cardon The purpose of this study was to investigate the effects of a back care education programme, consisting of six sessions of 1 h each, in fourth- and fifth-grade elementary schoolchildren. Testing consisted of a practical performance and a back care knowledge test. Forty-two subjects and 36 controls performed a pre-test and were tested within 1 wk after the programme. To monitor effects and follow-up effects on a larger sample, 82 different pupils were tested within 1 wk after the programme and 116 other children 3 mo after. Both larger samples were compared with one group of 129 controls. Interrater reliability for the test items of the practical assessment was high; intraclass correlation coefficients varied from 0.785 to 0.980. In the pre/post design study, interaction between time and condition was significant for the sum score of the practical assessment and for the knowledge test (p < 0.001), with higher scores for the intervention group (15% improvement for the knowledge test score, 31.6% for the practical sum score). Significantly higher sum scores for the knowledge test and for all practical assessment items were found in the intervention groups, tested within 1 wk and 3 mo after the programme, in comparison with the control group (p <0.001). Conclusion: The effectiveness of a primary educational prevention programme on back care principles was demonstrated in this study. Effectiveness, long-term outcomes and behavioural changes need further evaluation to optimize back care prevention programmes for elementary schoolchildren. [source] Effectiveness of dental trauma education for elementary school staffDENTAL TRAUMATOLOGY, Issue 2 2008Judy D. McIntyre Using a newly developed reliable survey instrument, we tested our elementary school staff participants about TDI before (time0), immediately after (time1), and three months after (time2) the intervention. Schools were randomized into three groups: no intervention/control (C), pamphlets (P), and pamphlets + lecture (P + L). Outcomes of interest were TDI knowledge over time relative to the interventions vs controls. Statistical analysis involved a repeated measures linear model. At time0, TDI knowledge was low among all three groups. At time1, knowledge increased among all groups and is given by P > P+L > C. For time2 vs time1, the P + L group retained the knowledge while in both the C and P groups the knowledge level decreased. Between time1 and time2, significant differences were found between both intervention groups when compared with the control (P vs C and P + L vs C: both P < 0.05). In summary, both P and P + L groups significantly improved TDI knowledge among elementary school staff, and this difference held up over time. These interventions have the potential to improve TDI management by elementary school staff when faced with such injuries. [source] Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trialsDIABETIC MEDICINE, Issue 6 2010K. Hawthorne Diabet. Med. 27, 613,623 (2010) Abstract To determine if culturally appropriate health education is more effective than ,usual' health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA1c, blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA1c showed an improvement at 3 months [weighted mean difference (WMD) ,0.32%, 95% confidence interval (CI) ,0.63, ,0.01] and 6 months post intervention (WMD ,0.60%, 95% CI ,0.85, ,0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than ,usual' health education in improving HbA1c and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research. [source] Smoking cessation in severe mental illness: what works?ADDICTION, Issue 7 2010Lindsay Banham ABSTRACT Aims The physical health of people with severe mental illness (SMI) is poor. Smoking-related illnesses are a major contributor to excess mortality and morbidity. An up-to-date review of the evidence for smoking cessation interventions in SMI is needed to inform clinical guidelines. Methods We searched bibliographic databases for relevant studies and independently extracted data. Included studies were randomized controlled trials (RCTs) of smoking cessation or reduction conducted in adult smokers with SMI. Interventions were compared to usual care or placebo. The primary outcome was smoking cessation and secondary outcomes were smoking reduction, change in weight, change in psychiatric symptoms and adverse events. Results We included eight RCTs of pharmacological and/or psychological interventions. Most cessation interventions showed moderate positive results, some reaching statistical significance. One study compared behavioural support and nicotine replacement therapy (NRT) to usual care and showed a risk ratio (RR) of 2.74 (95% CI 1.10,6.81) for short-term smoking cessation, which was not significant at longer follow-up. We pooled five trials that effectively compared bupropion to placebo giving an RR of 2.77 (95% CI 1.48,5.16), which was comparable to Hughes et al.'s 2009 figures for general population data; RR = 1.69 (95% CI 1.53,1.85). Smoking reduction data were too heterogeneous for meta-analysis, but results were generally positive. Trials suggest few adverse events. All trials recorded psychiatric symptoms and the most significant changes favoured the intervention groups over the control groups. Conclusions Treating tobacco dependence is effective in patients with SMI. Treatments that work in the general population work for those with severe mental illness and appear approximately equally effective. Treating tobacco dependence in patients with stable psychiatric conditions does not worsen mental state. [source] Assessing program fidelity in substance abuse health services researchADDICTION, Issue 11s3 2000Robert G. Orwin This paper addresses how treatment fidelity and related constructs (e.g. program implementation) can be assessed in alcohol, drug abuse and mental health services research. First, it introduces definitions of fidelity and related concepts, and then describes various concepts and tools from program evaluation that have proven useful for assessing fidelity. Next, several of these are illustrated in detail through a case study of a multisite fidelity assessment in substance abuse services research: the process evaluation of the NIAAA Homeless Cooperative Agreement Program. This evaluation included analysis of implementation at the program- and participant-level, the development of scales from the individual services data to estimate intervention strength, fidelity, and "leakage" (i.e. the degree to which services intended exclusively for intervention groups were inadvertently delivered to comparison groups) and the methods with which these data were used to assess whether programs were implemented as planned. [source] Improved quality of root fillings provided by general dental practitioners educated in nickel,titanium rotary instrumentationINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2007A. Molander Abstract Aim, To test the hypothesis that an increased utilization of nickel,titanium rotary instrumentation (NTRI) by general dental practitioners will lead to an increased frequency of good quality root fillings. A second aim was to determine whether the educational format would exert influence on the quality. Methodology, Dentists were assigned at random to three intervention groups: a 4-h lecture (L-group, n = 40); a 4-h lecture plus a full day hands-on course (LH-group, n = 40); or a control group receiving no instruction (n = 68). The control group received education later on in the study. Radiographs of two root filled molar teeth per dentist were selected at random before the start of the education program and after a 6-month clinical learning period. Using length, seal and shape of root-fillings a 5-level variable was created. Results, The rate of good quality root fillings increased after the introduction of NTRI. Calculated over all types of roots the frequency of excellent (score 1) root fillings increased from 31% to 51% (P = 0.006) in the L-group and from 27% to 47% (P = 0.016) in the LH-group. The frequency of low quality root-fillings (score 5) dropped in the L-group from 22% to 16% (P = 0.29) and in the LH-group from 13% to 9% (P = 0.48). No statistically significant difference was seen among the controls. Conclusions, When NTRI technology replaced manual stainless steel techniques the rate of good quality root fillings increased. A significant drop in the rate of low quality root fillings was not found. [source] Music-assisted relaxation to improve sleep quality: meta-analysisJOURNAL OF ADVANCED NURSING, Issue 7 2009Gerrit De Niet Abstract Title.,Music-assisted relaxation to improve sleep quality: meta-analysis. Aim., This paper is a report of a meta-analysis conducted to evaluate the efficacy of music-assisted relaxation for sleep quality in adults and elders with sleep complaints with or without a co-morbid medical condition. Background., Clinical studies have shown that music can influence treatment outcome in a positive and beneficial way. Music holds the promise of counteracting psychological presleep arousal and thus improving the preconditions for sleep. Data sources., We conducted a search in the Embase (1997 , July 2008), Medline (1950 , July 2008), Cochrane (2000 , July 2008), Psychinfo (1987 , July 2008) and Cinahl (1982 , July 2008) databases for randomized controlled trials reported in English, German, French and Dutch. The outcome measure of interest was sleep quality. Methods., Data were extracted from the included studies using predefined data fields. The researchers independently assessed the quality of the trials using the Delphi list. Only studies with a score of 5 points or higher were included. A pooled analysis was performed based on a fixed effect model. Results., Five randomized controlled trials with six treatment conditions and a total of 170 participants in intervention groups and 138 controls met our inclusion criteria. Music-assisted relaxation had a moderate effect on the sleep quality of patients with sleep complaints (standardized mean difference, ,0·74; 95% CI: ,0·96, ,0·46). Subgroup analysis revealed no statistically significant contribution of accompanying measures. Conclusion., Music-assisted relaxation can be used without intensive investment in training and materials and is therefore cheap, easily available and can be used by nurses to promote music-assisted relaxation to improve sleep quality. [source] Effect of Person-Centered Showering and the Towel Bath on Bathing-Associated Aggression, Agitation, and Discomfort in Nursing Home Residents with Dementia: A Randomized, Controlled TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004Philip D. Sloane MD Objectives: To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap). Design: A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover. Setting: Nine skilled nursing facilities in Oregon and six in North Carolina. Participants: Seventy-three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them. Measurements: Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora. Results: All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person-centered shower group (P<.001) and 60% in the towel-bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person-centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans. Conclusion: Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia. [source] Bone Mineral Response to a 7-Month Randomized Controlled, School-Based Jumping Intervention in 121 Prepubertal Boys: Associations With Ethnicity and Body Mass Index,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2002K. J. Mackelvie Abstract We examined the effects of a 7-month jumping intervention (10 minutes, 3 times per week) on bone mineral gain in prepubertal Asian and white boys (10.3 ± 0.6 years, 36.0 ± 9.2 kg) at 14 schools randomized to control (n = 60) and intervention (n = 61) groups. Intervention and control groups had similar mean baseline and change in height, weight, lean mass and fat mass, baseline areal bone mineral density (aBMD; g/cm2), bone mineral content (BMC; g; dual-energy X-ray absorptiometry [DXA], QDR 4500W), and similar average physical activity and calcium intakes. Over 7 months, the intervention group gained more total body (TB) BMC (1.6%, p < 0.01) and proximal femur (PF) aBMD (1%, p < 0.05) than the control group after adjusting for age, baseline weight, change in height, and loaded physical activity. We also investigated the 41 Asian and 50 white boys (10.2 ± 0.6 years and 31.9 ± 4.4 kg) who were below the 75th percentile (19.4 kg/m2) of the cohort mean for baseline body mass index (BMI). Boys in the intervention group gained significantly more TB and lumbar spine (LS) BMC, PF aBMD, and trochanteric (TR) aBMD (+ ,2%) than boys in the control group (adjusted for baseline weight, final Tanner stage, change in height, and loaded physical activity). Bone changes were similar between Asians and whites. Finally, we compared the boys in the control group (n = 16) and the boys in the intervention group (n = 14) whose baseline BMI fell in the highest quartile (10.5 ± 0.6 years and 49.1 ± 8.2 kg). Seven-month bone changes (adjusted as aforementioned) were similar in the control and intervention groups. In summary, jumping exercise augmented bone mineral accrual at several regions equally in prepubertal Asian and white boys of average or low BMI, and intervention effects on bone mineral were undetectable in high BMI prepubertal boys. [source] The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritisJOURNAL OF CLINICAL NURSING, Issue 7-8 2010Nurcan Y Aims and objectives., The aim in this study was to evaluate the effect of local heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. Background., Local heat application is used as a non-pharmacological practice for the treatment of knee osteoarthritis. On the other hand, literature reveals limited information on the effects of heat application. Design., The study was a comparative study. Methods., The patients with knee osteoarthritis were divided into two groups (23 patients in each) as intervention and control groups, and patients in the control group were applied with the routine medication of the physician. The intervention group received 20-minute heat application every other day for four weeks in addition to the routine medication. The data were collected using data collection form, Western Ontario and McMaster Universities Index and SF-36. Results., The Western Ontario and McMaster Universities pain and Western Ontario and McMaster Universities disability scores of the patients with knee osteoarthritis in control and intervention groups before and after the intervention were compared, and the differences for both scores in the change were found to be statistically significant (p < 0·05). Moreover, statistically significant differences were found between the control and intervention group patients in terms of changes in the scores for physical function, pain and general health perception (p < 0·05). Conclusions., It was found that heat application every other day decreased pain and disability of the patients with knee osteoarthritis. Also, heat application was found to improve the subdimensions of quality of life scores of physical function, pain and general health perception of patients. Relevance to clinical practice., The data obtained in this study on the efficiency of heat application on pain, stiffness, physical function and general health perception of patients with knee osteoarthritis may offer an insight into decision-making process for appropriate intervention. [source] Fermented milk containing Bifidobacterium lactis DN-173 010 improved self-reported digestive comfort amongst a general population of adults.JOURNAL OF DIGESTIVE DISEASES, Issue 1 2009A randomized, controlled, open-label, pilot study AIM: Some probiotics improve digestive comfort of people with Irritable Bowel Syndrome, but this needs confirmation in a healthy population. The objective of this pilot study was to investigate the effect of consuming fermented milk containing the probiotics Bifidobacterium lactis DN-173010 and yoghourt strains (test product) on digestive comfort and symptoms amongst adults without diagnosed gastrointestinal disorders. METHODS: The study was designed to approximate a real-life situation, by using a branded product in the intervention groups. In an open-label, randomized, controlled trial, 371 adults reporting digestive discomfort were randomized into three groups who had a daily consumption of either one or two pots of test product over 2 weeks, or to follow their usual diet. Digestive comfort and bother from digestive symptoms were assessed by questionnaire at baseline and follow-up (per protocol population n = 360). Self-reported change in digestive comfort and computed change between baseline and follow-up for each of 20 items were compared between groups (Cochran-Mantel-Haenszel test). RESULTS: A higher percentage of participants consuming the test product reported improved digestive comfort (1-pot group 82.5%; 2-pot group 84.3%), than controls (2.9%). Their self-reported change scores differed significantly (P < 0.001). For both test product groups, almost all symptom scores improved significantly more than controls (P < 0.001). There were no significant differences between 1-pot and 2-pot groups. CONCLUSIONS: This pilot study shows that daily consumption of a probiotic food in real-life conditions may be useful in improving digestive comfort and symptom experience of adults from general population. Further double-blind randomized controlled studies are required to confirm these health benefits. [source] The effect of caloric restriction interventions on growth hormone secretion in nonobese men and womenAGING CELL, Issue 1 2010Leanne M. Redman Summary Lifespan in rodents is prolonged by caloric restriction (CR) and by mutations affecting the somatotropic axis. It is not known if CR can alter the age-associated decline in growth hormone (GH), insulin-like growth factor (IGF)-1 and GH secretion. To evaluate the effect of CR on GH secretory dynamics; forty-three young (36.8 ± 1.0 years), overweight (BMI 27.8 ± 0.7) men (n = 20) and women (n = 23) were randomized into four groups; control = 100% of energy requirements; CR = 25% caloric restriction; CR + EX = 12.5% CR + 12.5% increase in energy expenditure by structured exercise; LCD = low calorie diet until 15% weight reduction followed by weight maintenance. At baseline and after 6 months, body composition (DXA), abdominal visceral fat (CT) 11 h GH secretion (blood sampling every 10 min for 11 h; 21:00,08:00 hours) and deconvolution analysis were measured. After 6 months, weight (control: ,1 ± 1%, CR: ,10 ± 1%, CR + EX: ,10 ± 1%, LCD: ,14 ± 1%), fat mass (control: ,2 ± 3%, CR: ,24 ± 3%, CR + EX: ,25 ± 3%, LCD: ,31 ± 2%) and visceral fat (control: ,2 ± 4%, CR: ,28 ± 4%, CR + EX: ,27 ± 3%, LCD: ,36 ± 2%) were significantly (P < 0.001) reduced in the three intervention groups compared to control. Mean 11 h GH concentrations were not changed in CR or control but increased in CR + EX (P < 0.0001) and LCD (P < 0.0001) because of increased secretory burst mass (CR + EX: 34 ± 13%, LCD: 27 ± 22%, P < 0.05) and amplitude (CR + EX: 34 ± 14%, LCD: 30 ± 20%, P < 0.05) but not to changes in secretory burst frequency or GH half-life. Fasting ghrelin was significantly increased from baseline in all three intervention groups; however, total IGF-1 concentrations were increased only in CR + EX (10 ± 7%, P < 0.05) and LCD (19 ± 4%, P < 0.001). A 25% CR diet for 6 months does not change GH, GH secretion or IGF-1 in nonobese men and women. [source] Methimazole protects lungs during hepatic ischemia,reperfusion injury in rats: An effect not induced by hypothyroidismJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2007Tanju Tütüncü Abstract Background:, Hepatic ischemia,reperfusion injury may lead to remote organ failure with mortal respiratory dysfunction. The aim of the present study was to analyze the possible protective effects of methimazole on lungs after hepatic ischemia,reperfusion injury. Methods:, Forty male Wistar albino rats were randomized into five groups: a control group, in which bilateral pulmonary lobectomy was done; a hepatic ischemia,reperfusion group, in which bilateral pulmonary lobectomy was done after hepatic ischemia,reperfusion; a thyroidectomy,ischemia,reperfusion group (total thyroidectomy followed by, 7 days later, bilateral pulmonary lobectomy after hepatic ischemia,reperfusion); a methimazole,ischemia,reperfusion group (following methimazole administration for 7 days, bilateral pulmonary lobectomy was done after hepatic ischemia,reperfusion); and a methimazole +l -thyroxine,ischemia,reperfusion group (following methimazole and l -thyroxine administration for 7 days, bilateral pulmonary lobectomy was performed after hepatic ischemia,reperfusion). Pulmonary tissue specimens were evaluated histopathologically and for myeloperoxidase and malondialdehyde levels. Results:, All of the ischemia,reperfusion intervention groups had higher pulmonary injury scoring indices than the control group (P < 0.001). Pulmonary injury index of the ischemia,reperfusion group was higher than that of both the methimazole-supplemented hypothyroid and euthyroid groups (P = 0028; P = 0,038, respectively) and was similar to that of the thyroidectomized group. Pulmonary tissue myeloperoxidase and malondialdehyde levels in the ischemia,reperfusion group were similar with that in the thyroidectomized rats but were significantly higher than that in the control, and both the methimazole-supplemented hypothyroid and euthyroid groups. Conclusion:, Methimazole exerts a protective role on lungs during hepatic ischemia,reperfusion injury, which can be attributed to its anti-inflammatory and anti-oxidant effects rather than hypothyroidism alone. [source] The Evaluation of School-Based Violence Prevention Programs: A Meta-Analysis,JOURNAL OF SCHOOL HEALTH, Issue 9 2008Hyoun-Kyoung Park-Higgerson PhD ABSTRACT Background:, Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school-based violence prevention programs. Methods:, Twenty-six randomized controlled trial (RCT), school-based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta-analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. Results:, There was no significant difference between interventions, although programs that used non,theory-based interventions, focused on at-risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size =,0.15, 95% CI =,0.29 to ,0.02, p = .03). Conclusions:, Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school-based violence prevention program success. [source] Does the Early Administration of Beta-blockers Improve the In-hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?ACADEMIC EMERGENCY MEDICINE, Issue 1 2010Ethan Brandler MD Abstract Objectives:, Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Methods:, The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0. Results:, Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90,1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%). Conclusions:, This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI. ACADEMIC EMERGENCY MEDICINE 2010; 17:1,10 © 2010 by the Society for Academic Emergency Medicine [source] Interventions for preventing obesity in childhood.OBESITY REVIEWS, Issue 3 2001A systematic review Abstract Background The prevalence of obesity and overweight is increasing worldwide. Obesity in children impacts on their health in both short- and long-term. Obesity prevention strategies are poorly understood. Objective To assess the effectiveness of interventions designed to prevent obesity in childhood. Search strategy Electronic databases were searched from January 1985 to October 1999. Selection criteria Data from randomized control trials and non-randomized trials with concurrent control group were included. A priori, studies with follow up of 1 year minimum were selected however, this was subsequently amended to include studies with a minimum follow up of three months. Data collection & analysis Two reviewers independently extracted data and assessed study quality. Main results Seven studies were included, three long-term (>1 years) and four short-term (>3 months and <1 years). The studies included were diverse in terms of study design and quality, target population, theoretical underpinning of intervention approach, and outcome measures. As such, it was not appropriate to combine study findings using statistical methods. Conclusions Two of the long-term studies (one focused on dietary education and physical activity vs. control, and the other only on dietary education vs. control), resulted in a reduction in the prevalence on obesity, but the third, which focused on dietary education and physical activity, found no effect. Of the four short-term studies, three focused simply on physical activity/reduction of sedentary behavious vs. control. Two of these studies resulted in a reduction in the prevalence of obesity in intervention groups compared with control groups, and another study found a non-significant reduction. The fourth study focused on dietary education and physical activity, and did not find an effect on obesity, but did report a reduction in fat intake. Overall, the findings of the review suggest that currently there is limited quality data on the effectiveness of obesity prevention programmes and as such no generalizable conclusions can be drawn. The need for well-designed studies that examine a range of interventions remains a priority. [source] MULTIDISCIPLINARY PAIN ABSTRACTS: 47PAIN PRACTICE, Issue 1 2004Article first published online: 15 MAR 200 The purpose of this multicenter, randomized, controlled trial was to compare the effect of manual therapy to exercise therapy in sick-listed patients with chronic low back pain. The effects of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and sick leave have been investigated in a number of studies. The results are, however, conflicting. Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 6 months were included. A total of 49 patients were randomized to either manual therapy (n=27) or to exercise therapy (n=22). Sixteen treatments were given over the course of 2 months. Pain intensity, functional disability (Oswestry disability index), general health (Dartmouth Care Cooperative function charts), and return to work were recorded before, immediately after, at 4 weeks, 6 months, and 12 months after the treatment period. Spinal range of motion (Schober test) was measured before and immediately after the treatment period only. Although significant improvements were observed in both groups, the manual therapy group showed significantly larger improvements than the exercise therapy group on all outcome variables throughout the entire experimental period. Immediately after the 2-month treatment period, 67% in the manual therapy and 27% in the exercise therapy group had returned to work. It was concluded that improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short- and long-term follow-up. [source] Preparation of parents by teaching of distraction techniques does not reduce child anxiety at anaesthetic induction.PEDIATRIC ANESTHESIA, Issue 9 2002A. Watson Introduction For those children having surgery, induction of anaesthesia is one of the most stressful procedures the child experiences perioperatively. Current work has failed to show a benefit of parental presence at induction of anaesthesia for all children. The reasons for lack of effect may include the high anxiety levels of some parents and also that the role for parents at their child's induction is not delineated. The main aim of this study was to see if parental preparation by teaching of distraction techniques could reduce their child's anxiety during intravenous induction of anaesthesia. Methods After ethics committee approval 40 children aged 2,10 years old, ASA status I or II undergoing daycase surgery under general anaesthesia were enrolled into the study. To avoid possible confounding factors children with a history of previous, surgery, chronic illness or developmental delay were excluded form participation. No children were given sedative premedication. After written informed consent by the parent, each child and parent was randomly assigned to an intervention or control group. Parents in the intervention group received preparation from a play specialist working on the children's surgical ward. It involved preparation for events in the anaesthetic room and instruction on methods of distraction for their child during induction using novel toys, books or blowing bubbles appropriate to the child's age. Preoperative information collected included demographic and baseline data. The temperament of the child was measured using the EASI (Emotionality, Activity, Sociability, Impulsivity) instrument of child temperament(l). In the anaesthetic room all children were planned to have intravenous induction of anaesthesia after prior application of EMLA cream. Anxiety of the child was measured by the modified Yale Preoperative Anxiety Scale (mYPAS)(2) by a blinded independent observer at three time points: entrance to the anaesthetic room, intravenous cannulation and at anaesthesia induction. Cooperation of the child was measured by the Induction Compliance Checklist (ICC) by the same observer (3). Postoperative data collected included parental satisfaction and anxiety scores measured by the Stait Trait Anxiety Inventory (STAI)(4) and at one week the behaviour of the child was measured Using the Posthospitalisation Behavioural Questionnaire (PHBQ)(5). Normally distributed data were analysed by a two-sample t-test, categorical data by Pearson's Chi-squared test and non-parametric data by the Wilcoxon rank-sum test. Results One parent withdrew after enrolment. This left 22 children in the control group and 17 in the intervention group. There were no significant differences in demographic and baseline data of the children between the two groups including ethnic origin, number of siblings, birth order of the child, recent stressful events in the child's life, previous hospital admissions and the temperament of the child. Parent demographics were also similar between groups including parent's age, sex, relationship to child and level of education. There were no significant differences in child anxiety or cooperation during induction measured by mYPAS and ICC between the control and intervention groups. More parents in the preparation group distracted their child than those without preparation but this did not reach significance. Parental anxiety immediately postinduction was similar between groups as was the level of parental satisfaction. The incidence of development of new negative postoperative behaviour of the child at one week was not significantly different between groups. Discussion This study shows that giving an active role for parents in the induction room, particularly by instructing them on distracting techniques for their child, does not reduce their child's anxiety compared to conventional parental presence. We conclude resources should not be directed at this type of parental preparation. Further work should examine the usefulness of distraction by nursing staff or play specialists during anaesthetic induction. [source] Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trialPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2000Dr Cecily Partridge Abstract Background and Purpose The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams. Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this result. Physiotherapy is one component of most rehabilitation teams and recent systematic reviews have shown that patients with stroke receiving more physiotherapy achieve more recovery from disability. However, information about the actual amounts of physiotherapy needed to achieve this result is not known. Method A pragmatic, randomized, single-blind, controlled trial comparing recovery from disability in subjects receiving the current standard amount of 30 minutes' physiotherapy with those receiving double that amount (60 minutes). The study included measures of physical performance and function, psychological aspects of anxiety and depression, and perceived control over recovery. Results Some 114 subjects were recruited to the study; full six-week data are available for 104 subjects and six-month data for 93 subjects. Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference. Scrutiny of the recovery curves of the whole sample showed that, in half the sample, three distinct patterns of recovery were demonstrated. Conclusion These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients. The subgroup analysis of patterns of recovery must be regarded as speculative, but provides the basis for hypotheses about those likely to respond well to more intensive therapy. Copyright © 2000 Whurr Publishers Ltd. [source] A preliminary investigation of an early intervention program: Examining the intervention effectiveness of the Bracken Concept Development Program and the Bracken Basic Concept Scale-Revised with Head Start studentsPSYCHOLOGY IN THE SCHOOLS, Issue 3 2004Patti Wilson This research study evaluated the efficacy of the Bracken Basic Concept Scale-Revised (BBCS-R; Bracken, 1998) and the Bracken Concept Development Program (BCDP; Bracken, 1986a) in a test-teach-test paradigm with students from a Head Start program. Prior to the intervention, 54 children were administered the BBCS-R and were divided into three groups, two of which received basic concept instruction. Once the intervention was completed, the children were reassessed with the BBCS-R. Posttest scores were calculated for each BBCS-R subtest and the Total Test and School Readiness Composites after controlling for the pretest scores. A MANOVA and sequential ANOVAs were conducted and proved a significantly higher performance of the two intervention groups compared to the control group. Effect sizes for five of the six BBCS-R subtests were classified as large, with the sixth (Time/Sequence) classified as medium. Discriminant function coefficients found that the Texture/Material subtest contributed the most to the detection of differences between the groups. However, no significant difference between the two intervention groups was found. © 2004 Wiley Periodicals, Inc. Psychol Schs 41: 301,311, 2004. [source] Teleconferenced educational detailing: Diabetes education for primary care physiciansTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2005FACPM, Stewart B. Harris MD Abstract Introduction: Formal didactic continuing medical education (CME) is relatively ineffective for changing physician behaviur. Diabetes mellitus is an increasingly prevalent disease, and interventions to improve adherence to clinical practice guidelines (CPGs) are needed. Methods: A stratified, cluster-randomized, controlled trial design was used to evaluate the effects of a teleconferenced educational detailing (TED) CME on glycemic control (hemoglobin [Hb] A1c) and family physician adherence to national diabetes guidelines. TED employed sequential, small-group, case-based education using CPGs delivered by a diabetes specialist. Medical record audit data from baseline through the end of a 12-month postintervention period were compared for the control and intervention groups. Satisfaction with the intervention was evaluated. Results: Sixty-one physicians provided 660 medical records. The intervention did not affect mean Hb A1c levels but did significantly (p = .04) alter the distribution of patients by category of glycemic control, with fewer in the intervention group in inadequate control (15.8% versus 23.9%). More patients took insulin (alone or with oral agents) in the intervention group (21.2% versus 12.0%, p = .03), and more took oral agents only in the control group (89.0% versus 82.9%, p = .005). More patients in the intervention group had documentation of body mass index (7.8% versus 1.9%, p < .02), eye exam (12.1% versus 5.1%, p = .02), and treatment plan (43.5% versus 23.6%, p = .01) and used a flow sheet (14.6% versus 7.7%, p < .03). Although there was general satisfaction with the teleconferencing format, specialist educators found the format more challenging than the family physicians. Discussion: CME delivered by teleconference was feasible, well attended, well received by participants, and improved some key diabetes management practices and outcomes. [source] A randomized trial evaluating a cognitive simulator for laparoscopic appendectomyANZ JOURNAL OF SURGERY, Issue 9 2010Benjamin P. T. Loveday Abstract Background:, The Integrated Cognitive Simulator (ICS) is a software application that integrates text, anatomy, video and simulation for training clinical procedures. The aim of this randomized controlled trial was to determine the usability of the ICS laparoscopic appendectomy module, and to determine its effectiveness in training the cognitive skills required for the procedure. Methods:, Junior surgical trainees were randomized into control and intervention groups. The latter had access to the ICS. Participants had three assessments: a pre-study questionnaire to determine demographics, 20 multiple choice questions to assess procedural knowledge (training effectiveness) after 2 weeks, and a questionnaire to assess usability after 4 months. Results:, Fifty-eight trainees were randomized. The overall response rate was 57%. The median scores for interface, functionality, usefulness and likelihood of utilization (usability) were 5/7 or higher. In the multiple choice questions (training effectiveness), first-year trainees in the intervention group scored higher than the control group (14.9 versus 12.1, P= 0.04), but second-year trainees did not. Use of the ICS did not alter the participants' perceived need for intra-operative guidance. Conclusions:, The ICS is considered highly usable by trainees. The ICS is effective for training cognitive skills for laparoscopic appendectomy among first-year surgical trainees. Training cognitive skills alone does not increase confidence in the ability to perform motor tasks. [source] Randomized Prospective Study to Evaluate Child Abuse Documentation in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 3 2009Elisabeth Guenther MD Abstract Objectives:, The objective was to determine whether an educational intervention for health care providers would result in improved documentation of cases of possible physical child abuse in children <36 months old treated in the emergency department (ED) setting. Methods:, This study had a statewide group-randomized prospective trial design. Participating EDs were randomized to one of three intervention groups: no intervention, partial intervention, or full intervention. Medical records for children <36 months of age were abstracted before, during, and after the intervention periods for specific documentation elements. The main outcome measure was the change in documentation from baseline. Generalized estimating equations (GEEs) were used to test for intervention effect. Results:, A total of 1,575 charts from 14 hospitals EDs were abstracted. Hospital and demographic characteristics were similar across intervention groups. There were 922 (59%) injury visits and 653 (41%) noninjury visits. For each specific documentation element, a GEE model gave p-values of >0.2 in independent tests, indicating no evidence of significant change in documentation after the intervention. Even among the 26 charts in which the possibility of physical abuse was noted, documentation remained variable. Conclusions:, The educational interventions studied did not improve ED documentation of cases of possible physical child abuse. The need for improved health care provider education in child abuse identification and documentation remains. Future innovative educational studies to improve recognition of abuse are warranted. [source] Effect on absorption and oxidative stress of different oral Coenzyme Q10 dosages and intake strategy in healthy menBIOFACTORS, Issue 1-4 2005R. B. Singh Abstract Introduction: The effect of various dosages and dose strategies of oral coenzyme Q10 (Q10) administration on serum Q10 concentration and bioequivalence of various formulations are not fully known. Subjects and Methods: In a randomized, double blind, placebo controlled trial 60 healthy men, aged 18,55 years, were supplemented with various dosages and dose strategies of coenzyme Q10 soft oil capsules (Myoqinon 100 mg, Pharma Nord, Denmark) or crystalline 100 mg Q10 powder capsules or placebo. After 20 days blood levels were compared and oxidative load parameters, malondialdehyde (MDA) and thiobarbituric acid reactive substances (TBARS) were monitored to evaluate bioequivalence. All the subjects were advised to take the capsules with meals. Blood samples were collected after 12 hours of overnight fasting at baseline and after 20 days of Q10 administration. Compliance was evaluated by counting the number of capsules returned by the subjects after the trial. Results: Compliance by capsule counting was >90%. Side effects were negligible. Serum concentrations of Q10 (average for groups) increased significantly 3,10 fold in the intervention groups compared with the placebo group. Serum response was improved with a divided dose strategy. TBARS and MDA were in the normal ranges at baseline. After 20 days intervention in the 200 mg group TBARS and MDA decreased, but the decrease was only significant for MDA (Fig. 2). Conclusions: All supplementations increased serum levels of Q10. Q10 dissolved in an oil matrix was more effective than the same amount of crystalline Q10 in raising Q10 serum levels. 200 mg of oil/soft gel formulation of Q10 caused a larger increase in Q10 serum levels than did 100 mg. Divided dosages (2 × 100 mg) of Q10 caused a larger increase in serum levels of Q10 than a single dose of 200 mg. Supplementation was associated with decreased oxidative stress as measured by MDA-levels. Indians appear to have low baseline serum coenzyme Q10 levels which may be due to vegetarian diets. Further studies in larger number of subjects would be necessary to confirm our findings. [source] Replacement of routine liver biopsy by procollagen III aminopeptide for monitoring patients with psoriasis receiving long-term methotrexate: a multicentre audit and health economic analysisBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2005R.J.G. Chalmers Summary Background, Patients receiving long-term methotrexate for psoriasis are at risk of developing hepatic fibrosis. Repeated liver biopsy has long been regarded as the only reliable method of detecting this and it is still recommended by the American Academy of Dermatology (AAD). More recently, monitoring by serum procollagen III aminopeptide (PIIINP) measurement (Orion Diagnostica, Espoo, Finland) has been advocated as a means of significantly reducing the need for liver biopsy. Objectives, To assess the validity of guidelines developed in Manchester for the use of PIIINP to monitor patients with psoriasis receiving long-term methotrexate; to assess the anticipated benefits to patients of introducing this change in practice, including reduction in requirement for liver biopsy; and to determine the impact of its introduction on healthcare costs. Methods, A multicentre audit was conducted over a 24-month period to compare the healthcare costs and outcomes of two intervention groups from centres where serial PIIINP measurement was employed with those of two control groups from centres in which AAD guidelines were followed. Results, A sevenfold reduction in the need for liver biopsy was observed in the two intervention groups (n = 166; 0·04 and 0·02 biopsies/patient/year, respectively) compared with the two control groups (n = 87; 0·26 and 0·30 biopsies/patient/year, respectively). Abnormalities of sufficient severity to influence management were identified in one in five patients biopsied in the main intervention group compared with one in 16 in the control groups. The overwhelming majority of patients surveyed expressed a preference for being monitored by methods that would minimize the need for liver biopsy. The adoption of PIIINP for monitoring would result in significant cost savings. Conclusions, This audit has shown that patients managed by the Manchester protocol using serial PIIINP measurement and selective liver biopsy were not disadvantaged in comparison with those managed according to AAD guidelines; they were subjected to sevenfold fewer liver biopsies without evidence that important liver toxicity was missed in the process. If PIIINP monitoring were widely adopted, methotrexate would become a more acceptable option for many patients who are dissuaded from considering it because of the threat of repeated liver biopsy; it would also result in significant savings to the healthcare budget. [source] Support and intervention groups for adolescents with cancer in two Ontario communities,CANCER, Issue S7 2006Maru Barrera PhD Abstract Adolescents who are treated for cancer must learn to negotiate challenging developmental tasks in the context of their treatment and adverse effects. Adverse affects of disease and treatment may prevent some of these adolescents from achieving full psychosocial development. Two programs developed independently to address the psychosocial and unique contextual needs of adolescents and young adults from different geographic regions in Ontario, Central urban and Northeastern rural, are described. The program in the urban area consists of eight 2-h sessions that combined structured creative activities and informal discussions of issues generated by adolescents; it includes a pre- post- intervention evaluation with standardized questionnaires. The Northeastern rural program consists of a monthly support open group that encourages sharing personal experiences and an annual expressive art retreat; both components include informal evaluation. Formal evaluation of these programs is in progress. Informal feedback from participants and parents suggest positive effects. These distinct and unique programs continue to evolve, as they address the unique psychosocial needs of adolescents and young adults in urban and rural areas. Cancer 2006. © 2006 American Cancer Society. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] Management of bronchiolitis without antibiotics: a multicentre randomized control trial in BangladeshACTA PAEDIATRICA, Issue 10 2009ARML Kabir Abstract Objective:, To ascertain that antibiotics have no role in the management of bronchiolitis. Design:, Multicentre randomized control trial (RCT). Setting:, Five purposively selected teaching hospitals in Bangladesh. Patient:, Children under 24 months old with bronchiolitis. Interventions:, Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures. Main outcome measures:, Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of ,rapid' and ,gradual', indicating improvement within ,four days' and ,beyond four days', respectively. Results:, Each intervention group consisted of 98 ± 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p < 0.62, p = 0.54, p < 0.27, p = 0.75, p = 0.76, p = 0.81, p > 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p < 0.07, p = 0.65, p = 0.24, p < 0.61, p = 0.22, p = 0.84, p = 0.29 and p = 0.96, respectively). However, nasal symptoms (runny nose and nasal blockage) also showed no difference among groups (p = 0.36 and p = 0.66, respectively). Thus, the dynamics of clinical outcome obviates that children not receiving antibiotics had similar clinical outcome than those who did. Conclusion:, In hospital settings, managing bronchiolitis with only supportive measures but without antibiotics remains preferable. [source] Effects of Tai Chi and resistance training on cardiovascular risk factors in elderly Chinese subjects: a 12-month longitudinal, randomized, controlled intervention studyCLINICAL ENDOCRINOLOGY, Issue 6 2005G. Neil Thomas Summary Background, ,Tai Chi is rapidly gaining in popularity, worldwide. This study was performed to assess its impact on cardiovascular risk factors in comparison with resistance training exercises in elderly Chinese subjects. Methods, A total of 207 healthy elderly participants (65,74 years, 113/207 (55%) men) were randomly assigned to one of three intervention groups: (1) Tai Chi, three times/week for 1 h/session (n = 64); (2) resistance training exercise, three times/week for 1 h/session (n = 65); (3) usual level of physical activity control group (n = 78). Anthropometric measures, dual X-ray densitometry body composition, blood pressure, lipids, glycaemic and insulin sensitivity indices were measured at baseline and 12 months. Repeated-measures analysis of variance (anova) was used to assess the between-group changes using a last-observation-carried-forward intention-to-treat approach. Results, A total of 180 (87·0%) subjects completed the study. No significant changes were identified in the Tai Chi group compared to the resistance training or control group. Of the primary outcomes, only the improvement in the insulin sensitivity index differed, being significantly greater in the resistance training than in the control group [mean difference 0·018 (95% confidence interval ( CI) 0·000,0·037) mmol glucose/min, P = 0·02), and tending to be greater than in the Tai Chi group (mean difference 0·019 (95% CI 0·000,0·038) mmol glucose/min, P < 0·06). Conclusion, Tai Chi had no significant effect on any measure compared to the controls, whereas resistance training improved the insulin sensitivity index in this 12-month study. [source] | |||||||||||||