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Selected AbstractsOn the reliability of a dental OSCE, using SEM: effect of different daysEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2008M. Schoonheim-Klein Abstract Aim:, The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days. Materials and methods:, In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16,18 5-min stations (scores 1,10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative (norm) decisions, for absolute (domain) and pass,fail (mastery) decisions. As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used. The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10. Results:, The mean weighted total OSCE score was 7.14 on a 10-point scale. With the pass,fail score set at 6.2 for the four OSCE, 90% of the 463 students passed. There was no significant increase in scores over the different days the OSCE was administered. ,Wished' variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations' difficulty (27.4%). The SEM norm was 0.42 with a CI of ±0.83 and the SEM domain was 0.50, with a CI of ±0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass,fail decisions, the use of minimal 17 stations is necessary in this dental OSCE. Conclusions:, It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education. [source] Abdominal Aortic Calcification Detected on Lateral Spine Images From a Bone Densitometer Predicts Incident Myocardial Infarction or Stroke in Older WomenJOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2008John T Schousboe MD Abstract Among a cohort of elderly women, abdominal aortic calcification scored on baseline lateral spine densitometric images intended for vertebral fracture assessment was associated with subsequent myocardial infarction or stroke over a median 4-yr period, independent of clinical cardiovascular disease risk factors. Introduction: Cardiovascular disease (CVD) risk among older women is not adequately captured by traditional CVD risk factors. Lateral spine images obtained on bone densitometers for vertebral fracture assessment (VFA) can detect abdominal aortic calcification (AAC), an important marker of subclinical CVD. Our objective was to estimate the association between AAC scored on VFA images and subsequent myocardial infarction (MI) or stroke in elderly women. Materials and Methods: Among participants in a randomized controlled trial (women; age >75 yr) of clodronate versus placebo, those who sustained an MI or stroke during the median 4-yr follow-up study period were selected as cases (n = 408), and 408 controls were randomly selected from the remainder of the parent study population. Baseline VFA images were scored for AAC with a previously validated 24-point scale and a newer, simpler 8-point scale. Results: The OR of incident MI or stroke for those in the middle and top tertiles, respectively, compared with the bottom tertile of AAC score were 1.14 (95% CI, 0.79,1.66) and 1.74 (95% CI, 1.19,2.56) for the 24-point scale and 1.42 (95% CI, 0.98,2.05) and 1.77 (95% CI, 1.22,2.55) for the 8-point scale, adjusted for age, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, blood pressure, smoking, renal function, health status, and baseline diagnoses of diabetes mellitus, hypertension, angina, and prior stroke. Conclusions: AAC scored on VFA images is independently associated with incident MI or stroke. Because bone densitometry is indicated for all women ,65 yr of age, VFA imaging offers an opportunity to capture this CVD risk factor in postmenopausal women undergoing bone densitometry at very little additional cost. [source] Development of an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes: the Q-DIOJOURNAL OF CLINICAL NURSING, Issue 7 2009Maria Müller-Staub Aims and objectives., This paper aims to report the development stages of an audit instrument to assess standardised nursing language. Because research-based instruments were not available, the instrument Quality of documentation of nursing Diagnoses, Interventions and Outcomes (Q-DIO) was developed. Background., Standardised nursing language such as nursing diagnoses, interventions and outcomes are being implemented worldwide and will be crucial for the electronic health record. The literature showed a lack of audit instruments to assess the quality of standardised nursing language in nursing documentation. Design., A qualitative design was used for instrument development. Methods., Criteria were first derived from a theoretical framework and literature reviews. Second, the criteria were operationalised into items and eight experts assessed face and content validity of the Q-DIO. Results., Criteria were developed and operationalised into 29 items. For each item, a three or five point scale was applied. The experts supported content validity and showed 88·25% agreement for the scores assigned to the 29 items of the Q-DIO. Conclusions., The Q-DIO provides a literature-based audit instrument for nursing documentation. The strength of Q-DIO is its ability to measure the quality of nursing diagnoses and related interventions and nursing-sensitive patient outcomes. Further testing of Q-DIO is recommended. Relevance to clinical practice., Based on the results of this study, the Q-DIO provides an audit instrument to be used in clinical practice. Its criteria can set the stage for the electronic nursing documentation in electronic health records. [source] ORIGINAL ARTICLE: Long-term outcomes of vertebroplasty for osteoporotic compression fracturesJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2010J Thillainadesan Abstract Introduction: This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Methods: Prospective assessment of short-term (,6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. Results: In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Conclusions: Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures. [source] Hyaluronan-based polymers in the treatment of osteochondral defectsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2000Luis A. Solchaga Articular cartilage in adults has limited ability for self-repair. Some methods devised to augment the natural healing response stimulate some regeneration, but the repair is often incomplete and lacks durability. Hyaluronan-based polymers were tested for their ability to enhance the natural healing response. It is hypothesized that hyaluronan-based polymers recreate an embryonic-like milieu where host progenitor cells can regenerate the damaged articular surface and underlying bone. Osteochondral defects were made on the femoral condyles of 4-month-old rabbits and were left empty or filled with hyaluronan-based polymers. The polymers tested were ACP sponge, made of crosslinked hyaluronan, and HYAFF-11 sponge, made of benzylated hyaluronan. The rabbits were killed 4 and 12 weeks after surgery, and the condyles were processed for histology. All 12-week defects were scored with a 29-point scale, and the scores were compared with a Kruskall-Wallis analysis of variance on ranks. Untreated defects filled with bone tissue up to or beyond the tidemark, and the noncalcified surface layer varied from fibrous to hyaline-like tissue. Four weeks after surgery, defects treated with ACP exhibited bone filling to the level of the tidemark and the surface layer was composed of hyaline-like cartilage well integrated with the adjacent cartilage. At 12 weeks, the specimens had bone beyond the tidemark that was covered with a thin layer of hyaline cartilage. Four weeks after surgery, defects treated with HYAFF-11 contained a rim of chondrogenic cells at the interface of the implant and the host tissue. In general, the 12-week defects exhibited good bone fill and the surface was mainly hyaline cartilage. Treated defects received significantly higher scores than untreated defects (p < 0.05), and ACP-treated defects scored significantly higher than HYAFF-11-treated defects (p < 0.05). The introduction of these hyaluronan-based polymers into defects provides an appropriate scaffolding and favorable microen-vironment for the reparative process. Further work is required to fully assess the long-term outcome of defects treated with these polymers. [source] Postoperative pain management: Study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of painNURSING & HEALTH SCIENCES, Issue 1 2003Joanne W. Y. Chung RN Abstract The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for ,worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management. [source] Use of Spinal Cord Stimulation in the Treatment of Phantom Limb Pain: Case Series and Review of the LiteraturePAIN PRACTICE, Issue 5 2010Ashwin Viswanathan MD Abstract Introduction: Despite technical advances in spinal cord stimulation (SCS), there is a paucity of recent literature regarding SCS for phantom limb pain. Methods: Between January 2003 and May 2008, four patients at M.D. Anderson Cancer Center underwent SCS for intractable phantom limb pain. A retrospective chart review was performed to assess outcomes and complications. A PubMed search was performed to review previously published series regarding the efficacy of SCS for phantom limb pain. Results: Postoperatively, all patients subjectively reported excellent pain relief (>80%). Patients were all followed with the Brief Pain Inventory. Patients 1 to 3 each reported a two-point decrease in their usual amount of pain using the numerical rating scale. Patient 4's numerical pain scale was unchanged. When using an 11-point scale to assess other symptomology along 10 dimensions, patients 1 to 3 demonstrated a decrease in their total symptom score by 13, 14, and 4 points, respectively. Patient 4 reported an increase by 5 points in his total symptom score. With regard to complications, patient 2 developed an allergic dermatitis to the generator requiring revision with a polyfluoroethylene (GorTex) pouch. Patient 3 developed a surgical site infection after an implantable pulse generator change. Patients 2 to 4 were very satisfied with their stimulator and would choose to undergo implantation again, with patient 1 having an equivocal response. Conclusions: For selected patients who have not obtained adequate relief with medical management, SCS for phantom limb pain can prove an effective intervention.,, [source] Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children , a randomized controlled studyPEDIATRIC ANESTHESIA, Issue 1 2007ROLAND RICHARD MEYER MD Summary Background:, Children may be agitated or even delirious especially when recovering from general anesthesia using volatile anesthetics. Many trials have focused on the newer agents sevoflurane and desflurane but for the widely used isoflurane little is known about its potential to generate agitation. We investigated the emergence characteristics of small children after sevoflurane or isoflurane with caudal anesthesia for postoperative pain control. Methods:, After institutional approval and parental consent, anesthesia was randomly performed with sevoflurane (n = 30) or isoflurane (n = 29) in children at the age of 3.8 ± 1.8 years during surgical interventions on the lower part of the body. After induction, all children received caudal anesthesia with bupivacaine (0.25%, 0.8 ml·kg,1). Postoperatively, the incidences of emergence agitation (EA) and emergence delirium (ED) were measured by a blinded observer using a ten point scale (TPS; EA = TPS > 5 ED = TPS > 7) as well as vigilance, nausea/vomiting and shivering. Results:, The two groups were comparable with respect to demographic data, duration of surgery and duration of anesthesia. There were also no differences in the period of time from the end of surgery until extubation, duration of stay in the PACU, postoperative vigilance and vegetative parameters. Incidence of EA was 30% (9/30) for sevoflurane and 34% (10/29) for isoflurane during the first 60 min in the PACU (P = 0.785). Likewise, the incidence of ED was not different between the groups (20% and 24%, respectively). Conclusions:, In our randomized controlled study, we found no difference in the incidence of EA or ED between sevoflurane and isoflurane. Therefore, the decision to use one or the other should not be based upon the incidence of EA or ED. [source] Concurrent validity of the NK hand dexterity testPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2001Joy C MacDermid BSc, PT PhD Co-Director Abstract Background and Purpose The present study evaluated the concurrent validity of the NK hand dexterity test (NKHDT) by use of three separate analyses: (1) the correlation between the NKHDT and a criterion comparator (Jebson's Hand Function Test (JHFT)); (2) the correlation between both dexterity tests and a patient-rated function questionnaire; and (3) the ability of subscales to differentiate between subjects with and without upper extremity pathology. Method The study population included 40 individuals with a variety of musculoskeletal problems affecting the upper extremity and 10 individuals without any history of upper extremity problems. Both dexterity tests were administered on a single occasion according to a standard protocol. Subjects also completed a rating scale which evaluated self-care, household work, work and recreation on an 0,10-point scale. Results The validity of the NKHDT was supported in all three analyses because: (1) the correlation between the NKHDT and JHFT subtests was moderate to strong (Pearson's r=0.47,0.87) and stronger when the objects were more similar in size; (2) both scales correlated to a similar extent with patient-rated function (Pearson's r=,0.34,0.67); and (3) all subscales were statistically different between subjects with and without upper extremity pathology (p<0.01). Conclusions The present study supports the use of the NKHDT as a measure of hand dexterity. Copyright © 2001 Whurr Publishers Ltd. [source] Visual judgements of steadiness in one-legged stance: reliability and validityPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2000Travis Haupstein Abstract Background and Purpose There is a paucity of information about the validity and reliability of clinicians' visual judgements of steadiness in one-legged stance. Such judgements are used frequently in clinical practice to support decisions about treatment in the fields of neurology, sports medicine, paediatrics and orthopaedics. The aim of the present study was to address the validity and reliability of visual judgements of steadiness in one-legged stance in a group of physiotherapists. Method A videotape of 20 five-second performances was shown to 14 physiotherapists with median clinical experience of 6.75 years. Validity of visual judgement was established by correlating scores obtained from an 11-point rating scale with criterion scores obtained from a force platform. In addition, partial correlations were used to control for the potential influence of body weight on the relationship between the visual judgements and criterion scores. Inter-observer reliability was quantified between the physiotherapists; intra-observer reliability was quantified between two tests four weeks apart. Results Mean criterion-related validity was high, regardless of whether body weight was controlled for statistically (Pearson's r=0.84, 0.83, respectively). The standard error of estimating the criterion score was 3.3 newtons. Inter-observer reliability was high (ICC (2,1) = 0.81 at Test 1 and 0.82 at Test 2). Intra-observer reliability was high (on average ICC (2,1) = 0.88; Pearson's r = 0.90). The standard error of measurement for the 11-point scale was one unit. Conclusions The finding of higher accuracy of making visual judgements than previously reported may be due to several aspects of design: use of a criterion score derived from the variability of the force signal which is more discriminating than variability of centre of pressure; use of a discriminating visual rating scale; specificity and clear definition of the phenomenon to be rated. Copyright © 2000 Whurr Publishers Ltd. [source] Assessment of the Intensity of Behavioural Traits and Ovulation between Synchronized and Non-synchronized CowsREPRODUCTION IN DOMESTIC ANIMALS, Issue 6 2007K Forster Contents Thirty cyclic, non-suckled Brahman cows were divided into three groups, all of which were synchronized sequentially with CIDR-B and observed continuously for 100 h to determine different behavioural oestrus signs. Twenty-four hours after implant withdrawal, all synchronized cows in the group, together with all other cows displaying oestrus, were subjected to intensive ultrasonographic observations (every 6 h for 120 h) to pinpoint the moment of ovulation. In the first group, oestrus and ovulation response was 60% (6/10), in the second 44% (4/9) showed oestrus and six ovulated, and in the third group oestrus and ovulation were 80% (8/10). Significant differences were observed between the second and third groups (p < 0.05). No differences were observed in the duration of oestrus, time when oestrus was displayed after implant withdrawal, time of ovulation and onset of oestrus, end of oestrus to ovulation, and intensity of oestrus on a point scale. The relationship between duration of oestrus and time of ovulation was r2 = 0.16. Ovulation, on average, was 32.1 ± 14.5 h after the onset of oestrus, 22.3 ± 16.5 h after the end of oestrus, and 91.8 ± 16.7 after implant withdrawal, although no significant differences were observed. One non-synchronized animal showed oestrous activity in the second group but failed to ovulate. In the third group, 8 animals showed oestrus, 4 with high concentrations of progesterone. Of the other four one ovulated. In conclusion, oestrous behaviour is not necessarily the best marker to predict the time when ovulation takes place due to variation in the length of the oestrous period and the possible integration of non-ovulatory animals into sexually active groups. [source] Pain Treatment and Recovery After Endoscopic Sinus SurgeryTHE LARYNGOSCOPE, Issue 8 2007Tatu P Kemppainen MD Abstract Objectives/Hypothesis: Early recovery and pain management after endoscopic sinus surgery (ESS) are largely unexplored regardless of the large number of ESSs performed by otorhinolaryngologists. In the present study, we evaluated whether scheduled administration of acetaminophen (paracetamol) for pain management after ESS would allow faster recovery to normal daily activities compared with acetaminophen administered on an as needed basis. Study Design: Open, prospective, randomized, controlled clinical trial with two parallel groups. Methods: There were 78 patients who were undergoing ESS and were randomized into two groups. The "scheduled" group (n = 38) was instructed to take two acetaminophen 665 mg modified-release tablets three times a day during the first five postoperative days, whereas the "as needed" group (n = 40) was given instructions to use acetaminophen 665 mg tablets only on an as needed basis. Patients filled in a questionnaire at the follow-up visits on the 7th and 30th postoperative days. The main outcome measures were return to normal daily activities (primary endpoint) and pain during the first week after surgery and patients' satisfaction with pain management (secondary endpoints). Results: Patients returned to their normal daily activities in 8.8 (SD 4.8) days in the "scheduled" group versus in 10.3 (SD 7.0) days in the "as needed" group (mean difference 1.5; 95% CI of the difference ,1.3 to 4.2; P = .29). In the "scheduled" group, the mean of worst pain was 3.4 (2.9) compared with 5.2 (3.0) in the "as needed" group on an 11-point scale (mean difference 1.7; 95% CI of the difference 0.4,5.2; P = .019). The patients in both groups were equally satisfied with pain management. Conclusions: The present study suggests that patients recover in 9 to 10 days after ESS when provided with appropriate pain management. Our data indicate that by prescribing scheduled acetaminophen, postoperative pain after ESS can be controlled effectively without the need for opioid analgesics. [source] Attending and Resident Satisfaction with Feedback in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 2009Lalena M Yarris MD Abstract Objectives:, Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real-time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED. Methods:, This observational study surveyed attending and resident physicians at 17 EM residency programs through web-based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10-point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses. Results:, Three hundred seventy-three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence-based decision-making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001). Conclusions:, Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED. [source] Bonfils semirigid endoscope for guidance during percutaneous tracheostomyANAESTHESIA, Issue 7 2006U. Buehner Summary We report on the use of the Bonfils semirigid scope for endoscopic guidance during percutaneous dilational tracheostomy. Forty patients requiring percutaneous dilational tracheostomy on the General or Neurosurgical Intensive Care Unit were enrolled in this study. We used the ,45 degree curved distal tip' scope in the first 15 patients, evaluating its ease of use, optical quality of focus and image resolution as well as light intensity on a 10-point scale. We evaluated straight and curved versions of it in another 15 and 10 patients, respectively. We examined the impact on ventilation and cardiovascular parameters. In all patients (n = 40) visualisation of the procedure was satisfactory. There were no clinically significant changes in ventilatory or cardiovascular parameters. The image quality for most patients received a score of 7,10. The Bonfils scope provides a practical alternative to flexible bronchoscopes in this setting. [source] Measuring men's opinions of prostate needle biopsyANZ JOURNAL OF SURGERY, Issue 8 2005Jessica C. C. Medd Background: Needle biopsy of the prostate is an important, common, invasive procedure. Little is known about men's perceptions of it. The present study was designed to assess men's experience of prostate biopsy, to determine the feasibility of a randomized trial of interventions to alleviate distress during prostate biopsy, and to develop a pragmatic outcome measure for such a trial. Methods: Of 33 consecutive men undergoing prostate biopsy at a Sydney (Australia), tertiary referral urology centre 31 men were selected for study. A cross-sectional, observational was performed. Participants completed both a 24-item questionnaire assessing relevant symptoms, attitudes and emotional responses and a semistructured interview shortly after their prostate biopsy. Each item of the questionnaire was rated on an 11-point scale from 0 (no trouble at all), to 10 (worst they could imagine). Results: The mean score for discomfort was 4.4 with 32% scoring ,7; the mean score for pain was 4.2 with 29% scoring ,7. The other most troubling aspects were: ,waiting for the result' (mean 4.4, 32% ,7) and ,fear of the result' (mean 3.7, 32% ,7). Seventy-one per cent of subjects stated that they would have been willing to participate in a randomized trial of interventions to make prostate biopsies less unpleasant. Thirteen of the 24 items were retained and refined for use as an outcome measure for subsequent trials. Conclusions: Many men experience pain, discomfort and anxiety during prostate needle biopsy and most would be willing to participate in trials of interventions to make it less unpleasant. [source] Beat the Heat: don't forget your drink , a brief public education programAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010Tracey Oakman Abstract Background: The Beat the Heat: don't forget your drink program was initiated to enable the general public to recognise and manage heat stress. It was accompanied by a telephone survey to assess program reach and knowledge and behaviours of the general public in managing heat stress. Methods: The program was implemented in the Riverina-Murray region of New South Wales, in the summer of 2008/09, through radio and television sound bytes, newspaper announcements, distribution of posters and brochures, and public talks. Computer Assisted Telephone Interviews were conducted with 328 randomly selected participants from across the region. Results: Sixty-three per cent of participants reported hearing heat health warnings and 53% changed their heat management strategies, although only 25% recalled the program slogan. On average, participants self-rated their understanding of managing heat health at 7.9 on a 10 point scale. More than 75% of participants said they would recognise the symptoms of heat stress. Most reported exposure to heat and health information from television, radio and newspapers rather than from posters, brochures and talks. Those at greatest risk included people who worked or exercised outdoors, men and those taking medication. Conclusions: Television, radio and newspapers were successful media for the program. Knowledge and responses of the general public to heat risks were well developed, with several exceptions , people taking medications, or working or playing sports outdoors, as well as tourists and men. These exceptions should be targeted in future programs. [source] Making Choices for Childbirth: A Randomized Controlled Trial of a Decision-aid for Informed Birth after Cesarean,BIRTH, Issue 4 2005Allison Shorten RN ABSTRACT:,Background:Decision-making about mode of birth after a cesarean delivery presents challenges to women and their caregivers and requires a balance of risks and benefits according to individual circumstances. The study objective was to determine whether a decision-aid for women who have experienced previous cesarean birth facilitates informed decision-making about birth options during a subsequent pregnancy. Method:A prospective multicenter randomized controlled trial of 227 pregnant women was conducted within 3 prenatal clinics and 3 private obstetric practices in New South Wales, Australia. Women with 1 previous cesarean section and medically eligible for trial of vaginal birth were recruited at 12 to 18 weeks' gestation; 115 were randomized to the intervention group and 112 to the control group. A decision-aid booklet describing risks and benefits of elective repeat cesarean section and trial of labor was given to intervention group women at 28 weeks' gestation. Main outcome measures included level of knowledge, decisional conflict score, women's preference for mode of birth, and recorded mode of birth. Results:Women who received the decision-aid demonstrated a significantly greater increase in mean knowledge scores than the control group (increasing by 2.17 vs 0.42 points on a 15-point scale)(p < 0.001, 95% CI for difference = 1.15,2.35). The intervention group demonstrated a reduction in decisional conflict score (p < 0.05). The decision-aid did not significantly affect the rate of uptake of trial of labor or elective repeat cesarean section. Preferences expressed at 36 weeks were not consistent with actual birth outcomes for many women. Conclusion:A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict. However, little evide nce suggested that this process led to an informed choice. Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice. Further work needs to examine ways to enhance women's power in decision-making within the doctor-patient relationship. (BIRTH 32:4 December 2005) [source] Ventilation threshold as a measure of impaired physical performance in adults with growth hormone excessCLINICAL ENDOCRINOLOGY, Issue 3 2002Scott G. Thomas Summary objective Fatigue is a prominent symptom among patients with GH excess and acromegaly. Identifying the physiological basis of such complaints and obtaining objective measures to quantify their severity remains an ongoing challenge. We investigated whether submaximal measures of aerobic performance can be used to assess GH excess-associated fatigue objectively. design and patients To investigate this possibility we examined the relation between physical function and physical capacity in 12 patients with active acromegaly and persistent fatigue before and after 3 and 6 months of treatment with the long-acting somatostatin analogue octreotide (LAR®). measurements Heart rate (HR) and rating of perceived exertion (RPE using Borg's 10-point scale) were measured during a 160-metre self-paced walk test (SPW). Maximum oxygen uptake (VO2max) and ventilation threshold (VeT: a measure of work rate when breathlessness develops) were measured during a progressive treadmill test to fatigue or symptom-limited maximum. The Profile Of Mood States questionnaire (POMS) was used to quantify subjective feelings of fatigue and vigour. Morning fasting levels of GH and IGF-I were measured using immunoassay of serum samples. results SPW speed at a fast pace of 1·69 ± 0·18 m/s was achieved with higher than normal HR (112 ± 15/min; normal = 102) and RPE (2·4 ± 1·2). Similar to GH-deficient adults, VO2max (22·6 ± 6·4 ml.kg,1.min,1; normal ~30 ml.kg,1.min,1) and VeT (13·1 ± 2·9 ml.kg,1.min,1; predicted normal ~16 ml.kg,1(min,1) were low. However, VeT occurred at a normal fraction of VO2max (VeT/VO2max = 0·58). VeT was significantly increased and plasma IGF-I levels reduced following 3 and 6 months of octreotide LAR® treatment. Reduction in circulating IGF-I levels was correlated with improvement in reported vigour (r = 0·85) and VeT (r = 0·65) (P < 0·05). conclusions Our findings demonstrate impairment in physical function and physical capacity consistent with the perception of increased fatigue among acromegalic patients. These objective measures of compromised physical function are similar to the changes that we have reported previously in adults with GH deficiency. Taken together, these data suggest that a narrow window for GH/IGF-I levels is required to maintain optimal physical function. [source] | |||||||||||||||||||