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Selected AbstractsPulse Pressure Determinants in Chronic Hemodialysis PatientsHEMODIALYSIS INTERNATIONAL, Issue 1 2003V Kovacic Introduction: Hypertension contributes to the cardiovascular morbidity in patients undergoing chronic hemodialysis therapy (PCHD). Pulse pressure (PP) was recognized as a correlate of mortality in PCHD. In order to demonstrate determinants of predialysis and postdialysis PP values in a group of PCHD, we conducted this study. Subjects and methods: Study subjects were 23 PCHD. Study time was 15 months. One hundred thirty six single hemodialysis (HD) treatments were processed. PP was computed as systolic-diastolic blood pressure (mmHg). Statistical methods used were Student's t test for independent data, multivariate analysis of variance, Pearson's correlation, and forward stepwise multiple regression analysis. Results: Postdialysis and predialysis PPs differed significantly (65.51 ± 19.00 vs. 60.55 ± 19.35, p = 0.002). We did not find gender differences in PP before and after HD. PP before HD was in negative correlation with phosphorus concentration (r = , 0.244, p = 0.002), parathyroid hormone (PTH)(r = , 0.177, p = 0.020), hemoglobin (r = , 0.301, p < 0.001), single HD duration (r = , 0.162, p = 0.030), ultrafiltration rate per HD (r = , 0.290, p = 0.001), years on the chronic hemodialysis treatment (r = , 0.261, p = 0.001) and ultrafiltration volume/dry body mass ratio (UF/W)(r = , 0.222, p = 0.005) and in positive concentration with weekly erythropoietin (r = 0.391, p < 001) and age (r = 0.285, p < 0.001). PP after HD was in significant negative correlation with phosphorus concentration (r = , 0.205, p = 0.009), PTH (r = , 0.187, p = 0.015), hemoglobin (r = , 0.238, p = 0.005), ultrafiltration per HD (r = , 0.370, p < 0.001), dry body mass index (r = , 0.225, p = 0.003), years of the chronic hemodialysis treatment (r = 0.330, p < 0.001), UF/W (r = , 0.340, p < 0.001) and in positive concentration with weekly erythropoietin (r = 0.361, p < 0.001) and age (r = 0.227, p = 0.004). Multiple regression analyses unveiled the strongest and negative correlations between PP after HD and UF/W ratio (, = , 0.41, p < 0.001). The strongest, but positive correlation was found between PP before HD and erythropoietin per week (, = 0.51, p < 0.001). Conclusion: Determinants of the pre/post PP values are similar. Ultrafiltration is a strong predictor of postdialysis PP value. [source] Social consumption of alcohol in adolescents with Type 1 diabetes is associated with increased glucose lability, but not hypoglycaemiaDIABETIC MEDICINE, Issue 8 2006D. Ismail Abstract Aims To determine the effects of social consumption of alcohol by diabetic adolescents on glycaemic control. Methods Fourteen (five male) patients aged > 16 years were recruited from the diabetes clinic at the Royal Children's Hospital. The continuous glucose monitoring system (CGMS) was attached at a weekend when alcohol consumption was planned for one night only. For each patient, the 12-h period from 18.00 h to 06.00 h for the night with alcohol consumption (study period) was compared with the same period with non-alcohol consumption (control period) either 24 h before or after the alcohol study night. Thus, each subject was his/her own control. Glycaemic outcomes calculated from continuous glucose monitoring included mean blood glucose (MBG), percentage of time spent at low glucose levels (CGMS < 4.0 mmol/l), normal glucose levels (CGMS 4.0,10.0 mmol/l) and high glucose levels (> 10.0 mmol/l) and continuous overall net glycaemic action (CONGA). Results The mean number of standard alcohol drinks consumed during the study period was 9.0 for males and 6.3 for females. There was no difference in percentage of time at high and normal glucose levels in the study and control periods. During the control period, there was a higher percentage of time with low glucose levels compared with the study period (P < 0.05). There was an increased level of glycaemic variation during the study time when compared with the control period. Conclusions In an uncontrolled, social context, moderately heavy alcohol consumption by adolescents with Type 1 diabetes appears to be associated with increased glycaemic variation, but not with low glucose levels. [source] Achieving long-term compliance with colonoscopic surveillance guidelines for patients at increased risk of colorectal cancer in AustraliaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007P. A. Bampton Summary We have previously demonstrated that we could improve colonoscopic surveillance practice for patients at increased risk of colorectal cancer by the adoption of guidelines, facilitated by a nurse co-ordinator. This study was to determine whether we could sustain this improvement over a longer period (4 years). All colonoscopic surveillance decisions made by the co-ordinated colorectal screening programme of our hospital between 2000 and April 2004 were reviewed. Reasons for variance were recorded, and surveillance decisions made in the last 4 months of the study time were compared with decisions made 4 years previously, both before and after the introduction of the co-ordinated programme. Between 2000 and 2004, 1794 surveillance decisions were made with variance occurring in 100. In the last 4 months of the period of study, 98% of decisions matched guidelines, suggesting that the improvement made following the adoption of the guidelines (45,96% p < 0.05) could be maintained. Reasons for variance from guidelines included a belief that the particular clinical scenario was not covered in the guidelines, disagreement with the guidelines or patient anxiety. Adherence to evidence based medicine guidelines for colonoscopy surveillance can be maintained over time at a high level. A number of clinical scenarios are not covered adequately by the existing guidelines and continue to generate disagreement amongst clinicians. [source] Perceived oral health: changes over 5 years in one Swedish age-cohortINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 3 2004K Ståhlnacke Objective:,The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5-year period, 1992,1997, using a cohort population from two Swedish counties.Methods:,In 1992, a cross-sectional mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Örebro and Östergötland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model.Results:,There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analysed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience. Conclusion: Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. However, this also means that the social differences remain, despite the official goals of increased equity. [source] Jordanian baccalaureate nursing students' perception of their learning stylesINTERNATIONAL NURSING REVIEW, Issue 1 2005F. A. Abu-Moghli rn Aim:, The purpose of this descriptive study was to determine Jordanian nursing students' perception of their learning styles. Method:, All nursing students enrolled in four universities offering a baccalaureate degree in nursing at the time of the research project (n = 420) were approached. A structured self-administered questionnaire (Autonomous Learner Index) developed by the researchers was used for data collection. The questionnaire was pilot tested on a sample of nursing students who were not included in the study. The tool was reliable with an alpha coefficient of 0.89. Findings:, The majority of Jordanian nursing students perceived themselves as independent learners. The vast majority of students indicated that they have a desire to learn new things, are curious to learn, and can identify their goal independently. However, a low percentage of students indicated having good study skills, ability to concentrate while studying and using their study time efficiently. The two-tailed t -test indicated no significant differences at alpha 0.05 levels between students' learning preferences and the selected demographic variables. Conclusion:, Based on the study findings, it is suggested that nurse educators should provide positive reinforcement of students' active involvement in the learning process, which will stimulate continued self-direction. Moreover, courses on study skills, writing skills, and literature searching skills should be introduced early in nursing curricula. [source] Effect of Alendronate on the Age-Specific Incidence of Symptomatic Osteoporotic FracturesJOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2005Marc C Hochberg MD Abstract Analyses of data from 3658 postmenopausal women with osteoporosis enrolled in the Fracture Intervention Trial showed that alendronate is effective in reducing the risk of symptomatic osteoporotic fractures across a spectrum of ages. Introduction: Most osteoporosis studies examine the relative risk of fracture based on the entire duration of treatment. Because older patients tend to be at higher risk for osteoporosis-related fractures, this analysis examined the effect of alendronate treatment on the relative risk of fracture in terms of the age that patients attained during the study. Materials and Methods: We studied 3658 postmenopausal women with osteoporosis 55-80 years of age at baseline enrolled in the Fracture Intervention Trial, a large randomized, double-blind, placebo-controlled study. Patients were treated with placebo or with alendronate at a daily dose of 5 mg for 2 years followed by 10 mg for an additional 1-2.5 years, and monitored for clinical fractures. Age, rather than study time, was the dynamic variable in our analysis. Results: The relative risk reductions for hip, clinical spine, and wrist fractures were constant across age groups, without evidence of a decline at older ages. Specifically, alendronate reduced the risk of clinical fracture by 53% at the hip (relative risk [RR] = 0.47; 95% CI = 0.27-0.81; p < 0.01), 45% at the spine (RR = 0.55; 95% CI = 0.37-0.83; p < 0.01), and 31% at the wrist (RR = 0.69; 95% CI = 0.50-0.98; p = 0.038). In addition, alendronate produced a significant risk reduction of 40% (RR = 0.60; 95% CI = 0.47-0.77; p < 0.01) for the composite event of clinical hip, spine, and wrist fractures. As a consequence of the constant relative risk model, the absolute risk reduction with alendronate treatment increased with age because of the age-related increase in fracture risk in the placebo group. The absolute risk reduction for the composite event (hip, spine, and wrist fractures together) for alendronate treatment versus placebo was 65, 80, 111, and 161 women with fractures per 10,000 PYR for the 55 to <65, 65 to <70, 70 to <75, and 75-85 year age groups, respectively. Conclusions: These data show that alendronate is effective in reducing the risk of symptomatic osteoporotic fractures across a spectrum of ages. The effectiveness is somewhat greater in patients with femoral neck T score , ,2.5 than in those with a T score , ,2.0. [source] Does adaptive training work?APPLIED COGNITIVE PSYCHOLOGY, Issue 2 2009Claudia Metzler-Baddeley People intuitively alter the allocation of study time between items of varying difficulty, and such adaptive learning methods are widely used in education and in commercially available memory training programs. We investigated the effectiveness of a computer-based adaptive learning system that utilises spacing and repetition effects by presenting difficult items with short gaps to establish fast learning, and easy items with long intervals to optimise long-term retention. The immediate and delayed effects of adaptive training on cued recall were investigated relative to a control condition of non-adaptive, random spacing. Adaptive training produced significantly higher immediate and delayed recall rates than random spacing. These results encourage the use of adaptive training in education and rehabilitation. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||