A significant decrease in EtISO was associated with epidural nalbuphine at 0.3 mg/kg ( 26.3 % ) and 0.6 mg/kg ( 38.4 % ) but not with saline in ovariohysterectomized dogs .


In the postoperative period , VAS and Colorado analgesic scores were lower for the dogs that received the higher nalbuphine dose , which only required supplemental analgesia 10 h following its administration , compared with dogs that received the lower dose .


Epidural nalbuphine significantly reduces the intra-operative isoflurane requirement and provides prolonged postoperative analgesia after ovariohysterectomy in dogs .


Parental smoking is associated with an increased risk of smoking among youth .


Epidemiological research has shown that parental smoking cessation can attenuate this risk .


This study examined whether telephone counselling for parents and subsequent parental smoking cessation affect smoking-related cognitions and smoking initiation among children of smoking parents .


Data of a two-arm randomized controlled trial were used in which 512 smoking parents were recruited into cessation support through their children 's primary schools .


After the baseline assessment , smoking parents were randomly assigned to tailored telephone counselling or a standard self-help brochure .


Parental cessation was measured as 6-month prolonged abstinence at the 12-month follow-up .


Children 's smoking-related cognitions and smoking initiation were examined at 3-month , 12-month , and 30-month follow-up .


No statistical evidence was found that children of parents who received telephone counselling tailored to smoking parents or children of parents who achieved prolonged abstinence differ in smoking-related cognitions ( i.e. , smoking outcome expectancies , perceived safety of smoking , self-efficacy to refrain from smoking , susceptibility to smoking ) or smoking initiation rate on any follow-up assessment .


This study is the first to examine the effects of an evidence-based smoking cessation treatment for parents and treatment-induced parental smoking cessation on cognitive and behavioural outcomes among children .


Although descriptive statistics showed lower smoking initiation rates among children of parents who achieved prolonged abstinence , there was no statistical evidence that telephone counselling tailored to parents or treatment-induced parental smoking cessation affects precursors of smoking or smoking initiation among youth .


Increasing rates of obesity and associated diseases and their consequences make the implementation of preventive and counteracting measures necessary .


The aim of this study was the examination of the long-term effects of financial incentives on weight loss in obese patients and the identification of influencing factors .


700 obese patients were randomly assigned to one of three study conditions : For reaching a pre-defined target weight within 4 months they were rewarded with Euro 150 , Euro 300 or not at all .


The effect of the incentives on weight loss in different subgroups was compared .


After 18 months , other possible influences on weight loss were analyzed by comparing responders and non-responders .


Financial rewards led to significant weight loss in all subgroups , whereupon the height of the incentive only mattered in some .


After 22 months , for several subgroups , the incentive 's effect was still visible .


Furthermore , responders showed more healthy behaviour , were better informed and reported more social support .


Especially for patient groups who do not lose weight in orthodox treatments alone , financial incentives can be an effective supplement .


In addition it became clear that this kind of reward programme can be implemented area-wide .


Older adults have increased visual impairment , including refractive blur from presbyopic multifocal spectacle corrections , and are less able to extract visual information from the environment to plan and execute appropriate stepping actions ; these factors may collectively contribute to their higher risk of falls .


The aim of this study was to examine the effect of refractive blur and target visibility on the stepping accuracy and visuomotor stepping strategies of older adults during a precision stepping task .


Ten healthy , visually normal older adults ( mean age 69.45.2 years ) walked up and down a 20m indoor corridor stepping onto selected high and low contrast targets while viewing under three visual conditions : best-corrected vision , +2.00 DS and +3.00 DS blur ; the order of blur conditions was randomised between participants .


Stepping accuracy and gaze behaviours were recorded using an eyetracker and a secondary hand-held camera .


Older adults made significantly more stepping errors with increasing levels of blur , particularly exhibiting under-stepping ( stepping more posteriorly ) onto the targets ( p < 0.05 ) , while visuomotor stepping strategies did not significantly alter .


Stepping errors were also significantly greater for the low compared to the high contrast targets and differences in visuomotor stepping strategies were found , including increased duration of gaze and increased interval between gaze onset and initiation of the leg swing when stepping onto the low contrast targets .


These findings highlight that stepping accuracy is reduced for low visibility targets , and for high levels of refractive blur at levels typically present in multifocal spectacle corrections , despite significant changes in some of the visuomotor stepping strategies .


These findings highlight the importance of maximising the contrast of objects in the environment , and may help explain why older adults wearing multifocal spectacle corrections exhibit an increased risk of falling .


Chemoradiotherapy has become the standard of care for head and neck squamous cell carcinoma ; however , those patients often experience multiple treatment-related symptoms or symptom clusters .


Two symptom clusters have been identified for this population .


Little is known about the risk factors of these symptom clusters .


Subjects comprised 684 patients who were treated with concurrent chemoradiotherapy in a phase 3 randomized clinical trial .


This trial compared standard fractionation radiotherapy to accelerated fractionation radiotherapy .


Symptom clusters were evaluated at the end of the first and the second cycle of chemotherapy , and 3 months after the start of radiotherapy .


Mixed-effect modeling was used to observe risk factors for symptom clusters .


Race and education were independent predictors for the head and neck cluster , whereas sex and history of tobacco use were independent predictors for the gastrointestinal cluster .


Primary cancer site was only significant for the head and neck cluster when other factors were not controlled : patients with oropharyngeal cancer had more severe symptoms in the head and neck clusters than did patients with laryngeal cancer .


In addition , patients receiving accelerated fractionation radiotherapy experienced more symptoms of radiomucositis , pain , and nausea at 3 months after the start of radiotherapy than those receiving standard fractionation radiotherapy .


Demographic characteristics were more predictive to symptom clusters , whereas clinical characteristics , such as cancer site and treatment arms , were more significant for individual symptoms .


Knowing the risk factors will enhance the capability of clinicians to evaluate patients ' risk of severe symptom clusters and to personalize management strategies .


To determine the physiological impact of exposure to weight stigma by examining alterations in salivary cortisol among lean and overweight women .


Participants were 123 lean and overweight adult women ( mean body mass index = 26.99 [ 7.91 ] kg/m ( 2 ) ) .


Participants ' salivary cortisol was assessed both before and after either a weight stigmatizing or a neutral video .


Participants completed self-report measures of mood and reactions to the video .


Height and weight were obtained at the conclusion of the study .


Participants in the stigmatizing condition exhibited significantly greater cortisol reactivity when compared with those in the neutral condition , irrespective of weight status ( Pillai trace = 0.077 ; F ( 1,85 ) = 7.22 , p = .009 ) .


Lean and overweight women in the stigmatizing condition were equally likely to find the video upsetting and were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media .


Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women .


These findings highlight the potentially harmful physiological consequences of exposure to weight stigma .


This study aimed to compare the effects of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time , the need for additional analgesics , postoperative recovery , and sedation and to find out its adverse effects in children having lower abdominal surgery .


40 children between 2 and 10 years of ASA I-II were randomized , and they received caudal anesthesia under general anesthesia .


Patients underwent the application of caudal block in addition to saline and 1 mL/kg bupivacaine 0.25 % .


In the postoperative period , Group C ( n = 20 ) was given 5 mL saline , and Group M ( n = 20 ) was given 0.30 mg/kg rectal midazolam diluted with 5 mL saline .


Sedation scale and postoperative pain scale ( CHIPPS ) of the patients were evaluated .


The patients were observed for their analgesic need , first analgesic time , and adverse effects for 24 hours .


Demographic and hemodynamic data of the two groups did not differ .


Postoperative sedation scores in both groups were significantly lower compared with the preoperative period .


There was no significant difference between the groups in terms of sedation and sufficient analgesia .


We conclude that caudal anesthesia provided sufficient analgesia in peroperative and postoperative periods , and rectal midazolam addition did not create any differences .


This trial is registered with ClinicalTrials.gov NCT02127489 .


Bleeding control with epinephrine hydrochloride-soaked cotton packing in the maxillary sinus after canine fossa puncture ( CFP ) during operation is a simple method for reducing complications , especially those associated with blood leakage from the maxillary sinus into the subcutaneous tissue .


Although CFP is a useful method for extensive maxillary sinus disease , complications can occur associated with nerve injuries or mucosal bleeding .


We evaluated whether maxillary sinus packing with epinephrine hydrochloride-soaked cotton pledgets would reduce complications after CFP .


Patients who met the inclusion criteria were randomly allocated to groups 1 ( packing ) and 2 ( no packing ) .


Patients underwent unilateral or bilateral CFP .


We compared the disease entities , complication incidence , and average symptom duration between the groups .


A total of 57 patients were included .


Group 1 underwent 36 CFPs , and complications occurred in 20 sides of 17 patients .


Group 2 had 39 CFPs , and 20 patients experienced complications in 26 sides .


The total number of complications was 40 and 73 in groups 1 and 2 , respectively .


Incidence or duration of facial , dental , or gum numbness did not differ between groups .


Tingling sensation , facial pain , facial swelling , and bruising showed significantly lower occurrence rates and shorter duration in group 1 .


Coffee consumption has been reported to decrease oxidative damage in peripheral white blood cells ( WBC ) .


However , effects on the level of spontaneous DNA strand breaks , a well established marker of health risk , have not been specifically reported yet .


We analyzed the impact of consuming a dark roast coffee blend on the level of spontaneous DNA strand breaks .


Healthy men ( n = 84 ) were randomized to consume daily for 4 weeks either 750 ml of fresh coffee brew or 750 ml of water , subsequent to a run in washout phase of 4 weeks .


The study coffee was a blend providing high amounts of both caffeoylquinic acids ( 10.18 0.33 mg/g ) and the roast product N-methylpyridinium ( 1.10 0.05 mg/g ) .


Before and after the coffee/water consumption phase , spontaneous strand breaks were determined by comet assay .


At baseline , both groups exhibited a similar level of spontaneous DNA strand breaks .


In the intervention phase , spontaneous DNA strand breaks slightly increased in the control ( water only ) group whereas they significantly decreased in the coffee group , leading to a 27 % difference within both arms ( p = 0.0002 ) .


Food frequency questionnaires indicated no differences in the overall diet between groups , and mean body weight during the intervention phases remained stable .


The consumption of the study coffee substantially lowered the level of spontaneous DNA strand breaks in WBC .


We conclude that regular coffee consumption contributes to DNA integrity .


Clinical trials of radiation after radical cystectomy ( RC ) and chemotherapy for bladder cancer are in development , but inclusion and stratification factors have not been clearly established .


In this study , the authors evaluated and refined a published risk stratification for locoregional failure ( LF ) by applying it to a multicenter patient cohort .


The original stratification , which was developed using a single-institution series , produced 3 subgroups with significantly different LF risk based on pathologic tumor ( pT ) classification and the number of lymph nodes identified .


This model was then applied to patients in Southwest Oncology Group ( SWOG ) 8710 , a randomized trial of RC with or without chemotherapy .


LF was defined as any pelvic failure before or within 3 months of distant failure .


Patients in the development cohort and the SWOG cohort had significantly different baseline characteristics .


The original risk model was not fully validated in the SWOG cohort , because lymph node yield was not as strongly associated with LF as in the development cohort .


Regression analysis indicated that margin status could improve the model .


A revised stratification using pT classification , margin status , and the number of lymph nodes identified produced 3 subgroups with significantly different LF risk in both cohorts : low risk ( pT2 ) , intermediate risk ( pT3 with negative margins AND 10 lymph nodes identified ) , and high risk ( pT3 with positive margins OR < 10 lymph nodes identified ) with 5-year LF rates of 8 % , 20 % , and 41 % , respectively , in the SWOG cohort and 8 % , 19 % , and 41 % , respectively , in the development cohort .


A model incorporating pT classification , margin status , and the number of lymph nodes identified stratified LF risk in 2 different RC populations and may inform the design of future trials .


Our primary purpose was to evaluate the efficacy of the high-potency 2C-adrenoceptor antagonist ORM-12741 in the attenuation of a cold-induced reduction in finger blood flow and temperature in patients with RP secondary to SSc .


Secondary objectives were to assess safety and tolerability .


This was a phase IIa , randomized , double-blind , crossover , single-dose , placebo-controlled , single-centre study .


Patients attended five times : initial screening , treatment visits 1-3 ( each at least 1 week apart ) and 1-2 weeks after the last treatment .


At each treatment visit , each subject received a single oral dose of 30 mg or 100 mg of ORM-12741 or placebo .


Thirty minutes later the subject underwent a cold challenge .


Blood flow to the fingers was assessed by three methods [ temperature by probe , laser Doppler imaging ( LDI ) and infrared thermography ] performed before , during and after the cold challenge .


Twelve patients ( 10 female , mean age 58 years ) were included .


The area under the rewarming curve ( LDI ) of the right index finger ( arbitrary flux units time ) was lower for both 30 mg ( P = 0.043 ) and 100 mg ( P = 0.025 ) of ORM-12741 compared with placebo , indicating delayed reperfusion .


The time to 70 % temperature recovery ( middle finger probe ) was longer with active than placebo treatment : mean ( s.d. ) values for placebo , 30 mg of ORM-12741 and 100 mg of ORM-12741 were 21.4 min ( 12.4 ) , 25.7 min ( 12.2 ) and 26.9 min ( 13.9 ) , respectively .


Overall ORM-12741 was well tolerated .


ORM-12741 did not expedite recovery from a cold challenge in the fingers of patients with SSc .


https://www.clinicaltrialsregister.eu/; no. 2010-024005-13 .


Approximal surfaces are a challenge to caries lesions control .


Silver diamine fluoride ( SDF ) is a simple,low-cost and promisor intervention for arresting caries lesions , but it has never been tested on approximal surfaces .


Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing ( control group ) .


Our second aim is to assess discomfort and satisfaction regarding interventions .


This is a randomized clinical trial , double-blinded , placebo-controlled study .


Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included .


Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded .


A minimum sample size of 504 surfaces will be required for each subgroup .


Individuals will be randomly allocated in three groups of interventions : SDF , resin infiltration , and control group .


Depending on the allocation , the patients will receive the active treatment and respective placebo therapies .


All patients will be oriented to daily flossing the included surfaces .


Our primary outcome will be caries progression by clinical and radiographic examinations .


Appointments will be timed and costs of materials will be considered to calculate cost-efficacy .


Patient discomfort will be assessed after interventions .


Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit .


Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6 , 12 , and 24 months to assess caries progression by visual examination and/or radiography .


Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes .


Costs will be compared and analyses of cost-efficacy will be performed .


Poisson analysis will test the association between intervention and reported discomfort and satisfaction .


Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions .


If our hypothesis is confirmed , the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents .


ClinicalTrials.gov ( NCT01477385 ) , Initial release : 11/16/2011 : last update : 06/02/2014 .


There is insufficient evidence to support use of occupational therapy interventions for patients with Parkinson 's disease .


We aimed to assess the efficacy of occupational therapy in improving daily activities of patients with Parkinson 's disease .


We did a multicentre , assessor-masked , randomised controlled clinical trial in ten hospitals in nine Dutch regional networks of specialised health-care professionals ( ParkinsonNet ) , with assessment at 3 months and 6 months .


Patients with Parkinson 's disease with self-reported difficulties in daily activities were included , along with their primary caregivers .


Patients were randomly assigned ( 2:1 ) to the intervention or control group by a computer-generated minimisation algorithm .


The intervention consisted of 10 weeks of home-based occupational therapy according to national practice guidelines ; control individuals received usual care with no occupational therapy .


The primary outcome was self-perceived performance in daily activities at 3 months , assessed with the Canadian Occupational Performance Measure ( score 1-10 ) .


Data were analysed using linear mixed models for repeated measures ( intention-to-treat principle ) .


Assessors monitored safety by asking patients about any unusual health events during the preceding 3 months .


This trial is registered with ClinicalTrials.gov , NCT01336127 .


Between April 14 , 2011 , and Nov 2 , 2012 , 191 patients were randomly assigned to the intervention group ( n = 124 ) or the control group ( n = 67 ) .


117 ( 94 % ) of 124 patients in the intervention group and 63 ( 94 % ) of 67 in the control group had a participating caregiver .


At baseline , the median score on the Canadian Occupational Performance Measure was 43 ( IQR 35-50 ) in the intervention group and 44 ( 38-50 ) in the control group .


At 3 months , these scores were 58 ( 50-64 ) and 46 ( 46-66 ) , respectively .


The adjusted mean difference in score between groups at 3 months was in favour of the intervention group ( 12 ; 95 % CI 08-16 ; p < 00001 ) .


There were no adverse events associated with the study .


Home-based , individualised occupational therapy led to an improvement in self-perceived performance in daily activities in patients with Parkinson 's disease .


Further work should identify which factors related to the patient , environmental context , or therapist might predict which patients are most likely to benefit from occupational therapy .


Prinses Beatrix Spierfonds and Parkinson Vereniging .


The UKW3 trial compared biopsy/pre-operative chemotherapy versus immediate nephrectomy and afforded the opportunity to examine the influence of percutaneous retroperitoneal biopsy and other factors on local and distant relapse of Wilms tumour ( WT ) .


Patients with unilateral WT ( stages I-IV ) excluding metachronous relapse or early progressive disease were eligible .


Metastatic and ` inoperable ' tumours were biopsied electively .


` Local ' was defined as relapse within the abdomen , except for liver metastases considered as ` distant ' relapse , together with other haematogenous routes .


Uni - and multivariable analyses estimated the risk factors for relapse .


Overall , 285/635 ( 44.9 % ) patients had a biopsy .


With a median follow-up of 10.1 years , 35 ( 5.5 % ) patients experienced a ` local ' , 15 a combined ( 2.4 % ) and 60 ( 9.4 % ) a ` distant ' relapse .


On univariate analysis , biopsy , anaplasia and tumour size were associated with an increased risk of local relapse .


On multivariable analysis , anaplasia and tumour size remained significant for local relapse whereas the elevated risk of biopsy ( hazards ratio ( HR ) = 1.80 : 95 % confidence interval ( CI ) 0.97-3 .32 , p = 0.060 ) was marginal .


Age , anaplasia , tumour size , lymph nodes metastases and stage , but not biopsy , were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis .


The UKW3 trial provides some reassurance that biopsy should not automatically lead to ` upstaging ' of WT .


Further assessment of this controversial area is required .


Comparison of local relapse rates in a multinational trial in which the United Kingdom ( UK ) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned .


To evaluate the usefulness and safety of bronchoscopy by the laryngeal mask airway ( LMA ) compared with by nose and by mouth .


Between April 2009 and Dec 2012 , we prospectively studied 150 analgesia brochoscopy in the operating theater of the our hospital .


All the patients were randomly assigned by computer to LMA group , non-LMA by nose group ( NLBN ) and non-LMA by mouth group ( NLBM ) according the way of bronchoscopy .


Each group had 50 cases .


We recorded the time of bronchoscopy just through subglottic , total operation time , the times of blood oxygen less than 80 % so as to suspend procedure and so on .


Intergroup comparisons showed no difference in gender , age , and the successful rate of biopsy ( P > 0.05 ) .


The time of bronchoscopy just through subglottic in LMA group was lower than that in NLBN group and in NLBM group significantly ( P < 0.01 ) , and no difference between two latter groups ( P > 0.05 ) .


Also , total operation time of LMA group was higher than that of others ( P < 0.05 ) , but no difference between the latter two groups .


There were 18 cases in NLBN group and 15 cases in NLBM group respectively , which were suspended procedure during operation due to low oxygen , and the difference did not reach statistical sense ( P > 0.05 ) .


There were 19 patients presented with nasal discomfort after operations in NLBN Group .


The patients in all the three groups had no bad memory or fear , and the acceptance rate of reoperation was all 100 % .


In general , as to the cases of the patients who presented with pharyngeal discomfort and abnormal pronunciation , there was significance difference between LMA Group and NLBN Group and also between LMA Group and NLBM Group , while the difference between NLBN Group and NLBM Group was not statistically significan .


The use of the LMA during FFB is safe , provides excellent patient comfort , reduces the time of bronchoscopy just through subglottic so as to decrease the total operation time , and is better to control the situation of patient in operation .


We investigated whether thymidylate synthase ( TS ) expression is a predictive marker for the clinical outcome of pemetrexed/cisplatin in patients with nonsquamous non-small-cell lung cancer .


Eligible patients were tested for TS expression by immunohistochemistry and stratified into either a TS-negative or a TS-positive group .


After stratification , patients in each group were randomly assigned ( 1:1 ratio ) to receive either pemetrexed/cisplatin or gemcitabine/cisplatin for a maximum of six cycles until disease progression .


The primary end point was evaluation of the interaction between TS groups and treatment allocation for objective response rate .


Of 321 enrolled patients with nonsquamous non-small-cell lung cancer , 315 received at least one dose of study chemotherapy and were analyzed .


By investigator assessment , response rates were 47 % for the pemetrexed/cisplatin arm and 21 % for the gemcitabine/cisplatin arm in the TS-negative group and 40 % and 39 % , respectively , for the TS-positive group ( interaction P = .0084 ) .


By independent reviewers , response rates of pemetrexed/cisplatin and gemcitabine/cisplatin were 39 % and 21 % , respectively , in the TS-negative group and 40 % and 48 % in the TS-positive group ( interaction P = .0077 ) .


The median progression-free survival times for the pemetrexed/cisplatin and the gemcitabine/cisplatin arms were 6.4 and 5.5 months , respectively , in the TS-negative group and 5.9 and 5.3 months in the TS-positive group ( interaction P = .07 ) .


With regard to response rate and progression-free survival , pemetrexed/cisplatin was superior to gemcitabine/cisplatin in the TS-negative group but not in the TS-positive group , indicative of TS expression as a potential predictive marker .


Additional prospective studies involving larger cohorts are warranted to confirm the predictive role of TS expression .


It is difficult to foster research utilization among allied health professionals ( AHPs ) .


Tailored , multifaceted knowledge translation ( KT ) strategies are now recommended but are resource intensive to implement .


Employers need effective KT solutions but little is known about ; the impact and viability of multifaceted KT strategies using an online KT tool , their effectiveness with AHPs and their effect on evidence-based practice ( EBP ) decision-making behavior .


The study aim was to measure the effectiveness of a multifaceted KT intervention including a customized KT tool , to change EBP behavior , knowledge , and attitudes of AHPs .


This is an evaluator-blinded , cluster randomized controlled trial conducted in an Australian community-based cerebral palsy service .


135 AHPs ( physiotherapists , occupational therapists , speech pathologists , psychologists and social workers ) from four regions were cluster randomized ( n = 4 ) , to either the KT intervention group ( n = 73 AHPs ) or the control group ( n = 62 AHPs ) , using computer-generated random numbers , concealed in opaque envelopes , by an independent officer .


The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers ( paid EBP time , mentoring , system changes and access to an online research synthesis tool ) .


Primary outcome ( self - and peer-rated EBP behavior ) was measured using the Goal Attainment Scale ( individual level ) .


Secondary outcomes ( knowledge and attitudes ) were measured using exams and the Evidence Based Practice Attitude Scale .


The intervention group 's primary outcome scores improved relative to the control group , however when clustering was taken into account , the findings were non-significant : self-rated EBP behavior [ effect size 4.97 ( 95 % CI -10.47 , 20.41 ) ( p = 0.52 ) ] ; peer-rated EBP behavior [ effect size 5.86 ( 95 % CI -17.77 , 29.50 ) ( p = 0.62 ) ] .


Statistically significant improvements in EBP knowledge were detected [ effect size 2.97 ( 95 % CI 1.97 , 3.97 ( p < 0.0001 ) ] .


Change in EBP attitudes was not statistically significant .


Improvement in EBP behavior was not statistically significant after adjusting for cluster effect , however similar improvements from peer-ratings suggest behaviorally meaningful gains .


The large variability in behavior observed between clusters suggests barrier assessments and subsequent KT interventions may need to target subgroups within an organization .


Registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12611000529943 ) .


Functional dysphonias are commonly associated with reduced treatment attendance leading to variable treatment outcomes .


Preliminary research has proposed that intensive treatment may improve client adherence and outcomes ; however , further research into the application of intensive models in functional dysphonia in comparison with standard intensity models is warranted .


The present study evaluated the impact of intensive and standard treatments on functional , well-being , and service outcome measures in clients with functional dysphonia .


Participants with a functional dysphonia were randomly allocated to one of two treatment groups : ( 1 ) intensive treatment ( n = 7 ) or ( 2 ) standard treatment ( n = 9 ) .


Participants completed the voice handicap index ( VHI ) and the Australian therapy outcome measures voice assessment ( conducted by a blinded assessor ) before and after treatment and 4weeks after treatment .


Satisfaction questionnaires were completed after treatment and data pertaining to attendance and duration of intervention were collected throughout treatment .


In addition to a vocal hygiene education session , all participants received a total of 8hours of treatment ; intensive treatment consisted of four 1-hour treatment sessions per week over 2weeks , whereas the standard group received one 1-hour treatment session per week over 8weeks .


High satisfaction and statistically significant improvements on the VHI ratings were found after treatment in the intensive group .


Significantly greater attendance rates were found in the intensive group .


Intensive treatment is a potentially viable service delivery option for functional dysphonia and warrants further larger scale investigation .


Previous studies show a prolongation of activated partial thromboplastin time and prothrombin time in healthy volunteers after treatment with sugammadex .


The authors investigated the effect of sugammadex on postsurgical bleeding and coagulation variables .


This randomized , double-blind trial enrolled patients receiving thromboprophylaxis and undergoing hip or knee joint replacement or hip fracture surgery .


Patients received sugammadex 4 mg/kg or usual care ( neostigmine or spontaneous recovery ) for reversal of rocuronium - or vecuronium-induced neuromuscular blockade .


The Cochran-Mantel-Haenszel method , stratified by thromboprophylaxis and renal status , was used to estimate relative risk and 95 % confidence interval ( CI ) of bleeding events with sugammadex versus usual care .


Safety was further evaluated by prespecified endpoints and adverse event reporting .


Of 1,198 patients randomized , 1,184 were treated ( sugammadex n = 596 , usual care n = 588 ) .


Bleeding events within 24 h ( classified by an independent , blinded Adjudication Committee ) were reported in 17 ( 2.9 % ) sugammadex and 24 ( 4.1 % ) usual care patients ( relative risk [ 95 % CI ] , 0.70 [ 0.38 to 1.29 ] ) .


Compared with usual care , increases of 5.5 % in activated partial thromboplastin time ( P < 0.001 ) and 3.0 % in prothrombin time ( P < 0.001 ) from baseline with sugammadex occurred 10 min after administration and resolved within 60 min .


There were no significant differences between sugammadex and usual care for other blood loss measures ( transfusion , 24-h drain volume , drop in hemoglobin , and anemia ) , or risk of venous thromboembolism , and no cases of anaphylaxis .


Sugammadex produced limited , transient ( < 1 h ) increases in activated partial thromboplastin time and prothrombin time but was not associated with increased risk of bleeding versus usual care .


To compare the therapeutic effect of traditional and modified apocrine gland removal surgery with the combination of high radiofrequency knife for axillary osmidrosis .


105 cases ( 210 sides ) were randomly divided into traditional group A ( 38 cases , 76 sides ) and modified group B ( 67 cases , 134 sides ) .


The wound healing and complications were recorded .


The clinical effect was followed up for 6-12 months after operation .


No flap necrosis happened in both groups .


The cure rate was 82.89 % ( 63/76 ) ) and 92.54 % ( 124/134 ) in group A and B , respectively , which was significantly different ( P < 0.05 ) .


The effective rate of hair removal in group A and B was 42.1 % , 59.7 % ( P < 0.05 ) .


There is no markedly difference between the two groups in postoperative hematoma ( P > 0.05 ) .


The recurrence rate in group A and B was 9.21 % and 1.49 % respectively , with a statistically difference between them ( P < 0.05 ) .


Modified apocrine gland removal surgery with the combination of high radiofrequency knife can expose the apocrine gland better and the gland , as well as hair , can be removed in the most .


The residue hair and recurrency of osmidrosis are very lower .


Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening examinations .


To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations .


From August 1 , 2006 , through September 31 , 2009 , 567 participants with diabetes were randomized and followed up to 5 years of follow-up ( last date of patient follow-up occurred on August 6 , 2012 ) as part of a multicenter randomized clinical trial with an intent to treat analysis .


We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic ( n = 296 ) or traditional surveillance with an eye care professional ( n = 271 ) .


Two years after enrollment , we offered telemedicine to all participants .


Percentage of participants receiving annual diabetic retinopathy screening examinations , percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from stage 0 ( none ) to stage 4 ( proliferative diabetic retinopathy ) , and percentage of telemedicine participants who would require referral to an eye care professional for follow-up care using a cutoff of moderate diabetic retinopathy or worse , the presence of macular edema , or an unable-to-determine result for retinopathy or macular edema .


The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less ( 94.6 % [ 280/296 ] vs 43.9 % [ 119/271 ] ; 95 % CI , 46.6 % -54.8 % ; P < .001 ) and greater than 6-month through 18-month ( 53.0 % [ 157/296 ] vs 33.2 % [ 90/271 ] ; 95 % CI , 16.5 % -23.1 % ; P < .001 ) time bins .


After we offered telemedicine to both groups , we could not identify a difference between the groups in the percentage of diabetic retinopathy screening examinations .


Diabetic retinopathy worsened by 2 stages or more in 35 ( 8.6 % ) of 409 participants ( 95 % CI , 5.8 % -11.2 % ) and improved by 2 stages or more in 5 ( 1.2 % ) of 409 participants ( 95 % CI , 0.1 % -2.3 % ) during the 4-year period .


The percent of telemedicine participants requiring referral ranged from 19.2 % ( 52/271 ) to 27.9 % ( 58/208 ) .


Telemedicine increased the percentage of diabetic retinopathy screening examinations , most participants did not require referral to an eye care professional , and diabetic retinopathy levels were generally stable during the study period .


This finding suggests that primary care clinics can use telemedicine to screen for diabetic retinopathy and monitor for disease worsening over a long period .


clinicaltrials.gov Identifier : NCT01364129 .


In this randomized trial , strut coverage and neointimal proliferation of a therapy of bare metal stents ( BMSs ) postdilated with the paclitaxel drug-eluting balloon ( DEB ) was compared with everolimus drug-eluting stents ( DESs ) at 6-month follow-up using optical coherence tomography .


We hypothesized sufficient stent coverage at follow-up .


A total of 105 lesions in 90 patients were treated with either XIENCE V DES ( n = 51 ) or BMS postdilated with the SeQuent Please DEB ( n = 54 ) .


At follow-up , comparable results on the primary optical coherence tomography end point ( percentage uncovered struts 5.649.65 % in BMS+DEB versus 4.939.29 % in DES ; P = 0.366 ) were found .


Thus , BMS+DEB achieved the prespecified noninferiority margin of 5 % uncovered struts versus DES ( difference between treatment means , 0.71 % ; one-sided upper 95 % confidence interval , 4.14 % ; noninferiority P = 0.04 ) .


Optical coherence tomography analysis showed significantly more global neointimal proliferation in the BMS+DEB group ( 15.77.8 versus 11.05.2 mm ( 3 ) proliferation volume/cm stent length ; P = 0.002 ) .


No significant focal in-stent stenosis analyzed with angiography ( percentage diameter stenosis at follow-up , 22.811.9 versus 16.910.4 ; P = 0.014 ) and optical coherence tomography ( peak local area stenosis , 39.513.8 % versus 36.815.6 % ; P = 0.409 ) was found .


Good stent strut coverage of > 94 % was found in both therapy groups .


Despite greater suppression of global neointimal growth in DES , both DES and BMS+DEB effectively prevented clinically relevant focal restenosis at 6-month follow-up .


http://www.clinicaltrials.gov .


Unique identifier : NCT01056744 .


Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members .


Given the role of obesity in the primary and tertiary prevention of breast cancer , the authors explored the feasibility of a mother-daughter weight loss intervention .


A randomized controlled trial of a mailed weight loss intervention was undertaken among 68 mother-daughter dyads ( n = 136 ) , each comprised of a survivor of breast cancer ( AJCC stage 0-III ) and her adult biological daughter .


All women had body mass indices 25 kg/m ( 2 ) and underwent in-person assessments at baseline , 6 months , and 12 months , with accelerometry and exercise capacity performed on a subset of individuals .


All women received a personalized workbook and 6 newsletters over a 1-year period that promoted weight loss ; exercise ; and a nutrient-rich , low-energy density diet .


A total of 25 dyads received individually tailored instruction ( individual ) , 25 dyads received team-tailored instruction ( TEAM ) , and 18 dyads received standardized brochures ( control ) .


The trial met its accrual target , experienced 90 % retention , and caused no serious adverse events .


Significant differences in baseline to 12-month changes were observed between individual versus control mothers for body mass index , weight , and waist circumference ( WC ) ; significant differences also were observed in the WC of corresponding daughters ( P < .05 ) .


Significant differences were found between individual versus control and team versus control dyads for WC ( P = .0002 and .018 , respectively ) , minutes per week of physical activity ( P = .031 and .036 , respectively ) , and exercise capacity ( P = .047 for both ) .


Significant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members .


For greater impact , more research is needed to expand this work beyond the mother-daughter dyad .


Childhood obesity is an increasing health problem globally .


Overweight and obesity may be established as early as 2-5 years of age , highlighting the need for evidence-based effective prevention and treatment programs early in life .


In adults , mobile phone based interventions for weight management ( mHealth ) have demonstrated positive effects on body mass , however , their use in child populations has yet to be examined .


The aim of this paper is to report the study design and methodology of the MINSTOP ( Mobile-based Intervention Intended to Stop Obesity in Preschoolers ) trial .


A two-arm , parallel design randomized controlled trial in 300 healthy Swedish 4-year-olds is conducted .


After baseline measures , parents are allocated to either an intervention - or control group .


The 6 - month mHealth intervention consists of a web-based application ( the MINSTOP app ) to help parents promote healthy eating and physical activity in children .


MINISTOP is based on the Social Cognitive Theory and involves the delivery of a comprehensive , personalized program of information and text messages based on existing guidelines for a healthy diet and active lifestyle in pre-school children .


Parents also register physical activity and intakes of candy , soft drinks , vegetables as well as fruits of their child and receive feedback through the application .


Primary outcomes include body fatness and energy intake , while secondary outcomes are time spent in sedentary , moderate , and vigorous physical activity , physical fitness and intakes of fruits and vegetables , snacks , soft drinks and candy .


Food and energy intake ( Tool for Energy balance in Children , TECH ) , body fatness ( pediatric option for BodPod ) , physical activity ( Actigraph wGT3x-BT ) and physical fitness ( the PREFIT battery of five fitness tests ) are measured at baseline , after the intervention ( six months after baseline ) and at follow-up ( 12 months after baseline ) .


This novel study will evaluate the effectiveness of a mHealth program for mitigating gain in body fatness among 4-year-old children .


If the intervention proves effective it has great potential to be implemented in child-health care to counteract childhood overweight and obesity .


ClinicalTrials.gov NCT02021786 ; 20 Dec 2013 .


Sevoflurane and propofol are both widely used in clinical anesthesia .


The aim of this study is to compare the effects of sevoflurane and propofol on right ventricular function and pulmonary circulation in patients receiving esophagectomy .


Forty adult patients undergoing an elective open-chest thoracotomy for esophagectomy were randomized to receive either propofol ( n = 20 ) or sevoflurane ( n = 20 ) as the main anesthetic agent .


The study was performed in Changzheng Hospital .


Hemodynamic data were recorded at specific intervals : before the surgery ( T0 ) , BIS values reaching 40 after anesthesia induction ( T1 ) , two-lung ventilation ( T2 ) , ten minutes after one-lung ventilation ( T3 ) , the end of the operation ( T4 ) using PiCCO2 and Swan-Ganz catheter .


CI , RVEF , RVSWI and RVEDVI were significantly smaller in propofol group than those in sevoflurane group throughout the surgery ( P < 0.05 ) .


However , SVRI was significantly greater in propofol group than that in sevoflurane group ( P < 0.05 ) .


Compared with the patients in propofol group , the patients who received sevoflurane had a greater reduction in OI and increase in Os/Ot ( P < 0.05 ) .


And , PVRI was significantly smaller in sevoflurane group than in propofol group ( P < 0.05 ) .


Anesthesia with sevoflurane preserved better right ventricular function than propofol in patients receiving esophagectomy .


However , propofol improved oxygenation and shunt fraction during one-lung ventilation compared with sevoflurane anesthesia .


To have the best effect , anesthesiologists can choose the two anesthetics flexibly according to the monitoring results .


Chlorophyll-a is a novel photosensitizer recently tested for the treatment of acne vulgaris .


We sought to evaluate the clinical efficacy and safety of chlorophyll-a photodynamic therapy used for acne treatment .


Subjects with acne on both sides of the face were included .


Eight treatment sessions were performed over a 4-week duration .


Half of the face was irradiated using a blue and red light-emitting diode after topical application of chlorophyll-lipoid complex .


The other half underwent only light-emitting diode phototherapy .


The lesion counts and acne severity were assessed by a blinded examiner .


Sebum secretion , safety , and histologic changes were also evaluated .


In total , 24 subjects completed the study .


Facial acne improved on both treated sides .


On the chlorophyll-a photodynamic therapy-treated side , there were significant reductions in acne lesion counts , acne severity grades , and sebum levels compared with the side treated with light-emitting diode phototherapy alone .


The side effects were tolerable in all the cases .


All the subjects were of Asian descent with darker skin types , which may limit the generalizability of the study .


A chlorophyll-a arm alone is absent , as is a no-treatment arm .


We suggest that chlorophyll-a photodynamic therapy for the treatment of acne vulgaris can be effective and safe with minimal side effects .


To observe the effect of Kuntai Capsule ( KC ) on the number of retrieved oocytes , the quality of high-quality oocytes and embryos in in vitro fertilization of poor ovarian response ( POR ) patients .


Totally 70 POR patients preparing for in vitro fertilization-embryo transfer ( IVF-ET ) were randomly assigned to the observation group and the control group , 35 cases in each group .


KC was administered to patients in the observation group in the preparation cycle ( i.e. , three menstrual cycles before IVF-ET ) and during the superovulation process .


Those in the control group took placebo during this period .


Before and after medication the improvement of Shen yin deficiency syndrome ( SYDS ) was observed in the two groups .


The basal follicle-stimulating hormone ( bFSH ) , luteinizing hormone ( LH ) , estradiol ( E2 ) , anti-Mullerian hormone ( AMH ) , the ratio of FSH to LH , and antral follicle count ( AFC ) were observed .


Besides , the E2 level of a single ovum on the day of HCG injection , the number of retrieved oocytes , the high-quality oocyte rate , and the high-quality embryos were observed .


Compared with the control group , the SYDS , decreased bFSH and LH levels , increased ACF numbers , the E2 level of a single ovum on the day of HCG injection , the number of retrieved oocytes , high-quality oocytes , and high-quality embryos were superior in the observation group ( P < 0.05 ) .


There was no statistical difference in the decreased FSH/LH level ( P > 0.05 ) .


E2 and AMH increased after medication of KC in the observation group , while they decreased after administration of placebos in the control group .


There was statistical difference in the post-pre treatment difference of E2 and AMH between the two groups ( P < 0.05 ) .


KC could increase the number of retrieved oocytes , and elevate the quality of occytes and embryos in the IVF-ET .


Post-visit `` booster '' sessions have been recommended to augment the impact of brief interventions delivered in the emergency department ( ED ) .


This paper , which focuses on implementation issues , presents descriptive information and interventionists ' qualitative perspectives on providing brief interventions over the phone , challenges , `` lessons learned '' , and recommendations for others attempting to implement adjunctive booster calls .


Attempts were made to complete two 20-minute telephone `` booster '' calls within a week following a patient 's ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine .


Over half ( 56.2 % ) of participants completed the initial call ; 66.9 % of those who received the initial call also completed the second call .


Median number of attempts to successfully contact participants for the first and second calls were 4 and 3 , respectively .


Each completed call lasted an average of about 22 minutes .


Common challenges/barriers identified by booster callers included unstable housing , limited phone access , unavailability due to additional treatment , lack of compensation for booster calls , and booster calls coming from an area code different than the participants ' locale and from someone other than ED staff .


Specific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system .


Future use of booster calls might be informed by research on contingency management ( e.g. , incentivizing call completions ) , smoking cessation quitlines , and phone-based continuing care for substance abuse patients .


Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting .


There are conflicting data on the use of cilostazol as triple antiplatelet therapy ( TAPT ) for improving clinical outcomes after drug-eluting stent implantation .


We aimed to evaluate whether 3-month use of cilostazol in addition to dual antiplatelet therapy ( DAPT ) improved clinical outcomes in patients with long or multivessel coronary artery disease ( CAD ) after biolimus-eluting stent ( BES ) implantation .


Patients ( n = 630 ) who had been successfully treated with BES implantation for lesions with 28 mm in stent length or 2 stents for different coronary arteries were enrolled in this prospective randomized multicenter trial .


All patients were randomly assigned to receive either DAPT ( aspirin and clopidogrel for 12 months , n = 314 ) or TAPT ( DAPT plus 3-month cilostazol use , n = 316 ) .


The primary end point was a device-oriented composite consisting of cardiac death , myocardial infarction ( not clearly attributable to a nontarget vessel ) , and ischemia-driven target lesion revascularization at 1-year follow-up .


A total of 314 patients in DAPT and 308 patients in TAPT were analyzed .


Multivessel CAD was present in 65.7 % of patients .


Stents 28 mm in length were implanted in 58.1 % of lesions .


There were no significant differences in baseline and angiographic characteristics between the 2 groups .


The primary end point was similar between the 2 groups ( 2.3 % in DAPT vs 1.9 % in TAPT , log-rank P = .799 ) .


In patients treated with BES implantation for long or multivessel CAD , 3 months of cilostazol use in addition to DAPT did not improve clinical outcome at 1-year follow-up .


The major side-effect of photodynamic therapy ( PDT ) on port wine stains ( PWS ) is pain during the treatment .


Although several strategies for controlling the pain during topical PDT achieve a reduction in the levels of pain , none were completely effective and convenient .


This randomized , double-blind , placebo-controlled clinical trial was designed to evaluate the efficacy and safety of an oral analgesic for the treatment of pain in PDT on PWS .


Fifty-eight patients with PWS on the face were included .


The treatment and placebo groups were selected by computer randomization .


The patients , doctor and statistician were blinded to the patients ' groups .


The analgesic contained 5mg of oxycodone in combination with 325 mg of acetaminophen .


The patient took the tablet orally 30 min before PDT .


The patient was injected intravenously with 4-5mg / kg photosensitizer PSD-007 within 5 min , and then the lesion was exposed to a 532 nm laser immediately for 30-60 min at 100 mW/cm ( 2 ) .


The intensity of the pain during irradiation , the characteristic and beginning time of pain , and adverse effects were recorded .


A visual analog scale ( VAS ) was used to assess the pain .


The time of the pain beginning was 8.31 4.58 min in the treatment group and 7.10 3.54 min in the placebo group , which was not significantly different ( P = 0.266 ) .


The VAS score in the treatment group was 7.88 1.52 compared with 8.17 1.12 in the placebo group , with no significant difference ( P = 0.422 ) .


The subgroup of age , gender , lesion location and classification between two groups had similar VAS score ( P > 0.05 ) .


No serious adverse events were reported .


This study found that oral oxycodone 5mg/acetaminophen 325 mg was completely ineffective for pain relief , and age , gender , lesion location and classification did not influence the pain perception and the analgesic effect .


The challenge of controlling pain during PDT on PWS remains .


New regimens to shorten tuberculosis treatment and manage patients with drug-resistant tuberculosis who are infected with HIV are urgently needed .


Experimental and clinical evidence suggests that the new drugs bedaquiline ( B ) and pretomanid ( Pa ) , combined with an existing drug , pyrazinamide ( Z ) , and a repurposed drug , clofazimine ( C ) , may assist treatment shortening of drug-susceptible and drug-resistant tuberculosis .


To evaluate the 14-day bactericidal activity of C and Z in monotherapy and in combinations with Pa and B.


Groups of 15 treatment-naive , sputum smear-positive patients with pulmonary tuberculosis were randomized to receive combinations of B with Z-C , Pa-Z , Pa-Z-C , and Pa-C , or C or Z alone , or standard combination treatment for 14 days .


The primary endpoint was the mean daily fall in log10 Mycobacterium tuberculosis CFU per milliliter sputum estimated by joint nonlinear mixed-effects Bayesian regression modeling .


Estimated activities were 0.167 ( 95 % confidence interval [ CI ] , 0.075-0 .257 ) for B-Pa-Z , 0.151 ( 95 % CI , 0.071-0 .232 ) for standard treatment , 0.124 ( 95 % CI , 0.035-0 .214 ) for B-Z-C , 0.115 ( 95 % CI , 0.039-0 .189 ) for B-Pa-Z-C , and 0.076 ( 95 % CI , 0.005-0 .145 ) for B-Pa-C .


Z alone had modest activity ( 0.036 ; 95 % CI , -0.026 to 0.099 ) .


C had no activity alone ( -0.017 ; 95 % CI , -0.085 to 0.053 ) or in combinations .


Treatments were well tolerated and safe .


B-Pa-Z , including two novel agents without resistance in prevalent M. tuberculosis strains , is a potential new tuberculosis treatment regimen .


C had no measurable activity in the first 14 days of treatment .


Clinical trial registered with www.clinicaltrials.gov ( NCT 01691534 ) .


To evaluate the impact of an 18-month school obesity prevention intervention on the health behaviors of 4th and 5th grade students based on ecological principles and formative research conducted in Mexico .


A Randomized Control Trial ( RCT ) , design was used to assign 27 schools to one of three conditions : basic or plus interventions and control .


School environment measures , children 's eating and physical activity behaviors , and body mass index were assessed four times over a 2-year period in a sample of 830 students .


In the intervention schools , the availability of healthy foods increased with a concomitant decrease in unhealthy food availability .


Food intake showed the same trend .


In the intervention schools , children did not engage in more moderate to vigorous physical activity ( MVPA ) in physical education ( PE ) class or recess but increased steps taken .


Obesity prevalence did not change .


The intervention improved the school food environment and child healthy behaviors .


To evaluate the therapeutic effect of warm acupuncture ( moxa-heated acupuncture ) needle stimulation of Waiguan ( TE 5 ) acupoint in the treatment of shoulder-hand syndrome ( phase I ) in patients with stroke .


Sixty stroke patients with shoulder-hand syndrome ( phase I ) were equally randomized into control group and warm acupuncture group .


Patients of the warm acupuncture group were treated by warm acupuncture stimulation of the affected TE 5 in combination with routine acupuncture stimulation of Jianyu ( LI 15 ) , Jianjing ( GB 21 ) , Quchi ( LI 11 ) , Wangu ( SI 4 ) , Yangchi ( TE 4 ) and Hegu ( LI 4 ) , and rehabilitation training ( passive and active upper-limb motion exercise for 30 min , once daily ) , and patients of the control group treated with routine acupuncture stimulation of the same acupoints mentioned above , and rehabilitation training .


The treatment was conducted once daily , 5 times per week for two weeks .


The patients ' clinical conditions were evaluated by using Visual Analogue Scale ( VAS , 0-10 points , shoulder pain degree ) , edema severity score ( 0 point : normal , 2 points : mild , 4 points : moderate , and 6 points : severe ) and simplified Fugl-Meyer motor assessment scale ( 0 , 1 and 2 points , upper-limb motor function ) before and after the treatment .


After the treatment , the scores of VAS and edema severity of the two groups were significantly decreased in comparison with pre-treatment in the same one group ( P < 0.01 ) , and the Fugl-Meyer motor scores were considerably increased ( P < 0.01 ) , suggesting an improvement of the shoulder-hand syndrome after two weeks ' treatment .


Of the two 30 patients in the control group and warm acupuncture group , 0 and 2 ( 6.7 % ) were cured , 7 ( 23.3 % ) and 25 ( 83.3 % ) experienced marked improvement , 17 ( 56.7 % ) and 2 ( 6.7 % ) were effective , 6 ( 20.0 % ) and 1 ( 3.3 % ) invalid , with the effective rates being 80.0 % and 96.7 % , respectively .


The effect of warm acupuncture group was superior to that of the control group ( P < 0.05 ) .


Warm acupuncture combined with routine acupuncture and rehabilitation training is effective in improving shoulder pain , hand edema and limb motor function in stroke patients with shoulder-hand syndrome at phase I.


Intermittent preventive treatment in pregnancy ( IPTp ) with sulfadoxine-pyrimethamine ( SP ) is recommended for malaria prevention in HIV-negative pregnant women , but it is contraindicated in HIV-infected women taking daily cotrimoxazole prophylaxis ( CTXp ) because of potential added risk of adverse effects associated with taking two antifolate drugs simultaneously .


We studied the safety and efficacy of mefloquine ( MQ ) in women receiving CTXp and long-lasting insecticide treated nets ( LLITNs ) .


A total of 1,071 HIV-infected women from Kenya , Mozambique , and Tanzania were randomized to receive either three doses of IPTp-MQ ( 15 mg/kg ) or placebo given at least one month apart ; all received CTXp and a LLITN .


IPTp-MQ was associated with reduced rates of maternal parasitemia ( risk ratio [ RR ] , 0.47 [ 95 % CI 0.27-0 .82 ] ; p = 0.008 ) , placental malaria ( RR , 0.52 [ 95 % CI 0.29-0 .90 ] ; p = 0.021 ) , and reduced incidence of non-obstetric hospital admissions ( RR , 0.59 [ 95 % CI 0.37-0 .95 ] ; p = 0.031 ) in the intention to treat ( ITT ) analysis .


There were no differences in the prevalence of adverse pregnancy outcomes between groups .


Drug tolerability was poorer in the MQ group compared to the control group ( 29.6 % referred dizziness and 23.9 % vomiting after the first IPTp-MQ administration ) .


HIV viral load at delivery was higher in the MQ group compared to the control group ( p = 0.048 ) in the ATP analysis .


The frequency of perinatal mother to child transmission of HIV was increased in women who received MQ ( RR , 1.95 [ 95 % CI 1.14-3 .33 ] ; p = 0.015 ) .


The main limitation of the latter finding relates to the exploratory nature of this part of the analysis .


An effective antimalarial added to CTXp and LLITNs in HIV-infected pregnant women can improve malaria prevention , as well as maternal health through reduction in hospital admissions .


However , MQ was not well tolerated , limiting its potential for IPTp and indicating the need to find alternatives with better tolerability to reduce malaria in this particularly vulnerable group .


MQ was associated with an increased risk of mother to child transmission of HIV , which warrants a better understanding of the pharmacological interactions between antimalarials and antiretroviral drugs .


ClinicalTrials.gov NCT 00811421 ; Pan African Clinical Trials Registry PACTR 2010020001813440 Please see later in the article for the Editors ' Summary .


To compare the efficacy difference in the treatment of functional dyspepsia between acupuncture at the acupoints selected by pattern/syndrome differentiation and domperidone .


Seventy cases were randomized into an acupuncture group ( 35 cases ) and a western medication group ( 35 cases ) .


In the acupuncture group , Zusanli ( ST 36 ) and Neiguan ( PC 6 ) were selected .


Taichong ( LR 3 ) and Neiting ( ST 44 ) were added for excess syndrome while Gongsun ( SP 4 ) and Yinlingquan ( SP 9 ) were added for deficiency syndrome .


A pair of electrodes was attached to one acupoint and an assistant point ( 2 mm next to the acupoint centripetally ) and stimulated with disperse-dense wave at 2 Hz/100 Hz , once a day .


In the western medication group , domperidone was prescribed for oral administration , 10 mg each time , three times a day .


In the two groups , the treatment of 5 days made one session and 4 sessions were required totally .


Nepean dyspepsia index ( NDI ) was compared after treatment , 1 , 2 , 3 , 4 and 5 months after treatment between the two groups respectively .


The score of symptom and score of life quality in NDI after treatment and at each follow-up time point were improved obviously in the acupuncture group as compared with those before treatment ( all P < 0.01 ) .


In the western mediation group , the score of symptom and the score of life quality in NDI after treatment and in follow-up of 1 , 2 and 3 months were improved obviously as compared with those before treatment ( all P < 0.01 ) , but the differences were not significant in follow-up of 4 and 5 months ( both P > 0.05 ) .


Compared with the western medication group , the symptom score of NDI was reduced obviously after treatment and in each time point of follow-up in the acupuncture group ( P < 0.05 , P < 0.01 ) , and the score of life quality was increased obviously ( P < 0.05 , P < 0.01 ) .


Acupuncture at the acupoints selected by pattern/syndrome differentiation and domperidone are effective in the treatment of functional dyspepsia .


Domperidone is unsatisfactory in the long-term effect , but acupuncture achieves the positive short-term and long-term effects on functional dyspepsia .


We compared the efficacy and safety of ozenoxacin ( a new nonfluorinated quinolone ) 1 % cream with placebo in the treatment of impetigo .


In a randomized , double-blind , multicenter study , patients received ozenoxacin cream or placebo cream twice daily for 5 days ( a third group received retapamulin 1 % ointment as a control ) .


Clinical , microbiological and laboratory evaluations were performed during follow-up ( over 2 weeks ) .


Ozenoxacin was superior to placebo ( success rate 34.8 vs 19.2 % ; p = 0.003 ) .


Microbiological success was 70.8 % for ozenoxacin and 38.2 % for placebo after 3-4 days and 79.2 % versus 56.6 % after 6-7 days .


Ozenoxacin produced more rapid microbiological clearance than retapamulin .


All treatments were well tolerated .


Ozenoxacin 1 % cream was effective and safe in the treatment of impetigo .


Anemia is the most common adverse event in patients with chronic hepatitis C virus ( HCV ) treated with telaprevir ( TVR ) combined triple therapy .


We examined the effects of drug dose adjustment on anemia and a sustained viral response ( SVR ) during combination therapy .


This study enrolled 62 patients treated with TVR ( 2,250 mg ) for 12 weeks plus pegylated interferon-alpha-2b and ribavirin for 24 weeks .


The patients were assigned randomly to the TVR-standard or - reduced groups before treatment .


At the occurrence of anemia ( hemoglobin < 12 g/dL ) , the TVR-reduced group received 1500 mg TVR plus the standard dose of ribavirin , whereas the TVR-standard group received the standard TVR dose ( 2,250 mg ) and a reduced dose of ribavirin ( 200 mg lower than prescribed originally ) .


The safety and SVR at 24 weeks were compared between the TVR-standard ( n = 28 ) and TVR-reduced ( n = 25 ) groups .


No differences in the proportion of patients who became HCV RNA-negative were detected between the TVR-standard and - reduced groups ( 72 and 72 % at week 4 , 79 and 84 % at the end of treatment , and 76 and 80 % at SVR24 , respectively ) .


Two groups had comparable numbers of adverse events , which led to the discontinuation of TVR in 14 patients of TVR-standard group and in 14 of TVR-reduced group .


A lower incidence of renal impairment was observed in the TVR-reduced group ( 6 % ) than the TVR-standard group ( 11 % , not statistically significant ) .


TVR dose adjustment could prevent anemia progression without weakening the anti-viral effect during triple therapy in HCV-patients .


To compare the temporomandibular joint changes in adolescent Class II division 1 malocclusion patients with mandibular retrusion treated with Twin - block and Class II elastics .


Sixty Class II division 1 malocclusion patients with mandibular retrusion were divided into 3 groups ( Twin - block group , Class II elastic group and control group , 20 patients in each group ) randomly .


Differences of condylar process morphology were compared using cone - beam CT ( CBCT ) before and after treatment .


Condylar largest anteroposterior diameter and upper condylar height increased after treatment in both Twin-block group and Class II elastic group .


The condylar largest anteroposterior diameter and upper condylar height were longer in both Twin - block group [ ( 8.51 1.48 ) and ( 7.39 1.42 ) mm ] and Class II elastic group [ ( 8.44 1.03 ) and ( 7.24 0.89 ) mm ] than those in the control group [ ( 7.47 1.27 ) and ( 6.47 1.56 ) mm ] ( P < 0.05 ) .


No significant difference was found in other measurements ( P > 0.05 ) .


Condylar largest anteroposterior diameter and upper condylar height in Class II division 1 malocclusion patients increased after treatment using Twin - block and Class II elastics .


There was no significant difference between two groups .


During total knee arthroplasty ( TKA ) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions .


For blood loss management during TKA , pre-operative autologous blood donation ( PABD ) is still a standard of care .


In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and , if yes , for which group of patients .


Patients were randomised to three groups .


In group 1 patients did not donate autologous blood , in group 2 patients donated 1 dose 72hours prior to TKA and in group 3 patients donated autologous blood 14days prior to TKA .


In all patients haemoglobin , haematocrit , thrombocyte and reticulocyte values , iron concentrations ( Fe , unsaturated iron binding capacity , total iron binding capacity ) , activated partial thromboplastin time , prothrombin time , and intra-operative and post-operative blood loss were measured and compared .


With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded , which significantly increased the cost of treatment for these patients .


For patients undergoing TKA , PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion .


Results of our study showed that PABD in non-anaemic patients is not justified and is not economically feasible .


Randomized clinical trial .


Objectives To compare the blood pressure ( BP ) and heart rate ( HR ) response of healthy volunteers to posteriorly directed ( anterior-to-posterior [ AP ] ) pressure applied to the cervical spine versus placebo .


Manual therapists employ cervical spine AP mobilizations for various cervical-shoulder pain conditions .


However , there is a paucity of literature describing the procedure , cardiovascular response , and safety profile .


Thirty-nine ( 25 female ) healthy participants ( mean SD age , 24.7 1.9 years ) were randomly assigned to 1 of 2 groups .


Group 1 received a placebo , consisting of light touch applied to the right C6 costal process .


Group 2 received AP pressure at the same location .


Blood pressure and HR were measured prior to , during , and after the application of AP pressure .


One-way analysis of variance and paired-difference statistics were used for data analysis .


There was no statistically significant difference between groups for mean systolic BP , mean diastolic BP , and mean HR ( P > .05 ) for all time points .


Within-group comparisons indicated statistically significant differences between baseline and post-AP pressure HR ( -2.8 bpm ; 95 % confidence interval : -4.6 , -1.1 ) and between baseline and post-AP pressure systolic BP ( -2.4 mmHg ; 95 % confidence interval : -3.7 , -1.0 ) in the AP group , and between baseline and postplacebo systolic BP ( -2.6 mmHg ; 95 % confidence interval : -4.2 , -1.0 ) in the placebo group .


No participants reported any adverse reactions or side effects within 24 hours of testing .


AP pressure caused a statistically significant physiologic response that resulted in a minor drop in HR ( without causing asystole or vasodepression ) after the procedure , whereas this cardiovascular change did not occur for those in the placebo group .


Within both groups , there was a small but statistically significant reduction in systolic BP following the procedure .


To examine whether improvements in health behaviors are associated with reduced risk of cardiovascular disease ( CVD ) in individuals with newly diagnosed type 2 diabetes .


Population-based prospective cohort study of 867 newly diagnosed diabetic patients aged between 40 and 69 years from the treatment phase of the ADDITION-Cambridge study .


Because the results for all analyses were similar by trial arm , data were pooled , and results were presented for the whole cohort .


Participants were identified via population-based stepwise screening between 2002 and 2006 , and underwent assessment of physical activity ( European Prospective Investigation into Cancer-Norfolk Physical Activity Questionnaire ) , diet ( plasma vitamin C and self-report ) , and alcohol consumption ( self-report ) at baseline and 1 year .


A composite primary CVD outcome was examined , comprised of cardiovascular mortality , nonfatal myocardial infarction , nonfatal stroke , and revascularization .


After a median ( interquartile range ) follow-up period of 5.0 years ( 1.3 years ) , 6 % of the cohort experienced a CVD event ( 12.2 per 1,000 person-years ; 95 % CI 9.3-15 .9 ) .


CVD risk was inversely related to the number of positive health behaviors changed in the year after diabetes diagnosis .


The relative risk for primary CVD event in individuals who did not change any health behavior compared with those who adopted three/four healthy behaviors was 4.17 ( 95 % CI 1.02-17 .09 ) , adjusting for age , sex , study group , social class , occupation , and prescription of cardioprotective medication ( P for trend = 0.005 ) .


CVD risk was inversely associated with the number of healthy behavior changes adopted in the year after the diagnosis of diabetes .


Interventions that promote early achievement of these goals in patients with newly diagnosed diabetes could help reduce the burden of diabetes-related morbidity and mortality .


Several studies have found that brief interventions ( BIs ) for drug misuse have superior effectiveness to no-treatment controls .


However , many health centers do not provide BIs for drug use consistently due to insufficient behavioral health staff capacity .


Computerized BIs for drug use are a promising approach , but their effectiveness compared with in-person BIs has not been established .


This study compared the effectiveness of a computerized brief intervention ( CBI ) to an in-person brief intervention ( IBI ) delivered by a behavioral health counselor .


Two-arm randomized clinical trial , conducted in two health centers in New Mexico , United States .


Participants were 360 adult primary care patients with moderate-risk drug scores on the Alcohol , Smoking , and Substance Involvement Screening Test ( ASSIST ) who were randomly assigned on a 1:1 basis to a computerized brief intervention ( CBI ) or to an in-person brief intervention ( IBI ) delivered by a behavioral health counselor .


Assessments were conducted at baseline and 3-month follow-up , and included the ASSIST and drug testing on hair samples .


The IBI and CBI conditions did not differ at 3 months on global ASSIST drug scores [ b = -1.79 ; 95 % confidence interval ( CI ) = -4.37 , 0.80 ] or drug-positive hair tests [ odds ratio ( OR ) = 0.97 ; 95 % CI = 0.47 , 2.02 ] .


There was a statistically significant advantage of CBI over IBI in substance-specific ASSIST scores for marijuana ( b = -1.73 ; 95 % CI = -2.91 , -0.55 ; Cohen 's d = 0.26 ; P = 0.004 ) and cocaine ( b = -4.48 ; 95 % CI = -8.26 , -0.71 ; Cohen 's d = 0.50 ; P = 0.021 ) at 3 months .


Computerized brief intervention can be an effective alternative to in-person brief intervention for addressing moderate drug use in primary care .


To examine the relationship between inflammatory and coagulation biomarkers and cardiac autonomic function ( CAF ) as measured by heart rate variability in persons with HIV .


This analysis included 4073 HIV-infected persons from the Strategies for Management of Antiretroviral Therapy study .


We examined the association between IL-6 , high-sensitivity C-reactive protein ( hsCRP ) and D-dimer with heart rate variability measures ( SDNN and rMSSD ) , both cross-sectionally and longitudinally .


Cross-sectional analysis revealed significant inverse associations between IL-6 , hsCRP and d-dimer with SDNN and rMSSD ( p < 0.01 for all comparisons ) .


However , longitudinal analysis failed to show a significant association between baseline IL-6 , hsCRP and d-dimer with change in CAF over time .


Cross-sectionally , higher levels of inflammatory and coagulation biomarkers were associated with lower levels of CAF in the Strategies for Management of Antiretroviral Therapy trial .


Although deterioration in CAF was observed during followup , baseline levels of inflammatory and coagulation markers were not predictive of the decline in CAF over time .


To compare the difference in the efficacy on low back pain of cold-damp pattern between electric-thermal Bian-stone therapy and moxibustion box therapy .


Forty-one cases of low back pain of cold-damp pattern were randomized into an electric-thermal Bian-stone therapy group ( group A , 26 cases ) and a box moxibustion therapy group ( group B , 15 cases ) .


In the group A , the electric-thermal Bian-stone was placed over Shenshu ( BL 23 ) and Weizhong ( BL 40 ) .


The temperature of stone was adjusted in accordance with patient 's comfort .


In the group B , moxibustion box was used over Shenshu ( BL 23 ) and Weizhong ( BL 40 ) .


The treatment was given once every day or every two days .


Ten treatments made one session .


The symptom and physical signs score of low back pain and the score of cold-damp syndrome were observed before and after treatment in the patients .


The symptom and physical signs score of low back pain and the score of cold-damp syndrome were all improved in the two groups ( all P < 0.01 ) .


The changing rate of symptom and physical signs and syndrome were ( 37.04 + / - 32.68 ) % and ( 22.85 + / - 29.95 ) % in the group A , and were ( 47.29 + / - 22.08 ) % and ( 23.89 + / - 22.53 ) % in the group B , respectively , without significant difference in comparison between the two groups ( all P > 0.05 ) .


The efficacy on low back pain of cold-damp pattern treated with the electric-thermal Bian-stone therapy is similar to that of moxibustion box therapy .


This therapy is characterized as more convenient , safer operation and less pollution .


Omega-3 fatty acids confer beneficial health effects , but North Americans are lacking in their dietary omega-3-rich intake .


Supplementation is an alternative to consumption of fish ; however , not all omega-3 products are created equal .


The trial objective was to compare the increases in blood levels of omega-3 fatty acids after consumption of four different omega-3 supplements , and to assess potential changes in cardiovascular disease risk following supplementation .


This was an open-label , randomized , cross-over study involving thirty-five healthy subjects .


Supplements and daily doses ( as recommended on product labels ) were : Concentrated Triglyceride ( rTG ) fish oil : EPA of 650mg , DHA of 450mgEthyl Ester ( EE ) fish oil : EPA of 756mg , DHA of 228mgPhospholipid ( PL ) krill oil : EPA of 150mg , DHA of 90mgTriglyceride ( TG ) salmon oil : EPA of 180mg , DHA of 220mg .


Subjects were randomly assigned to consume one of four products , in random order , for a 28-day period , followed by a 4-week washout period .


Subsequent testing of the remaining three products , followed by 4-week washout periods , continued until each subject had consumed each of the products .


Blood samples before and after supplementation were quantified for fatty acid analysis using gas chromatography , and statistically analysed using ANOVA for repeated measures .


At the prescribed dosage , the statistical ranking of the four products in terms of increase in whole blood omega-3 fatty acid levels was concentrated rTG fish oil > EE fish oil > triglyceride TG salmon oil > PL krill oil .


Whole blood EPA percentage increase in subjects consuming concentrated rTG fish oil was more than four times that of krill and salmon oil .


Risk reduction in several elements of cardiovascular disease was achieved to a greater extent by the concentrated rTG fish oil than by any other supplement .


Krill oil and ( unconcentrated ) triglyceride oil were relatively unsuccessful in this aspect of the study .


For the general population , the form and dose of omega-3 supplements may be immaterial .


However , given these results , the form and dose may be important for those interested in reducing their risk of cardiovascular disease .


ClinicalTrials.gov : NCT01960660 .


The purpose of this study was to compare cosmesis at 3 to 4 months and infection in simple lacerations irrigated with normal saline ( NS ) versus activated chlorine dioxide ( CD ) .


This was a prospective , randomized trial of a convenience sample of patients .


This study was approved by the institutional review board and Food and Drug Administration as a physician-sponsored trial ( FDA investigational new drug no. 68762 ) .


The study was conducted in a large urban , academic emergency department .


Patients aged 18 to 100 with simple , uncomplicated lacerations requiring repair that were less than 8 hours old were enrolled .


Patients were randomized to receive either NS or CD wound irrigation .


Demographics , infection , and cosmesis were analyzed and assessed .


Cosmetic outcome was assessed at 3 to 4 months using a visual analog scale ( VAS ) , wound evaluation score ( WES ) , patient VAS ( VASPt ) , and digital imaging VAS by 2 plastic surgeons ( VASPlast ) .


One hundred ninety-three patients were enrolled .


Data analysis was available for 175 cases ( 86 NS and 89 CD ) .


Wound infection follow-up was obtained in 74.9 % of the patients .


The 3 - to 4-month cosmesis follow-up was 37.7 % for VAS/WES , 40.0 % for VASPt , and 37.7 % for VASPlast .


There were no significant differences in demographics , key wound characteristics , infection , adverse reactions , and cosmesis .


The authors report the use of a novel antimicrobial irrigation solution .


Chlorine dioxide appears to be a safe biologically acceptable antiseptic wound irrigant that does not appear to interfere with cosmetic outcomes .


A reduced exercise capacity is associated with increased morbidity and mortality in patients with advanced non-small cell lung cancer ( NSCLC ) .


Therapeutic exercise can be beneficial and neuromuscular electrical stimulation ( NMES ) of the quadriceps muscles may represent a practical approach .


The primary aim of this study was to determine the acceptability of NMES of the quadriceps to patients with NSCLC used alongside palliative chemotherapy .


Secondary aims explored aspects of safety and efficacy of NMES in this setting .


Patients with advanced NSCLC due to receive first-line palliative chemotherapy were randomized to usual care with or without NMES .


They were asked to undertake 30 minute sessions of NMES , ideally daily , but as a minimum , three times weekly .


For NMES to be considered acceptable , it was predetermined that 80 % of patients should achieve this minimum level of adherence .


Qualitative interviews were held with a subset of patients to explore factors influencing adherence .


Safety was assessed according to the Common Terminology Criteria for Adverse Events .


Quadriceps muscle strength , thigh lean mass , and physical activity level were assessed at baseline and after three cycles of chemotherapy .


49 patients ( 28 male , median ( IQR ) age 69 ( 64-75 ) years ) participated .


Of 30 randomized to NMES , 18 were eligible for the primary endpoint , of whom 9 ( 50 % [ 90 % CI , 29 to 71 ] ) met the minimum level of adherence .


Adherence was enhanced by incorporating sessions into a daily routine and hindered by undesirable effects of chemotherapy .


There were no serious adverse events related to NMES , nor significant differences in quadriceps muscle strength , thigh lean mass or physical activity level between groups .


NMES is not acceptable in this setting , nor was there a suggestion of benefit .


The need remains to explore NMES in patients with cancer in other settings .


Current Controlled Trials ISRCTN 42944026 www.controlled-trials.com/ISRCTN42944026 .


To compare the effectiveness of virtual reality-based balance exercises to conventional balance exercises during vestibular rehabilitation in patients with unilateral peripheral vestibular loss ( UVL ) .


Assessor-blind , randomized controlled trial .


Two acute care university teaching hospitals .


Patients with UVL ( N = 71 ) who had dizziness/vertigo , and gait and balance impairment .


Patients with UVL were randomly assigned to receive 6 weeks of either conventional ( n = 36 ) or virtual reality-based ( n = 35 ) balance exercises during vestibular rehabilitation .


The virtual reality-based group received an off-the-shelf virtual reality gaming system for home exercise , and the conventional group received a foam balance mat .


Treatment comprised weekly visits to a physiotherapist and a daily home exercise program .


The primary outcome was self-preferred gait speed .


Secondary outcomes included other gait parameters and tasks , Sensory Organization Test ( SOT ) , dynamic visual acuity , Hospital Anxiety and Depression Scale , Vestibular Rehabilitation Benefits Questionnaire , and Activities Balance Confidence Questionnaire .


The subjective experience of vestibular rehabilitation was measured with a questionnaire .


Both groups improved , but there were no significant differences in gait speed between the groups postintervention ( mean difference , -.03 m/s ; 95 % confidence interval [ CI ] , -.09 to .02 m/s ) .


There were also no significant differences between the groups in SOT scores ( mean difference , .82 % ; 95 % CI , -5.00 % to 6.63 % ) or on any of the other secondary outcomes ( P > .05 ) .


In both groups , adherence to exercise was high ( 77 % ) , but the virtual reality-based group reported significantly more enjoyment ( P = .001 ) , less difficulty with ( P = .009 ) and less tiredness after ( P = .03 ) balance exercises .


At 6 months , there were no significant between-group differences in physical outcomes .


Virtual reality-based balance exercises performed during vestibular rehabilitation were not superior to conventional balance exercises during vestibular rehabilitation but may provide a more enjoyable method of retraining balance after unilateral peripheral vestibular loss .


Feedback is a critical component of any educational intervention .


When it comes to feedback associated with inhaler technique education , there is a lack of knowledge on its role or its potential to solve the major issue of poor inhaler technique .


This study aims to explore the role of feedback in inhaler technique education and its impact on the inhaler technique of patients over time .


A parallel-group , repeated-measures study was conducted in the community pharmacy in which the effectiveness of current best practice inhaler technique education utilising qualitative visual feedback ( Group 1 ) was compared with a combination of qualitative and quantitative visual feedback ( Group 2 ) .


The impact of these two interventions on inhaler technique maintenance was evaluated .


Community pharmacists were randomly allocated to recruit people with asthma who were using a dry powder inhaler .


At Visit 1 their inhaler technique was evaluated and education delivered and they were followed up at Visit 2 ( 1 month later ) .


Both educational interventions resulted in an increase in the proportion of patients with correct inhaler technique : from 4 % to 51 % in Group 1 and from 6 % to 83 % in Group 2 ( Pearson 's Chi-Squared , P = 0.03 , n = 49 , and Pearson 's Chi-Squared , P = 0.01 , n = 48 , respectively ) .


The magnitude of improvement was statistically significantly higher for Group 2 compared with Group 1 ( n = 97 , P = 0.02 , Pearson 's Chi-Square test ) .


The nature of feedback has an impact on the effectiveness of inhaler technique education with regard to correct inhaler technique maintenance over time .


Viability seems to be important in preventing ventricular remodeling after acute myocardial infarction ( AMI ) .


We investigated the influence of viability , as demonstrated with low-dose dobutamine echocardiography , and the role of early revascularization on the process of left ventricular ( LV ) remodeling after AMI .


We retrospectively investigated 224 patients who were initially included in the viability-guided angioplasty after acute myocardial infarction-trial ( VIAMI-trial ) .


Patients in the VIAMI-trial did not undergo a primary or rescue percutaneous coronary intervention and were stable in the early in-hospital phase .


Patients underwent viability testing within 72hours after AMI .


Patients with viability were randomized to an invasive strategy or an ischemia-guided strategy .


Follow-up echocardiography was performed at a mean of 205days .


In this echocardiographic substudy , patients were divided into three new groups : group 1 , viable and revascularized before follow-up echocardiogram ; group 2 , viable , but medically treated ; and group 3 , non-viable patients .


Group 1 showed preservation of LV volume indices .


The ejection fraction ( EF ) increased significantly from 54.0 % to 57.5 % ( P = 0.047 ) .


Group 2 showed a significant increase in LV volume indices with no improvement in EF ( 53.3 % versus 53.0 % , P = 0.86 ) .


Group 3 showed a significant increase in LV volume indices , with a decrease in EF from 53.5 % to 49.1 % ( P = 0.043 ) .


Multivariate logistic regression analysis indicated the number of viable segments and revascularization during follow-up as independent predictors for EF improvement , especially in patients with lower EF at baseline .


Viability early after AMI is associated with improvement in LV function after revascularization .


When viable myocardium is not revascularized , the LV tends to remodel with increased LV volumes , without improvement of EF .


Absence of viability results in ventricular dilatation and deterioration of EF , irrespective of revascularization status .


NCT00149591 ( assigned : 6 September 2005 ) .


To evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae .


Pragmatic , parallel group , cluster randomised controlled trial .


228 care homes ( > 10 beds each ) , both with and without the provision of nursing care , local to 11 trial administrative centres across the United Kingdom .


1042 care home residents with a history of stroke or transient ischaemic attack , including those with language and cognitive impairments , not receiving end of life care .


114 homes ( n = 568 residents , 64 % from homes providing nursing care ) were allocated to the intervention arm and 114 homes ( n = 474 residents , 65 % from homes providing nursing care ) to standard care ( control arm ) .


Participating care homes were randomised between May 2010 and March 2012 .


Targeted three month programme of occupational therapy , delivered by qualified occupational therapists and assistants , involving patient centred goal setting , education of care home staff , and adaptations to the environment .


Primary outcome at the participant level : scores on the Barthel index of activities of daily living at three months post-randomisation .


Secondary outcome measures at the participant level : Barthel index scores at six and 12 months post-randomisation , and scores on the Rivermead mobility index , geriatric depression scale-15 , and EuroQol EQ-5D-3L questionnaire , at all time points .


64 % of the participants were women and 93 % were white , with a mean age of 82.9 years .


Baseline characteristics were similar between groups for all measures , personal characteristics , and diagnostic tests .


Overall , 2538 occupational therapy visits were made to 498 participants in the intervention arm ( mean 5.1 visits per participant ) .


No adverse events attributable to the intervention were recorded .


162 ( 11 % ) died before the primary outcome time point , and 313 ( 30 % ) died over the 12 months of the trial .


The primary outcome measure did not differ significantly between the treatment arms .


The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm ( 95 % confidence interval -0.33 to 0.70 , P = 0.48 ) .


Secondary outcome measures also showed no significant differences at all time points .


This large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service , including staff training , for care home residents living with stroke related disabilities .


The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity , mobility , mood , or health related quality of life , at all observational time points .


Providing and targeting ameliorative care in this clinically complex population requires alternative strategies.Trial registration Current Controlled Trials ISRCTN00757750 .


To evaluate the cost-effectiveness of specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy , compared with care as usual .


Randomized controlled trial including an economic evaluation from a health-care and societal perspective , using a one-year time horizon .


Audiologic center .


A referred sample of 626 patients with tinnitus were eligible for participation .


Approximately 492 patients were included in the study .


Eighty-six ( 35 % ) of 247 patients in the usual care group , and 74 ( 30 % ) of 245 patients in the specialized care group were lost to follow-up by month 12 .


Quality adjusted life years ( QALYs ) as measured with the Health Utilities Index Mark III and cost in US dollars .


Compared with patients receiving usual care , patients who received specialized care gained on average 0.015 QALYs ( 95 % bootstrapped confidence interval [ BCI ] , -0.03 to 0.06 ) .


The incremental costs from a societal perspective are $ 357 ( 95 % BCI , - $ 1,034 to $ 1,785 ) .


The incremental cost per QALY from a societal perspective amounted to $ 24,580 .


The probability that SC is cost-effective from a societal perspective is 58 % for a willingness to pay for a QALY of $ 45,000 .


Specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy is cost-effective as compared with usual care .


Although uncertainty surrounding the incremental costs and effects is considerable , sensitivity analysis indicated that cost-effectiveness results were robust .


The brain serotonin level is decreased in individuals with autism .


Buspirone is a 5-HT ( 1A ) receptor agonist with antiaggressive effects increasing prosocial behaviors .


We conducted an 8-week randomized double-blind placebo-controlled clinical trial .


Participants included 40 outpatient children and adolescents with autism .


The patients took buspirone plus risperidone or risperidone plus placebo during 8 weeks .


The patients were assessed at baseline , week 4 , and week 8 using the Aberrant Behavior Checklist-Community Rating Scale .


Eighteen patients in the placebo group and 16 patients in the buspirone group completed this trial .


The mean dose of buspirone was 6.7 ( SD 2.7 ) mg/day .


Irritability subscale score significantly decreased during this trial in both groups ( buspirone group : declined from 25.7 [ SD 5.7 ] to 16.3 [ SD 8.5 ] ; placebo group : declined from 24.7 [ SD 7.6 ] to 18.2 [ SD 7.7 ] ) .


The Cohen d effect size was .45 .


Thirteen ( 81.2 % ) of 16 patients in the buspirone group and 7 ( 38.9 % ) of 18 patients in the placebo group showed a 30 % decline in irritability score .


The relative risk for treatment was 2.1 .


There were no serious adverse effects .


The most common adverse effects in the buspirone group were increased appetite , drowsiness , and fatigue .


This clinical trial supports that low dose buspirone plus risperidone is more effective than risperidone plus placebo for treating irritability in individuals with autism .


To identify which training approach , if any , is most effective for improving perception of frequency-compressed speech .


A between-subject design using repeated measures .


Forty young adults with normal hearing were randomly allocated to one of four groups : a training group ( sentence or consonant ) or a control group ( passive exposure or test-only ) .


Test and training material differed in terms of material and speaker .


On average , sentence training and passive exposure led to significantly improved sentence recognition ( 11.0 % and 11.7 % , respectively ) compared with the consonant training group ( 2.5 % ) and test-only group ( 0.4 % ) , whilst , consonant training led to significantly improved consonant recognition ( 8.8 % ) compared with the sentence training group ( 1.9 % ) , passive exposure group ( 2.8 % ) , and test-only group ( 0.8 % ) .


Sentence training led to improved sentence recognition , whilst consonant training led to improved consonant recognition .


This suggests learning transferred between speakers and material but not stimuli .


Passive exposure to sentence material led to an improvement in sentence recognition that was equivalent to gains from active training .


This suggests that it may be possible to adapt passively to frequency-compressed speech .


Clinical practice guidelines ( CPGs ) are not readily implemented in clinical practice .


One of the impeding factors is that physical therapists do not hold realistic perceptions of their adherence to CPGs .


Peer assessment ( PA ) is an implementation strategy that aims at improving guideline adherence by enhancing reflective practice , awareness of professional performance , and attainment of personal goals .


The purpose of this study was to compare the effectiveness of PA with the usual case discussion ( CD ) strategy on adherence to CPGs for physical therapist management of upper extremity complaints .


A single-masked , cluster-randomized controlled trial with pretest-posttest design was conducted .


Twenty communities of practice ( n = 149 physical therapists ) were randomly assigned to groups receiving PA or CD , with both interventions consisting of 4 sessions over 6 months .


Both PA and CD groups worked on identical clinical cases relevant to the guidelines .


Peer assessment focused on individual performance observed and evaluated by peers ; CD focused on discussion .


Guideline adherence was measured with clinical vignettes , reflective practice was measured with the Self-Reflection and Insight Scale ( SRIS ) , awareness of performance was measured via the correlation between perceived and assessed improvement , and attainment of personal goals was measured with written commitments to change .


The PA groups improved more on guideline adherence compared with the CD groups ( effect = 22.52 ; 95 % confidence interval [ 95 % CI ] = 2.38 , 42.66 ; P = .03 ) .


The SRIS scores did not differ between PA and CD groups .


Awareness of performance was greater for the PA groups ( r = .36 ) than for the CD groups ( r = .08 ) ( effect = 14.73 ; 95 % CI = 2.78 , 26.68 ; P = .01 ) .


The PA strategy was more effective than the CD strategy in attaining personal goals ( effect = 0.50 ; 95 % CI = 0.04 , 0.96 ; P = .03 ) .


Limited validity of clinical vignettes as a proxy measure of clinical practice was a limitation of the study .


Peer assessment was more effective than CD in improving adherence to CPGs .


Personal feedback may have contributed to its effectiveness .