Search

Background: Excessive wait times for specialist care can have a substantial negative impact on health outcomes. The Champlain BASETM (Building Access to Specialists through eConsultation) eConsult service based in Ottawa, Canada has demonstrated the ability to improve patients' access to specialist care.Objective: We interviewed patients who were treated using eConsult in order to explore their attitudes towards the service and their experiences of receiving care via the service.Methods: We conducted a thematic analysis of patient interviews using a constant comparative approach. Patients whose primary care providers used the eConsult service in their care were contacted by telephone between June 2015 and January 2016 and completed 15-min semi-structured interviews.Results: Of 43 contacted participants, 30 completed interviews (70%). Over half of all respondents (n = 16) reported receiving a follow-up call or appointment within 1 week, and 26 stated that eConsult was useful in their case. Participants unanimously agreed that eConsult was an acceptable way to access specialist care, and 29 stated that they would ask their primary care provider to use eConsult on their behalf in the future. Three themes emerged from the thematic analysis of patient comments: access, acceptability of eConsult and strengthened role of the primary care provider.Conclusions: Patients expressed acceptance for eConsult as a model for improving access to specialist care, had largely positive experiences with it as a model of care delivery, and supported its use in their future care. [ABSTRACT FROM AUTHOR]

Background: Informal or family caregivers are important contributors to health and health care and require support to sustain their role and address particular challenges. An experience-based health website may be an accessible, effective way to offer caregivers peer support and ultimately better equip them to care for themselves and their loved ones.Objectives: This study investigated how caregivers access and use information on the Internet about caregiving and their perspectives on the design and features of a new personal health experiences (PHEx) website.Methods: This was a qualitative descriptive study that involved three focus groups of caregivers for a total of 16 participants in a university-affiliated hospital in Quebec. Thematic analysis was used with transcriptions of recorded sessions.Results: With respect to how participants accessed and used health information, three themes emerged: searching for and choosing health websites, empowerment through the use of online health information, and concerns about health information on the Internet. In terms of their views on a health experiences website, the two main themes were: factors important for first impressions and perceived needs and expectations.Conclusion: Caregivers accessed and chose health information in a similar manner to other people but still offered additional insights regarding online health information retrieval, usage, and other perspectives, which will be helpful for future web-based initiatives that aim to provide support to caregivers. [ABSTRACT FROM AUTHOR]

Background Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short-term adherence. Psoriasis is a chronic disease, and long-term adherence is an even bigger problem. Objectives To determine how well medication is used in the long-term topical treatment of psoriasis and to assess the potential of an internet-based reporting intervention to improve treatment adherence and outcomes. Methods An investigator-blinded, prospective study evaluated topical fluocinonide adherence in 40 patients with mild-to-moderate psoriasis over 12 months. Subjects were randomized in a 1 : 1 ratio to standard-of-care or internet-based reporting group. Adherence was objectively monitored with Medication Event Monitoring System® caps. Results Fifty per cent of subjects discontinued the treatment. Greater adherence was seen in the intervention group compared with the standard-of-care group (50% vs. 35%, P = 0·08). Psoriasis Area and Severity Index improved more in the intervention group at month 1 (1·61 vs. −0·12, P = 0·003), month 3 (2·50 vs. 0·79, P = 0·025) and month 12 (3·32 vs. 0·34, P = 0·038) than in the standard-of-care group. Conclusions This study likely underestimates the challenge of long-term adherence, as adherence tends to be better in research studies than in clinical practice. This study also did not fully account for primary nonadherence. Adherence to topical treatment is low in the short term and decreased further in the long term, a considerable challenge for dermatologists to address. A reporting intervention may be one of the ways we can improve our patients' treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: To develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized.Design: Online Delphi technique.Setting and Participants: A group of 32 national EBP experts from different health professions.Intervention: The experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori.Main Outcome Measure: Level of consensus in the Content Validity Index Item.Results: An EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round.Conclusions: A new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion. [ABSTRACT FROM AUTHOR]

Study Question: Does the prevalence of online education in fertility center websites differ for lesbian, gay, bisexual, transgender (LGBT) couples compared to online education for heterosexual couples?Summary Answer: This review of fertility center websites showed that the majority of websites with patient education for heterosexual couples do not have similar materials for LGBT couples.What Is Known Already: In order to have biologically related children, LGBT individuals or couples utilize assisted reproductive technologies (ART). Fertility clinic websites provide online education to familiarize patients with the different ART procedures; however, no studies have examined the prevalence of educational information for LGBT couples compared to information for heterosexual couples utilizing ART.Study Design, Size and Duration: This website review evaluated Centers for Disease Control and Prevention (CDC)-reported fertility center websites. Websites were reviewed in 2014 using the latest 2011 CDC report, and reviewed again in 2015 with the latest 2013 CDC report.Participants/materials, Setting, Method: Patient education information was coded using categories determined after a sample review, and differences were analyzed with χ(2) tests, with P-values calculated with Fisher's exact test.Main Results and the Role Of Chance: In 2014, 31.1% (121) of 389 websites with information for heterosexual couples also contained information for LGBT couples. In 2015, the number of fertility centers with information for LGBT couples increased by 52.9% to 185 (P < 0.001) of 407 (45.5%) fertility center websites. However, the majority of fertility clinic websites (54.5%) with information for heterosexual couples still do not include information specific to LGBT couples.Limitations, Reasons For Caution: The lack of online information on fertility center websites may not directly reflect the quality of care LGBT individuals or couples receive in the clinic, and the effect of this absence of online information on the clinical experiences of LGBT patients is unknown.Wider Implications Of the Findings: These findings add to the growing body of work showing disparities in the treatment of LGBT persons compared to the overall population. To overcome these discrepancies, healthcare providers should adapt their practice to include this growing and underserved patient population.Study Funding/competing Interests: Funding was provided by the Medical Student Summer Research Scholarship, Barbur Khalique Foundation. There are no competing interests. [ABSTRACT FROM AUTHOR]

Background. Crowdsourcing, the process of shifting individual tasks to a large group, may enhance human immunodeficiency virus (HIV) testing interventions.We conducted a noninferiority, randomized controlled trial to compare first-time HIV testing rates among men who have sex with men (MSM) and transgender individuals who received a crowdsourced or a health marketing HIV test promotion video. Methods. Seven hundred twenty-one MSMand transgender participants (≥16 years old, never before tested for HIV) were recruited through 3 Chinese MSMWeb portals and randomly assigned to 1 of 2 videos. The crowdsourced video was developed using an open contest and formal transparent judging while the evidence-based health marketing video was designed by experts. Study objectives were to measure HIV test uptake within 3 weeks of watching either HIV test promotion video and cost per new HIV test and diagnosis. Results. Overall, 624 of 721 (87%) participants from 31 provinces in 217 Chinese cities completed the study. HIV test uptake was similar between the crowdsourced arm (37% [114/307]) and the health marketing arm (35% [111/317]). The estimated difference between the interventions was 2.1% (95% confidence interval, -5.4% to 9.7%). Among those tested, 31% (69/225) reported a new HIV diagnosis. The crowdsourced intervention cost substantially less than the healthmarketing intervention per first-time HIV test (US$131 vs US$238 per person) and per new HIV diagnosis (US$415 vs US$799 per person). Conclusions. Our nationwide study demonstrates that crowdsourcing may be an effective tool for improving HIV testing messaging campaigns and could increase community engagement in health campaigns. [ABSTRACT FROM AUTHOR]

Twitter is a social networking service that has emerged as a valuable tool for healthcare professionals (HCPs). It is the only platform that allows one to connect, engage, learn, and educate oneself and others in real time on a global scale. HCPs are using social media tools to communicate, educate, and engage with their peers worldwide. Twitter allows HCPs to deliver easily accessible "real-time" clinical information on a global scale. Twitter has more than 500 million active users who generate more than 58 million tweets and 2.1 billion search queries every day. Here, we explain why Twitter is important, how and when an infectious diseases (ID) HCP should use Twitter, the impact it has in disseminating ID news, and its educational value. We also describe various tools within Twitter, such as Twitter Chat, that connect and bond HCPs on a specific topic. Twitter may help ID HCPs teach others about the global responsible use of antimicrobials in a world of escalating antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Children’s exposure to the marketing of energy-dense nutrient-poor (EDNP) foods is a public health concern and marketing investment is known to be shifting to non-broadcast media, such as the Internet. This paper examines the perceptions of parents and children on ethical aspects of food marketing to which children are exposed. The research used qualitative methods with parent-child (aged between 8–13 years), from South Australia. Thirteen parent-child pairs participated in this research. Ethical concerns raised by parents and children included, the marketing of EDNP foods, pester power and family conflict and the use of powerful techniques via the Internet. Their views on rights and responsibilities represented a complex mixture of idealistic and pragmatic positions. They appeared to be caught within the tensions of problematizing unhealthy food marketing to children, both as a social problem and as an individual problem. Their dilemmas are not dissimilar to the broader policy debate in Australia on the matter of food marketing to children. The stale-mate on statutory regulations to protect children from exposure to EDNP food marketing could be advanced by stronger use of ethical arguments to protect children from harmful exploitation and to protect parents from forces that undermine their authority. [ABSTRACT FROM PUBLISHER]

Social media applications such as Twitter, YouTube and Facebook have attained huge popularity, with more than three billion people and organizations predicted to have a social networking account by 2015. Social media offers a rapid avenue of communication with the public and has potential benefits for communicable disease control and surveillance. However, its application in everyday public health practice raises a number of important issues around confidentiality and autonomy. We report here a case from local level health protection where the friend of an individual with meningococcal septicaemia used a social networking site to notify potential contacts. [ABSTRACT FROM PUBLISHER]

Background: Chronic stress affects many Americans. Stress management programs may be prohibitively expensive or have limited access. Purpose: This study aims to determine feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial. Methods: Participants were randomly allocated to ISM, ISM plus online message board (ISM+), or control groups. Perceived stress, mindfulness, self-transcendence, psychological well-being, vitality, and quality of life were measured at baseline, week 8, and week 12 using standard validated questionnaires. Results: ISM and ISM+ groups demonstrated statistically significant improvements compared with control on all measures except vitality and physical health. Conclusions: The ISM program effectively and sustainably reduced measures of stress. The magnitude of improvement is comparable to traditional mindfulness programs, although fewer participants were engaged. This feasibility study provides strong support for online stress management programs, which increase access at a fraction of cost of traditional programs. [ABSTRACT FROM AUTHOR]

Background Birth-related perineal trauma has a major impact on women's health. Appropriate management of perineal injuries requires clinical knowledge and skill. At present, there is no agreement as to what constitutes an effective clinical training programme, despite the presence of sufficient evidence to support standardised perineal repair techniques. To address this deficiency, we developed and validated an interactive distance learning multi-professional training package called MaternityPEARLS. Method MaternityPEARLS was developed as a comprehensive e-learning package in 2010. The main aim of the MaternityPEARLS project was to develop, refine and validate this multi-professional e-learning tool. The effect of MaternityPEARLS in improving clinical skills and knowledge was compared with two other training models; traditional training (lectures + model-based hands on training) and offline computer lab-based training. Midwives and obstetricians were recruited for each training modality from three maternity units. An analysis of covariance was done to assess the effects of clinical profession and years of experience on scoring within each group. Feedback on MaternityPEARLS was also collected from participants. The project started in January 2010 and was completed in December 2010. Results Thirty-eight participants were included in the study. Pretraining and post-training scores in each group showed considerable improvement in skill scores (p<0.001 in all groups). Mean changes were similar across all three groups for knowledge (3.24 (SD 5.38), 3.00 (SD 3.74), 3.30 (SD 3.73)) and skill (25.34 (SD 8.96), 22.82 (SD 9.24), 20.7 (SD 9.76)) in the traditional, offline computer lab-based and e-learning groups, respectively. There was no evidence of any effect of clinical experience and baseline knowledge on outcomes. Conclusions MaternityPEARLS is the first validated perineal trauma management e-learning package. It provides a level of improvement in skill and knowledge comparable to traditional methods of training. However, as an e-learning system, it has the advantage of ensuring the delivery of a standardised, continuously updated curriculum that has global accessibility. [ABSTRACT FROM AUTHOR]

One of the most common and challenging problem in biomedical text mining is to mine protein-protein interactions (PPIs) from MEDLINE abstracts and full-text research articles because PPIs play a major role in understanding the various biological processes and the impact of proteins in diseases. We implemented, PPInterFinder-a web-based text mining tool to extract human PPIs from biomedical literature. PPInterFinder uses relation keyword co-occurrences with protein names to extract information on PPIs from MEDLINE abstracts and consists of three phases. First, it identifies the relation keyword using a parser with Tregex and a relation keyword dictionary. Next, it automatically identifies the candidate PPI pairs with a set of rules related to PPI recognition. Finally, it extracts the relations by matching the sentence with a set of 11 specific patterns based on the syntactic nature of PPI pair. We find that PPInterFinder is capable of predicting PPIs with the accuracy of 66.05% on AIMED corpus and outperforms most of the existing systems. [ABSTRACT FROM AUTHOR]

The available curated data lag behind current biological knowledge contained in the literature. Text mining can assist biologists and curators to locate and access this knowledge, for instance by characterizing the functional profile of publications. Gene Ontology (GO) category assignment in free text already supports various applications, such as powering ontology-based search engines, finding curation-relevant articles (triage) or helping the curator to identify and encode functions. Popular text mining tools for GO classification are based on so called thesaurus-based--or dictionary-based--approaches, which exploit similarities between the input text and GO terms themselves. But their effectiveness remains limited owing to the complex nature of GO terms, which rarely occur in text. In contrast, machine learning approaches exploit similarities between the input text and already curated instances contained in a knowledge base to infer a functional profile. GO Annotations (GOA) and MEDLINE make possible to exploit a growing amount of curated abstracts (97 000 in November 2012) for populating this knowledge base. Our study compares a state-of-the-art thesaurus-based system with a machine learning system (based on a k-Nearest Neighbours algorithm) for the task of proposing a functional profile for unseen MEDLINE abstracts, and shows how resources and performances have evolved. Systems are evaluated on their ability to propose for a given abstract the GO terms (2.8 on average) used for curation in GOA. We show that since 2006, although a massive effort was put into adding synonyms in GO (+300%), our thesaurus-based system effectiveness is rather constant, reaching from 0.28 to 0.31 for Recall at 20 (R20). In contrast, thanks to its knowledge base growth, our machine learning system has steadily improved, reaching from 0.38 in 2006 to 0.56 for R20 in 2012. Integrated in semi-automatic workflows or in fully automatic pipelines, such systems are more and more efficient to provide assistance to biologists. [ABSTRACT FROM AUTHOR]

The vast collection of biomedical literature and its continued expansion has presented a number of challenges to researchers who require structured findings to stay abreast of and analyze molecular mechanisms relevant to their domain of interest. By structuring literature content into topic-specific machine-readable databases, the aggregate data from multiple articles can be used to infer trends that can be compared and contrasted with similar findings from topic-independent resources. Our study presents a generalized procedure for semi-automatically creating a custom topic-specific molecular interaction database through the use of text mining to assist manual curation. We apply the procedure to capture molecular events that underlie 'pain', a complex phenomenon with a large societal burden and unmet medical need. We describe how existing text mining solutions are used to build a pain-specific corpus, extract molecular events from it, add context to the extracted events and assess their relevance. The pain-specific corpus contains 765 692 documents from Medline and PubMed Central, from which we extracted 356 499 unique normalized molecular events, with 261 438 single protein events and 93 271 molecular interactions supplied by BioContext. Event chains are annotated with negation, speculation, anatomy, Gene Ontology terms, mutations, pain and disease relevance, which collectively provide detailed insight into how that event chain is associated with pain. The extracted relations are visualized in a wiki platform (wikipain.org) that enables efficient manual curation and exploration of the molecular mechanisms that underlie pain. Curation of 1500 grouped event chains ranked by pain relevance revealed 613 accurately extracted unique molecular interactions that in the future can be used to study the underlying mechanisms involved in pain. Our approach demonstrates that combining existing text mining tools with domain-specific terms and wiki-based visualization can facilitate rapid curation of molecular interactions to create a custom database. [ABSTRACT FROM AUTHOR]

The objectives of this study were to systematically review the literature for studies that used cone beam CT (CBCT) to automatically or semi-automatically model the upper airway (including the pharyngeal, nasal and paranasal airways), and to assess their validity and reliability. Several electronic databases (MEDLINE®, MEDLINE In-Process & Other Non- Indexed Citations, all evidence-based medicine reviews including the Cochrane database, and Scopus) were searched. Abstracts that appeared to meet the initial selection criteria were selected by consensus. The original articles were then retrieved and their references were searched manually for potentially suitable articles that were missed during the electronic search. Final articles that met all the selection criteria were evaluated using a customized evaluation checklist. 16 articles were finally selected. From these, five scored more than 50% based on their methodology. Although eight articles reported the reliability of the airway model generated, only three used intraclass correlation (ICC). Two articles tested the accuracy/validity of airway models against the gold standard, manual segmentation, using volumetric measurements; however, neither used ICC. Only three articles properly tested the reliability of the three-dimensional (3D) upper airway model generated from CBCT and only one article had sufficiently sound methodology to test the airway model's accuracy/validity. The literature lacks proper scientific justification of a solid and optimized CBCT protocol for airway imaging. Owing to the limited number of adequate studies, it is difficult to generate a strong conclusion regarding the current validity and reliability of CBCT-generated 3D models. [ABSTRACT FROM AUTHOR]

This section presents abstracts on medical topics which include the use of the Internet and social software by plastic surgeons, skin malignancies on the head and neck and the effect of localized burn injury on skeletal muscle.

Objectives To analyze content and quality of headache, abdominal pain, and dysmenorrhoea websites, and to thematically analyze online pain forums. Methods Websites offering support, advice, or information regarding pain were explored. Websites were analyzed quantitatively using the Health-Related Website Evaluation Form and the DISCERN scale. Websites containing forum functions were thematically analysed assessing how the Internet is used for support and advice. Results 63 websites were included. Few websites scored in the upper quartiles of scores on the measures. 7 websites contained supportive posts, pertaining only to dysmenorrhoea. The ways users cope and the coping judgements of other forum users are presented thematically. 3 themes emerged: (1) passively engaged postings, (2) actively engaged postings, and (3) reactively engaged postings. Conclusions Internet pain resources are of low quality and questionable value in providing help to adolescents. Future research should explore how to improve quality. [ABSTRACT FROM AUTHOR]

Summary In order to build a common data pool and estimate the disease burden of primary immunodeficiencies (PID) in Europe, the European Society for Immunodeficiencies (ESID) has developed an internet-based database for clinical and research data on patients with PID. This database is a platform for epidemiological analyses as well as the development of new diagnostic and therapeutic strategies and the identification of novel disease-associated genes. Since its start in 2004, 13 708 patients from 41 countries have been documented in the ESID database. Common variable immunodeficiency (CVID) represents the most common entity with 2880 patients or 21% of all entries, followed by selective immunoglobulin A (sIgA) deficiency (1424 patients, 10·4%). The total documented prevalence of PID is highest in France, with five patients per 100 000 inhabitants. The highest documented prevalence for a single disease is 1·3 per 100 000 inhabitants for sIgA deficiency in Hungary. The highest reported incidence of PID per 100 000 live births was 16·2 for the period 1999-2002 in France. The highest reported incidence rate for a single disease was 6·7 for sIgA deficiency in Spain for the period 1999-2002. The genetic cause was known in 36·2% of all registered patients. Consanguinity was reported in 8·8%, and 18·5% of patients were reported to be familial cases; 27·9% of patients were diagnosed after the age of 16. We did not observe a significant decrease in the diagnostic delay for most diseases between 1987 and 2010. The most frequently reported long-term medication is immunoglobulin replacement. [ABSTRACT FROM AUTHOR]

BACKGROUND The Internet has revolutionized fertility care since it became a popular source of information and support for infertile patients in the last decade. The aim of this scoping review is to map (i) the main categories of patient-focused Internet interventions within fertility care, (ii) the detailed composition of the interventions and (iii) how these interventions were evaluated. METHODS A literature search used various ‘Internet’ and ‘Infertility’ search terms to identify relevant studies published up to 1 September 2011. The selected studies had to include patients facing infertility and using an infertility-related Internet intervention. We charted data regarding categories of interventions, components of interventions and evaluation methodology. We categorized the stages of research using the UK's Medical Research Council framework for evaluating complex interventions. RESULTS We included 20 studies and identified 3 educational interventions, 2 self-help interventions, 1 human-supported therapeutic intervention, 9 online support groups and 2 counselling services. Information provision, support and mental health promotion were common aims. Few interactive online components were present in the online programmes. Three studies were in the pilot phase and 17 were in the evaluation phase. CONCLUSIONS Several categories of patient-focused Internet-based interventions in fertility care are primarily applied to provide support and education and promote mental health. The interventions could be improved by using more interactive and dynamic elements as their key components. Finally, more emphasis on methodological standards for complex interventions is needed to produce more rigorous evaluations. This review shows where further development or research into patient-focused Internet interventions in fertility-care practice may be warranted. [ABSTRACT FROM PUBLISHER]

Background Web-based health risk assessment (HRA) programs can be effective in primary prevention of cardiovascular diseases (CVD). Insight into determinants of participation could improve implementation in the workplace.Aims To evaluate determinants of participation and reasons for non-participation in a web-based HRA offered to 5125 employees at four Dutch financial and information technology services companies.Methods The study consisted of a questionnaire to compare sex, age, self-rated health, smoking, current work ability and sick leave between participants and non-participants in the HRA program, as well as reasons for non-participation.Results HRA participation rate was 37% (1907/5125) and 14% of the non-participants (423/3102) completed the non-participant questionnaire. There were no differences between participants and non-participants in sex, education level, smoking, and current work ability. Compared with non-participants, participants were older (44 versus 41 years, P < 0.001). Among participants, 85% rated their health as ‘good’ or ‘very good’, compared with 78% among non-participants (P < 0.001); 88% of the participants reported fewer than 10 days sickness absence in the previous year, compared with 86% of the non-participants (P < 0.05). Reported reasons for non-participation included lack of time (39%) and not being aware of the opportunity to participate (11%).Conclusions Evaluation of demographic, health-related, and work-related determinants of participation in a web-based HRA showed differences between participants and non-participants in self-rated health and absenteeism. Implementing a less time-consuming HRA process and providing adequate information to employees prior to inviting them may be necessary to reach larger proportions of employees, including those with less favourable health and work characteristics. [ABSTRACT FROM PUBLISHER]

Objective To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control. Design Cluster-randomized trial with baseline and follow-up cross sections of diabetes patients in each participating physician's practice. Setting Eleven US Southeastern states, 2006–08. Participants Two hundred and five rural primary care physicians. Intervention Multi-component interactive intervention including Web-based continuing medical education, performance feedback and quality improvement tools. Primary Outcome Measures ‘Acceptable control’ [hemoglobin A1c ≤9%, blood pressure (BP) <140/90 mmHg, low-density lipoprotein cholesterol (LDL) <130 mg/dl] and ‘optimal control’ (A1c <7%, BP <130/80 mmHg, LDL <100 mg/dl). Results Of 364 physicians attempting to register, 205 were randomized to the intervention (n= 102) or control arms (n= 103). Baseline and follow-up data were provided by 95 physicians (2127 patients). The proportion of patients with A1c ≤9% was similar at baseline and follow-up in both the control [adjusted odds ratio (AOR): 0.94; 95% confidence interval (CI): 0.61, 1.47] and intervention arms [AOR: 1.16 (95% CI: 0.80, 1.69)]; BP <140/90 mmHg and LDL <130 mg/dl were also similar at both measurement points (P= 0.66, P= 0.46; respectively). We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures. Intervention physicians engaged with the Website over a median of 64.7 weeks [interquartile range (IQR): 45.4–81.8) for a median total of 37 min (IQR: 16–66). Conclusions A wide-reach, low-intensity, Web-based interactive multi-component intervention did not improve control of glucose, BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US. [ABSTRACT FROM AUTHOR]

Abstract: Background: The EpiCom-study investigates a possible East-West-gradient in Europe in the incidence of IBD and the association with environmental factors. A secured web-based database is used to facilitate and centralize data registration. Aim: To construct and validate a web-based inception cohort database available in both English and Russian language. Method: The EpiCom database has been constructed in collaboration with all 34 participating centers. The database was translated into Russian using forward translation, patient questionnaires were translated by simplified forward-backward translation. Data insertion implies fulfillment of international diagnostic criteria, disease activity, medical therapy, quality of life, work productivity and activity impairment, outcome of pregnancy, surgery, cancer and death. Data is secured by the WinLog3 System, developed in cooperation with the Danish Data Protection Agency. Validation of the database has been performed in two consecutive rounds, each followed by corrections in accordance with comments. Results: The EpiCom database fulfills the requirements of the participating countries’ local data security agencies by being stored at a single location. The database was found overall to be “good” or “very good” by 81% of the participants after the second validation round and the general applicability of the database was evaluated as “good” or “very good” by 77%. In the inclusion period January 1st –December 31st 2010 1336 IBD patients have been included in the database. Conclusion: A user-friendly, tailor-made and secure web-based inception cohort database has been successfully constructed, facilitating remote data input. The incidence of IBD in 23 European countries can be found at www.epicom-ecco.eu. [Copyright &y& Elsevier]

Introduction: Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone–Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. Methods: One thousand two hundred and two participants were randomized to phone, Web, or combined phone–Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. Results: Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone–Web, 41% Web), and those in the phone–Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. Conclusions: Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities. [ABSTRACT FROM AUTHOR]

Introduction: Web-based treatments can deliver broad reaching, relatively inexpensive, and clinically tested methods for smoking cessation. We performed a systematic review of randomized controlled trials (RCTs) of smoking cessation to evaluate the efficacy of Web-based interventions in adults, college students, and adolescents.Methods: MEDLINE, EMBASE, The Cochrane Library, CINAHL, and PsycINFO were searched from January 1, 1990 through February 12, 2010 for RCTs examining the efficacy of Web-based smoking cessation programs. Paired reviewers abstracted data on study design, patient characteristics, and outcomes sequentially and did quality assessments independently.Results: Twenty-one RCTs met eligibility criteria, with 15 conducted among adults. Among adults, 2 RCTs found that a multicomponent intervention with Web and non-Web–based elements was more efficacious than a self-help manual, and one of 2 RCTs found that Web-based interventions may be more effective than no treatment. Three trials provided insufficient evidence to demonstrate whether Web-based interventions were more efficacious than counseling. By contrast, tailored Web sites in 2 RCTs and greater Web site exposure in 6 of 7 RCTs were associated with higher rates of abstinence. Among college students, evidence supporting use of Web-based interventions was insufficient because the one RCT conducted was also a multicomponent intervention. Five RCTs among adolescents demonstrated mixed results, with insufficient evidence supporting their efficacy.Conclusions: Evidence supporting the use of Web-based interventions for smoking cessation is insufficient to moderate in adults and insufficient in college students and adolescents. These RCTs have, however, elucidated clinical, methodological, and statistical practices that are likely to improve future trial design and treatment delivery. [ABSTRACT FROM AUTHOR]

Abstract: Internet use and access in the UK has increased rapidly in the last decade, with the concept of ‘information superhighway’ recognised as an axiom of Internet technology. Despite this, few studies have sought to investigate the incidence of use of the Internet as an advice resource outside of the health information arena. With an increasing impetus in the public sector towards the provision of online delivery mechanisms for civic orientated activities, including advice provision, it is timely to better understand the appropriateness of online advice seeking. Focusing on young people aged between 18 and 24years, we investigated how much the Internet was used to obtain information about everyday problems with a legal dimension, who used it, how it was used and how successful respondents were in searching for information online. Data were extracted from a large-scale household survey of adults’ experience of problems with a legal dimension conducted across England and Wales (10,512 adult respondents). Results revealed significant growth in the use of the Internet to obtain information about such problems, rising from 4% in 2001 to around 18% in 2008. The responses of the 18–24year olds to the survey illustrated that despite having comparatively high levels of Internet access, this age group utilised it to a lesser degree than similarly ‘connected’ age cohorts, and were less successful when doing so. This study highlights aspects of the second digital divide, going beyond access to explore use and outcomes of use. Implications for the future of the Internet in providing information and advice for young people, are discussed. [Copyright &y& Elsevier]

Little is known about the reach of Internet self-management interventions. The aim of this study was to evaluate different definitions of participation rate and compare characteristics among subcategories of participants and nonparticipants on demographic and clinical factors using de-identified electronic medical record data. Data are presented on recruitment results and characteristics of 2,603 health maintenance organization members having type 2 diabetes invited to participate in an Internet self-management program. There was a 37% participation rate among all members attempted to contact and presumed eligible. There were several significant differences between participants and nonparticipants and among subgroups of participants (e.g., proactive volunteers vs. telephone respondents) on factors including age, income, ethnicity, smoking rate, education, blood pressure, and hemoglobin A1c. These results have important implications for the impact of different recruitment methods on health disparities and generalization of results. We provide recommendations for reporting of eligibility rate, participation rate, and representativeness analyses. [ABSTRACT FROM AUTHOR]

The article presents abstracts of studies to be presented at the 2010 Annual Meeting of the Society of Behavioral Medicine (SBM) on April 7-10, 2010 including "The Role of Subjective Perceptions of Reactivity in Stress Regulation," by Rau and colleagues, "Multiple Health Behavior Change Interventions: Benefits and Challenges," by Nigg and colleagues, and "An Evaluation of Interactive Internet Modules on Treatment Outcomes," by Ross and colleagues.

Background: Reviews state that there is a room for improvements of smoking cessation (SC) intervention in general practice. [ABSTRACT FROM PUBLISHER]

Abstract: Introduction: Many therapeutic decisions in the management of fistulizing and fibrostenotic Crohn''s disease (CD) have to be taken without the benefit of strong scientific evidence. For this reason, explicit appropriateness criteria for CD fistula and stenosis treatment were developed by a multidisciplinary European expert panel in 2004 with the aim of making them easily available on the Internet and thus allowing individual case scenario evaluation; these criteria were updated in 2007. Methods: Twelve international experts convened in Geneva, Switzerland in December 2007. Explicit clinical scenarios, corresponding to real daily practice, were rated on a 9-point scale based on evidence from the published literature and panelists'' own expertise. Median ratings were stratified into three categories: appropriate (7–9), uncertain (4–6) and inappropriate (1–3). Results: Overall, panelists rated 60 indications pertaining to fistulas. Antibiotics, azathioprine/6-mercaptopurine and conservative surgery are the mainstay of therapy for simple and complex fistulas. In the event of previous failure of azathioprine/6-mercaptopurine therapy, methotrexate and infliximab were considered appropriate for complex fistulas. The panel also rated 72 indications related to the management of fibrostenotic CD. The experts considered balloon dilation, if the stricture was endoscopically accessible, stricturoplasty and bowel resection to be appropriate for small bowel fibrostenotic Crohn''s disease, and balloon dilation and bowel resection appropriate for fibrostenotic colonic disease. In the presence of an ileocolonic or ileorectal anastomotic stricture of <7 cm, endoscopic balloon dilation, and bowel resection were considered appropriate. Conclusion: Antibiotics, azathioprine/6-mercaptopurine, and conservative surgery are the mainstay of therapy for fistulizing Crohn''s disease. Infliximab is a therapeutic option in patients without prior response to immunosuppressant therapy. In fibrostenotic Crohn''s disease, endoscopic balloon dilation, if feasible, or surgical therapy should be considered. These expert recommendations are available online (www.epact.ch). Prospective evaluation is now needed to test the validity of these appropriateness criteria in clinical practice. [Copyright &y& Elsevier]

The article discusses the impact of using the Internet on the practice of nephrology. It highlights the problems concerning the use of the technology in the daily practice of nephrology, including quality, independence and bias, and socioeconomic status. It explores the functions and the usage of the Internet-based Personal Health records (iPHR). It mentions that the use of the Internet had improved productivity, reduced the number of office visits, and saved money.

Background. Septic shock is common and results in significant morbidity and mortality. Adjunctive treatment with corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of corticosteroid therapy among patients with septic shock. Methods. Medline, Embase, Cochrane Library, Web of Science, and Google Scholar were searched for randomized trials and observational studies published from January 1993 through December 2008. Studies were selected if they included adults with septic shock, discussed treatment with intravenous corticosteroids, and reported at least 1 outcome of interest (e.g., mortality, shock reversal, or incidence of superinfection). Two reviewers independently agreed on eligibility, assessed methodologic quality, and abstracted data. Results. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated for 28-day all-cause mortality, shock reversal at 7 days, and incidence of superinfection with use of random-effects models. Analyses, stratified by adrenal responsiveness, were prespecified. Eight studies (6 randomized trials) involving a total of 1876 patients were selected. Overall, corticosteroid therapy did not result in a statistically significant difference inmortality (42.2% [369 of 875 patients] vs. 38.4% [384 of 1001]; RR, 1.00; 95% CI, 0.84-1.18). A statistically significant difference in the incidence of shock reversal at 7 days was observed between patients who received corticosteroids and those who did not (64.9% [314 of 484 patients] vs. 47.5% [228 of 480]; RR, 1.41; 95% CI, 1.22-1.64), with similar point estimates for both corticotropin stimulation test responders and nonresponders. No statistically significant difference was found in the incidence of superinfection between patients treated with corticosteroids and patients not treated with corticosteroids (25.3% [114 of 450 patients] vs. 22.7% [100 of 441]; RR, 1.11; 95% CI, 0.86-1.42). Conclusions. In patients with septic shock, corticosteroid therapy appears to be safe but does not reduce 28- day all-cause mortality rates. It does, however, significantly reduce the incidence of vasopressor-dependent shock, which may be a clinically worthwhile goal. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one on eHealth promotion, one on the development and efficacy of Internet intervention research, and one on the integration of other eHealth technologies in pediatric psychology.

In this article the author discusses the research on the interest of parent and provider in Internet intervention by using an infant sleep program as an illustration. It states that a survey was conducted to examine the parent and provider interest in online dissemination of a behavioral sleep intervention. Results show that the Internet has become an essential source of healthcare and medical information for parent and provider.

The Internet is an important source of health information. Thus, the frequency of Internet searches may provide information regarding infectious disease activity. As an example, we examined the relationship between searches for influenza and actual influenza occurrence. Using search queries from the Yahoo! search engine (http://search.yahoo.com) from March 2004 through May 2008, we counted daily unique queries originating in the United States that contained influenza-related search terms. Counts were divided by the total number of searches, and the resulting daily fraction of searches was averaged over the week. We estimated linear models, using searches with 1-10-week lead times as explanatory variables to predict the percentage of cultures positive for influenza and deaths attributable to pneumonia and influenza in the United States. With use of the frequency of searches, our models predicted an increase in cultures positive for influenza 1-3 weeks in advance of when they occurred (P < .001), and similar models predicted an increase in mortality attributable to pneumonia and influenza up to 5 weeks in advance (P < .001). Search-term surveillance may provide an additional tool for disease surveillance. [ABSTRACT FROM AUTHOR]

Summary: Intramural hematoma (IMH) of the aorta is a well-known variant of aortic dissection; however, the optimal initial treatment strategy for type A IMH remains controversial. An English language search of Medline for manuscripts on the treatments and outcomes of IMH with the keywords ‘intramural hematoma’, ‘ascending aorta or type A’, ‘aortic disease’ with cross-references was performed for articles dating from January 1986 to September 2006. Primary outcomes of interest were initial treatment strategies as well as the early and overall mortality rates. Earlier publications studying overlapping patient groups from the same institutions were excluded. Case reports and small series of less than 10 patients were not enrolled. Data from 328 reported cases in 12 studies were extracted. Initial surgery and medical treatment were performed for 168 (51.2%) and 160 (48.8%) patients, respectively. Nine out of 12 studies (75%) came from Asia. The early mortality rate was 10.1% (17/168) and 14.4% (23/160) in patients who received initial surgery and medical treatment, respectively (p =0.37). The optimal initial treatment strategy for type A IMH may still be individualized. Initial medical treatment and timed surgical therapy seems to be associated with higher early mortality rates in patients with type A IMH, even in a primarily Asian cohort. The impact of either initial treatment strategy on long-term survival must be evaluated in further study. [Copyright &y& Elsevier]

In 2005, scientists within several UK-based academic and industrial organizations came together to work on a research project, funded jointly by the UK Department for Environment, Food and Rural Affairs and several industry partners. The project was entitled Biofortification through Agronomy and Genotypes to Elevate the Levels of Selenium (BAGELS). The aim of the BAGELS project, which will report in 2009, is to determine if it is possible to increase safely the selenium (Se) content of bread, through the use of Se-containing fertilizers (i.e. agronomic biofortification). The BAGELS project is also seeking to study the natural genetic variation in grain Se concentration to determine if it might be possible to breed for Se-enriched wheat (i.e. genetic biofortification). The underlying rationale for the BAGELS project is that Se-biofortified wheat is a potential strategy for increasing the dietary intakes of Se and thereby improve human health for most of the population. It was recognized that an official website for the BAGELS project could be used to communicate the importance of Se to human health in addition to providing a simple means to exchange results between scientists. Therefore, the aim of my research project was to create a BAGELS project website, which delivered specific objectives to meet the needs of the project manager and project consortium members. After investigation into website design and construction, accessibility and web-authoring tools, a final dynamic website was created using the free open source software Joomla!. A review of the recent scientific studies on Se and health, and the options for increasing Se intake were included as a first step towards developing a source of public information. There is strong evidence linking low Se intake and status in humans and adverse health effects, including immune disfunction and cancer. [ABSTRACT FROM PUBLISHER]

Human immunodeficiency virus (HIV) treatment programs in resource-limited areas are expanding rapidly. Providing training and education to health care providers in these programs is a major challenge. We have employed Internet-based conferencing technology to conduct interactive case-based training conferences with health care professionals in Africa, Asia, and the Caribbean. This online program may be a model for other efforts to provide education to health care providers treating HIV-infected patients in the developing world. [ABSTRACT FROM AUTHOR]

Background: Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight. Purpose: The aim was to assess nutrition; physical activity; and, secondarily, body weight in the tailored, social cognitive Guide to Health (GTH) Internet intervention delivered in churches. Methods: Participants (N �= �1,071; 33% male, 23% African American, 57% with body mass index�≥�25, 60% sedentary, Mdn age �=� 53 years) within 14 Baptist or United Methodist churches were randomized to the GTH intervention only (GTH-Only; 5 churches), with church-based supports (GTH-Plus; 5 churches), or to a waitlist (control; 4 churches). Verified pedometer step counts, measured body weight, fat, fiber, and fruit and vegetable (F&V) servings from food frequency and supermarket receipts were collected at pretest, posttest (7 months after pretest), and follow-up (16 months after pretest). Results: Participants in GTH-Only increased F&V at post (≍�1.50 servings) compared to control (≍ �0.50 servings; p� =� .005) and at follow-up (≍�1.20 vs.�≍ �0.50 servings; p m� =� .038) and increased fiber at post (≍�3.00�g) compared to control (≍ �1.5�g; p �=� .006) and follow-up (≍ �3.00�g vs.�≍�2.00�g; p� =� .040). GTH-Plus participants compared to control increased steps at post (≍ �1,500 steps/day vs.�≍�400 steps/day; p �= �.050) and follow-up (≍ 1,000 steps/day vs. ≍ - 50 steps/day; p �= .010), increased F&V at post (≍�1.5 servings; p� = �.007) and follow-up (≍�1.3 servings; p �= �.014), increased fiber at post (≍�3.00 g; p� =� .013), and follow-up (≍�3.00; p� =� .050) and decreased weight at post (≍ - 0.30�kg vs.�≍�+�0.60�kg; p �= �.030). Conclusions: Compared to control, both GTH treatments improved nutrition at posttest, but church supports improved physical activity and nutrition at posttest and follow-up, suggesting environmental supports may improve Internet-based interventions. [ABSTRACT FROM AUTHOR]

Motivation: The ambiguity of biomedical entities, particularly of gene symbols, is a big challenge for text-mining systems in the biomedical domain. Existing knowledge sources, such as Entrez Gene and the MEDLINE database, contain information concerning the characteristics of a particular gene that could be used to disambiguate gene symbols.Results: For each gene, we create a profile with different types of information automatically extracted from related MEDLINE abstracts and readily available annotated knowledge sources. We apply the gene profiles to the disambiguation task via an information retrieval method, which ranks the similarity scores between the context where the ambiguous gene is mentioned, and candidate gene profiles. The gene profile with the highest similarity score is then chosen as the correct sense. We evaluated the method on three automatically generated testing sets of mouse, fly and yeast organisms, respectively. The method achieved the highest precision of 93.9% for the mouse, 77.8% for the fly and 89.5% for the yeast.Availability: The testing data sets and disambiguation programs are available at http://www.dbmi.columbia.edu/~hux7002/gsd2006Contact:friedman@dbmi.columbia.edu [ABSTRACT FROM AUTHOR]

Purpose. A meta-analysis of randomized, controlled trials that evaluated the effect of the macrolide antimicrobial, azithromycin, on clinical outcomes in patients with coronary artery disease (CAD) was conducted. Methods. A systematic literature search of MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews was conducted using specific search terms. Randomized, controlled trials comparing patients receiving azithromycin or placebo in secondary CAD patients with adequately reported data on mortality and clinical cardiac endpoints were included. A random-effects model was used. Results. Six studies (n = 13,778) met the inclusion criteria. The trials varied in their design. On meta-analysis, azithromycin resulted in a nonsignificant reduction in mortality versus placebo (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.77?1.09, p = 0.31). Four trials reported rate of nonfatal myocardial infarction (MI). Azithromycin did not have an effect on the rate of nonfatal MI versus placebo (OR, 0.95; 95% CI, 0.80?1.13, p = 0.57). Five trials reported rates of hospitalization in which no significant difference was seen with azithromycin versus placebo (OR, 0.97%, 95% CI, 0.80?1.17, p = 0.76). Six trials were used to evaluate the composite cardiovascular endpoint. Again, no significant benefit was seen with azithromycin versus placebo (OR, 0.93; 95% CI, 0.84?1.03, p = 0.218). Conclusion. Meta-analysis showed that azithromycin does not appear to reduce the frequency of recurrent cardiac events in patients with CAD. Results from ongoing trials may clarify the role of azithromycin in the secondary prevention of coronary events. [ABSTRACT FROM AUTHOR]

Internet-based cessation programs are promising. However, little information exists on how to recruit college smokers to participate in online interventions. Two studies assessed the feasibility of Internet health screening as a recruitment strategy for college smokers. The Internet Survey Study compared Internet (n = 735), mail (n = 1,490), and phone (n = 550) surveys as means to identify college smokers. The RealU Recruitment Study described the use of an Internet-based general health screening survey (N = 25,000) to recruit for an online cessation trial. The Internet Survey Study showed that, despite large differences in response rates (Internet = 38%, mail = 47%, phone = 90%; p<.001), the rates of past-month tobacco use were similar (Internet = 35%, mail = 38%, phone = 34%; p = .35). Among past-month users, a greater proportion reported daily use on the Internet (33%) and phone (37%) surveys versus the mail survey (23%, p = .007). In the RealU Recruitment Study, 517 college smokers were recruited in 1 week. The Internet survey response rate was 26%, the prevalence of current smoking was 29%, the eligibility rate was 87%, and the enrollment rate was 32% (517/1,618). Internet health screening can be used to quickly identify and enroll large numbers of college smokers in an online smoking cessation intervention. [ABSTRACT FROM AUTHOR]

Obtaining spirometric testing and providing those results to individuals who smoke has been advocated as a motivational tool to improve smoking cessation. However, its effectiveness is not known. We conducted a systematic review to determine if this approach improves rates of smoking cessation. Data sources included MEDLINE (1966 to October 2005), the Cochrane Library, and experts in the field. Eligible randomized controlled trials (RCTs) enrolled at least 25 smokers per arm, evaluated spirometry with associated counseling or in combination with other treatments, followed subjects at least 6 months, and provided smoking abstinence rates. Results from nonrandomized studies also were summarized. The primary outcome was patient-reported long-term (at least 6 months) sustained abstinence with biological validation. Additional outcomes included self-reported abstinence and point-prevalence abstinence. Seven RCTs (N = 6,052 subjects) met eligibility criteria. Follow-up duration ranged from 9 to 36 months. In six trials, the intervention group received concomitant treatments previously demonstrated to increase cessation independently. The range of abstinence was 3%–14% for control subjects and 7%–39% among intervention groups, statistically significantly in favor of intervention in four studies. The only RCT that assessed the independent contribution of spirometry in combination with counseling demonstrated a nonsignificant 1% improvement in patient-reported point-prevalence abstinence at 12 months in the group that received spirometry plus counseling versus counseling alone (6.5% versus 5.5%). Findings from observational studies were mixed, and the lack of controls makes interpretation problematic. Available evidence is insufficient to determine whether obtaining spirometric values and providing that information to patients improves smoking cessation compared with other smoking cessation methods. Spirometric values are of limited benefit as a predictor of smoking cessation or as a tool to “customize” smoking cessation strategies. [ABSTRACT FROM AUTHOR]

The article reports on how the authors reached their clinical decision of whether cardiac rehabilitation improved the quality of life of a man with coronary artery disease who received percutaneous transluminal coronary angioplasty (PTCA) with the insertion of a stent. The authors, who are physical therapists, conducted literature searches through the MEDLINE medical electronic database and initially searched with the keywords cardiac rehabilitation, exercise training, and PTCA. The authors summarize the clinical trials that they read. Based on their findings through the literature search, the authors conclude that cardiac rehabilitation did improve patients' quality of life after PTCA.

Objective. Pulsed radiofrequency, where short bursts of radiofrequency energy are applied to nervous tissue, has been used by pain practitioners as a non- or minimally neurodestructive technique, alternative to radiofrequency heat lesions. Clinical advantages and mechanisms of this treatment remain unclear. The objective of this study was to review current clinical and laboratory data. Design. We systematically searched the MEDLINE database (PubMed) and tables of contents of electronically available pain journals. Reference lists of relevant reports and international scientific pain congress abstract books were also hand searched. Only those reports on pulsed radiofrequency were withheld. Results. The final analysis yielded 58 reports on the clinical use of pulsed radiofrequency in different applications: 33 full publications and 25 abstracts. We also retrieved six basic science reports, five full publications, and one abstract. Conclusions. The accumulation of these data shows that the use of pulsed radiofrequency generates an increasing interest of pain physicians for the management of a variety of pain syndromes. Although the mechanism of action has not been completely elucidated, laboratory reports suggest a genuine neurobiological phenomenon altering the pain signaling, which some have described as neuromodulatory. No side effects related to the pulsed radiofrequency technique were reported to date. Further research in the clinical and biological effects is justified. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this pilot feasibility study was to evaluate the effects of an innovative, Internet-based psychosocial intervention for family caregivers of older adults with neurodegenerative disease. Design and Methods: After receiving signed informed consent from each participant, we randomly assigned 66 caregivers to an Internet-based intervention or to a no-intervention control group. The intervention group received computers and training in order to access a password-protected Web site with links to information, e-mail, and threaded discussion. Unique to the Web site was a video-conferencing link that supported caregivers' participation in a 10-session, manual-guided psychosocial support group, followed by 12 additional online sessions facilitated by a group member. Participants completed health-status and stress-response measures at baseline and 6-month follow-up. Results: Content analysis of archived video sessions showed (a) reliable adherence to the manual-guided support-group intervention and (b) online group discussion themes similar to those in face-to-face caregiver support groups. Analyses of stress-response outcome data showed significant between-group differences, with the intervention group experiencing a decline in stress compared with an escalation in stress for the control group. Implications: Despite the limitations of this pilot study in terms of limited sample size and 54% dropout of control participants at 6-month follow-up, the results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Summary: Minimally invasive conduit harvesting techniques for coronary artery bypass grafting have developed over the past decade, aiming to reduce the morbidity and recovery time associated with the procedure, whilst preserving the quality of the conduit. Two types of commonly harvested free conduits include the great saphenous vein and the radial artery. Although much research has focussed on comparing less invasive and conventional harvest techniques, there is at present no consensus on the areas where one technique is superior to the other. Aspects of conduits that deserve appreciation when comparing minimally invasive and open harvesting techniques include wound healing at the harvest site, the macroscopic, histological and functional quality of the conduit, but perhaps most importantly its long-term angiographic patency. This paper aims to review the literature comparing minimally invasive and conventional conduit harvesting techniques for coronary artery bypass grafting, with regard to the previously mentioned factors. A literature search of Medline, Ovid, Embase and Cochrane databases was used to identify comparative studies published between 1997 and 2005. Outcomes of interest included: wound infection, non-infective healing disturbances, post-operative pain, neurological disturbance, mobility, patient satisfaction, conduit quality (macroscopic, histological and functional) and long-term conduit patency. A scoring system was applied and used to grade the quality of the evidence, based on which a recommendation of it being ‘good’ (Grade A), ‘fair’ (Grade B), or ‘insufficient’ (Grade C) was made. Results showed that there was ‘good’ evidence to suggest that wound infection and non-infective complications are reduced with minimally invasive harvest as compared to conventional vein harvest. The evidence suggesting that post-operative pain and mobilisation is reduced after minimally invasive vein harvest and that once harvested, the conduits are macroscopically comparable to conventional ones, is only ‘fair’. Finally, although initial reports are encouraging, there is at present insufficient evidence to comment on whether minimally invasive radial artery harvesting is better than that of conventional open surgery. Wounds from minimally invasively harvested venous conduits appear to be less prone to complications although more comparative evidence on conduit quality and long-term patency is eagerly awaited. [Copyright &y& Elsevier]

Background Epidemiological studies have provided growing evidence of a link between atopy and cancer risk. Objectives To review the evidence from case–control studies and cohort studies on a possible association between atopic dermatitis (AD) and cancer risk, with particular attention to the case definition of AD. Methods Studies with quantitative data on the association between AD (eczematous disease) and cancer risk were obtained from MEDLINE in combination with a review of cited references. Results In 23 publications, AD was implicated in the risk of haematological [childhood leukaemia ( n = 3), adult leukaemia ( n = 3), non-Hodgkin lymphoma (NHL; n = 4) and different haematological cancers ( n = 1)], pancreatic ( n = 5), skin ( n = 2) and brain malignancies ( n = 5). The overall picture of the results of these studies shows that a history of AD may be associated with a decreased risk of pancreatic cancer, brain tumour and childhood leukaemia, although in most instances the findings were not statistically significant. No consistent associations were observed for skin cancer or NHL. The definition of AD had varying quality, and was imprecise in the majority of publications. Conclusions The findings of the epidemiological studies tend to support a lower risk of cancer among persons with a history of AD. Although a more careful definition of AD is needed, these epidemiological studies could provide an estimate of the background cancer risk in patients with AD when the long-term effects of treatments for AD are assessed. [ABSTRACT FROM AUTHOR]

Background Nurses play lead roles in the delivery of care in dermatology. While a number of primary studies have been conducted evaluating nurse-led care in dermatology, review and synthesis of the findings from these studies has not been undertaken. Objectives To systematically identify, summarize and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in dermatology. Methods Systematic searches were done of CINAHL, MEDLINE, British Nursing Index and the Royal College of Nursing Library Catalogue from 1990 until March 2005. The searches were not restricted to the U.K., and were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. Results A total of 14 relevant publications were identified (and included findings from both primary and secondary care), of which five were descriptions of nursing activities, five were evaluations of nurse interventions and four were patient evaluations of nurse-led care. The evidence emerging from the literature indicates that nurses are treating a number of dermatological conditions, primarily using treatment protocols, across a broad range of clinical settings. However, there is a lack of confidence among nurses working in primary care (predominantly practice nurses) to treat some of these conditions (including scalp scaling in psoriasis and infected eczema). Although the importance of education is recognized, the educational needs of these nurses are frequently unmet. The benefits of nurse interventions on service delivery include a reduction in the severity of condition and more effective use of topical therapies. Patients report faster access to treatment, a reduction in referrals to the GP or dermatologist, and an increase in knowledge of their condition. Conclusions Nurses frequently play lead roles in the diverse range of models of care that exist in dermatology. Although findings of the review are generally positive, there are methodological weaknesses and under-researched issues, e.g. cost effectiveness of nurse-led care, and extended independent and supplementary nurse prescribing in dermatology, that point to the need for further rigorous evaluation. [ABSTRACT FROM AUTHOR]

Objective To report preliminary efficacy data from a Web-based family problem-solving intervention to improve parent and child adaptation. Method Eight parents and six children with moderate to severe traumatic brain injury (TBI) who were injured more than 15 months earlier (M =16 months) participated in the intervention. Families were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after they completed self-guided Web exercises on problem-solving, communication, and antecedent behavior management strategies. Results Paired t tests comparing pre- and post-intervention scores revealed significant improvements in injury-related burden, parental psychiatric symptoms, depression, and parenting stress. There were also significant reductions in antisocial behaviors in the injured child, but not in self-reported depressive symptoms. Conclusions These findings suggest that a computer-based intervention may successfully be used to improve both parent and child outcomes following TBI in children. [ABSTRACT FROM AUTHOR]

Patients with short bowel syndrome require long term parenteral nutrition support. However, after massive intestinal resection the intestine undergoes adaptation and nutritional autonomy may be obtained. Given that the complications of parenteral nutrition may be life threatening or result in treatment failure and the need for intestinal transplantation, a more attractive option is to wean patients off nutrition support by optimising the adaptive process. The article examines the evidence that after extensive small bowel resection adaptation occurs in humans and focuses on the factors that influence adaptation and the strategies that have been used to optimise this process. The review is based on an English language Medline search with secondary references obtained from key articles. There is evidence that adaptation occurs in humans. Adaptation is a complex process that results in response to nutrient and non-nutrient stimuli. Successful and reproducible strategies to improve adaptation remain elusive despite an abundance of experimental data. Nevertheless given the low patient survival and quality of life associated with other treatments for irreversible intestinal failure it is imperative that clinical research continues into the optimisation of the adaptation. [ABSTRACT FROM AUTHOR]