Search

The Schwartz Center Educational Rounds, the first Schwartz Center Rounds held at an educational institution, emphasize the overall theme of difficult conversations faced by students and professionals with patients, families, and other members of the health care team. Students in the health care professions do not have sufficient opportunities to practice the communication and decision making skills integral to compassionate caregiving. Such practice enhances communication with patients and families, as well as with other members of the interdisciplinary team. This article presents the underlying assumptions for this change-oriented project and describes the development, implementation, and evaluation of the Rounds for an interdisciplinary group of graduate students during a 4-year period.

Objective: To investigate the association of aerobic fitness (VO(2)max) with pain intensity as reported by a sample of patients with chronic low back pain (LBP)., Design: Cross-sectional with partial longitudinal follow-up., Setting: Outpatient interdisciplinary pain management program in a teaching hospital., Patients: A convenience sample of 75 patients with chronic LBP., Intervention: Patients reported pain intensity before and after undergoing a modified treadmill test. Peak VO(2) was measured by using indirect calorimetry. Predicted VO(2)max was determined by extrapolating peak VO(2) and heart rate values during testing to predicted maximal heart rate., Main Outcome Measures: Aerobic fitness and pain intensity before and after testing., Results: No significant relation was found between pain intensity and predicted VO(2)max or aerobic fitness., Conclusion: There is no association between pain intensity and aerobic fitness. Deconditioning, defined as a lack of cardiovascular fitness levels normal for age and gender, therefore does not contribute to pain intensity in patients with chronic LBP., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Background: Patients with adult-onset growth hormone deficiency have reduced bone density and increased fat mass. Growth hormone at high doses may decrease body fat in these patients, but the effects of growth hormone at more physiologic doses on bone density and body composition have not been convincingly shown., Objective: To determine whether long-term growth hormone therapy at a dose adjusted to maintain normal insulin-like growth factor 1 (IGF-1) levels has clinical effects in patients with adult-onset growth hormone deficiency., Design: Randomized, placebo-controlled study., Setting: Tertiary referral center., Patients: 32 men with adult-onset growth hormone deficiency., Intervention: Growth hormone (initial daily dose, 10 micrograms/kg of body weight) or placebo for 18 months. The growth hormone dose was reduced by 25% if IGF-1 levels were elevated., Measurements: Body composition and bone mineral density of the lumbar spine, femoral neck, and proximal radius were measured by dual energy x-ray absorptiometry at 6-month intervals. Markers of bone turnover were also measured during the first 12 months of the study., Results: Growth hormone therapy increased bone mineral density in the lumbar spine by a mean (+/- SD) of 5.1% +/- 4.1% and bone mineral density in the femoral neck by 2.4% +/- 3.5%. In the growth hormone group, significant increases were seen in the following markers of bone turnover: osteocalcin (4.4 +/- 3.6 mg/L to 7.2 +/- 4.6 mg/L) and urinary pyridinoline (39.0 +/- 19.8 nmol/mmol of creatinine to 55.7 +/- 25.5 nmol/mmol of creatinine) and deoxypyridinoline (8.4 +/- 7.1 nmol/mmol of creatinine to 14.9 +/- 9.4 nmol/mmol of creatinine). Percentage of body fat in the growth hormone group decreased (from 31.9% +/- 6.5% to 28.3% +/- 7.0%), and lean body mass increased (from 59.0 +/- 8.5 kg to 61.5 +/- 6.9 kg). These changes were significant compared with corresponding changes in the placebo group (P < 0.01 for all comparisons)., Conclusions: Growth hormone administered to men with adult-onset growth hormone deficiency at a dose adjusted according to serum IGF-1 levels increases bone density and stimulates bone turnover, decreases body fat and increases lean mass, and is associated with a low incidence of side effects.

Cardiac rehabilitation outcome assessment has reflected the isolated concerns of different professionals, each addressing different factors of the problems of patients. Physical, medical, psychosocial, and epidemiological approaches have been taken. Discrepancies in findings may relate more to problems with assessment than to the technology itself, and can undermine the usefulness of the intervention.

Orthopedic physical therapists' knowledge of pain mechanisms and methods of pain management and their attitudes toward working with patients with benign chronic pain were studied. A random sample of 500 members of the American Physical Therapy Association's Section on Orthopaedics received by mail a 36-item questionnaire. Statistical analysis of scores, using frequencies, means, and correlations was performed on the 119 (23.8%) usable returns. All but 4% of the respondents preferred to work with patients who are not likely to have chronic pain. Seventy-two percent believed their entry-level education in pain management and theory was very inadequate or less than adequate to deal with an orthopedic patient population. Pain knowledge scores were low (35.8 out of 46 points), and the scores on positive attitudes toward treating patients with benign chronic pain were lower (20.5 out of 36 points). The study suggests specific deficiencies in orthopedic physical therapists' knowledge of clinical pain mechanisms and management and potentially undesirable attitudes toward treating patients with chronic pain.

Plasma progesterone levels were measured daily to determine the accuracy of diagnosing ovulation by rectal palpation carried out every other day; 81.5 per cent mares injected with human chorionic gonadotrophin showed increases of progesterone more than 1 ng/ml by 72 h after injection compared with 65 per cent of mares injected with gonadotrophin releasing hormone (GnRH) or saline. Mating at ovulation achieved a 74 per cent pregnancy rate in mares given hCG compared with 50 per cent given GnRH and 45 per cent controls. Diagnosis of ovulation per rectum on the basis of a pit in the ovarian surface or the presence of a soft friable structure was found to be accurate in 91 per cent of cases. Diagnosis based on the presence of a firm plum-like structure or the disappearance of a previously identified follicle at a given site was 60 per cent accurate. In cases of rectal diagnosis of non-ovulation 38 per cent had actually ovulated based on a rise in progesterone more than 1 ng/ml and a further 19 per cent showed a rise in progesterone by 24 h after the diagnosis. The use of hCG may improve conception rates by synchronisation of ovulation and mating and where rectal palpation of the ovaries remains the only basis for timed mating.