The objective of this pilot study was to evaluate the effects of exenatide on BMI (primary endpoint) and cardiometabolic risk factors in nondiabetic youth with extreme obesity. Twelve children and ...adolescents (age 9–16 years old) with extreme obesity (BMI ≥1.2 times the 95th percentile or BMI ≥35 kg/m2) were enrolled in a 6‐month, randomized, open‐label, crossover, clinical trial consisting of two, 3‐month phases: (i) a control phase of lifestyle modification and (ii) a drug phase of lifestyle modification plus exenatide. Participants were equally randomized to phase‐order (i.e., starting with control or drug therapy) then crossed‐over to the other treatment. BMI, body fat percentage, blood pressure, lipids, oral glucose tolerance tests (OGTT), adipokines, plasma biomarkers of endothelial activation, and endothelial function were assessed at baseline, 3‐, and 6‐months. The mean change over each 3‐month phase was compared between treatments. Compared to control, exenatide significantly reduced BMI (−1.7 kg/m2, 95% confidence interval (CI) (−3.0, −0.4), P = 0.01), body weight (−3.9 kg, 95% CI (−7.11, −0.69), P = 0.02), and fasting insulin (−7.5 mU/l, 95% CI (−13.71, −1.37), P = 0.02). Significant improvements were observed for OGTT‐derived insulin sensitivity (P = 0.02) and β‐cell function (P = 0.03). Compliance with the injection regimen was excellent (≥94%) and exenatide was generally well‐tolerated (the most common adverse event was mild nausea in 36%). These preliminary data suggest that exenatide should be evaluated in larger, well‐controlled trials for its ability to reduce BMI and improve cardiometabolic risk factors in youth with extreme obesity.
Most studies in adults suggest that acute glucose consumption induces a transient impairment in endothelial function. We hypothesized that obese youth would demonstrate reduced endothelial function ...and increased inflammation and oxidative stress following acute glucose ingestion and that transient elevations in plasma glucose would correlate with endothelial dysfunction, inflammation, and oxidative stress. Thirty‐four obese (BMI ≥95th percentile) children and adolescents (age 12.4 ± 2.6 years; BMI = 37.9 ± 6.7 kg/m2; 50% females) underwent measurement of endothelial function (reactive hyperemic index (RHI)), glucose, insulin, C‐reactive protein (CRP), interleukin‐6 (IL‐6), circulating oxidized low‐density lipoprotein (oxLDL), and myeloperoxidase (MPO) in a fasting state and at 1‐ and 2‐h following glucose ingestion. Repeated measures ANOVA with Tukey post‐tests and Pearson correlations were performed. Glucose and insulin levels significantly increased at 1‐ and 2‐h (all P values < 0.001). Compared to baseline, there were no statistically significant differences in 1‐ and 2‐h RHI, CRP, IL‐6, and oxLDL. However, MPO significantly decreased at the 1‐ (P < 0.05) and 2‐h (P < 0.001) time points. At the 1‐h time point, glucose level was significantly inversely correlated with RHI (r = −0.40, P < 0.05) and at the 2‐h time point, glucose level was positively correlated with MPO (r = 0.40, P < 0.05). An acute oral glucose load does not reduce endothelial function or increase levels of inflammation or oxidative stress in obese youth. However, associations of postprandial hyperglycemia with endothelial function and oxidative stress may have implications for individuals with impaired glucose tolerance or frank type 2 diabetes.
Abstract Objective: To review published criteria for specifically evaluating health related information on the world wide web, and to identify areas of consensus. Design: Search of world wide web ...sites and peer reviewed medical journals for explicit criteria for evaluating health related information on the web, using Medline and Lexis-Nexis databases, and the following internet search engines: Yahoo!, Excite, Altavista, Webcrawler, HotBot, Infoseek, Magellan Internet Guide, and Lycos. Criteria were extracted and grouped into categories. Results: 29 published rating tools and journal articles were identified that had explicit criteria for assessing health related web sites. Of the 165 criteria extracted from these tools and articles, 132 (80%) were grouped under one of 12 specific categories and 33 (20%) were grouped as miscellaneous because they lacked specificity or were unique. The most frequently cited criteria were those dealing with content, design and aesthetics of site, disclosure of authors, sponsors, or developers, currency of information (includes frequency of update, freshness, maintenance of site), authority of source, ease of use, and accessibility and availability. Conclusions: Results suggest that many authors agree on key criteria for evaluating health related web sites, and that efforts to develop consensus criteria may be helpful. The next step is to identify and assess a clear, simple set of consensus criteria that the general public can understand and use. Key messages Many organisations and individuals have published criteria to evaluate health related information on the world wide web A literature and world wide web search found that the most frequently cited criteria were those dealing with content, design and aesthetics of site, disclosure of authors, sponsors, or developers, currency of information, authority of source, and ease of use Criteria related to confidentiality and privacy were only cited by one author Consensus regarding critical criteria for evaluation of web based health information seems to be emerging Our results indicate that many authors agree on key criteria for evaluating health related web sites, and that efforts to develop a set of key criteria may be helpful
Information and communication technologies may help reduce health disparities
through their potential for promoting health, preventing disease, and supporting
clinical care for all. Unfortunately, ...those who have preventable health problems
and lack health insurance coverage are the least likely to have access to
such technologies. Barriers to access include cost, geographic location, illiteracy,
disability, and factors related to the capacity of people to use these technologies
appropriately and effectively. A goal of universal access to health information
and support is proposed to augment existing initiatives to improve the health
of individuals and the public. Both public- and private-sector stakeholders,
particularly government agencies and private corporations, will need to collaboratively
reduce the gap between the health information "haves" and "have-nots." This
will include supporting health information technology access in homes and
public places, developing applications for the growing diversity of users,
funding research on access-related issues, ensuring the quality of health
information and support, enhancing literacy in health and technology, training
health information intermediaries, and integrating the concept of universal
access to health information and support into health planning processes.
Acupuncture as an Adjunct to Pulmonary Rehabilitation Deering, Brenda M; Fullen, Brona; Egan, Claire ...
Journal of cardiopulmonary rehabilitation and prevention,
2011-November/December, Letnik:
31, Številka:
6
Journal Article
Recenzirano
PURPOSE:Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and by both systemic and airway inflammation. In COPD, acupuncture has been shown to improve ...quality-of-life scores and decrease breathlessness; similar findings have also been reported after pulmonary rehabilitation (PR). The hypothesis of this study was that acupuncture in conjunction with pulmonary rehabilitation would improve COPD outcome measures compared to pulmonary rehabilitation alone.
METHODS:The design was a randomized prospective study; all subjects had COPD. There were 19 controls, 25 who underwent PR, and 16 who had both acupuncture and PR. The primary outcome measure was a change in measures of systemic inflammation at the end of PR and at 3 month followup. Lung function, including maximum inspiratory pressure (PiMax), quality-of-life scores, functional capacity including steps taken, dyspnea scores, and exercise capacity, were secondary endpoints.
RESULTS:After PR, both groups had significantly improved quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and PiMax, but no change in measures of systemic inflammation compared with the controls. There were no differences in most of the outcome measures between the 2 treatment groups except that subjects who had both acupuncture and PR remained less breathless for a longer period.
CONCLUSION:The addition of acupuncture to PR did not add significant benefit in most of the outcomes measured.
Introduction
Venous thromboembolism risk assessment (VTERA) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user‐friendly electronic VTERA ...tool.
Material and methods
We developed “Thrombocalc”, an electronic VTERA tool using Microsoft EXCEL™. Thrombocalc was designed as a score‐based tool to facilitate rapid assessment of all women after childbirth. Calculation of a total score estimated risk of venous thromboembolism in line with consensus guidelines. Recommendations for thromboprophylaxis were included in the VTERA output. Implementation was phased. Uptake of the VTERA tool was assessed prospectively by monitoring the proportion of women who gave birth in our institution and had a completed risk assessment. Factors affecting completion and accuracy of risk assessments were also assessed.
Results
Thrombocalc was used prospectively to risk‐assess 8380 women between September 2014 and December 2015. Compliance with this tool increased dramatically throughout the study period; over 92% of women were risk‐assessed in the last quarter of data collection. Compliance was not adversely affected if delivery took place out of working hours adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 0.93–1.14. Risk assessment was less likely in the case of cesarean deliveries (aOR 0.66, 95% CI 0.60–0.73) and stillborn infants (aOR 0.48, 95% CI 0.29–0.79). Misclassification of risk factors led to approximately 207 (2.5%) inaccurate thromboprophylaxis recommendations.
Conclusions
Our electronic, score‐based VTERA tool provides a highly effective mechanism for rapid assessment of individual postpartum venous thromboembolism risk in a high‐throughput environment.
A major concern for patient safety in hospitals is accurate medication administration. To improve the medication administration process, nurses and pharmacists must report system problems. Although ...staff supported the concept of medication error reporting, they did not report errors. Inherent fear of retribution, punitive actions, and professional humiliation prevented self-reporting of medication errors. Our hospital's quality improvement department developed, implemented, and evaluated a program called LifeSavers. Its purpose was to build a nonpunitive culture and to increase medication error reporting by staff. In one year, the LifeSavers program increased medication error disclosures from 14 to 72 reports per month. The successful development of a nonblame culture of medication error reporting led to identified sources of problems and improvement of the medication administration system.
The report of Ahmad Risk and Joan Dzenowagis for the World Health Organization 1 provides a useful compendium and commentary for those who are trying to get a handle on the proliferation of quality ...improvement mechanisms for the health Internet. The authors observe that all the initiatives begin with quality criteria that derive from similar roots and have involved consensus-building, the scope of which depended on how the initiative's participants defined their interests and constituents. The author's equally persuasive discussion of the many remaining pitfalls in implementation and sustainability suggests that the individual initiatives might be interested in common solutions to share the burdens of operating and financing quality improvement activities on an on-going basis.
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