On the Functional Capacity and Quality of Life of Patients with Acromegaly: Are They Candidates for Rehabilitation Programs?

[Purpose] This study compared patients having active acromegaly with those having controlled acromegaly in terms of peripheral muscle strength, body composition, and functional capacity. We also examined the associations between these measures. [Methods] A total of 14 patients with active acromegaly, 12 patients with controlled acromegaly, and 12 healthy controls were subjected to isometric dynamometry, surface electromyography, electrical bioimpedance, and a six-minute walk test. [Results] The active acromegaly group exhibited significantly more fat-free mass than the control group. With respect to the peripheral muscle performance, the controlled acromegaly group presented a significantly lower electromyographic median frequency than the control group. The quadriceps maximum strength was significantly lower in the controlled acromegaly group than in the control group. The fat-free mass was significantly correlated with the quadriceps maximum strength. The global scores of the Acromegaly Quality of Life Questionnaire were significantly correlated with the six-minute walk distance. [Conclusion] Patients with acromegaly have more fat-free mass, less peripheral muscle strength, and greater fatigability than healthy control subjects. These findings depend on the degree of hormonal control. In acromegalic patients, peripheral muscle strength is related to body composition, and functional capacity is correlated with quality of life.Key words: Acromegaly, Muscle strength, Exercise tolerance     

Which Treatment is More Effective for Functional Ankle Instability: Strengthening or Combined Muscle Strengthening and Proprioceptive Exercises?

[Purpose] The purpose of this study was to implement combined muscle strengthening and proprioceptive exercises to examine the effects of combined exercises on functional ankle instability. [Subjects and Methods] Experiments were conducted with 30 adult males and females. The study subjects were randomly assigned to either a control group (Group A), a muscle strengthening exercise group (Group B), or a combined muscle strengthening and proprioceptive exercise group (Group C) consisting of 10 subjects each. In Group A, measurements were only conducted before and after the experiment without any intervention, whereas the exercise programs for Group B and Group C were implemented three days per week for four weeks. [Results] Muscle strength showed significant increases in Groups B and C compared with the control group during plantar flexion, dorsiflexion, inversion, and eversion. The Cumberland ankle instability tool showed significant increases in Group B and Group C compared with Group A and significant increases in Group C compared with Group B. [Conclusion] Applying combined muscle strengthening and proprioceptive exercises to those who have functional ankle instability is more effective than applying only muscle strengthening exercises.Key words: Functional ankle instability, Strength, Cumberland ankle instability tool     

Nursing competence 10 years on: fit for practice and purpose yet?

Aims and objectives. This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments. Background. In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the ‘knowledgeable doer’ and examines the consequences of the change on nursing competency from the 1990s to the present day. Methods. This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn. Conclusions. From 1923–1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty‐five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors’ surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses ‘fit for practice and purpose’ may still prevail. Relevance to clinical practice. The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice.     

PIK3CA and KRAS mutations predict for response to everolimus therapy: now that’s RAD001

Targeted cancer therapeutics can be effective when patients are preselected to maximize the chance of response. Increasingly, molecular markers such as oncogenic DNA mutations are being exploited to help guide patient preselection. These DNA lesions can predict for either a positive or negative response to a given drug. Finding such predictive biomarkers is an ongoing challenge. New work by Di Nicolantonio and colleagues in this issue of the JCI demonstrates that PI3K catalytic α subunit (PIK3CA) mutations can sensitize cancer cells to the mammalian target of rapamycin (mTOR) inhibitor everolimus. In addition, they show that the concurrent presence of PIK3CA mutations and mutations in either KRAS or BRAF predict for resistance to this drug. These data suggest that mTOR inhibitors currently in use will be ineffective against cancers that have a mutation in either KRAS or BRAF despite having PI3K/AKT/mTOR pathway activation. In the past few decades, developers of new anticancer therapies have moved away from cytotoxic drugs that simply target the proliferative hallmark of all cancer cells. Currently, targeted therapies dominate cancer drug development with the aim of blocking the growth and spread of cancer by interfering with specific molecules involved in the progression of a given tumor. One of the most successful targeted anticancer therapies developed is the kinase inhibitor imatinib, which targets the product of the BCR-ABL oncogene that drives disease in all patients with chronic myeloid leukemia (CML) (1). However, for most targeted therapies, only a subset of the patients predicted to respond do so. For example, EGFR-directed therapies were thought to inhibit the growth of non–small-cell lung cancers with EGFR overexpression, but only those cancers with certain activating EGFR mutations respond to these small molecule inhibitors (2, 3). It has therefore become critically important to develop predictive biomarkers for patients who are likely to respond to a given therapy and, equally important, for those who will not. As an example, testing for KRAS mutations has become mandatory for colorectal cancer patients receiving EGFR-directed therapies because the presence of KRAS mutations predicts for resistance to this class of drugs (4). In this issue of the JCI, Di Nicolantonio and colleagues have now uncovered mutations that seem to predict for response to the anticancer drug everolimus, which targets mammalian target of rapamycin (mTOR) (5).     

In response to: specialization in physiotherapy: musings on current concepts and possibilities for harmonization across the European Union [Donaghy and Gosling,Phys Ther Rev 1999; 4: 51–60]

Abstract

Donaghy and Gosling have written a paper that articulates many interesting issues with respect to the specialization process in physiotherapy. I will structure this response around three topics that are particularly interesting to me: tension between generalist and specialist practitioners, differentiation of specialists from experts, and the formal specialization process.