Improving physicians' and nurses' clinical breast examination: a randomized controlled trial

Health professionals' clinical breast examination accuracy and skills are not optimal. We conducted a randomized trial to evaluate changes in physicians' and nurses' lump detection accuracy and examination skills after a training program emphasizing development of tactile skills and using silicone breast models containing lumps of varying sizes, degrees of hardness, and depth of placement. Sensitivity, specificity, and examination technique were measured before and four months after training in 43 experimental group and 46 control group participants. Mean sensitivity increased from 57% to 63% in the experimental group but decreased from 57% to 56% in the control group (P less than or equal to .05). The experimental group's posttest sensitivity was better for each lump characteristic, with statistically significant improvement for the very small (0.3 cm) and medium hard lumps. Duration of examination independently predicted sensitivity. Specificity decreased from 56% to 41% in the experimental group while it increased from 56% to 68% in the control group (P less than or equal to .05). Physicians had significantly higher mean sensitivity than nurses overall, as well as for the larger (1.0 cm), very small (0.3 cm), and softer lumps, but significantly lower mean specificity (33% versus 57%, P = .03). The experimental group improved significantly in five of six technique components while the control group improved in only one. To determine the effect of training on specificity in the clinical setting, we examined medical records of women seen by a subset of experimental and control physicians during the six months following training. There were no significant differences in the proportion of abnormal breast examinations reported or the number of mammograms ordered by experimental and control physicians. Our results show health professionals can be taught successfully to improve their clinical breast examination accuracy and skills.     

Worksite intervention effects on physical health: a randomized controlled trial

Overweight and physical inactivity are risk factors for increased disease burden and health care expenditure. Well-designed studies are still needed to determine the treatment efficacy of worksite interventions targeting such risk factors. This randomized controlled trial was conducted at one of Australia's casinos in 2002-2003, to investigate the effects of a comprehensive exercise and lifestyle intervention on physical fitness. Only 6.4% of the workforce expressed interest in being study participants. Seventy-three employees (aged 32 +/- 8 years, 51% overweight/obese, 73% shift workers and 52% women) were recruited and randomized to treatment or wait-list control groups for 24 weeks, 44 of whom completed the intervention. Components of the intervention include supervised moderate-to-high intensity exercise including combined aerobic (at least 20 min duration 3 days/week) and weight-training (for an estimated 30 min completed 2-3 days/week), and dietary/health education (delivered via group seminars, one-on-one counselling and literature through the provision of a worksite manual). ANCOVA, by intention-to-treat and of study completers, found significant between-group differences in the mean waist circumference and predicted maximal oxygen uptake (VO2max), favouring the intervention, but effects were concentrated in one subject. For study completers, between-group differences in the mean waist circumference (82.3 +/- 9.2 versus 90.5 +/- 17.8 cm, p = 0.01) and predicted VO2max (47 versus 41 ml/kg/min, p < 0.001) remained significant without the outlier, favouring the intervention. Higher intervention compliance predicted greater improvements in physical fitness. No significant effects on body mass or body mass index were found. This worksite intervention significantly improved waist circumference and aerobic fitness in healthy but sedentary employees, most of whom were shift workers. Worksite interventions have the potential to counter the increasing burden of overweight and obesity, particularly visceral adiposity, as well as physical inactivity; however, substantial barriers to adoption/adherence need to be overcome for greater feasibility and impact on employee physical health.     

Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial

PURPOSE

This study was designed to evaluate potential preventive effects of meditation or exercise on incidence, duration, and severity of acute respiratory infection (ARI) illness.

METHODS

Community-recruited adults aged 50 years and older were randomized to 1 of 3 study groups: 8-week training in mindfulness meditation, matched 8-week training in moderate-intensity sustained exercise, or observational control. The primary outcome was area-under-the-curve global illness severity during a single cold and influenza season, using the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) to assess severity. Health care visits and days of missed work were counted. Nasal wash collected during ARI illness was assayed for neutrophils, interleukin-8, and viral nucleic acid.

RESULTS

Of 154 adults randomized into the study, 149 completed the trial (82% female, 94% white, mean age 59.3 ± 6.6 years). There were 27 ARI episodes and 257 days of ARI illness in the meditation group (n = 51), 26 episodes and 241 illness days in the exercise group (n = 47), and 40 episodes and 453 days in the control group (n = 51). Mean global severity was 144 for meditation, 248 for exercise, and 358 for control. Compared with control, global severity was significantly lower for meditation (P = .004). Both global severity and total days of illness (duration) trended toward being lower for the exercise group (P=.16 and P=.032, respectively), as did illness duration for the meditation group (P=.034). Adjusting for covariates using zero-inflated multivariate regression models gave similar results. There were 67 ARI-related days of-work missed in the control group, 32 in the exercise group (P = .041), and 16 in the meditation group (P <.001). Health care visits did not differ significantly. Viruses were identified in 54% of samples from meditation, 42% from exercise, and 54% from control groups. Neutrophil count and interleukin-8 levels were similar among intervention groups.

CONCLUSIONS

Training in meditation or exercise may be effective in reducing ARI illness burden.     

Improving primary health care through systematic supervision: a controlled field trial

Most primary health care services in developing countries are delivered by staff working in peripheral facilities where supervision is problematic. This study examined whether systematic supervision using an objective set of indicators could improve health worker performance. A checklist was developed by the Philippine Department of Health which assigned a score from 0 to 3 on each of 20 indicators which were clearly defined. The checklist was implemented in 4 remote provinces with 6 provinces from the same regions serving as a control area. In all 10 provinces, health facilities were randomly selected and surveyed before implementation of the checklist and again 6 months later. Performance, as measured by the combined scores on the 20 indicators, improved 42% (95% Cl = 29% to 55%) in the experimental group compared to 18% (95% Cl = 9% to 27%) in the control group. In the experimental, but not in the control facilities, there was a correlation between frequency of supervision and improvements in scores. The initial cost of implementing the checklist was US $ 19.92 per health facility and the annual recurrent costs were estimated at $ 1.85. Systematic supervision using clearly defined and quantifiable indicators can improve service delivery considerably, at modest cost.     

Improving subjective health at the worksite: a randomized controlled trial of stress management training,physical exercise and an integrated health programme

Our objective was to evaluate the effect of 12 weeks of stress management training (SMT), physical exercise (PE) and an integrated health programme (IHP) in a worksite setting on subjective health complaints. To do this, we randomly split 860 employees into the following groups: control (n = 344), PE (n = 189), IHP (comprising physical exercise and health information) (n = 165) and SMT (n = 162). There were no significant effects on subjective health complaints, sick leave or job stress. However, strong and specific positive effects were experienced for the particular goal areas defined for each intervention. The PE group showed improved general health, physical fitness and muscle pain, while the SMT group showed improved stress management. The IHP group showed the strongest effects, affecting most goals set for treatment.     

Sensitivity to change of health status measures in a randomized controlled trial: comparison of the COOP charts and the SF-36

This study compared the sensitivity to change of comparable dimensions of a multi-item multi-dimensional health status measure (the SF-36) with the equivalent single item domains on the Dartmouth COOP charts. One hundred and twenty nine patients were randomized to either day case laparoscopic surgery (n=60) or open inguinal hernia repair (n=69). Respondents completed the SF-36 and COOP charts at baseline (prior to surgery) and at follow up at 10 days and 6 weeks. Equivalent dimensions of physical functioning, mental health/emotional condition, social activities, pain and overall condition/general health on the two questionnaires were compared. Despite slightly different pictures of change provided by the physical functioning and overall condition/general health dimensions the general picture of change provided by the two instruments was similar. At 10 days, patients who underwent open surgery reported far greater levels of dysfunction than those who underwent laparoscopic surgery on both questionnaires. At 6 weeks the pain dimension of both questionnaires indicated a large improvement from baseline, whilst no other domain on either questionnaire for either group indicated such improvement. The general picture of change provided by the two measures was similar. The results suggest that both the SF-36 and the COOP charts may prove suitable for the assessment of health perception outcomes in surgical clinical trials. Differences on certain domains were caused in large measure by the nature of the questions posed. The study once again highlights the importance of checking item content to determine the suitability of any particular measure for a given study.     

Improving follow-up after an abnormal pap smear: A randomized controlled trial

Less than 60% of women diagnosed with cervical abnormalities on Pap smears return for proper surveillance and timely treatment. Previous tactics used to motivate these women to return have mainly relied on costly intensive recall efforts. Using a framework based on psychological value expectancy theory, a pamphlet was designed to motivate women with abnormal Pap smears to return for a repeat Pap smear. The effect of this pamphlet was tested in a randomized controlled trial. A total of 161 women with abnormal Pap smears were randomized and received either the pamphlet plus a notification letter or the letter only. The compliance rate was 64.2% in the intervention group and 51.3% in the comparison group (P = 0.10; two-tailed). In addition, subgroups of women who do not practice health-related behaviors were identified as groups where more intensive interventions may be needed. These results have implications for future strategies used to recall women with abnormal Pap smears.     

Improving the prevention and control of hazardous substance exposures: a randomized controlled trial in manufacturing worksites

BACKGROUND: New measures of exposure prevention (EP) activity were used to evaluate the effectiveness of a 16-month management-focused intervention addressing hazardous substance exposures in manufacturing work settings. METHODS: EP efforts were assessed using a rating scheme developed for this study. The rating scheme yields a set of measures of exposure potential and protection, which are combined into an overall EP summary rating. A randomized, controlled design was used to assess intervention effectiveness. Fifteen large manufacturing worksites completed the 16-month intervention and follow-up assessments. Analyses were conducted on the 107 production processes assessed at both baseline and final. RESULTS: Patterns of improvement within the intervention condition were consistent with the intervention emphasis on upstream or source-focused intervention; whereas patterns in controls were consistent with prevalent practice (more downstream, worker-focused). A mixed model analysis of variance showed greater improvement in EP ratings in intervention versus controls, but the difference in improvement was moderate and statistically non-significant. CONCLUSIONS: This study has demonstrated that EP efforts in the manufacturing sector can be systematically assessed across the full range of hazardous substances in use, and that such assessments can serve both needs assessment and effectiveness evaluation functions. Findings suggest that more sustained or intense management-focused intervention would significantly improve EP activity in manufacturing settings.     

Alcohol and high-density-lipoprotein cholesterol: a randomized controlled trial

1. A randomized controlled trial of cross-over design was set up to examine the effect of alcohol on blood lipids and certain haematological variates relevant to ischaemic heart disease. 2. One hundred subjects drank some alcohol for 4 weeks (mean intake 18.4 g/d) and abstained totally for 4 weeks, the order of these periods being randomized. 3. Alcohol appeared to produce a rise of 7% in serum high-density-lipoprotein (HDL) cholesterol, probably due to a rise in the HDL2 subfraction. 4. No significant change was detected in plasma fibrinogen or the other haematological indices. 5. These results are consistent with the hypothesis that a moderate intake of alcohol confers some protection against heart disease.     

Preventing alcohol-exposed pregnancies: a randomized controlled trial

BACKGROUND: Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States. DESIGN: A randomized controlled trial (2002-2005; data analyzed 2005-2006) of a brief motivational intervention to reduce the risk of an alcohol-exposed pregnancy (AEP) in preconceptional women by focusing on both risk drinking and ineffective contraception use. SETTING/PARTICIPANTS: A total of 830 nonpregnant women, aged 18-44 years, and currently at risk for an AEP were recruited in six diverse settings in Florida, Texas, and Virginia. Combined settings had higher proportions of women at risk for AEP (12.5% overall) than in the general population (2%). INTERVENTIONS: Participants were randomized to receive information plus a brief motivational intervention (n=416) or to receive information only (n=414). The brief motivational intervention consisted of four counseling sessions and one contraception consultation and services visit. MAIN OUTCOME MEASURES: Women consuming more than five drinks on any day or more than eight drinks per week on average, were considered risk drinkers; women who had intercourse without effective contraception were considered at risk of pregnancy. Reversing either or both risk conditions resulted in reduced risk of an AEP. RESULTS: Across the follow-up period, the odds ratios (ORs) of being at reduced risk for AEP were twofold greater in the intervention group: 3 months, 2.31 (95% confidence interval [CI]=1.69-3.20); 6 months, 2.15 (CI=1.52-3.06); 9 months, 2.11 (CI=1.47-3.03). Between-groups differences by time phase were 18.0%, 17.0%, and 14. 8%, respectively. CONCLUSIONS: A brief motivational intervention can reduce the risk of an AEP.     

Small individual loans and mental health: a randomized controlled trial among South African adults

Background  

In the developing world, access to small, individual loans has been variously hailed as a poverty-alleviation tool – in the context of "microcredit" – but has also been criticized as "usury" and harmful to vulnerable borrowers. Prior studies have assessed effects of access to credit on traditional economic outcomes for poor borrowers, but effects on mental health have been largely ignored.     

Promoting uptake of influenza vaccination among health care workers: a randomized controlled trial

In a randomized controlled trial, an intensive promotional campaign failed to increase the uptake of vaccination against influenza among health care workers. The uptake of vaccination was low.