echocardiographic measures in 6 to 7 year old children after an 8 month exercise program

The influence of an exercise intervention program on cardiac dimensions was studied in 79 normal children (aged 6 to 7 years) in an experimental (n = 38) and control (n = 41) group. The experimental group participated in an aerobic exercise session that met four days/week for 8 months. Anthropometric measurements and M mode echocardiograms were obtained before and after the intervention program. Comparison of the data between groups revealed no significant (probability [p] > 0.05) differences in left ventricular end-diastolic dimension, shortening fraction or resting heart rate. Left ventricular posterior wall thickness exhibited a significant increase (p < 0.0256) from 3.9 to 4.7 mm in the experimental group compared with an increase from 4.3 to 4.6 mm in the control group after correcting for preintervention differences with an analysis of covariance. Likewise, left ventricular mass increased significantly (p < 0.0004) from 21.2 to 27.4 g in the experimental group compared with 23.4 to 25.8 g in the control group. These findings indicate that when compared with control subjects, young children involved in an aerobic exercise program showed progressive increases in left ventricular posterior wall thickness and left ventricular mass and no change in left ventricular end-diastolic dimension, shortening fraction or resting heart rate.     

Statistical approaches for evaluating surrogate outcomes in clinical trials: A systematic review

The use of surrogate outcomes that predict treatment effect on an unobserved true outcome may have substantial economic and ethical advantages, through reducing the length and size of clinical trials. There has been extensive investigation of the best means of evaluating putative surrogates. We present a systematic review on the evolution of statistical methods for validating surrogates starting from the defining paper of Prentice (1989). We highlight the fundamental differences in the current statistical evaluation approaches, their advantages and disadvantages, and examine the understanding and perceptions of investigators in this area.     

Revisit patient safety initiatives

Updated CMS and JCAHO patient safety recommendations cause health care facilities to question their existing policies and procedures.     

Alignment of nephrology training with workforce, patient, and educational needs: an evidence based proposal

Summary

Background and objectives

Competency-based training programs focus on the product of training rather than the process with the desired attributes and skills set of the specialist directing the training program. These ideal skills and qualities have yet to be formally identified for nephrology training. The objectives of our study were: (1) to define the attributes of a “high quality” nephrologist from the perspectives of the trainer (nephrologist), trainee, and renal patient and (2) identify components and relative frequencies of nephrologists'' work practice.

Design, setting, participants, & measurements

Four substudies were undertaken, utilizing a combined quantitative and qualitative approach: (1) a national nephrology workforce study, (2) in-depth interviews of nephrology patients, (3) in-depth interviews of nephrology trainees, and (4) in-depth interviews of practicing nephrologists.

Results

Patients value good communication skills above other attributes. Nephrologists and trainees identify particular personal attributes, a holistic and evidence-based approach to patient care, and good clinical skills as paramount. Although nephrologists spend most of their time in clinical practice, substantial time is also spent in research, teaching, and administrative work.

Conclusions

For the first time, an evidence-based approach has been used to help define qualities desired in a practicing nephrologist. Along with training and assessment in clinical practice, this research supports nephrology training programs incorporating training in basic interventions, research skill acquisition, administration, and teaching. Training toward high standards in advanced communication and the maintenance of a holistic approach to patient care are necessary.     

A 10 Mb duplication in chromosome band 5q31.3-5q33.1 associated with late-onset lipodystrophy, ichthyosis, epilepsy and glomerulonephritis

We report here a 44 years-old patient with late-onset partial lipodystrophy, mental retardation, epilepsy, ichtyosis and glomerulonephritis, carrying a 10 Mb duplication of the chromosome 5q31.3-5q32.1 region detected by array-CGH.