A descriptive study of the usage of spinal manipulative therapy techniques within a randomized clinical trial in acute low back pain

The majority of randomized clinical trials (RCTs) of spinal manipulative therapy have not adequately defined the terms 'mobilization' and 'manipulation', nor distinguished between these terms in reporting the trial interventions. The purpose of this study was to describe the spinal manipulative therapy techniques utilized within a RCT of manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), and a combination of both (CT; n = 80) for people with acute low back pain (LBP). Spinal manipulative therapy was defined as any 'mobilization' (low velocity manual force without a thrust) or 'manipulation' (high velocity thrust) techniques of the spine described by Maitland and Cyriax. The 16 physiotherapists, all members of the Society of Orthopaedic Medicine, utilized three spinal manipulative therapy patterns in the RCT: Maitland Mobilization (40.4%, n = 59), Maitland Mobilization/Cyriax Manipulation (40.4%, n = 59) and Cyriax Manipulation (19.1%, n = 28). There was a significant difference between the MT and CT groups in their usage of spinal manipulative therapy techniques (chi2 = 9.178; df = 2; P = 0.01); subjects randomized to the CT group received three times more Cyriax Manipulation (29.2%, n = 21/72) than those randomized to the MT group (9.5%, n = 7/74; df = 1; P = 0.003). The use of mobilization techniques within the trial was comparable with their usage by the general population of physiotherapists in Britain and Ireland for LBP management. However, the usage of manipulation techniques was considerably higher than reported in physiotherapy surveys and may reflect the postgraduate training of trial therapists.     

Racial/ethnic variation in cigarette smoking among the civilian US population by occupation and industry, TUS-CPS 1998-1999

BACKGROUND: Although observational research studies have shown variance in the prevalence of smoking among occupations and industries, few have examined the role of race/ethnicity. This study examined racial/ethnic variation in the prevalence of current smoking and cigarette consumption patterns by occupation, industry and workplace smoking policy. METHODS: Data were examined for 9095 African American (AA), 1025 American Indian/Alaska Native, 3463 Asian/Pacific Islander (AAPI), 8428 Hispanic, and 86,676 white participants in the 1998-1999 Tobacco Use Supplement to the Current Population Survey. Race-stratified multivariate logistic regression analyses, Chi-square tests, and ANOVA were used to examine the association between the covariates and smoking prevalence and cigarette consumption patterns. RESULTS: Current smoking prevalence ranged from a high of 35.1% for AI/AN to 15.2% for AAPI. Occupation was not significantly associated with current smoking for Hispanics, AI/ANs, and AAPIs while neither occupation nor industry was associated with current smoking among African Americans after adjustment for gender, age group, education, income, or workplace smoking policies. DISCUSSION: These data confirm results of previous studies that show occupation and industry variation in smoking prevalence and also highlight the importance of examining racial/ethnicity as a covariate in studies of smoking prevalence.     

Serum concentrations of estrogens, sex hormone-binding globulin, and androgens and risk of breast cancer in postmenopausal women

We assessed the relationship between serum concentrations of estrogens, androgens, and sex hormone-binding globulin and risk of breast cancer among postmenopausal women. Study participants provided serum prior to breast biopsy or mastectomy in 3 hospitals in Grand Rapids, Michigan between 1977 and 1987. A total of 179 subjects with localized breast cancer were compared to 152 subjects with nonproliferative breast changes that have not been associated with elevated breast cancer risk. Increasing serum concentrations of estrone and estrone sulfate were associated with increases in breast cancer risk; the odds ratios (ORs) in the fourth quartiles compared to the first were 2.3 (95% confidence interval (CI) 1.1-4.6) for both (p-trend = 0.02 and 0.03, respectively). Estradiol and bioavailable estradiol concentrations were associated with nonstatistically significant increases in risk. Androstenediol levels were associated with risk (p-trend = 0.01); the OR in the fourth compared to the first quartile was 2.2 (95% CI 1.0-4.6). Testosterone, dehydroepiandrosterone and androstenedione levels were not associated with increased risk. Sex hormone-binding globulin was associated with a nonsignificant decrease in risk. Associations with estrone and estrone sulfate persisted after adjustment for androstenediol (ORs for fourth compared to first quartiles were 2.0 (95% CI 0.9-4.5) and 2.2 (95% CI 1.0-4.6), respectively (p-trend = 0.16 for both). The association with androstenediol was attenuated after adjustment for estrone (OR for fourth compared to first quartile was 1.6 (95% CI 0.7-3.6); p-trend = 0.13). Higher serum concentrations of estrogens were associated with increased breast cancer risk in postmenopausal women. Androgen levels were not independently associated with substantially increased risk.     

Continuing effectiveness of a community child health programme for medical students

In 1998 an innovative, inter-university child health learning programme involving a wide range of community child healthcare agencies was developed and evaluated. There is little information available on the progress over time of similar curriculum innovations. The programme was re-evaluated in 2003 regarding continued effectiveness. Programme records between 1998 and 2003 were reviewed together with programme coordinator recollections. Agency staff and student feedback questionnaire responses were compared for 1998 and 2003. Agency flexibility in programming and capacity for student visits decreased between 1998 and 2003. Fourteen of the 36 agencies offering placements in 2003 had been with the programme in 1998. In only five of these agencies was the contact person for the programme unchanged. Despite high agency turnover, programme evaluations and student reports and presentations consistently supported achievement of programme aims. Although the programme continued to meet its specific aims, a number of agency factors outside the control of the programme coordinators posed real threats to long-term programme success.     

First clinical experience with the air purge control and electrical remote-controlled tubing clamp in mini bypass

Abstract:  Most mini bypass systems do not contain a venous and cardiotomy reservoir in the cardiopulmonary bypass (CPB) circuit and lack the capability to remove venous air. In conjunction with the manufacturer the air purge control system, a system which automatically removes air that is captured in a venous bubble trap, has been developed. This system is combined with an electrical remote clamp, which automatically clamps the arterial line in case air leaves the bubble trap. Twenty consecutive patients undergoing surgery with CPB were included in this clinical validation. Venous air was removed by the air purge control during bypass. The electrical remote clamp was never activated by the system, confirming that the air purge control adequately removed venous air during these cases. The air purge control, in conjunction with the electrical remote clamp, is a valuable safety feature in mini bypass, enhancing patient safety and user friendliness while providing a level of safety equivalent to those of conventional bypass systems.     

Correlation between core biopsy and excisional biopsy in breast high-risk lesions

BACKGROUND: The purpose of the current study was to compare the prevalence of invasive or in situ cancer at excisional biopsy in patients with image-guided core needle biopsy (CNB)-proven atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma-in-situ (LCIS). Factors affecting the upgrade rate to malignancy were also identified. METHODS: Patients diagnosed with ADH, ALH, or LCIS on image-guided CNB (stereotactic or ultrasound) from 1995 to 2005 were identified through radiologic and surgical databases. Patients who subsequently underwent excisional biopsy of their lesion were included in the study. The imaging, medical records, and pathology of these patients were reviewed. RESULTS: Ninety-six patients with either ADH (61/96, 63%), ALH (19/96, 20%), or LCIS (16/96, 17%) on image-guided CNB proceeded to excisional biopsy. Malignancy was detected on excisional biopsy in 31% of patients with ADH, 16% of patients with ALH, and 25% of patients with LCIS. There were no significant differences between the 2 groups in terms of age, parity, hormonal status, or previous benign breast biopsies. The presence of a mass on mammography was associated with an increased upgrade rate to malignancy, while biopsies performed using vacuum-assisted devices, larger gauge biopsy needles, and greater number of cores were associated with a lower upgrade rate. CONCLUSIONS: Our data suggest that excisional biopsy is warranted in all patients with CNB diagnoses of ADH, ALH, or LCIS to exclude the presence of cancer.     

Body growth after combined liver-kidney transplantation in children with primary hyperoxaluria type 1

BACKGROUND: Children with primary hyperoxaluria type 1 (PH1) often develop severe growth failure, which is related to metabolic and endocrine consequences of chronic renal failure, and/or oxalate deposition in bone and cartilage. Combined liver and kidney transplantation (LKT) corrects the underlying metabolic defect and restores renal function in these children. METHODS: We therefore analyzed longitudinal growth of 24 children with PH1 who underwent LKT at nine European centers. Mean age at LKT was 8.9 years, and mean duration of follow-up was 5.7 years. RESULTS: After LKT mean standardized height tended to increase from -1.79 SD to -1.47 SD until last observation. Mean adult height amounted to 167 cm and 158 cm in boys and girls, respectively. At last observation, seven out of 24 patients were stunted. Within the whole study population, the degree of catch-up growth after LKT was positively associated with degree of stunting at the time of LKT and negatively associated with prednisolone dosage explaining together 39% of the overall variability. CONCLUSIONS: Combined LKT does not induce true catch-up growth in the majority of children with PH1. Due to the preexisting growth retardation at the time of LKT, one third of patients end up with a reduced final height.     

An economic evaluation of pediatric small bowel transplantation in the United Kingdom

BACKGROUND: Small bowel transplantation (SBTx) offers an alternative to parenteral nutrition (PN) for the treatment of chronic intestinal failure in children: this study estimated its cost-effectiveness in the early phase of a U.K. program. METHODS: Children assessed for SBTx were categorized as: 1) requiring SBTx following PN-related complications (n=23), 2) stable at home not requiring SBTx (n=24), and 3) terminally ill and unsuitable for SBTx (n=6). Costs were estimated from detailed resource-use data. Two comparisons were used for effectiveness: actual survival following transplantation (n=14) compared to: 1) estimated survival without transplantation using a prognostic model, and 2) the waiting list experiences of all patients listed for SBTx (n=23). RESULTS: Mean costs up to 30 months were pounds sterling 207,000 for those transplanted or on the waiting list, pounds sterling 159,000 for those stable on home PN, and pounds sterling 56,000 for those terminally ill. The prognostic model estimated a mean survival gain from transplantation of 0.12 years over 30 months, and suggested that transplantation was cost-saving. The second approach suggested that transplantation reduced survival by 0.24 years at an additional cost of pounds sterling 131,000. CONCLUSIONS: Firm conclusions on cost-effectiveness of SBTx are not possible given the two different estimates. The prognostic model approach (suggesting that pediatric SBTx may provide a small survival benefit at a small reduction in costs) should be less subject to bias, but the model requires external validation. Meanwhile, children at risk of fatal PN-complications should be given the opportunity to receive a SBTx only within a continuing formal assessment of the technology.     

Factor structure of the Trinity Amputation and Prosthesis Experience Scales (TAPES) with individuals with acquired upper limb amputations

OBJECTIVES: To investigate the factorial composition of the Trinity Amputation and Prosthesis Experience Scales (TAPES), a multidimensional assessment of adaptation to amputation and prosthesis, for use with individuals with acquired upper limb amputations. DESIGN: Cross-sectional survey of members of the British Limbless Ex-Service Men's Association. RESULTS: A total of 101 individuals (men, 100; mean age, 73.8 yrs, SD 11.94) with acquired upper limb amputations (98 traumatic cases) completed the TAPES. Principal components analyses with varimax rotation revealed four psychosocial subscales (general adjustment, social adjustment, optimal adjustment, and adjustment to limitation), four activity-restriction subscales (restriction of lifestyle, social restriction, occupational restriction, and restriction of mobility), and a single prosthesis-satisfaction subscale. Each of these subscales had high internal reliability. CONCLUSIONS: The TAPES structure can be meaningfully represented in terms of nine internally consistent subscales. Additional research needs to be done on the TAPES for use with individuals with upper limb amputations. In particular studies of the scales, predictive validity is warranted.