A new clinical trial of the effect of larval therapy

The VenUS II trial is the first large, prospective clinical study to investigate the effect of larval therapy and hydrogel on both the bacteriology and healing of leg ulcers. This trial will compare the clinical and cost effectiveness of two types of larval therapy (loose and bagged) with a standard debridement intervention (hydrogel) in terms of effects on time to complete healing, time to debridement, wound microbiology, cost of treatment and health-related quality of life. This paper describes the aims and design of the trial, outlines the eligibility criteria for patients and discusses the nurses' role in the study. This article has not been subject to peer review.     

Behavioral therapy in the treatment of pediatric obesity

This article was designed to make a strong case for the importance of studying behavior and using behavioral therapy in the treatment of pediatric obesity. Behavioral treatments have been the most studied approaches to pediatric obesity, with great success. Six studies that provided long-term results are presented, and ideas for translating behavioral therapy into common pediatric practice are presented. Additional progress is needed to incorporate new findings in learning and behavioral neuroscience into clinical interventions and to integrate behavioral therapy with pharmacologic interventions and genetic predispositions and new advances in nutrition and exercise science.     

"No thank you": Why elderly patients declined to participate in a research study

Objectives: To compare the population consenting for a study of the effectiveness of a pharmacistrun medication review clinic with the population not consenting for patients aged over 65 years old with respect to age, sex and number of repeat medicines. To explore the reasons why some patients declined to consent to the study.Methods: Letters were sent to 2,403 patients aged 65 and over and taking at least one repeat medicine from 4 general practices. If no reply was received to a second letter they were followed up by telephone. If they declined to consent they were asked for their reasons. Data for consenting and nonconsenting patients was collected on the stratification factors: age, sex and number of repeat medicines. Multiple logistic regression was used to assess the association of each factor with consent rates.Results: Consenting patients were dissimilar to nonconsenting patients. Patients were less likely to consent if they were older, OR (95% CI) = 0.54 (0.46,0.64), or female, OR (95% CI) = 0.74 (0.63,0.88). Patients were more likely to consent if on 5 or more repeat medicines: OR (95% CI) = 1.3 (1.1,1.5). Ten broad categories of reasons why patients did not wish to participate were identified from the patient interviews.Conclusions: Patients were less likely to give their consent if they were elderly, female and on fewer repeat medicines. A number of administrative and behavioural factors were identified which reduced the chances of informed consent being given. These factors need to be addressed to maximise numbers of consenting patients in medication review studies.     

Greater variety of fruit served in a four-course snack increases fruit consumption

Greater variety of energy-dense foods increases intake in meals composed of several courses. Little research has examined the effect of variety in low-energy-dense foods (i.e., fruits and vegetables). This study examined the effect of fruit variety on fruit intake during a four-course snack. Twenty unrestrained eaters (50% female, 100% White and Non-Hispanic, aged 26.5±8.1years, with a body mass index [BMI] of 22.9±3.0kg/m) completed two, counter-balanced sessions, VARIETY and NON-VARIETY. In VARIETY, participants received four highly-liked fruits over 4, 7-min courses, while in NON-VARIETY participants received their most highly-liked fruit (fruit 1) for each of the four courses, to consume ad libitum. Intake, grams and energy, in each course was measured. Changes in pleasantness for each of the four fruits, with measures taken prior to course 1 and at the completion of course 4, were calculated. Greater intake (grams and energy) occurred in course 4 in VARIETY as compared to NON-VARIETY. Changes in pleasantness for fruit 1 were significantly different between the sessions, with NON-VARIETY decreasing more so than VARIETY. These results indicate that greater fruit variety increased fruit consumption in the last course, which may be due to differential changes in fruit pleasantness.     

Intra- and interindividual variation in measurements of beta-carotene, retinol, and tocopherols in diet and plasma

Twenty-four men were studied for 4 wk to estimate intra- and interindividual variation of retinol, beta-carotene, and tocopherols in diet and plasma. Ratios of intra- to interindividual variances ranged from 0.62 for beta-carotene in plasma to 6.02 for vitamin E in diet. Results indicate that 3-9 independent measurements may be required to distinguish reliably even large differences (approximately 1 SD) in these micronutrients; 28-86 independent measurements may be needed for small differences (approximately 0.25 SD). If uncontrolled, large ratios of intra- to interindividual variance can constitute an important source of error in studies of micronutrients.     

Biochemical nature of the prostate-associated antigen identified by the monoclonal antibody, KR-P8

The KR-P8 monoclonal antibody identifies an organ-specific antigen that is associated with normal as well as malignant specimens of human prostate tissue. The antigen is secreted by cells of the prostate and is present in samples of seminal plasma. Data presented here describe the biochemical nature of the antigen that is recognized by KR-P8 as it occurs in seminal plasma and in extracts prepared from cells of the prostate tumor line, PC3. Antigen contained in seminal plasma migrated as a broad band on SDS-polyacrylamide gels in the molecular weight range of 48,000-75,000 d. A similar pattern was observed for antigen prepared from detergent extracts of PC3 cells. The antigen was found to be sensitive to treatment with trypsin and chymotrypsin and the contribution of carbohydrate residues to the structure of the molecule was shown by studies that demonstrated binding of the antigen to Concanavalin A and Soybean Agglutinin lectins. Loss of antigenicity subsequent to periodate oxidation suggested that carbohydrate units are involved in the recognition site for KR-P8 on the antigen.     

Accuracy and precision of manufacturer-supplied liquid medication administration devices before and after patient education

ObjectiveTo compare the accuracy and precision of a manufacturer-supplied dropper versus a pharmacy-supplied syringe when measured by a trained student pharmacist and to evaluate patients' ability to accurately measure a prescribed amount of medication with these devices before and after counseling on their use.MethodsThis was a two-phased study with a pretest/posttest design of 125 community pharmacy patrons of Virginia community pharmacies. Deliverable volume was measured by a student pharmacist for nystatin suspension and digoxin elixir using the manufactured-supplied device. Patients at pharmacies were asked to complete a short survey, then asked to measure a specified dose of nystatin suspension and digoxin elixir (using the manufacturer-supplied administration device). The patients repeated this a second time after a student provided education on how to properly use each administration device. The main outcomes measure was whether education on an administration device would provide more measurement accuracy using medications with different physical properties.ResultsFor nystatin, 88% and 85.6% of patients measured with an error of greater than or equal to 20% before and after counseling, respectively. For digoxin, the totals were 24.8% before counseling and 4% after. A statistically significant (P < 0.05) difference was observed in the percent measurement error before and after counseling for nystatin and digoxin both for patients who had been educated before the study and for those who had not been counseled.ConclusionIn general, the accuracy of medication dosage devices seems to be most affected by viscosity of the liquid being measured. With education on proper use, the oral syringe provides a statistically and clinically significant improvement in dosing accuracy for viscous medications compared with the manufacturer-supplied dropper. Pharmacists must review with patients the proper way to use a manufacturer- or pharmacy-supplied oral delivery device for appropriate dosing measurements.     

How professionals define medicines management: a preliminary qualitative investigation

“Medicines management” is a poorly defined concept within pharmacy practice and little is known about the understanding of the term by other health professionals Semi‐structured interviews with GPs, practice nurses and community pharmacists showed that they viewed medicines management in relation to specific tasks and activities, their own specialist training and in the context of current health priorities Three main interpretations emerged: medication focused, patient focused and a professional instigated focus An accepted understanding of terms such as like “medicines management” is essential for an effective intra‐ and inter‐professional approach to supporting people and their medicines