Minimal clinically important difference. Low back pain: outcome measures

A proposed standard "core set" of outcome measures for low back pain includes 5 domains: back-specific function, generic health status, pain, work disability, and patient satisfaction. This paper focuses on the 2 recommended back-specific measures of function: the Roland-Morris Disability Questionnaire (RDQ) and the Oswestry Disability Index (ODI). We specifically address their ability to measure change. A systematic review of the literature identified a total of 78 and 71 (RDQ and ODI, respectively) articles as potentially relevant. Detailed tables are provided for each citation, with the type of back pain population studied, the type of change measured, the estimate of change, and the interval over which the change was studied. These tables should be used as a reference for sample size calculation. The responsiveness of the RDQ found in the literature ranges from 2 to 8 points on its 0 to 24 scale depending on what change is being measured. As a rough guide, Roland recommends that a change in 2-3 points on the RDQ should be considered the minimum clinically important change. Choosing any value larger than 5 in designing a clinical trial would risk underpowering the trial, since fewer patients are needed if a trial is designed on the basis of a large change score.     

ACUPUNCTURE CHANNELS - MYTH OR REALITY GS Sekhon School of Surgery and Allied Sciences

Spurred by recent advances in the ancient science of acupuncture in China, world interest in the subject has renewed. While the benefits of acupuncture are evident, its. mode of action and the existence of channels and collaterals are major controversial subjects. Based on personal experience and that of some of their colleagues and patients, the authors believe that channels and collaterals exist. These channels not only play a role in the treatment of deep seated dis- eases and analgesia induction and probably a.lso moderate normal healthy perception. The ex- istence of channels and their collaterals has not been proved anatomically.     

Health care utilization and workplace interventions for neck and upper limb problems among newspaper workers

Data on the use of various therapeutic interventions among working populations at risk for musculoskeletal disorders are rare, despite the need for such information in assessing adherence to best practices. Using the results of a cross-sectional survey of newspaper workers who reported neck and upper limb pain or discomfort (n = 309), we describe the prevalence of a wide range of clinical and workplace interventions. Information/education, exercises, and physical treatments were the most common interventions, and work changes were less prevalent. Those with more frequent, longer-duration, and/or more severe symptoms more commonly reported visits to physiotherapists and health practitioners at work and use of physical treatments, medications, and devices. The multiplicity of interventions used pose evaluation challenges for occupational health practitioners and researchers.     

Compliance in a randomized clinical trial of dietary fat reduction in patients with breast dysplasia

Dietary compliance was studied in 57 women participating for 1 y in a randomized clinical trial of dietary fat reduction. Nutrient analysis of food records, collected at 0, 6, and 12 mo, was compared with changes observed in lipid profiles and with chemical analysis of duplicate diets. Both food records and duplicate meals showed a significant decrease in fat intake (from 36 to 23% of total calories, p less than 0.0001) and a significant increase in carbohydrate (from 43 to 56% of total calories, p less than 0.0001) in the intervention group. The calculated nutrient intake from food records tended to overestimate the intake of protein, fat, and carbohydrate compared with the chemically analyzed method. The mean level of plasma cholesterol in the intervention group was significantly reduced (7.3%, p less than 0.01) in the first 6 mo after a reduction in dietary fat but the levels observed did not differ significantly between the groups at any time.     

Factors related to the practice of breast self examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories

Background  

The Malaysian Ministry of Health promotes breast self-examination (BSE) for all women, and Pap smear screening every three years for all sexually active women ages 20 years and above. The objectives of this paper were to examine the practice of these two screening tests among women production workers in electronics factories, and to identify factors related to practice.     

Dimensions of nurse and patient roles in labor

Nurses, as the principal caregivers during labor, play a major role in structuring the social context of childbirth. The influence of nurse‐patient verbal interaction on the social construction of the childbirth experience was investigated. Verbatim records of nurse‐patient interaction during labor were analyzed using Stiles's (1978a) Taxonomy of Verbal Response Modes. Nurse and patient scores on three dimensions of interpersonal roles, attentiveness, acquiescence, and presumptuousness, were determined. The results indicated that nurses established and maintained control over the definition of the childbirth experience. The viewpoint of the laboring woman was seldom acknowledged as relevant. Presumption of knowledge of the laboring woman's experience and failure to determine her perception of the situation can have a negative impact on individualization of care and the creation of a patient‐centered birthing environment.     

抗真菌药物的研究II.C-端含氧代赖氨酸二肽的合成及抗白念珠菌活性

引用违法传递概念设计合成了11个C-末端含氧代赖氨酸二肽,进行抗深部致病菌-白念珠菌活性试验,体外实验结果显示极强的抑菌活性,MIC在12.5～0.8μg/disk之间,较母体氧化赖氨酸大50～135倍(克分子比。