"Mad for Fitness": an exercise group to combat a high incidence of postnatal depression

Health visitors working in a socially and economically deprived area of the Wirral, Merseyside wanted to find innovative ways to address the high incidence of postnatal depression in their caseloads. Believing that exercise may have a beneficial effect on depression, they set up a project to make fitness activities more affordable and available to their client base. After an initial survey of local mothers had indicated support, a pilot "swim, gym and crèche" scheme was set up in a Leisure Centre in partnership with other agencies. The response from the pilot group was positive and suggested that the participants were benefiting mentally and physically from the exercise and the social aspects of the group. Parents began to take a greater part in running the group and funding was obtained to continue the scheme. Further evaluation is in progress and there are plans to replicate the scheme in other areas of the local Primary Care Trust.     

The use of intraperitoneal bupivacaine to decrease the length of stay in elective laparoscopic cholecystectomy patients

This prospective, double-blind, randomized, and placebo-controlled study evaluates the effectiveness of intraperitoneal bupivacaine in decreasing the length of stay for elective laparoscopic cholecystectomy patients. Seventy-seven patients undergoing elective laparoscopic cholecystectomy before noon at a single institution and by a single group of surgeons were entered into the study. The pharmacy randomly assigned each patient to one of four study groups (control, predissection, postdissection, and both). Two syringes (A and B) containing 15 cm3 of either normal saline or 0.5 per cent bupivacaine were sent with the patient to surgery. Syringe A was sprayed over the perihepatic area before any dissection, and B was sprayed over the perihepatic area just before port removal. Preoperative, intraoperative, and postoperative data were collected. Sixty-six patients completed the study: control, 14; predissection, 18; postdissection, 15; and both, 19. There was no statistical difference between the predissection, postdissection, and both groups regarding same-day discharge. Therefore, these groups were combined for comparison against the control group. The study found that patients receiving bupivacaine at any time during the surgery were more likely to go home the same day as their procedure (79% vs 43%, respectively: P < 0.02).     

Clinical benefits of neoral C2 monitoring in the long-term management of renal transplant recipients

BACKGROUND: Cyclosporine monitoring using the 2-hr postdose sample, C2, has been shown to have advantages in monitoring de novo renal transplant recipients. The purpose of this study was to assess cyclosporine exposure, using C2, in stable renal transplant patients previously monitored by C0 to determine the effect of dose reduction on patients with C2 more than 10% above target and the course of those with C2 at and more than 10% below target, whose dose was not modified. METHODS: One hundred and seventy-five patients, three or more months after transplantation, had C2 assessed. The relationship of C2 to C0 and of both to renal function was analyzed by linear regression. Blood pressure, serum creatinine level, and lipids were followed for a mean of 15+/-2.6 months. RESULTS: Eighty-five patients had values more than 10% above target, 42 were within 10% of target, and 48 were more than 10% below target. Cyclosporine dose was reduced in all patients above target. In this group, serum creatinine level was stable overall, but fell significantly in 46 (54%) of 85 from 153+/-55 to 132+/-49 microM. Blood pressure also fell in that group from 135/82 to 131/77. Serum creatinine level was stable in the remaining two groups of patients. CONCLUSIONS: These data suggest that dose reduction in many overexposed patients leads to improvements in renal function and blood pressure. Further study is required to confirm the long-term benefits of this strategy.     

Capillary pressure in subjects with type 2 diabetes and hypertension and the effect of antihypertensive therapy

Raised capillary pressure has been implicated in the formation of diabetic microangiopathy in type I diabetes, in which it is elevated in those with the earliest signs of diabetic kidney disease but remains normal in those without complications. In subjects with type 2 diabetes without complications, capillary pressure is normal, although alterations in the pressure waveforms suggested enhanced wave reflections. The nature of skin capillary pressure in subjects with type 2 diabetes and hypertension remains to be elucidated, as does the effect of blood pressure-lowering therapy on capillary pressure in these subjects. Three studies were performed in well-matched groups. First, capillary pressure was elevated in hypertensive subjects with type 2 diabetes compared with normotensive subjects with type 2 diabetes (20.2 [17.4 to 22.7] mm Hg versus 17.7 [16.1 to 18.9] mm Hg, respectively, P<0.03, Mann-Whitney U test). Second, no significant difference was detected between hypertensive subjects with type 2 diabetes and hypertensive subjects without type 2 diabetes (19.4 [15.8 to 21.3] mm Hg versus 17.2 [15.1 to 19.8] mm Hg, respectively, P=0.5, Mann-Whitney U test). Finally, patients with type 2 diabetes were recruited to a case-control study. Seven subjects received blood pressure-lowering therapy and 8 did not. Therapy reduced capillary pressure from 18.2 [15.8 to 20.1] mm Hg to 15.9 [15.4 to 17.0] mm Hg (P=0.024 ANOVA), in contrast to the lack of effect of time alone. Mean arterial pressure was reduced from 110 [102 to 115] mm Hg to 105 [101 to 111] mm Hg (P=0.006, ANOVA). These findings provide a plausible mechanism by which reducing arterial hypertension may reduce the risk of microangiopathy in type 2 diabetes.     

Meeting the requirements for becoming a nurse lecturer

Career planning is essential for nurses considering a change in role, as it provides direction and enables them to use time and money efficiently. This article describes a survey of 25 universities in which each participating institution was asked to comment on the required characteristics of nurse lecturers. The results should be useful to nurses who are planning to become nurse lecturers in the future.     

Recommendations for reporting results of diagnostic genetic testing (biochemical,cytogenetic and molecular genetic)

Genetic test results can have considerable importance for patients, their parents and more remote family members. Clinical therapy and surveillance, reproductive decisions and genetic diagnostics in family members, including prenatal diagnosis, are based on these results. The genetic test report should therefore provide a clear, concise, accurate, fully interpretative and authoritative answer to the clinical question. The need for harmonizing reporting practice of genetic tests has been recognised by the External Quality Assessment (EQA), providers and laboratories. The ESHG Genetic Services Quality Committee has produced reporting guidelines for the genetic disciplines (biochemical, cytogenetic and molecular genetic). These guidelines give assistance on report content, including the interpretation of results. Selected examples of genetic test reports for all three disciplines are provided in an annexe.Diagnostic genetic testing is an extremely rapidly expanding area encompassing a broad range of laboratory investigations to analyse chromosomes (from classical karyotype to molecular cytogenetics), nucleic acids (DNA, RNA), proteins and metabolites used to detect heritable or somatic mutations, genotypes or phenotypes related to disease and health. Genetic testing requires particular consideration in that it is usually performed only once in a patient''s lifetime, and the results may have considerable importance for lifetime decisions not only for the individuals being tested but also for children and family. Interpreting and reporting variation in germline chromosomes, DNA sequences or their products is a heavy clinical responsibility for prediction of susceptibility to disease, patient diagnosis, prognosis, counselling, treatment or family planning. Providing a set of reporting frameworks that can be customised for different testing contexts but share some common principles could be beneficial to the practice of a number of laboratories, including non-OECD members and/or laboratories that do not participate in External Quality Assessments (EQA), and to laboratories with blurred boundaries between research and genetic testing services.Although several guidelines already exist for reporting the results of genetic testing,^1,2,3 these focus on molecular genetic testing and do not cover the other two branches of laboratory genetics, namely biochemical genetics and cytogenetics. Based on recent surveys of EQA results presented by some European EQA providers and the request from genetic laboratories for comprehensive reporting guidelines, it was considered that a unifying attempt to harmonise the reporting practice of genetic tests in Europe and neighbouring countries would be welcome.     

Estimates of basilar-membrane nonlinearity effects on masking of tones and speech

OBJECTIVE: The aim of this experiment was to assess the contribution of cochlear nonlinearities to speech recognition in noise for individuals with normal hearing and a range of quiet thresholds. For signals close to the characteristic frequency (CF) of a place on the basilar membrane, the normal growth of response of the basilar membrane is linear at lower signal levels and compressed at medium to higher signal levels. In contrast, at moderate to high CFs, the basilar membrane responds more linearly to stimuli at frequencies well below the CF regardless of input level. Thus, for moderate-level speech and a lower frequency masker, the response to the masker grows linearly whereas the response to the speech is compressed, which may result in changes in the effectiveness of the masker on speech recognition with increases in masker level. To test this hypothesis, observed speech-recognition scores were compared with scores predicted using an audibility-based model, which did not include nonlinear effects that may influence masker effectiveness. DESIGN: Growth of simultaneous masking was measured for moderate-level bandpass-filtered nonsense syllables and for 350-msec pure tones at frequencies within the speech passband. Masker frequencies were within (on-frequency) or below (off-frequency) the speech passband. Estimates of basilar-membrane nonlinearities were derived from growth-of-masking functions for 10-msec, 2.0- and 4.0-kHz tones in narrowband, off-frequency maskers presented simultaneously. Subjects were 26 adults with normal hearing with approximately a 20-dB range of average quiet thresholds. RESULTS: Breakpoints (i.e., the levels corresponding to the transitions from linear to nonlinear responses) were strongly associated with quiet thresholds but slopes measured above the breakpoints were independent of quiet thresholds. Individual differences were substantially larger for off-frequency masking of pure tones and speech than for on-frequency masking of pure tones and speech. Using an audibility-based predictive model, the change in speech audibility resulting from the compressed response to speech with increasing off-frequency masker level (and the resulting decline in scores) was well predicted from nonlinear growth of masking for pure tones measured in the same off-frequency masker. However, absolute speech-recognition predictions were generally inaccurate and were a function of how well pure-tone signal levels at masked threshold estimated masker effectiveness for speech. That is, subjects with lower off-frequency masked thresholds had less accurate predictions of speech recognition in off-frequency maskers. CONCLUSIONS: Large individual differences in off-frequency masking of pure tones and speech are consistent with the assumption that small changes in the shape of the basilar-membrane input-output function result in large changes in the amount of off-frequency masking but small (if any) changes in on-frequency masking where the signal and masker are subject to a similar compression. Growth of off-frequency masking of pure tones and speech were correlated with each other, consistent with the underlying basilar-membrane response, and consistent with changes in breakpoints for subjects with normal hearing and a range of quiet thresholds. These results provide support for a role of nonlinear effects in the understanding of speech in noise.     

Impact of commercial support on continuing pharmacy education

INTRODUCTION: There is a serious debate over the involvement of the pharmaceutical industry in continuing education. Policies that govern the planning of continuing education for pharmacists center on the potential conflict of interest when there is commercial support for programs. The purpose of this study was to investigate the impact of commercial support on the provision and perceived outcomes of continuing pharmacy education. METHODS: A survey was administered online to a national sample of accredited providers of continuing pharmacy education, resulting in 134 responses. The 64-item survey was developed to measure the planning practices of these providers and their perceptions of the educational and noneducational consequences of commercial support for continuing education. RESULTS: One hundred thirty-four usable questionnaires (34%) were received from 386 leaders in pharmacy education. Approximately 86% of providers and 43% of programs received commercial support. Although the Accreditation Council for Pharmacy Education requires that providers review instructional content and materials for commercially supported programs before delivery, only 43% always did so. Commercial support was perceived to have consequences for provider organizations, pharmacists, and patients, such as increased cost and use of drugs and financial dependency of providers and participants on industry support. DISCUSSION: The results of our study lead to the conclusions that commercial support of continuing education is widespread, affects continuing education programs, and is perceived to have significant educational and noneducational consequences. The profession should ensure that continuing education guidelines are unambiguous related to specific practices that are allowable and unallowable when receiving commercial support. Future research should study the consequences of commercial support behaviorally by examining the effects on pharmacy professionals' practice and pharmaceutical care.     

Greater Maternal Weight Gain During Pregnancy Predicts a Large but Lean Fetal Phenotype: A Prospective Cohort Study

The objective of this study is to describe the fetal phenotype in utero and its associations with maternal pre-pregnancy weight and gestational weight gain. This prospective longitudinal cohort included 179 Australian women with singleton pregnancies. Serial ultrasound measurements were performed at 19, 25, 30 and 36 (±1) weeks gestation and maternal anthropometry were collected concurrently. The ultrasound scans included the standard fetal biometry of head circumference, biparietal diameter, abdominal circumference, and femur length, and body composition at the abdomen and mid-thigh, including fat and lean mass cross-sectional areas. Maternal gestational weight gain was compared to current clinical guidelines. The participants had an average of 3.7 ± 0.8 scans and birth data were available for 165 neonates. Fifty four per cent of the cohort gained weight in excess of current recommendations, according to pre-pregnancy body mass index (BMI). Maternal gestational weight positively predicted fetal abdominal circumference (P 0.029) and lean abdominal mass area (P 0.046) in linear mixed model regression analysis, adjusted for known and potential confounders. At any pre-pregnancy BMI gaining weight above the current recommendations resulted in a larger fetus according to standard biometry, because of significantly larger lean muscle mass at the abdomen (P 0.024) and not due to an increase in fat mass (P 0.463). We have demonstrated the importance of maternal weight gain, independent of pre-pregnancy BMI, to support the growth of a large but lean fetus. Prenatal counselling should focus on achieving a healthy BMI prior to conception so that gestational weight gain restrictions can be minimised.