Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.

Background: While electroconvulsive therapy (ECT) in major depression is effective, cognitive effects limit its use. Reducing the width of the electrical pulse and using the right unilateral electrode placement may decrease adverse cognitive effects, while preserving efficacy.

Methods: In a double-masked study, we randomly assigned 90 depressed patients to right unilateral ECT at 6 times seizure threshold or bilateral ECT at 2.

HIV testing among at-risk adolescents and young adults: a prospective analysis of a community sample.

Purpose: Little is known about predictors of human immunodeficiency virus (HIV) testing among sexually active adolescents, who account for a large proportion of new HIV infections. This study sought to determine predictors of HIV testing among a large community-based sample of adolescents in three cities who had recent unprotected sexual intercourse.

Methods: Sexually active adolescents (N = 1222) completed baseline and 3-month assessments of sexual behavior, substance use and HIV testing behaviors as part of a larger, multi-site, brief HIV prevention program.

Hydrolysis of a series of parabens by skin microsomes and cytosol from human and minipigs and in whole skin in short-term culture.

Parabens are esters of 4-hydroxybenzoic acid and used as anti-microbial agents in a wide variety of toiletries, cosmetics and pharmaceuticals. It is of interest to understand the dermal absorption and hydrolysis of parabens, and to evaluate their disposition after dermal exposure and their potential to illicit localised toxicity. The use of minipig as a surrogate model for human dermal metabolism and toxicity studies, justifies the comparison of paraben metabolism in human and minipig skin.

The distribution of esterases in the skin of the minipig.

Skin esterases serve an important pharmacological function as they can be utilised for activation of topically applied ester prodrugs. Understanding the nature of these enzymes, with respect to their role and local activity, is essential to defining the efficacy of ester prodrugs. Minipigs are used as models to study the kinetics of absorption of topically applied drugs.

Specificity of procaine and ester hydrolysis by human, minipig, and rat skin and liver.

The capacity of human, minipig, and rat skin and liver subcellular fractions to hydrolyze the anesthetic ester procaine was compared with carboxylesterase substrates 4-methylumbelliferyl-acetate, phenylvalerate, and para-nitrophenylacetate and the arylesterase substrate phenylacetate. Rates of procaine hydrolysis by minipig and human skin microsomal and cytosolic fractions were similar, with rat displaying higher activity. Loperamide inhibited procaine hydrolysis by human skin, suggesting involvement of human carboxylesterase hCE2.

Enhancing clinical skills education: University of Virginia School of Medicine's Clerkship Clinical Skills Workshop Program.

In 1993, the University of Virginia School of Medicine began a clinical skills workshop program in an effort to improve the preparation of all clerkship students to participate in clinical care. This program involved the teaching of selected basic clinical skills by interested faculty to small groups of third-year medical students. Over the past 14 years, the number of workshops has increased from 11 to 31, and they now involve clerkship faculty from family medicine, internal medicine, and pediatrics.

A systematic review and economic evaluation of statins for the prevention of coronary events.

Objectives: To evaluate the clinical effectiveness and cost-effectiveness of statins for the primary and secondary prevention of cardiovascular events in adults with, or at risk of, coronary heart disease (CHD).

Data Sources: Electronic databases were searched between November 2003 and April 2004.

Review Methods: A review was undertaken to identify and evaluate all literature relating to the clinical and cost effectiveness of statins in the primary and secondary prevention of CHD and cardiovascular disease (CVD) in the UK.

Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial.

The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data.

Acceptance of HIV testing among African-American college students at a historically black university in the south.

Purpose: Routine HIV testing on college campuses has the potential to increase students' awareness of their HIV status. Testing targeted only at persons reporting HIV risk behaviors will not identify infected persons who may deny or be unaware of their risk. Thus, this study sought to investigate the acceptability of rapid HIV testing among African-American college students in a nontraditional setting on a historically black college/university (HBCU) campus.

High- but not low-dose folic acid improves endothelial function in coronary artery disease.

Background: While folic acid (FA) reduces plasma homocysteine (Hcy), whether the simultaneous improvement in endothelial function is dependent on Hcy lowering per se is questionable. In the present study the relationship between FA dose, Hcy lowering and endothelial function in patients with coronary artery disease (CAD) was investigated.

Materials And Methods: Eighty-four patients with CAD received either 400 microg FA or 5 mg placebo daily for a 6-week treatment period.

Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative.

Objective: The objective of this study was to compare the primary and secondary outcomes of very low birth weight infants before and after participation in the Breathsavers Group of the Vermont Oxford Network-sponsored Neonatal Intensive Care Quality Collaborative.

Methods: Hospitals that participated in the Breathsavers Group contributed clinical data on the outcomes of their very low birth weight infants to the Vermont Oxford Network using standardized clinical definitions, data forms, and inclusion criteria. Outcomes from the last year of the collaborative, 2003, were compared with those from the baseline year, 2001.

Evaluation and development of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants.

Objective: The objective of this study was to describe development and implementation of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants (birth weight: 501-1500 g).

Methods: Results of Breathsavers Group meetings, conference calls and critically appraised topic summaries were used to construct potentially better practices. Implementation plans and experiences were reported by participants and collated.

Public health training in genitourinary medicine.

GUM consultants need skills that fall into the broad area of public health

Increased sensitivity to warfarin after heart valve replacement.

Background: The dosage requirement of warfarin to achieve a given international normalized ratio (INR) often varies considerably between the immediate postoperative period and long-term follow-up in patients with prosthetic heart valves, leading to INR instability.

Objective: To document the extent of warfarin sensitivity in a prospective study of patients receiving heart valve replacements.

Methods: Clinical and laboratory data regarding anticoagulation for 111 patients who received warfarin following heart valve replacement were collected during their hospital stay (induction period) and between 1 and 3 months after surgery (follow-up period).

Regional response of myocardial acceleration during isovolumic contraction during dobutamine stress echocardiography: a color tissue Doppler study and comparison with angiocardiographic findings.

Background: Color tissue Doppler imaging permits noninvasive quantitation of regional wall motion. In experimental studies, a new marker, the slope of the isovolumic contraction wave, isovolumic acceleration (IVA) was more insensitive to ventricular loading conditions than myocardial velocities. This study compared the regional response IVA to dobutamine stress echocardiography to angiographic findings.

Conveying the message about optimal infant positions.

The purpose of this study was to determine a convenient communication tool to help educate parents about varying the positions of their new babies. Eighty-eight percent of babies whose parents had received a brochure explaining the importance of early and regularly scheduled "tummy time" were placed in the prone position more than one time a day. Seventeen of 34 babies were started prone before the second week of life.

The impact of job strain on the predictive validity of the theory of planned behaviour: an investigation of exercise and healthy eating.

Objectives: This study examined the impact of the job strain model on exercise and healthy eating within the framework of the Theory of Planned Behaviour.

Design: Participants completed a questionnaire measuring the components of the Theory of Planned Behaviour and the job strain model. A follow-up questionnaire a week later measured behaviour.

Evaluation of an innovative approach to the Director of Public Health's annual report.

Background: The aim of this study was to evaluate the process of an innovative 'presentation with discussion' approach to the Director of Public Health's (DPH) annual report for North Derbyshire Health Authority.

Study Design: Mixed methods-survey and interviews.

Methods: Survey methods were used to obtain qualitative and quantitative data.

Strain rate imaging after dynamic stress provides objective evidence of persistent regional myocardial dysfunction in ischaemic myocardium: regional stunning identified?

Objective: To investigate whether persistent ischaemic dysfunction of the myocardium after dynamic stress can be diagnosed from changes in ultrasonic strain rate and strain.

Design: Prospective observational study, with age matched controls.

Setting: University hospital.

The role of perceived need within the theory of planned behaviour: a comparison of exercise and healthy eating.

Objectives: This study examined the effect of perceived need on exercise and healthy eating using the theory of planned behaviour (TPB). In addition, it investigated the determinants of perceived need.

Method: Participants completed a questionnaire measuring components of TPB and perceived need.

Impact of educational mailing on the blood pressure of primary care patients with mild hypertension.

Objective: To assess the effectiveness of mailed hypertension educational materials.

Design: Prospective, randomized, controlled single-blind trial.

Setting: Primary care practice-based research network in which 9 clinics located in Portland, Oregon participated.

Role of natriuretic peptides in regulation of conduit artery distensibility.

Arterial distensibility, assessed by the pulse-wave velocity (PWV), is an independent predictor of cardiovascular risk. We investigated whether natriuretic peptides, acting locally, modify conduit artery distensibility in vivo. All studies were conducted in anesthetized sheep (n = 18) by using a validated ovine hindlimb model.

Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants.

Objective: Nosocomial bloodstream infections (NBIs) are associated with serious morbidity and prolonged length of stay (LOS) in very low birth weight (VLBW) infants. However, the marginal costs and excess LOS associated with these infections have never been measured in different birth weight (BW) categories after adjustment for many of the potentially confounding demographic variables, comorbidities, and treatments. The objective of this study was to measure the marginal cost and excess LOS caused by NBIs in surviving VLBW infants in different BW categories.

Lack of type 1 sensitization to laundry detergent enzymes among consumers in the Philippines: results of a 2-year study in atopic subjects.

Background: Enzymes have been safely used in laundry products for many years. The risk of developing adverse responses to enzymes in laundry detergents among consumers in countries where hand laundry predominates is expected to be low.

Objectives: To understand how consumers in hand laundry markets used detergent products; to show that use of enzyme-containing detergents did not lead to sensitization in an atopic population with compromised skin; and to show that enzyme detergents did not have an adverse effect on skin condition.