Psychosocial telephone interventions for patients with cancer and survivors: a systematic review.

OBJECTIVE: Over one third of patients with cancer experience elevated psychosocial distress. As screening for distress becomes more common, the number of patients referred for psychosocial care will increase. Psychosocial telephone interventions are recommended as a convenient and exportable alternative to in-person interventions addressing psychosocial distress. This study reviews the efficacy of randomized controlled trials (RCTs) of psychosocial telephone interventions for patients with cancer. METHODS: We conducted a systematic review of peer-reviewed RCTs evaluating telephone interventions in adult patients with cancer across the survivorship continuum. RESULTS: Through a database search, 480 articles were identified. After manual review, 13 were included, with 7 additional studies identified by back citation, totaling 20 studies. Participants were largely Caucasian, highly educated, with mean age ranging from 49 to 75 years. Most participants were patients with breast cancer (n = 13 studies). Sample sizes were generally small, with most patients recruited from large medical centers. Only one screened for psychosocial need. Interventions varied greatly in length and intensity. Eight studies reported significant effects post-intervention in the hypothesized direction on at least one psychosocial outcome measure. Of these eight studies, four included more than one follow-up assessment; of these, only one reported significant effects at last follow-up. No clear commonalities were found among studies reporting significant effects. CONCLUSIONS: Methodological concerns and lack of consistency in adherence to CONSORT reporting guidelines were identified. This body of research would benefit from well-designed, theory-based RCTs adequately powered to provide more definitive evidence for intervention efficacy. This will probably require multi-institutional collaborations, guided by intervention and research methodology best practices.

Prevalence and predictors of distress in posttreatment adult leukemia and lymphoma survivors.

This paper examines predictors of cancer-specific distress among posttreatment adult leukemia and lymphoma survivors (LLS). Using a survey mailed to LLS in the Colorado Central Cancer Registry (N = 477), the authors developed a multivariable risk profile for distress. Thirty one percent of LLS reported indicators of distress. Significantly higher distress was associated with younger age (p < 0.001) in bivariate analyses. The risk profile included fear of recurrence, financial burden, and younger age. Distress did not attenuate based on time since treatment completion and may persist up to 4 years posttreatment, suggesting a need for intervention, particularly among high-risk LLS.

Early effect of tidal volume on lung injury biomarkers in surgical patients with healthy lungs.

BACKGROUND: The early biological impact of short-term mechanical ventilation on healthy lungs is unknown. The authors aimed to characterize the immediate tidal volume (VT)-related changes on lung injury biomarkers in patients with healthy lungs and low risk of pulmonary complications. METHODS: Twenty-eight healthy patients for knee replacement surgery were prospectively randomized to volume-controlled ventilation with VT 6 (VT6) or 10 (VT10) ml/kg predicted body weight. General anesthesia and other ventilatory parameters (positive end-expiratory pressure, 5 cm H2O, FIO2, 0.5, respiratory rate titrated for normocapnia) were managed similarly in the two groups. Exhaled breath condensate and blood samples were collected for nitrite, nitrate, tumor necrosis factor-α, interleukins-1ß, -6, -8, -10, -11, neutrophil elastase, and Clara Cell protein 16 measurements, at the onset of ventilation and 60 min later. RESULTS: No significant differences in biomarkers were detected between the VT groups at any time. The coefficient of variation of exhaled breath condensate nitrite and nitrate decreased in the VT6 but increased in the VT10 group after 60-min ventilation. Sixty-minute ventilation significantly increased plasma neutrophil elastase levels in the VT6 (35.2 ± 30.4 vs. 56.4 ± 51.7 ng/ml, P = 0.008) and Clara Cell protein 16 levels in the VT10 group (16.4 ± 8.8 vs. 18.7 ± 9.5 ng/ml, P = 0.015). Exhaled breath condensate nitrite correlated with plateau pressure (r = 0.27, P = 0.042) and plasma neutrophil elastase (r = 0.44, P = 0.001). Plasma Clara Cell protein 16 correlated with compliance (r = 0.34, P = 0.014). CONCLUSIONS: No tidal volume-related changes were observed in the selected lung injury biomarkers of patients with healthy lungs after 60-min ventilation. Plasma neutrophil elastase and plasma Clara Cell protein 16 might indicate atelectrauma and lung distention, respectively.

Predictors of early faculty attrition at one Academic Medical Center.

BACKGROUND: Faculty turnover threatens the research, teaching and clinical missions of medical schools. We measured early attrition among newly-hired medical school faculty and identified personal and institutional factors associated with early attrition. METHODS: This retrospective cohort study identified faculty hired during the 2005-2006 academic year at one school. Three-year attrition rates were measured. A 40-question electronic survey measured demographics, career satisfaction, faculty responsibilities, institutional/departmental support, and reasons for resignation. Odds ratios (ORs) and 95 percent confidence intervals (95% CI) identified variables associated with early attrition. RESULTS: Of 139 faculty, 34% (95% CI = 26-42%) resigned within three years of hire. Attrition was associated with: perceived failure of the Department Chair to foster a climate of teaching, research, and service (OR = 6.03; 95% CI: 1.84, 19.69), inclusiveness, respect, and open communication (OR = 3.21; 95% CI: 1.04, 9.98). Lack of professional development of the faculty member (OR = 3.84; 95% CI: 1.25, 11.81); institutional recognition and support for excellence in teaching (OR = 2.96; 95% CI: 0.78, 11.19) and clinical care (OR = 3.87; 95% CI: 1.04, 14.41); and >50% of professional time devoted to patient care (OR = 3.93; 95% CI: 1.29, 11.93) predicted attrition. Gender, race, ethnicity, academic degree, department type and tenure status did not predict early attrition. Of still-active faculty, an additional 27 (48.2%, 95% CI: 35.8, 61.0) reported considering resignation within the 5 years. CONCLUSIONS: In this pilot study, one-third of new faculty resigned within 3 years of hire. Greater awareness of predictors of early attrition may help schools identify threats to faculty career satisfaction and retention.

Cancer patient and survivor research from the cancer information service research consortium: a preview of three large randomized trials and initial lessons learned.

The authors describe 3 large randomized trials from the Cancer Information Service Research Consortium. Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 also tests a telephone callback intervention delivered by a cancer information specialist. All participants receive standard print material specific to each project. Preliminary results from the 2-month follow-up interviews are reported for the initial wave of enrolled participants, most of whom were recruited from the Cancer Information Service (1-800-4-CANCER) telephone information program (Project 1: n =208; Project 2: n =340; Project 3: n =792). Self-reported use of the multimedia program was 51%, 52%, and 67% for Projects 1, 2, and 3, respectively. Self-reported use of the print materials (read all, most, or some) was 90%, 85%, and 83% for Projects 1, 2, and 3, respectively. The callback intervention was completed by 92% of Project 3 participants. Among those using the Cancer Information Service Research Consortium interventions, perceived usefulness and benefit was high, and more than 90% reported that they would recommend them to other cancer patients. The authors present 5 initial lessons learned that may help inform future cancer communications research.

The Living Well by Faith Health and wellness program for African Americans: an exemplar of community-based participatory research.

BACKGROUND: Using community-based participatory research (CBPR) as a guiding framework, a faith-based diet, nutrition and physical activity intervention for African Americans was implemented and evaluated as a small-scale randomized trial. METHODS: Five churches were recruited (intervention=3, control=2), resulting in an enrolled sample of 106 adults (intervention=74, control=32). The control group received a minimal intervention consisting of one educational workshop. The Living Well By Faith intervention group received a more intensive 8-week program. Classes were held twice a week and included educational workshops and exercise sessions. Both interventions were delivered at participating churches. Assessments for program evaluation occurred at baseline and 2-month follow-up. These included weight, blood pressure, percent body fat, and physical fitness using the step test. RESULTS: The sample was predominantly African American, female and well educated. At baseline, no significant differences between intervention and control groups were found for any of the primary endpoints. At 2-months follow up, the intervention group, compared to the control group, showed significant decreases in weight (P<.02), BMI (P<.05), and % body fat (P<.03), with a significant increase in physical fitness (P<.02). Systolic blood pressure also showed group differences in the predicted direction (P=.10). CONCLUSION: This study provides an exemplar of CBPR. The results obtained are sufficiently promising to support more research involving similar interventions of longer duration and with longer-term follow-up for evaluation.

Sacroiliac Joint Fusion Methodology - Minimally Invasive Compared to Screw-Type Surgeries: A Systematic Review and Meta-Analysis.

BACKGROUND: Sacroiliac (SI) joint fusion represents a unique area of orthopedic surgery with procedural literature dating to the early 1920s, showing limited innovation in either technique or hardware over the last 90 years. Recent improvements in the diagnosis and treatment of SI joint dysfunction warrant comparisons to older surgical techniques. OBJECTIVE: To evaluate treatment efficacies and patient outcomes associated with minimally invasive joint fusion in comparison to screw-type surgeries. STUDY DESIGN: Systematic review and meta-analysis. SETTING: Electronic databases, EMBASE, Pubmed (Medline), manual bibliography cross-referencing for published works until Dec. 31, 2017. METHODS: A thorough literature search was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Data repositories accessed included Pubmed and EMBASE, until Dec. 31, 2017. All studies evaluating sacroiliac joint fusion and reporting quantifiable outcome data were included. Exclusion criteria included nonhuman studies, qualitative reviews, and meta-analyses. Data compilation, coding, and extraction were performed using MedAware Systems proprietary software. Data from each study were extracted by 2 analysts, using software that allowed automatic comparisons of all data fields. The standardized mean difference (SMD) was used as a summary statistic for pooling outcomes data across studies. Multiple outcome measures were grouped into 3 categories, according to similarity of measurements - Pain, Disability/Physical Function, and Global/QOL. RESULTS: A total of 20 studies had adequate data to calculate a SMD, and were included in the meta-analysis. Results of iFuse trials were compared to screw type trials, pooled in 3 categories of outcomes - Pain, Disability/Physical Function, and Global/QOL. The Pain category showed a statistically significant (P = 0.03) difference in outcomes for patients receiving the iFuse implant compared to screw types (SMD = 2.04 [95%CI: 1.76 to 2.33] vs. 1.28 [95%CI: 0.47 to 2.09]), with iFuse showing significantly better outcomes. The Disability category also showed a statistically significant (P = 0.01) difference in outcomes for patients receiving the iFuse implant compared to screw types (SMD = 1.68 [95%CI: 1.43 to 1.94] vs. 0.26 [95%CI: -1.90 to 2.41]), with iFuse showing significantly better outcomes. For Global/Quality of Life (QOL) outcomes, there was a significant difference (P = 0.04) between iFuse and screw-type procedures (SMD = 0.99 [95%CI: 0.75 to 1.24] vs. 0.60 [95%CI: 0.33 to 0.88]), with iFuse showing significantly better outcomes. There was a statistically significant correlation between lower baseline Oswestry Disability Index (ODI) and Short Form 36 Health Survey (SF-36) values and better post treatment outcomes (r2 = 0.47, P < 0.01, and r2 = 0.30, P < 0.01, respectively). An association was found between pain at baseline and better outcomes (r2 = 0.21, P < 0.01), where worse baseline pain was associated with better outcomes. LIMITATIONS: There was a limited number of studies in this meta-analysis with treatments that could be properly classified as screw-type. CONCLUSION: In this analysis, compared to screw-type surgeries, the iFuse system showed statistically superior outcomes. This was the case when outcome measures were classified into 3 main categories - Pain, Disability/Physical Function, and Global/QOL. KEY WORDS: Meta-analysis, systematic review, sacroiliac joint, sacroiliac joint fusion.

The reno-vascular A2B adenosine receptor protects the kidney from ischemia.

BACKGROUND: Acute renal failure from ischemia significantly contributes to morbidity and mortality in clinical settings, and strategies to improve renal resistance to ischemia are urgently needed. Here, we identified a novel pathway of renal protection from ischemia using ischemic preconditioning (IP). METHODS AND FINDINGS: For this purpose, we utilized a recently developed model of renal ischemia and IP via a hanging weight system that allows repeated and atraumatic occlusion of the renal artery in mice, followed by measurements of specific parameters or renal functions. Studies in gene-targeted mice for each individual adenosine receptor (AR) confirmed renal protection by IP in A1(-/-), A2A(-/-), or A3AR(-/-) mice. In contrast, protection from ischemia was abolished in A2BAR(-/-) mice. This protection was associated with corresponding changes in tissue inflammation and nitric oxide production. In accordance, the A2BAR-antagonist PSB1115 blocked renal protection by IP, while treatment with the selective A2BAR-agonist BAY 60-6583 dramatically improved renal function and histology following ischemia alone. Using an A2BAR-reporter model, we found exclusive expression of A2BARs within the reno-vasculature. Studies using A2BAR bone-marrow chimera conferred kidney protection selectively to renal A2BARs. CONCLUSIONS: These results identify the A2BAR as a novel therapeutic target for providing potent protection from renal ischemia.

Chronic renal dysfunction following liver transplantation.

With most of the immunosuppressive protocols consisting of calcineurin inhibitors (CI), nephrotoxicity has become a major long-term complication often compromising outcome. In a single-center retrospective study, we reviewed 1173 liver transplantations to identify variables indicative for the occurrence of chronic renal dysfunction (CRD) (defined as > or = 1 episode of serum creatinine increase > or = 1.8 mg/dL > or = 2 wk). Chronic renal dysfunction was found in 137 (11.7%) of all transplants [82 (7%) early (after 3-12 months), 55 (4.7%) late-onset (> 12 months)]. Compared to 5-/10-yr survival rates in non-CRD transplants (84/74%) survival was significantly decreased in early (66/46%), but unchanged in late-onset CRD (98/86%). Rates of alcoholic cirrhosis and prior renal dysfunction were significantly increased in patients with CRD. In a multivariate logistic regression analysis, only cyclosporine A (CyA) as immunosuppression remained an independent risk factor. No correlations to age, gender, rejection/retransplantation or diabetes were found. Surprisingly, renal function (creatinine) showed no difference between patients on CI monotherapy (FK/CyA) compared to those who had mycophenolate mofetil (MMF) added. In liver transplantation, early onset CRD significantly compromises survival. CyA-based immunosuppression appears to have a stronger impact than FK. The fact that patients with long-term severe chronic renal dysfunction failed to improve under MMF rescue therapy emphasizes the importance of new diagnostic strategies to earlier identify at-risk patients.

Single-institution experience with pemetrexed and bevacizumab as salvage therapy in advanced non-small-cell lung cancer.

BACKGROUND: Second-line cytotoxic therapy for patients with advanced non-small-cell lung cancer (NSCLC) includes single-agent pemetrexed or docetaxel. The addition of bevacizumab to carboplatin/paclitaxel in the first-line setting was shown to improve survival and response. We assessed pemetrexed and bevacizumab compared with pemetrexed alone in the salvage setting. PATIENTS AND METHODS: Patients with advanced NSCLC, in whom at least first-line therapy failed and who received pemetrexed alone or pemetrexed/bevacizumab, were analyzed. RESULTS: From March 2005 through March 2006, we identified 25 patients treated with pemetrexed or pemetrexed/bevacizumab in the salvage setting. There were no significant differences in clinical features. All 25 were evaluable for overall survival, 21 for time to progression, and 19 for objective response evaluation. After a median follow-up of 9.3 months, there were no differences between the cohorts for median overall survival, time to progression, or objective disease control rate (partial response and stable disease). The 6-month survival rate was 56.3% for the pemetrexed group and 66.7% for the pemetrexed/bevacizumab group. There were no grade 3-5 hemorrhagic events. CONCLUSION: This retrospective single institution analysis showed that pemetrexed/bevacizumab was safely administered in the salvage setting of advanced NSCLC. Whether bevacizumab enhances the efficacy of pemetrexed remains to be determined and is the subject of an ongoing randomized clinical trial. Until those results are reported, off-label use of pemetrexed and bevacizumab is not recommended.

A survey of propofol abuse in academic anesthesia programs.

BACKGROUND: Although propofol has not traditionally been considered a drug of abuse, subanesthetic doses may have an abuse potential. We used this survey to assess prevalence and outcome of propofol abuse in academic anesthesiology programs. METHODS: E-mail surveys were sent to the 126 academic anesthesiology training programs in the United States. RESULTS: The survey response rate was 100%. One or more incidents of propofol abuse or diversion in the past 10 yr were reported by 18% of departments. The observed incidence of propofol abuse was 10 per 10,000 anesthesia providers per decade, a fivefold increase from previous surveys of propofol abuse (P = 0.005). Of the 25 reported individuals abusing propofol, 7 died as a result of the propofol abuse (28%), 6 of whom were residents. There was no established system to control or monitor propofol as is done with opioids at 71% of programs. There was an association between lack of control of propofol (e.g., pharmacy accounting) at the time of abuse and incidence of abuse at the program (P = 0.048). CONCLUSIONS: Propofol abuse in academic anesthesiology likely has increased over the last 10 yr. Much of the mortality is in residents. Most programs have no pharmacy accounting or control of propofol stocks. This may be of concern, given that all programs reporting deaths from propofol abuse were centers in which there was no pharmacy accounting for the drug.

Effect of intensive blood pressure control with valsartan on urinary albumin excretion in normotensive patients with type 2 diabetes.

BACKGROUND: Diabetes is the most common cause of renal failure in the United States, and data regarding the effects of aggressive blood pressure (BP) therapy in normotensive patients with type 2 diabetes are inadequate. METHODS: A total of 129 type 2 diabetic patients with a BP of <140/80 to 90 mm Hg without overt albuminuria were randomized to either intensive BP control (diastolic BP goal 75 mm Hg) using an angiotensin II receptor blocker, valsartan, versus moderate BP control (diastolic BP 80 to 90 mm Hg with placebo initially) to evaluate the effect on the change in urinary albumin excretion (UAE) from baseline. RESULTS: The mean entrance BP was 126 +/- 8.8/84 +/- 2.4 mm Hg. The mean follow-up period was 1.9 +/- 1.0 years. During the follow-up period, the mean BP was 118 +/- 10.9/75 +/- 5.7 for the intensive v 124 10.9/80 6.5 mm Hg for the moderate BP groups (P < .001). No difference was observed in change in creatinine clearance or serum creatinine from baseline between the two groups. An analysis of covariance model for change in log (UAE + 1), adjusting for age, HBA(1c), duration of diabetes, baseline log (UAE + 1), sex, and ethnicity resulted in a significant treatment difference at 2 years (P = .007) with intensive BP control reducing log (UAE+1) compared with moderate BP control. CONCLUSION: Intensive BP control with valsartan to <120/80 mm Hg in normotensive patients with type 2 diabetes and normo- or microalbuminuria significantly decreased the progression of UAE and in some cases caused regression of UAE.

Walking and Non-HDL-C in adults: a meta-analysis of randomized controlled trials.

An elevated level of non-high-density lipoprotein cholesterol (non-HDL-C) is a major risk factor for cardiovascular disease. The purpose of this study was to use the meta-analytic approach to examine the effects of walking on non-HDL-C in adults. Twenty-two randomized controlled trials representing 30 outcomes from 948 subjects (573 exercise, 375 control) met our inclusion criteria. Across all designs and categories, random effects modeling resulted in a significantly greater decrease in the walking group when compared with the control group of approximately 4% for non-HDL-C (+/- standard error of the mean, -5.6+/-1.8 mg/dL, 95% confidence interval, -8.8 to -2.4 mg/dL). Meta-regression showed a statistically significant association between changes in non-HDL-C and the year of publication, with greater reductions associated with more recent publication year (R2 = 0.23, p = 0.005). The results of this meta-analytic review suggest that walking reduces non-HDL-C in adult humans.

Variability of measured resting metabolic rate.

BACKGROUND: The necessity of a 12-h fast before resting metabolic rate (RMR) is measured is often a barrier to measuring RMR. OBJECTIVE: We compared RMR measurements obtained in the morning and afternoon and across repeated days to elucidate the magnitude and sources of variability. DESIGN: Healthy men (n = 12) and women (n = 25) aged 21-67 y, with body mass indexes (in kg/m(2)) ranging from 17 to 34 and body fat ranging from 6% to 54%, completed 4 RMR measurements. RMR measurements were made in the morning (after a 12-h fast and 12 h postexercise) and in the afternoon (after a 4-h fast and 12 h postexercise) on 2 separate days with the ventilated-hood technique. Body composition was assessed by dual-energy X-ray absorptiometry. RESULTS: Mean (+/- SE) afternoon RMR was significantly higher than morning RMR on both visit 1 (1593.5 +/- 35.6 compared with 1508.0 +/- 31.5 kcal/d; P = 0.001) and visit 2 (1602 +/- 29.3 compared with 1511.4 +/- 35.9 kcal/d; P = 0.001). The 2 morning measurements (r = 0.93) and the 2 afternoon measurements (r = 0.93) were highly correlated, and no significant differences between measurements were observed. The mean difference between the morning and afternoon measurements was 99.0 +/- 35.8 kcal/d (6%). CONCLUSIONS: Repeated morning and evening measurements of RMR were stable and highly correlated. Day-to-day measurements of RMR were not significantly different. RMR measured in the afternoon after a 4-h fast and exercise was approximately 100 kcal/d higher than RMR measured in the morning.

Exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis of individual patient data.

BACKGROUND: Low bone mineral density (BMD) at the lumbar spine is a major public health problem among postmenopausal women. We conducted a meta-analysis of individual patient data (IPD) to examine the effects of exercise on lumbar spine BMD in postmenopausal women. METHODS: IPD were requested from a previously developed database of summary means from randomized and nonrandomized trials dealing with the effects of exercise on BMD. Two-way analysis of variance tests with pairwise comparisons (p < or =.05) and 95% confidence intervals (CIs) were used to determine the statistical significance for changes in lumbar spine BMD. RESULTS: Across 13 trials that included 699 subjects (355 exercise, 344 control), a statistically significant interaction was found between test and group (F = 15.232, p =.000). Pairwise comparisons (Bonferroni t tests) revealed a statistically significant increase in final minus initial BMD for the exercise group ( +/- SD = 0.005 +/- 0.043 g/cm(2), t = 2.46, p =.014, 95% CI = 0.001-0.009) and a statistically significant decrease in final minus initial BMD for the control group ( +/- SD = -0.007 +/- 0.045 g/cm(2), t = -3.051, p =.002, 95% CI = -0.012--0.002). Changes were equivalent to an approximate 2% benefit in lumbar spine BMD (exercise, +1%, control, -1%). CONCLUSIONS: The results of this IPD meta-analysis suggest that exercise helps to improve and maintain lumbar spine BMD in postmenopausal women.

Aerobic exercise and lipids and lipoproteins in women: a meta-analysis of randomized controlled trials.

BACKGROUND: Cardiovascular disease (CVD) in women is the leading cause of mortality in the United States, and less than optimal lipid and lipoprotein levels are major risk factors for CVD. The purpose of this study was to use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in women. METHODS: Studies were retrieved via computerized literature searches, review of reference lists, hand searching selected journals, and expert review of our reference list. The inclusion of studies was limited to randomized controlled trials published in the English language literature between January 1955 and January 2003 in which aerobic exercise was used as the primary intervention in adult women aged > or =18 years. One or more of the following lipids and lipoproteins were assessed: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). RESULTS: Using a random effects model, statistically significant improvements were observed for all lipids and lipoproteins (TC, +/- SEM, -4.3 +/- 1.3 mg/dl, 95% CI -6.9 to -1.7 mg/dl; HDL-C, +/- SEM, 1.8 +/- 0.9 mg/dl, 95% CI 0.1 to 3.5 mg/dl; LDL-C, +/- SEM, -4.4 +/- 1.1 mg/dl, 95% CI -6.5 to -2.2 mg/dl; TG, +/- SEM, -4.2 +/- 2.1 mg/dl, 95% CI -8.4 to -0.1 mg/dl). Reductions of approximately 2%, 3%, and 5%, respectively, were observed for TC, LDL-C, and TG, whereas an increase of 3% was observed for HDL-C. CONCLUSIONS: Aerobic exercise is efficacious for increasing HDL-C and decreasing TC, LDL-C, and TG in women.

The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials.

Resting blood pressure in children and adolescents can track into adulthood. The purpose of this study was to use the meta-analytic approach to examine the effects of exercise on resting systolic and diastolic blood pressure in children and adolescents. Twelve randomized, controlled trials representing 16 outcomes in 1,266 subjects met the inclusion criteria. Reductions in blood pressure were approximately 1% and 3% for resting systolic and diastolic blood pressures, respectively. However, random-effects modeling using 5000 bootstrap confidence intervals revealed that neither result was statistically significant (systolic, x-bar (x);+/-SEM=-1+/-2; 95% bootstrap confidence intervals=-2 to 0 mm Hg; diastolic, x+/-SEM=-2+/-1; 95% bootstrap confidence intervals=-3 to 0 mm Hg). The results of this study suggest that short-term exercise does not appear to reduce resting systolic and diastolic blood pressure in children and adolescents. However, a need exists for additional studies, especially in hypertensive children and adolescents.

Responding to a significant recruitment challenge within three nationwide psychoeducational trials for cancer patients.

PURPOSE: When faced with a significant recruitment challenge for three nationwide psychoeducational trials targeting prostate and breast cancer patients, the Cancer Information Service Research Consortium initiated outreach efforts to increase accrual. Recruitment is reported by major outreach strategy to inform the use of similar campaigns, either as primary recruitment efforts or to supplement "in-reach" recruitment within oncology settings. METHODS: During a 33-month period, recruitment was tracked from the National Cancer Institute's Cancer Information Service (CIS), the American Cancer Society (ACS), Dr. Susan Love Research Foundation's Love/Avon Army of Women (AOW), Internet advertising, press releases, radio/television interviews, recruitment materials in community venues, and outreach to churches and cancer support organizations. RESULTS: Across projects, the majority (89 %) of recruited participants (N = 2,134) was obtained from the CIS (n = 901, 19 months of recruitment), AOW (n = 869, 18 months), and ACS (n = 123, 12 months). Other efforts showed minimal gain in recruitment. CONCLUSIONS: Cancer information programs (e.g., CIS and ACS) and registries of individuals willing to participate in cancer-related research (e.g., AOW) can represent exceptional resources for outreach recruitment of cancer patients, especially when the eligibility criteria are highly restrictive. However, these resources do not yield samples representative of the larger population of adults diagnosed with cancer, and conclusions from such trials must be tempered accordingly. IMPLICATIONS FOR CANCER SURVIVORS: Inadequate recruitment to randomized controlled trials limits the creation of useful interventions for cancer survivors. By enrolling in cancer registries and taking part in research, cancer survivors can contribute to the development of effective resources for the survivor population.

Injectable multiple sclerosis medications: a patient survey of factors associated with injection-site reactions.

Although injection-site reactions (ISRs) occur with US Food and Drug Administration-approved injectable disease-modifying therapies (DMTs) for multiple sclerosis, there are currently few reports of real-world data on ISR management strategies or possible correlations between ISRs and patient demographics, disease characteristics, and missed injections. Patient-reported data on the use of DMTs, patient demographic and disease characteristics, missed injections, and ISR reduction strategies were collected via e-mail, a patient registry (www.ms-cam.org), and a Web-based survey. Of the 1380 respondents, 1201 (87%) indicated that they had used injectable DMTs, of whom 377 (31%) had used intramuscular (IM) interferon beta-1a (IFNß-1a), 172 (14%) had used subcutaneous (SC) IFNß-1a, 183 (15%) had used SC IFNß-1b, and 469 (39%) had used glatiramer acetate (GA). The majority of respondents were older (73% were ≥40 years), female (79%), married or living with a partner (72%), white (94%), and nonsmoking (82%). Injection-site reaction incidence, grouped according to severity, varied among DMTs, with IM IFNß-1a causing significantly (P < .001) fewer mild, moderate, or severe ISRs than the other therapies. Female sex and younger age were significantly (P < .05) associated with more moderate ISRs among users of IM IFNß-1a, SC IFNß-1b, and GA. Nonwhites reported severe ISRs more often than whites. For all DMTs injection-site massage and avoidance of sensitive sites were the most frequently used strategies to minimize ISRs. These data may help identify patients with characteristics associated with a higher risk for ISRs, allowing health-care professionals to provide anticipatory guidance to patients at risk for decreased adherence or discontinuation.