A randomized controlled trial of an online health tool about Down syndrome.

PURPOSE: We sought to determine if a novel online health tool, called Down Syndrome Clinic to You (DSC2U), could improve adherence to national Down syndrome (DS) guidelines. We also sought to determine if primary care providers (PCPs) and caregivers are satisfied with this personalized online health tool. METHODS: In a national, randomized controlled trial of 230 caregivers who had children or dependents with DS without access to a DS specialist, 117 were randomized to receive DSC2U and 113 to receive usual care. The primary outcome was adherence to five health evaluations indicated by national guidelines for DS. DSC2U is completed electronically, in all mobile settings, by caregivers at home. The outputs-personalized checklists-are used during annual wellness visits with the patient's PCP. RESULTS: A total of 213 participants completed a 7-month follow-up evaluation. In the intention-to-treat analysis, the intervention group had a 1.6-fold increase in the number of indicated evaluations that were recommended by the primary care provider or completed compared with controls. Both caregivers and PCPs reported high levels of satisfaction with DSC2U. CONCLUSIONS: DSC2U improved adherence to the national DS health-care guidelines with a novel modality that was highly valued by both caregivers and PCPs.

A systematic review of motivational interviewing within musculoskeletal health.

Motivational interviewing (MI) has been investigated within a range of healthcare environments though to date no studies have systematically assessed its application and effectiveness within musculoskeletal health. The aim of this study is to identify interventions that have utilised MI to create change within musculoskeletal healthcare, evaluate quality and effectiveness, as well as identify the level of training received by those utilising the approach. The search strategy identified both published and unpublished or grey literature through electronic resources, reference list and content searches. Five studies were identified for quality assessment. Due to variations in delivery modality, musculoskeletal condition and type of MI application it was not possible to provide direct comparative interpretations for these factors. A data synthesis was used to provide a summary of study characteristics, a narrative overview and conduct a quality assessment as well as considering authors comments on study limitations. The results of the quality assessment highlighted a number of methodological issues which supported and expanded upon those expressed by the studies authors. None of the studies contained children or young people and in terms of training there were variations in training provider, duration and competency, as well as variation in the fidelity of MI. The findings have highlighted the need for well designed randomised controlled trials that are suitability powered to measure the effectiveness of MI within musculoskeletal health. Future studies may consider the application of MI within musculoskeletal conditions in terms of self-management and its application to creating lifestyle changes (e.g., diet, exercise) for adults, as well as children and young people. Research currently being conducted may expand upon the evidence, feasibility and validity of MI within areas such as fibromyalgia, osteoporosis, arthritis, understanding of knee replacement and rehabilitation.

Medical students' self-perceived competence and prescription of patient-centered physical activity.

OBJECTIVE: The primary objective of this study was to explore medical students' perceptions of their own competence and the importance they assign to patient-centered physical activity (PA) prescription. METHODS: 246 undergraduate medical students (27% response rate) from two large universities in Western Canada completed an online survey designed to assess their perceived competence and importance related to patient-centered PA prescription. Data collection took place in September and October of 2007. RESULTS: While medical students perceived PA-related prescription to be important (M(response)=26.6 out of 36, SD=5.1), students perceived they had only moderate competence at conducting PA-related prescription (M(response)=20.7 out of 36, SD=6.8). Students achieving national PA guidelines perceived significantly higher competence than students not achieving PA guidelines. Students in their first or second year of medical school perceived PA-related prescription to be of higher importance than students in their third or fourth years. CONCLUSION: Medical students indicated that patient-centered PA prescription was important. However, they indicated less than moderate competence at performing several fundamental PA prescription behaviors. This study suggests that medical students may not be adequately prepared to dispense patient-centered PA prescriptions with their patients.

Increased susceptibility of arterial tissue to wire perforation with the application of high-frequency mechanical vibrations.

High-frequency mechanical vibrations (20-50 kHz), delivered via small diameter flexible wire waveguides represent a minimally invasive technology for the treatment of chronic total occlusions and in other tissue ablation applications. Tissue disruption is reported to be caused by repetitive mechanical contact and cavitation. This work focuses on the effects of vibrating wire waveguides in contact with arterial tissue. An apparatus with clinically relevant parameters was used, characterized as operating at 22.5 kHz and delivering amplitudes of vibration of 17.8-34.3 µm (acoustic intensity, I(SATA): 1.03-3.83 W/cm(2)) via 1.0-mm diameter waveguides. Inertial cavitation (in water at 37 °C) was determined to occur above amplitudes of vibration greater than 31.4 µm (I(SATA) = 3.21 W/cm(2)). The energized waveguides were advanced through tissue samples (porcine aorta) and the force profiles were measured for a range of acoustic intensities. The results show that the tissue perforation initiation force, perforation initiation energy, and total energy required to perforate the tissue reduces with increasing acoustic intensity. No significant reduction in perforation force or energy was observed in the inertial cavitation region. Multistage perforation was evident through the force profile and histological examination of the tissue samples post wire waveguide perforation.

The effect of lordosis, disc height change, subsidence, and transitional segment on stand-alone anterior lumbar interbody fusion using a nontapered threaded device.

In this study, we retrospectively evaluated 37 consecutive patients who underwent stand-alone anterior lumbar interbody fusion (ALIF); for indications that included degenerative disc disease, concordant pain on discography, disc space collapse of more than 50%, and failure of nonoperative management for at least 4 consecutive months. Patient demographics, procedural data, and prospective Short Form 36 General Health Survey composite scores were collected. Mean follow-up was 24.2 months. In this cohort of patients with degenerative disc disease, there was no loosening or migration of implants. Stand-alone ALIF using a threaded interbody fusion device provided excellent clinical results and return-to-work rates with few complications. Increased lordosis was associated with increased subsidence and less favorable outcome. Patients with a transitional segment displayed relatively smaller increases in lordosis and better outcomes than patients without a transitional segment.

Therapeutic ultrasound angioplasty: the risk of arterial perforation. An in vitro study.

The use of therapeutic ultrasound delivered via small diameter wire waveguides may represent an emerging minimally invasive approach in the treatment of chronic total occlusions (CTOs), calcified and fibrous plaques. The distal-tip mechanical vibrations (typically 0-210 microm peak-to-peak) have been reported to debulk rigid calcified and fibrous tissues while healthy elastic arterial tissue remains largely unaffected. The risk of arterial (healthy tissue) perforation with energized waveguides is not fully understood. An ultrasonic apparatus capable of delivering a range of wire waveguide distal-tip displacements, up to 80 microm peak-to-peak (p-p), at an operational frequency of 22.5 KHz (+/- 6%) has been developed. For three distal-tip displacement settings (32, 50 and 80 microm p-p) with 1.0 mm diameter waveguides, the force required to perforate healthy porcine aortic tissue was experimentally determined. The results show a distinct two stage perforation, thought to be the result of different mechanical properties of the layers in the arterial wall. The average maximum force (N) required to cause perforation with the 1.0 mm diameter ultrasonic waveguide activated at the three settings was experimentally determined to be 2.7 N (32 microm p-p), 2.6 N (50 microm p-p) and 2 N (80 microm p-p). The force required to cause perforation of the tissue with no ultrasound was found to be approximately 4 N. These results highlight that when ultrasound energy is applied to the waveguide, less force is required to perforate healthy arterial tissue. This reduction in perforation force is more pronounced at higher ultrasonic displacements, similar to those reported in clinical studies for the effective removal of diseased calcified and fibrous plaques.