Increasing the packing of small aneurysms with soft coils: an in vitro study.

The aim of this study was to determine whether or not the use of Soft and Ultra Soft Guglielmi detachable coils (GDCs) may improve the packing of cerebral aneurysms. Six coiling scenarios of a silicone aneurysm model were conducted using Standard, Soft, and Ultra Soft GDCs. Coils were introduced up to the point when the adjunct of one more coil caused protrusion out of the aneurysm sac. Packing ratios (volume of coils/aneurysm volume) ranged between 30 and 55%. The highest degree of packing was achieved with the combination of Soft GDC-18 coils and Ultra Soft GDC-10 coils. There is a positive relationship between the use of Soft and Ultra Soft GDC coils and greater aneurysm filling.

Empowerment: from philosophy to practice.

Our paper reviews the philosophical and theoretical foundations of the empowerment approach to chronic disease care and education. The fundamental differences between the compliance and empowerment approaches are elucidated. The empowerment philosophy is based on the premise that human beings have the capacity to make choices and are responsible for the consequences of their choices. Empowerment is defined as an educational process designed to help patients develop the knowledge, skills, attitudes, and degree of self-awareness necessary to effectively assume responsibility for their health-related decisions. Using empowerment as an intellectual foundation, an holistic approach to health education is presented. Topics such as well-being, self-image, motivation, adaptability, stress management, problem-solving, social support, self-awareness, and hope, are discussed. Our paper asserts that health educators have a responsibility to address the physical, emotional, cognitive, and spiritual needs of persons challenged to live with a chronic disease.

Patient empowerment. Results of a randomized controlled trial.

OBJECTIVE: The purpose of this study was to determine if participation in a patient empowerment program would result in improved psychosocial self-efficacy and attitudes toward diabetes, as well as a reduction in blood glucose levels. RESEARCH DESIGN AND METHODS: This study was conducted as a randomized, wait-listed control group trial. The intervention group received a six-session (one session per week) patient empowerment education program; the control group was assigned to a wait-list. At the end of 6 weeks, the control group completed the six-session empowerment program. Six weeks after the program, both groups provided follow-up data. RESULTS: The intervention group showed gains over the control group on four of the eight self-efficacy subscales and two of the five diabetes attitude subscales. Also, the intervention group showed a significant reduction in glycated hemoglobin levels. Within groups, analysis of data from all program participants showed sustained improvements in all of the self-efficacy areas and two of the five diabetes attitude subscales and a modest improvement in blood glucose levels. CONCLUSIONS: This study indicated that patient empowerment is an effective approach to developing educational interventions for addressing the psychosocial aspects of living with diabetes. Furthermore, patient empowerment is conducive to improving blood glucose control. In an ideal setting, patient education would address equally blood glucose management and the psychosocial challenges of living with diabetes.

Guidelines for facilitating a patient empowerment program.

The traditional medical treatment model often ignores the emotional, spiritual, social, and cognitive aspects of living with a chronic disease such as diabetes. Empowerment programs address these psychosocial areas by helping individuals develop skills and self-awareness in goal setting, problem solving, stress management, coping, social support, and motivation. Although many diabetes educators have been taught to use an empowerment curriculum to facilitate self-management, there is minimal research concerning the actual process of providing such programs to patients. We evaluated an empowerment curriculum (Empowerment: A Personal Path to Self-Care) with a diverse group of individuals with diabetes to determine the key elements of planning and implementing a successful diabetes patient empowerment program.

Oral L-alloisoleucine loading studies in healthy subjects and in patients with maple syrup urine disease.

Total body and renal elimination of L-alloisoleucine was assessed after oral loads (0.57 mmol/kg body wt) in four healthy subjects and in five patients with maple syrup urine disease (MSUD) of different degrees of severity. As judged from the fictive initial concentration, L-alloisoleucine is distributed evenly in the total body water space. In the controls, estimated half-time of total elimination was 9.2 +/- 2.2 h (n = 4). In the MSUD patients, it ranged from 26 h (mild variant) to about 8 d (classical type). Because of its low renal clearance rate, L-alloisoleucine was cleared through ketomethylvalerate to greater than 99% in normals and to at least 73% in the MSUD patients. Assuming small variation in the losses of ketomethylvalerate through L-isoleucine formation and through renal excretion, this test allows ranking of MSUD patients with regard to their residual in vivo branched-chain oxo-acid dehydrogenase activity.

On the mechanism of L-alloisoleucine formation: studies on a healthy subject and in fibroblasts from normals and patients with maple syrup urine disease.

L-Alloisoleucine formation from L-isoleucine was studied in vitro and in vivo. When a healthy subject was loaded with L-isoleucine, plasma levels of L-isoleucine and 3-methyl-2-oxopentanoate (KMV), as well as L-alloisoleucine, increased. Peak values were reached successively and were in the order L-isoleucine much greater than KMV much greater than L-alloisoleucine. Metabolic clearance of L-isoleucine and KMV was rapid; clearance of L-alloisoleucine was considerably delayed. When human skin fibroblast cultures were challenged with L-isoleucine, KMV accumulated at a gradually decreased rate, whereas L-alloisoleucine accumulated at a gradually accelerated rate. KMV and L-alloisoleucine formation were related and depended on the L-isoleucine concentration applied. In cell lines derived from MSUD patients (classical form), metabolite formation was only about 2-fold higher than in control strains. The relatively small difference between normal and MSUD fibroblasts in vitro as opposed to the striking differences between healthy subjects and MSUD patients in vivo are discussed with respect to the significance of physiological mechanisms participating in the formation and degradation of L-alloisoleucine in man.

Psychometric study of patient knowledge test.

The results of a psychometric study of the Test of Patient Knowledge are reported. The 50-item, multiple-choice test, developed by Etzwiler and associates at the International Diabetes Center, consists of a total score and seven subscores based on seven nonoverlapping content categories: nutrition, insulin, general knowledge, methods of control, pattern control, exercise, and complications. The results described herein provide evidence for the validity of the test (content, concurrent, and discriminant validity), a high level of reliability (Cronbach's alpha = .88), readability for the layperson at the 7th- to 8th-grade level, and sensitivity to instructional gains. The literature on psychometric research with other tests of patient knowledge of diabetes is reviewed and compared with the results of this study.