Action planning: making change happen in clinical practice.

This article describes how the authors helped practitioners to develop their action planning skills in conjunction with a practice development strategy in an acute hospital, using an approach called concept analysis, embellished by a systematic literature review. As a result of this, two tools were developed to help practitioners become more effective in action planning. This article describes the process and the tools that resulted, and illustrates the impact and benefits of using these tools in practice. It concludes that action planning, when undertaken rigorously and effectively, is a key skill for changing the workplace culture from one where the action plan belongs to one person to one where everyone takes responsibility for action.

Physical activity dose-response effects on outcomes of depression and anxiety.

PURPOSE: The purpose of this study was to examine the scientific evidence for a dose-response relation of physical activity with depressive and anxiety disorders. METHODS: Computer database searches of MEDLINE, PsychLit, and Internet and personal retrieval systems to locate population studies, randomized controlled trials (RCTs), observational studies, and consensus panel judgments were conducted. RESULTS: Observational studies demonstrate that greater amounts of occupational and leisure time physical activity are generally associated with reduced symptoms of depression. Quasi-experimental studies show that light-, moderate-, and vigorous-intensity exercise can reduce symptoms of depression. However, no RCTs have varied frequency or duration of exercise and controlled for total energy expenditure in studies of depression or anxiety. Quasi-experimental and RCTs demonstrate that both resistance training and aerobic exercise can reduce symptoms of depression. Finally, the relation of exercise dose to changes in cardiorespiratory fitness is equivocal with some studies showing that fitness is associated with reduction of symptoms and others that have demonstrated reduction in symptoms without increases in fitness. CONCLUSION: All evidence for dose-response effects of physical activity and exercise come from B and C levels of evidence. There is little evidence for dose-response effects, though this is largely because of a lack of studies rather than a lack of evidence. A dose-response relation does, however, remain plausible.

Prepro-galanin messenger RNA levels are increased in rat locus coeruleus after treadmill exercise training.

The effects of treadmill exercise training on prepro-galanin (GAL) and tyrosine hydroxylase (TH) gene expression in the locus coeruleus (LC) were examined. Male Fischer-344 rats (n=9) were assigned to 6 weeks of treadmill running. An additional group of animals comprised the sedentary home cage control group (n=9). Levels of GAL and TH messenger RNA (mRNA) in the LC were measured using in situ hybridization histochemistry with autoradiography. Levels of GAL mRNA were higher in treadmill trained animals compared to sedentary animals, but there was no effect of treadmill running on TH mRNA. These results suggest that gene expression for galanin is responsive to repeated exercise stress and may have a neuromodulatory role in LC-noradrenergic adaptation to treadmill exercise training.

Worksite physical activity interventions.

BACKGROUND: National objectives for public health have targeted worksite as important settings for interventions to increase physical activity. However, expert reviews reveal no scientific consensus about the effectiveness of worksite interventions for increasing physical activity or fitness. METHODS: We judged the quantity and quality of existing evidence against scientific standards for the internal and external validity of the research design and the validity of measurements. Meta-analytic methods were used to quantify the size of effects expressed as Pearson correlation coefficients (r). Variation in effect was examined in relation to several features of the studies deemed important for implementing successful worksite interventions. Pre-experimental cohort studies were excluded because they are sensitive to secular trends in physical activity. RESULTS: Twenty-six studies involving nearly 9,000 subjects yielded 45 effects. The mean effect was heterogeneous and small, r = 0.11 (95% CI, -0.20 to 0.40), approximating 1/4 S.D., or an increase in binomial success rate from 50% to 56%. Although effects varied slightly according to some of the study features we examined, effects were heterogeneous within levels of these features. Hence, the moderating variables examined did not explain variation in the effects (P > 0.05). The exception was that effects were smaller in randomized studies compared with studies using quasi-experimental designs (P < 0.05). CONCLUSIONS: Our results indicate that the typical worksite intervention has yet to demonstrate a statistically significant increase in physical activity or fitness. The few studies that have used an exemplary sample, research design, and outcome measure have also yielded small or no effects. The generally poor scientific quality of the literature on this topic precludes the judgment that interventions at worksites cannot increase physical activity or fitness, but such an increase remains to be demonstrated by studies using valid research designs and measures.

Plasma concentrations of mianserin after single dose and at steady-state in depressed elderly patients.

Plasma mianserin and desmethylmianserin concentrations were measured in 17 clinically depressed elderly patients after a single 30 mg dose of mianserin. The patients then received mianserin 30 mg daily for up to 6 weeks and the plasma concentrations were measured at weekly intervals. The relationship between concentrations of mianserin and desmethylmianserin at steady-state and at 16 and 24 hours after the single test dose was not good enough to be used for prediction of dosage requirements. Reasons for this finding are discussed.

Rapid diagnosis of urinary tract infection using a simple photometer.

A photometric method which detects bacterial multiplication in urine is described. The apparatus is both inexpensive and easy to use, and results are obtained within four hours. A total of 217 urine specimens from 181 patients were assessed and the results compared with the corresponding laboratory tests, which showed a significant growth in 102 specimens. The sensitivity and specificity of the photometric method was 77% and 99%, respectively, with a positive accuracy of 99%. The photometer detected 83% of significant enterobacterial infections and 76% of mixed infections. It is suggested the false negative results (23%) may have included high laboratory colony counts not associated with active urinary tract infection.

Five year follow-up of effects of treatment of mild and moderate hypertension.

A five-year follow-up study of the effects of treating patients with both mild and moderate hypertension was performed. The patients were identified during a hospital-based community survey of hypertension. A total of 961 patients were divided into four groups. The first group, the controls, were age- and sex-matched normotensive subjects selected sequentially from the same survey. The second group were patients defined as well-controlled hypertensives; the third group were patients whose blood pressures were less well-controlled; and the fourth group consisted of patients who, for various reasons, were not treated and as such acted as an untreated control group. Both mortality and morbidity were considerably greater in the untreated patients than in the normal subjects. The well-controlled hypertensive patients showed no difference in either morbidity or mortality from normal subjects. The less well-controlled patients had a significantly greater cardiovascular morbidity but no excess mortality over groups 1 and 2. This was true for both mild and moderate hypertension and for women as well as men. These findings therefore confirm the conclusions of other recent studies that good control of hypertension at all levels and in both sexes is justified by the reduction in morbidity and that even less than excellent control is of considerable benefit.