Pre-test genetic counseling services for hereditary breast and ovarian cancer delivered by non-genetics professionals in the state of Florida.

Genetic counseling and testing for hereditary breast and ovarian cancer now includes practitioners from multiple healthcare professions, specialties, and settings. This study examined whether non-genetics professionals (NGPs) perform guideline-based patient intake and informed consent before genetic testing. NGPs offering BRCA testing services in Florida (n = 386) were surveyed about clinical practices. Among 81 respondents (response rate = 22%), approximately half reported: sometimes scheduling a separate session for pre-test counseling lasting 11-30 min prior to testing, discussing familial implications of testing, benefits and limitations of risk management options, and discussing the potential psychological impact and insurance-related issues. Few constructed a three-generation pedigree, discussed alternative hereditary cancer syndromes, or the meaning of a variant result. This lack of adherence to guideline-based practice may result in direct harm to patients and their family members. NGPs who are unable to deliver guideline adherent cancer genetics services should focus on identification and referral of at-risk patients to in person or telephone services provided by genetics professionals.

Genetic counselors' practices and confidence regarding variant of uncertain significance results and reclassification from BRCA testing.

Studies indicate variant of uncertain significance (VUS) results are challenging for genetic counselors and patients, often resulting in negative patient outcomes. Genetic counselors' current practices regarding VUS are unknown. This study utilized a national survey of genetic counselors (n = 932) to examine current practices and confidence related to disclosing BRCA VUS results and reclassification information. For participants (n = 398), descriptive statistics were calculated regarding patient demographic characteristics, practices and confidence, and cross tabulation was used to identify participant's actions when receiving a reclassified VUS. Upon receiving a BRCA VUS report, the majority reported providing patients with information about the frequency with which their VUS was seen and patient ancestry, but a minority discussed DNA banking. Most were confident in their understanding of, and ability to explain, VUS results to patients, but felt less confident about achieving high levels of patient understanding. Upon reclassification, the majority reported calling the patient and mailing the results, but when the reclassification was deleterious, the majority also met with the patient face-to-face. Given the lack of standard professional guidelines about informing patients of initial and reclassified VUS results, this overview provides important insight into genetic counselors' current practices and confidence.

Development of a biocrystallisation assay for examining effects of homeopathic preparations using cress seedlings.

A major challenge in basic research into homeopathic potentisation is to develop bioassays that yield consistent results. We evaluated the potential of a seedling-biocrystallisation method. Cress seeds (Lepidium sativum L.) germinated and grew for 4 days in vitro in Stannum metallicum 30x or water 30x in blinded and randomized assignment. 15 experiments were performed at two laboratories. CuCl(2)-biocrystallisation of seedlings extracted in the homeopathic preparations was performed on circular glass plates. Resulting biocrystallograms were analysed by computerized textural image analysis. All texture analysis variables analysed yielded significant results for the homeopathic treatment; thus the texture of the biocrystallograms of homeopathically treated cress exhibited specific characteristics. Two texture analysis variables yielded differences between the internal replicates, most probably due to a processing order effect. There were only minor differences between the results of the two laboratories. The biocrystallisation method seems to be a promising complementary outcome measure for plant bioassays investigating effects of homeopathic preparations.

Repetitions of fundamental research models for homeopathically prepared dilutions beyond 10(-23): a bibliometric study.

INTRODUCTION: Repeatability of experiments is an important criterion of modern research and a major challenge for homeopathic basic research. There is no recent overview about basic research studies in high homeopathic potencies that have been subjected to laboratory-internal, multicenter or independent repetition trials. METHODS: We considered biochemical, immunological, botanical, cell biological and zoological studies on high potencies, i.e. beyond a dilution of 10(-23). Main sources of information were reviews, personal contact with members of the homeopathic basic research community, and the MEDLINE and HOMBREX databases. Studies were extracted from the publications and grouped into models. Studies were further sorted according to repetition type (laboratory-internal, multicenter, or independent) and results achieved. RESULTS: A total of 107 studies were found. Of these, 30 were initial studies. In the attempt to reproduce one of these initial studies, 53 follow-up studies yielded comparable effects (35 laboratory-internal, 8 multicenter, 10 independent repetitions), eight studies showed a consistent, yet different result from the initial study (2 laboratory-internal, 2 multicenter, 4 independent repetitions), and 16 studies yielded no effects (5 laboratory-internal, 2 multicenter, 9 independent repetitions). When all repetitive studies are considered, 69% reported effects comparable to that of the initial study, 10% different effects, and 21% no effects. Independently performed repetition studies reported 44% comparable effects, 17% different effects, and 39% no effects. CONCLUSIONS: We identified 24 experimental models in basic research on high homeopathic potencies, which were repeatedly investigated. 22 models were reproduced with comparable results, 6 models with different results, and repetition showed no results for 15 models. Independent reproductions with either comparable or different results were found for seven models. We encourage further repetition trials of published studies, in order to learn more about the model systems used and in order to test their repeatability.

Empirical investigation of preparations produced according to the European Pharmacopoeia monograph 1038.

According to the European Pharmacopoeia monograph 1038 (Praeparationes homoeopathicae), homeopathic preparations are produced by successive dilution and succussion steps. Dilution levels beyond Avogadro's limit, however, render specific effects implausible according to standard scientific knowledge. Accordingly, we were interested in a critical empirical investigation of preparations produced according to this monograph. Within a precursor study we developed a bioassay based on a fingerprint metabolomic analysis of Lepidium sativum seeds germinated in vitro in either homeopathic preparations or controls in a blinded and randomized assignment. Results of the precursor study were not consistent with the hypothesis that the effects of a Stannum metallicum 30x preparation are identical to placebo. In the present study we investigated the reproducibility of these effects after scrutinizing and optimizing experimental procedures. Ten independent experiments were performed in a blinded and randomized assignment in two independent laboratories. Additionally, 10 systematic negative water control experiments were performed in both laboratories to critically assess the stability of the experimental set-up. The effects of the Stannum metallicum 30x treatment were reproduced. The systematic negative control experiments did not yield false-positive results, indicating a stable experimental set-up. We thus repeatedly observed biological effects conflicting with the assumption that Stannum metallicum 30x is identical to placebo. We therefore wish to discuss whether these findings are to be considered a scientific anomaly or whether they might stimulate further investigations to clarify whether application of the European Pharmacopoeia monograph 1038 may result in pharmaceutical preparations with specific effects.

Provider-reported acceptance and use of the Centers for Disease Control and Prevention messages and materials to support HPV vaccine recommendation for adolescent males.

PURPOSE: We evaluated Florida-based physicians' awareness and use of the Centers for Disease Control and Prevention's (CDC) "You are the Key" campaign website, including messages to support physicians' human papillomavirus (HPV) vaccine recommendations. METHODS: Using closed-ended and free-text survey items, physicians' (n=355) practices related to HPV vaccination recommendations for males and use of the CDC's materials were assessed. Descriptive statistics were calculated for closed-ended questions, and thematic analysis was conducted on free-text responses. RESULTS: Over half of physicians were aware of the CDC's website (n=186; 57.9%); of those aware, fewer than half reported using the website (n=86; 46.2%). Slightly more than half reported awareness of the CDC's messages (n=178; 55.3%); however, less than one-third of those aware reported using them (n=56; 31.5%). Physicians' comments on the CDC's messages were favorable; 78.6-93.2% said they would use a message in clinic. CONCLUSION: Additional research is needed to identify the best mechanisms for resource dissemination and to understand why physicians do not use these messages, despite favorable attitudes.

[Myocardial revascularization in left coronary trunk lesion in patients over 65 years old]. / Cirurgia de revascularização miocárdica na lesão do tronco da coronária esquerda em pacientes acima de 65 anos de idade.

PURPOSE: To study the short and long-term follow-up of patients with left main coronary artery disease (LMCAD) and age over 65 years, by comparing the results with patients under 65 years-old. METHODS: Twenty-two patients with LMCAD and mean age of 69 +/- 3.5 years (group I) were underwent isolated coronary artery bypass grafting (CABG) and compared to 31 patients with LMCAD, mean age of 54 +/- 7 years (group II), who also underwent isolated CABG. The life-table Kaplan-Meyer method was used to estimate the post-operative survival. The chi-square and Student "t" test were used when necessary. RESULTS: Despite higher operative mortality in group I (9.1% x 3.2%), the difference was statistically not significant. The operative morbidity was similar in both groups. Actuarial survival at 4 years was 85% in group I and 95% in group II. Actuarial survival free of cardiac events was 69% in group II and 75% in group II. CONCLUSION: The CABG is well tolerated and had low morbidity and acceptable mortality in old patients with LMCAD. The long-term survival in these patients was very similar to the younger patients.

Effect of bio-feedback techniques on chronic asthma in a summer camp environment.

Bio-feedback mediated deep muscle relaxation procedures demonstrated significant improvement in 22 asthmatic children attending a summer camp for the care and rehabilitation of asthmatic children. However, caution is expressed in the interpretation of the findings pending a replication of the research with more rigorous controls.

Effects of training on the visual recognition of consonants.

Visual recognition of consonants was studied in 31 hearing-impaired adults before and after 14 hours of concentrated, individualized, spechreading training. Confusions were analyzed via a hierarchical clustering technique to derive categories of visual contrast among the consonants. Pretraining and posttraining results were compared to reveal the effects of the training program. Training caused an increase in the number of visemes consistently recognized and an increase in the percentage of within-viseme responses. Analysis of the responses made revealed that most changes in consonant recognition occurred during the first few hours of training.

Estudo comparativo entre as associacoes da clortalidona com o verapamil e o metoprolol na hipertensao arterial:avaliacao por cicloergometria. / Comparative study of the associations of chlorthalidone with verapamil and metoprolol in arterial hypertension: evaluation by cycloergometrics

Vinte e cinco pacientes participaram de estudo aberto comparativo entre o uso do verapamil e do metoprolol associados a clortalidona no tratamento da hipertensao arterial de grau leve ou moderado. O prazo de uso de cada esquema medicamentoso foi de 15 dias, sendo a avaliacao terapeutica realizada por analise da curva de pressao arterial nos testes cicloergometricos, feitos ao final de cada etapa. No inicio da fase de testes e entre o uso de cada associacao decorreram 15 dias sem uso de qualquer droga. Tanto o verapamil quanto o metoprolol, associados a clortalidona, revelaram eficacia terapeuticas em 100% dos casos com normalizacao nao so da pressao arterial basal como dos valores de esforco em mais de 70% dos casos. Pouco significativa foi a diferenca entre a acao dos dois esquemas terapeuticos, variando apenas o comportamento da frequencia cardiaca e a presenca de para-efeitos propios

Acao do verapamil como agente hipotensor - Analise da curva de pressao arterial em teste cicloergometrico. / Action of verapamil as hypotensive agent- analysis of the curve of arterial blood pressure in cycloergometric test

Vinte e nove pacientes com hipertensao arterial leve e/ou moderada, nao tratados ou sem uso de medicacao por prazo minimo de 90 dias, foram submetidos a 3 testes ergometricos com avaliacao de curva de pressao arterial. O primeiro teste foi realizado sem uso de qualquer substancia, caracterizando-se a presenca do quadro hipertensivo. No segundo e terceiro testes, foram administrados, alternadamente aos pacientes, verapamil em dose unica de 120 a 360 mg por via oral e placebo, 2 horas antes da prova, sendo medida a PA a cada 60 s durante o decorrer do esforco e repouso posterior. O verapamil teve efeito hipotensor significativo em 63% dos pacientes, em 29% nao houve qualquer modificacao da curva tensional nos 3 testes; 8% dos pacientes tiveram diminuicao de seus niveis tensionais com placebo. Sao analisados ainda os para-efeitos da droga, resultados gerais dos testes ergometricos e a validade do metodo na avaliacao da terapeutica anti-hipertensiva