The EVAR Trial 1: has it led to a change in practice?

OBJECTIVES: To assess whether the publication of the EVAR Trial 1 (June 2005) had an impact on practice in our centre. METHODS: A retrospective study of all patients undergoing abdominal aortic aneurysm (AAA) repair in Leicester, from the year before publication of EVAR Trial 1 data to the year after (July 2004 - June 2006). Data from the study period was then compared with practice over the last six years (January 2000 - December 2006). RESULTS: The proportion of endovascular aneurysm repairs (EVARs) did not change significantly in the year following publication of EVAR Trial 1 data (52% VS 57%, p=0.64). The mean age of patients offered open repair (OR) fell in the year following publication (69 years +/- 6.68 vs 72 years +/- 5.71, p<0.05). Despite this, there was no significant change in their fitness (physiological POSSUM scores: 19.2 +/- 3.91 vs 18.2 +/- 3.74, P=0.30). There was an overall increase in the percentage of EVARs in the years 2000 (28%) to 2006 (57%). CONCLUSION: There was no significant difference in the percentage of EVARs between the two years of study. However, over the last six years, there has been an increasing number performed in our unit and we now do more EVARs than ORs.

Interventions for reducing anxiety in women undergoing colposcopy.

BACKGROUND: Before cervical cancer develops the cells of the cervix become abnormal. Following an abnormal cervical smear colposcopy is performed. Colposcopy is the visualisation of the cervix using a binocular microscope. Women experience high levels of anxiety and negative emotional responses at all stages of cervical screening. High levels of anxiety before and during colposcopy can have adverse consequences, including pain and discomfort during the procedure and high loss to follow-up rates. This review evaluates interventions designed to reduce anxiety levels during colposcopic examination. OBJECTIVES: To compare the efficacy of various interventions aimed at reducing anxiety during colposcopic examination in women. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL), (Cochrane Library, Issue 1, 2006) MEDLINE (1951-2006), EMBASE (1980-2006), CINAHL (1982-2006), Psych Lit and CancerLit, NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocols. SELECTION CRITERIA: Randomised and quasi randomised controlled trials of interventions to reduce anxiety during colposcopic examination. DATA COLLECTION AND ANALYSIS: One author searched the citations and reference lists. Studies that appeared to meet inclusion criteria were retrieved and assessed independently by the remaining three authors. The methodological quality of included studies was assessed using the Cochrane Collaboration Back Review Group's methodological quality criteria (van Tulder 2003). MAIN RESULTS: Eleven trials were included, these trials used various interventions to reduce anxiety. These examined 1441 women's anxiety levels after different types of intervention. These included: Information leaflets - (proved not to be associated with anxiety reduction). Counselling: pre-colposcopic counselling was not associated with anxiety reduction. Information leaflets and information video and pre-colposcopy counselling was not associated with a reduction in anxiety levels. Listening to music during colposcopy: this intervention was associated with reduction in anxiety levels (p < 0.002). Video colposcopy was associated with reduction in anxiety levels, and the reduction in anxiety was significant (p < 0.0002). Information using graphs and verbal information and information video versus information only when sought: There was no significant reduction in the level of anxiety in the intervention group. Information leaflets and information video versus information leaflets only: There was a reduction in anxiety levels in the intervention group compared to the control group (p < 0.00001). AUTHORS' CONCLUSIONS: Anxiety appears to be reduced by playing music during colposcopy, showing information videos prior to colposcopy and viewing video colposcopy during the procedure. Although information leaflets did not reduce anxiety levels, they did increase knowledge levels and so are useful in obtaining clinical consent to the colposcopic procedure.

Sedentary daily expenditure: a base for estimating individual energy requirements.

As a base for estimating individual energy requirements, we propose using the energy expenditure of a sedentary day with regular meals and sleep at night. Ninety-five 24-h measurements of sedentary daily expenditure (SDE) by direct calorimetry on 37 men and women were analyzed, showing that fat-free mass combined with body mass index correlated highly with SDE (r2 = 0.92) with an SE of 5%. Weight and fat mass were better predictors for women and excellent predictors for men. We found that weight and height accurately predicted fat mass if suitable exponents were used in the expression wt/htx. Testing predictive equations with our own and other sets of data showed good agreement between estimated and observed SDEs. As a base for estimating individual energy requirements. SDE is more precise than basal metabolic rate and it can be predicted with useful accuracy from simple measures of weight and height.

Flight crews with upper respiratory tract infections: epidemiology and failure to seek aeromedical attention.

A voluntary questionnaire was used to determine the epidemiology of upper respiratory infections (URI), and whether aeromedical attention was sought. Questionnaires completed by 256 of 276 eligible flight crewmembers revealed that over half, 61.7% (158), reported having greater than or equal to 1 URI during a 6-month period, for a total of 272 URIs. No statistically significant associations, p greater than 0.05, were noted between the occurrence of URI and sex, age, pilot vs. enlisted, or smoking status. Subjects with children living at home with them were more likely to report having URIs than those with no children, p less than 0.10. Aeromedical attention was not sought in 55.5% (151/272) of the URI episodes. An Aeromedical Concern (AMC) was determined to occur in 69.5% (105/151) of these representing 38.6% (105/272) of all URIs. The most common reason for AMC was taking self-prescribed medications. AMCs were more frequent among enlisted personnel than officers (pilots), p less than 0.05. Possible reasons why AMCs may occur are discussed. In summary, URIs are common in aircrews, as is the failure to seek aeromedical attention.

Perception of near earth altitudes by pilots: ascending vs. descending over both a land and water surface.

Thirteen experienced HH-3 pilots were tested on their ability to obtain four target altitudes between 25 and 200 ft. The target altitudes were attempted by both ascending from 0 ft and descending from 500 ft. Subjects were tested both over a land and water surface for a total of 16 recorded achieved altitudes per pilot. The pilots had full aircraft control but were without use of altimeters. Subjects showed wide variation for each test situation with some achieved altitudes exceeding the target altitude by 100% while others were below the target altitude. The predominant error was an achieved altitude greater than the target altitude. The mean achieved altitude when descending to a given target altitude exceeded the mean achieved altitude when ascending to the same target altitude. There was no statistically significant difference in mean achieved altitude between land and water surfaces. In conclusion, this study revealed that even experienced pilots may not estimate with good accuracy their altitude in the near Earth environment. The error in altitude perception is of concern for safe ground clearance.

Klebsiella pneumoniae bacteremia in the community hospital.

The purpose of this study was to elicit the circumstances of occurrence and organism sensitivities of Klebsiella pneumoniae bacteremia in the community hospital, since data on this illness from the community hospital are rare. All records of documented Klebsiella pneumoniae bacteremia (46 cases) at Alachua General Hospital, Gainesville, Florida, over the period July 14, 1982, through July 27, 1985, were reviewed in detail. Fifty-nine percent (27 organisms) were nosocomial, whereas 41% (19 organisms) were community acquired. The most common predisposing disorders in these patients were, in decreasing order, malignancy; following gastrointestinal or biliary surgery; biliary tract obstruction; diabetes; and unknown. Twenty-two percent (10) of the patients died from bacteremia. The majority of organisms tested were sensitive to mezlocillin, cephalothin, cefoxitin, tetracycline, tobramycin, gentamicin, co-trimoxazole and ceftizoxime. Therapy was considered to be appropriate in 89% (41) of the patients and inappropriate in 10.9% (5) of the patients. Contrary to previous thought, Klebsiella pneumoniae bacteremia is a relatively common problem in the community hospital and may be community acquired as well as nosocomial. There are many characteristics of this disease in the community that are different from those reported in studies on Klebsiella pneumoniae bacteremia from large referral centers.

Preparation for elective colorectal surgery using a video: a questionnaire-based observational study.

OBJECTIVE: Every patient has a perception about surgery and psychological preparation of the patient has an important impact on their postoperative recovery and outcome. In this study we looked at impact of a visual educational aid, in the form of a patient DVD on outcome following colorectal surgery within an enhanced recovery programme (ERP). DESIGN: We carried out a prospective analysis of a consecutive series of patients undergoing elective colorectal resection. All patients were given information about their operation in a clinic setting. Our intervention included a 15 minute patient educational video describing the preoperative assessment, post-operative recovery and advice on discharge. A questionnaire on patients' views of ERP and video education was given on discharge. SETTING: University teaching hospital PARTICIPANTS: Patients undergoing elective colorectal resection MAIN OUTCOME MEASURES: Outcomes studied included length of hospital stay, patient perception of ERP, postoperative complications and readmissions: RESULTS: Thirty-two patients underwent elective colorectal surgery over a 3 month period. Median length of stay in hospital was 5 days. The questionnaire response rate was 100%. All patients thought they were well informed of the enhanced recovery programme. Eighty-eight percent responded that the video information provided about their operation was adequate, with 28% finding the video very helpful and more useful than other forms of patient information. There were no major postoperative complications and no readmissions. CONCLUSION: Audiovisual presentation in the form of a patient video is a useful tool in the psychological preparation of patients undergoing colorectal surgery.

Estimation of true dihedral angles and relative grain boundary energies in polycrystals using the disector.

Relative grain boundary energies can be simply related to true dihedral angles, which are the angles between grain boundary planes meeting at triple edges in polycrystals. Some limited efforts in the measurement of true dihedral angles have used the technique of serial sectioning, which is usually cumbersome and time consuming. In this study the three-dimensional probe called the 'disector' has been employed to evaluate true dihedral angles. This probe, combined with automated image processing, introduces precision as well as efficiency, overcomes the disadvantages of the two-dimensional probe and is far less tedious and less complicated than serial sectioning. It is shown that the technique is relatively simple and therefore can be applied to obtain a significantly large and accurate statistical sample of true dihedral angles. The application of this method is demonstrated by evaluating the triple junction geometry and the associated relative grain boundary energies in polycrystalline 316L austenitic stainless steel.

Reliability and reproducibility of maximal oxygen uptake measurement in children.

Maximal aerobic capacity of 66 ten year old ice hockey players was measured on a treadmill twice over a 4 to 5 month period. This time approximated mid (T1) to post (T2) competitive season. The results of these VO2 max tests were grouped according to the presence or absence of a plateau in the oxygen uptake (less than 2.1 ml/kg-min) during the last work loads before fatigue. The mean values for T1 and T2 were not significantly different for any of the measurements made; the reproducibility was considered to be high. The reliability of the measures varied with the presence or absence of a plateau at maximum, for example; VO2 max, plateau r = 0.74, no plateau r = 0.27; heart rate, plateau r = 0.92, no plateau r = 0.40. The differences between the mean values for the "double plateau" group when compared to the "no plateau" group were not significant for VO2 max, HR or VE. The differences were significant for the post-exercise blood lactate and respiratory exchange values at T2 only; the "double plateau" group reached higher values in each case (R = 1.00 vs 0.92; blood lactate 6.5 vs 5.4 mM/1).

A controlled prospective study of the effect of endurance training on the recurrence rate of myocardial infarction. A description of the experimental design.

A multicenter prospective study has been designed to determine whether participation in an exercise program which produces a significant training effect will affect the recurrence rate in men who have survived an initial myocardial infarction. The control group consists of subjects who participate in a program involving low intensity activities designed to avoid a significant training effect. The subjects will be followed for a period of 4 years and a reduction of 50 per cent in the risk of recurrence will be considered clinically significant. The criteria for entry, the method of allocation, the structure of the exercise program and method of assessing cardiorespiratory fitness are described.