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Patients with diabetic neuropathy and peripheral arterial disease often suffer pain, develop foot wounds, and go on to lose limbs leaving them with a painful limb. Electrical stimulation is one possibility open to physicians. In this study, the effects of the FlowAid FA100 SCCD, a sequential contraction compression device, were tested. The FA100 device is noninvasive; it uses 4 electrodes to sequentially stimulate the calf muscles in a modified intermittent pneumatic compression manner. A total of 14 patients with diabetic neuropathy, peripheral arterial disease, unilateral amputation, and a painful limb were treated with FlowAid FA100 (FlowAid Medical Technologies Corporation, New York, NY) with prior ethical approval. The study design was open, pre-post intervention comparison, and nonrandomized. Pain perceived was measured using Visual Analogue Scale (VAS) scores. Assessments of ankle brachial index (ABI), ultrasound color Duplex, and tissue oxygen using the transcutaneous oxygen technique were done at baseline and 2 successive follow-ups 4 weeks apart. Three out of 14 patients dropped out on account of distances involved in traveling to the clinic. Eleven out of 14 patients experienced statistically significant reduction in pain mean VAS scores (7.5 ± 0.93 to 5.8 ± 1.47, P = .002) associated with increase in ABI (0.64 ± 0.06 to 0.69 ± 0.04, P < .001) and transcutaneous oxygen tension measured on the dorsum (29.4 ± 4.03 to 33.2 ± 5.26 in mm Hg, P = .005). When pain scores were regressed against ABI and transcutaneous oxygen tension values, there was a significant association between these ( r = 0.8, P = .002). The reduction in pain following regular use of FlowAid was accompanied by beneficial and statistically significant increases in perfusion and oxygenation.

Purpose: To assess effectiveness, 1-year post-intervention, of a program delivered in jails with women to improve cervical health literacy (CHL) and up-to-date Papanicolaou (Pap) screening. Design: Pre-post design to evaluate Pap screening and CHL effects 1 year after our original randomized wait-list control study. Setting: Surveys conducted in Kansas City, 2015 to 2017 (baseline in 2014). Participants: Adult women (n = 133). Intervention: One-week (10-contact-hour), small-group, CHL program. Measures: Surveys to assess CHL components and up-to-date Pap screening. Analysis: χ2 and t tests, followed by best-subsets logistic regression using sociodemographic and CHL components to fit an optimal model for up-to-date screening 1-year post-intervention. Results: 73% (133/182) women retained at 1-year. From pre-intervention, 6 of 8 CHL components improved (.01 > P > .001). Up-to-date Pap screenings increased over pre-intervention (72%-82%, P < .05). Best-subset model to predict up-to-date screening included age; public benefits; medical insurance; 5 CHL components (knowledge, benefits, barriers, seriousness, susceptibility). Conclusion: A brief intervention to promote cervical health literacy, delivered with women during a jail detention, can lead to sustained improvements in CHL and prevention practices.

This study examined the effect of a six week combined movement and story-telling intervention on motor competence and naming vocabulary in British pre-schoolers. Using a cluster randomised design, three pre-school classes were allocated to one of a combined movement and story-telling intervention ( n = 22), or a movement only ( n = 25) or story-telling only ( n = 27) intervention. Motor competence and language ability were assessed pre, post and eight weeks post intervention. Results from repeated measures ANOVA indicated significantly greater improvement in both motor competence and language ability pre to post intervention for the combined movement and story-telling group compared to the movement only or story-telling only groups. However, for the period post intervention to eight weeks post intervention the magnitude of change for motor competence and language ability was significant for all groups and similar in magnitude. The results of this study demonstrate the efficacy of combining movement and story-telling, over movement or story-telling alone, to benefit both motor competence and language ability in pre-schoolers. Combining both movement and story-telling appears to offer synergistic benefits in relation to physical and communication development, which are critical for good development in the early years.

Introduction The aim was to investigate whether therapeutic massage was effective in relieving pain in elderly residents with dementia. Methods A randomized controlled study was conducted in an aged care facility. Ten participants with dementia or advanced dementia were allocated to an intervention group or a control group. The intervention group received 10 min of massage (effleurage, kneading, and trigger point therapy) four times per week for 4 weeks. The Pain Assessment in Advanced Dementia scale was used as the outcome measure. Results No significant changes in mean outcome measure scores were found post intervention (Intervention mean = 5.0 ± 3.49; Control mean = 5.2 ± 3.49: t(8) = 0.09, p = 0.93). However, the Intervention Group had a greater magnitude of change (1.200 ± 1.78) when compared to the control group (0.800 ± 2.16). Conclusion Therapeutic massage may provide a useful adjunct to the current pain management plan of patients with dementia.

The link between second hand smoke exposure (SHSe) and health issues in children has been well established. The objective of this study was to determine if a short intervention implemented among pediatricians promotes improvement in the promotion of smoking cessation to caregivers and increase pediatricians’ awareness of the Smoking Cessation Trust (SCT). Pediatricians from 6 clinics were randomly assigned to the control or intervention group. All pediatricians received a survey to assess baseline knowledge, confidence and behaviors in smoking cessation promotion and utilization of the SCT. Pediatricians in intervention group received an educational lecture delivered by a physician. Two months post intervention, pediatricians in the control and intervention group received a survey to assess changes from baseline. Out of 36 general pediatricians, 27 completed the surveys for use in the analysis of this study (75%). Intervention group made more referrals to the SCT, compared to controls (p=0.048) and to baseline (p=0.0065). Pediatricians in the intervention group were more confident in recommending the use of NRT (0.040) and schedule a follow up to discuss smoking cessation (p=0.029) after the intervention. The intervention group was more likely to refer caregivers to smoking cessation programs (p=0.027), discuss a child’s health risk from SHSe (0.031) and recommending the use of NRT to help quit (p=0.047) post intervention. The results from this study indicate that a short intervention can increase confidence and behavior in various parameters of smoking cessation promotion and significantly improve the rate in which pediatricians refer smoking caregivers to the SCT.

The Department of Health’s ‘High Impact Intervention (HII) – Peripheral intravenous cannula care bundle’ lists six actions to be performed at the time of peripheral intravenous cannulation. Audit of compliance to these requires documentation. We assessed documentation on the anaesthetic charts of 50 surgical patients. Purpose-made stickers were then placed on all anaesthetic charts. Re-assessment of a further 50 patients’ charts demonstrated a significant improvement in documentation of the bundle post intervention (Fisher’s exact test P < 0.0001). This is an example of how a low-tech intervention can produce a high impact improvement in documentation.

Background and objectives: Knee osteoarthritis is the most common joint disease. We aimed to compare the efficacy and safety of intra-articular injection of a newly developed plasma rich in growth factor (PRGF) versus hyaluronic acid (HA) on pain and function of patients with knee osteoarthritis. Methods: In this single-blinded randomized clinical trial, patients with symptomatic osteoarthritis of knee were assigned to receive 2 intra-articular injections of our newly developed PRGF in 3 weeks or 3 weekly injections of HA. Our primary outcome was the mean change from baseline until 2 and 6 months post intervention in scores of visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. We used analysis of variance for repeated-measures statistical test. Results: A total of 69 patients entered final analysis. The mean age of patients was 58.2 ± 7.41 years and 81.2% were women. In particular, total WOMAC index decreased from 42.9 ± 13.51 to 26.8 ± 13.45 and 24.4 ± 16.54 at 2 and 6 months in the newly developed PRGF group (within subjects P = .001), and from 38.8 ± 12.62 to 27.8 ± 11.01 and 27.4 ± 11.38 at 2 and 6 months in the HA group (within subjects P = .001), respectively (between subjects P = .631). There was no significant difference between PRGF and HA groups in patients’ satisfaction and minor complications of injection, whereas patients in HA group reported significantly lower injection-induced pain. Conclusions: In 6 months follow up, our newly developed PRGF and HA, both are effective options to decrease pain and improvement of function in patients with symptomatic mild to moderate knee osteoarthritis.

Percutaneous transluminal tibial balloon angioplasty has an important role in the therapeutic approach of critical limb ischaemia. Despite a growing number of patients with critical limb ischaemia, there are no trials to guide the pharmacologic approach post intervention. Guidelines pertaining to the antiplatelet therapy post percutaneous transluminal tibial balloon angioplasty have not been developed. In addition, critical limb ischaemia patients have multiple comorbidities and a higher risk of bleeding. To examine the shortest duration of antiplatelet therapy post percutaneous transluminal tibial balloon angioplasty, we reviewed the preclinical data used to develop the standards for the current angioplasty technique.

Introduction: Unnecessary laboratory utilization due to inappropriate test-ordering behaviour among hospital clinicians and community general practitioners is an ongoing problem in many hospitals and primary care trusts throughout the UK and abroad. In January 2007, our hospital removed the ‘tick box’ for PSA from its laboratory tests request form, in a managed way, with the intention of reducing unnecessary requests for this test. Here we address the impact this action had on the number of PSA tests being requested and its downstream effects on prostate cancer diagnosis. Methods: Using our laboratory database we compared the number of hospital and local GP requests for PSA, before and after modification of our laboratory form (requests from 2004 to 2006 were compared to 2007). We then correlated this data with the number of fast-track target referrals (2 week wait) from primary care for suspected prostate cancer, the results of prostate biopsies, and the number of prostate cancers being diagnosed, over the same time period. Results: Mann—Whitney non-parametric testing demonstrated a 17% reduction in the median number of PSA requests since the change was introduced ( p = 0.001). Subset analysis revealed an 18% reduction in GP requests ( p = 0.002). However no change was found in the number of prostate cancer diagnoses being made ( p = 0.86) and the number of target referrals for suspected prostate cancer ( p = 0.59) in the months of April, May, June, July, August and September of 2004–2006 as compared to the same months in 2007. The rate of patients undergoing biopsy increased in the post intervention period from 15.5 to 18.5 patients per month. The rate of negative biopsies remained stable, changing from 7.2 to 7.3 per month, and the rate of positive biopsies increased from 8.3 to 11.2 per month. This change reduced the false negative rate (suspected cancer, negative biopsy) from 46% to 40% in the period following the intervention. The rate of target referrals leading on to cancer showed a small increase after the intervention from 2.9 to 3.3 per month. Conclusions: Our study shows that with this simple modification to the design of our laboratory request form, whereby the doctor must make an active written decision to order a PSA test, there was a significant reduction in the number of PSA requests, both in the hospital and in the community, without patient safety being compromised as measured by maintaining the number of fast-track target referrals for suspected prostate cancer and the number of prostate cancers diagnosed.

The purpose of this study was to investigate the effect of emotional intelligence (EI) training and development on the EI profile scores of individual cricketers. 24 players attending the South African National Cricket Academy were randomised to an intervention group (EI training and development intervention program) or control group (no intervention). The experimental design was executed in 2007 and 2008 with different cohorts of players. The EI of the players was measured pre and post intervention using the Mayer, Salovey & Caruso Emotional Intelligence Test (MSCEIT). In 2007 the baseline Total EI score for the intervention group was 84.9 and the post intervention Total EI score was 96.6, giving a relative increase of 13.7%. By comparison, the baseline Total EI score for the control group was 81.8 and post intervention the Total EI score was 83.4, giving a relative increase of 2%. In 2008 the baseline Total EI score for the intervention group was 89.4 and the post intervention Total EI score was 101.7, giving a relative increase of 13.8%. By comparison, the baseline Total EI score for the control group was 87.4 and the post intervention Total EI score was 84.8, a relative decrease of 3.1%. The estimated intervention effect for the percentage change in Total EI score over both years is 14.5% (95% CI: 11.9 to 17.2%) and is significant, indicating EI training and development may contribute to increasing the EI profile of individual cricketers.

The purpose of this study was to evaluate the translation of positive research findings about a job retention intervention for persons with chronic illnesses to rehabilitation practice. A program to provide the intervention was developed and marketed in the community. Fifty-seven consumers with chronic illnesses received the intervention provided by five rehabilitation counselors. Follow-up data were collected from consumers and counselors. Marketing data indicated that advertising the program through health voluntary organizations was most successful. Follow-up data indicated that modifications to the intervention were needed, including increased individualization and additional telephone contact at 6 months post intervention. Short-term outcomes evaluated in this study showed that consumer participants experienced significant improvement in awareness and confidence in ability to manage health-related work problems and took actions recommended by the counselors. The results indicate that the job retention intervention shown to be efficacious in a randomized trial can be effective when carried out in practice at the community level.

Objective: To examine the effects of a brief Tai Chi Chuan Qigong (`Qigong') exercise intervention on individuals with traumatic brain injury. Design: A single-centre randomized controlled trial pilot study. Setting: A registered charity day centre in the community. Subjects: Twenty individuals with traumatic brain injury. Intervention: Intervention participants attended a Qigong exercise session for one hour per week over eight weeks. Control participants engaged in non-exercise-based social and leisure activities for the same intervention period. Measures: Outcome was assessed at baseline and post intervention using the General Health Questionnaire-12, the Physical Self-Description Questionnaire and the Social Support for Exercise Habits Scale, to measure perceived mood, self-esteem, flexibility, coordination, physical activity and social support. Results: Groups were comparable at baseline. After the intervention, mood was improved in the exercise group when compared with controls (U = 22.0, P =0.02). Improvements in self-esteem (Z = 2.397, P =0.01) and mood (Z = —2.032, P =0.04) across the study period were also evident in the exercise group only. There were no significant differences in physical functioning between groups. In view of the sample size, these findings are inconclusive. Conclusions: This study provides preliminary evidence that a brief Qigong exercise intervention programme may improve mood and self-esteem for individuals with traumatic brain injury. This needs to be tested in a large-scale randomized trial.

Objective Botulinum toxin type A (BtA) injection in the therapeutic treatment of muscle hypertonicity has been documented to reduce spasticity in specific muscle groups, with the effect lasting 1–3 months. The objective of this study was to evaluate the combined effect of an intensive occupational therapy (OT) programme following BtA injection in the treatment of spastic pronators in children with cerebral palsy. Methods This study used a pre/post intervention measurement design. Five children with cerebral palsy and hand function impairment were enrolled for intervention and followed-up longitudinally at 1, 3, 6 and 12 months. All patients received BtA injection to left pronators followed by OT according to treatment guidelines and standard assessment protocol. Outcome measures included change in spasticity, active range of motion (AROM), sensibility, power grip strength and functional hand grips. Results Significant improvements in muscle tone, AROM, sensibility and functional hand grips were observed over time. The restoration of hand function and sensibility lasted up to 12 months after injection. In addition, we observed that four children gained sensibility, which did not demonstrate any tendency to diminish with time. Conclusion A combination of BtA injection and OT is effective for reducing spasticity in the pronators of children with cerebral palsy.

The aim of this paper is to evaluate the effectiveness of an intervention to deter underage alcohol sales by targeting alcohol retailers instead of underage youth. A quasi-experiment using a repeated-intervention design was conducted for a random sample (n=143) of off-sale alcohol outlets from across New Orleans. Compliance checks of off-sale outlets were conducted at baseline, two months after the intervention, and eight months after the intervention. At baseline, only 11.2% (16/143) of outlets were compliant. Following the intervention, compliance increased to 39.9% (p

Aims: Hypoglycaemia confers excess morbidity and mortality. UK guidelines recommend capillary blood glucose (CBG) measurement is repeated 15 minutes following identification and treatment of CBG