Peripheral arterial disease: gadolinium-enhanced MR angiography versus color-guided duplex US--a meta-analysis

PURPOSE: To summarize and compare the published data on gadolinium-enhanced magnetic resonance (MR) angiography and color-guided duplex ultrasonography (US) for the work-up for peripheral arterial disease. MATERIALS AND METHODS: Studies published between January 1984 and November 1998 were included if (a) gadolinium-enhanced MR angiography and/or color-guided duplex US were performed for evaluation of arterial stenoses and occlusions in the work-up for peripheral arterial disease of the lower extremities, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or derivable. RESULTS: With a random effects model, pooled sensitivity for MR angiography (97.5% [95% CI: 95.7%, 99.3%]) was higher than that for duplex US (87.6% [95% CI: 84.4%, 90.8%]). Pooled specificities were similar: 96.2% (95% CI: 94.4%, 97.9%) for MR angiography and 94.7% (95% CI: 93.2%, 96.2%) for duplex US. Summary receiver operating characteristic analysis demonstrated better discriminatory power for MR angiography than for duplex US. Regression coefficients for MR angiography versus US were 1.67 (95% CI: -0.23, 3.56) with adjustment for covariates, 2.11 (95% CI: 0.12, 4.09) without such adjustment, and 1.73 (95% CI: 0.44, 3.02) with a random effects model. CONCLUSION: Gadolinium-enhanced MR angiography has better discriminatory power than does color-guided duplex US and is a highly sensitive and specific method, as compared with conventional angiography, for the work-up for peripheral arterial disease

Research in Industry Case Studies : Action Learning

Intro: The six step information process model for life long learning of defining, locating, selecting, organising, presenting and evaluating is often in reality a five step model with the evaluating step rarely given any time or credence. Yet it is this last step which results in the most effective change. Action research will provide a framework for a measured response to problem solving and can result in a much closer questioning of the interplay between circumstance, change and consequence. In any situation, work practice can become accepted and routine with little critical reflection on what happens, why it happens or investigation of the actual outcomes of workplace initiatives. While all employees are directed in their endeavours by organisational goals and outcomes, you can affect improvements through examination of your performance and work practices. Action research allows you as a practitioner, in this case as an IL professional, to step outside your routine and take the opportunity to reflect on what is being done and whether your intended outcomes match the actual outcomes

The prevalence and incidence of musculoskeletal symptoms among hospital physicians: a systematic review

Physicians are exposed to a range of work-related risk factors that may result in occupational diseases. This systematic review aims at shedding light on the prevalence and incidence of musculoskeletal complaints among hospital physicians. A systematic literature search was performed in Pubmed and EMBASE (1990-2010), and methodological quality criteria were applied. A search was done for musculoskeletal complaints. Five medium-quality studies and three high-quality studies were included in this review. The definitions and assessment used in the studies for musculoskeletal complaints were different. In short, the frequently reported prevalence for hand and wrist pain was 8-33 and 0%, 17% for shoulder pain, and 9-28% for neck pain. Moreover, the annual prevalence of low back pain was between 33 and 68%. The limited number of studies makes it difficult to draw conclusions, and the results should be intepreted with care. In conclusion, musculoskeletal complaints may be work-related complaints in hospital physicians, which need future attentio

Analysing mosaic data by a ‘Wheel of Participation’ to explore physical activities and cycling with children and youth with cerebral palsy

Children and youth with Cerebral Palsy (CP) have limited opportunities for participation. These qualitative results are part of a mixed methods study exploring the effects of participation in physical activities including adapted cycling. Objectives: The first aim was to explore physical activity participation of children and youth with CP. The second aim was to introduce information about adapted cycling and explore if they would participate in the future. Methods: Mosaic methods were adapted and this involved the use of puppetry, pictures and drawing and they also kept a written diary. Results: 18 participants were recruited aged 2–13, 11 male, 7 female resulting in 17 interviews and 15 diaries. The participants had a range of communication abilities, 10 spoke verbally, 3 were nonverbal, 2 used Makaton signing and 3 had dysarthria. The data were managed in NVIVO and analysed with coding using a template approach. The themes which emerged revealed some barriers and encouragers of physical activity participation represented by a ‘Wheel of Participation’. The interview and diary data enabled their voices to be heard as their ‘Mosaic’ was built up through this iterative analytic process. 11 of the 18 children actually tried adapted cycling following the provision of written information. Conclusion: This change behaviour was positive and further research should explore habitual participation in physical activities such as adapted cycling. By hearing their perspectives about participation in physical activities and cycling, the experiences described suggest there are now some enjoyable opportunities for participation for children and youth with CP

Waist circumference predicts clustering of cardiovascular risk factors in older South Africans

Objecti~'eand design. A cross-sectional analytical study to determine the cardiovascular risk factor profile of older residents of fishing villages on the West Coast of South Africa, and to det.ermine which anthropometric measures are associated with risk factors. Subjects. A convenient community-based sample of 152 subjects of mixed ancestry aged 55 years and over was recruited door-to-door using an address list of ageeligible subjects provided by the local public health care clinics. Methods. Cardiovascular relationships were im'estigated between: (i) number of risk factors (hypertension, hypercholesterolaemia, diabetes) and body mass index (8MI), waist-to-hip ratio (WHR), and waist circumference; and (ii) continuous cardiovascular risk factor variables and physical activity, smoking, dietary intake, and 24-hour urinary sodium and potassium concentrationS. Results. The prevalence of hypertension (~ 160/95 mmHg) was 74.3% (95% CI: 67.2 - 81.4%). Neither 24- hour urinary sodium nor potassium concentrations was associated with blood pressure (BP). Past, but not present, moderate-intensity physical activity, particularly that associated with occupation, was negatively associated with systolic BP (r = -0.24, P < 0.05). The prevalence of diabetes and hypercholesterolaemia (serum cholesterol ~ 6.5 mmolll) was 24.6% (95% CI: 17.2 - 32%) and 40% (95% CI: 31.8 - 48.2%),respectively. The percentage of subjects with 0, 1, or 2 or more cardiovascular risk factors was 13.4%,44.1% and 42.5%, respectively. Subjects with a waist circumference ~ 92 em had a significantly higher number of cardiovascular risk factors than those with a waist circumference < 92 cm (Xl =9.29, P < 0.01), and this association remained significant even after controlling for age, sex and smoking (P < 0.05). Neither 8MI tertiles according to sex, nor a 8MI cut-point ~ 30, was significantly associated with a clustering of risk factors. COllclusioll. In a sample of older South Africans of ntlxed ancestry at high risk of cardiovascular disease, waist circumference ~ 92 em predicts clustering of risk factors, Independentl)' of BMI. This simple, populationspecific reference value may provide a useful screening tool to identify at-risk Individuals for targeted prevention for coronary heart disease and associated metabolic disorders

Living renal donors: optimizing the imaging strategy--decision- and cost-effectiveness analysis

PURPOSE: To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors. MATERIALS AND METHODS: In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography, contrast material-enhanced spiral computed tomographic (CT) angiography, and combinations of these imaging techniques was evaluated. Outcome measures included lifetime cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. A base-case analysis was performed with a 40-year-old female donor and a 40-year-old female recipient. RESULTS: For the donor, MR angiography (24.05 QALYs and 9,000 dollars) dominated all strategies except for MR angiography with CT angiography, which had an incremental ratio of 245,000 dollars per QALY. For the recipient, DSA and DSA with MR angiography yielded similar results (10.46 QALYs and 179,000 dollars) and dominated all other strategies. When results for donor and recipient were combined, DSA dominated all other strategies (34.51 QALYs and 188,000 dollars). If DSA was associated with a 99% specificity or less for detection of renal disease, MR angiography with CT angiography was superior (34.47 QALYs and 190,000 dollars). CONCLUSION: For preoperative imaging in a potential renal donor, DSA is the most cost-effective strategy if it has a specificity greater than 99% for detection of renal disease; otherwise, MR angiography with CT angiography is the most cost-effective strategy